Nursing Commons^™

The Lived Experience Of Intersectionality Among African American Women With Breast Cancer, Teri D. Armour Burton

Dissertations

African American women (AAW) continue to have breast cancer mortality rates that are 42% higher than White women (De Santis et al., 2015). Researchers suggest that an epistemological approach that integrates the biomedical and feminist models would be more effective in addressing health disparities. The concept of intersectionality, which grew out of the Black feminist movement, provides a lens in which to view the lived experiences of AAW with breast cancer. The intersectionality paradigm attempts to address the marginalized, oppressive, intersecting social existence of AAW through the examination of identity, social class, and power.

This qualitative study applied a descriptive …

Mexican-Born Immigrant Decision-Making About Self-Management Of Type 2 Diabetes, Virginia Lynn Hart-Kepler

Dissertations

Purpose: This study explored how English-speaking Mexican-born immigrants with diabetes 2 (T2D) made decisions about diabetes self-management (DSM).

Background: Little is known about the self-care decisions of Mexican-born adults living in America with T2D. This information is needed so that health care professionals (HCPs) might better support patients’ DSM. T2D is a serious, multi-system disease, effecting persons of Mexican heritage almost twice as often as non-Hispanic whites (NHW); with lower insulin sensitivity, rapid prediabetes/T2D onset, and severe outcomes. Ineffectively managed blood glucose (BG) risks serious complications, reduced life quality, and premature death. T2D is primarily self-managed; requiring BG control. HCPs …

Second-Generation Thai American Women's Perceptions On Cervical Cancer Screening, Essie Asawapornmongkol

Dissertations

Background: Cervical cancer is one of the most preventable diseases in the United States (US) (Center for Disease Control and Prevention, 2015a). Despite advances in early detection and a vaccine available, it continues to affect Southeast Asian American (SEAA) women in high numbers. Multiple barriers to cervical cancer screening are seen among SEAA women, which include acculturation, age, marital status, apprehension, financial burden, access to healthcare, and knowledge about cervical cancer, screening, and preventative health (Ho & Dinh, 2010). Studies on SEAA women and cervical cancer screening primarily involve women who were born in Southeast Asia. These studies have not …

Diabetes Self-Management Education (Dsme) Program For Glycemic Control, Jenilyn P. Peros

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this quality improvement project was to implement and evaluate the impact of Diabetes Self-Management Education (DSME) program with type 2 diabetes mellitus (DM) patients. The goals were to improve glycosylated hemoglobin (A1C) and improve patient satisfaction.

Methods: A quality improvement project using the Iowa model was implemented in a primary care setting in Southern California to provide DSME program for adults with type 2 diabetes. A nurse practitioner conducted three DSME group sessions, which were done for 90 minutes per session in a 4-month period. The American Association of Diabetes Educators (AADE) 7 self-care behavior …

A Structured Telephonic Transition Program For Heart Failure Patients, Julia E. Robinson

Doctor of Nursing Practice Final Manuscripts

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors.

The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior …

Appropriate Gestational Weight Gain, Eugelyn Opalec Santos

Doctor of Nursing Practice Final Manuscripts

Abstract

Over the past 30 years, excessive weight gain during pregnancy among American women has been a significant concern, resulting in serious health consequences to mothers and their newborns. During 2011, 48% of U.S. women gained more than the ideal amount of weight during pregnancy. Several international studies have also documented that excessive weight gain during pregnancy is associated with adverse maternal and neonatal outcomes. As a result, one in ten babies were born prematurely in the United States in 2014. Based on the Institute of Medicine's (IOM) guidelines (2009), the purpose of this project was to implement the Healthy …

Health Care Transition Program For Adolescents With Spina Bifida, Teresa M. Scavone

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project was to evaluate the feasibility of implementing an NP facilitated formal transition program for adolescents with Spina Bifida. There is an increased awareness of the need for health care transition for youth with special health care needs (YSHCN) due to the 2009-2010 Maternal Child Health Branch National Survey findings that only 40% of YSHCN receive adequate support for transition that meets the core outcome measures. Recent studies have investigated transition in youth with chronic disease specific conditions such as diabetes, cystic fibrosis, and congenital heart defects, and provide valuable insight into possible strategies for …

Evaluation Of A Smoke And Tobacco-Free Initiative In A Student Wellness Center, Angelito Dela Cruz

Doctor of Nursing Practice Final Manuscripts

Background

Tobacco use remains a leading cause of preventable disease and death in the U.S. Nearly all tobacco users begin using tobacco by 26 years of age. In a Southwest university, 9% of students smoke tobacco. This project evaluated a university-wide tobacco-free initiative by reviewing students’ use of tobacco cessation services following a tobacco-free policy implementation. This project also reviewed students’ tobacco use following campus tobacco cessation counseling.

Methods

A smoke and tobacco-free campus policy was implemented in August 2015. The Student Wellness Center provided free tobacco cessation services to all students. Each tobacco cessation counseling session lasted a minimum …

Stress Management In A Corporate Setting, Erinn Gelakoska, Susan Instone

Doctor of Nursing Practice Final Manuscripts

Abstract

The purpose of this evidence-based project was to implement a sustainable stress management program in a corporate setting, utilizing company stress management resources. A three-step program was initiated to include a 30-minute stress education session, followed by a 30-minute one-on-one session with a nurse practitioner student utilizing aspects of motivational interviewing to develop a goal oriented stress management plan. An individual one-month follow up was also performed. Of the 30 employees who attended the educational session, 15 signed up for a one-on-one session. Eight out of the 15 employees completed the one-month follow up. Employees completed a pre and …

Improving Suicide Risk Management In Military Primary Care, John A. Hoyos

Doctor of Nursing Practice Final Manuscripts

Background: In the military, completed suicides and attempt rates have risen across the services since 2001 by 82% per 100,000 in spite of various intervention programs. The literature suggests that absent and inadequate suicide assessments may be part of the problem. Primary care providers are often not prepared for risk assessment and management of suicidal patients.

Aim/Purpose of Project: The project sought to improve the consistency of providers in conducting adequate risk assessments and providing crisis hotline information to patients who were cleared to return home after an encounter, as required by NPSG 15.01.01.

Project Plan Process: This evidenced-based project …

Improving Postexposure Hiv Follow-Up In Healthcare Workers, Linda Valles Gutierrez

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based practice (EBP) project is to improve the HIV postexposure follow-up (PEFU) rate in healthcare workers (HCWs) through implementation of a revised infection control policy and reminder system. Occupational exposure to HIV is a significant risk for all healthcare workers. In the United States every year, 1 out of 10 U.S. healthcare workers suffers a blood or body fluid exposure (BBFE). Transmission of one serious blood-borne infection can cost more than a million dollars for medications, follow-up laboratory testing, clinical evaluation, lost wages, and disability payments. Completion of HIV PEFU in HCWs is very low nationally. …

Obstructive Sleep Apnea: Emphasis On Discharge Education After Surgery, Arbert Almoite Nazareno, Cresilda Newsom, Esther Lee, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to evaluate the effectiveness of discharge education (DCE) on obstructive sleep apnea (OSA) for increasing continuous positive airway pressure (CPAP) compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

Background & Evidence for Problem: In the United States, the prevalence of OSA in the adult population is approximately 20%. Over half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. …

Implementing The 5as Framework For Obesity Management, Jennifer C. Sassman

Doctor of Nursing Practice Final Manuscripts

This Doctor of Nursing Practice (DNP) pilot project strives to improve management of obesity by increasing provider knowledge and utilization of the 5As Framework which is an effective evidence-based intervention and a behavioral counseling tool. Pre-data including BMI and waist circumference were collected over one month. An educational in-service on the 5As was held for one primary care nurse practitioner. Post data was gathered over five months. Provider knowledge on the 5As was increased however, there was not an increase in identifying obesity. The 5As was used about 10% of time with obese patients. This pilot project can be expanded …

An Adult Pcv13 Vaccination Protocol In The Retail Healthcare Setting, Christine P. Duong

Doctor of Nursing Practice Final Manuscripts

Purpose – To establish an adult Pneumococcal (PCV13) vaccination protocol within a chain of retail healthcare clinics.

Background - Invasive Pneumococcal disease results in significant morbidity and mortality in patients ≥65 and those with immunocompromised status. Despite CDC recommendations, national PCV13 vaccination rates remain low in these populations. No adult PCV13 vaccination protocol existed in the project retail healthcare clinics.

Project Plan Process – An evidence-based PCV13 vaccination protocol based on the CDC guidelines using the Provus Discrepancy Evaluation Model as a framework was implemented. NPs were educated on indications for PCV13 vaccinations and a questionnaire to identify those patients …

Preoperative Assessment Clinic Reduces Total Joint Arthroplasty Case Cancellations, Angelica Adriano

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project was to reduce the rate of elective total joint arthroplasty case cancellations by implementing a nurse practitioner-led Preoperative Assessment Clinic (POAC), in the orthopedic department of a major southern California Veterans Affairs (VA) hospital. Retrospective data collected in a 12-month time period showed a surgical cancellation rate of 22%. Reasons for delays or cancellations included: medical instability, abnormal labs and/or studies, patients requiring referral to specialists, dental clearance, patient-initiated cancellations, and active infections. The POAC reduced the rate of case cancellations at 1 year to 17% and at 2 years to 9%. Lost revenue …

The Effect Of Personal Portable Alarms On Clinical Staff’S Perception Of Safety At An Adult Psychiatric Hospital Unit, Kornelia A. Kopec

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to introduce portable personal alarms to all clinical staff on an acute adult psychiatric locked unit at the Mesa Vista Behavioral Health Hospital, San Diego. The purpose was to increase staff’s perceived and actual safety. The project resulted in an increase of staff’s perception of safety in areas such patient safety as perceived by staff, improved perception of addressing medical errors, and improved perception of learning culture at the facility. While 80% of responding staff found the concept of portable personal alarms beneficial, most agreed alternative models of alarms should be investigated, due …

Access And Barriers To Care During Transition From Active Duty To Veteran Status In Veterans With Diabetes: A Look At Health Literacy, Change, And Ongoing Diabetes Self-Management Education, Mark R. Malebranche

Dissertations

Background and Rationale: Transition from active duty to veteran status may be a challenging time, especially for veterans with diabetes. These veterans face multiple changes that can cause distress. Most veterans with diabetes have type 2 diabetes, however a diagnosis of type 1 diabetes on active duty is cause for discharge for active duty.

Purposes and Aims: The purpose of this study was to describe the transition experience of veterans diagnosed with diabetes while on active duty from active duty to veteran status. The study describes barriers and facilitators to healthcare and diabetes self-care management. The four aims of the …

School Nurse Perceptions And Decisions About Children Self-Carrying Inhalers In School, Lisa Anne Dominguez Jaurigue

Dissertations

Every state in the United States has passed legislation allowing students to self-carry rescue inhalers in the school setting. Many organizations are stakeholders in respiratory issues, school health issues, and pediatric issues, recommending the support of this practice. Students’ ability to self-carrying rescue inhalers in the school setting has been impacted by school nurse perceptions and decision-making. This study addressed the questions: (a) What are school nurse perceptions and attitudes in regard to children self-carrying inhalers in the school setting? (b) How do school nurses decide whether children can self-carry inhalers in the school setting? and, (c) Are school districts …

In-Hospital Factors Associated With Supplementation Among Healthy, Full-Term, Breastfed Infants, Jodi Kae O'Brien

Dissertations

Background: Formula supplementation of healthy, term, breastfed infants born to mothers who plan to exclusively breastfeed persists at high rates, in spite of global reduction efforts. The identification of modifiable risk factors for supplementation and effective nursing care for successful breastfeeding is understudied.

Purpose: This study aimed to better understand the obstetrical, hospital, and nursing factors associated with supplementation during the hospital stay. The aims were: (1) examine the relationships between aspects of hospital care of infants who are supplemented compared to infants exclusively breastfed and (2) determine what in-hospital risk factors increase the odds of formula supplementation among a …

The Effect Of Organizational Commitment, Organizational Based Self Esteem And Work Engagement On Nurses' Perception Of Medication Errors, Vanessa V. Wertheim

Dissertations

Background: Organizations rely on the accurate reporting of medication errors or omissions by bedside nurses to improve the medication delivery system in order to prevent further errors from occurring in the future. In a time where nurses are managing more complex patients with shorter lengths of stay, full engagement in the role is essential. Literature from other disciplines suggests that many factors can influence work engagement (Chughtai & Buckley, 2011; Schaufeli, Salanova, González-Romá & Bakker, 2002; Schaufeli & Bakker, 2003). Two of these factors include organizational commitment and organizational-based self-esteem (Allen & Meyer, 1990; Bowling, Eschleman, Wang, Kirkendall & Alarcon, …

Use Of Video Games In Patients' Self-Management Of Pain: A Feasibility Study, Janet Donnelly Phd(C), Rn-Bc, Acns-Bc, Pccn

Dissertations

Background: Pain affects more than 75 million Americans and is the primary reason people seek medical attention. Pain is a common cause of disability and diminished quality of life. While anecdotal evidence exists regarding nurses’ use of distraction therapy activities in pain management, little empirical research data is available.

Purpose: To examine the effects of video game use (VGU) on pain perception, pain interference perception and perceived self-efficacy in pain management in adult inpatients.

Conceptual Model: The conceptual model is based on Self-efficacy Theory (Bandura, 1995). The antecedents of the concept of distraction therapy with use of VGs in patients’ …

Avoiding Hospital-Acquired Conditions: A Qualitative Analysis Of Early Top Performers, Tammy Doolittle

Dissertations

Preventable medical errors in hospitals cost our nation an estimated 180,000 annual deaths and tens of billions of dollars. The Patient Protection and Affordable Care Act mandated improvements in quality and patient safety. The Centers for Medicare and Medicaid Services, acting on these imperatives initiated legislation-mandated programs halting reimbursement to hospitals for specific hospital-acquired conditions (HAC) coined as Never Events. To date, studies have focused on quantifying incidence of specific HAC and assessing policy impact without correlating findings to actual outcome performance. The purpose of this study was to develop an understanding of organizational, contextual, process, and other factors occurring …

Exploring The Lived Experience Of Male-To-Female Transgender Youth Accessing Trans-Related Healthcare In Los Angeles, Marcel Fomotar

Dissertations

Background: According to the National Institutes of Health (NIH) (2015), LGBTI individuals delay healthcare treatment because they fear stigmatization or because they believe many healthcare professionals lack knowledge and experience working with LGBTI individuals. The phenomenon of living as a transgender person and accessing trans-related healthcare is understudied.

Aim: To explore the perceived meaning of accessing transgender-related healthcare among transgender youth.

Method: A phenomenological qualitative design grounded on Husserl’s descriptive phenomenology was used to explore the ascribed meaning associated to accessing trans-related healthcare services among transyouth as they experienced and perceived it. A purposive and thematic sample of Male-to-Female transyouth …

A Grounded Theory Approach To Healthy Work Environment: Its Impact On Nurses, Patient Safety, And Significance In Healthcare Settings, Nicole Sevilla-Zeigen

Dissertations

A healthy working environment has been an area of interest for occupation health providers. There is anticipation that a safe working environment improves patient safety, which is associated with reduction in clinical nurse errors. Issues with medication errors and poor working environment pose a greater risk to patient safety. The aim of this qualitative study was to provide a broad understanding on nurses’ perceptions on the processes that influence a healthy working environment and the impacts of a healthy working environment on patient safety. An interpretive grounded theory methodology was used in this study to evaluate nurses’ perceptions in acute …

Transitions To Assisted Living Within A Continuing Care Retirement Community, Judith H. Scott

Dissertations

Purpose/Aims: The purpose of this study was to explore the lived experience of older single women who moved from their independent homes to the assisted living setting, both situated within a Continuing Care Retirement Community (CCRC).

Rationale: Anecdotally, CCRC transitions have been viewed as either one dreaded possible step toward the end of life or a supportive place to open a new chapter in older adults’ lives. However, no studies have actually examined this experience among older single women, who comprise a large proportion of people making this transition.

Background: Older adults move to assisted living within a CCRC when …

Symptom Experience And Influenza-Like Illness In A Military Population, Monique Bouvier

Dissertations

AIMS: The primary objective of this study was to identify if symptom presentation expressed over the course of an influenza-like illness (ILI) can predict virus type by use of unsupervised machine learning. The secondary objective was to describe clinical characteristics of strain specific coronavirus. Finally, examine the psychometric properties of the Canadian Acute Respiratory Illness and Flu Scale (CARIFS).

BACKGROUND: ILI outbreaks have been a significant source of non-battle injury among military personnel. Many different viruses cause ILI, and it is difficult to determine which virus is causing the illness. Recent studies have examined the etiology and epidemiology of ILIs. …

Sleep Disordered Breathing And Pregnancy: Prevalence And Outcomes At Delivery, Ryan Lyle Nations

Dissertations

Introduction
Sleep Disordered Breathing (SDB) during pregnancy is associated with maternal and neonatal morbidity, and in-hospital mortality. A recent prevalence study using the Nationwide Inpatient Sample reported an obstructive sleep apnea (OSA) prevalence of 7.3 per 10,000 in 2013, a rate of 24% per year over the last decade. The rise in prevalence mirrors the rise in obesity. Military Treatment Facilities (MTF) have seen an increase in obesity and related co-morbidities with an unknown prevalence of SDB. Most studies have been conducted in high-risk populations; the general prevalence of SDB and its association with adverse pregnancy outcomes in a military …

Exploring Unintended Pregnancy In The United States Military: A Phenomenological Approach, Mary Kathryn Phillips

Dissertations

Nearly half of the 6.7 million pregnancies in the United States each year are unintended. The U.S. unintended pregnancy rate is significantly higher than the rate in many other developed countries. By age 45, more than half of all American women will have experienced an unintended pregnancy, and three in ten will have had an abortion. Previous empirical research aimed to fix the rate of unintended pregnancy before it was adequately explored. The rationale for this study emanated from the belief that interventions intended to reduce the rate of unintended pregnancy will be more successful if the essence of unintended …

Factors Associated With High Risk Infant Follow-Up Attendance, Martha Grant Fuller

Dissertations

Prematurity is a significant public health problem and preterm infants face well described risks of adverse neurodevelopmental outcomes. Bronfenbrenner’s bioecological theory of development describes interactions between biological and environmental factors and explains how these interactions can impact development. Systematic follow-up of preterm, high-risk infants is recommended for early identification of problems and provision of interventions and support services. Most research on follow-up attendance has involved small, single sites. A retrospective analysis of population based data available in the California Children’s Services High Risk Infant Follow-up Quality of Care Initiative (HRIF-QCI) data system was performed to examine factors associated with attendance …

Wecan Implementation For Parents Of At-Risk Hispanic Adolescents In Middle School, Shannon Leigh Devita

Doctor of Nursing Practice Final Manuscripts

Abstract

CDC-reported childhood obesity rates have tripled in the past three years. Among children in grades five, seven and nine, 30% are overweight or obese, with Hispanic students more likely to be overweight than White students. This evidence-based project examined the effectiveness of NHLBI’s WeCan! for at-risk middle-school-age Hispanic children and parents. The program was implemented at school in two weekly sessions, and its effectiveness was evaluated using the WeCan! survey. The program resulted in improved knowledge, behaviors, and attitudes related energy balance, portion size, healthy foods, physical activity, and screen time and may be useful in other school settings.