Medicine and Health Sciences Commons^™

The Effects Of Exercise On Breastmilk Composition And Supply: A Critical Literature Review, Jewell Mcroy

Masters Theses, 2020-current

It is well established that breastfeeding provides dual benefits to both the mother and the infant and is the preferred method of providing nutrients to infants essential for growth and development. Participating in regular physical exercise is also well-supported by research to be beneficial to one’s overall health and quality of life. Currently there are no physical activity guidelines developed for women who are postpartum and breastfeeding. An online database search was conducted; three articles met the inclusion criteria and were included within the review. Studies were included if there were direct measures of human breastmilk composition, supply/volume, and included …

Interprofessional Education (Ipe) And Interprofessional Education Collaborative (Ipec) Competencies Of Clinical And Healthcare Administration Undergraduate Students, Shelly Gompf

Dissertations, Theses, and Projects

The healthcare industry is dependent on the successful delivery of effective education to undergraduate healthcare students. Curriculum and instruction, experiences both inside and outside of the classroom, significantly contribute to students' successful development. A critical element for successful healthcare delivery is to continue building a sustainable culture for all healthcare workers that will increase skills for improved ethics and values, inter-disciplinary understanding of roles and responsibilities, interprofessional communication, and teamwork. One teaching approach that continues to produce positive results is interprofessional education (IPE). This teaching method, supported by the experiential learning theory, brings clinical stakeholders together to problem-solve and make …

Grassroots Advocacy With Tennessee Disability Coalition, Sylvia Stenger

OTD Capstone Projects

Grassroots advocacy initiative to gather family feedback and recommendations on group 4 of the Employment and Community First CHOICES Program in order to advocate for continued refinement of the ECF CHOICES Program with TennCare.

A Descriptive Study Of Male Victims Of Sexual Assault Seen For A Sexual Assault Forensic Medical Examination, Madeleine Prince

Undergraduate Honors Theses

Ten percent of all victims who report a sexual assault (SA) are male (Department of Justice, 2013), yet there has been little research on their experiences. Further study on the unique characteristics of male SA victims is warranted. The purpose of this study is to explore, identify, and analyze variables of male SA victims who received a SA forensic medical examination (SAFME), and identify implications and areas for future research. Data from the SAFME charts were entered into the Statistical Package for the Social Sciences (SPSS) version 25. Male victims were compared to female victims from the same data set. …

Regional Integration: Physician Perceptions On Electronic Medical Record Use And Impact In South West Ontario, Sadiq Raji

Electronic Thesis and Dissertation Repository

Regional initiatives in the health care context in Canada are typically organized and administered along geographic boundaries or operational units. Regional integration of Electronic Medical Records (EMR) has been continuing across Canadian provinces in recent years, yet the use and impact of regionally integrated EMRs are not routinely assessed and questions remain about their impact on and use in physicians’ practices. Are stated goals of simplifying connections and sharing of electronic health information collected and managed by many health services providers being met? What are physicians’ perspectives on the use and impact of regionally integrated EMR? In this thesis, I …

Risk Stratification For Treatment Decisions In People At Ultra-High Risk For Psychosis: A Cost-Effectiveness Analysis, Olajumoke Marissa Ologundudu

Electronic Thesis and Dissertation Repository

People with psychotic disorders have long-term negative health outcomes and contribute large health system costs. Intervening among those at ultra-high risk (UHR) for psychosis may prevent or mitigate risk for psychotic disorder; however, it is unclear if we should treat all UHR individuals or only those above a certain risk threshold. The objectives were to systematically review the literature on the cost-effectiveness of UHR programs, and to conduct an economic evaluation of a risk stratification strategy, where treatment decisions are based on the probability of transitioning to psychotic disorder. Our systematic review found that UHR programs are potentially cost-effective. The …

Assessment Of Landing Biomechanics And Rehabilitation After Anterior Cruciate Ligament Reconstruction, Sheila S. Gagnon

Electronic Thesis and Dissertation Repository

Aberrant landing biomechanics increase the risk of anterior cruciate ligament (ACL) injury and are a focus of rehabilitation after ACL reconstruction. The purpose of the present thesis was to develop and evaluate methods of assessing landing mechanics and investigate the effects of different rehabilitation strategies after ACL reconstruction. Three studies were conducted. The first study used a Delphi process to develop the content of a Clinician-Rated Drop Vertical Jump Scale to evaluate jump landing mechanics during rehabilitation after ACL reconstruction. Twenty experts participated in four rounds of questioning, resulting in 92% agreement for knee valgus collapse, lateral trunk lean, insufficient …

The Associations Of Out-Of-Home Placement With Penile-Vaginal Intercourse, Age Of Sexual Debut And Pregnancy Among Child Welfare Involved Youth: A Cross-Sectional Study Using The National Survey Of Child And Adolescent Well-Being (Nscaw) Ii, Gabriela S. Betancourt

Dissertations and Theses

Background: Studies of youth in out-of-home (OOH) care and adults with histories of OOH placements have found evidence of poorer sexual and reproductive health (SRH) compared with their counterparts in the general population, including inconsistent use of male condoms and contraceptives, higher prevalence of adolescent pregnancy, and history of unwanted sexual debut. However, within the population of youth involved in child welfare, the effects of OOH placement on SRH have been difficult to establish. The overall goals of the current study were to compare SRH indicators (ever having penile–vaginal intercourse; early age of sexual debut; reported pregnancy) among youth involved …

Oral Chemotherapy: Safe Handling In The Home, Cynthia Huff

DNP Qualifying Manuscripts

Background: According to the National Institute for Occupational Safety and Health (2016), oral anticancer agents (OAC) are hazardous drugs (HD) and require the same safe handling interventions in the home setting as in controlled health care environments. The use of a safe handling checklist for OAC administration is a way nurses can provide safe handling education to patients and caregivers and assess for understanding and competency for critical tasks. Effective home management strategies outlining caregiver protections, proper storage, administration of OACs, spill clean-up, and waste disposal could reduce exposure risks to toxic agents.

Objective: To present a safe-handling checklist …

A Compelling Case For Evidence-Based Practice Mentor Development Programs: An Integrative Review, Stacy Alves

DNP Qualifying Manuscripts

Background: In 2008, The Institute of Medicine (IOM) set a goal that by 2020, 90% of healthcare decisions would originate from the best evidence available. This goal remains intangible for many organizations. Despite reporting quality and safety as a top organizational priority, a survey of 276 Chief Nurse Executives (CNEs) found that only roughly 50% of the CNEs said that EBP was practiced in their hospitals only “somewhat” or “not at all” (Melnyk, Gallagher‐Ford, Thomas, Troseth, Wyngarden, Kzalacha, 2016). Many organizations struggle to systematically integrate EBP into practice (Melnyk et al., 2018; Warren et al., 2016a). The Advancing Research and …

Epidemics, Politics And Public Health: Ludwig Rajchman, Md, The League Of Nations Health Organization And The Creation Of A Transnational Health Institution, Paul J. Weinbaum

Electronic Theses and Dissertations

Traditional scholarship on the League of Nations labels the organization as a failure because it did not prevent the outbreak of the World War II. Recent research examines League activities in a more comprehensive manner and concludes that the organization should be credited with important and enduring achievements. Perhaps the most successful work was carried out by the Health Section led by Dr. Ludwick Rajchman. Using primary sources from the League archives in Geneva, documents from organizations such as the Rockefeller Foundation, articles from medical journals and other relevant secondary sources, I argue that the Health Section, became the world’s …

Usp <800> Compliance: A Hazardous Drug Safe Handling Ppe Toolkit For Infusion Nurses, Cynthia Huff

Doctor of Nursing Practice (DNP) Projects

Problem: Safety concerns have existed for more than 40 years about how hazardous drug (HD) exposure contributes to long- and short-term adverse health outcomes for healthcare workers (HCWs). Careless handling may cause toxic residues to infiltrate hospital environments and patient care areas, and can even be traced to patients’ homes. New government regulations will require healthcare organizations to minimize exposure risks to HCWs by fully implementing the U.S. Pharmacopeia (USP) Convention Chapter 800: Hazardous Drugs: Handling in Healthcare Settings (USP, 2016) on December 1, 2019. According to Polovich and Olsen (2017), “The implementation of the USP <800> Standards will represent …

Implementing Askme3 Approach To Adult Learning Through The Kalamazoo Literacy Council, Hailey Beyer

Honors Theses

Background: Ask Me 3 was developed as a tool to help individuals successfully communicate with their healthcare providers (Institute for Healthcare Improvement, n.d.). This was designed to study the effectiveness of this tool in educating adult learners of Kalamazoo, MI, through the Kalamazoo Literacy Council (KLC) Virtual Learning Center.

Objective: The objective was to determine whether learners of the Kalamazoo Literacy Council gained confidence communicating with a healthcare provider through the implementation of a distance education Ask Me 3 program.

Methods: Learners associated with the KLC were sent a pre-lesson survey asking them to assess their confidence levels with using …

Reviewing Patient Satisfaction Of Lifecare Alliance Services Provided To The Columbus Community, Sean Ruffner

Masters Theses/Capstone Projects

Two separate patient satisfaction surveys were sent out to LifeCare Alliance’s customers. Each patient was asked a set of five questions that generalized the encounters as a whole experience. The first survey is for patients that were seen by nurses for footcare, general wellness and more (1A - PowerPoint). The other survey was sent to clients who received the flu vaccine (1B - PowerPoint). To conclude, data was then collected and analyzed using an excel spreadsheet (1C – PowerPoint).

Health Insurance And The Undocumented Immigrant, Anja Diercks

Honors Theses

The purpose of this thesis is to perform a comparative analysis on how seven different countries (USA, South Africa, Germany, England, Canada, France and Singapore) organize their healthcare system to cope with the issue of undocumented immigrants and whether or not these systems in place were “fair.” The thesis will also explore the possible ways the United States could change to be more inclusive and fairer in the world of healthcare and health insurance for the undocumented immigrant. A study on what fairness means both in ethical and economical terms is done to suggest a new basis of a fair …

The Effect Of Pigmentation On Latex And Non-Latex Orthodontic Elastics, Dustin Wilson

Electronic Thesis and Dissertation Repository

Background: Intraoral Elastics have been widely used in Orthodontics for well over 100 years. Changes in material composition, manufacturing and addition of color to elastics has shown to effect force levels over time.

Aim: The purpose of the study was to determine the effect of pigmentation on force levels and their degradation over time in both Latex and Non-Latex orthodontic intraoral elastics.

Materials & Methods: Groups consisted of elastics in Latex from American Orthodontics in both natural and four different colors, American Orthodontics Non-Latex in natural, Ormco Latex in both natural and four different colors, Auradonics Latex in both natural …

Reducing Length Of Stay After Total Hip And Knee Arthroplasty: Assessing Cost-Effectiveness, Caregiver Involvement And Surgical Approach, Bryn O. Zomar

Electronic Thesis and Dissertation Repository

Purpose

The overall purpose of this dissertation was to evaluate factors related to reducing length of stay after total hip and knee arthroplasty (THA and TKA).

Methods

Study 1 was a randomized controlled trial (RCT) to investigate the cost-effectiveness of outpatient THA compared to standard overnight stay. Study 2 was a prospective cohort study to assess patient- and caregiver-related factors and how they may relate to caregiver strain and level of assistance when caring for patients undergoing THA and TKA. Finally, Study 3 was a 2x2 factorial RCT to compare the trajectory of early functional recovery between the medial parapatellar …

Intersectional Social Inequalities And Cognitive Functioning Among Community-Dwelling Older Adults In England: A Decomposition Analysis Of The Mediating Role Of Loneliness, Chantel Walwyn

Electronic Thesis and Dissertation Repository

Normative cognitive decline is an emerging public health issue for older adult populations. It is necessary that we take an intersectional approach to examining heterogeneity in cognitive health outcomes. Using complex longitudinal survey data from the English Longitudinal Study of Ageing (ELSA), multiple linear regression models were used to examine the relationship between intersectional group membership based on age, education, and sex, and change in cognitive functioning domains (memory function, and executive function) over an 8-year period. Three-way decomposition analysis was also used to examine the mediating effect of loneliness on the association between intersectional group membership and the change …

Safety Huddles: A Safety Net For Nurses Amid The Covid-19 Pandemic, Miranda Saint-Louis

DNP Qualifying Manuscripts

In March 2020, our 31-bed geriatric medical unit was designated the first COVID-19 unit in a teaching hospital located in a New York City COVID-19 hot zone. At the time, little was known about SARS-CoV-2 and the disease it caused. We needed to find a way to keep them calm, assure their safety, and provide competent and compassionate patient care in a situation where best practices had not yet been established. The concepts from this article can be applied to provide support staff in any crisis. Providing a safety net for staff enables a focus on life-saving patient care without …

Mexican Americans' Perspectives On "Borderline Diabetes" In Amarillo, Texas, Priscella Pena-Correa

Nursing ETDs

The purpose of this study was to explore the meaning of and experiences living with “borderline diabetes” among Mexican American adults residing in or around Amarillo, Texas. Sixteen Mexican Americans who self-identified as having “borderline diabetes” participated. Research questions focused on how participants understood the condition, self-care practices, and recommendations for improving prediabetes healthcare and education. An interpretive description approach was used to analyze data from phone interviews. Principal findings revolved around issues of disclosure vs. secrecy, information seeking, and challenges or “struggle” to change lifestyle, particularly diet. Self-care was managed in a relational way with support of family, friends, …

Mindful Mind Project, Toussaint Campbell

Capstones

Mindfulness includes the methods one takes to care for themselves by acknowledging and accepting one’s feelings, thoughts, and bodily sensations while conducting daily tasks. Mindfulness can manifest in unique actions and activities depending on an individual's needs. However, many lack education on mental health resources as well as access to the tolls that could be beneficial to them. This collection of opinion pieces takes a look at themes in a society where mindfulness can be incorporated and how practices can impact communities of color.

Link to capstone: https://mindfulmindproject.com/

A Stroke Of Misfortune, Madison Ruffo

Capstones

In May 2019 my great grandmother, Carmel Ruffo, went to the hospital for a bowel impaction. One month and one stroke later she died. Since then, my great uncle–her son–has worked tirelessly seeking answers about the nature of his mother’s death. But the healthcare industry is a labyrinth of mind-boggling jargon, complex policies, and too-often dead ends.

In this story, the reader follows my uncle and me, just one of the hundreds of thousands of grieving families who suspect medical error contributed to their loved one’s death, as we navigate the bureaucracy of New York’s healthcare system and dig for …

Improving Clinical Communication And Collaboration Through Technology, Michelle Machon

Doctor of Nursing Practice (DNP) Projects

Problem: Over the last 30 years, clinical communication methodologies in healthcare have evolved to become such disparate systems that they lead to confusion, wasted time, and clinician dissatisfaction. The Joint Commission (2016) reports up to 78% of sentinel events in hospitals are linked to communication failures, which have obvious implications for hospital systems in the quality and safety of their current communication systems.

Context: The purpose of this project was to determine the effectiveness of implementing a unified clinical communication technology platform in an acute care hospital setting and to make recommendations from that implementation to the organization’s larger health …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Role Of The Acid Sensing Ion Channel 1a In The Systemic Circulation, Selina M. Garcia

Biomedical Sciences ETDs

Acid-sensing ion channel 1a (ASIC1a) is a non-selective cation channel that is expressed in vascular smooth muscle cells. However, little is known about the contribution of ASIC1a to vascular reactivity and cardiovascular homeostasis. We have previously shown that ASIC1a contributes to pulmonary vascular smooth muscle cell (VSMC) Ca²⁺ entry and vasoconstriction as well as chronic hypoxia-induced pulmonary hypertension. However, a role of ASIC1a in the systemic circulation is unclear. Previous reports have shown that ASIC1a is expressed in femoral and cerebral arteries, however, these studies suggest that ASIC1a contributes to vascular reactivity through neuronal regulation rather than vascular. Therefore, …

Reducing Hospital Acquired Pressure Injuries Through A Standardized Prevention Bundle, Austin Lee Stoker

Master's Projects and Capstones

Abstract PROBLEM: Currently healthcare acquired pressure injuries (HAPIs) in the United States result in significant and unnecessary costs along with lost revenue for healthcare facilities. These costs are estimated to be between 9.1 and 11.6 billion dollars annually. Pressure Injuries (PIs) are directly associated with decreases in patient outcomes and are deemed preventable incidents. HAPI prevention can mitigate this clinical and financial problem for patients and organizations. CONTEXT: Unnecessary patient harm related to four HAPI occurrences in the last quarter on the 2B Medical Surgical Telemetry Unit in an integrated managed care delivery system continue to be of concern. Adherence …

Improving Nurse Engagement Through Unit Practice Councils: A Literature Review, Pavna Sloan

Doctor of Nursing Practice (DNP) Projects

Problem: According to The Advisory Board Company, nurses are the least engaged group of healthcare employees (The Advisory Board Company, 2014). This finding concerns healthcare organizations because those with a high percentage of disengaged nurses have increased nurse turnover rates and decreased patient satisfaction and safety scores (Kutney-Lee et al., 2016). Shared governance, in the form of the Unit Practice Councils (UPC), is a model healthcare organizations implement to increase nurse engagement. A review of the current literature is needed to evaluate if the model is effective.

Purpose: The purpose of this article is to provide a comprehensive literature …

Implementing Simulation In Icu New Graduate Nursing Orientation: Introducing Two Practice Innovations, Aiza Quinday Msn

Master's Projects and Capstones

A change project involving the use of innovative wearable simulation technology was integrated into the 12-week new graduate nurse ICU training program at one community hospital in Northern California. Project implementation was interrupted by the Covid-19 pandemic, so only the first pilot training session was conducted. Initial results from this training session suggest that the simulation training had a positive impact on the nurses’ ability to assess patient breath sounds and to recognize and treat a rapidly deteriorating patient. This training session also allowed the project team to identify additional areas of skill assessment and opportunities for improvement for the …

Policy Analysis: Appropriate Opioid Prescribing Practices For Post-Surgical Patients, Joan S. Daversa

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from …