Medicine and Health Sciences Commons^™

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Atrial Fibrillation Management In Hispanic Adults, Tania Borja

Dissertations

Background: Research has found atrial fibrillation (AF) to be the primary or a contributing cause of death on 183,321 death certificates, and an underlying cause of death for 26,535 Americans in 2019. Findings indicate an increased AF diagnosis in White people compared to racial and ethnic minorities, contrasting widespread findings of increased prevalence of cardiovascular disease and ischemic strokes in minorities. Significant disparities—by race and socioeconomic status in disease distribution and access to testing and lifesaving treatments—have been documented, specifically associated with social determinants of health (SDOH); i.e., the conditions in which people are born, grow, live, work, and age. …

Mantram For Mamas: A Pilot Study For Postpartum Women, Ritamarie Smedile

Dissertations

Objective: This pilot study launched an online Mantram Repetition Program (oMRP) using a virtual health portal that aimed to explore online portal accessibility, oMRP acceptance, and overall interface satisfaction among a sample of postpartum women.

Background: Postpartum depression remains one of the most common and severe childbirth complications, affecting more than 13% of women during the first three months after childbirth. Cognitive or behavioral talk therapy sessions and medication are the most frequently recommended treatments to alleviate symptoms. Although effective, women tend not to enroll or adhere to these modalities, suggesting they need alternative treatment plans. A possible alternative, mirroring …

Special Education: Inclusion And Exclusion In The K-12 U.S. Educational System, Erik Brault

Dissertations

The U.S. Department of Education defines students with disabilities as those having a physical or mental impairment that substantially limits one or more life activities. Previous research has found that students with disabilities placed in inclusive environments perform better academically and socially compared to students with disabilities who are placed in segregated environments. Yet, we know that inclusion in K-12 general education classrooms across the country is not consistently implemented.

The purpose of this study was to better understand the effects, if any, of general education high school teachers’ personal and professional experiences and knowledge on their attitudes toward educating …

Queering Healthcare Equity: Exploring How Two Community Health Centers That Specialize In Lgbtq Healthcare Frame Cultural Competence, Tommy Royston

Dissertations

Despite increased advocacy and funding, significant inequities in healthcare access, quality of care, and health outcomes have continued to persist for lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) communities. Intersecting marginalized identities such as race, gender, and disability compound health inequities faced by LGBTQ folx. These inequities are not random; rather, they result from deeply embedded homophobia, transphobia, ableism, and racism that pervade the U.S. healthcare system. An exploratory comparative case study was completed using qualitative data collection methods (i.e., key informant interviews, focus groups, and document analysis) to investigate how two California-based Federally Qualified Health Centers (FQHCs) that specialize in …

Nursing Education In Complementary Alternative Modalities: A Case Study, Deborah Bird

Dissertations

Purpose: The purpose of this embedded case study was to describe the preparation for and utilization of complimentary alternative modality (CAM) interventions by an experienced Doctor of Nursing Practice (DNP) prepared nurse practitioner (NP) working in an outpatient setting.

Background: Given the widespread use of CAM by the American public and the potential complications involved in combining CAM and standard medical care, a lack of educational preparation in CAM interventions by NPs delivering primary care in outpatient health care settings represents both a potential risk and a missed opportunity to provide holistic patient care. Such a lack of knowledge also …

Correlates Of Health Literacy And Perceptions Of Burden Among Caregivers Of Persons Diagnosed With Chronic Illnesses, Mubarak Aldawsare

Dissertations

Background/Rationale: Greater attention is needed on factors effectively supporting caregivers because poor well-being of caregivers can hamper overall patient outcomes. Lack of awareness of caregiver burden has implications for healthcare systems globally. Caregivers may encounter various levels of burden as a result of providing long-term care to individuals diagnosed with one or more chronic illnesses. Caregivers with inadequate health literacy are more likely to experience feelings of uncertainty, and as a result, caregiver burden. Little is known about the impact of the health literacy of caregivers on the level of burden when providing care to individuals with complex care …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Transitions In Palliative Care: Referral Time And Healthcare Utilization In Advanced Stage Colon, Rectal And Lung Cancer Patients., Ann Lawani

Dissertations

Background: Despite lung, colon, and rectal cancer being the leading and third leading cause of cancer-related death among both men and women respectively, few studies have examined Palliative Care Consultation (PCC) on healthcare utilization (HCU) in individuals with advanced stage diagnosis in this disease cohort. Extant research shows advanced stage cancer patients receive aggressive treatments, within the last 30 days of life. Palliative care is linked to less aggressive cancer treatment, and palliative interventions applied early, at diagnosis of advanced cancer, is more favorable for improving symptom and disease management. Patients and family members with early PCC are better informed …

A Description Of Impostor Phenomenon In Certified Registered Nurse Anesthesiologists, Jeffrey R. Darna

Dissertations

Background: Imposter Phenomenon (IP) is an evolving, multidimensional construct defined as self-perceived intellectual phoniness and professional ineptitude frequently experienced by individuals working in high performance or competitive environments. IP consequences include psychological distress, role under-optimization, and professional paralysis. Certified Registered Nurse Anesthesiologists (CRNAs) are at risk for impostorism; however, IP presence, intensity, and career effects are unknown.

Purpose: The study measured IP in CRNAs and determined the relationship between IP and select sociodemographic and practice variables.

Methods:

Design: A descriptive, cross-sectional correlation design measured IP using an Internet-based survey from a random sample of 170 members of the American …

Cardiology Implications Of Ed Covid-19 Patients In An Underserved Rural Health Care Environment, Pedro Colio

Dissertations

Background/Purpose: Positive COVID-19 patients with chronic comorbidities have been associated with severe cardiac complications (e.g., STEMI, NSTEMI, myocarditis, pericarditis, AF) specifically among underserved communities. Acute STEMI and NSTEMI are cardiac conditions associated with ruptured atherosclerotic plaque leading to significant myocardial injury. AF, the most common arrhythmia leading to cerebrovascular accidents, is also common in hospitalized patients with severe illnesses. Myocarditis and pericarditis are inflammatory heart conditions associated with acute viral infections. According to the literature, these cardiac issues have been linked as complications of COVID-19. COVID 19 is an emerging, complex, and costly public health challenge globally with potential lifelong …

Phenomenological Study Of The Lived Experience Of New Graduate Nurses Caring For Hospitalized Patients Living With Dementia, Geline Buenconsejo

Dissertations

Title. Phenomenological Study of the Lived Experience of New Graduate Nurses Caring for Hospitalized Patients Living with Dementia.

Purpose. This study explored new graduate nurses’ lived experiences in caring for hospitalized patients living with dementia.

Background. The first twelve months of transitioning from student to professional nurse in acute care settings are the most stressful, emotionally challenging, and mentally exhausting for new nurses striving to apply newly acquired skills into practice. Some of the most challenging patients for nurses to care for are hospitalized patients living with dementia (PtLWD). With the projected increase in the number of patients with dementia …

Trauma Recidivism: Threat Orientations And Recurrent Injury Perceptions, Molly Bauer, Ann M. Mayo

Dissertations

Purpose: To describe select sociodemographic and clinical variables, threat orientations, and the perceived likelihood of recurrent injury (PLRI) of individuals deemed at risk for trauma recidivism (TR).

Background: Injuries and violence are the leading cause of traumatic death among persons aged 1 to 44 in the United States. Trauma recidivism occurs when an individual experiences more than one significant injury requiring hospital care in a five-year period. The relationship between a trauma recidivist’s perception of recurrent injury and orientation towards a threat remains unclear.

Conceptual Basis: Trauma recidivism risk factors contribute to forming an individual’s PLRI. When individuals acknowledge the …

Transitioning Eating Practices Of Older Adults, Michelle Lajoy Jackson

Dissertations

Purpose: The purpose of this descriptive qualitative study was to explore what factors may have influenced the transition of an individual older adult’s eating practices over a lifespan and the impact participants perceived those factors currently had upon their nutritional health in older adulthood.

Background: The older adult population is recognized as one of the fastest growing populations in the United States. One of many growing concerns for this population is the impact of dietary practices on the morbidity and mortality of this aging population. There is limited research to date that has explored the transitioning of appetite …

Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon

Dissertations

Background: Many IR procedures offer a less invasive and economical alternative to some open or laparoscopic surgeries. Patients undergoing a procedure without moderate sedation are awake, alert, with heightened sensory perceptions, and vulnerable to their surroundings. There is a gap in the current body of literature relating to the IR nurse’s experience of caring for patients during procedures without the use of moderate sedation.

Purpose/Aims: The purpose of this study was to explore the lived experience of Interventional Radiology (IR) nurses caring for conscious patients undergoing a procedure without the use of sedation. This phenomenological study aimed to describe the …

Biomarkers And Factors Related To Risk Of Acute Kidney Injury, Mary Ann David

Dissertations

Background: Acute kidney injury (AKI) is associated with increased mortality, morbidity, length of hospital stay, and in-hospital cost. Timely intervention is needed to prevent disease progression, but the delay in diagnostic process often results in delayed treatment. Recent studies show a significant increase in novel urine biomarkers (UB), TIMP-2 and IGFBP7, has been linked to an increased risk of AKI.

Objectives: The purpose of this study was to examine the relationships among participants’ sociodemographic and clinical characteristics, including select biomarkers, care management processes, treatments, and patient outcomes in a sample of hospitalized critically ill patients in southern California.

Findings: Study …

When "First, Do No Harm" Fails: A Restorative Justice Approach To Workgroup Harms In Healthcare, Pedro L. Flores

Dissertations

In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified …

A Qualitative Exploration Of The Patient Care Experience As Perceived By Hispanic Patients Receiving Care At A Safety-Net Facility, Silvinia Cuizon

Dissertations

Purpose: The purpose of this study was to understand how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net facility perceive and interpret the care experience with the goal of generating a grounded theory model to guide care delivery and improve perception of care for this population.

Background/Rationale: The patient experience is the current federally mandated hospital quality indicator that measures the range of interactions patients have with their hospital admission, which has fiscal and clinical implications for the delivery of care. Many safety-net health care delivery systems, which primarily serve traditionally underserved populations, and …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Strategies For The Improvement Of Healthcare Through Simulation, Roger Lankheet

Dissertations

Title:Strategies for the improvement of healthcare through simulation

Background: Medical errors continue to plague the healthcare industry. The annual rates of morbidity are approximately 2.69 million (AHRQ, 2019), while mortality rates exceed 400,000 per annum (Makary & Daniel, 2016). There may be no panacea to combat these egregious rates. However, simulation of patient care events may better prepare healthcare professionals to prevent medical errors as it has been proven to be an effective learning strategy (Kirkham, 2018), enhancing skills while gaining experiential knowledge, without risk to actual patients.

Purpose: The purpose of this qualitative study was to gain a …

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …

Neonatal Toxic Stress And Long-Term Neurodevelopment In Premature Infants, Rachelle Sey

Dissertations

Background: Evidence suggests the presence of complex biologic connections between the social environment, neurologic development, and long-term health. Premature infants spend many months in the Neonatal Intensive Care Unit (NICU) often separated from their parent(s). Decrease in the age of viability threshold allows extremely preterm infants to benefit from lifesaving therapies; however, they are frequently exposed to significant stressors that increase their risk for adverse neurodevelopmental outcomes.

Purpose: The purpose of this study is to examine the relationship among socio-demographic factors, exposure to stressors in the NICU environment, stress modifiers/buffers, neonatal morbidities at discharge, and 1. 2-year neurodevelopmental outcomes and …

Suicide Mortality Of Emergency Department Patients, Briony Marie Dubose Mhi, Rn, Lss, Bb

Dissertations

Purpose The purpose of this retrospective comparative study is to describe relationships among biological, psychological, sociocultural factors and emergency department (ED) care among discharged ED patients and describe the association of these variables with subsequent suicide mortality.

Rationale Identifying patients who are most at risk of suicide mortality post ED discharge can focus resources, refine interventions, and prevent suicide. Additionally, recognizing patterns of ED care including ordering of a psychiatric evaluation and disposition status can provide data for potential practice changes.

Background Suicide is the 10th leading cause of death in the United States and has been since 2008. Suicide …

Timing Of Therapeutic Hypothermia & Short-Term Infant Outcomes, Brooke Rakes

Dissertations

Background: Hypoxic-ischemic encephalopathy (HIE) can result in devastating long-term neurological morbidity and/or death. Current evidence recommends initiating Therapeutic Hypothermia (TH), as early as possible, however, research specifically describing TH timing in relation to short-term infant outcomes is limited with mixed results.

Purpose: Examine TH timing (TH initiation time & time to target temperature) on short-term outcomes (neonatal seizure; brain injury) of infants >35weeks, with suspected HIE, born at a large urban women’s medical center.

Methodology: Retrospective, cross-sectional, correlational design examining data extracted from electronic health record from November 1, 2012- March 31, 2020. Descriptive and inferential statistics were performed.

Results …

Life Satisfaction: Aging Female Informal Caregivers Of Persons With Dementia, Deborah Ann Monson

Dissertations

Purpose/Aims

The purpose of this study was to describe the relationship between aging female informal caregivers of persons with dementia (PWD) and care recipients’ PWD demographic factors, aging female informal caregivers of PWD social support factors, positive and negative feelings, a sense of flourishing, stress, and life satisfaction.

Background/Rationale

Older adults with dementia are living longer and the majority are receiving care by aging female informal caregivers. Dementia incrementally worsens over time impacting informal caregiver life satisfaction. Most studies have focused on negative aspects of informal caregiving. Therefore, this study investigated both positive and negative aspects of caregiving.

Conceptual Basis …

Time To Medical Help-Seeking For Adults Who Experience Symptoms Of Stroke In A California-Mexico Border Region, Jean Rockwell

Dissertations

Background: Acute thrombolytic therapy for ischemic stroke must be administered within 4.5 hours of stroke symptom onset. Despite its proven efficacy fewer than 12% of those suffering acute ischemic stroke receive this treatment. The most common reason for low utilization is late medical help-seeking. Though the relationship among predictor variables and time to medical help-seeking have been explored in previous studies, it stills remains uncertain which predictors are most influential. The aim of this study was to identify factors associated with time to medical help-seeking for patients who experienced symptoms of stroke within a U.S. Southern California-Mexico border region. This …

Feasibility Of Online Nutritional Counseling And/Or Remote Self Weighing In Pregnant Women With Obesity, Rebecca Mattson

Dissertations

Purpose

The purpose of this feasibility study is to determine the magnitude of effect using a combination of weekly weights and an online registered dietician to control excessive gestational weight gain in pregnant women with obesity using a pilot randomized controlled trial.

Specific Aims

There are three specific aims. Aim 1: Describe the study population in terms of sociodemographic influences (e.g., ethnicity, age, weight, and height) and obstetrical influences (i.e., parity and pregnancy weight). Aim 2: Measure participant satisfaction with the study interventions of weekly weighing and online nutrition counselling. Aim 3: (a) Explore the differences in gestational weight …

Chronic Pain, Sleep Disruption, And Work Performance In The Military, Jeffrey Ransom

Dissertations

Abstract

Background and Significance: Managing pain is a challenge for many organizations, including the U.S. military. The added complication of managing sleep disruption compounds the issue. Examining pain and sleep disruption in the context of work performance within the military is critical to understanding the impact of these conditions on our nation’s fighting forces.

Purpose: Examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Research Aims: 1) Describe sociodemographic characteristics, military service characteristics, clinical characteristics, and work performance of active duty service members, 2) Examine relationships between these …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …