Medicine and Health Sciences Commons^™

Implementing A Cauti Bundle In The Adult Hospitalized Trauma Population, Sabrina Marcella Braun

Walden Dissertations and Doctoral Studies

The use of an indwelling catheter is a common occurrence in the hospital setting. Careful evaluation of the initial indication for catheterization and need for continued catheterization is necessary to mitigate the complications of catheter insertion, which includes urinary tract infection. Catheter associated urinary tract infections (CAUTI) are the most common healthcare-associated infection in the United States, with > 30% of these infections reported. More than 560,000 hospital acquired urinary tract infections occur annually. CAUTI and its complications increase morbidity and mortality, hospital length of stay, readmission rates, cost, and the use of antimicrobial medication. CAUTI was identified as an outlier …

Understanding Characteristics Of Chronic Obstructive Pulmonary Disease Readmissions In An Acute Care Hospital, Jordan Danyale Brautigam

Walden Dissertations and Doctoral Studies

Patients suffering from chronic obstructive pulmonary disease (COPD) not only face difficulties managing their disease but are also faced with a higher risk of being readmitted to a hospital after an initial visit for acute exacerbation of their condition. Despite hospitals’ many attempts to offset this burden, readmission reduction programs are not effective. The purpose of this quantitative study was to further research an organization’s specific population surrounding patient comorbidities, reasons for readmissions, and demographic characteristics that may lend insight into reasons for readmissions. The research design was a retrospective analysis of a health system’s electronic medical record with a …

Increasing Compliance Of Chlorhexidine Wipes To Prevent Hospital-Acquired Infections, Kelly Jean Dunn

Walden Dissertations and Doctoral Studies

AbstractHealthcare-acquired infections (HAIs) are complications of healthcare linked to increased mortality, morbidity, and length of stay. Assiduous surveillance and constant reeducation can decrease HAI incidence and reduce the healthcare burden caused by these events. Evidence has demonstrated that using 2% chlorhexidine wipes instead of bathing with soap and water greatly reduces the bacteria on the skin and prevents infections such as catheter-associated urinary tract infections and central line-associated bloodstream infections. The practice-focused question for this quality assurance doctoral project was to evaluate if an educational intervention improved compliance of chlorhexidine wipe use among ICU nurses with the hope of improving …

Family Functioning During Deployment And Reintegration Of Military Members, Heather Graham

Walden Dissertations and Doctoral Studies

Military members and their families face unique stressors related to separation and reintegration. These life-changing events can lead to domestic violence, divorce, depression, suicide, and behavioral problems within the family. It was unknown whether the implementation of a nursing clinical practice guideline (CPG) would help nurses to identify family functioning concerns or psychosocial issues enabling earlier interventions. The purpose of this doctoral project was to create a CPG that can be used at military treatment facilities (MTFs) to screen military members and their families to identify family functioning concerns so that the provider can make referrals as needed. The circumplex …

The Lived Experiences Of Clinical Nursing Faculty With Student Performance Anxiety, Heather Lapoint

Walden Dissertations and Doctoral Studies

The nursing shortage in the United States has led to a call for nursing education reform. Current clinical educational methods precipitate nursing student performance anxiety (PA). PA can inhibit the clinical judgment, reasoning, critical thinking, and the adaptability required for advancing healthcare initiatives and reducing the nursing shortage. PA has not been defined nor addressed in undergraduate nursing education. The purpose of this descriptive phenomenological study was to explore the lived experiences of associate degree (AD) nursing program faculty in addressing student PA as it occurs in the clinical setting. Specifically, how faculty define PA and recognize, address, and assess …

Childhood Obesity, Yvette Ledjo

Walden Dissertations and Doctoral Studies

AbstractObesity in adolescents is a worldwide epidemic. According to the Centers for Disease Control and Prevention, approximately 17% of adolescents in the United States are obese. These statistics put pressure on public health nationally and internationally. Obesity leads to chronic diseases such as cardiovascular disease, diabetes, and arthritis. This doctor of nursing practice project was carried out in a juvenile correctional facility’s clinic, where detainees visited for treatment of acute and chronic health-related issues. Clinicians address detainees’ problems, but a gap was identified in the knowledge of these clinicians. This project focused on closing that knowledge gap by providing a …

Perceptions On Maternal Mortality Among The Ekpeye Community, Theresa Tenim Ogide-Alaeze

Walden Dissertations and Doctoral Studies

In Africa, especially Nigeria, maternal mortality is a public health issue among women of childbearing age (WCBA). WCBA living in the Ekpeye community located in Rivers state in Nigeria are at high risk of maternal deaths during pregnancy and labor or delivery. Data were obtained through key informant interviews with 9 relatives, friends, and health workers. The purpose of the key informant interviews was to identify perceived barriers that result in high maternal deaths and facilitators seen as promoters to reduce pregnancy-related deaths. The participants identified 11 core themes as contributors to maternal death: (a) postpartum death, (b) financial insecurity, …

Hospice Interdisciplinary Use Of The Social Work Assessment Tool For Military Families, Miranda Lishell Rankin

Walden Dissertations and Doctoral Studies

The development of the social work assessment tool (SWAT) was an initiative designed by members of the National Hospice and Palliative Care Organization to move hospice and palliative care social workers into the arena of viewing the family as an extension of the patient. Of those dying in the United States, 1 out of 4 is a military veteran (vet) in need of assessments, culturally relevant interventions, and/or supports at the end of life. For military families, caring for vets at the end of life can prompt stressors that may require culturally unique assessments and/or interventions. Tsai’s (2003) theory of …

Understanding The Experiences Of Young Adults Receiving Community-Based Eating Disorder Care, Hali Sitarz

Walden Dissertations and Doctoral Studies

AbstractIn Ontario, Canada, eating disorder care is predominately delivered through nurse practitioner-led community outreach programs; however, there is a paucity of evidence informing the role of nurses in terms of outpatient treatment, community-based care, and young adult patient experiences. With high rates of morbidity and mortality, it is imperative to establish an evidence-informed approach to eating disorder treatment and ensure that care is patient-centered. This interpretive phenomenological study explored the experiences of young adults receiving community-based treatment in Ontario. Reigel, Stromberg & Jaarsma’s Middle Range Theory of Self-Care in Chronic Illness was used as an orientating framework. Seven young adults, …

Partner Notification Of Hiv Status Among Cameroonian Men Who Have Sex With Men, Pius Muffih Tih

Walden Dissertations and Doctoral Studies

AbstractHIV prevalence rates are higher among men who have sex with men (MSM) than in the general population. Although there is ample evidence that partner notification (PN) effectively breaks the HIV transmission chain among MSM, it has not been practiced consistently in Cameroon. This study aimed to assess the perceptions and acceptability of PN of HIV status among MSM and use by health care workers (HCWs) in Cameroon. The health belief model underpinned this qualitative inquiry, in which I recruited 15 HCWs and 16 MSM using snowball sampling. I used in-depth personal interviews for data collection with notes taken using …

Effects Of A Blended Basic Telemetry Course On The Telemetry Reading Proficiency Of Newly Licensed Registered Nurses, Joan Yankalunas

Walden Dissertations and Doctoral Studies

Telemetry interpretation is a common skill required by registered nurses (RNs) to take care of patients in an acute care setting. Telemetry education guidelines are needed because there are no established standards for the amount, type, or scope of education needed for RNs who take care of patients on continuous telemetry monitoring. The purpose of this retrospective analysis design study, guided by Benner’s skill acquisition model and Kirkpatrick’s learning outcomes measurement theory, was to (a) determine the effect of a blended telemetry course, which is a combination of eLearning and an instructor-led class, on the telemetry reading proficiency of RNs …

The Relationship Between Cervical Cancer And Women Living With Disabilities In Kentucky, Carolyn Akakpo

Walden Dissertations and Doctoral Studies

AbstractDespite many national interventions, cervical cancer (CC) rates persist, and in Kentucky (KY), CC incidence rates are on the rise. Additionally, women with disabilities face more barriers to secondary prevention and healthcare access, have more known risks, and experience more health disparities than women without disabilities. Given that 1 in 4 persons live with a disability, the purpose of this observational, cross-sectional, quantitative study was to explore the relationship between CC and women with disabilities as evidenced by reproductive cancer discharges from inpatient hospital (IHD) and outpatient services databases (OSD) so as to compare population-specific differences from social determinants of …

Black Msm And Hiv Testing History Levels In The Clinical And Nonclinical Settings, Naana Cleland

Walden Dissertations and Doctoral Studies

Black men who have sex with men (BMSM) are more likely unaware of their HIV status, are less likely to get tested annually, and prefer to use HIV testing services (HTS) in the nonclinical settings, compared to other MSM subgroups. Guided by the behavioral model for vulnerable populations and a cross-sectional quantitative design, three substudies were conducted using secondary data for 1189 BMSM, 18 years or older, from the HIV Prevention Trial Network 061 Study. Chi-square, multinomial logistic regression (MLR), and z-test methods were used to examine the association between population characteristics (predisposing, enabling, and need factors) and HIV testing …

Reducing Heart Failure Readmissions Through Staff Education, Christopher Davio

Walden Dissertations and Doctoral Studies

Heart failure is a chronic health condition that can have devastating effects on thephysical and social well-being of patients. One critical component to heart failure treatment is understanding of the disease process and daily self-management for patients. The gap in practice at an acute care facility in the northwest United States was the lack of comprehensive discharge patient teaching to patients diagnosed with heart failure. The project explored if a heart failure education session for nurses would increase knowledge and competency on heart failure education. Knowle’s theory of adult learning was used to frame the project components. Thirty-one nursing staff …

Structural Empowerment And Employee Commitment Among Millennial Newly Registered Nurses, Janice Hill

Walden Dissertations and Doctoral Studies

AbstractThe nursing shortage is one of the most challenging issues in global healthcare. While not an all-encompassing solution, labor force retention could alleviate the crisis. The purpose of this study, guided by Kanter’s structural theory of organizational behavior, was to determine the relationships between access to power, opportunity for growth, structural empowerment (SE), and employee commitment among millennial newly registered nurses (NRNs) and to determine if there is a difference in SE between male and female millennial NRNs. Survey data collected from 148 participants were analyzed using Spearman rank-order correlation tests and showed statistically significant correlations between access to power …

Effect Of Educational Training On Nurse Leaders’ Knowledge, Attitude, And Behavior Toward Suicide Prevention, Ruth Odochi Idediora

Walden Dissertations and Doctoral Studies

Suicide is the 10th leading cause of death among adults in the United States and one of the top 10 most commonly occurring events that lead to serious injury or death in the hospital. Nurse leaders who are not working in psychiatric facility are instrumental in promoting culture of safety to mitigate adverse outcomes like suicide. The purpose of this single group pre-and post-test study, guided by the theory of planned behavior, was to determine the effect of the American Psychiatric Nurses Association Competency-Based Training for Suicide Prevention (Acute Care Setting Course) on the knowledge, attitude, and behavior (KAB) of …

Nurse Perception Of Pain And Innovative Approaches To Pain Management, Tracey-Ann Nichole Knight

Walden Dissertations and Doctoral Studies

AbstractInsufficient assessment and management of pain among the patient population during their hospital stay may result in ineffective delivery of care, increased length of stay, poor clinical outcomes, and decreased patient satisfaction. The quality report at a local facility showed compliance scores of 78% for administration of pain medication and 79% for reassessment of pain. These scores and the weekly patients’ satisfaction survey results suggested a substandard adherence to the facility’s pain management guidelines. One identified barrier to properly managing patients’ pain was nurses’ lack of knowledge and understanding of the theoretical foundation of pain management. The purpose of this …

Health Systems Predictors And Trends Of Access To Vaccinations In 9 Sub-Saharan African Countries, Mirfin Mpundu

Walden Dissertations and Doctoral Studies

The purpose of this ecological quantitative study was to examine the predictors of health systems building blocks and their interactions in improving access and uptake of immunizations in nine sub-Saharan African countries. Immunization rates in this region remain lower than global targets leading to preventable diseases and mortality. Using the systems approach, the study examined the relationships among five independent variables: quality of service delivery, governance, vaccine supply, health financing, socioeconomic factors and the dependent variable, access to immunizations. Datasets from the WHO and UNICEF were used. Analysis included a series of descriptive statistics, logistic and linear regression, and correlations. …

The Relationship Between Program Leadership, Resident Physicians’ Wellbeing, And Quality Of Care, Fatima Msheik

Walden Dissertations and Doctoral Studies

Research studies have shown that organizational leadership and support affect organizational outcomes in many sectors, including healthcare. However, less is known about how organizational leadership influences the quality of patient care by physicians. This study was guided by the perceived organizational support theory and leader-member exchange theory that provide general understanding of how supportive leadership influences staff wellbeing and productivity. Ninety-five resident physicians residing in Lebanon participated in this cross-sectional study and completed an online survey, which consisted of demographics and five tools, namely, the Leader-Member Exchange 7, Perceived Organization Support 8, Maslach Burnout Inventory 7, Utrecht Work Engagement 9, …

Staff Education Program For Nurses Caring For Patients With Medical Decline On A Geriatric Psychiatric Unit, Portia Denise Risper

Walden Dissertations and Doctoral Studies

AbstractElderly patients admitted to psychiatric units are a vulnerable population, some may have mental disorders, physical decline, cognitive challenges; along with other comorbidities in addition to their mental illness. However, their physical health needs may be overlooked due to the presenting behaviors mimicking mental health behaviors. The nurses working in the local hospital facility’s geri-psych unit failed to recognize signs and symptoms of physical decline in their severely mentally ill (SMI) patients. Not recognizing and reporting acute changes resulted in patients’ prolonged hospitalization, decreased quality of life, and increased cost to the facility. The purpose of this DNP project was …

A Retrospective Program Evaluation Of Existing Quality Improvement Project Colorectal Cancer Screening, Laveda Lynn Roberts

Walden Dissertations and Doctoral Studies

The United States Preventive Services Task Force (USPSTF) makes recommendations on preventive health screenings based on the level of evidence. Colorectal Cancer is the third most commonly diagnosed cancer. The practice problem for this DNP QI project, is that providers are not following the USPSTF Guidelines on colorectal cancer screening with the FQHC scores below the HRSA expectation of 80% showing only a 43% screening compliance rate for patients age 50 -75 years. The purpose of this DNP QI project was to evaluate the effectiveness of the existing QI initiative for provider colorectal screening of patients age 50-75 years, then …

Examining The Efficacy Of A School-Based Mental Health Program In Iowa, Karen A. Rodriguez

Walden Dissertations and Doctoral Studies

Evidence shows that treating mental health issues positively impacts academic and other life outcomes for students. However, there remains a gap in knowledge specific to academic outcomes and to rural school districts. It is important for mental health providers, educators, and third-party payers to gain an understanding of how treating mental health in the school setting affects student performance. The purpose of this quantitative study, which had contribution analysis as its theoretical framework, was to examine the academic and behavioral outcomes of participating in a school-based mental health (SBMH) program in rural school districts in Iowa. The specific focus was …

Measuring Nurse Competence In The Emergency Department, Matthew Lojo

University of the Pacific Theses and Dissertations

Background: “Nurses provide essential care to the millions of people who are hospitalized each year as a result of illness or injury” (Smith, 2012, p. 172). The Institute of Medicine reported approximately 44,000-98,000 patients die annually resulting from a medical error, and health care errors ranked among the top 10 for the leading causes of death in the United States (Smith, 2012).

Problem: Nurse competence impacts safe and quality nursing, and several research studies investigated the measurement of nurse competence among nurses in various nursing settings (Flinkman et al., 2016). However, a review of the research revealed limited studies in …

Effects Of Chronic Energy Drink Consumption On Cardiometabolic Endpoints, May Chen

University of the Pacific Theses and Dissertations

Background: Since its introduction in the early 2000s, energy drinks have become increasingly popular among an extensive range of consumers, including adolescents and young adults. Currently, the United States Food and Drug Administration (FDA) does not regulate the formulation of energy drinks, which may vary widely in the amounts of caffeine and sugar, as well as various types of supplements. Recent reports of severe and fatal adverse effects related to energy drinks have led to growing concerns on the safety of energy drink consumption.

Objective: This study aimed to investigate the effects of chronic daily consumption of energy drinks on …

Regulation Of Intracellular Aryl Hydrocarbon Receptor Protein Levels, Jinyun Chen

University of the Pacific Theses and Dissertations

The aryl hydrocarbon receptor (AHR) is a ligand-activated signaling molecule which controls tumor growth and metastasis, T cell differentiation, and liver development. Expression levels of this receptor protein are sensitive to the cellular p23 protein levels in immortalized cancer cell lines. As little as 30% reduction of the p23 cellular content can suppress the AHR function. Here we reported that down-regulation of the p23 protein content in normal, untransformed human bronchial/tracheal epithelial cells to 48% of its content also suppresses the AHR protein levels to 54% of its content. This p23-mediated suppression of AHR is responsible for the repression of …

Midazole-Based Ph-Sensitive Convertible Liposomes For Anticancer Drug Delivery, Ruiqi Huang

University of the Pacific Theses and Dissertations

Solid tumors possess biological features that are different from those in healthy tissues, which provides opportunities of anticancer treatment by nanomedicines. Due to the presence of the fenestrated tumor vasculatures, nanomedicines can selectively accumulate in tumor tissues by the enhanced permeability and retention (EPR) effect. The acidic pH in tumor interstitium (pH 6.0-7.0) also provides a promising mechanism to trigger the nanomedicines to promote the cellular uptake of cargo drugs. The previously reported stealth liposomes coated with PEG are known to accumulate in tumors owing to their prolonged circulation time. The PEG coating on liposomes can hinder serum protein adsorption …

Role Of Polymer Physicochemical Properties On In Vitro Mucoadhesion, Qing Zhang

University of the Pacific Theses and Dissertations

Polymers with mucoadhesive properties are universally used in the development of mucoadhesive drug delivery system. Their physicochemical properties as well as the mechanisms related to their adhesive actions draw great attention for the modification of mucoadhesive properties.

In this study, relationships between physicochemical properties of hydroxypropyl methylcellulose (HPMC) compacts and mucoadhesive performance were investigated. Different commercial grades of HPMC (K3, E3, E5, E50, K4M, E4M and K15M) were prepared into compacts, and their surface hydrophilicity and hydration behavior were characterized. The in vitro mucoadhesive performance was determined by the tension strength between the compacts and different regions of mucous membrane …

Development Of Lipid-Based Nano Formulations Of Miriplatin Against Lung Cancer, Zizhao Xu

University of the Pacific Theses and Dissertations

Cancer is the second leading cause of death and is responsible for approximately 9.6 million deaths worldwide in 2018. Among all oncological diseases, lung cancer claims the highest mortality (male: 23.5%; female: 22%) and the second most new cases (male: 13%; female: 12%) in the US. Approximately 40% of newly diagnosed lung cancer patients are in the advanced stage IV, for which platinum-based chemotherapy is the first-line treatment, either by itself or in combination with surgery or radiotherapy.

Cisplatin, the first-generation platinum-based anticancer chemotherapeutic agent, has the highest potency against lung cancer but carries many severe adverse effects. Cisplatin also …

Elephant And Anchors ‒ Photoelectron Photoion Coincidence Spectroscopy Of Small Oxygenated Molecules, Apeter Weidner

University of the Pacific Theses and Dissertations

The dissociative photoionization reactions of two small, oxygenated organics, namely 1,3-dioxolane and methyl vinyl ketone, were studied by photoelectron photoion coincidence (PEPICO) spectroscopy. Experiments involving 1,3-dioxolane were carried out in the photon energy range of 9.5‒13.5 eV. The statistical thermodynamics model shows that a total of six dissociation channels are involved in the formation of three fragment ions, namely C3H5O2+ (m/z 73), C2H5O+ (m/z 45) and C2H4O+ (m/z 44), with two channels contributing to the formation of each. By comparing the results of ab initio quantum chemical calculations to the experimentally derived appearance energies of the fragment ions, the most …

Studies On The Size And Non-Planarity Of Aromatic Stacking Moiety On Conformation Selectivity And Thermal Stabilization Of G-Quadruplexes, Mandeep Singh

University of the Pacific Theses and Dissertations

Targeting DNA has the advantage over proteins for cancer remediation because of the fewer copies of the ligands required for the desired therapeutic effect. Traditionally, covalent DNA binders like alkylating agents have been used to induce genetic instability through the formation of DNA lesions and strand breaks, leading to cellular apoptosis. The primary drawback of this treatment is the non-specific binding that affects both cancerous and non-cancerous cells. G-quadruplexes are the DNA secondary structures that are present in abundance near the promoter regions of the oncogenes and are involved in the regulation of their activities. A ligand-mediated stabilization of G-quadruplexes …