Medicine and Health Sciences Commons^™

Permanent Housing And On-Site Nursing Care: Effects On Homeless Individuals With Hiv And Other Cormorbidities, Lynelle Hinden

Dissertations

Abstract

Problem. Providing housing to otherwise homeless individuals who are HIV/AIDS-positive has been demonstrated to improve control of the disease. This was a healthcare quality initiative to review the viral load and Cluster of Differentiation Protein Four positive (CD4+) counts over time of residents in an urban housing facility for HIV/AIDS-positive individuals. Also, a nurse-run clinic was introduced for residents, especially those with comorbidities such as hypertension and diabetes.

Methods. A repeated measures design was utilized. Viral loads and CD4+ counts were retrospectively reviewed from facility records at entrance into and five-years later at the facility. Additionally, measurements of blood …

Assessment Of Nursing Knowledge Before And After Implementation Of Educational Intervention On Heart Failure, Sarah Scott

Dissertations

Purpose: The purpose of this study was to assess the knowledge of nursing staff on a cardiology unit before and after the implementation of heart failure specific education. Methods: Forty staff nurses on a cardiology unit at a single institution were given The Nurses Knowledge of Heart Failure Education Principles Survey (NKHFEP), a validated tool to assess nursing knowledge of heart failure. A series of four educational sessions were given to the same forty nurses. They were then given the NKHFEP survey a second time to assess change in knowledge post educational intervention. Results: The mean of Pre-education (M = …

Implementing The Cdcs Core Elements Of Outpatient Antibiotic Stewardship Program Into The Urgent Care, Deanna Powelson

Dissertations

Purpose: The inappropriate use of antibiotics has led to the development of antimicrobial

resistance which is a severe threat to the public and an increasing global problem. The

Centers for Disease Control and Prevention (CDC) estimates at least two million illnesses

and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States (CDC,

2014). The purpose of this quality improvement (QI) project was to evaluate the

effectiveness of an antibiotic stewardship program (ASP) on urgent care providers'

prescribing on viral respiratory tract infections (RTIs) including the common cold,

pharyngitis, and bronchitis.

Methods: This QI project implemented the CDCs Core …

An Exploration Of Nicu Nursing Staff Perspective On The Change From Pod To Private Room Patient Care, Julie Nickles

Dissertations

Neonatal Intensive Care Units (NICU) are designed to care for critically ill newborns who require constant care. The design of the NICU may have an impact on not only the patient and their family but also the nursing staff. Historically neonatal intensive care have employed a cohort model of care. In this model multiple infants are in the same room or pod. With success of single room maternity care, the increased need for changes in neonatal care became apparent. Today, new parents desire extended contact with their extremely preterm and often very sick infant. This trend has led a standard …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Primary Care, Elizabeth Segura

Dissertations

Abstract

Problem: The Patient Centered Medical Home (PCMH) is a model of care that improves the quality and experience of care and decreases cost. Use of a validated depression screening tool for adult patients is a PCMH certification requirement. The purpose of this quality initiative was to obtain baseline data when a depression screening tool was utilized among adult patients in an internal medicine clinic within a Midwestern public health department.

Methods: This was a quality improvement project utilizing a descriptive and observational design. A retrospective medical record review was used to assess the rate of depression screening utilizing the …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Assessing The Impact Of Practice Transition On Advance Practice Registered Nurse’S Job Stress And Job Satisfaction, Patricia E. Hendrickson

Dissertations

Problem

The impact of the transition to full practice authority (FPA) on job satisfaction and job stress has not been previously described in the literature.

Method

Job satisfaction, job stress, and practice transition stress data was collected from a sample of 33 Advance Practice Registered Nurses (APRN) working at the VA St Louis Health Care System using Misener Nurse Practitioner Job Satisfaction Survey (MNPJSS), National Institute of Occupational Safety and Health Generic Job Stress Questionnaire (NIOSH-GJSQ), and student-developed practice transition stress questionnaire during the initial phase of FPA transition.

Results

APRNs were minimally satisfied to satisfied. Job stress from work …

Nurse-Led Triage Clinic In An Hiv Supportive Housing Apartment Community, Sally Breen

Dissertations

Problem: HIV-positive persons living in supportive housing who were otherwise homeless are reported to have better health outcomes than those who remain homeless. This was a quality improvement project to obtain baseline information regarding the implementation of onsite nursing services for individuals and their families residing in an HIV-positive supportive housing apartment community in an urban Midwestern city. Methods: A nurse triage clinic was implemented in partnership with the Doorways organization. Two registered nurses staffed the clinic two days per week. Data was collected on demographics and clinic utilization over a nine-week period. Results: Of the apartment residents, N=95, the …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Alternatives In Magnesium Sulfate Treatment Courses: An Investigation Of Physician Prescribing Behaviors, Erin Williams

Dissertations

Problem: The gold standard for managing preeclampsia in the postpartum patient is 24- hours of magnesium sulfate as this is the time the patient is most susceptible to experiencing a seizure (American College of Obstetricians & Gynecologists, 2013). However, these patients are at an increased risk for experiencing adverse health outcomes, as well as interruptions in maternal-infant bonding due to the mother requiring a higher level of care. Methods: A one group pretest-posttest design was conducted to gain a better understanding of the current practice while also assessing the willingness of physicians to change prescribing behavior after receiving the research-based …

Prophylactic Antibiotic Use In Female Patients With Pelvic Floor Reconstructive Surgery: A Retrospective Comparative Effectiveness Study, Courtney E. Turnbough

Dissertations

Problem: The purpose of this project was to determine the most effective prophylactic antibiotic to decrease the number of patients who have urinary tract infections (UTIs) after pelvic floor reconstructive surgery in a gynecological reconstructive surgery practice.

Methods: This was a retrospective chart review from 2015-2017 that included 732 subjects from a single practice. All patients underwent pelvic floor reconstructive surgery, with or without a midurethral sling placed. Patients also had a catheter and vaginal packing postoperatively. Patients who had a culture-proven UTI within the six-week postoperative period were noted.

Results: There were less UTIs (χ2 = 12.119, df = …

Measurements That Matter: Assessment & Management Of The Symptoms Of Chronic Illness Using The Integrated Palliative Outcome Scale (Ipos), Deborah Jeffery

Dissertations

ABSTRACT

Measurements that Matter: Assessment and Management of the Symptoms of Chronic Illness Using the Integrated Palliative Outcome Scale (IPOS)

Background: The mission of the Advanced Illness Management (AIM) program at the Visiting Nurse Association of Greater St. Louis (VNA) is to relieve the burden of serious illness by providing exceptional care to patients and families through symptom management. A validated symptom tool was needed for holistic assessment.

Purpose: This is a quality-improvement project aimed at enhancing symptom management in patients experiencing advanced illness in a community-based palliative care program. Provider use of the Integrated Palliative Outcome Scale (IPOS) as …

Implementation Of National Pediatric Guidelines To Prevent Chemotherapy Induced Nausea And Vomiting In Children With Cancer, Taryn Sandheinrich

Dissertations

Purpose: The purpose of this study was to assess the use of supplemental, as needed (prn) pharmacologic interventions for uncontrolled acute chemotherapy induced nausea and vomiting (CINV) in children with cancer after implementation of new pediatric CINV prophylaxis guidelines. Description of Project: A retrospective chart review was completed on forty-three children admitted to the hospital for chemotherapy during a 3 month period in 2017 to document the use of medications given for acute breakthrough CINV. The pre-implementation group received anti-emetics based on the institutional standard of care. A second retrospective chart review was completed on thirty-three children admitted to …

Implementing A Caps Simulation To Increase Nursing Education Practice Students’ Self-Awareness Of Attitudes And Beliefs About Poverty, Melissa Ehmke

Dissertations

Problem. The purpose of this project is to determine if college students who are currently in nursing school, will benefit from the addition of a poverty simulation to positively influence their self-awareness and individual-level beliefs and attitudes towards poverty, therefore being able to serve those in poverty fully and guide them to appropriate resources.

Methods. Bachelor of Science in Nursing (BSN) and Doctoral Nursing Practice (DNP) students participated in a three-hour Community Action Poverty Simulation (CAPS). A twenty-one item Attitude Toward Poverty Scale short form (ATPS) survey was completed pre and post-simulation participation.

Results. Significant improvements resulted in three of …

Evaluation Of Educating Registered Nurses Prior To Implementing New Evidence-Based Protocol: Enhanced Recovery After Surgery (Eras), Lisa Brooks

Dissertations

Evidence-based protocols promote standardization of care and patient safety. The inclusion of major stakeholders is imperative to the success of implementation of a new protocol. The “Enhanced Recovery After Surgery” (ERAS) protocol was implemented at the Veterans Administration Medical Center – St. Louis prior to formal education of direct-care registered nurses (RNs), a major stakeholder group. Due to the lack of knowledge, the RNs who were expected to implement and adhere to the ERAS protocol were not prepared and displayed a lack of confidence. Subsequently, an educational training intervention was designed and executed with thirty-five RN participants. Prior to this …

Predictors Of First Semester Baccalaureate Nursing Student Academic Success, Julie Twidwell

Dissertations

Accreditation standards, such as those of the American Association of Colleges of Nursing Commission on Collegiate Nursing Education’s program indicators, require pre-licensure programs of nursing to report outcome metrics which includes program completion rates. In response to regulatory requirements and accreditation standards, pre-licensure programs of nursing have an interest in selecting applicants most likely to meet outcomes standards. Attrition is a serious issue with implications for students, pre-licensure programs of nursing, the nursing workforce, and populations requiring nursing care. Academic failure due to insufficient cognitive aptitude often contributes to the attrition rate. Pre-licensure programs of nursing may consider interviews, essays, …

"Understanding Lgbtq+ Intimate Partner Violence & Challenges In, Dr. Juanita Yates

Dissertations

This research project is a focus on Intimate Partner Violence (IPV) within LGBTQ+

community and the challenges associated with seeking family support. IPV is defined as a violent

or aggressive behavior within the home, typically involving the violent abuse of an intimate spouse

or partner. However, IPV can happen on the street, in one’s home or even in a public place. Those

exposed to IPV can be children, men and women. IPV is a prevalent issue in our society (Bright

2008). According to Ristock (2005), violence in LGBTQ+ relationships may be referred to as

partner violence, relationship violence, or LGBTQ+ …

Hybrid Model - Statistical Features And Deep Neural Network For Brain Tumor Classification In Mri Images, Mustafa Rashid Ismael

Dissertations

A brain tumor is the most common disease that affects the central nervous system (CNS), the brain, and spinal cord. It can be diagnosed using the safest and most reliable imaging modality, the Magnetic Resonance Imaging (MRI), by radiologists who may use the assistance of computer-aided diagnosis (CAD) tools. Automated diagnosis is sought because it is essential to overcome the drawbacks of the manual diagnosis, such as time and the stress of viewing MRI images for long hours, and the human error potential. Image analysis and machine learning algorithms are tools that can be used to build an intelligent CAD …

Submandibular Mechanical Stimulation Of Upper Airway Muscles To Treat Obstructive Sleep Apnea, Ferhat Erdogan

Dissertations

The extrinsic tongue muscles are activated in coordination with pharyngeal muscles to keep a patent airway during respiration in wakefulness and sleep. The activity of genioglossus, the primary tongue-protruding muscle playing an important role in this coordination, is known to be modulated by several reflex pathways mediated through the mechanoreceptors of the upper airways. The main objective is to investigate the effectiveness of activating these reflex pathways with mechanical stimulations, for the long-term goal of improving the upper airway patency during disordered breathing in sleep. The genioglossus response is examined during mandibular and sub-mandibular mechanical stimulations in healthy subjects during …

The Effect Of Mantram Repetition On Qol In Low-Income, Urban Dwelling Older Adults, Marissa Katerina Mackiewicz

Dissertations

Background: Quality of life is an important concept of increasing significance for the healthcare in the United States, especially when taken in perspective of the aging population. Low-income, urban dwelling older adults are challenged in a number of ways that may negatively impact their QOL. This unique group is prone to report lower QOL, therefore, interventions targeted to improve QOL are timely. The purpose of this study was to describe the effect of mantram repetition (MR) on QOL in a sample of low-income, urban dwelling older adults.

Methods: A quasi-experimental pre-posttest study was conducted using a sample population of low-income …

Examining The Relationships Between Ethnicity, Palliative Care And Readmissions In The Heart Failure Population, Deanna Johnston

Dissertations

Specific Aim: The aim of this dissertation is to analyze the relationships between ethnicity, palliative care consultation and readmissions in the heart failure population at a community hospital that serves a large diverse population.

Background: Hospitals struggle with preventing readmissions. There are many interventions that can be implemented to help prevent readmissions, and Palliative Care (PC) is one of those interventions. PC has many benefits including symptom management, improved communication through the healthcare continuum, understanding of illness and treatment options, and can be provided in conjunction with curative treatments. Heart failure is one of the most common readmission diagnoses. …

The Association Of Kangaroo Mother Care, Energy Conservation, And Bonding In Preterm Neonates, Dorothy Forde

Dissertations

Purpose:To examine the association of kangaroo mother care (KMC) on energy utilization and bonding as evidenced by reduced biochemical markers of adenosine triphosphate (ATP) degradation, hypoxanthine (Hx), xanthine (Xa), and uric acid (UA), and (allantoin), a measure of oxidative stress in preterm infants 24-36 weeks gestation. A secondary objective was to compare specific physiological parameters using bedside monitoring and perfusion and oxygenation of the gut using near-infrared spectroscopy (NIRS) during 1 hour of KMC compared to incubator care.

Study design: A randomized controlled trial (RCT) examining the effects of 1-hour of KMC or 1-hour incubator care on urinary markers …

Priapism Among Male Adolescents With Sickle Cell Disease, Prince Ocansey

Dissertations

The purpose of this qualitative phenomenological study was to describe the lived experience of priapism among male adolescents with sickle cell disease (SCD). A painful genetic disorder with no cure, SCD severely impacts the lives of patients, as well as their families and friends. Priapism is one of the complications of SCD and involves persistent and painful penile erections. The review of literature established a gap in researchers’ understanding of the lived experience of priapism among male adolescents with SCD. This study aimed to bridge that gap.

Using a convenience sampling method, 7 adolescent males between the ages of 16 …

Identification Of Nurse-Controlled Predictors Of Pain In Patients Undergoing A Total Hip Or Total Knee Arthroplasty, Melodie Ruth Daniels

Dissertations

Objectives: The purpose of this study was to examine relationships among nursing interventions and pain status during hospitalization in orthopedic surgical patients receiving total hip or knee arthroplasty in one of four community hospitals in San Diego, California.

Background: The epidemic of opioid-related adverse events creates a need for opioid sparing approaches to pain management. Pain management practices have been studied in relation to medicine; however, the relationship between pain and opioid sparing, nurse-specific interventions is not clear.

Methods: The retrospective descriptive study examined Electronic Health Record (EHR) data of patients (N = 1657) discharged after a total hip …

Oxygen Consumption In Sepsis, Julie Graham

Dissertations

Background: Sepsis is a life-threatening condition that can lead to septic shock and death. With over 300,000 annual cases (AHRQ, 2011) costing a staggering $1.5 billion (Health Care Utilization Project Brief #185), the importance of sepsis is becoming clear. However, some basic biological mechanisms are poorly understood. Study Purpose: This study investigated the relationships between select demographics, resting energy expenditure (REE), serum lactate, SOFA score mortality index, oxygen consumption [by way of measuring net oxygen consumed, (V02) and net carbon dioxide produced (VC02)], and sepsis. Specific Aims: Aims were to describe 1) patient demographics, serum lactate, SOFA score mortality index, …

The Prospective Influence Of Religiousness On Alcohol Use: What Role Do Perceived Norms Play?, Corey Todd Brawner

Dissertations

Alcohol misuse is recognized as one of the most pressing health hazards for college students. Previous research has supported a protective relationship between religiousness and problematic alcohol use, but it is less clear what aspects of religiousness are protective and through what mechanisms its effect is exerted. The current study utilized a prospective design to accomplish three primary goals: (1) Delineate the protective effects of religious motivation and public participation on alcohol use and alcohol-related problems in a sample of undergraduates at a large public university in the southeastern United States, (2) determine whether effects were maintained long-term, and (3) …

An Investigation Of The Impact Of Family Dynamics On Obesity Among African American Adolescent Girls, Tina Mcdyess

Dissertations

Children who are overweight and obese are more likely to maintain their weight status into adulthood (Fletcher, Cooper, Helms, Northington, & Winters, 2009; World Health Organization [WHO], 2015). The prevalence of obesity has shown a more consistent increase among African Americans aged 2-19 (Flegal, Carroll, Kit, & Ogden, 2012; Ogden, Carroll, Kit, & Flegal, 2012; Ogden, Carroll, Kit & Flegal, 2014) with an even greater disparity among African American girls (Ogden & Carroll, 2010). Family dynamics is one of the many factors of the environment that has been linked to obesity among children and adolescents. The purpose of this study …

Exploring The Relationship Between Family Social Capital And Utilization Of Well Child Preventative Health Care Services, Kristi K. Westphaln

Dissertations

Background: Passage of the Affordable Health Care Act of 2010 increased insurance coverage for children, however possession of health care insurance doesn’t always equate to effective use of health care services. Misuse and underutilization of health care homes is associated with higher costs, fragmentation of health care, and poor health outcomes across the lifespan. Along with reliance upon the health care system, child health and well-being are dependent upon social factors such as interactions with caregivers and communities. Family social capital (FSC) addresses the interrelated nature of child health and family interaction while also promoting family cohesion as currency …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

Interactions And Pathogen Transmission Between Carnivores In Madagascar, Fidisoa Rasambainarivo

Dissertations

Introduced carnivores exert considerable pressure on native predators through predation, competition and disease transmission. Improved understanding of determinant factors of interactions and pathogen transmission between introduced and endemic wildlife may help to predict disease emergence, avoid pathogen spillover and help control outbreaks. Using non-invasive camera traps, I identified areas where transmission of pathogens might happen through records of shared space-use within a protected area in Eastern Madagascar. I showed that indirect interactions between animals were more likely to occur near the research station which may constitute a disease transmission hotspot for carnivores in the landscape. Secondly, I investigated the associations …