Medicine and Health Sciences Commons^™

Minimizing Avoidable Interruptions During Medication Administration, Jaleel Anne Arnado

Master's Projects and Capstones

The objective of this CNL Internship Project is to improve patient outcomes and nurse satisfaction by minimizing the avoidable interruptions that occur during medication administration. The microsystem is a pediatric and adult medical-surgical overflow unit at a large, urban teaching hospital in Northern California. A series of surveys for nurses and patients and observations of medication administrations were conducted to assess barriers during mediation administration. It was determined phone calls interrupt a nurse the most during medication administration. Interruptions leave the medication administration process vulnerable to errors because it disrupts the nurse’s workflow and thought process. Because most pediatric medication …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Assessing Cultural Competence In Health Professional Student's, Sophia Jones

Seton Hall University Dissertations and Theses (ETDs)

Background-The United States has become a more diverse society and healthcare professionals must be ready to meet the needs of this more culturally diverse society. Students studying in the many areas of healthcare must learn to be culturally competent. To ensure that students are culturally competent and can provide culturally competent care routed in a global perspective their abilities must be developed and assessed. With the absence of any such assessment tool in the literature reviewed the objective set forth in a preliminary study was to develop a tool to assess cultural competence from a global perspective. With this …

Correlating Coworker Relations, Employee Involvement, And Leadership With Associate Commitment In Select Healthcare Companies Using A Mixed Sequential Explanatory Design, Kimberly Ann Lee

Theses & Dissertations

Increasing patient demands and decreasing reimbursement require better efficiency and effectiveness in health care systems and, subsequently, in health care teams. These environmental and societal factors are further complicated by the complex initiatives set forth by the Affordable Care Act (2010). In this study, the researcher sought to examine and identify the strongest variables of health care teaming and to explore resulting themes through the perception of groups of health care associates. This mixed sequential explanatory design first examined the relationships between coworker relations, employee involvement, and leadership with associate commitment and with each other. An existing database of associate …

Socio-Economic And Cultural Determinants Of Health Care Services Utilization In Ghana, Vickita Akosua Antwiwaa Harvey

UNLV Theses, Dissertations, Professional Papers, and Capstones

The study examines the relationship between socio-economic and cultural determinants of health care service utilization in Ghana using Ghana Demographic and Health Survey (GDHS) 2008 data collected by Ghana Statistical Service (GSS) in which a two-stage sample design was used. The first stage involved a systematic sampling, with probability proportional to size, of 412 clusters using the 2000 Ghana Population and Housing Census as the sampling frame. At the second stage, systematic samples of 30 households from each cluster were selected, making a total of 12,360 sampled households. According to the GSS, data were not collected in some of the …

Family Nurse Practitioner Mentoring Relationships' Impact On Organizational Commitment, Patricia Bartley-Daniele

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family nurse practitioners (FNPs) are vital primary care providers who are responding to increased primary health care needs in the United States. Organizational commitment is reflective of workplace relationships that foster professional development, innovation, and outcome achievement. An organizationally committed FNP workforce is essential to achieving primary health care goals.

Mentorship has been proposed as a strategy to foster FNP organizational commitment. Mentoring has been characterized as a teaching-learning relationship. The mentor can serve as a guide to foster graduate FNP practitioner transition into primary care practice. Types of mentoring relationships occur in formal workplace settings or develop as informal …

Classification Of Clinical Outcomes Using High-Throughput And Clinical Informatics., Alexander Carswell Cambon

Electronic Theses and Dissertations

It is widely recognized that many cancer therapies are effective only for a subset of patients. However clinical studies are most often powered to detect an overall treatment effect. To address this issue, classification methods are increasingly being used to predict a subset of patients which respond differently to treatment. This study begins with a brief history of classification methods with an emphasis on applications involving melanoma. Nonparametric methods suitable for predicting subsets of patients responding differently to treatment are then reviewed. Each method has different ways of incorporating continuous, categorical, clinical and high-throughput covariates. For nonparametric and parametric methods, …

Designing A Sustainable And Transferable Inventory Management System For Small Healthcare Facilities, Shree Frazier

Open Access Theses

Managing the costs of supplies within healthcare facilities has been a task that has plagued the health industry for many years. Many facilities are accustomed to using a par system approach. This involves bringing an inventory item to an amount sufficient for daily operation. This method often requires daily inspection by a healthcare worker, which reduces his/her time spent performing value added tasks. Employees at small healthcare facilities have multiple responsibilities, therefore they cannot afford to spend much time on inventory management. A proposed approach is the Kanban method, which allows for strict monitoring of inventory items without the need …

Comparing Generational Differences In Job Satisfaction And Retention (Anticipated Turnover) Among Nurses Working In Magnet Versus Non-Magnet Designated Hospitals, Laura E. Cima

Seton Hall University Dissertations and Theses (ETDs)

Background and Purpose of the Study: Experts in the nursing profession predict a catastrophic nursing shortage by 2025. Nursing shortages have devastating effects on hospitals from a quality of care, patient and family satisfaction and financial perspectives. Given these issues, the most logical approach to this shortage is retention of nurses rather than recruitment. The Magnet designation is one mechanism to retain nursing staff.

Another phenomenon exists within the work environment that makes this shortage different from others. Currently, there are four generations of nurses working in the healthcare environment. Each of these generational cohorts has different values and …

Layout Planning Of Logistics Network For Medical Instruments Based On Third-Party Logistics, Kewei Xu

World Maritime University Dissertations

No abstract provided.

Re-Engineered Discharge Planning In A Rural Mississippi Hospital To Reduce 30 Day Readmission Rates Among Heart Failure Patients, Roxie Mae Hogan

Doctoral Projects

The hospital discharge is a complex process that involves interdisciplinary efforts to avoid readmissions and decrease health care costs. The purpose of this capstone project was to take a leadership role in translating evidence into practice by successfully preparing NWMRMC discharge planning stakeholders to adapt Project RED for use with HF patients admitted to NWMRMC.

A comprehensive systematic improvement plan, Project RED is designed to improve the work flow process through the use of timelines and strategies. Project RED supports discharge planning, helps to prevent readmission, and facilitates knowledge transfer that promotes sustainable changes. Re-Engineered Discharge Planning (RED), 6 step …

Modeling Solutions For Prevention Of Medicare Insolvency For The Baby Boomer Generation (Born 1946 - 1964), Gregory Thomas Scott

Health Services Research Dissertations

Medicare, a United States social insurance program operated by the United States federal government, began operating in a deficit in the year 2010. More funding was expended than revenue received for medical care, creating significant shortfalls for the Medicare Trust Fund. This study examined possible initiatives to describe Medicare funding related to issues as financial shortfalls utilizing mathematical modeling and simulation. The Park Conceptual Model is a framework created to identify internal and external changes that influence bankruptcies related to municipalities, and this Model served as the theoretical basis for this study.

The following study addressed insolvency as negative cash …

A Case Study Of Collaborative Governance: Oregon Health Reform And Coordinated Care Organizations, Oliver John Droppers V

Dissertations and Theses

The complexity of issues in health care in the United States--specifically insurance coverage, access, affordability, quality of care, and financing--requires effective new models for governing, in which governmental and non-governmental organizations seek to solve problems collaboratively rather than independently. This research explores collaborative governance as a model to form new partnerships among for-profit, nonprofit, and public organizations in an effort to create community-based, locally governed health care entities in Oregon through coordinated care organizations (CCOs). A key question is whether collaboration, through CCOs, brings together government and non-governmental organizations to solve "intractable problems" by establishing new public-private partnerships in Medicaid. …

Burnout And Other Complex Challenges Causing Doctors To Become Patients In France And The United States, Cherry Chahal

Honors Theses

Everyday, people feel a calling to become a doctor for various reasons. These reasons include experiencing a disease or illness either through a family member or on one’s own, having a desire since childhood from hearing stories and wanting to help others, and perhaps wanting to propagate a family tradition and career. Out of all of the many reasons in the world, a desire to help others rises above the rest among to-be doctors. Thus, medical students and doctors dedicate their lives to learning about the human body in depth, well beyond what any introductory courses in biology will teach. …

Patient Safety Culture And High Reliability Organizations, Jared D. Padgett

Walden Dissertations and Doctoral Studies

A 1999 evaluation of case studies performed by staff from the Institute of Medicine found that between 40,000 and 98,000 patients died from preventable errors, while 43,598 individuals died in car accidents that year. A 2011 report increased that estimate nearly 10 times. Widespread preventable patient harm still occurs despite an increase in healthcare regulations. High-reliability organization theory has contributed to improved safety and may potentially reverse this trend. This explorative single case study explored how the perceptions and experiences of nursing and respiratory staff affected the successful transition of a healthcare organization into a reliability-seeking organization. Fourteen participants from …

Basic Human Health And Sustainable Community Development: A Case Study Of A Community In Monte Plata, Dominican Republic, Rachelle H. Arnoux

Capstone Collection

One of my objectives in conducting this research is to enhance my skills in data collection while simultaneously improving my writing skills. More substantively, I wanted to explore how access to healthcare in a developing country like the Dominican Republic can contribute to sustainable development. As good health is fundamental and vital for all human beings, it is important in the context of this study to understand how the healthcare system in a particular country gives the population access to quality healthcare. Referring myself specifically to the situation at Batey Relief Alliance (BRA) Dominicana medical center in the Dominican Republic …

Racial Disparities In Adherence To Cardiovascular Medications Among The Elderly In Medicare: Three Empirical Essays, Mustafa Hussein Muhammad Hussein

Theses and Dissertations (ETD)

This dissertation sought to explore the relatively understudied area of racial disparities in adherence to cardiovascular medication regimens among the elderly. Black and Hispanic seniors are well documented to have lower rates of adherence to their prescribed cardiovascular medications, relative to their white counterparts. This disproportionately lower adherence places these minority groups at higher risk for worse cardiovascular prognosis and premature cardiovascular death. The Medicare Program, which covers healthcare predominantly for elderly Americans, offers an interesting laboratory to study these disparities and their response to policy changes. Using nationally representative data from the Medical Expenditure Panel Survey on white, black, …

Predictors And Mediators Of Long-Term Functional Limitations In The Older Adult Population, Teresa Maria Bell

Theses and Dissertations (ETD)

With nearly 40 million Americans being treated for nonfatal injuries in emergency departments annually, the burden of nonfatal injury in the United States is extensive. The longterm functional consequences of these injuries can be enduring and far-reaching, especially for older adults. Although studies have reported that persistent functional deficits exist after injury, less information is known about long-term recovery patterns and the factors that influence functional outcomes.

The primary aims of this study are to (1) classify differences in long-term, longitudinal changes in functional limitations within the injured population, (2) identify individual characteristics that predict recovery after injury and (3) …

An Assessment Of The Health Needs Of Maine Veterans And Their Access To Veterans Administration Health Care Services, Kristin Brawn

Muskie School Capstones and Dissertations

On a state level, only a few assessments have been conducted, which indicate that Maine veterans are also experiencing similar mental and physical health issues; however, it does not appear that the adequacy of Maine’s VHA services to meet the needs of Maine’s veterans has been comprehensively evaluated. It is unknown whether the physical and mental health needs of Maine’s veterans are currently being met. Therefore, this project proposes to determine if there is a similar problem among Maine’s veterans in regard to health issues and lack of access to VHA health services, as has been reported at the national …

The Role Of Faith-Based Clinics In America's Healthcare System, Parker Jennings Loy, Parker Jennings Loy

Chancellor’s Honors Program Projects

No abstract provided.

Rural Pediatric Primary Care Practice Patterns As A Result Of An On-Site Behavioral Health Consultant: A Retrospective Analysis, Kayla D. Mccarter

Undergraduate Honors Theses

Nationally, it has been estimated that 10 to 21% of children with psychosocial concerns are seen in primary care settings (Jellinek et al., 1999; McInerny, Szilagyi, Childs, Wasserman & Kelleher, 2000; Palermo et al., 2002). Often, however, children go undiagnosed with/treated for psychosocial concerns in pediatric primary care due to lack of physician time and poor referral rates to mental health providers. Evaluations of integrated care models, in which a behavioral health consultant is present in primary care practices, has shown to increase the availability of mental health services (Stancin, Perrin, & Ramirez, 2009). Using extant data from patient records …

Quality Of Primary Care From The Patient Perspective In Saudi Arabia : A Multi-Level Study., Khalid Awad Alahmary

Electronic Theses and Dissertations

Objectives: To assess primary care performance for measures of patients’ experience in Community-based Primary Care (CPC) and Employer-based Primary Care (EPC) systems in Saudi Arabia, to examine variations in performance across the two systems, and to explore factors at both the individual-level and the organizational-level that explain variations in primary care performance. Design and Methods: This is an observational and cross-sectional study, using comparative design and survey research methods. The newly revised and re-translated Arabic version of the Primary Care Assessment Survey (PCAS) was used to measure patients’ experience of primary care. PCAS operationalizes the IOM definition of primary care, …

More Than A Diagnosis: Enabling Medical Students To Understand And Address The Patient’S Psychological Needs, Paige Jarmuz

Honors Capstone Projects - All

Patient-centered care is a framework for providing medical services in a humanistic, patient-focused manner. Although there are many proposed dimensions, it is simply the perspective of caring for the patient as a person with psychosocial needs, not just a diagnosis. Extensive literature review was completed to gain understanding of the application of patient-centered care in undergraduate medical education, as well as the evidence behind implementing patient-centered methods. Aspects of patient-centered care may be taught in many medical schools but their importance warrants a stronger focus. Incorporating aspects of patient- centered care is not only most ethical, but also is also …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

Modeling And Optimization Of Care Transitions, Yuming Mo

Open Access Theses

More than 145 million people live with at least one chronic condition, and almost half of them have multiple conditions. As a result, many managed care and integrated delivery systems have taken a great interest in alleviating the many deficiencies in managing the current care system that spans across various care delivery settings. In addition, many Americans have to rely on some social health insurance plan to cover her care expenses. As a result, these patients often may not been sufficiently cured but have to be transitioned to less expensive but less medically intensive facilities, due to the increasing pressure …

Potential Influences Of Compliance For Short-Term Recovery From Sports-Related Concussion, Erin R. Ewing

Open Access Theses & Dissertations

Currently, treatment of sports-related concussion dictates the prescription of physical and cognitive rest to allow the injured brain to recover and for concussion-related symptoms to subside. However, clinicians who prescribe rest are often met with resistance from athletes who do not recognize its therapeutic value in the recovery process. Research has shown that athletes often fail to comply with rest recommendations, resulting in protracted recovery and the persistence of symptoms. Method: This study employed a three-group pretest-posttest experimental design to compare the effects of three different concussion management protocols. Participants were recently concussed athletes ages 18-25 seen in the UTEP …

An Analysis Of The Effects Of The 2003 And 2011 Acgme Work Hour Rules On Medical Resident Satisfaction At An Independent Academic Medical Center, Rachael E. Trout

Theses, Dissertations and Capstones

The purpose of this research was to determine what effects, if any, the 2003 and 2011 ACGME work hour rules had on medical resident satisfaction at an independent academic medical center in the United States. This research analyzed results of a survey administered by an independent academic medical center utilizing its own instrument of measure. Items reviewed to determine self-perceived satisfaction included questions related to program director effectiveness, resident input, quality of life, and satisfaction with program. Four comparisons were reviewed and analyzed for statistical significance utilizing the Mann-Whitney U non-parametric test for independent samples. The results indicated neither the …

Direct-To-Consumer Advertising Of Drugs And Patients' Health Care Seeking Behaviors, Patricia Elaine Kennedy-Tucker

Walden Dissertations and Doctoral Studies

Known as direct-to-consumer advertising (DTCA), pharmaceutical companies in the United States are permitted to advertise prescription drugs directly to consumers. The purpose of this quantitative study was to determine if an association exists between DTCA and health care-seeking behaviors. The theoretical framework for this study involved social learning theory, information integration theory, and prospect theory. The research questions identified if exposure to DTCA (a) is associated with physician office visits, (b) influences a patient/physician conversation regarding a prescription, (c) influences requesting a prescription, and (d) has an impact on patients' ratings of the overall interaction with the physician. Data were …

Emerging Diabetes Pandemic In India: A Case Study For An Integrative Approach, Chhaya Sanjeev Chaudhry

Walden Dissertations and Doctoral Studies

Every day, India sees the addition of 5,000 new cases of diabetes to its current diabetic population of 65 million people. This number is projected to cross the 100 million mark in 15 years. The emerging pandemic scale of diabetes growth is straining India's already-overburdened public healthcare resources. India is home to several well-established native and adapted foreign traditions of medicine that are widely practiced. These traditions include Ayurveda, yoga and naturopathy, unani, siddha, and homeopathy. The modern and traditional medicine approaches are extensively used as independent systems. The purpose of this qualitative research case study was to evaluate the …

A Correlational Analysis Of Empowerment And Experience With Resistance To Change, Rita Elizabeth Burgess

Walden Dissertations and Doctoral Studies

Despite more than 60 years of research about the nature of change, resistance to change remains a problem across industries. Health care leaders have limited knowledge of how health care managers' perceptions of empowerment, years of experience, and resistance to change (RTC) relate. The purpose for this nonexperimental correlational study was to examine the relationship between empowerment, years of experience, and RTC among managers via an online survey. The theoretical framework incorporated Kanter's structural empowerment theory and Kotter's change theory. The sample included 245 out of 1,181 health care managers from Veterans Administration (VA) hospitals in the New York metropolitan …