Medical Specialties Commons^™

Growing Evidence For The Impact Of Air Pollution On Depression, Naureen Akber Ali, Adeel Khoja

School of Nursing & Midwifery

No abstract provided.

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Factors Associated With Hospital Readmissions Among United States Dialysis Facilities, Amber B. Paulus

Theses and Dissertations

Hospital readmissions are a major burden for patients with end stage renal disease (ESRD). On average, one in three hospital discharges among patients with ESRD are followed by a readmission within 30 days. Currently, dialysis facilities are held accountable for readmissions via the ESRD Quality Incentive Program standardized readmission ratio (SRR) clinical measure. However, little is known about facility-level factors associated with readmission. Additionally, unlike other standardized measures of quality in the dialysis setting, incident patients within their first 90-days of dialysis are included in the performance calculation. This study analyzed CMS Dialysis Facility Report data from 2013 to 2016 …

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …

Adaptation And Validation Of The Situation Awareness Global Assessment Technique For Student Registered Nurse Anesthetists, Deniz Dishman

Theses and Dissertations

Anesthesia is a health care specialty fraught with high workload demands, stressful work environments, increased production pressure, work areas with many distractions, an increasing use of advanced technology, and the constant need to prioritize work actions. Effective clinical judgment in this dynamic environment necessitates that the provider demonstrate the ability to project what may occur secondary to actual or potential condition changes. These key elements operationalize situation awareness (SA).

High level SA is an important characteristic for the successful development of student registered nurse anesthetists (SRNAs). With Endsley’s “Theory of Situation Awareness” as the foundation, the goal of this study …

Health Literacy: Approach To Colon Cancer In African Americans, Judith Jefferson-Gordon

Doctor of Nursing Practice Program Projects

Health literacy is vitally important for African-Americans (AA), with higher incidence and mortality rates of colon cancer compared to Caucasians nationally and in Ohio. Larrabee's Model for Change to EBP and Self -Efficacy Middle range nursing theory guided this DNP project. A retrospective chart review of AA patients with colon cancer was completed to determine types of teaching methods used by nurses during the clinical encounter. A convenience sample (8%) of AA patients received colon cancer care in the ambulatory setting at the healthcare facility in the Midwest. More than half were female and the remainder were male (65% vs. …

Frailty In Patients Undergoing Left Ventricular Assist Device Implantation, Candice Falls

Theses and Dissertations--Nursing

Heart failure is a progressive condition that affects over 5.7 million Americans and costs associated with heart failure account for 2-3 % of the national health care budget. The high rates of morbidity and mortality along with increased costs from readmissions associated with advanced heart failure have led to the exploration of advanced treatments such as left ventricular assist devices (LVADs). LVADS have demonstrated morbidity and mortality benefit but cost remains extensive with costs per quality-adjusted years > $400,000. With this in mind, it is important to identify those who are most likely to benefit from an LVAD to avoid unfavorable …

Gay Men And Satisfaction With Health Care Interactions, Michael Huggins

Theses and Dissertations--Nursing

The purpose of this research was to determine relationships among depression, anxiety, self-rated physical and mental health, self-advocacy, internalized homophobia, and quality of patient-provider communication to satisfaction with health care interactions. These were measured while controlling for select demographic variables: age; ethnicity; urban or rural domicile; relationship status; household income; highest educational attainment; health insurance; disclosure to health care provider as a gay man; reason for last healthcare visit; and, general health self-rating. The specific aims of this study were to: 1) identify general characteristics of gay men in this sample; 2) examine how levels of satisfaction with health care …

Depression Screening For Bariatric Surgical Patients, Cova Teresa Stidham

Walden Dissertations and Doctoral Studies

Obesity in the United States has increased to epidemic numbers over the last decade. Practitioners need to reverse the trend. To address the problem of depression in obesity, a practice guideline from a bariatric clinic for under-served populations was proposed to an expert panel. The Spell Out on First Use (PHQ-9) screening is a valid and reliable self-screening tool to assist the practitioner in determining the level of depression if any. The PHQ-9 has nine questions. No formal screening existed at the bariatric clinic, and the practice guideline (with algorithm and revised workflow) was proposed for use at the clinic. …

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

The Effect Of Narrative Medicine Combined With Medication Assisted Treatment On Decreasing The Desire To Use Intravenous Substances In Hospitalized Patients With Infective Endocarditis, Paula Works

DNP Projects

Substance abuse is a significant problem that spans the nation. Of particular concern is the growing population of patients at UK HealthCare who have endocarditis as a complication from IV substance abuse.

PURPOSE: The aims of this study were

1. To assess the effect of narrative medicine combined with MAT, compared to MAT alone, on desire to use in hospitalized patients with a history of IV substance use
2. To examine the changes in quality of life before and after the introduction of narrative medicine in hospitalized patients with a history of IV substance abuse using The Quality of Life Scale (QOLS). …

The Effect Of Provider Education On Copd Screening Rates In The Primary Care Setting, Kelli Craig

DNP Projects

BACKGROUND: Chronic Obstructive Pulmonary Disease is one of the leading causes of morbidity and mortality in the United States. With early detection, COPD is a treatable disease, highlighting the need for an effective screening measure. The COPD Population Screener Questionnaire (COPD-PS) is a valid, accurate questionnaire that can identify individuals likely to have COPD.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy and screening rates of COPD using the COPD-PS screening tool among primary care providers.

METHODS: This study was a single-center, pre/post implementation study to evaluate …

The Effects Of Compassion Fatigue On Burnout Among Inpatient Psychiatric And Intensive Care Unit Nurses, Amita Madan Neidlinger

DNP Projects

PURPOSE: This DNP project is relevant to nurses of the psychiatric and Intensive Care Unit (ICU) setting, as high stress environments may produce higher rates of compassion fatigue and burnout. Investigation of these areas may help illuminate unnecessary healthcare costs that are associated with these phenomena. This DNP project is important to the University of Kentucky’s healthcare system, its patients, and nurses. Increased absenteeism and increased medication errors are positively associated with the prevalence of compassion fatigue and burnout in nurses. Outcomes from this project will allow identification of unnecessary healthcare costs and encourage administrators to focus on reducing nurse …

Sustainability And Impact Of Lung Health Outpatient Resource Center, Maureen Lintner, Jose Morales, Rosario Dominguez, Margarita Pallares, Maribel Matos, Robert Ramirez, Tina Hyman, Cristiana Rivas

All Publications

No abstract provided.

Factors Contributing To The Negative And Unhealthy Psychological Conditions In The Ed Rn, Ariana M. Nieves

Honors Undergraduate Theses

The emergency department is a stressful environment. Emergency department registered nurses (ED RNs) are at an increased risk of development of negative and unhealthy psychological conditions due to their frequent exposure to stress and traumatic events. These conditions include post-traumatic stress disorder, compassion fatigue, and burnout syndrome, which are already known to be common in the emergency department registered nurse population. It is important to understand the factors that influence the development of these psychological conditions in order to provide better education to nurses regarding prevention of the development of these psychological conditions. This literature review aimed to identify articles …

The Maternal Health Behaviours Of Non-Irish Nationals During Pregnancy And The Effect Of Time Living In Ireland, R. Palmer, R. Layte, John Kearney

Articles

Objectives Maternal health behaviours (MHBs) can influence pregnancy outcomes. Despite efforts internationally to encourage positive MHBs, women often fail to comply with pregnancy guidelines. International studies show differences in MHBs between nationalities and an effect of time spent in the host country. There is limited Irish data in this area, with no previous research relating to the effect of time in Ireland.

Study design This study is a cross-sectional analysis of the Growing Up in Ireland infant cohort, a nationally representative longitudinal study. Methods Examination of the MHBs of non-Irish nationals during pregnancy and the effect of time in Ireland …

Patient-Centered Medical Homes In Community Oncology Practices: Changes In Spending And Care Quality Associated With The Come Home Experience, Teresa M. Waters, Cameron M. Kaplan, Ilana Graetz, Mary M. Price, Laura A. Stevens, Barbara L. Mcaneny

Health Management and Policy Faculty Publications

PURPOSE:

We examined whether the Community Oncology Medical Home (COME HOME) program, a medical home program implemented in seven community oncology practices, was associated with changes in spending and care quality.

PATIENTS AND METHODS:

We compared outcomes from elderly fee-for-service Medicare beneficiaries diagnosed between 2011 and 2015 with breast, lung, colorectal, thyroid, or pancreatic cancer, lymphoma, or melanoma and served by COME HOME practices before and after program implementation versus similar beneficiaries served by other geographically proximate oncologists. Difference-in-differences analysis compared changes in outcomes for COME HOME patients versus concurrent controls. Propensity score matching and regression methods were adjusted for …

Perceived Impact Of Ambient Operating Room Noise By Certified Registered Nurse Anesthetists, Marianne S. Cosgrove

Theses and Dissertations

It is widely acknowledged that elevated levels of noise are commonplace in the healthcare environment, particularly in high acuity areas such as the operating room (OR). Excessive ambient noise may pose a threat to patient safety by adversely impacting provider performance and interfering with communication among perioperative care team members. With respect to the certified registered nurse anesthetist (CRNA), increased ambient OR noise may engender distractibility, diminish situation awareness and cause untoward health effects, thereby increasing the possibility for the occurrence of error and patient injury.

This research project analytically examines the perceived impact of ambient noise in the operating …

The Quest For Self: Using Mandala Art In Reflective Practice Journaling, Kathleen Quinn

Comparative Woman

This article is a nexus of research, personal journaling reflections, and mandala creation from the authors own journals and focuses on the use of Mandalas as part of a reflective practice journaling process. Attention to mandala usage within reflective practice considering depth interiority, engaging and sharing with others. The authors approach to mandala construction is included followed by an exercise for observation and assessment of mandalas. The structure for reflective practice helps shape transformational leaders, using expressive arts, narratives in journaling. This transformational Discovery pathway and narrative exercises can be used for creating professional learning communities. This form of reflective …

The Role Of An Advanced Practice Provider (App) And Its Relation To Physician Shortages And Rural Healthcare Survival: A State-By-State Analysis, Allen Anderson

Dissertations, Theses, and Projects

The extent that Advanced Practice Providers (APPs) are able to practice independently with a full scope of practice varies state-by-state. The purpose of this paper was to review how APPs could help in a number of different areas of healthcare. This analysis examines the state of rural healthcare and reviews physician shortage statistics and hospital closures by state. In the examination, it also evaluates which states have full scope, reduced scope, and restricted scope of practice laws and cross-references that with states that have experienced a hospital closure. Through case studies, this research finds that APPs can be an alternative …

Improving Breastfeeding In Rural Tanzania Using Bardach’S Policy Analysis Methodology, Katherine Skiff

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under five years (U5Y) compared to all other preventive interventions. The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. Shirati hospital, in rural Tanzania, does not have a breastfeeding policy. Bardach’s 8-Fold Pathway for policy analysis methodology (adapted by Collins for health policy) was used to evaluate three promising breastfeeding policies to improve compliance with this recommendation. They include …

Use Of Telemedicine To Improve Cpap Non-Adherence In Patients With Obstructive Sleep Apnea, A Pilot Study, Kristin L. Hanger

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

The aim of this project is to improve continuous positive airway pressure (CPAP) non-adherence in patients newly diagnosed with obstructive sleep apnea. Obstructive sleep apnea (OSA) is caused by recurrent collapse of the upper airway during sleep. Untreated, OSA is associated with co-morbidity and decreased quality of life. The standard for OSA treatment is CPAP. Adherence to CPAP is not optimal. Applying telemedicine technology to monitor adherence of CPAP treatment, allows for early intervention. Prior research has shown mixed results with use of telemedicine on non-adherence rates.

This is a pilot study using telemedicine to monitor adherence data to …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis

Doctoral Projects

The management of a difficult airway by anesthesia providers is a core component of providing safe care. Simulation provides an opportunity for the student to manage uncommon clinical scenarios without harm to an actual patient. This project aimed to determine if the use of simulation may be useful in training Student Registered Nurse Anesthetist in the management skills of a difficult airway. The proposed intervention of this project was the addition of simulation experience to didactic lecture covering difficult airway management techniques. As supported in the Adult Learning Principles of Medical Learners, by allowing the SRNA to actively participate in …

Best Practice Policy Recommendation For Neuraxial Anesthesia Skin Antiseptic Solutions, Kyle Adams

Doctoral Projects

A clinical affiliate hospital in Mississippi lacked a best practice clinical policy regarding the most appropriate skin preparation solution to use prior to neuraxial anesthesia. The evidence showed that alcoholic chlorhexidine is the optimal solution due to advanced characteristics which help reduce infection. Reducing infections can potentially reduce further complications for the patient, hospitalization length, and cost. Also, chlorhexidine was found safe to use for neuraxial anesthesia if cross-contamination is avoided and adequate drying time is allowed. Lastly, alcoholic povidone-iodine is an appropriate alternate if 0.5% chlorhexidine is unavailable.

A best practice clinical policy was formulated and presented to a …

The Utilization Of Venous-Venous Extracorporeal Membrane Oxygenation Membrane For The Management Of Status Asthmaticus, Kenneth Miller Msrt, Med, Rrt-Accs, Faarc,, Jennifer Strow Do, Alison N. Bedekovich Msn, Rn

Patient Care Services / Nursing

No abstract provided.

Early Oral Feeding After Bowel Resection, Jennifer Strang

Theses & Dissertations

Research Focus: The primary purpose of this project was to determine if there was an association of factors with time to first solid meal in gastrointestinal (GI) surgery patients and the impact solid diet has on length of stay (LOS) in the hospital, GI symptoms, and incidence of post-operative ileus (POI). A secondary purpose was to observe and describe when an oral diet was started and the progression of diet after GI surgery.

Research Methods: This study was a cross-sectional, retrospective chart review of a convenience sample in a multi-centered hospital system conducted in 84 GI resection patients …

The Politics Of Abortion And Maternal Health: A Discussion Paper, Ihsan Ullah, Ayaz Ayub, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

Abortion should be legally allowed for women because it can save mothers from childbirth-related complications and death. Legal abortion is one of the safest methods to terminate a pregnancy when there is a risk to the mother’s health by childbirth or severe deformity of the fetus or it is unwanted. Unfortunately, approximately half of all abortions worldwide mostly in nations where abortion is severely restricted and are performed in dangerous settings. These risky abortions are a significant contributor to maternal morbidity and disability. Limiting a woman's access to an abortion does not stop abortion; rather, it just encourages more risky …

Screening, Brief Intervention, And Referral To Treatment For Alcohol Misuse In Primary Care, Sai-Han Ackerman Yu

Doctor of Nursing Practice

An annual average of 88,000 deaths in the United States from 2006 to 2010 has been attributed to alcohol misuse, defined as risky or heavy alcohol consumption. Heavy or risky alcohol use for all adults aged 65 and older and for women aged 18 and older is defined as consuming more than 7 drinks per week and/or 3 drinks per day. For men aged 18 to 65 years of age, heavy or risky alcohol use is defined as consuming more than 14 drinks a week and/or 4 drinks a day. Chronic alcohol misuse increases the incidence of heart problems, cognitive …