Nursing Commons^™

Barriers And Perceptions To Obtaining Palliative Care In The Emergency Department, Jacqueline Lucille Saucier

Dissertations

Background:

Purpose: This study explored barriers and perceptions of providing palliative care services while patients are in the emergency department (ED) in order to increase the>likelihood of caregivers to elicit palliative care methodologies for patients with chronic illness, who are not necessarily at the end of life, but rather who are identified through repeated visits to the ED.

Design and Methods: A mixed methods approach was used to explore the barriers and perceptions of providing palliative care services in the ED. By using a qualitative approach, evidenced by grounded theory, this study explored the barriers and perceptions of providing …

Getting On The Same Page: A Grounded Theory Study Of Nurse And Physician Collaborative Practice Development, Julie Cerese

Dissertations

The movement toward an integrated approach to healthcare professionals' education, interprofessional education (IPE), has been advancing over the past 60 years in the United Kingdom, Canada, and more recently in the United States. Support for IPE as a mechanism to positively impact collaborative practice and patient outcomes comes from international and national healthcare and educational leadership agencies as well as professional medicine and nursing thought leaders. Theories have evolved to explain the linkages among IPE, collaborative practice, and positive patient outcomes. Researchers have found support for the short term positive impact of IPE on attitudes, perceptions, clarity about roles and …

The Impact Of Mood On Health Behaviors And Quality Of Life For Women With Cardiovascular Disease, Jacqueline Ann Tulley

Dissertations

Methods/Measurements: A cross-sectional correlational design explored the relationships between symptoms, functional status, health perceptions and QoL in women with CVD. The aims of the study were: 1) to determine the relationship of symptoms (depression/anxiety) to functional status (health-promoting behaviors), health perceptions (illness perception), and QoL; and 2) to determine whether age is a factor contributing to negative mood symptoms, functional status, health perceptions, and QoL after controlling for social support. Measurements were collected at one time-point to address these aims that included the following: biological function (Framingham Recurrent Risk Model and Functional Comorbidity Index), symptoms (Patient Health Questionnaire-8 and Generalized …

Perceptions Of Pediatric Hospital Safety Culture In The U.S.: A Secondary Data Analysis Of The 2016 Hospital Survey On Patient Safety Culture, Pamela J. Gampetro

Dissertations

This study explored differences in conceptualizing safety cultures in pediatric hospitals and specialty units from an interprofessional perspective on a national level. Errors in the pediatric population can quickly cause harm and frequently lead to adverse events (AEs). Research has explored the problems of patient harm and identified strategies to prevent those harms; but sustainable improvements, particularly in pediatric settings, have not been achieved. This cross-sectional descriptive study used national data from the Hospital Survey on Patient Safety Culture's 2016 dataset developed by the Agency for Healthcare Research and Quality measuring 12 dimensions of safety culture. The extracted sample included …

High School Seniors' Educational Experience Lnfluencing The Decision To Pursue A Career In Nursing, Ryan L. Rowe

Dissertations

Many high school students interested in nursing as an occupation choose to engage in a Career and Technical Education (CTE) program and subsequently progress through the exploration stage of Super’s Career Development Theory in a succinct, deliberate, and intentional manner. While CTE continues to serve as an educational option for many high school students interested in nursing, its value as a means for students to crystallize, specify, and implement the choice to pursue the high-wage, high-skill, and high-demand career of nursing is not understood to the extent possible. CTE is regularly overlooked as a viable educational option by high school …

Predictors Of Cognitive Function Among Cognitively Impaired Older African Americans Living In Congregate Residential Settings, Zyra Daffodil Apugan

Dissertations

The purpose of this secondary data analysis was to identify potential psychosocial predictors of cognition, including social support, depression, and functional activity, among older African Americans, ≥ 65 years, with a diagnosis of Alzheimer’s disease and living in congregate residential settings. Guided by the main effect model of social support, this study used existing data from the National Alzheimer’s Coordinating Center Uniform Data Set, an NIH-funded multicenter study. Results showed that on average, the participants (n=56) were 81.7 years of age with 13.8 years of education. All, but six, were married. Bivariate Pearson correlations indicate a moderately strong negative relationship …

Monitoring Patient Safety In The Recovery Room, Gail Davis

Dissertations

Respiratory depression is a serious complication after surgery. Early detection is a major patient safety concern for recovery room personnel as patients recover from anesthesia and experience pain. The opioids used for pain management may contribute to over-sedation effects and respiratory depression. Vital signs and pulse oximetry are standard postoperative monitoring procedures. End-tidal capnography and arterial blood gases may augment the standard-of-care procedures but may not be effective at detecting early respiratory depression. The purpose of this study was to generate baseline data trending patient safety variables and outcomes for postoperative patients using standard monitoring with standard-of-care plus transcutaneous capnography …

Implementation Of The National Asthma Guidelines In A Residential Pediatric Clinic, Patricia A. Foster-Staples

Dissertations

Abstract

Purpose: Foster care children admitted to residential facilities are a unique and vulnerable group, many presenting with undiagnosed or poorly managed asthma. The alarming rate of residents admitted to a particular residential primary care clinic with a diagnosis of asthma led to the project question: “Based on record reviews, does staff education about the importance of utilizing the national guidelines for asthma education influence the implementation of such guidelines in a residential pediatric clinic?” The purpose of this quality improvement project was to implement a systematic process to influence practice change. The project was conducted over a period …

A Healthcare Provider Needs Assessment Regarding Transgender Patient Health For A Student Health Services Center, Dorothy J. Cochran

Dissertations

Objective: This study sought to identify education and training needs of university health service providers regarding transgender patient care. Transgender patients are a vulnerable population who tend to have negative health outcomes. Limited information exists regarding transgender patients and their providers at student university health services nationally.

Methods: The researcher conducted a one hour semi-structured focus group with the professional staff at a Midwestern state university health service. The focus group conversation was guided by a list of prepared questions but other issues were allowed to arise. Two readers qualitatively analyzed the focus group transcripts for predominant themes.

Participants: The …

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

An Exploratory Study Of The Utilization Of Evidence-Based Pharmacological Treatment On Heart Failure Patients In Mississippi And Its Impact On Readmission, Keri A. Barron

Dissertations

The purpose of this study was to explore the relationship of adherence to evidence-based guidelines for pharmacologic management by select Mississippi hospitals and their hospital readmission rates. This was an exploratory study with a retrospective design. This design offered insight into the relationship between readmissions of heart failure patients and adherence to the national guidelines for the pharmacologic treatment of heart failure. The study took place in a hospital in the southeastern section of the United States. Data were collected from a database of patients with heart failure seen between January 2011 and June 2014.

The unit of analysis for …

A Motivational Profile Of Nurses Who Pursue Doctoral Education, Tomekia Yvette Luckett

Dissertations

The need for nurses to pursue doctoral education is imperative to the professionalization of the discipline of nursing in light of the changing healthcare environment. Presently, < 1% of the nursing workforce possesses a doctoral degree (“Transforming Nursing Education,” 2016), albeit recommendations from the Institute of Medicine (IOM) (2010) admonish the need to increase the number of doctoral-prepared nurses. The need to understand characteristics of nurses who seek doctoral education is critical in planning long-term strategies for nursing education in the United States (US) (Kovner, Brewer, Katigbak, Djukic, & Fatehi, 2012). In conjunction with describing characteristics of nurses pursuing doctoral education, this research describes the motivational orientation and factors of registered nurses (RNs) pursuing doctoral education.

A descriptive correlational design was utilized to examine concepts relating to motivational orientation of RNs pursuing doctoral education. Participants were divided into two categories: (a) RNs seeking the Doctor of Philosophy (Ph.D.) degree and (b) RNs pursuing the Doctor of Nursing Practice (DNP) degree. A total of 173 RNs enrolled in either a Ph.D. or DNP program in the Gulf South region of the US comprised the final sample. Binary logistic regression was utilized …

Post-Intensive Care Syndrome: Comparison Of Educational Interventions To Educate Parents Of Children Hospitalized In The Pediatric Intensive Care Unit At St. Louis Children’S Hospital, Stephanie A. Esses

Dissertations

Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS). Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.

Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.

Results: A total of 62 parents/caregivers received one of three educational interventions: informational brochures (n=22), scripted informational conversation (n=20), or …

Improving New Graduate Critical Care Nurse Practitioner Knowledge And Retention Using A Dedicated Orientation And Mentoring Program, Katherine Huffer

Dissertations

Abstract

Background: There has been a significant amount of research into the many challenges that nurse practitioners (NPs) face as they transition from school to practice, however, there is limited research on how to improve this transition. Regardless of the setting in which the NPs are working, novices NPs alike report feelings of being unprepared and experiencing high levels of stress, anxiety, fear, and frustration. New research suggests that a comprehensive NP orientation and residency programs may provide a way to integrate the new NPs into their practice environment successfully.

Method: Kern’s Six Step Approach to Curriculum Development for Medical …

The Acute Care Pediatric Nurse Practitioner In Missouri: An Analysis Of Needs Assessment, Jessica L. Mann

Dissertations

Introduction: Due to an increasing number of acutely ill pediatric patients and changing healthcare demands, there is an even greater need for nurse practitioners (NPs) to work in the area of pediatric acute care (AC). There is a lack of alignment of education and certification with the scope of practice of the AC Pediatric Nurse Practitioner (PNP). The development and implementation of a graduate level AC PNP program in Missouri will support the alignment of education, clinical training, and certification with the scope of practice of the AC PNP and improve access to a quality program for nurses that currently …

Investigating Personality Traits Of Registered Nurses: Implications For Personnel Evaluation, Stephanie N. Means

Dissertations

The United States is currently facing a registered nurse (RN) shortage that is expected to reach the millions in the next few years. Since the beginning of the century, healthcare professionals and administrators have strived to develop and implement ways to increase recruitment and retention in the nursing field. It has been recognized that the key to recruitment and retention is to get the right nurse in the right place, which means focusing on clinical proficiencies as well as personality qualities and characteristics. Personality assessment has long been used to evaluate person-job (P-J) fit of applicants for positions across the …

The Effectiveness Of Combined Appointments And Influenza Immunization Rates In A Rural Wic Population, Lisa L. Sitler

Dissertations

Purpose: The purpose of this descriptive retrospective study was to examine predictors and barriers to influenza immunizations receipt in a low-income WIC population.

Method: A quality improvement project was conducted in October 2010 in which 129 caregivers of children having WIC appointments were randomly assigned to receive (a) influenza immunizations at the time of the WIC visit or (b) educational materials and a later immunization. Caregivers completed a survey about their perceptions of influenza immunizations. Tanahashi’s access to care model (1978) was used to identify predictors (acceptability, accessibility, availability, and effectiveness) of influenza immunizations.

Analysis: In analysis …

Social Ecological Factors Associated With Parental Vaccination Decisions And Perceptions Of Barriers To Childhood Immunizations, Catherine A. Ferris

Dissertations

The success of childhood immunizations has led to a decrease in the visibility of the morbidity and mortality of vaccine-preventable diseases. Parents are questioning the validity and safety of vaccines resulting in significantly increasing numbers of underimmunized and unvaccinated children throughout the country. The purpose of this dissertation was to explore the perceptions of barriers to immunizations in parents with children, birth to 12 months of age presenting for a well-child or vaccinations-only visit to one of two pediatric primary care clinics located in San Diego County. The social ecological model was used to guide this dissertation. A cross-sectional, descriptive …

It Is Always The Monkey On My Back: The Diagnosis Of Cirrhosis, Mary Tiberg

Dissertations

Mary Tiberg

Loyola University Chicago

IT IS ALWAYS THE MONKEY ON MY BACK: THE DIAGNOSIS OF CIRRHOSIS

A significant current challenge in health care today is meeting the needs of a population that has chronic disease, especially for those that have a health condition with a life threatening long -term outcome (Falkenstern, et al., 2005). In these health illness transitions, when there are no secure expectations, there are the additional burdens of enduring emotional unease, facing the closing stages of physical stamina, and confronting an indeterminate future. The objective of this study was to explore and describe the experience of …

The Health Of Human Trafficking Victims In San Diego, California: A Retrospective Study, Noelle Lipkin Leveque

Dissertations

Background/Purposes/ Aims: Human trafficking (HT) is a threat to human rights globally. Studies indicate between 28% and 87% of HT victims encountered a health care professional during their trafficking period. Nonetheless, little is known about the health care needs of victims of HT. The purpose of this study was to examine the health care needs of a self-identified group of trafficked women in San Diego County, California.

Conceptual Basis: The Model of Human Trafficking and Health by Zimmerman et al. (2011) was used to identify multiple determinates of health following the trafficking period including demographic factors (age at assessment, age …

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 …

Correlation Of The Boost Risk Stratification Tool As A Predictor Of Unplanned 30-Day Readmission In Elderly Patients, Carol K. Sieck

Dissertations

Carol K. Sieck

Loyola University Chicago

CORRELATION OF THE BOOST RISK STRATIFICATION TOOL AS A PREDICTOR OF UNPLANNED 30-DAY REAMDISSION IN ELDERLY PATIENTS

Risk stratification tools can identify patients at risk for 30-day readmission but available tools lack predictive strength. While physical, functional and social determinants of health have demonstrated an association with readmission, available risk stratification tools have been inconsistent in their use of variables to predict readmission. The Better Outcomes by Optimizing Safe Transitions (BOOST) 8 P's tool is a risk stratification tool developed by the Society of Hospital Medicine but has no published validation studies. The theoretical …

Unavoidable Pressure Ulcers: An Ethnonursing Study, Catherine M. Clarey-Sanford

Dissertations

Catherine M. Clarey-Sanford

Loyola University Chicago

UNAVOIDABLE PRESSURE ULCER: AN ETHNONURSING STUDY

In an effort to improve patient safety and the quality of care in the acute care setting, there has been an increased focus on the prevention of adverse events believed to be avoidable. Hospital-acquired pressure ulcers (HAPU) have been listed as one of those adverse events, and hospitals are no longer reimbursed for related costs. However, there are patient conditions and clinical situations in which a pressure ulcer can be deemed unavoidable. In acute care, unavoidable means that the patient developed a pressure ulcer even though the provider …

Simulation Using A Standardized Patient To Measure Perception And Congruency Of Spiritual Care For A Veteran From Three Perspectives To Inform Nursing Education And Practice, Mary E. Desmond

Dissertations

Spiritual care refers to a purposeful process of helping another find meaning and purpose

in life through a mutual connection. Providing spiritual care is a professional nursing mandate, yet nurses report barriers in education and practice. Veterans want spiritual care to promote quality of life, and to cope with military experiences and chronic conditions. Patients report receiving less than desired spiritual care and nurses report infrequent provision of spiritual care. It is also unclear how congruent patients and nurses are in their perceptions of spiritual care. A spiritual care simulation and performance checklist was developed using a review of the …

What Is The Relationship Between Vitamin D Status, Pregnancy Symptoms And Quality Of Life?, Jennifer Woo

Dissertations

Purpose and Background/Significance: The main purpose of the study is to determine: (1) to determine if there is a relationship between vitamin D status, pregnancy symptoms, health promoting behaviors, and quality of life and (2) to determine if differences exist in pregnancy symptoms, health promoting behaviors and quality of life between African American and Hispanic women. There is evidence to show that vitamin D deficiency has been associated with numerous symptoms such as musculoskeletal pain, poor sleep, and depression. However, whether low levels of vitamin D is associated with these and other symptoms during pregnancy is unknown. What is known …

Identifying The Complexity Of Bipolar Disorder, Brandie Marie Stiles

Dissertations

Bipolar disorder is a complex illness that is difficult to correctly diagnosis and treat. Experts estimate that a correct diagnosis and treatment for bipolar disorder may be delayed for up to 7-10 years after symptoms become problematic. The primary purpose of this study was to identify the complexity of diagnosing bipolar disorder, including diagnostic patterns, recommended treatment, and patient response. A focused ethnography, including in-depth interviews and a retrospective chart review, were completed to answer the research questions: 1) What is the nature of the experience of receiving a diagnosis of bipolar disorder? 2) What are the diagnostic and treatment …

Implementation Of Sleep Assessment Questionnaire In College Health And Counseling Visits: A Quality Improvement Pilot, Sarah Ruth Jackson

Dissertations

Sleep deprivation or sub-optimal sleep hygiene in college students has profound implications. Decreased cognitive performance, increased depression or mood concerns, higher rates of usage of alcohol or marijuana to compensate for poor sleep are all interconnected. The American College Health Survey (2011) results indicated that students do not receive support or education on the importance of sleep habits from their schools or medical providers. This DNP project explored two areas of interest. The first was a change in patient interview protocol as a quality improvement project in UMSL University Health, Wellness, Counseling & Disability Access Services (UHWC&DAS). The second area …

Group Empowerment Capacity And Capability In Associate Degree Schools Of Nursing In The United States, Christy Lee Savell

Dissertations

The purpose of conducting this research was to determine the perception of group empowerment capacity (EC) and group empowerment capability (E) among faculty and administrators in associate degree nursing programs (ADN) in the United States (U.S.), whether there was a significant difference in the scores of EC and E between the two groups and if there was a significant relationship between the mediating variables and EC. The study was conducted online with administrators and faculty of ADN programs throughout the United States (U.S.). Information letters with questionnaire links were sent to all members of the Organization of Associate Degree Nurses …