Nursing Commons^™

The Impact Of Bullying Victimization And Sexual Orientation On The Severity Of Suicidal Behavior, Annalyn Demello

Dissertations and Theses (Open Access)

Background: Lesbian, gay, and bisexual (LGB) youth face a disproportionate risk of suicidal ideation and attempt compared to their heterosexual counterparts. The Minority Stress Theory and Interpersonal Theory of Suicide posit that chronic stress, which can occur as a result of bullying victimization, can lead to loneliness, self-hate, and suicidal ideation. The escalation from ideation to attempt can occur quickly, and most youth who survive suicide attempts pursue subsequent, riskier attempts. It is crucial to intervene when behaviors are less severe. The primary aim of this study was to compare the magnitudes of association between independent variables (bullying and sexual …

Molecular Diagnosis Of Intestinal Parasites: Impact On Growth Among Preschool-Age Children In Rural Ecuador, Patricia Bryan

Dissertations and Theses (Open Access)

Background: Gastrointestinal (GI) parasites may have important influences on growth outcomes during early childhood. Previous studies investigating the effects of GI parasites on growth have predominantly used microscopy-based diagnostic methods with low sensitivity. Few accurate epidemiologic data are available on GI parasitic infections among rural Ecuadorian children. To investigate the impact of single and multiple GI parasite infections on growth during early childhood data from a longitudinal birth cohort in Ecuador were analyzed.

Purpose: The aims of this study were to determine the prevalence of GI parasites (soil-transmitted helminths and intestinal protozoa) and to describe associations between GI parasitic infections …

Understanding Motivation To Lead In Nurses, Janete Sheiner

Dissertations and Theses (Open Access)

Background: Nurse leaders are indispensable to the delivery of quality, patient-centered care. They are influential in the practice environment, contributing to front-line staff job satisfaction. They work to improve retention, turnover, organizational health, and patient outcomes. Yet, there is a dearth of research investigating the motivating factors that appeal to, encourage, discourage, and help retain nurse leaders in their roles. The forecast of a shortage of nurse leaders, along with the reluctance of nurses to assume leadership roles, is affecting healthcare organizations throughout the United States. An in-depth understanding of the underlying factors related to motivation that appeal to, encourage, …

Caregivers Of Medically Fragile Children With Technology Needs, Vuong Prieto

Dissertations and Theses (Open Access)

Background: Medically fragile children (MFC) with technology needs have complex and challenging health care needs in the home setting. Providing care can have both negative and positive psychological and social impacts on the caregivers’ health related quality of life (HRQOL).

Aims: a) To examine the relationship between caregiver burden, caregiving satisfaction, and HRQOL in caregivers of MFC with technology needs. b) To identify caregiver and child related variables of caregiver burden and caregiving satisfaction.

Methods: A cross sectional study was conducted over four months at a children’s hospital and outpatient clinics. Caregivers completed three one-time surveys (Zarit Burden Interview, Caregiving …

Left Ventricular Assist Device Adjustment Impacted By Patient Trajectory: A Qualitative Exploratory Study, Brittany Rhoades

Dissertations and Theses (Open Access)

Background: Left Ventricular Assist Devices (LVADs) are used as advanced therapy for advanced heart failure in order to sustain patients until a heart transplant is available (bridge to transplant, ‘BTT’) or until the end of life (destination therapy, ‘DT’). Despite the differences in treatment trajectory, BTT and DT patients are provided the same education. Currently it is unknown if the two groups compare to living with the LVAD regarding adjustment.

Aims: The aim of this study was to explore LVAD patient experience, describe how patients construct the impact of the LVAD on daily life and self-care and compare the findings …

Pediatric Intensive Care Hospitalization: Sibling Experience, Karla Abela

Dissertations and Theses (Open Access)

Prior research on the impact of pediatric intensive care unit (PICU) hospitalization on families have been predominantly focused on the parents, yet siblings who visit the ill child in the PICU environment remain understudied. The aim of this study was to describe the experiences of 9- to 17-year-old siblings of acutely critically ill or injured children. A generic qualitative approach using one-to-one interviews, observations, and clinician notes was used to gain an understanding of the experience of siblings who visited the PICU. Qualitative analytic methods were used to analyze the data. The findings from 16 siblings (mean age 6.3 years) …

Latino Perspectives In Childhood Fever Management: A Focused Ethnography, Darlene Acorda

Dissertations and Theses (Open Access)

Background: Fever is the most common presenting complaint in the pediatric setting. Latino parents have greater misconceptions and are less knowledgeable of fever compared to other groups. They are more likely to believe that fever can cause serious harm and to present to the emergency department for non-emergent illness. Latino health practices are heavily influenced by cultural beliefs, yet few studies have focused on parental fever perception in this rapidly growing population. It is estimated that by 2050, 32% of the U.S. child population will be of Latino descent. Understanding the Latino perspective is a critical first step to …

Maternal And Newborn Outcomes For Women Living With Hiv In Adapted Group Prenatal Care, Jodi Behr

Dissertations and Theses (Open Access)

Background: For women living with HIV (WLWH), managing HIV and their pregnancy can be challenging. WLWH have been identified at risk for lower adherence to prenatal care, increased maternal HIV Plasma RNA levels, decreased newborn gestational age, and newborn birth weight. Improved outcomes have been found with group prenatal care. Maternal and newborn outcomes for WLWH and their newborns in group prenatal care compared to WLWH and their newborns in individual care have not been evaluated.

Purpose: The aims of this study were to evaluate group differences between WLWH who attended individual prenatal care appointments (IC) compared to WLWH who …

Evaluation Of An Advanced Quality Improvement Program, Arjun M. Dangre Bds Mph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Texas Children’s Hospital implemented the Advanced Quality Improvement and Patient Safety Program (AQI) in 2009, designed to train clinicians and staff to develop leaders in quality improvement to improve patient care, lower costs, change culture, and lead improvement initiatives at the organization. Evaluations of the AQI programs measured the program’s effectiveness in achieving its goals and objectives. This paper describes the Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety program (AQI,) the program’s evaluation processes, and show the results of the evaluation of the AQI programs using evaluation surveys completed by QI participants over the span of 13 successful …

Caring Minds, Uthealth Cizik School Of Nursing

Caring Minds

No abstract provided.

Perceptions Of Nurses After The First Year Of Practice: Expectations And Reality, Susan R. Lesser

Dissertations and Theses (Open Access)

Background: The nursing profession is facing a critical shortage stemming from retirement of experienced nurses, increasing healthcare needs of an older population, and more inclusive healthcare coverage. Newly licensed nurses (NLNs) have been the long-term plan to fill the gap. Despite the support from nurse residency programs (NRPs), many of these graduate nurses are leaving their first position. This turnover of nurses is detrimental to the nursing shortage, and financially burdensome for health care systems.

Purpose: Two aims were explored: 1) to better understand the perceptions of newly licensed nurses after the first year of practice about their expectations and …

Vasopressor Titration In Medical Intensive Care Patients With Septic Shock: A Descriptive Study, Daniel Arellano

Dissertations and Theses (Open Access)

Background: Vasopressor therapy in patients with septic shock can lead to harmful effects.

Objective: To describe vasopressor titration in patients with septic shock.

Methods: Single-center descriptive study of 60 intensive care unit (ICU) patients to calculate rates for events of failure to titrate, incorrect titration, and correct titration in 15- minute intervals for the duration of vasopressor therapy. Total hospital and ICU days, mortality rate, vasopressor dose and time, and the impact of hydrocortisone on vasopressor use were examined.

Results: During the total vasopressor infusion time of 2598 hours, 5395 failure-to-titrate events were noted. There were 316 incorrect titrations and …

An Exploration Of Psychosexual Functioning And Factors Affecting The Prophylactic Decision-Making Process In Women Of Childbearing Age With A Brca 1/Brca2 Mutation, Alexis Hayes

Dissertations and Theses (Open Access)

Background: A breast cancer type 1 and type 2 susceptibility protein (BRCA1/BRCA2) gene mutation carries an 85%- 90% lifetime risk of developing breast cancer and a 27%-65% chance of developing ovarian cancer. There is minimal evidence regarding how psychosexual functioning, the psychological well-being in regards to body image and sexuality, affects the decision to have prophylactic treatment in women of childbearing age (18 - 49) with a BRCA gene mutation. Diagnosis of a BRCA gene mutation presents a dilemma where life-changing medical decisions must be made to prevent breast and ovarian cancer. Throughout decision-making and following surgical prophylactic interventions, such …

Mhealth Acceptance And Usage Among South Asian Adults In The U.S., Padmavathy Ramaswamy

Dissertations and Theses (Open Access)

Background: Modifiable lifestyle factors such as physical inactivity and unhealthy diet contribute to the increased risk of cardiovascular diseases (CVD) and diabetes (DM) in South Asians (SAs) (Volgman et al., 2018). Interventions using mobile health (mHealth) have demonstrated feasibility and potential efficacy for ethnic minorities (Bender et al., 2018), and have the potential to be of preventive and therapeutic value in reducing the burden of CVD and DM in SAs living in the US. However, there is a gap in knowledge regarding the usage and acceptance of mHealth among SAs.

Purpose: The objectives were to examine the overall …

Predictors Of Short-Term Residential Treatment Completion Preceded By Detoxification For Opioid Use Disorder, Christopher Gideon

Dissertations and Theses (Open Access)

Background and Significance: Deaths related to opioid overdose are increasing. Treatment for opioid use disorder (OUD) is necessary to help prevent future opioid abuse, and often involves opioid detoxification, followed by short-term residential treatment, typically lasting about 28 days. Literature regarding OUD and short-term residential treatment is limited. Predictors of short-term residential completion, including whether detoxification was performed, may help addiction professionals individualize treatments. This study’s purpose was to determine predictors of short-term residential completion treatment for OUD, and whether detoxification prior to entering residential treatment may also be a factor in residential completion.

Method: De-identified data regarding …

Understanding Diabetes Health Beliefs And Health Practices In Vietnamese Americans, Linda Sheen

Dissertations and Theses (Open Access)

Background: Diabetes related complications resulting in mortality and morbidity are higher among Vietnamese individuals living in the U.S. with diabetes. Few studies have examined the personal perceptions and cultural beliefs pertaining to disease management. An in-depth understanding of perception and cultural beliefs in regard to diabetes self-management is needed for the development of culturally appropriate interventions in this population.

Purpose: Two specific aims were explored: 1) To explore how Vietnamese individuals living in the U.S. with prediabetes and diabetes conceptualize diabetes self-management and; 2) to understand how Vietnamese individuals living in the U.S. with prediabetes and diabetes integrate …

Vitamin D Status And Risk Of Incident Tuberculosis Disease: A Nested Case-Control Study, Systematic Review, And Individual-Participant Data Meta-Analysis, Omowunmi Aibana, Chuan-Chin Huang, Said Aboud, Alberto Arnedo-Pena, Mercedes C Becerra, Juan Bautista Bellido-Blasco, Ramesh Bhosale, Roger Calderon, Silvia Chiang, Carmen Contreras, Ganmaa Davaasambuu, Wafaie W Fawzi, Molly F Franke, Jerome T Galea, Daniel Garcia-Ferrer, Maria Gil-Fortuño, Barbará Gomila-Sard, Amita Gupta, Nikhil Gupte, Rabia Hussain, Jesus Iborra-Millet, Najeeha T Iqbal, Jose Vicente Juan-Cerdán, Aarti Kinikar, Leonid Lecca, Vidya Mave, Noemi Meseguer-Ferrer, Grace Montepiedra, Ferdinand M Mugusi, Olumuyiwa A Owolabi, Julie Parsonnet, Freddy Roach-Poblete, Maria Angeles Romeu-García, Stephen A Spector, Christopher R Sudfeld, Mark W Tenforde, Toyin O Togun, Rosa Yataco, Zibiao Zhang, Megan B Murray

Faculty, Staff and Student Publications

BACKGROUND: Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk.

METHODS AND FINDINGS: We assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. …

An Examination Of Student Performance In Pre-Requisite Coursework And Upper Division Nursing Coursework, Jennifer L. Brown, Cheryl M. Smith

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Admission and retention of qualified nursing students are essential in meeting the demands of a rapidly changing health care environment and nursing shortage. The purpose of this exploratory correlational study was to determine the relationship between student performance in quantitative pre-requisite coursework and student performance in upper division nursing coursework in order to identify students at-risk for attrition. A series of descriptive and correlational analyses were conducted using pre-existing institutional data. A moderate relationship existed among the chemistry II and first-year upper division nursing courses (r = .21 to r = .40). These results suggest that prerequisite chemistry course …

Use Of Best Practice Alerts To Improve Adherence To Evidence-Based Screening In Pediatric Diabetes Care, Daniel Desalvo, Sara K. Bartz, Blair Mockler, Rona Y. Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database …

Implementation Of A Critical Incident Stress Management Program For Nurse Anesthetists., Peter C. Slivinski, Joanne V. Hickey

Journal of Nursing & Interprofessional Leadership in Quality & Safety

BACKGROUND: Healthcare is a stressful profession where in addition to routine stressors, there are critical incident (CI) events which are occurrences capable of overwhelming an individual’s normal coping mechanisms. The purpose of this quality improvement project was to improve the process by which certified registered nurse anesthetists (CRNAs) exposed to critical incident events are provided post-critical incident support thus mitigating the potential for CI stress

METHODS: We created a CI stress management pilot program for nurse anesthetists employed by an academic hospital located in the Southeastern United States. The program was based upon concepts introduced by Medically Induced Trauma Support …

What You Need To Know About Bar-Code Medication Administration, Marie E. Mcbee Dnp, Msn, Martha Kuhlmann Dnp, Msn, Rn, Fnp, Pmhcns-Bc, Aprn, Pam Patterson Dnp, Msn, Ne-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and …

Peripheral Intravenous Infiltrates: Engaging Staff To Increase Reporting, Emily Weber, Kimberly Castrillon, Joyce Ramsey-Coleman

Journal of Nursing & Interprofessional Leadership in Quality & Safety

A large free standing children’s academic hospital aimed to improve patient safety and outcomes by decreasing the overall severity of peripheral intravenous infiltration and extravasations (PIVIEs). A care bundle was developed by creating a PIVIE measurement tool within the electronic medical record (EMR) and integrating the tool into standardized daily practice for nurses. The care bundle included creating a team of clinical leaders consisting of empowered bedside nurses acting as mobilized resources embedded into each unit. The initiative resulted in a large scale increase in reported PIVIEs system-wide within 1 month of education dissemination to bedside RN staff. The QI …

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

The Effect Of Meditation On Stroke-Survivor Resilience: Secondary Analysis Of Existing Data, Mary Love

Dissertations and Theses (Open Access)

Purpose: To test the effect of meditation on resilience of community-dwelling stroke survivors, and to identify resilience predictor variables in these survivors.

Methods: Sub-study with secondary analysis of existing data from the parent study, MEditatioN for post stroke Depression (MEND). Paired samples t-test was used to evaluate the effect of meditation on resilience of stroke-survivors (n=20) in the intervention group. Bivariate analysis and general linear modeling (GLM) were used to identify demographic, clinical, and psychological predictor variables of baseline resilience for all stroke survivors (n=34).

Results: The increase in stroke-survivor resilience scores from baseline (mean 3.46, SD=.81) to intervention completion …

Human Papillomavirus Vaccination Status And Endorsement Among Undergraduate Nursing Students: A Secondary Data Analysis, Ashley Hollins

Dissertations and Theses (Open Access)

Background: Human papillomavirus (HPV) vaccination has immense potential to prevent HPV-related infections but vaccination rates remain suboptimal. Nurses could potentially increase vaccination rates by providing recommendations and addressing vaccine concerns. As student nurses’ transition into practice, it is important to identify factors that could influence their attitudes and uptake of the HPV vaccine; however, these factors remain unknown.

Purpose: We proposed to: (1) identify factors associated with HPV vaccination status and (2) to identify student nurses’ perception of parental vaccine hesitancy, preferred counseling strategies, and factors associated with intention to counsel parents on HPV.

Methods: The current study was a …

Impact Of Adult Attachment Style On Outcome Trajectories In A Parent-Focused Early Language Development Intervention, Cary Cain

Dissertations and Theses (Open Access)

Background: Disparities in early language development have been noted for children from low-income homes, which can impact their educational and health trajectory. The quantity and quality of language exposure in the home environment influences a child’s language development. Adult attachment style is a predictor of parenting behavior and could impact critical interactions between the parent and child. Evidence demonstrates that differences in adult attachment style impact program participation and outcomes in early childhood parenting programs delivered through home visitation.

Aims: The aims of this study were to 1) explore the association of adult attachment style on intervention outcome trajectories from …

Relationships Among Optimism, Inflammation, And Stroke Recovery, Yun-Ju Lai

Dissertations and Theses (Open Access)

Objective: Post-stroke inflammation is detrimental to the brain and results in an unfavorable recovery. Optimism has been associated with lower inflammation and better health outcomes among people with medical conditions, but no studies have assessed this association in the stroke population. The overall goals were to examine the relationships among optimism, stroke severity, physical disability, and inflammation during hospitalization and evaluate the relationships among optimism, inflammation, and stroke recovery over the three-month post-stroke period.

Methods: This study was a secondary analysis of data collected from the BioRepository of Neurological Diseases biobank. Outcomes included optimism, stroke severity, physical recovery, and inflammatory …

Exploring Occupational Stress Among Nurse Leaders: Factors Influencing Nurse Leader Retention And Organizational Commitment, Nnenna Emelogu

Dissertations and Theses (Open Access)

Background: Nurse leader sustainability is essential to organizational climate and patient care outcomes. The state of science of nurse leader sustainability is fragmented and warrants critical examination. Current research exists examining the impact of occupational stress among frontline nurses. However, research is scarce exploring occupational stress among nurse leaders.

Purpose: To narrow knowledge gaps by exploring perceptions of occupational stress among nurse leaders and their responses to stress.

Methods: A generic qualitative descriptive approach was used to explore perceptions of occupational stress among nurse leaders. The final sample consisted of 17 participants via purposive sampling. Thematic content analysis was used …

Waiting For A Liver Transplant: A Qualitative Study, Ayoka Badmus

Dissertations and Theses (Open Access)

Background: Advances in liver transplantation have significantly improved survival rates, making liver transplant a viable option for those with End Stage Liver Failure (ESLF). However, patients diagnosed with ESLF may experience a significant period of waiting before a liver transplant surgery, due to a limited supply of donor livers. Empirical evidence is scarce on the experience of patients waiting for a liver transplantation.

Objective: The objective of this study was to explore the waiting experience of patients diagnosed with ESLF and to identify their perceived challenges and needs while waiting for a liver transplant.

Methods: Using a generic qualitative …

Sustainability In Quality Improvement And Patient Safety Initiatives, Angelo P. Giardino, Eileen R. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term 'evaporation of improvements' addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & …