Nursing Commons^™

Perceptions Of Health Practices And Interactions With The Us Healthcare System Among Bhutanese Refugees: A Qualitative Approach, Amy E. Szajna

Journal of Refugee & Global Health

Purpose

The aim of this pilot study was to explore health practices of Bhutanese refugees and their interactions with the US healthcare system and providers.

Methodology

Researchers conducted 12 in-depth interviews and 7 patient-provider observation units as part of this descriptive qualitative study.

Results

Participants identified individual definitions of health and behaviors they value to maintain health. They identified significant trust and faith in their healthcare provider and valued provider-directed suggestions. Participants cited concerns with patient-provider communication resulting from limited English proficiency and frequent changes in primary care providers.

Discussion

This study is useful to inform further research and potential …

Barriers That Restrict Health Care Access For The Deaf Community And Interventions For Improved Patient Quality Care, Jacqueline Meraz

Grace Peterson Nursing Research Colloquium

Background: Deaf patients have lower levels of health literacy, given less health prevention, more likely to engage in harmful behaviors, and had higher rates of health disparities compared to the hearing population. Deaf people avoid healthcare because of their distrust of healthcare providers, and their previous negative experiences regarding communication issues. Barriers that restrict health care and proposed interventions were studied regarding the deaf patient population to account for these disparities.

Objectives: The purpose of this literature review is to identify barriers that deaf patients face when seeking healthcare and was framed using the Cultural Care Theory.

Method: An integrative …

Formula And Milk Food Insecurity Amongst Infants And Children In Wic Families, Kristen Hench

Grace Peterson Nursing Research Colloquium

No abstract provided.

Commencement Program 2019, Loma Linda University

Commencement Programs

CONTENTS

1 | Message from the President

3 | 2019 Events of Commencement

5 | The Academic Procession

7 | Significance of Academic Regalia

9 | The Good Samaritan

10 | University History Highlights

12 | Loma Linda University Song - "Healing Love"

13 | Criteria for Institutional Awards—Loma Linda University and Loma Linda University Health

15 | Loma Linda University Health and Loma Linda University Honorees

34 | The Programs, The School Honorees, and The Speakers

• School of Medicine, 35
• School of Pharmacy, 66
• School of Dentistry, 79
• School of Allied Health Professions - Allied Health Studies, Cardiopulmonary Sciences, …

Missed Shots: Increasing Flu Vaccine Documentation Utilizing A Clinical Reminder In A Student Health Clinic, Noelle Simms

Doctor of Nursing Practice Final Manuscripts

Objectives: The primary purpose of this evidence-based practice project is to increase influenza vaccination documentation in the student health setting utilizing a standardized clinical reminder.

Participants: 1,337 undergraduate and graduate students at a private university is Southern California.

Methods: A clinical reminder template was created and added to the intake form in the electronic medical record. The medical assistants complete the template with the patient. The provider then orders the vaccine or educates the patient based on the documented refusal reason.

Results: During the 10-week implementation period there was a 46% increase from baseline in flu vaccine documentation at the …

Understanding The Impact Of A Perinatal Mood And Anxiety Disorders Phone Support Line, Diana Nguyen, Semira Semino-Asaro

Doctor of Nursing Practice Final Manuscripts

Postpartum depression affects one in every seven women and anxiety is estimated to range from 13-21% in new mothers. Risk factors include prior diagnosis of depression, family history of depression, having medical complications during childbirth including a premature baby and a lack of social, emotional support. The purpose of this evidence-based practice project was to increase the amount of data gathered by a local perinatal support organization by analyzing the callers’ demographics through phoneline surveys and use the information to expand resources and access to care for mothers with perinatal mood and anxiety disorders (PMADs). The project was guided by …

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …

Optimizing An Order Set To Streamline Health Care Delivery In The Emergency Department For Patients Requiring Hiv Post-Exposure Care, Marlisha Smith

Doctor of Nursing Practice Final Manuscripts

Background: The Centers for Disease Control and Prevention (CDC) updated guidelines to support efforts to decrease the number of Human Immunodeficiency Virus (HIV) incidences. The principle method for risk reduction utilized in the guidelines is the 28-day non-occupational post-exposure prophylaxis (nPEP) antiretroviral course administered within 72 hours of exposure. Despite this recommendation, adherence to a full 28-day course nPEP is very low nationally. Root cause analysis completed at the study site indicated that the use of an outdated order set caused unwarranted variability in care which accounted for failure in the delivery of appropriate nPEP care and low medication adherence. …

The Lived Experience Of Discharged And Readmitted African Americans With Chronic Obstructive Pulmonary Disease To A Safety-Net Hospital, Kiiyonna Jones

Dissertations

Background:Chronic Obstructive Pulmonary Disease (COPD) is a debilitating respiratory disease that negatively affects the quality of life of those affected and has been a major contributor to the continuous rise in healthcare cost in the Unites States (Guarascio, Ray, Finch, & Self, 2013; National Heart Lung and Blood Institute, 2009; Shavelle, Paculdo, Kush, Mannino, & Straus, 2009; Scott, Smith, Sullivan, & Mahajan, 2001). In 2014, Centers for Medicare & Medicaid Services (CMS) identified COPD as an applicable condition to the Hospital Readmissions Reduction Program, which penalizes healthcare organizations having readmissions higher than the national average. COPD is the second …

Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr

Doctor of Nursing Practice Final Manuscripts

Purpose: Evaluation of an evidence-based protocol that measures the effectiveness of universal depression screening at an integrated healthcare center. At risk patients are those who complete a patient health questionnaire (phq-9) and score ≥ 10 when presenting for a primary care visit. A score of ≥ 10 prompts further evaluation by the primary care provider (PCP) prior to behavioral health care management (BHCM) referral.

Background: In 2016, 16.2 million adults aged 18 or older in the U.S. experienced a major depressive episode (MDE). 65.3% of those received some form of treatment from a healthcare professional (therapy and/or medication). Early identification …

Increasing Long Acting Reversible Contraception Use In Primary Care: Removing The Barriers, Jessamyn Phillips

Doctor of Nursing Practice (DNP) Projects

Problem: Unintended pregnancy is a serious public health concern. About half of all pregnancies in the United States are unintended (Guttmacher Institute, 2016). This project lead by a Doctor of Nursing Practice (DNP) student at the University of San Francisco, will showcase the development, implementation, and evaluation of a LARC training program aimed at improving confidence in counseling, competence in insertion, and evaluation increased rates of LARC usage in primary care, directed at reducing unintended pregnancy rates. This program expands upon the Healthy People 2020 goals dedicated to family planning and emphasis on increased utilization of the most effective forms …

Adolescent Sexual Reproductive Health Course: A Mixed Media Intervention And Quality Improvement Project In A School-Based Setting, Stephanie Calabrese

Doctor of Nursing Practice (DNP) Projects

Section I: Abstract

Problem: California’s adolescents carry a significant burden of newly acquired sexually transmitted infections (STIs) and gaps in adolescent sexual and reproductive health (SRH) knowledge have led to poor adolescent health outcomes. (CDE, 2019). Context: The California Healthy Youth Act (AB 329) was enacted on January 1, 2016, calling all school districts to ensure that all pupils receive comprehensive sexual health education, and HIV prevention education (CDE, 2019). In a proactive motion, parents from a northern California middle school approached a university to provide a Doctor of Nursing Practice (DNP) student to instruct its sixth grade’s …

Enhancing Nutrition Education For School Aged Children; A Preventive Health Measure And Quality Improvement Project, Fanny M. Powell

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of the DNP project was to improve nutritional knowledge of the adolescents at Kings Canyon Unified School District while also improving their perceived ability to choose healthy food. This project was enveloped in a larger community outreach mission utilizing a free school-based clinic for the purposes of providing sports physicals to students and health screening and physicals to the community. Additionally, nurse practitioner students engaged in a cultural immersion experience through clinical rotations in Central Valley.

Methods: Adolescent students who registered for the clinic watched a nine-minute nutrition video, created by the DNP student, while waiting …

The Effects Of A Mobile Fitness Application On Weight Management And Physical Acticity Amongst University Students, Erica Deenihan

Evidence-Based Practice Project Reports

The prevalence of obesity, and obesity related diseases throughout America, specifically in regard to the college student population has steadily climbed over the course of the last forty years, due largely in part to the increase in sedentary lifestyle behaviors, amongst other factors (Swanson, 2016). Physical activity has been widely recognized as a valid means of combatting obesity and weight gain while promoting health related quality of life (Swanson, 2016). Therefore, implementing strategies aimed at increasing physical fitness in attempt to control weight management is imperative to promoting improved health outcomes. The purpose of this evidence-based project was to examine …

The Effect Of Home Blood Pressure Monitoring And Self-Titration On Achieving Blood Pressure Targets, Katina A. Varner

Evidence-Based Practice Project Reports

One-third of U.S. adults over the age of 20 are hypertensive, with an estimated cost of $47.5 billion in direct medical expenses and increased individual CVD risk (CDC, 2018). Routine office visits afford primary care providers a means of managing hypertension; however, time constraints limit the ability to accurately assess and track BP in most patients (Jung, 2015). The purpose of this project was to determine if implementation of HBPM and an algorithm for selftitration of antihypertensive medications increased the number of participants at guideline recommended BP goal over a 90-day period. The Health Promotion Model provided the theoretical framework …

Clinical Practice Guideline Adherence: Primary Prevention Of Cardiovascular Disease In At-Risk Adults, Sharnita L. Rice

Evidence-Based Practice Project Reports

The American College of Cardiology (ACC) and the American Heart Association (AHA) (2013; 2016), as well as the American Diabetes Association (ADA) joined forces to create clinical practice guidelines (CPGs) recommendations for healthcare providers (HCPs) to follow with the aim of preventing cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality in the United States. The Centers for Disease Control (2017a) estimates CVD costs 325 billion dollars annually. Although CVD has an astronomical cost associated with it, CPG adherence continues to be an issue among HCPs and improvement is warranted. The purpose of this EBP project …

The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava

Evidence-Based Practice Project Reports

The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient outcomes, …

Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif

Evidence-Based Practice Project Reports

The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care …

Rural Hospital Nursing Skill Mix And Work Environment Associated With Frequency Of Adverse Events., Jessica G. Smith, Colin M. Plover, Moira C. Mcchesney, Eileen T. Lake

College of Population Health Faculty Papers

Introduction: Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events.

Objectives: The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals.

Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. …

Childhood Obesity: Getting Back To The Basics, Fanny Powell

DNP Qualifying Manuscripts

Childhood obesity is an epidemic that affects the nation. The Centers for Disease Control and Prevention (CDC) (2015) states that over the past thirty years, the prevalence of childhood obesity has more than doubled in younger children and quadrupled in adolescents (CDC, 2015). Although obesity is a multifactorial health issue that is affected by genetics, metabolic factors, socioeconomic factors, and lifestyle choices (Stanford, 2018), a majority of pediatric obesity is as a result of consuming more energy than the body utilizes. There are both immediate and long-term consequences of obesity that negatively affect a child’s health which may carry over …

The Efficacy Of An Educational Intervention To Improve Low Influenza Vaccination Rates Among Federal Health Care Workers, Cynthia Berfect-Shelby

Electronic Theses and Dissertations

Influenza is a preventable communicable illness that has a significant impact on people of all ages. In 2018 it was estimated that 80,000 people died of influenza-related illnesses. Infants and elderly people are among the most vulnerable populations. The Centers for Disease Control and Prevention and Healthy People 2020 recommend that health care facilities have a 90% vaccination rate. Despite the recommendations and a mandatory directive, many facilities within the Veterans Health Administration struggle to reach influenza vaccination rates above 60%. Pender’s health promotion model was used as the theoretical framework to explore the reasons why health care workers refuse …

A Multifaceted Approach To Antibiotic Stewardship In The Outpatient Clinical Setting For Bronchitis, Elizabeth A. Weaver

Evidence-Based Practice Project Reports

Antimicrobial resistance is a world-wide health crisis (Infectious Disease Society of America [IDSA], 2016; World Health Organization [WHO], 2017) expedited by the overuse/inappropriate use of antibiotics. In the outpatient setting it has been determined that approximately 60% of antibiotic therapies are prescribed (Centers for Disease Control and Prevention [CDC], 2016). Antibiotic stewardship is the coordinated effort to improve the use of antibiotic therapies, minimize misdiagnosis and delayed diagnosis and select appropriate antibiotic drug regimens (IDSA, 2016). The purpose of this evidence-based practice project was to evaluate the effects of an antibiotic stewardship program (presentation, survey collection, bimonthly e-mail reminders, patient …

Use Of Smartphone Application To Facilitate Weight Loss And Promote Accountability In Obese And Overweight Patients, Angela M. Turner

Evidence-Based Practice Project Reports

In 2015, the U.S. Department of Health and Human Services published a National Health and Nutrition Survey (NHANES) on obesity from 2011 through 2014. From the survey, it was determined that the prevalence of obesity in the U.S. was 36% in adults and 17% in young adults/children (Ogden et al., 2015). Lifestyle modifications including moderation of caloric intake and increased exercise have been shown to be effective for both prevention and treatment of obesity. The purpose of this evidence-based practice (EBP) project involved the design, administration, and evaluation of a technology-assisted weight loss intervention to address the health problem of …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough

Evidence-Based Practice Project Reports

As a leading cause of death worldwide, coronary artery disease affects people of all races and ethnicities. The foundation for the prevention of secondary fatal cardiac events, such as stroke or myocardial infarction, is lifestyle modification to effectively lower cholesterol levels. Lifestyle change impacts diet, physical activity, smoking habits, vital sign measures, and stress management. The purpose of this evidence-based practice project was to reduce implement a lifestyle intervention to lower LDL-C levels and promote healthier lifestyles. This practice change was developed utilizing Stetler’s Research Utilization model to promote evidence-based practice changes in the clinical setting. Nola Pender’s Health Promotion …

The Effects Of A Dementia Simulation Experience On Attitudes Towards People With Dementia, Micah Huckabee

Health, Human Performance and Recreation Undergraduate Honors Theses

Introduction: The neurodegenerative effects of dementia resulting in cognitive and behavioral impairments is plausibly one of the reasons for a societal stigma towards individuals with dementia. Societal stigmas are associated with decreased life satisfaction, depressive symptoms, and decreased psychological well-being for stigmatized individuals. In an effort to improve attitudes towards individuals with dementia, this study utilized a dementia simulation to measure attitudinal changes after a dementia simulation. Methods: There were 33 participants in this study (13 male and 20 female) between the ages of 18 and 25. Participants completed a Dementia Attitudes Scale (DAS) survey, and then they dressed in …

The Perception Of Iron-Deficient Anemia In Bolgatanga, Ghana Among Women Of Childbearing Age, Sydney Albrecht

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Objective: To understand the perception of anemia among the women of childbearing age in Bolgatanga, Ghana, and to correlate the reasoning with the high incidence of anemia in the area.

Method: This research was a qualitative study consisting of 67 interviews over the course of the three weeks that were spent in Bolgatanga. 50 of these interviews were women of childbearing age (15-49), 6 were health professionals, and 11 were women older than the age range provided. Interviews were taken from the maternity clinics nearby as well as from women in a rural area that was a 10-minute taxi ride …

Implementing An Honors Nonprofit Internship: Hub Of Hope, Janet Wagner

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Human trafficking is the term used to describe modern-day slavery, which is a global problem, but it is also present here in the United States. During this last year, I have worked with the Northwest Arkansas nonprofit Hub of HOPE. This organization, founded in 2016 by Jennifer Sorey, supports victims of human trafficking and raises awareness by educating Arkansans on the pervasiveness of human trafficking and its implications for our community. As part of my work, I completed the Sexual Assault Nurse Examiner training to understand how to work with human trafficking victims who are also victims of sexual assault …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

Correlation Between Myostatin And Lean Muscle Mass In Older Adults, Mishann Luedders

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Correlation Between Myostatin and Lean Muscle Mass in Older Adults.

Luedders, M., Gray, M., Patton, S., Washington, T., Binns, A. Exercise Science Research Center, University of Arkansas, Fayetteville, AR.

Background: Our older adult population is growing exponentially and with it, the number of falls and debilitating injuries that afflict their population grows as well. A fall brings with it many possible injuries, healthcare costs, fear and increased mortality. There seems to be a lack of preventative measures in our healthcare system to help protect our elders. One possible measure is a simple blood test that looks at the level of …