Nursing Commons^™

Evaluation Of A Substance Abuse Screening Tool In The Pediatric Emergency Room, Jody Sims

Dissertations

Abstract

Background: Substance abuse among adolescents is one of the most serious social health problems in the United States. The prevalence of alcohol use in adolescents is as high as 80%, while opioid overdose deaths among adolescents have risen by greater than 50% in the last 10 years. Alcohol, tobacco, and other substance use has also increased among youth and is not being properly evaluated in the pediatric hospital setting. The purpose of this project was to evaluate the use of a substance abuse screening tool with SBIRT trained staff in the pediatric emergency room setting.

Methods: The CRAFFT substance …

Improving Pediatric Asthma Outcomes Through Pictorial Asthma Action Plans, Julia Donovan

Dissertations

Problem: Asthma is the leading chronic disease of children and the leading cause of childhood emergency department (ED) visits, hospitalizations, and missed school days. Asthma action plans (AAPs), including photographs or pictures of asthma medications, symptoms, triggers, and devices, have improved parents’ understanding of their child’s asthma and have increased their comfort level in caring for their child.

Methods: An interventional pre-post study with a mixed-method research design, at a large, urban, primary care pediatric clinic with two locations, evaluated the effectiveness of a pictorial AAP on a child’s asthma control. A pictorial AAP was provided, and a childhood asthma …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Self-Care, Resilience, Self-Compassion, And Burnout In Doctoral Nursing Students: An Exploratory Needs Assessment, Logan Justice

Dissertations

Abstract

Problem: In the United States, one in three nurses experience symptoms of burnout, and doctoral nursing students are additionally challenged to juggle multiple school, work, and life demands (Reith, 2018; Woo et al., 2020). The purpose of this project was to explore the current self-care practices of doctoral nursing students to understand how self-care relates to resilience and burnout.

Methods: This exploratory needs assessment utilized a convenience sample of Doctor of Nursing practice (DNP) and Doctor of Philosophy (PhD) nursing students at a medium sized midwestern university. An electronic data collection survey was constructed to assess student self-care practices, …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

The Association Between Pelvic Floor Dysfunction And Mental Health In Natal Females With A Focus On Native American Populations, Lexxie Gramke

Dissertations

Purpose

Over half of natal females in the United States suffer from pelvic floor dysfunction (PFD). PFD can increase risk of mental health sequelae; however, no studies have been conducted examining the association between mental health and PFD in the Native American (NA) population. This dissertation aims to evaluate the association between PFD, with a focus on overactive bladder (OAB), and mental health in females with specific attention to NAs.

Methodology

A current state of the science review examined the literature for associations between OAB with depression and anxiety in females. Utilizing this literature review, a theoretical model was constructed …

Nurse Practitioner's Perspectives On Human Trafficking In The Emergency Department; A Narrative Inquiry, Ann Gerhart

Dissertations

Background: Human trafficking (HT) is a global and domestic concern that impacts individuals, families, and communities. Over the last ten years, HT has become a significant public health concern intersecting with the health care community in various settings. HT abuse and oppression have both short- and long-term health consequences. Approximately 50 to 88% of trafficked individuals visit a health care provider, and 63% of those visits are evaluated in the emergency department (ED). Nurse practitioners (NPs) working in the ED interact with HT individuals but have not been represented in recent research scholarship.

Purpose: The purpose of this qualitative …

Anxiety And Agitation In Adult Patients Admitted To An Emergency Room During The Covid-19 Pandemic, Doris L. Asombrado

Dissertations

Purpose: The purpose of this retrospective correlational study was to identify the relationship between COVID-19 status and the prevalence of anxiety-agitation with select sociodemographic and clinical characteristics in adults admitted to the ED during the pandemic (03/01/2020 through 12/31/2020).

Background: COVID-19 infections combined with the WHO and CDC recommendations to mitigate spread have had deleterious psychosocial and economic outcomes with the risk of subsequent COVID-19 related mental illness. Studies indicate one in three adults experience anxiety or depression.

Methods: This retrospective correlational study reviewed 2,572 psychiatric admissions from a Southern California ED during the pandemic from March 1, 2020 through …

The Lived Experience Of Patients With Clostridioides Difficile, Andrea Scherschel

Dissertations

Background: Clostridioides difficile (C. difficile) is the most common healthcare-acquired gastrointestinal infection in the United States. While there is a plethora of information on the treatment and diagnosis of C. difficile infection (CDI) in the literature, there is a paucity of research findings describing the lived experience of a person with the disease.

Objective: This study described the lived experience of patients who have had one or more CDIs.

Lines of Inquiry: There were two lines of inquiry for this study: (1) Describe the lived experience of having a CDI, and (2) determine if photo-elicitation as a research modality enhanced …

Mantram For Mamas: A Pilot Study For Postpartum Women, Ritamarie Smedile

Dissertations

Objective: This pilot study launched an online Mantram Repetition Program (oMRP) using a virtual health portal that aimed to explore online portal accessibility, oMRP acceptance, and overall interface satisfaction among a sample of postpartum women.

Background: Postpartum depression remains one of the most common and severe childbirth complications, affecting more than 13% of women during the first three months after childbirth. Cognitive or behavioral talk therapy sessions and medication are the most frequently recommended treatments to alleviate symptoms. Although effective, women tend not to enroll or adhere to these modalities, suggesting they need alternative treatment plans. A possible alternative, mirroring …

Social Determinants Of Health And Health Confidence, Laura Truman

Dissertations

Purpose/Aims: The purpose of this study was to investigate the relationship among social determinants of health (SDOH), select sociodemographics, and health confidence level in adults receiving care at an urgent care center.

Background/Rationale: To improve overall health and reduce health inequities during a global pandemic and unprecedented rates of inflation, the relevancy and urgency of identifying how patient-level SDOH impact health confidence level are even greater. Extant research indicates a relationship between the number of unmet social needs and low health confidence. Low health confidence predicts poor involvement in self-care and is associated with an increased use of costly health …

How Exemplary Chief Nurse Executives Utilize The Six Domains Of Conflict Transformational Strategies To Establish Common Ground And Produce Breakthrough Results, Michael Thompson

Dissertations

Purpose: The purpose of this phenomenological method study was to identify and describe strategies that exemplary chief nurse executive leaders use to identify and establish common grounds to produce breakthrough results in healthcare by using the six domains of transformational conflict strategies: collaboration, communication, emotional intelligence, ethical behaviors, problem solving, and shared interest.

Methodology: As a part of the thematic phenomenological study, the research identified and described the lived experiences of eight exemplary chief nurse executive leaders in health care who used conflict transformational strategies to find common ground to produce breakthrough results. The target population for the study included …

Nursing Education In Complementary Alternative Modalities: A Case Study, Deborah Bird

Dissertations

Purpose: The purpose of this embedded case study was to describe the preparation for and utilization of complimentary alternative modality (CAM) interventions by an experienced Doctor of Nursing Practice (DNP) prepared nurse practitioner (NP) working in an outpatient setting.

Background: Given the widespread use of CAM by the American public and the potential complications involved in combining CAM and standard medical care, a lack of educational preparation in CAM interventions by NPs delivering primary care in outpatient health care settings represents both a potential risk and a missed opportunity to provide holistic patient care. Such a lack of knowledge also …

The Motherhood Crusade: Rural Low-Income Mothers, Support, And Empowerment, Christina Castellano

Dissertations

Previous research has shown that postpartum women with untreated mental health conditions are more likely to fail to manage their own health, have inadequate nutrition, abuse substances, experience abuse, be less responsive to their baby’s needs, have fewer positive interactions with their baby, experience difficulties breastfeeding, and question their abilities as a mother. Rural culture plays a complex role in the transition to motherhood, influencing whether mothers seek out and use resources. While more is known about location and access issues, less is known about how rural culture and, more specifically, how empowerment and social support impact postpartum experience. The …

Effectiveness Of Follow Up Phone Calls On Postpartum Women After Discharge: A Program Evaluation, Camille Williams

Dissertations

After an expectant mother gives birth, they are closely monitored for 48 to 72 hours after delivery and then discharged from the hospital. They are then typically seen by their physician for a postpartum follow up appointment within six to eight weeks for their postpartum follow up visit. Although complications during this postpartum period can still arise, postpartum women are rarely assessed during this time. Follow-up phone calls have been known to improve patient outcomes and communication between patients and providers once patients are discharged from the hospital. In January of 2020, the Mother/Baby Unit at a midwestern metropolitan hospital …

Where Have All The Surgical Nurses Gone? Staffing Shortages In Surgical Departments Post Covid-19 Shutdowns, Phoenix Neal

Dissertations

March 2020 changed the healthcare field entirely. When the COVID-19 pandemic swept through the United States in early 2020, it was recommended that surgical departments nationwide shutdown altogether or at least decrease their workloads to exclusively emergent procedures. This step was taken both to save surgical equipment for more critical patients and to offload those staff members from surgical departments to more critical areas in the hospital systems.

This exploratory study was completed to investigate the impact of COVID-19 surgical department shutdowns on current surgical staffing. This research explored different factors such as health insurance availability, childcare availability, shift change, …

The Lived Experiences Of Icu, Med-Surg, And Er Nurses In The United States Attempting To Breastfeed During The Covid-19 Pandemic, Amy Seay

Dissertations

Breastfeeding is important to promote the health of both mothers and babies (Centers for Disease Control and Prevention [CDC], 2021). Many mothers experience workplace barriers and stress which negatively impact breastfeeding duration (McCardel & Padilla, 2020; Nagel et al., 2022). However, a gap in the literature exists surrounding specific barriers and the impact of stress on U.S. nurses who breastfeed. Specifically, workplace challenges and stress among nurses resulting from the COVID-19 pandemic lack exploration.

This interpretive phenomenological study explored the lived experiences of ICU, Med-Surg, and ER nurses who attempted to breastfeed during the COVID-19 pandemic. Roy’s adaptation model was …

Nursing Faculty Perceptions Of Stress, Coping, And Intent To Leave The Profession In The Ongoing Covid-19 Pandemic: A Quantitative Study, Lynlee Morgan

Dissertations

The COVID-19 pandemic impacted all of society to varying degrees; this impact was especially true in higher education due to an overnight transition to distance learning and incessant pivots to meet new guidelines and overcome obstacles. Nursing faculty were significantly impacted due to the responsibility of producing safe, qualified, competent practitioners to provide care in the clinical setting. The limitations in or exclusions from clinical experiences combined with the fact that faculty were managing personal concerns and had never encountered these unprecedented conditions exacerbated the challenge of preparing new nurses. This study was critical due to the faculty role and …

Adherence To Antihypertensive Medications Among African Americans Adults, Obiageli Obah-Mbanefo

Dissertations

Purpose: To describe adherence to antihypertensive medications among African Americans adults aged 35 to 65 years in south Los Angeles.

Study Aims: Aim 1: Describe patient sociodemographic factors (age, gender, education, insurance, employment, living arrangement and income), clinical factors (history of current depressive symptoms, comorbidities, comorbidity Charlson score and number of comorbidities), health literacy level, and medication adherence to hypertension (HTN) medications. Aim 2: Describe the relationships between sociodemographic factors, clinical factors, health literacy level, and medication adherence. Aim 3: Compare medication adherence between patients with high health literacy level, low possible health literacy, and low health literacy level.

Background: …

Chaos Is Not Rational: Nursing Leadership And Intuition In Disaster Preparedness And Response, Sarah Banks

Dissertations

Nurses are looked upon as leaders in disaster preparedness and response. Charged with making life-altering decisions, experienced nurse leaders utilize analytical and intuitive strategies to manage crisis situations. Rarely recognized by upper-level management and educational institutions, intuition is our natural ability to know something without any evidence or validation. Intuition allows us to make decisions in ever-changing circumstances when solutions are not obvious. Though difficult to explain, intuition is a powerful skill that gives nurse leaders the confidence needed to make decisions based on their previous experience. Experienced nurse leaders utilize intuition to arrive at a solution without conscious awareness …

Simulation Psychological Safety Ecosystem: A Grounded Theory Study Of Nurses’ Experience With Psychological Safety In Prelicensure Simulation, Susan Eller

Dissertations

Over the past couple of decades, the utilization of simulation-based education in prelicensure nursing expanded in both frequency and functionality. Learning through simulation requires psychological safety where participants feel comfortable engaging to their fullest extent and can speak up or ask questions without fear of embarrassment to themselves or others. Professional simulation organizations provide recommendations for creating psychological safety, yet anecdotal stories from nurses report variability in their experiences ranging from positive to negative. Research regarding psychological safety in nursing education revealed some consistent themes of anxiety due to being observed or unfamiliar with simulation environments or expectations. The evolving …

Effects Of Resilience Coaching On Behavioral Health Nurse Burnout, Dalila Franklin

Dissertations

Abstract

Background: Inpatient, staff nurse burnout negatively impacts nurses’ mental and physical health, hospital nurse retention and turnover, and patient care. The Stress First Aid for Health Workers program attempts to bolster resilience and subsequently reduce burnout among mental health nurses in this project.

Method: This quality improvement (QI) project was an observational pre-post survey design and was conducted on a cohort sample of inpatient, behavioral health nurses at an urban, mid-sized, Midwestern hospital psychiatric unit to assess personal, work-related, client-related, and overall burnout utilizing the Copenhagen Burnout Inventory (CBI) tool to quantitatively measure burnout pre- and three months post-implementation …

Palliative Care Services On An Adult Inpatient Oncology Unit, Heather E. Barger

Dissertations

Abstract

Problem: Palliative care (PC) services are widely underutilized for patients with cancer, partly due to the shortage of PC specialists. Additionally, many Americans have not filled out advance directive (AD) paperwork which is commonly addressed in PC. In the absence of an AD, cancer patients are at risk of receiving undesired aggressive treatments in the event they are unable to make decisions independently.

Methods: This quality improvement pilot initiative utilized a descriptive observational design to evaluate the number of ADs documented in the electronic health record (EHR) on an inpatient oncology unit. A retrospective EHR review was used to …

Fall Prevention Among Older Adult Behavioral Health Patients, Jodie Shipley

Dissertations

Abstract

Problem: Inpatient falls are a major patient safety issue. Behavioral health units experience higher rates of falls among elderly patients with between 13.1 to 25 falls per 1,000 occupied bed days (OBD). The risk of falls for the aged population is increased on a psychiatric unit due to a myriad of issues including psychotropic medications, over-activity on the unit, and confusion (Wong & Pang, 2019).

Methods: This QI project is an observational descriptive pilot intervention evaluation of a redesigned fall prevention program with the aim to reduce falls on a midsized suburban Midwestern inpatient geriatric behavior health …

Burnout, Collective Efficacy, And The Social Network Of A Unit, Amy Kiefer

Dissertations

Burnout, Collective Efficacy, Social Network, Social Network Analysis

Assessing Nursing Student Engagement In Clinical And Simulation Experiences, Karrie Osborne

Dissertations

clinical education, nursing education, student engagement

Effectiveness Of A Virtual Learning Environment On Pediatric Students’ Knowledge, Self-Confidence And Satisfaction With Learning Growth And Development Concepts, Laura Marie Robbins-Frank

Dissertations

growth and development, knowledge, pediatric nursing students, satisfaction, self-confidence, virtual learning environments

Patient Perception Of Intensive Care Unit Discomfort, Essa Hakamy

Dissertations

Background: Discomfort has a significant effect on patient health and well-being; however, the symptoms are often difficult to address in ICU. Most patients in ICU are unable to communicate, making it difficult for physicians and nurses to distinguish between pain and discomfort. For example, artificial airways and assisted ventilation prevent patients from communicating. Patients may also have difficulty communicating due to delirium, fatigue, sedation, or neurological disease. Rationale: Discomfort has a considerable influence on patient health outcomes and well-being if not identified and addressed. Researchers have not explicitly explored discomfort apart from pain, which underscores the importance of studying the …

Adults With Preexisting Diagnosis Of Heart Failure In The Environment Of Coronavirus Disease 2019, Ronald Phillips

Dissertations

Background: Heart disease continues to be the leading cause of death among adults in the United States and other industrialized countries. Heart failure (HF) is a form of heart disease and has become an epidemic with complications and medical care costs increasing at an alarming rate. HF affects more than 5.7 million adults in the United States with an incidence between 550,000 to 670,000 annually, primarily affecting females, African Americans, and adults aged 55 years and older. HF is also associated with a high rate of mortality, estimated to increase, with a risk rate of 13%, 32%, and 64% among …

Evaluating Sbirt In A Behavioral Health Urgent Care, Christina L. Williams

Dissertations

Background: Adolescent substance use (SU) is a major health concern. Most youth who engage in alcohol and other SU do not meet criteria for SU disorder (SUD). Nonetheless, evidence shows SU during adolescence impacts cognitive, social, and emotional development, increases risk of physical injury, and may progress to SUD in adulthood. Only half of clinicians properly screen adolescents for SU; those identified with SUD often receive no intervention. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention to address this problem. The purpose of this project was to evaluate implementation of SBIRT using CRAFFT 2.1+N, a SU …