Medicine and Health Sciences Commons^™

Feasibility And Measurement Of Bedside Pumping In The Nicu: A Mixed Methods Study, Jessica Gomez

Dissertations & Theses (Open Access)

Abstract

Background: Supporting preterm infants with mother’s own milk (MOM) can improve health outcomes and decrease mortality.¹ Freshly pumped MOM, within four hours of expression, has the highest availability of bioactive components versus stored MOM. However, fresh milk is often not readily available due to the disconnected process of breastfeeding that occurs with preterm infants in the NICU. One convenient solution to improve access to fresh MOM is for the mother to pump at the infant's bedside. This intervention could improve the mother's pumping experience and provide the infant access to fresh MOM.

Purpose: This study aimed to evaluate …

Exploring The Novice Nurses’ Perceptions Of Communication Dynamics In The Operating Room, Lasandra Brown

Dissertations & Theses (Open Access)

Background: Communication among the multidisciplinary team members in an operating room setting is essential for effective and safe patient care. Studies have previously addressed communication breakdowns among team members, and miscommunications have been demonstrated to significantly challenge efficiency in the operating room. Novice nurses play an integral role in the success of operating room procedures and must possess strong communication skills that facilitate optimal patient outcomes.

Purpose: The aim of this study was to explore novice nurses’ perceptions of factors that influence the dynamics of team communication in the operating room setting.

Methods: An inductive thematic, qualitative analysis of 11 …

Symptom Experience Of Patients With Advanced Melanoma Undergoing Immune Checkpoint Inhibitor Therapy, Natalie Jackson-Carroll

Dissertations & Theses (Open Access)

Background: Immune checkpoint inhibitors (ICIs) are novel therapeutic agents utilized in the management of advanced melanoma. Though generally well-tolerated, patients receiving ICIs experience treatment-related toxicities at varying onset and intensity. Assessment and evaluation of these toxicities and their impact on a quality of life is essential to comprehensive cancer care. Patient-reported outcomes (PRO) contribute vital data to a clinical assessment, supporting clinicians in their ability to improve outcomes. To date, there is no melanoma-specific or ICI-specific PRO measure of symptom burden available.

Purpose: The purpose of this study was to describe the symptom experience from the patient's perspective and how …

Baby Boomer Gay Men’S Lived Experiences With Primary Healthcare: A Qualitative Study, Aaron J. Loeb

Dissertations & Theses (Open Access)

Background: Baby boomer gay men have experiences discrimination in healthcare settings. Members of the LGBTQIA+ population are often studied as a single entity, which fails to account for the distinct cultural and social generational differences within this population that may affect their experiences of health care. A paucity of research is available on baby boomer gay men’s perspectives about primary healthcare experiences. Such knowledge is necessary to improve inclusiveness in healthcare settings and health outcomes.

Purpose: The purpose of this study was to describe baby boomer gay men’s lived experiences with primary healthcare. The specific aims are to describe: (1) …

Mental Health And Parenting Among Young Adults Experiencing Homelessness With And Without Their Children, Rebecca Bergh

Dissertations & Theses (Open Access)

Background: Parent-child separation and custody loss are common among parenting young adults experiencing homelessness (YAEH). These experiences may be traumatic for YAEH, a population already vulnerable to mental health disorders and high levels of trauma. Little is known about how YAEH who have their children with them compare to YAEH separated from their children in terms of mental health and risk and resilience factors. Further evidence is needed to better understand the parenting and mental health support needs among YAEH, particularly surrounding parent-child separation.

Aims: This study aimed to examine the characteristics of (1) parenting YAEH living with their children …

Noninvasive Screening Of Nonalcoholic Fatty Liver Disease Among People Living With Hiv, Essi M. Havor

Dissertations & Theses (Open Access)

Background: Nonalcoholic fatty liver disease (NAFLD) disproportionately affects up to 75% of people living with HIV (PLWH). Given the high HIV prevalence in Houston and Harris County, knowledge of the prevalence of NAFLD in PLWH is needed to inform prevention efforts. In addition, such knowledge is required to raise awareness among at-risk individuals and healthcare professionals.

Specific Aims: This cross-sectional study aimed (1) to examine the demographic, behavioral, clinical, and psychosocial characteristics of PLWH in Houston/Harris County, Texas, and to estimate the prevalence of NAFLD, (2) to determine factors associated with the severity of NAFLD, and (3) to identify specific …

Shared Decision Making In Self-Care Management And Health Outcomes Of Adolescents And Young Adults With Sickle Cell Disease, Judith M. Odityo

Dissertations & Theses (Open Access)

Background: Shared decision making (SDM) is a model of care with a potential to guide disease self-care management and promote optimal health outcomes in adolescents and young adults (AYA) with sickle cell disease (SCD).

Aims: To identify the perceived involvement of AYA with SCD in the SDM process and examine its association with self-care management and health outcomes.

Methods: Data were collected from a major sickle cell center. Using a cross-sectional design, participants completed surveys and data were analyzed with descriptive statistics, analysis of variance, multiple linear regression, and correlational statistics.

Results: Participants (N=25) were on average age 22.72 (SD …

Endothelial To Mesenchymal Transition In Human And Murine Congenital Diaphragmatic Hernia Pulmonary Hypertension, Jamie L. Gilley

Dissertations & Theses (Open Access)

Background: Congenital diaphragmatic hernia (CDH) is one of the most complex congenital disorders, characterized by pulmonary hypertension and hypoplasia. CDH-associated pulmonary hypertension (CDH-PH) features devastating morbidity and mortality (25-30%) among neonates. An unmet need is determining the mechanisms triggering CDH-PH to save infants and improve their quality of life. Prior data suggest abnormal remodeling of the pulmonary vascular extracellular matrix, presumed to be driven by endothelial-to-mesenchymal transition (EndoMT), hinders postnatal vasodilation and limits efficacy of anti-PH therapy in CDH. Although abnormal vascular development and remodeling are known CDH traits, there is limited data on the role of EndoMT in CDH-PH. …

Cost-Benefit Analysis Of A Pediatric Patient Blood Management Program, Karen D. Gibbs

Dissertations & Theses (Open Access)

Introduction

Red blood cell (RBC) transfusions can be a life-saving and important intervention used to replace blood loss or manage anemia, but they also come with risks from transfusion-associated adverse events (TAAEs). Patient blood management (PBM) involves a multidisciplinary approach to optimize care of patients who may need a transfusion, including blood conservation modalities, patient-centered decision making, among others. The impact of PBM in the pediatric setting is not well understood, particularly the impact on TAAEs and the economic impact of these programs.

The following specific aims were pursued: (1) To investigate the effect of a PBM program on transfusion …

Listening To Remotely Monitored Home-Based Preferred Music For Pain In Older Adults With Low Back Pain: A Pilot Study Of Feasibility And Acceptability, Setor Kofi Sorkpor

Dissertations & Theses (Open Access)

Background: Low back pain (LBP) is a complex, multifaceted, and widespread condition that impairs the quality of life of older adults aged 65 years or older. Although nonpharmacologic interventions informed by the biopsychosocial model are recommended as first-line therapy for LBP, pharmacologic therapies, including opioids, are commonly used as first-line interventions in practice. This could be attributed to a lack of understanding of the analgesic properties of most nonpharmacologic interventions. Nonetheless, some nonpharmacologic therapies, such as passive music listening, have been shown to modulate pain via pathways that target the neurophysiological mechanisms associated with pain.

Specific Aims: The specific aims …

Postpartum Depression Screening In The Neonatal Intensive Care Unit: Maternal And Provider Perspectives, Candice Triulzi

Dissertations & Theses (Open Access)

Objective: Although mothers of preterm infants are at increased risk for postpartum depression (PPD), PPD screening conducted by neonatal providers in the Neonatal Intensive Care Unit (NICU) is currently not a standard of care. The purpose of this study was to explore maternal and provider perceptions of neonatal providers conducting PPD screening in the NICU.

Design: This study was conducted with a qualitative approach.

Setting: A 24-bed Level III NICU in Houston, TX acted as the study site.

Participants: Participants were purposively sampled (N=31) and included mothers of NICU infants (n=15) and NICU providers (n=16).

Methods: Semi-structured individual and paired …

Perceptions Of Integrating Immersive Virtual Reality Simulation As A Teaching Methodology In A Hospital Setting, Ladonna Christy

Dissertations & Theses (Open Access)

Introduction As newly licensed nurses enter the workforce with limited experience and limited clinical reasoning skills, nursing educators must employ innovative strategies to teach graduate nurses how to identify and manage clinical deterioration – skills which are vital to saving lives and improving outcomes. Fully immersive Virtual Reality (VR), (also defined as Immersive VR) is one effective educational strategy available for hospital educators to use for preparing newly licensed nurses to recognize and manage clinical deterioration.

Objective The purpose of this study was to explore perceptions of hospital-based nurse educators, simulation specialists, and nursing leaders with respect to integrating immersive …

Factors Associated With Advance Care Planning Engagement In Healthy Young Adults, Pablo J. Vasquez

Dissertations & Theses (Open Access)

Background: Advance care planning (ACP) is a process that supports individuals at any stage of health in understanding and sharing their personal values and goals pertaining current or future medical needs with their families and healthcare providers. Although ACP is applicable to adults of any age and any stage of the health continuum, it is widely associated with older or terminally ill populations, and the need for end-of-life (EOL) planning in healthy young adults is generally found unnecessary. The National Institutes of Health supports the expansion of ACP research in understudied populations. Investigating ACP in healthy young adults support such …

Associations Of Perceived Overall Health, Psychological Distress, Functional Impairment, And Alcohol Use Among Older Adults Of Sexual Minority Status And Heterosexual Peers, Carolyn Tran

Dissertations & Theses (Open Access)

Background: Lesbian, gay, and bisexual (LGB) adults, 50 and older, are likely to have experienced mistreatment and discrimination, contributing to poor physical and mental health and risky behaviors, such as alcohol misuse. Few studies have examined the relationships between perceived health, psychological distress, functional impairment, and alcohol use of older LGB adults and heterosexuals.

Specific Aims: The specific aims were: (1) to determine if perceived overall health status is associated with psychological distress and functional impairment in sexual minority older adults compared to heterosexual older adults, and (2) to determine if sexual minority status moderates the relationship between psychological distress …

Genetics In The Nicu: Nurses’ Perceived Knowledge And Desired Education, Kathleen Shields

Dissertations & Theses (Open Access)

A large proportion of infants admitted to neonatal intensive care units (NICUs) have genetic conditions. NICU nurses play an important role in providing comprehensive care to these patients and their families. Previous research has demonstrated gaps exist in the genetics knowledge of nurses and that they lack comfort applying genetics information to clinical practice, but no research has been done assessing the knowledge of or comfort with genetics of NICU nurses specifically. NICU nurses (n=122) completed an online survey assessing their perceived knowledge of genetics, comfort with clinical scenarios involving genetics, and desired genetics education. Participants reported the highest levels …

Molecular Diagnosis Of Intestinal Parasites: Impact On Growth Among Preschool-Age Children In Rural Ecuador, Patricia Bryan

Dissertations & Theses (Open Access)

Background: Gastrointestinal (GI) parasites may have important influences on growth outcomes during early childhood. Previous studies investigating the effects of GI parasites on growth have predominantly used microscopy-based diagnostic methods with low sensitivity. Few accurate epidemiologic data are available on GI parasitic infections among rural Ecuadorian children. To investigate the impact of single and multiple GI parasite infections on growth during early childhood data from a longitudinal birth cohort in Ecuador were analyzed.

Purpose: The aims of this study were to determine the prevalence of GI parasites (soil-transmitted helminths and intestinal protozoa) and to describe associations between GI parasitic infections …

Development And Preliminary Psychometric Testing Of The Drake Atrial Electrogram Assessment Survey: Daegas©, Jeanette Drake

Dissertations & Theses (Open Access)

Background: Critical care nurses (CCNs) who care for postoperative cardiac surgery patients need specialty knowledge, for example, knowledge of atrial electrograms (AEGs). An inadequate audit trail exists for psychometric performance of instruments to measure CCN knowledge of AEGs. A 29-item survey previously pilot tested with a convenience sample of CCNs in the Pacific Northwest had a Kuder-Richardson-20 estimate of internal consistency of .75. The survey was revised to 20 items (14 knowledge and 6 AEG interpretation) and named the Drake Atrial Electrogram Assessment Survey (DAEGAS).

Objectives: The study objectives were to assess evidence for content validity (content validity …

The Impact Of Bullying Victimization And Sexual Orientation On The Severity Of Suicidal Behavior, Annalyn Demello

Dissertations & Theses (Open Access)

Background: Lesbian, gay, and bisexual (LGB) youth face a disproportionate risk of suicidal ideation and attempt compared to their heterosexual counterparts. The Minority Stress Theory and Interpersonal Theory of Suicide posit that chronic stress, which can occur as a result of bullying victimization, can lead to loneliness, self-hate, and suicidal ideation. The escalation from ideation to attempt can occur quickly, and most youth who survive suicide attempts pursue subsequent, riskier attempts. It is crucial to intervene when behaviors are less severe. The primary aim of this study was to compare the magnitudes of association between independent variables (bullying and sexual …

Latino Perspectives In Childhood Fever Management: A Focused Ethnography, Darlene Acorda

Dissertations & Theses (Open Access)

Background: Fever is the most common presenting complaint in the pediatric setting. Latino parents have greater misconceptions and are less knowledgeable of fever compared to other groups. They are more likely to believe that fever can cause serious harm and to present to the emergency department for non-emergent illness. Latino health practices are heavily influenced by cultural beliefs, yet few studies have focused on parental fever perception in this rapidly growing population. It is estimated that by 2050, 32% of the U.S. child population will be of Latino descent. Understanding the Latino perspective is a critical first step to …

Maternal And Newborn Outcomes For Women Living With Hiv In Adapted Group Prenatal Care, Jodi Behr

Dissertations & Theses (Open Access)

Background: For women living with HIV (WLWH), managing HIV and their pregnancy can be challenging. WLWH have been identified at risk for lower adherence to prenatal care, increased maternal HIV Plasma RNA levels, decreased newborn gestational age, and newborn birth weight. Improved outcomes have been found with group prenatal care. Maternal and newborn outcomes for WLWH and their newborns in group prenatal care compared to WLWH and their newborns in individual care have not been evaluated.

Purpose: The aims of this study were to evaluate group differences between WLWH who attended individual prenatal care appointments (IC) compared to WLWH who …

Pediatric Intensive Care Hospitalization: Sibling Experience, Karla Abela

Dissertations & Theses (Open Access)

Prior research on the impact of pediatric intensive care unit (PICU) hospitalization on families have been predominantly focused on the parents, yet siblings who visit the ill child in the PICU environment remain understudied. The aim of this study was to describe the experiences of 9- to 17-year-old siblings of acutely critically ill or injured children. A generic qualitative approach using one-to-one interviews, observations, and clinician notes was used to gain an understanding of the experience of siblings who visited the PICU. Qualitative analytic methods were used to analyze the data. The findings from 16 siblings (mean age 6.3 years) …

Left Ventricular Assist Device Adjustment Impacted By Patient Trajectory: A Qualitative Exploratory Study, Brittany Rhoades

Dissertations & Theses (Open Access)

Background: Left Ventricular Assist Devices (LVADs) are used as advanced therapy for advanced heart failure in order to sustain patients until a heart transplant is available (bridge to transplant, ‘BTT’) or until the end of life (destination therapy, ‘DT’). Despite the differences in treatment trajectory, BTT and DT patients are provided the same education. Currently it is unknown if the two groups compare to living with the LVAD regarding adjustment.

Aims: The aim of this study was to explore LVAD patient experience, describe how patients construct the impact of the LVAD on daily life and self-care and compare the findings …

Understanding Motivation To Lead In Nurses, Janete Sheiner

Dissertations & Theses (Open Access)

Background: Nurse leaders are indispensable to the delivery of quality, patient-centered care. They are influential in the practice environment, contributing to front-line staff job satisfaction. They work to improve retention, turnover, organizational health, and patient outcomes. Yet, there is a dearth of research investigating the motivating factors that appeal to, encourage, discourage, and help retain nurse leaders in their roles. The forecast of a shortage of nurse leaders, along with the reluctance of nurses to assume leadership roles, is affecting healthcare organizations throughout the United States. An in-depth understanding of the underlying factors related to motivation that appeal to, encourage, …

Caregivers Of Medically Fragile Children With Technology Needs, Vuong Prieto

Dissertations & Theses (Open Access)

Background: Medically fragile children (MFC) with technology needs have complex and challenging health care needs in the home setting. Providing care can have both negative and positive psychological and social impacts on the caregivers’ health related quality of life (HRQOL).

Aims: a) To examine the relationship between caregiver burden, caregiving satisfaction, and HRQOL in caregivers of MFC with technology needs. b) To identify caregiver and child related variables of caregiver burden and caregiving satisfaction.

Methods: A cross sectional study was conducted over four months at a children’s hospital and outpatient clinics. Caregivers completed three one-time surveys (Zarit Burden Interview, Caregiving …

Perceptions Of Nurses After The First Year Of Practice: Expectations And Reality, Susan R. Lesser

Dissertations & Theses (Open Access)

Background: The nursing profession is facing a critical shortage stemming from retirement of experienced nurses, increasing healthcare needs of an older population, and more inclusive healthcare coverage. Newly licensed nurses (NLNs) have been the long-term plan to fill the gap. Despite the support from nurse residency programs (NRPs), many of these graduate nurses are leaving their first position. This turnover of nurses is detrimental to the nursing shortage, and financially burdensome for health care systems.

Purpose: Two aims were explored: 1) to better understand the perceptions of newly licensed nurses after the first year of practice about their expectations and …

Understanding Diabetes Health Beliefs And Health Practices In Vietnamese Americans, Linda Sheen

Dissertations & Theses (Open Access)

Background: Diabetes related complications resulting in mortality and morbidity are higher among Vietnamese individuals living in the U.S. with diabetes. Few studies have examined the personal perceptions and cultural beliefs pertaining to disease management. An in-depth understanding of perception and cultural beliefs in regard to diabetes self-management is needed for the development of culturally appropriate interventions in this population.

Purpose: Two specific aims were explored: 1) To explore how Vietnamese individuals living in the U.S. with prediabetes and diabetes conceptualize diabetes self-management and; 2) to understand how Vietnamese individuals living in the U.S. with prediabetes and diabetes integrate …

Vasopressor Titration In Medical Intensive Care Patients With Septic Shock: A Descriptive Study, Daniel Arellano

Dissertations & Theses (Open Access)

Background: Vasopressor therapy in patients with septic shock can lead to harmful effects.

Objective: To describe vasopressor titration in patients with septic shock.

Methods: Single-center descriptive study of 60 intensive care unit (ICU) patients to calculate rates for events of failure to titrate, incorrect titration, and correct titration in 15- minute intervals for the duration of vasopressor therapy. Total hospital and ICU days, mortality rate, vasopressor dose and time, and the impact of hydrocortisone on vasopressor use were examined.

Results: During the total vasopressor infusion time of 2598 hours, 5395 failure-to-titrate events were noted. There were 316 incorrect titrations and …

An Exploration Of Psychosexual Functioning And Factors Affecting The Prophylactic Decision-Making Process In Women Of Childbearing Age With A Brca 1/Brca2 Mutation, Alexis Hayes

Dissertations & Theses (Open Access)

Background: A breast cancer type 1 and type 2 susceptibility protein (BRCA1/BRCA2) gene mutation carries an 85%- 90% lifetime risk of developing breast cancer and a 27%-65% chance of developing ovarian cancer. There is minimal evidence regarding how psychosexual functioning, the psychological well-being in regards to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (18 - 49) with a BRCA gene mutation. Diagnosis of a BRCA gene mutation presents a dilemma where life-changing medical decisions must be made to prevent breast and ovarian cancer. Throughout decision-making and following surgical prophylactic interventions, such …

Mhealth Acceptance And Usage Among South Asian Adults In The U.S., Padmavathy Ramaswamy

Dissertations & Theses (Open Access)

Background: Modifiable lifestyle factors such as physical inactivity and unhealthy diet contribute to the increased risk of cardiovascular diseases (CVD) and diabetes (DM) in South Asians (SAs) (Volgman et al., 2018). Interventions using mobile health (mHealth) have demonstrated feasibility and potential efficacy for ethnic minorities (Bender et al., 2018), and have the potential to be of preventive and therapeutic value in reducing the burden of CVD and DM in SAs living in the US. However, there is a gap in knowledge regarding the usage and acceptance of mHealth among SAs.

Purpose: The objectives were to examine the overall …

Predictors Of Short-Term Residential Treatment Completion Preceded By Detoxification For Opioid Use Disorder, Christopher Gideon

Dissertations & Theses (Open Access)

Background and Significance: Deaths related to opioid overdose are increasing. Treatment for opioid use disorder (OUD) is necessary to help prevent future opioid abuse, and often involves opioid detoxification, followed by short-term residential treatment, typically lasting about 28 days. Literature regarding OUD and short-term residential treatment is limited. Predictors of short-term residential completion, including whether detoxification was performed, may help addiction professionals individualize treatments. This study’s purpose was to determine predictors of short-term residential completion treatment for OUD, and whether detoxification prior to entering residential treatment may also be a factor in residential completion.

Method: De-identified data regarding …