Medicine and Health Sciences Commons^™

Feasibility Study Among Military Personnel With Traumatic Amputation During Military Combat Or Training, Michele (Shelly) R. Burdette-Taylor Phd, Msn, Rn-Bc, Cwcn, Cfcn

Dissertations

Military operations have resulted in a significant number of mangled extremities leading to traumatic amputations. Extremity injuries predominate, representing 50% to 70% of all injuries treated (Melcer, 2010). The majority of injuries sustained in Operation Endearing Freedom/Operation Iraqi Freedom (OEF/OIF) are combined penetrating, burn and blast injuries, traumatic amputation, and infections from the multi-drug resistant organism, Acinetobacter (Melcer, 2010). The purpose of this study was to measure the quality of well-being and impact of events in a group of adults who served in the U.S. armed forces and sustained the loss of one or more limbs during any combat or …

Personal Factors, Perceptions, Influences And Their Relationship With Adherence Behaviors In Patients With Diabetes, Glenn E. Hagerstrom

Nursing Dissertations (PhD)

Problem and significance: Adherence to health-promoting behaviors in a diabetes self-care regimen is essential for individuals with diabetes and can assist providers and individuals with diabetes management. The purpose of this research was to explore the relationship between personal factors (age, length of diabetes diagnosis, perceived health status, weight), perceived barriers to action (number of barrier days), interpersonal influences (social support), situational influences (depressive symptoms), and patient adherence to health-promoting behaviors (blood glucose monitoring, diet, and exercise) and health outcomes ( A1c and body mass index) in a diabetes self-care regimen.

Methods: A descriptive correlational analysis was performed using baseline …

The Relationship Of Personal Characteristics, Behavorial Capability, Environmental Factors, And Hypertension Medication Adherence In African American Adults With Metabolic Syndrome, Karen Andrea Armstrong

Nursing Dissertations (PhD)

Disparities in medication adherence (MA) associated with African American (AA) adults may be related to a dynamic interplay between personal factors, behavioral capability, and environmental factors. The purpose of the study was to examine this relationship in AA adults with metabolic syndrome (MetS). A cross-sectional, correlational analysis was conducted from baseline data from a larger intervention study. Constructs from the Social Cognitive Theory were used to predict MA. The sample of 91 AA adults with MetS was primarily middle-aged (age range 45-70 years old; M 53, SD 6.3), female (79%), relatively well-educated, and married. Despite being on antihypertensive medications, 53% …

The Effects Of Pattern Recognition Based Simulation Scenarios On Symptom Recognition Of Myocardial Infarction, Critical Thinking, Clinical Decision-Making, And Clinical Judgment In Nursing Students, Susan A. Walsh

Nursing Dissertations (PhD)

In the United States nearly 1 million annual new and recurrent myocardial infarctions (MI) occur with 10% of patients hospitalized with MI having unrecognized ischemic symptoms. Inexperienced nurses are expected to accurately interpret cardiac symptom cues, possibly without ever having experienced care of patients with MI, yet have been shown to be less able to classify symptom cues and reach accurate conclusions than experienced nurses. The purpose of this study was to test an educational intervention using theories of pattern recognition to develop CT in MI and improve nursing students’ clinical decision-making and clinical judgment using high fidelity patient simulation. …

Shrouded In Stigma: A Heuristic Study Of Living With Hiv, Neal Stacy Rosenburg

Dissertations

HIV-related stigma is a serious hindrance to addressing the recruitment, maintenance, and follow-up nursing care of HIV-infected persons. This study was anchored within the heuristic research model, which engaged both the researcher and participants in a dialogical and aesthetic manner to unveil the stigma of HIV. The close proximity of the researcher and study participants revealed the most visceral, emotional, and self-reflective nature of gathering data, while maintaining the integrity and rigor of a qualitative study. The purpose of this heuristic study was to examine the lived experiences of HIV-infected individuals relating to internalized stigma within an existential context. This …

The Cultivation And Practice Of Spiritual Care Expertise In An Inpatient Palliative Care Setting, Gail Elaine Pittroff

Dissertations

Caregivers involved in palliative care seek to understand problems and challenges at end of life through research to determine the best care for patients and their families. Spiritual care is a key component of quality end of life care, yet there is a paucity of research on spiritual care in inpatient settings at end of life in nursing literature. The purpose of this study was to examine the personhood and spiritual care practices of inpatient palliative nurse consultants. This study describes expert nurse’s experience of delivering spiritual care for patients and families at end of life in inpatient palliative care …

The Mother's Perspective: Understanding More About The Health Care Needs Of The Preschool Child With Autism, Margaret W. Bultas

Dissertations

Background Information: The prevalence of autism spectrum disorders (ASD) has dramatically risen over the last decades. It is known that children with ASD visit health care providers (HCP) more frequently than typically developing peers. Given behavioral and medical complexities of these children, mothers may experience barriers in this process. Purpose: The purpose of this study was to gain a better understanding of mothers’ experiences of taking their children to the HCP. Aims of this study were to reveal mothers’ concerns related to these experiences, examine resources and barriers affecting the quality of the visit, and discover more about the effect …

Awareness Cultivation: Designing A Transcultural Patient Family Advisory Council, Lisa G. Peterson

Theses and Graduate Projects

This project explores the rationale that supports designing and implementing a transcultural patient family advisory council (PFAC) at a large academic center in the Midwest where eight disease-diagnosis based PFAC's already exist. Potential pitfalls and obstacles that could interfere with such a council being successful will also be reviewed. In addition, Madeline Leininger's theory of Culture Care Diversity and Universality is applied to add support to this effort. Specifically, the stranger to trusted friend enabler explains how having such a committee can foster mutually beneficial relationships that demonstrate a change in culture and attitudes at this traditional physician-lead institution.

Mother-Infant Synchrony During Infant Feeding, Barbara Reyna

Theses and Dissertations

MOTHER-INFANT SYNCHRONY DURING INFANT FEEDING By Barbara A. Reyna, PhD A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2010. Major Director: Rita H. Pickler, PhD Endowed Nursing Alumni Professor Department of Family and Community Health Nursing, School of Nursing Synchrony between a mother and her infant is fundamental to their developing relationship. Feeding is an essential activity that provides an opportunity for interaction between a mother and her infant and may lead to synchronous interaction. The purpose this study was to develop and test a …

Caring Beyond Constraint: A Nursing Model Of Presence In A Time Limited Procedural Practice, Laura Becker

Theses and Graduate Projects

The purpose of this paper is to support the value of maintaining presence within a time limited procedural practice. Specifically, it presents the significance of a nursing presence model based on Jean Watson's human caring theory within an outpatient procedural endoscopy unit which has high patient volumes and time limited processes. It describes the process for developing a care model of nursing presence and methods used to integrate this model into practice. It also includes an evaluation of the methods to determine themes and make comparisons to determine effectiveness of theory integration into nursing practice.

Replicating Success: Developing An Educational Process For Improving Nursing Accuracy When Using A Patient Classification System, Dewey M. Moulton

Theses and Graduate Projects

The use of patient classification systems (PCS), within hospitals has been and still is utilized primarily for determining staffing requirements, based upon the projected needs of the patient. Since its conception in the 1950's, health care management has worked to develop a system that accurately depicts those needs to provide good patient care. Recently, a major tertiary health care center located in the Midwest region of the United States implemented a revised patient classification system within its acute care setting. Nurses were provided various levels of education regarding its use. Because of this, accuracy by nurses using the patient classification …

Spermatogenesis: Laser Microdissection Optimization, Deborah Ann Hansen

Dissertations

Studies link paternal environmental exposures to pesticides, herbicides, and radiation to adverse reproductive outcomes such as developmental delays, malignancies, and structural birth defects. To date, 900 children of Vietnam veterans with presumed Agent Orange exposure receive VA presumptive service connected benefits because these children have Spina Bifida. To date, there are limited data to explain the underlying causal mechanisms whereby paternal environmental exposures result in adverse reproductive events. Laser microdissection (LMD) is the only technology that allows the isolation of cell subpopulations from complex tissues such as the testes without disturbing the cell’s bimolecular signature. LMD is essential in the …

Thinking Differently: Developing A Fall Risk Assessment For The Emergency Department Setting, Carissa K. Fauks

Theses and Graduate Projects

When a patient falls in the hospital it ends up being costly for both the patient and the hospital. Having an awareness of risk factors that lead to an increase in patient falls becomes very important for all nursing staff. However, the contributing factors are not the same for every department in a hospital. The focus of this proposal is the development of a fall assessment that is specific to the emergency department. Age, cognition, elimination, physical mobility, and medications were the risk factors determined to be most important after a review of the literature. Once the fall assessment scale …

Facial Expression Discriminates Between Pain And Absence Of Pain In The Non-Communicative, Critically Ill Adult Patient, Mamoona Arif-Rahu

Theses and Dissertations

BACKGROUND: Pain assessment is a significant challenge in critically ill adults, especially those unable to communicate their pain level. At present there is no universally accepted pain scale for use in the non-communicative (cognitively impaired, sedated, paralyzed or mechanically ventilated) patient. Facial expressions are considered among the most reflexive and automatic nonverbal indices of pain. The facial expression component of pain assessment tools include a variety of facial descriptors (wincing, frowning, grimacing, smile/relaxed) with inconsistent pain intensity ratings or checklists of behaviors. The lack of consistent facial expression description and quantification of pain intensity makes standardization of pain evaluation difficult. …

Characterizing Dietary Intake And Physical Activity Affecting Weight Gain In Kidney Transplant Recipients, Connie Klopfenstein Cupples

Theses and Dissertations (ETD)

Weight gain following kidney transplant is a significant problem with 50 to 90% of kidney transplant recipients gaining weight. Potential factors leading to weight gain following kidney transplantation have been thought to include a change in lifestyle such asdietary intake and physical activity, along with the use of immunosuppressant medications to preserve the newly implanted organ. Other influences affecting weight gain include genetic determinates such as age, gender and race. There is little data to confirm which of these factors may indeed lead to weight gain and obesity. The purpose of this study was to examine dietary intake and physical …

Recent Accelerated Second-Degree Baccalaureate Graduates’ Perceptions Of Educational Preparation, Susan Candelaria

UNLV Theses, Dissertations, Professional Papers, and Capstones

As of 2008, the U.S. Department of Labor is predicting a need for greater than one million new registered nurses by the year 2016 (American Associations of Colleges of Nursing [AACN], 2008). One way that nursing schools around the country are dealing with this issue is through the creation of accelerated second-degree programs for non-nursing graduates.

The purpose of this descriptive study was to examine the perceptions of educational preparation of accelerated second-degree baccalaureate graduates, who have been out of school for at least one year, but no longer than four years. The sample consisted of 54 graduates from an …

Near Miss Reporting: An Educational Program, William Strub

Nursing Masters

In October 2007, the Medicare system contemplated future introduction of a new policy, which would no longer pay for eight preventable medical errors. With this potential new change in policy it becomes increasingly more important for health care institutions to monitor (track) medical errors and determine what measures can be taken proactively to prevent the occurrence of errors. The errors that might not be financially reimbursed under Medicare in the future include: - Sponges and/or surgical tools left in patients after surgery - Treatment of problems arising from air embolisms or incompatible blood transfusions - Treatment of bedsores developed while …

Energy Webs And Nursing Praxis: Patterning In The Lived Experience Of Type 2 Diabetes, Karen Marcus Glasenapp

Doctor of Nursing Practice Projects

Diabetes is an illness best described as costly, complex, chronic, and epidemic in the United States, affecting nearly 24 million children and adults; 90% of who have type 2 diabetes (Centers for Disease Control and Prevention, 2008). On average, every 20 seconds in the United States, an individual 20 years of age and older receives a diagnosis of diabetes; yet, an estimated 6 million people with the disease remain undiagnosed (American Diabetes Association, 2010b). The financial burden of this disease, the inconsistent effectiveness of well-intentioned diabetes programs to educate and actualize change behavior, and the limited resources of millions of …

Direct Care Workers Perceptions And Practices Related To Quality Of Life In Long Term Care, Karen M. Kinyon

Dissertations

The focus of this case study was to discover how DCWs define success in their practice and what institutional and individual factors contribute to their successful practices. It describes how DCWs perceive quality of life for NH residents and how their practices reflect quality of life indicators. The conceptual model for which this research is based on was developed around the concepts that individual and institutional factors contribute to the successful practices of direct care workers; and, how these DCWs perceive quality of life influences how they practice to promote quality of life for nursing home residents. Using a case …

Application Of A Judgment Model Toward Measurement Of Clinical Judgment In Senior Nursing Students, Tiwaporn Pongmarutai

UNLV Theses, Dissertations, Professional Papers, and Capstones

Clinical judgment, defined as “the application of the nurse’s knowledge and experience in making decisions about client care” (The National Council of State Boards of Nursing, 2005, p. 2), has been recognized as a vital and essential skill for healthcare providers when caring for clients. Undisputedly, nurses represent the largest component of the healthcare profession and, therefore, play a major role in ensuring quality patient care in the United States. Although the concept of clinical judgment in nursing has been discussed for more than three decades, and in spite of numerous efforts to improve student clinical judgment, the recent literature …

Student Persistence In Associate Degree Nursing Programs At Mississippi Community Colleges, Kathryn Lee Fleming

Dissertations

The purpose of this study was to examine factors of student persistence and attrition in addition to strategies that may help students persist in associate degree nursing programs at community colleges. Data were collected from nursing students enrolled in first-year associate degree nursing programs at participating Mississippi community colleges and analyzed using multiple regression and repeated measures ANOVAs. Tinto’s Classic Model and Bean & Metzner’s Nontraditional Model of Student Attrition were utilized in this study. This mixed methods convenience sample yielded 564 participants, and the results were as follows: environmental factors and demographic factors of student persistence were found to …

Staying Alive: A Nursing Care Model In The Technical Delivery Of Dialysis, Sylvia Moe

Theses and Graduate Projects

The purpose of this project is to develop a model of a caring-healing transformational relationship by using Watson's caring theory to enhance the patient's experience on dialysis. The nursing model in a large tertiary hospital in the Midwest uses relationship-based care to identify nursing roles that will be used in the mentoring model. Transpersonal caring promotes the caring practice which is the essence of nursing and is associated with a greater sense of self-knowledge, self-control and well being with increased nurse satisfaction. It is the authentic caring knowledge and caring practice integrated in the environment for the delivery of the …

Teaching And Learning About Patient-Centered Care And Quality Using A Hybrid Learning Approach, Linda A. Johnson

Nursing Masters

Teaching RN to BSN nursing students to incorporate patient-centered care and quality concepts into practice presents both challenges and opportunities for educators. While guidelines and tools exist, the development of praxis can be an intricate process. This article describes the development, deployment and evaluation of an RN to BSN hybrid course focused on patient-centered care and quality. Strategies and evaluation methods will be outlined and consideration of the efficacy of using a hybrid instructional design will be discussed.

Factors That Influence Organizational Commitment In Nurse Manager / Subordinate Dyads, Laurie Stegeman

Master's Theses

According to Buerhaus, Auerbach and Staiger (2009), despite the current easing of the nursing shortage due to the recent recession and many nurses putting off retirement, the nursing shortage is projected to grow to approximately 260,000 registered nurses by the year 2025. Creating a work environment within nursing practice that is healthy and productive is essential to maintaining an adequate nursing workforce (Shirey, 2006). Nurse leaders play a vital role in creating work environments that are healthy, positive and productive. The problems associated with decreasing levels of organizational commitment (OC) among staff nurses ultimately resulting in losing dedicated, skilled nursing …

Intimidation And Disruptive Behaviors In The Health Care Setting, Janelle Wade

Master's Theses

Intimidation and disruptive behavior can undermine patient care and cause staff dissatisfaction and turnover of professionals in the health care setting. These behaviors have been linked to patient safety issues, nurse satisfaction, nurse retention, as well as ineffective communication and collaboration (Fontaine & Gerardi, 2005; Institute for Safe Medication Practices (ISMP), 2004; Martin, 2008; Rosenstein & O‟Daniel, 2005). The Joint Commission has made recommendations to reduce the incidence of disruptive behaviors. Hospitals are being asked to take responsibility, hold physicians accountable for their actions, and address workplace intimidation (ISMP, 2004; Rosenstein & O‟Daniel, 2005; The Joint Commission, July 2008). The …

Evaluation Of Oncology Nurses' Knowledge, Practice Behaviors, And Confidence Specific To Chemotherapy Induced Peripheral Neuropathy, Rebecca Denise Mcallister

USF Tampa Graduate Theses and Dissertations

Chemotherapy induced peripheral neuropathy (CIPN) remains one of the most serious and challenging symptoms oncology nurses encounter in caring for patients receiving neurotoxic chemotherapy. CIPN is under-addressed, under-reported, and symptoms are minimized by healthcare providers, which adversely affect patient quality of life, physical function, and emotional well-being. There is an absence of research examining nurses’ knowledge and practice behaviors related to CIPN. The purpose of this study was to explore oncology nurses knowledge, practice behaviors, confidence, and the relationship between education, experience, and knowledge specific to CIPN.

Data was collected at Oncology Nursing Society (ONS) Chapter meetings throughout central and …

Nurturing The Novice: Lnitiating The Journey Of Transformational Shifts In The Development Of Future Nurse Mentors, Brenda Ranstrom-Llambes

Theses and Graduate Projects

The nursing profession is facing a shortage of 400,000 RNs by 2020 (Shirey, 2006), many of them holding Ieadership positions, This situation could lead to a large number of novice nurse leaders during a time when the demands for dynamic and effective leadership are growing in the evolving and complex healthcare environment. Now is the time to educate current leaders regarding the role they play in the success or failure of these novice leaders. By incorporating knowledge from Jean Watson's (1985, 2005) Caring Theory, Bernard Bass' (1985, 1998) Transformational Leadership Theory and Patricia Benner's (2001) adaptation of the Dreyfus Skill …

Exploring Oncology Nurses Attitudes Towards Suicide In Cancer Patients, Bonnie L. Hoover

Nursing Masters

Oncology nurses are recognized experts in the care of patients with cancer. As such, oncology nurses excel at the management of symptoms related to both the disease itself, as well as treatment, affecting the lives of patients experiencing cancer. These symptoms include physical, social, and psychological components.

Comparative Study Of Intravenous Insulin Protocols: Paper-Based Versus Computer-Based, Arleen B. Miller

Nursing Masters

Background: Scientific evidence exists to demonstrate that glycemic control produces a positive outcome for critically ill patients by decreasing mortality and morbidity. Results of published research have revealed a reduction of mortality in critically ill patients when serum blood glucose levels are maintained at a level of less than 150mg/dL. Recommendations from the Surviving Sepsis Campaign for treatment of patients in septic shock include use of intravenous insulin therapy to control hyperglycemia via the use of a validated protocol for insulin dose adjustment. Purpose: The purpose of this study was to determine whether glycemic control (less than 150mg/dL) was attained …

The Transition From Hospital To Home In Parents Of Pediatric Solid Organ Transplant Recipients, Stacee M. Lerret

Dissertations (1934 -)

Readiness for hospital discharge is an under-investigated topic in pediatric solid organ transplant. The immediate post-operative period and first few weeks after transplant are a critical time period where patients are at high risk for transplant-related complications.

A correlation design framed by Meleis' Transitions Theory were used to determine; (1) the influences of discharge teaching and care coordination on parent readiness for hospital discharge among parents of children who have experienced solid organ transplantation; and (2) the relationship of parent readiness for hospital discharge with coping, adherence difficulty, utilization of healthcare resources, and family impact in the first three weeks …