Nursing Commons^™

Health Literacy, Cognitive Impairment, And Medication Adherence In Veterans With Heart Failure, Lee Ann Hawkins Phd

Dissertations

Background: Heart failure (HF) affects 5.8 million people in the United States, costly in terms of patient mortality and morbidity as well as healthcare dollars. One important manifestation of poor HF outcomes is the excessive admission-readmission cycle. Non-adherence to medication is responsible for the majority of HF readmissions. Identification and intervention for key factors contributing to poor medication adherence is critical to improving outcomes. Two such factors prevalent in persons with HF are cognitive impairment (CI) and poor health literacy (HL). There is a paucity of tested interventions designed to improve medication adherence by addressing underlying CI or HL. A …

Obstructive Sleep Apnea And The Effects Of Co-Existing Factors On Pacu Stay Time, Shari F. Jones Phd, Crna

Dissertations

Significance/Background: Obstructive Sleep Apnea (OSA) is the most common disturbance during sleep affecting 30% of the population. The occurrence of moderate/severe OSA is 11.4% in men and 4.7% in women. OSA is caused by repetitive partial or complete obstruction of the upper airway with apnea episodes. OSA is prevalent in western society, yet is frequently undiagnosed due to lack of knowledge of the disorder. This population presents a challenge during the peri-operative period due to increased risk for several complications. Of particular interest to Nurse Anesthetists, are respiratory complications that result in delayed emergence from anesthesia, delayed post-operative recovery, increased …

Case Study Of Parents Caring For A Child Having Type-1 Diabetes With Optimal Hga1c, Elizabeth Ciaccio Phd

Dissertations

Type 1 diabetes in school age children is a complex condition requiring continuous physical, nutritional, and therapeutic monitoring to prevent lifelong complications and maintain quality of life. In 2011, one in 400 children in the United States were affected by it. The purpose of this research study was to understand how parents achieve optimal HgA1c for their school age children with type-1 diabetes. Currently, there is very little research documenting how parents achieve this goal. Understanding this phenomenon more clearly can be used to inform future research, improve practice and provide information for development of effective health policy. Management of …

Breast Health And Mammography Screening In Older Women, Martha A. Ibarra Phd, Msn, Anp, Rn

Dissertations

Age-related health disparities in breast cancer screening are a public health concern. From 2002 to 2006, the median age for newly diagnosed cases of breast cancer was 61 years and the median age for breast cancer mortality was 68 years of age (Surveillance Epidemiology and End Results [SEER], 2009). Mammography is the best available screening tool for breast cancer detection (Susan G. Komen Foundation, 2008). The Centers for Medicare and Medicaid Services (CMS, 2006) reported that only about half of older women who are eligible for mammograms through Medicare obtain a mammogram every two years. The literature identifies psychosocial barriers, …

Pain Management In Triage And Reducing Percentage Of Left Without Being Seen In An Overcrowded Ed, Christina Ballejos-Campos Phd

Dissertations

Although in most emergency rooms, the patient is seen first by a highly trained triage nurse, the ED physician is trained to determine if the patient can safely leave the ED prior to in-depth exam, treatment and diagnosis. The goal is to keep the left without being seen by a physician percentage low, since a high number would indicate poor quality, additionally patients who present with pain, and then leave the ED prior to being seen can pose a greater risk. This study examined the association of nurse-initiated triage pain protocol on the LWOBS percentage rate of patients who present …

Nurse Manager Transformational Leadership Practices And Patient Outcomes Among Magnet And Non-Magnet Hospitals, Bridgett Byrd Sellars Phd, Msn, Ma, Rn

Dissertations

In 2004 the Institute Of Medicine called for healthcare leaders to embrace and adopt transformational leadership practices to promote quality of care and favorable patient outcomes. Nurse managers are accountable for 24-hour operations of their departments and influence patient outcomes. The purpose of this research was to examine the relationships among nurse manager transformational leadership practices, patient outcomes and hospital types (Magnet, On The Journey, and Non-Magnet). A correlational study examined relationships between self-reported transformational leadership practices of nurse managers and patient outcomes by hospital types. The study was conducted using a purposive sample of Association of California Nurse Leader …

A Qualitative Descriptive Study Of The Work Of Nurses In Interventional Radiology, Brenda Naef Boone Phd

Dissertations

This dissertation study explored the work of nurses in interventional radiology. Interventional radiology (IR) is an emerging field of practice in health care. More and more procedures that were historically done in the operating room are being performed in IR. This has led to higher acuity patients and an increased need for specialized nursing care. The work of nurses in this area of practice is not well described and as such can lead to a lack of understanding of nursing involved in high tech low touch areas. This qualitative descriptive research study was conducted to shed light on this under …

Inpatient Glycemic Management: Glucose Control Relationship With Hospital Variables, Discharge Planning And Education, Crisamar Javellana-Anunciado Phd, Fnp-Bc, Rn

Dissertations

This dissertation study examined the relationship of glucose control with clinical outcomes, costs, discharge planning and education. Extant studies showed that hyperglycemia, in the presence or absence of a diabetes diagnosis, is prevalent in hospitalized patients. Hyperglycemia is found in one-third of all hospital admissions and is linked to poor clinical outcomes and increased healthcare costs. Furthermore, clinical evidence suggests that lack of discharge coordination associated with medical errors and readmission. This entire body of work contains three distinct sections: Two manuscripts and a grant proposal. The two manuscripts in this study were based on more current retrospective data at …

Relationship Between Delirium And Night-Time Interruptions In Icu, Amy R. Stuck Phd, Rn

Dissertations

Background: This dissertation examined the phenomenon of delirium in the intensive care unit (ICU) setting. Delirium is a form of cognitive disturbance with a physiologic etiology and complex, multifactorial mechanisms of causation and risk. Delirium in the ICU patient presents a significant risk for adverse outcomes including increased mortality, length of stay, falls, and restraint use. ICU delirium can lead to persistent cognitive impairment beyond discharge and frequent skilled nursing placement. Identifying delirium requires accurate diagnosis that is optimized when validated instruments are used. Sleep deprivation has been linked to adverse health consequences including delirium. Previous studies investigating the relationship …

Tobacco-Use Promotional Environment And Intrapersonal Environment: Predictors Of Smoking Intention Among Young Southern California Thai-American Adolescents, Arpakorn Magkunthod Phd, Msn, Rn

Dissertations

This study explores tobacco-use related environment, intrapersonal factors, and smoking initiation in Thai-American adolescents aged 10 to 16 living in Southern California. A purposive sample of 217 youth was recruited from seven Thai-community centers located in four counties of Southern California: The sample was fairly evenly distributed by gender with female (54.5%) and almost three quarters (70.9%) were born in the United States (70.9%). Age ranged from 10 to 16 years, with the mean age 12.71 years old (SD =1.835); 27% reported age of 11. Data were collected using the 97 item Teen Tobacco-Use Questionnaire. Findings indicated 12 participants (6.3%) …

Documentation: Delirium In The Hospitalized Older Adult, Jacqueline Fitzgerald Close Phd

Dissertations

Background: Delirium is a common, life threatening and preventable geriatric syndrome. Because this condition is frequently addressed by administering dangerous antipsychotic drugs, it is imperative that accurate systematic assessments are charted to determine the actual need for these medications. The purpose of the study was to describe medical record documentation of a systematic assessment of delirium in older adults who had been administered an antipsychotic medication. Methods: A descriptive correlational retrospective design was used for this medical record data based study. The setting was a 107 bed acute care community hospital located in southern California. Inclusion criteria were medical records …

Oncology Nurses' Cultural Competence, Knowledge, And Attitudes Toward Cancer Pain, Ayman Alnems Phd, Msn, Rn

Dissertations

Effective pain management requires appropriate knowledge, attitudes, and assessment skills. The purposes of this study were to obtain information about the knowledge and attitudes of oncology nurses related to cancer pain and its management, to evaluate oncology nurses' cultural competence, and to investigate relationships between oncology nurses' cultural competence and their pain management knowledge and attitudes. Ferrell and McCaffery's (2008) Nurses' Knowledge and Attitude Survey Regarding Pain (NKASRP), the Cultural Competence Assessment Survey (CCA) (Doorenbos, Schim, Benkert, & Borse, 2005; Schim, Doorenbos, Miller, & Benkert, 2003), and a demographic questionnaire were used to measure oncology registered nurses' cultural competence and …

California School Nurses' Knowledge, Attitude, And Intention To Participate In Sexuality Education, Maria G. Matza Phd, Msn, Rnc

Dissertations

A critical need exists to provide adolescents with sexual health education as demonstrated by our nation's position in having the highest adolescent pregnancy rates among all the developed nations. The critical need is further pronounced by California's changing demographic profile of young Latinos who are projected to be the majority in 2042 and continue to demonstrate higher pregnancy and birth rates than other racial and ethnic groups. Currently, there is limited evidence to confirm if California's students are receiving sexual and reproductive health as required by law, nor is there evidence to link school nurses as teachers or consultants in …

Factors And Health Promoting Behaviors That Influence Maternal And Infant Outcomes In Older Pregnant Thai Women, Supawadee Thaewpia Phd, Msn, Rn

Dissertations

This dissertation summarizes research conducted in partial fulfillment of the program requirements for the Doctor of Philosophy in Nursing degree from the Hahn school of Nursing and Health Sciences, University of San Diego. The results of the dissertation research are organized as three discrete papers. Article one is entitled; "Reliability and Validity of Thai Translations of Instruments Measuring Psychosocial Factors and Health Promoting Behaviors among Older Pregnant Thai Women." This article describes the dissertation research study in which the selected instruments were piloted at an antenatal clinic in Thailand. The article determines the instruments' ability to examine perceived benefits, perceived …

The Impact Of Guided Imagery On Sleep Quality In Mothers Of Preterm Infants, Linda M. Schaffer Phd, Mn, Rn

Dissertations

Background: Mothers who have given birth to preterm infants are at an increased risk for impaired sleep. Evidence based interventions are needed to assist mothers in improving their sleep quality as few are available. Purpose: Guided by the transactional framework of Lazarus and Folkman (1984), the purpose of this study was to: describe maternal and infant factors which influence sleep quality, examine the relationships between depression, anxiety, stress, social support, to sleep quality, and describe the influence of a R-GI intervention on sleep quality among a sample of mothers whose preterm babies were admitted to NICU. Methods: This prospective, descriptive, …

Nursing Students' Lived Experiences Surrounding Medication Administration, Sally Nan Morgan Phd

Dissertations

Medication errors are abounding and the complexity of medication administration creates an environment where health care providers are at risk for making errors. This environment includes nursing students learning medication administration. Coupled with a rigid, protocol-driven pedagogy, nursing students may be placed in a learning experience counterproductive to accuracy. Previous studies have focused on causes and perceptions of medication errors looking for the delineation between safe and unsafe practice. In doing so, past research may have narrowed the path of discovery needed to diminish medication errors. In addition, research regarding the lived experience of nursing students while they are learning …

Call-Shift Fatigue And Use Of Countermeasures And Strategies By Certified Registered Nurse Anesthetists, Ramona M. Domen Phd, Crna

Dissertations

Purpose: The purpose of this study was to examine whether Certified Registered Nurse Anesthetists (CRNAs) experience fatigue during call and to assess their use of fatigue avoidance strategies (practices that prevent fatigue) and fatigue countermeasures (practices that decrease fatigue) to mitigate its effects. Method: Using a cross sectional descriptive survey design, data were collected from a randomly selected sample of 323 practicing CRNAs who worked call shifts. Data analysis: Data were analyzed using descriptive and multivariate statistics. Results: The sample was fairly evenly distributed with slightly more female respondents, 55% (n = 179). Fifty four percent worked a weekday call …

Health Literacy And Health Promotion Behaviors Among Samoans, Katherine Tong Phd, Msn, Cfnp, Phn

Dissertations

Limited health literacy is associated with failure to engage in health promotion behaviors. Few studies examine this relationship among Samoans. This study used a cross-sectional correlational design to determine health literacy levels and their relationship to health promoting behaviors in a southern California Samoan population. Health literacy (Short form Test of Functional Health Literacy in Adults) and health promotion behaviors (Health Promotion Lifestyle Profile II) were measured in a convenience sample of 87 Samoans in southern California. Data analysis employed chi-square, t-test, and one- way ANOVA. Significant associations were found for health literacy and demographic characteristics of employment and marital …

Associations Among Perceived Benefits, Barriers, Cues, And Physical Activity In Thai Primary Students, Sireewat Ar-Yuwat Phd, Mph, Rn

Dissertations

The purpose of this study is to examine the relationships between perceived benefits, perceived barriers, and cues to action and levels of physical activity in Thai fourth grade students. The Health Belief Model was used as the theoretical framework of the study to investigate students' beliefs related to physical activity. The participants in this cross-sectional study were fourth grade students selected by a simple random sampling method. A sample of 123 students was recruited from primary schools in Muang district, Phitsanulok province. The sample schools were selected by stratified random sampling. For data collection, the study utilized two instruments: the …

Lived Experience: East African Somali Speaking Women Accessing The U.S. Healthcare System, Shukri Adam Phd

Dissertations

Access to prenatal healthcare for East African Somali Speaking Women (EASSW) who are immigrants to the U.S. has been dependent on the availability of a systematic healthcare treatment model. The purpose of this study was to explore EASSW's lived experiences in accessing prenatal healthcare services in the U.S. A descriptive, qualitative phenomenological approach informed by the work of Husserl was used to explore EASSW's experiences, views, and problems encountered while attempting to access prenatal healthcare services in the U.S. Fifteen EASSW of childbearing age (ages 18–45) were recruited for this study. All participants interviewed privately, beginning with a semi-structured, open-ended …

A Retrospective Analysis Of Maternal And Child Outcomes Following An Obesity Intervention Program, Melinda S. Bender Phd

Dissertations

Background: One of the highest risk groups for childhood obesity and associated co-morbidities in the United States are low-income Hispanic preschool children. To reduce obesity, effective interventions are being sought to improve health behaviors among high risks groups. Objectives: To evaluate a subset of data from a larger 9-month promotora facilitated obesity intervention study. The aims were to determine: 1) pre- to post-program differences in health behaviors including: (a) children's consumption of high carbohydrate beverages (HCB); and (b) maternal walking, beliefs, knowledge, self-efficacy, and relationship building regarding nutrition and physical activity; and 2) which covariates were significant for change in …

Cord Blood Collection In Pregnant Women For Stem Cell Research, Irene Carr Phd

Dissertations

Umbilical cord blood (UCB) stem cells form commonly banked types of human tissue. Confusion remains about sources of stem cells and their use. Birth is a once in a lifetime opportunity with 74 million births per year in the world and four million occur in the United States. Cord blood contains hematopoietic stem cells and pluripotent mesenchymal cells (Moise, 2005). There is a surge of interest in the clinical use and research investigation of umbilical cord blood for transplantation and regenerative medicine. Clinicians need increased awareness and education of options for private versus public donation and banking of cord blood …

Examining Nursing Presence In The Acute Care Setting As An Indicator Of Patient Satisfaction With Nursing Care, Wendy Hansbrough Phd, Msn, Rn

Dissertations

Nursing presence is conceptualized as occurring within the nurse-patient relationship when the nurse acknowledges the uniqueness of the patient, within his or her context of being and chooses to intervene on the patient's behalf with a patient who allows the nurse into a reciprocal relationship. Nursing presence is described as occurring in varying levels and nurse expertise is suggested as one antecedent. Quantification of nursing presence would be useful in examination of nursing care outcomes, quality management and research. The Presence of Nursing Scale, PONS (Kostovich, 2002) was used in this study to test its reliability and determine its validity …

Emergence Delirium In U.S. Military Combat Veterans, Jason M. Mcguire Phd, Crna

Dissertations

This dissertation study examined the phenomenon of emergence delirium in U.S. military combat veterans. Emergence delirium is a post-anesthetic phenomenon that occurs immediately following emergence from general anesthesia and is characterized by agitation, confusion, and violent physical and/or verbal behavior. Clinical evidence suggests that emergence delirium is occurring with greater frequency among military personnel returning from conflict in the Middle East. This body of work is a culmination of three distinctive phases and is presented in three individual manuscripts. The first manuscript, "Risk Factors for Emergence Delirium in U.S. Military Members," was published in the Journal of PeriAnesthesia Nursing with …

California School Nurse Survey, Rachel Van Niekerk Phd

Dissertations

The purpose of this study was to obtain evidence to support the assumption that school nurses have a positive effect on school attendance and medication administration practices and to hear the voice of the California school nurse. Data from this exploratory, descriptive study came from an online researcher developed survey consisting of both forced choice and open-ended questions completed by California school nurses representing the three major regions of California (Northern, Central, and Southern). The following three research questions guided the study: 1) What is the relationship between school and nurse factors on student outcomes? 2) How valued do California …

Mother-Son Connectedness, Substance Use, And Young Men's Criminal Justice System Involvement, Kim L. Moreno Phd

Dissertations

The relationship between a mother and her son and its influence on health and risk behaviors as a boy becomes a man has had little exploration. The purpose of this study was to examine the relationships between mother-son connectedness, substance use, serious delinquency, violent delinquency, and criminal justice system involvement in young men. This study uses data from The National Longitudinal Study of Adolescent Health (ADD Health), a school-based study of students in grades 7–12 in the United States. Multiple regression, ANOVA, and logistic regression were used to analyze independent and dependent variables. Results show a perception of connectedness, which …

The Post Deployment Lived Experience Of U.S. Military Troops After Combat-Related Blast Exposure, Shirely A. Jett Phd

Dissertations

Blast-induced neurotrauma (BINT) is a newly emerging re-occurrence of an old combat-related injury in U.S. military troops returning from deployment in Afghanistan and Iraq. BINT is leading to a silent epidemic of symptomatic troops who face barriers to accessing healthcare and suffer debilitating symptoms in silence. The purpose of this hermeneutic phenomenological study was to discover the meaning of the lived experience of U.S. troops returning from Afghanistan and Iraq after combat-related blast exposure. Eleven service members and veterans ranging in age from 21 to over 30 years old participated in semi-structured face to face interviews. These service members and …

A Quantitative Inquiry Into Moral Distress And Psychological Empowerment In Critical Care Nurses Caring For Adults During End Of Life, Annette Marie Browning Phd, Rn, Cns

Dissertations

Background Critical care nurses care for many adults at end of life and it is known that these nurses can experience moral distress. Moral distress occurs when nurses are unable to perform what they believe is ethically correct. There has been speculation that psychological empowerment may ameliorate moral distress among critical care nurses. However, research has yet to examine the relationship between moral distress and psychological empowerment in the population of critical care nurses.

Objectives To describe the relationships between moral distress, psychological empowerment and select demographics in critical care nurses caring for patients at EOL.

Method Using a quantitative …

Nutritional Status And Clinical Outcomes Of Residents Admitted To A Nursing Home, Sheryl Nespor Phd

Dissertations

Purpose The purpose of this research study was to describe the nutritional status (well nourished, at risk for malnutrition, or malnourished) of residents admitted to nursing homes and adverse clinical outcomes in those residents after four weeks. Methodology A descriptive, correlational design utilizing medical record data was used to examine the relationship between nutritional status and adverse clinical outcomes of weight loss and pressure ulcers. Results The sample (n=69) was predominately Caucasian (90%) with 38% having one or more pressure ulcers on admission. Most of the residents were admitted from an acute care facility (97%) and were either malnourished or …

Fibromyalgia Self-Care Management: Use Of Essential Oils, Regina Ann Sacco Izu Phd

Dissertations

Fibromyalgia is a female dominant chronic syndrome of diffuse muscle pain on palpation of at least 11 of 18 syndrome-associated tender points present for 3 months or longer. There is no cure. Self-care management involving multimodal integrative medicine approaches may increase treatment involvement resulting in a sense of control and pain relief. This embedded, single case study explored 'how' and 'why' an informant with fibromyalgia chose to initiate and continue self-care management using essential oils over several years to treat symptoms within context reality. Orem's Self-Care Deficit Model and the Principles of Integrative Medicine from the University of Arizona formed …