Medicine and Health Sciences Commons^™

Enhanced Iot-Based Electrocardiogram Monitoring System With Deep Learning, Jian Ni

UNLV Theses, Dissertations, Professional Papers, and Capstones

Due to the rapid development of computing and sensing technologies, Internet of Things (IoT)-based cardiac monitoring plays a crucial role in providing patients with cost-efficient solutions for long-term, continuous, and pervasive electrocardiogram (ECG) monitoring outside a hospital setting. In a typical IoT-based ECG monitoring system, ECG signals are picked up by sensors located on the edge, and then uploaded to the remote cloud servers. ECG interpretation is performed for the collected ECGs in the cloud servers and the analysis results can be made instantly available to the patients as well as their healthcare providers.In this dissertation, we first examine the …

Fear Of Recurrence As A Mediator Of Illness Perception And Perceived Stress In Acute Myocardial Infarction Survivors, Sarah E. Zvonar

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The primary objective of this study is to evaluate fear of recurrence as a mediator of illness perception and perceived stress. This research will determine how illness perceptions and fear of recurrence affect perceived stress in the acute myocardial infarction (AMI) population. Other aims will observe how demographics predict patients who may experience increased fear of recurrence and stress in the AMI population, how the variables of fear of recurrence change over time, and if fear of recurrence is still a significant mediator after controlling for depression and anxiety.Rational/ Conceptual Basis/ Background: Acute myocardial infarctions (AMIs) are often accompanied …

New-R Intervention For Clients With Severe Mental Illness And Obesity: Grant Writing For Implementation Funds Supporting Occupational Therapy Interventions, Kaitlyn Hoffman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Increasing numbers of people suffer from obesity and severe mental illness co-morbidly. If these conditions remain untreated, they can harm an individual's health and well-being. Unfortunately, there are very few programs currently available that target both management and improvement of these conditions simultaneously. Even so, despite the lack of programming options, it must be noted that the NEW-R program strives to reach those goals, although there hasn't been an abundance of literature supporting the effectiveness of this program. This poses a concern for occupational therapy practitioners who hope to assist their clients in managing these conditions as occupational therapy treatments …

Self-Reported Covid-19 Diagnosis And Severity And Its Association With Utilization Of And Delays In Needed Medical Care, Mohammad Hesam Alavi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Covid-19, caused by the virus SARS-CoV-2, was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. The pandemic-related disruptions and the pursuant lockdowns have adversely impacted every aspect of people’s lives including access to medical care, cancer care, preventive medicine, mental health, and dental care in an already imperfect healthcare system in the US. This study utilized the 2020 self-reported data from quarters 3 and 4 of the National Health Interview Survey, a cross-sectional interview survey by the Centers for Disease Control and Prevention, to determine the possible association of self-reported COVID diagnosis, test positivity, and …

Predictor Of Hospital Closure In The United States, Haniyeh Shariatmadari

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospital closures have recently been more common and a crucial concern in the United States since they can influence many aspects of patients' health conditions. This situation has led many scholars to investigate the adverse effect of hospitals closure. Previous research has well documented the effects of a hospital closure. However, there is a lack of studies on the predictor of a hospital closure. To fill this gap, the objective of this longitudinal study is to explore organizational and market factors associated with hospital closure. We used Data from the American Hospital Association (AHA), the Centers for Medicare and Medicaid …

Quality Of Care: A Business Case For Us Hospitals, Iwimbong Kum Ghabowen

UNLV Theses, Dissertations, Professional Papers, and Capstones

The Patient Protection and Affordable Care Act present some threats and opportunities to many hospitals across the USA. Under the Value-Based Purchasing Program, acute care hospitals' rewards are tied to incentive payments for the quality of care provided in the inpatient hospital. In the last 20 years, growing research has examined the effects of the quality of care on the financial performance of hospitals. There is a gap in the literature, particularly exploring the relationship between quality and hospital financial performance using national samples. This dissertation investigates the association between patients' experience of care, 30-day readmission rates, and case-mix-index (CMI) …

The Nursing Leader’S Role In Decreasing Implicit Rationing By Improving The Nursing Work Environment, Allison Mchugh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite all the literature about missed care and its contributing factors, it is prevalent in most hospitals worldwide. Missed care is the result of care that is implicitly rationed. For this paper, implicit rationing is defined as how nurses decide what care is delivered based on the present work environment. Many factors influence implicit rationing. One such factor is the work environment. The association between the nursing work environment and implicit rationing is well described in the literature. The nursing leader is in a formal position responsible for patient outcomes and the nursing practice environment. Therefore, it is important to …

New Nurse Reality Shock & Early Burnout: Can Role Transition Education Received During New Nurse Residency Positively Affect Satisfaction?, Bonnie L. Stolzman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Newly licensed nurses are at incredibly high risk for reality shock leading to early burnout which results in many of them resigning their positions or leaving nursing altogether. Common feelings leading to reality shock often involve exhaustion, cynicism, depersonalization, decreased self-efficacy, and decreased job satisfaction. The result of early burnout presents significant financial strain and quality concerns for our already struggling healthcare systems. In the 1960s and early 1970s, Marlene Kramer brought her research regarding newly licensed nurses and their experience of “reality shock” to publication. Kramer felt strongly that reality shock was a key factor that led newly licensed …

Developing Strategic Partnerships To Impact Population Health: A Professional Development Module, Andra S. Scano

UNLV Theses, Dissertations, Professional Papers, and Capstones

Massive organizational changes occurring in our health care delivery system have provided opportunities for nurse leaders who think in terms of population health, to develop new skills needed to impact the populations they serve. Aspects of these changes include a focus on the delivery of primary and community-based care and the development of partnerships, alliances, and other linkages across settings to build integrated systems (Williams, 2020, p. 17). Turner (2020) asserts that population-focused nurse leaders are charged with creating a new future for healthier communities which often involves strategic partnership development. However, strategic partnership development is a complex task that …

An Evaluation Of Care Coordination In Reducing Depression Symptoms And Emergency Room Visits, Stacy Sumpter

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background: Individuals living with multiple chronic conditions (MCC) account for 26% of the population; however, they consume 84% of healthcare resources, are three times more likely to have depression than healthy individuals, and have increase emergency room (ER) visits and healthcare resource use. This population requires coordinated health care to reduce unnecessary spending and the misappropriation of healthcare resources. The purpose of this project was to evaluate the efficacy of care coordination (CC) and the support system it provides in lowering depression symptoms and ER visit frequency as a viable measure to reduce overall healthcare costs.

Methods: The healthcare providers, …

Management Of Atrial Fibrillation With Smartphone Technology, Teresa Praus

UNLV Theses, Dissertations, Professional Papers, and Capstones

Atrial fibrillation is the most common arrhythmia affecting over six million people; it is predicted to increase two-fold by the year 2050. This arrhythmia results in a lack of

atrial/ventricular communication, accompanied by ineffective atrial contraction, suboptimal ventricular filling, and thrombus formation. This may lead to stroke, and ultimately heart failure. The current economic burden related to the complications of atrial fibrillation is estimated to be greater than $6 billion annually with potentially catastrophic events, further increasing expenditure.

When patients experience symptoms related to atrial fibrillation, it is common for them to present to a hospital emergency department. These visits, …

Effect Of Bundled Payments As A Care Improvement Initiative On Hospital Care Of Total Joint And Sepsis: A Perspective On Organizational Effectiveness, Pearl Kim

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study investigates the potential impact of the Bundled Payments for Care Improvement (BPCI) initiative from Center for Medicare and Medicaid Services on hospital performance and behavior related to effectiveness and efficiency. The BPCI is under the Affordable Care Act and provides hospitals with a fixed amount of reimbursement for a total episode of care. Building on the agency theory, I argue that the BPCI initiative has the potential to enhance the effectiveness and efficiency of hospital care. This quasi-experimental study examines the changes in hospital care outcomes of patients with replacement of the lower extremity or sepsis in BPCIparticipating …

Evidence-Based Practice Guide And Workflows: Improving Hospital Throughput And Reducing Emergency Department Overcrowding, Maulah Halley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospitals in the United States are experiencing disruptions to patient throughput. These disruptions create barriers to patients who seek emergent care in the Emergency Department (ED) and who must be moved to hospital inpatient beds after the decision to admit has been made. As a result, patients requiring hospital admission via the ED may have long wait times, which, in turn, contribute to ED crowding and overcrowding. The root causes of ED overcrowding are inefficiencies within the system and the inability of hospitals to meet demand. Although bed capacity on any given unit may not be altered, ED patient’s arrival …

Leadership Development In Nursing: Planning From The Bedside To The Executive Suite, Janet C. Wright

UNLV Theses, Dissertations, Professional Papers, and Capstones

Nurses comprise the largest portion of the healthcare sector workforce over 4 million professional nurses licensed in the United States (National Council of State Boards of Nursing, 2019). Leading within a vast workforce such as nursing requires the nurse leader to have the expertise of the nursing profession along with leadership and business skills to maintain competitiveness in the complex healthcare industry. Consequences of effective leadership include improved patient outcomes, decreased staff turnover, and decreased costs to the organization related to patient outcomes and turnover costs. These results suggest the importance for organizations to ensure their leaders are properly trained …

Association Between Alcohol Screening And Brief Intervention During Routine Check-Ups And Alcohol Consumption Among Adults Living In California, Gene Kilian Wells

UNLV Theses, Dissertations, Professional Papers, and Capstones

Objective: Alcohol consumption accounts for 1 in 10 deaths among U.S. adults, and has cost upwards of $200 billion in a single year due to lost productivity. Alcohol Screening and Brief Intervention (ASBI) was developed as a treatment approach for use in primary care to identify and reduce hazardous and harmful substance use behaviors among the general population. Although ASBI has proven to be successful, implementation rates remain low. Few studies have been conducted in Nevada to encourage or improve ASBI implementation in primary care. In order to better support Nevada policy decisions, this study investigates the proportion of ASBI …

A Qualitative Study Of Job Competencies For Healthcare Social Work Administrators: An Application Of The Short Competency Model Process Used To Identify The Behaviors And Personal Characteristics Of Exemplary Performers, Lashonda Jones-Moore

UNLV Theses, Dissertations, Professional Papers, and Capstones

Job competencies are central to every organization’ s human resource management system. Competencies can be used to help organizations create high performance cultures, select and hire a workforce, develop leaders, and establish a foundation for training strategies. Social work, as a profession, has developed competency models for many specialized fields of social work. Health is the second most common practice area reported by social workers with a master’ s degree in social work, the predominant social work degree for licensed social workers. In highly structured, rapidly evolving, and complex organizations such as healthcare systems, leaders and managers require distinctively different …

Athletes’ Perceptions Of Athletic Trainers Quality Of Care, Chadley Foster

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to explore student athletes’ perceived satisfaction of care from certified and licensed athletic trainers (ATC) and satisfaction of care between full time and graduate student ATCs at University of Nevada, Las Vegas (n=61). Studies identify satisfaction as a method to measure quality of care and its influence on many aspects of athletes’ success including health outcomes. This is the first study that evaluated multiple aspects of care including type and length of sport participation, academic class status, number of ATCs seen, primary ATC (graduate or full time), number of interactions with primary ATC, injury, …

Improving Transitions Of Care In The Perioperative Setting, Brian Wayne Selig

UNLV Theses, Dissertations, Professional Papers, and Capstones

It is estimated that nearly 200,000 Americans die each year due to preventable medical mistakes (Gupta, 2012), and nearly 80% of all medical errors involve some form of miscommunication between healthcare providers (Joint Commission Center for the Transformation of Healthcare, 2013). Handoffs, or the transitioning of patient care from one provider to another, occur multiple times each day in the hospital setting and done incorrectly can lead to significant mistakes in patient care.

The purpose of this project was to improve the quality of handoffs that occurred between perioperative and inpatient nurses at an urban, tertiary medical center. A shared …

Patient Service Quality And Health Maintenance Organizations: Not An Oxymoron, Jessica Mcbeath

UNLV Theses, Dissertations, Professional Papers, and Capstones

Today’s quality movement in health care has driven the importance of patient satisfaction and experience across the industry. While the subject is of huge interest to researchers and health care companies, many struggle to identify a unified list of attributes that are applicable globally. Due to the industry’s uniqueness, it becomes necessary to understand the population and specific attributes for each. In review of previous service quality research, this study presents many dimensions and attributes for application. Using existing service quality framework 5Qs, this study provides unique findings correlated to existing literature and presents actionable items.

Purpose: The purpose of …

Understanding The Experience Of Medicare Advantage Patients In A Health Maintenance Organization, Curtis E. Boldman

UNLV Theses, Dissertations, Professional Papers, and Capstones

This study was conducted using a single Health Maintenance Organization in Las Vegas, NV to determine the key drivers and attributes of quality in the patient experience for Medicare Advantage holders. The purpose of this study was to investigate these perceptions of quality to assist the provider in identifying the areas in their treatment process which could be refined in order to better serve their customer base. With the recent changes in healthcare laws, patient satisfaction is now a key determinant in the financial compensation providers receive for services performed.

Data was collected by doing patient intercepts outside of the …

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 …

Evaluation Of An Educational Intervention On Perceptions Of A Patient Safety Culture Among Staff In Acute Care Nursing Units, Cynthia Ann Parkman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Patient safety has always been a central focus of nursing practice. Current research makes it increasingly clear that what occurs in the surrounding health care environment impacts patient safety. The protracted nursing shortage and nurse turnover may adversely affect patient outcomes and are exacerbated by an environment of disruptive behavior, conflict, and poor communication in the nursing workplace. The Joint Commission has identified these behaviors as key elements that jeopardize the "culture of safety" necessary to assure safe, quality patient outcomes. A culture of safety includes the attributes of teamwork, communication openness, collaboration, and a manager's positive focus on prevention …

Evaluating Shared Governance For Nursing Excellence, Evette Michelle Wilson

UNLV Theses, Dissertations, Professional Papers, and Capstones

The national challenges of nursing shortages, decreased staffing levels, and increased patient acuities have contributed to nurse's increased workload and job dissatisfaction. Nurses have become frustrated with the professional practice environment. The inability to make decisions about issues that affect their nursing practice and the care provided to their patients results in nurses leaving the work environment in search of higher job satisfaction. Employers are becoming more creative in their strategies to improve the work environment and retain nurses within their organizations. Healthcare leaders have implemented management strategies such as shared governance models. These models focus on providing a satisfying …

Perceptions Of Hospital Patient Safety Culture In Department Of Veterans Affairs Station 593 Southern Nevada, Kimberly Falco

UNLV Theses, Dissertations, Professional Papers, and Capstones

Opportunities for error exist, adverse events occur, and challenges endure. However, patients will continue to experience preventable adverse events unless steps are taken. Efforts to improve patient safety are critical to today's healthcare environment. The Department of Veterans Affairs (VA) believes that the identification of adverse events allows for creation of system improvements to increase patient safety.

Implementing safety culture requires a proper assessment of existing barriers and potential challenges. Patient safety culture assessments start by evaluating the current patient care environment. This assists the organization in identifying barriers to patient safety and in working toward creating a culture of …

The Presence Of Methicillin Resistant Staphylococcus Aureus (Mrsa) On Environmental Surfaces In Healthcare Facilities Pre- And Post-Cleaning, Aaron Thomas Hunt

UNLV Theses, Dissertations, Professional Papers, and Capstones

The emergence of antibiotic resistant bacteria is a serious public health issue affecting millions of people. Methicillin-resistant Staphylococcus aureus(MRSA) is a leading cause of healthcare acquired infections today. Research has shown that patients infected or colonized with MRSA shed the bacteria into the environment, where the bacteria can survive for long periods of time and become potential sources of infection. Currently, infection prevention efforts focus on active surveillance, hand hygiene, personal protective equipment use and antimicrobial stewardship, with less attention given to environmental cleaning. Nevertheless, environmental cleaning is essential to remove infectious agents from environmental surfaces and prevent transmission. The …

Comparison Of Study/Article Characteristics And Methodological Quality Of International Nurse Workplace Violence Research Published Before And After The Joint Commission Sentinel Event Alert On Disruptive Behaviors, Terressa Margarette Stowell Love

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The majority of new nurses experience workplace violence from other nurses. The purpose of this study was to compare study/research characteristics and methodological quality of international nurse workplace violence research published before and after the 2008 release of the U.S. The Joint Commission (TJC) sentinel event alert on disruptive behaviors.

Methods: Thirty-nine quantitative nurse workplace violence research articles published between 2001 and 2012 were assessed and divided into two groups: articles published (a) before the 2008 TJC sentinel event alert or the same year, i.e., 2001-2008 (BTJC) and (b) after the 2008 TJC sentinel event alert, i.e., 2009-2012 (ATJC). …

Retaining Intensive Care Nurses In Las Vegas: The Importance Of Nurse Manager Leadership, Megan Vendetti

UNLV Theses, Dissertations, Professional Papers, and Capstones

In today's healthcare climate, retaining staff nurses is desirable and may be a more permanent solution to improve the nursing shortage. Employing a leadership style that is conducive to staff nurse job satisfaction may be needed to achieve that goal. The purpose of this study was to determine the relationship of the unit manager leadership style with job satisfaction and intent to stay in the intensive care setting. Staff nurses in two Las Vegas hospitals, one private and one public, were surveyed. A questionnaire was developed and voluntarily completed by 125 registered nurses employed in adult and pediatric intensive care …