Medicine and Health Sciences Commons^™

Implementation Of The National Asthma Guidelines In A Residential Pediatric Clinic, Patricia A. Foster-Staples

Dissertations

Abstract

Purpose: Foster care children admitted to residential facilities are a unique and vulnerable group, many presenting with undiagnosed or poorly managed asthma. The alarming rate of residents admitted to a particular residential primary care clinic with a diagnosis of asthma led to the project question: “Based on record reviews, does staff education about the importance of utilizing the national guidelines for asthma education influence the implementation of such guidelines in a residential pediatric clinic?” The purpose of this quality improvement project was to implement a systematic process to influence practice change. The project was conducted over a period …

A Healthcare Provider Needs Assessment Regarding Transgender Patient Health For A Student Health Services Center, Dorothy J. Cochran

Dissertations

Objective: This study sought to identify education and training needs of university health service providers regarding transgender patient care. Transgender patients are a vulnerable population who tend to have negative health outcomes. Limited information exists regarding transgender patients and their providers at student university health services nationally.

Methods: The researcher conducted a one hour semi-structured focus group with the professional staff at a Midwestern state university health service. The focus group conversation was guided by a list of prepared questions but other issues were allowed to arise. Two readers qualitatively analyzed the focus group transcripts for predominant themes.

Participants: The …

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

Discriminative And Reinforcing Effects Of Cocaine-Levamisole Combinations, Zachary J. Zimmermann

Dissertations

The behavioral and neurochemical effects of cocaine are well established, and it is one of the most widely abused illicit drugs. Illicit cocaine is often adulterated with levamisole, which is an anthelmintic that was withdrawn from the U. S. market in 2000. It has been hypothesized that levamisole, unlike other common adulterants which are added as simple bulking agents, has effects of its own which may be responsible for its use as an adulterant. Although these effects are speculative, the addition of levamisole to cocaine has become an increasing public health concern, as serious adverse effects (e.g., vasculitis, neutropenia) of …

Birth Record Analysis Of Gestational Diabetes: Applications For Intervention Planning, Elizabeth L. Macquillan

Dissertations

Gestational diabetes (GDM) rates in the U.S. and in Michigan have increased over the past several decades, along with the increases in Type 2 Diabetes Mellitus and obesity. GDM is associated with adverse health outcomes for mothers and their offspring. Many current maternal-infant health (MIH) programs in Michigan do not target women with GDM. This study aims to assess state-level rates of GDM in pregnancy with a combination of statistical and spatial analyses using Geographic Information Systems (GIS) for the purpose of informing content and location of public health interventions.

Existing data from 2013 Michigan birth records (107,743 births) were …

William Walker And The Seeds Of Progressive Imperialism: The War In Nicaragua And The Message Of Regeneration, 1855-1860, John J. Mangipano

Dissertations

For a brief period of time, between 1855 and 1857, William Walker successfully portrayed himself to American audiences as the regenerator of Nicaragua. Though he arrived in Nicaragua in June 1855, with only fifty-eight men, his image as a regenerator attracted several-thousand men and women to join him in his mission to stabilize the region. Walker relied on both his medical studies as well as his experience in journalism to craft a message of regeneration that placated the anxieties that many Americans felt about the instability of the Caribbean. People supported Walker because he provided a strategy of regeneration that …

A Novel Role For Osteopontin In Facilitating West Nile Virus Neuroinvasion, Amber M. Paul

Dissertations

West Nile virus (WNV) is a positive-sensed, single-stranded RNA flavivirus that can cause human neuroinvasive diseases, including encephalitis, meningitis, and flaccid paralysis. The mechanisms by which WNV enters the central nervous system and the host-factors that are involved in WNV-neuroinvasiveness are not completely understood. Osteopontin (OPN), a multifunctional glycoprotein, has been implicated as a bio-marker for a number of neuroinflammatory diseases. In particular, secreted (s)OPN has been implicated to participate in recruitment of polymorphonuclear neutrophils (PMN) to sites of its expression, while PMNs have been suggested to act as WNV reservoirs. Therefore, sOPN recruitment of PMNs may contribute to neuroinvasive …

An Exploratory Study Of The Utilization Of Evidence-Based Pharmacological Treatment On Heart Failure Patients In Mississippi And Its Impact On Readmission, Keri A. Barron

Dissertations

The purpose of this study was to explore the relationship of adherence to evidence-based guidelines for pharmacologic management by select Mississippi hospitals and their hospital readmission rates. This was an exploratory study with a retrospective design. This design offered insight into the relationship between readmissions of heart failure patients and adherence to the national guidelines for the pharmacologic treatment of heart failure. The study took place in a hospital in the southeastern section of the United States. Data were collected from a database of patients with heart failure seen between January 2011 and June 2014.

The unit of analysis for …

Defining Deliberate Practice In Supervised Dietetics Education, Kevin D. Haubrick

Dissertations

Deliberate practice serves as a potential framework to understand what activities, attributes, and characteristics make an individual an expert in their chosen field or profession. Historically, deliberate practice activities included those that were highly structured with purposeful goals, frequent repetition, and active feedback with immediate remediation. Deliberate practice has never been defined within the context of supervised dietetics education; therefore, the purpose of this research was to develop a valid and reliable instrument to define deliberate practice in supervised dietetics practice, based on the opinions of practitioners and educators in dietetics and allied health professions. Segment one of the research …

The Design Of An Instrument To Assess Clinical Laboratories Efficacy Post Implementation Of The Patient Protection Affordable Care Act, Harry Mcdonald Jr.

Dissertations

The healthcare system in the United States has undergone substantial changes in support of the Patient Protection and Affordable Care Act (PPACA). On March 23, 2010, the implementation of the new healthcare law brought universal healthcare access to all Americans, while attempting to increase quality and decrease medical costs. The new law promotes more of a quality-focused, outcome-based model rather than a pay-for-fee service model; thus, moving the paradigm from infrequent to preemptive healthcare. The PPACA postulates as the only way to achieve cost savings while increasing quality and access. Never before has there been such an extensive change to …

Study Of Rickettsia Parkeri Colonization And Proliferation In The Tick Host Amblyomma Maculatum (Acari: Ixodidae), Khemraj Budachetri

Dissertations

Amblyomma maculatum (Gulf coast tick) ticks are prevalent across the Atlantic to Gulf Coast region of United States. These ticks are recognized vectors of Rickettsia parkeri, a spotted fever group of Rickettsia (SFGR) known to cause American boutonneuse fever associated with fever and eschar rashes localized to the site of bites. We hypothesized that Rickettsia parkeri colonization and proliferation in the tick vector involve pathogen-symbiont dynamics and tick-pathogen interactions, which influence rickettsial transmission to the victims after tick bites. The rickettsial infection is maintained across the tick life cycle for many generations due to transovarial and transstadial transmission of …

An Analysis Of Ed Nurse Opinion Of Their Ed Nurse Manager Leadership Characteristics And Outcomes, Charlotte Ann Gore

Dissertations

The purpose of this cross-sectional, descriptive, correlational study was to examine ED staff nurses’ opinions of their ED nurse managers’ full range of leadership characteristics , the degree to which the characteristics correlate with specific outcomes of leadership behavior, and how the results of the measure and subscale compare to other nursing groups in literature. The Multifactor Leadership Questionnaire 5X Rater Form (MLQ 5X Rater Form) was used to measure ED staff nurses’ opinions of their ED nurse managers, along with an ED Staff Nurse Demographics Questionnaire to gather information about the characteristics of the population. The population for this …

A Motivational Profile Of Nurses Who Pursue Doctoral Education, Tomekia Yvette Luckett

Dissertations

The need for nurses to pursue doctoral education is imperative to the professionalization of the discipline of nursing in light of the changing healthcare environment. Presently, < 1% of the nursing workforce possesses a doctoral degree (“Transforming Nursing Education,” 2016), albeit recommendations from the Institute of Medicine (IOM) (2010) admonish the need to increase the number of doctoral-prepared nurses. The need to understand characteristics of nurses who seek doctoral education is critical in planning long-term strategies for nursing education in the United States (US) (Kovner, Brewer, Katigbak, Djukic, & Fatehi, 2012). In conjunction with describing characteristics of nurses pursuing doctoral education, this research describes the motivational orientation and factors of registered nurses (RNs) pursuing doctoral education.

A descriptive correlational design was utilized to examine concepts relating to motivational orientation of RNs pursuing doctoral education. Participants were divided into two categories: (a) RNs seeking the Doctor of Philosophy (Ph.D.) degree and (b) RNs pursuing the Doctor of Nursing Practice (DNP) degree. A total of 173 RNs enrolled in either a Ph.D. or DNP program in the Gulf South region of the US comprised the final sample. Binary logistic regression was utilized …

A Mixed-Methods Study: Self-Efficacy And Barriers To Participation In Workplace Wellness Programs, Massiel Perez-Calhoon

Dissertations

America needs a healthy workforce to sustain the country. The scourge of obesity continues to plague Americans despite government initiatives such as the Affordable Care Act and wellness programs in the workplace to combat this epidemic. However, despite initiatives to make America healthy, barriers continued to impede the nation’s health. Lack of awareness and sensitivity to what motivates individual participants versus group participants built formidable barriers to accessing all workplace employees equitably. The purpose of this study was twofold. First, the intent of this study was to explore the relationship between self-efficacy and the impact on participation and engagement when …

Post-Intensive Care Syndrome: Comparison Of Educational Interventions To Educate Parents Of Children Hospitalized In The Pediatric Intensive Care Unit At St. Louis Children’S Hospital, Stephanie A. Esses

Dissertations

Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS). Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.

Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.

Results: A total of 62 parents/caregivers received one of three educational interventions: informational brochures (n=22), scripted informational conversation (n=20), or …

Improving New Graduate Critical Care Nurse Practitioner Knowledge And Retention Using A Dedicated Orientation And Mentoring Program, Katherine Huffer

Dissertations

Abstract

Background: There has been a significant amount of research into the many challenges that nurse practitioners (NPs) face as they transition from school to practice, however, there is limited research on how to improve this transition. Regardless of the setting in which the NPs are working, novices NPs alike report feelings of being unprepared and experiencing high levels of stress, anxiety, fear, and frustration. New research suggests that a comprehensive NP orientation and residency programs may provide a way to integrate the new NPs into their practice environment successfully.

Method: Kern’s Six Step Approach to Curriculum Development for Medical …

The Acute Care Pediatric Nurse Practitioner In Missouri: An Analysis Of Needs Assessment, Jessica L. Mann

Dissertations

Introduction: Due to an increasing number of acutely ill pediatric patients and changing healthcare demands, there is an even greater need for nurse practitioners (NPs) to work in the area of pediatric acute care (AC). There is a lack of alignment of education and certification with the scope of practice of the AC Pediatric Nurse Practitioner (PNP). The development and implementation of a graduate level AC PNP program in Missouri will support the alignment of education, clinical training, and certification with the scope of practice of the AC PNP and improve access to a quality program for nurses that currently …

Implementation Of A Daily Checklist To Improve Patient Safety And Quality Of Care In A Pediatric Intensive Care Unit, Catherine Reese

Dissertations

Background

Multiple industries have demonstrated checklists to be of great value in reducing errors of omission and improving communication. In healthcare, checklists have been shown to ensure patients receive evidence-based, safe care. In a fast paced environment of a critical care unit, adverse events are common and can have significant consequences on patient outcome. Safety guardrails are necessary to minimize naturally occurring human error. Safety checklists help support best practices to standardize care and support processes to improve outcome.

Objectives

To develop and implement a daily safety checklist in a pediatric intensive care unit (PICU) to enhance clinical care and …

Right Hemisphere Capacities For Word-Finding: Bilateral Modulation Of Event-Related Potentials In Healthy Adults And Adults With Aphasia, Amanda C. Alton

Dissertations

Language tasks are typically lateralized to the language dominant left hemisphere in healthy right-handed adults. Additionally, lesions in left frontotemporal areas typically result in a variety of language impairments called aphasia. Interestingly, increased activation in right cerebral regions homologous to left side lesions has been observed in patients with aphasia during word-finding tasks. The neural mechanism and the impact on word-finding remain unclear. There are two competing theories concerning compensatory right hemisphere activation. One view is that the right hemisphere plays a supportive role, taking over functions of the damaged left hemisphere. The other perspective is that rightward laterality is …

The Influence Of Culture On The Use Of Healthcare Services By Refugees In Southcentral Kentucky: A Mixed Study, Chika N. Ejike

Dissertations

The world as a global village has become a ubiquitous trope in the popular discourse, and Bowling Green, Kentucky, with its substantial immigrant population, may be considered an exemplar of this idealized community. It has become an ideal location for research regarding the challenges faced by immigrants. Due to the diverse cultural identities of the refugee/immigrant population, it is particularly well suited for studies into complex culturally dependent healthcare utilization patterns.

The central research question for the study was as follows: What are the healthcare-seeking behavioral patterns (as influenced by culture) among refugees at their nearest healthcare facilities? This mixed …

Factors That Influence Physicians To Assume Leadership Roles: A Focus On Clinical Integration, Jennifer Lynne Jackson

Dissertations

The Patient Protection and Affordable Care Act of 2010 (PPACA) drastically altered the healthcare industry in the United States. Along with multiple other directives, the PPACA mandated that physicians and hospitals work together in strategies known as clinical integration. For effective clinical integration to be achieved, interdependence among physicians and hospitals is required to provide the highest quality outcomes for patients at the best possible value. To this end, healthcare leaders have identified that the key to establishing successful clinical integration is the presence and commitment of physician leaders (Penlington & Marshall, 2016).

This study explores factors that influenced a …

Investigating Personality Traits Of Registered Nurses: Implications For Personnel Evaluation, Stephanie N. Means

Dissertations

The United States is currently facing a registered nurse (RN) shortage that is expected to reach the millions in the next few years. Since the beginning of the century, healthcare professionals and administrators have strived to develop and implement ways to increase recruitment and retention in the nursing field. It has been recognized that the key to recruitment and retention is to get the right nurse in the right place, which means focusing on clinical proficiencies as well as personality qualities and characteristics. Personality assessment has long been used to evaluate person-job (P-J) fit of applicants for positions across the …

Job Retention And Job Satisfaction At The Behavior Therapist Level Working In Aba Companies In The Home Setting, Melissa M. Dauster

Dissertations

Purpose: The purpose of this relational study was to identify and compare the factors related to job satisfaction and job retention as perceived by behavior therapists working with children diagnosed with autism. A second purpose of the study was to determine the relationship between the level of burnout related to job retention, and the intrinsic and extrinsic level of motivation related to job satisfaction as perceived by Behavior Therapists working with students with autism. A further purpose of the study is to describe the improvements in the work place that behavior therapists working with students with autism identified as necessary …

The Effectiveness Of Combined Appointments And Influenza Immunization Rates In A Rural Wic Population, Lisa L. Sitler

Dissertations

Purpose: The purpose of this descriptive retrospective study was to examine predictors and barriers to influenza immunizations receipt in a low-income WIC population.

Method: A quality improvement project was conducted in October 2010 in which 129 caregivers of children having WIC appointments were randomly assigned to receive (a) influenza immunizations at the time of the WIC visit or (b) educational materials and a later immunization. Caregivers completed a survey about their perceptions of influenza immunizations. Tanahashi’s access to care model (1978) was used to identify predictors (acceptability, accessibility, availability, and effectiveness) of influenza immunizations.

Analysis: In analysis …

The Leadership Behaviors Of A Successful Ncaa Division I Water Polo Coach: A Phenomenological Study, Scott T. Mccall

Dissertations

The purpose of this qualitative phenomenological study was to understand and describe the transformational leadership behaviors of a successful NCAA Division I water polo coach. This study examined the transformational leadership behaviors of a NCAA Division I coach who led a team to a national championship and who was a former Olympic athlete and national team coach. Data were collected from interviews of the head coach and participants who had direct lived experiences with the coach, as well as through observations of practices and games, and the collection of artifacts.

The findings from this research showed that the head coach …

Factors Affecting Mental Health Seeking Behaviors Of Law Enforcement Officers, Vincent M. Haecker

Dissertations

The intent of this study was to elicit perspectives from law enforcement counselors, clinicians, chaplains, and peer group leaders for factors affecting law enforcement officer’s (LEOs) seeking mental health assistance. The law enforcement and mental health communities have gone to great lengths to ensure assistance is available to LEOs in an effort to counter the stress and trauma associated with the policing profession. Past studies attempted to elicit LEOs attitudes on mental health services, generating mixed results and were unable to establish why available services were underutilized. This study employed a qualitative methodology to elicit perspectives on this phenomena from …

Social Ecological Factors Associated With Parental Vaccination Decisions And Perceptions Of Barriers To Childhood Immunizations, Catherine A. Ferris

Dissertations

The success of childhood immunizations has led to a decrease in the visibility of the morbidity and mortality of vaccine-preventable diseases. Parents are questioning the validity and safety of vaccines resulting in significantly increasing numbers of underimmunized and unvaccinated children throughout the country. The purpose of this dissertation was to explore the perceptions of barriers to immunizations in parents with children, birth to 12 months of age presenting for a well-child or vaccinations-only visit to one of two pediatric primary care clinics located in San Diego County. The social ecological model was used to guide this dissertation. A cross-sectional, descriptive …

Role Of Jagged1 In The Enrichment Of Cancer Stem Cells In Her2+ Breast Cancer, Deep Shah

Dissertations

Purpose: Breast cancer is the second leading cause of cancer-related deaths among women worldwide. Human Epidermal Growth Factor Receptor 2 (HER2) positive subtype of breast cancer is driven by a subpopulation of cells possessing stem cell properties of self-renewal and differentiation, known as Cancer Stem Cells (CSCs). CSCs are implicated in tumor growth as well as radiotherapy and chemotherapy associated resistance. Notch receptors promote breast CSCs survival and self-renewal, and overexpression of Notch ligand Jagged1 predicts poor prognosis. We showed previously that Notch could be an important target in trastuzumab/lapatinib resistant HER2+ breast cancer.

Experimental Design: Here, we sought to …

It Is Always The Monkey On My Back: The Diagnosis Of Cirrhosis, Mary Tiberg

Dissertations

Mary Tiberg

Loyola University Chicago

IT IS ALWAYS THE MONKEY ON MY BACK: THE DIAGNOSIS OF CIRRHOSIS

A significant current challenge in health care today is meeting the needs of a population that has chronic disease, especially for those that have a health condition with a life threatening long -term outcome (Falkenstern, et al., 2005). In these health illness transitions, when there are no secure expectations, there are the additional burdens of enduring emotional unease, facing the closing stages of physical stamina, and confronting an indeterminate future. The objective of this study was to explore and describe the experience of …

Examining The Effects Of Adolescent Binge Alcohol Exposure On The Negative Feedback Of The Hpa Axis And Adult Responses To Psychological Stress, Audrey Rose Torcaso

Dissertations

Binge drinking during adolescence is a common occurrence which is associated with increased risk of developing alcohol dependence and other mental health disorders. Hypothalamo-pituitary-adrenal (HPA) axis dysfunction is one characteristic commonly observed in many affective disorders, including anxiety and depression. Our laboratory has previously demonstrated that adolescent binge-pattern alcohol exposure results in long-term dysfunction of the HPA axis in a Wistar rat model, characterized by deficient glucocorticoid feedback inhibition. The current study aimed to characterize the behavioral phenotype of these rats in response to psychological stress during adulthood, and furthermore sought to understand the molecular mechanisms by which adolescent binge …