Nursing Commons^™

A Behavioral Weight Loss Program For Low-Income Adults With Obesity And Hiv, Sophai Thach

Dissertations

Problem: Obesity, having a body mass index (BMI) of 30 kg/m² or greater, increases the risk for cardiovascular disease. For people living with HIV (PLWH), this increases their risk for myocardial infarctions by 50% and causes this life-threatening event to occur at a younger age compared to those who are not diagnosed with HIV.

Methods: With obesity disproportionately affecting people with low income, this study aims to evaluate the effects of a 12-week behavioral weight loss program that utilizes journaling as a self-monitoring tool, weekly educational classes, and individualized goal-setting on PLWH with obesity who live in …

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …

Patient Perception Of Fall Risk And High Fall Risk Screening Scores, Nicole D. Pena

Dissertations

Purpose: The purpose of the study was to describe the relationship between patient

perception of fall risk and high fall risk screening scores.

Background: Despite mandated government regulations and multiple hospital

interventions, falls are the most prevalent adverse event among hospitalized patients and

are the leading driver of health care costs, amounting to over $30 billion each year with

projections to double by 2030. Recently, perception was identified as a major component

in preventing falls. A dearth of research examines the relationship between a patient’s

perceived risk for falls and standardized fall screening scores.

Methods: A descriptive correlational design with …

Perinatal Mood And Anxiety Disorders, Stigma, And Social Support Among Postpartum Women, Ellen K. Fleischman

Dissertations

Purpose/Aims: The purpose of this descriptive, correlational, cross-sectional study was to examine the relationships among perinatal mood and anxiety disorder (PMAD) symptomatology, select demographics, stigma of mental illness, and social support, among inpatient postpartum women. Rationale: PMADs affect as many as 21% of childbearing women, yet these disorders are identified and treated less than half the time. There is a gap in the literature regarding the relationships among stigma, social support, and PMADs in postpartum women.

Conceptual Basis/Background: Despite recommendations from professional organizations, screening for PMADs is not consistently completed using a valid, reliable instrument. Stigma contributes to the low …

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

Dissertations

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

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Adult Postoperative Open-Heart Patients: Anemia And 30-Day Hospital Readmission, Lindsey Ryan

Dissertations

Background. In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.

Purpose/Aims. The following were specific aims of this dissertation:

• Aim 1. To develop an operational definition of the term condition-based maintenance as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.
• Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.
• Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart …

Patient’S Utilization Of Health Information Technologies For Disease Self-Management, Mahmoud Hamzeh Altawalbih

Dissertations

Background: The rapid growth of Health Information Technologies (HITs) provides

patients with greater opportunity to take control over their health. HITs utilization has

been proven to be a critical component of disease self-management and can result in

positive outcomes. Its widespread adoption and utilization is still relatively low among

patients with chronic disease. It is important to understand the factors that may impact

HITs utilization, such as the perceived Task-Technology Fit (TTF). A very limited

number of studies have examined the relationship between HITs utilization and the

perceived fit between task and technology in the context of TTF theory.

Aims/ …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

Resilience And Coping In Mothers Of Children With Sickle Cell Disease, Holly Carter

Dissertations

Sickle cell disease (SCD) is a prominent chronic illness in the United States. The Centers for Disease Control and Prevention (2016) estimated that one child out of every 365 African-American births will have SCD, affecting approximately 100,000 Americans. Supporting and promoting the integrity of the family and its’ members when a child has SCD is important for each family member’s well-being. Specific family characteristics, such as resilience and coping are important to understand because they can mitigate stress and create positive family outcomes (Brown et al., 1993; Cousino & Hazen, 2013; Hildenbrand, Barakat, Alderfer, & Marsac, 2015; O’Hanlon, Camic, & …

Attitudes Of New Graduate Rns Regarding Their Readiness For Practice Before And After Hospital Orientation, Diane Young

Dissertations

The acuity level of patients continues to increase making it more vital than ever that new graduate Registered Nurses (RNs) be prepared to give safe, quality care when leaving their hospital’s orientation program (Spector et al., 2015). Today, new graduate RNs need orientation programs that will ensure a smooth transition into nursing practice. This involves the ability to apply higher-level knowledge and skills in everyday practice situations, thereby, maintaining quality care (Henderson, Ossenberg, & Tyler, 2015).

The purpose of this study was to identify differences between new graduate RNs’ opinions on readiness for practice, as measured by the Casey-Fink Readiness …

Mississippi Registered Nurse Perceptions When Communicating With Limited-English-Speaking And Non-English-Speaking Patients, Mary Pipper Widdig

Dissertations

Communication serves as the foundation for safe and effective healthcare practice. Effective nurse-patient communication is the cornerstone of the nurse-patient relationship and is vital for the delivery of safe and effective healthcare. Research has shown patients who are communication impaired are at a greater risk of medical error and poorer health outcomes. A review of the literature revealed various nurse perceptions of barriers when providing care for limited-English-speaking patients and non-English-speaking patients. LEP and NEP patients also identified similar perceived barriers when receiving care. Both nurses and patients revealed a distrust for interpreters and interpreter services. The literature review revealed …

Simulation As Replacement For Traditional Clinical In Pre-Licensure Nursing Education: Outcomes Of Different Ratios Of Replacement Time For Traditional Clinical With Simulation, Tiffany Zyniewicz

Dissertations

The use of simulation in nursing education has grown over the last 30 years. The National Council of State Boards of Nursing National Simulation Study indicated that up to 50% of traditional clinical hours can be replaced with simulation at a 1:1 replacement ratio and produce the same outcomes. A review of the literature indicated that there is no standard replacement ratio for simulation time to traditional clinical time being used in pre-licensure nursing education in the United States. The purpose of this study was to explore the outcomes of utilizing a 1:1 simulation-to-traditional clinical time replacement ratio and a …

Exploring The Homeless Persons Perception Of Living In A Long-Term Care Facility, Janice Woods

Dissertations

Objective:The purpose of this study was to explore the lived experiences of homeless persons admitted to a nursing home facility. Originally, the study was to explore their understanding of and their experience with advance health care planning; coincidently, the participants were more open to their experience of living in a long-term care facility.

Method:A convenience sample of 13 participants (12 male, 1 female) at four long-term care facilities in Southern California were interviewed about their perception of advanced health care planning, including the physician’s orders for life sustaining treatment (POLST); a consent form required in all nursing homes. …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Older Adults’ Implementation Of Discharge Instructions Following An Acute Care Hospital Stay, Brenda Miller

Dissertations

Discharge instructions are a self-care guide for patients after discharge from an acute care hospitalization. The discharge process starts on admission to the hospital and continues until discharged. Many patients rely on informal caregivers to provide support after a discharge. However, it is often unclear whether the patients or caregivers completely understand instructions provided during the discharge process. Key concepts related to how discharge instructions were implemented following discharge to home have been understudied from the patient’s and informal caregivers’ perspectives. Developing effective discharge instructions based on study findings may assist in reducing 30-day hospital readmission rates.
This study was …

Perioperative Antimicrobial Prophylaxis In Vascular Surgery: A Quality Assessment And Improvement Project, Brian Torres

Dissertations

Introduction: Prophylactic antimicrobial selection and administration for the prevention of surgical site infections in vascular surgery is a recommended best practice. Non-adherence to published guidelines on the selection and administration of antimicrobials has been observed and may lead to reduced efficacy of antimicrobial prophylaxis.

Methods: An observational, descriptive design was used to study clinician knowledge and behavior and included a retrospective patient record review and provider knowledge survey. A clinical education intervention targeting providers responsible for the selection and administration of antimicrobial prophylaxis was conducted. A repeat patient record review and knowledge survey was completed following the education intervention.

Results: …

The Influence Of Stressful Life Events On The Development Of Type 2 Diabetes, Joshua Minks

Dissertations

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM.

Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran …

Human Trafficking Identification Among Nurse Practitioner Students During Objective Structured Clinical Examinations, Zoe Onyun

Dissertations

Problem: Human trafficking (HT) is a significant worldwide and domestic issue affecting all ages, races, and genders resulting in over 40 million victims globally. Nurse practitioners (NP) often unknowingly come into contact with victims of HT, however, few NP’s have had formal education on the topic and may fail to recognize signs and risk factors. The purpose of this study was to initiate HT training for NP students.

Methods: A quality improvement (QI) initiative for a university college of nursing (CON) utilizing a prospective, observational, descriptive, cohort design. A plan-do-study-act (PDSA) methodology was implemented. A written case study given …

The Lived Experiences Of Parenting Children With Food Allergies: A Phenomenological Study, Anne Zavell

Dissertations

This phenomenological study focuses on five mothers' experiences of the phenomenon of living with a diagnosed food allergy in the family. Attention is given to the contexts or situations that have typically influenced or affected their experiences, including the impact of the diagnoses, travel and restaurants, friendships, sibling relationships, and anxiety. There is a major emphasis on these mothers' experiences advocating for the needs of their children in schools, including their strategies, concerns, and frustrations. Policies related to food allergies are reviewed from the contemporary and historical perspectives, with recommendations for policy change. The lived experiences of food allergy mothers …

The Lived Experience Of Spiritual Well-Being Amongst Informal Caregivers Of Persons With Dementia On Palliative Care Living At Home, Michael Baumgardner

Dissertations

Title. The Lived Experience of Spiritual Well-Being Amongst Informal Caregivers of Persons with Dementia on Palliative Care Living at Home.

Purpose.This study explored the lived experience of spiritual well-being amongst informal caregivers of a person with dementia who were living at home and enrolled in palliative care.

Background. Patients with dementia comprise the third leading diagnosis in palliative care patients and many receive informal care from family members. Palliative care improves quality of life in patients and their informal caregivers. However, little is known about spiritual well-being in the setting of caregiving of persons with dementia on palliative care. …

Psychiatric Patients’ Perception Of Involvement In The Plan Of Care, Jaspal Kaur Gill

Dissertations

Background: There is an increased need to actively engage and involve patients in their care planning in healthcare facilities including psychiatric facilities (Wills, Riefer, Schauer, & del Vecchio, 2011). There has been a growing interest in patient-centered care and patients’ involvement in their plan of care as it leads to positive healthcare outcomes and increased patient satisfaction. However, there is a lack of research on how psychiatric patients perceive their involvement in the care planning while they are admitted to an inpatient psychiatric facility.

Aim: The aim of this qualitative phenomenological research study was to explore patients’ perception …

Lived Experience After Surgery Among Hispanic Adults, Kimberly Sanchez

Dissertations

Background: In 2010, more than 51.4 million procedures were performed in hospitals in the United States. Almost half of all patients had a surgical procedure prior to their hospital discharge and over 80% of patients experienced acute pain after surgery. When acute pain persists for two or more months after surgery, chronic pain develops, costing the United States up to $635 billion annually. Hispanics, in particular, disproportionately experience disparities in pain treatment as they are less likely to receive analgesics. Routine pain assessments conducted using instruments may be inaccurately capturing the pain experience of Hispanic adults. No research has …

Patient Outcomes Associated With Delayed Rapid Response System Activation: A Retrospective Comparative Study, Ricardo Padilla

Dissertations

Purpose: The purpose of the dissertation study was to determine the difference in survival and length of stay (LOS) between patients who experienced a delay in Rapid Response System (RRS) activation and those patients who had no delay.

Rationale: There is evidence to support that the RRS is often not activated in a timely manner potentially leading to negative patient outcomes.

Background: Delaying treatment for in-hospital clinical deterioration has been associated with Serious Adverse Events (SAEs), including increased mortality, protracted LOS during hospitalization, and significant increased financial costs. The RRS was created as a hospital-wide approach to prevent SAEs; however, …

Women's Decision-Making For Subsequent Pregnancy After A Cesarean Delivery, Melinda Dixon

Dissertations

The purpose of this study is to generate a theory of the decision making process for women as they choose a birth option after a previous Cesarean delivery. The research method of choice when little is known about the phenomena is qualitative research. A qualitative approach was used to generate a substantive theory of decision making for women deciding subsequent pregnancy birth mode after a previous Cesarean delivery. The classical grounded theory methodology including sampling plan, recruitment, data collection and analysis outlined in Glaser and Strauss (1967) guided this study. Twelve study participants with a history of one previous Cesarean …

The Effectiveness Of An Ambulatory Care Health System Redesign On Patient Engagement, Healthcare Utilization, And Clinical Indicators, Nancy Johansen Madsen

Dissertations

Diabetes is a lifelong debilitating and deadly chronic disease affecting nearly one out of every eleven Americans. This public health problem costs $245 billion annually in the United States. Long term research trials have shown that diabetes complications can be prevented with good glycemic control, but it is difficult for patients to maintain control without much support from their healthcare team. U.S. healthcare remains fragmented. With the passage of the Affordable Care Act, there are opportunities to redesign health care delivery to minimize fragmentation and improve patient outcomes. The aim of this study is to determine if a redesigned care …

Predicting Decision-Making In Relation To Health-Risk Behavior In College Freshmen, Anne Bijumon Luckose

Dissertations

Method/Measurements: A cross-sectional correlational design explored the relationships between decision-making, health-risk behaviors and social support systems in college freshmen. The aims of the study were: 1) to explore the relationship between decision-making and health-risk behaviors among college freshmen; 2) to determine whether or not family support and social support jointly predict decision-making among college freshmen; and 3) to ascertain whether or not the effect of family support on decision-making is different for male and female college freshmen. Measurement was collected at one time-point and participants in this study completed on-line questionnaires through a web-based online survey software application with measures …

Behavioral Symptom Clusters, Inflammation, And Quality Of Life In Chronic Low Back Pain Patients, Anitha Saravanan

Dissertations

Chronic low back pain (CLBP) is a prevalent condition, often involving an inflammatory process. Those with CLBP frequently experience behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, which may exacerbate pain and reduce quality of life (QOL). The purpose of this study was to identify behavioral symptom clusters (depressive mood, fatigue, poor sleep) in individuals with CLBP, and to determine whether there are differences in pain, QOL and inflammation (plasma IL-6) based on cluster membership. CLBP patients (N=69; age = 56±13 years) completed measures of pain, depressive mood, fatigue, sleep, and QOL. Blood was obtained for IL-6 measurement. LCA …

Nurse Expectations As Compared To Perceived Reality, Kathryn Mckelvy

Dissertations

Burnout and turnover in nursing have been well documented in nursing literature, but little is known about a nurse’s expectations of the profession compared to their perceived reality of the profession. Do these expectations meet the reality of the workplace, and does this cause the nurse to make a career change? What factors influence a nurse to leave the profession, job-hop, or return to school to further their education? The rate of nurse turnover is an ongoing issue with a lack of research regarding the foundation of nurse expectations compared to the realities of the profession.

The purpose of this …

Self-Care Vs. Self-Sacrifice In Medical-Surgical Nursing Culture: A Critical Ethnography, Elise Jordan Juergens

Dissertations

The critical ethnography research examines need prioritization culture among medical-surgical nurses. Grove, Burns, and Gray (2013) define the problem statement as an explicit identification of the research need. Literature search yields scarce ethnographic research on the nursing population as a culture-sharing group, and no qualitative research exists regarding medical-surgical nurses’ self-need prioritization. The purpose of this critical ethnography is to observe medical-surgical nursing culture, related to personal need prioritization, as reflected by behavior and dialogue.

Qualitative research methodology is appropriate where statistical data is not. Research motivation involves seeking insight and sociocultural understanding. Critical ethnography is the chosen qualitative research …