Nursing Commons^™

A Comparison Of Medication Managemnt Between Older And Younger Adults Living With Hiv, Judy A. Frain

Dissertations

The aims of this study were to examine whether there are differences in medication management between older and younger adults living with Human Immunodeficiency Virus and to explore the relationship between age and personal factors including cognitive ability, depression and self-efficacy on medication management. The research utilized a descriptive-correlational, cross-sectional design to compare medication management between older and younger adults living with HIV and to describe differences in predictive factors of cognition, depression, and self-efficacy on medication management ability between older and younger adults living with HIV. Results indicate both older and younger adults have high rates of mild cognitive …

Move Montana: An Exercise Program For Children, Adolescents, And Their Families, Deanna Lynn Babb

Dissertations

Despite advances in medical science, the prevalence of obesity in the US has more than doubled in the last three decades, to over 72 million people (CDC, 2009). The purpose of this project was to pilot an exercise program that would increase physical activity in a group of adolescents and one of their parents or guardians. A convenient sample of 10 adults and eight adolescents returned surveys and exercised through the entire eight weeks (N = 18). Ten of the 18 participants (56%), six parents and four adolescents, reported increased frequency of exercise each week throughout the eight week period. …

Implementation Of Mental Health Screening In An Adolescent Health Care Clinic, Lisa Colleen Isenberg

Dissertations

The purpose of this project was to increase the awareness of adolescent mental health issues and emphasize the importance of screening for depression and suicidal ideations, to provide clinicians mental health screening tools, and to determine the barriers and challenges involved in performing mental health screenings in practice. This project implemented mental health screenings in an adolescent, urban, walk in health clinic and evaluated the mental health screening and implementation process from the patient and the provider perspectives and determined the resources needed for follow up. This practice evaluation project included a mental health screening on consenting 18-24 year olds, …

First Year Baccalaureate Nursing Program Outcomes: Effects Of Prerequisite Courses And Preadmission Testing, Sonya House

Dissertations

Schools of Nursing are faced with the difficult task of selecting students for admission into nursing programs. This responsibility is challenging as the number of students applying to programs typically outweighs the number of students who can be admitted. As a result, faculty must identify methods for selecting students who have the greatest likelihood of being successful. As noted in the literature, attrition that occurs as the result of being academically underprepared is found in the beginning of nursing programs (Murray, Merriman, & Adamson, 2008). The central research question represents the purpose of the study: To what extent do prerequisite …

Description Of Medical-Surgical Nurses Care Of Patients At Risk For Pressure Ulcers, Barbara Jean Mayer Phd

Dissertations

Aim: The purpose of this qualitative study was to explore and describe the level of understanding of PU development and prevention and perceptions of implementing PU prevention measures in nurses caring for patients in medical-surgical units. Method: The study was conducted in three (3) community hospitals within the same healthcare system using an Interpretive Description approach. Six (6) focus groups were conducted including thirty (30) participants. Findings: Participants described their knowledge of PU development and prevention as good and perceived continuing education as important in maintaining knowledge levels. Two (2) methods of identifying patients at risk for PU development were …

Risk-Appropriate Maternal Care: Identifying Risk Factors That Effect Maternal Outcome, Lucy R. Van Otterloo Phd, Msn, Rnc, Cns

Dissertations

Although maternal deaths are the most tragic of obstetric events it continues to be a rare event. Maternal morbidity, on the other hand, is increasing and poses a greater impact on the economic, psychological, and physical health of the woman and her family, yet it has not been the focus of measurement or research since there is no systematic collection of data available. As complications increase, the likelihood of adverse maternal outcomes such as longer postpartum stays due to the need for more extensive care will also increase. Nurses are being challenged to use their knowledge and skills to identify …

Nutritional Status Of Patients With End Stage Liver Disease: An Outpatient Assessment, Anna Marie Cumming-Browne Hefner Phd, Msn, Cpnp, Rn

Dissertations

Cirrhosis is the 12th leading cause of death in the United States. It is well documented end stage liver disease drives a patient to a catabolic state thus depleting them of essential nutrients. Malnutrition is often unrecognized and untreated in outpatients. Though BMI, nutritional intake, anthropometric measurements have been used in clinical trials, there still remains no standard nutritional assessment. The purpose of this dissertation was to (1) identify the incidence of malnutrition in patients with compensated and decompensated liver disease utilizing defined nutritional parameters (Subjective Global Assessment, anthropometric measurements, hand grip strength, and laboratory values) and (2) correlate with …

Psychometric Properties Of Standardized Patient And Faculty Rater's Evaluations Of Pre-Licensure Nursing Student Competencies, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp, Bc

Dissertations

The use of simulation as a teaching modality has been rooted in the military, aviation, space, and engineering for centuries (Bradley, 2006). Clinical simulation allows for training of healthcare providers that might be too costly, risky, or hazardous in the clinical setting (Bradley, 2006). A variety of simulation modalities are used including virtual learning, task trainers, mannequins, and standardized patients (SPs). External demands for improved accountability of clinical performance is requiring nursing educators to reevaluate methods of teaching and how we measure nursing competence (Nehring & Lashley, 2010). Standardized patients have been used in medical school curricula to teach and …

Nursing Students' Attitudes Toward Science In The Nursing Curricula, Jill Deanne Maroo

Dissertations

The nursing profession combines the art of caregiving with scientific concepts. Nursing students need to learn science in order to start in a nursing program. However, previous research showed that students left the nursing program, stating it included too much science (Andrew et al., 2008). Research has shown a correlation between students’ attitudes and their performance in a subject (Osborne, Simon, & Collins, 2003). However, little research exists on the overall attitude of nursing students toward science. At the time of my study there existed no large scale quantitative study on my topic. The purpose of my study was to …

The Impact Of Technology Attitudes And Skills Of Rural Health Clinic Nurses On The Level Of Adoption Of Electronic Health Records In Mississippi, Jennifer Lynn Styron

Dissertations

The evolution of health information technology continues to reform the delivery of efficient, safe, and equitable healthcare in the United States. One such example is the emergence of electronic health records (EHRs) and the discerning emphasis placed on using this technology in meaningful ways. While the integration of EHRs into daily practice impacts all healthcare professionals, nurses remain a prominent driver in the successful adoption and usage of these systems. It is therefore imperative to understand the impact of nurses’ technology attitudes and skills on the level of EHR adoption in Mississippi.

This quantitative study examined the technology attitudes and …

Toward A Model For Predicting Depression Among Veterans, Nita Aurora Magee-Cornelius

Dissertations

Major depression, identified as a leading cause of disability in the United States, is often first diagnosed by primary care providers. This disability is associated with increased morbidity, mortality, and a lower quality of life. With approximately one in every three veteran diagnosed with depression and the rate of suicide increasing in the United States military (Department of Veterans Affairs, 2009), the Patient Health Questionnaire-2 items (PHQ-2) can be instrumental in identification and monitoring of depressive symptoms. The purposes of this retrospective study were to determine the prevalence of depression, as measured by the federally mandated PHQ-2 in the VA, …

Perceptions Of Workplace Bullying Among Practicing Registered Nurses, Crystal Regina Threadgill

Dissertations

Workplace bullying (WPB) is a social and organizational problem. Within the health care arena, employees, particularly registered nurses, are at risk. WPB has several adverse effects and has been cited in the literature as closely associated with burnout and nurses leaving their positions. This quantitative study examined workplace bullying among practicing registered and its relationship with burnout and nurses’ intent to leave their current position.

The surveys utilized were the Negative Acts Questionnaires-Revised (NAQ-R), Maslach Burnout Inventory Survey, Intention to Turnover Scale and a demographic survey. Of the surveys distributed, a total of 185 were returned from one selected hospital …

A Case Study Exploring Restraint And Seclusion Use In School-Age Children On An Inpatient Psychiatric Unit, Michelle Buckman Phd

Dissertations

Perceptions of children restrained and secluded (R&S) were explored using Yin's methodology and critical theory. The literature presented reviewed proponent's and opponent's views of the R&S intervention used on inpatient psychiatric units for the containment of violent patients. Despite reports of physical and emotional injury to staff and patient during restraining and secluding children, the intervention is still in use. Using Machover's framework, a semi-structured interview and drawings were used to illicit information from a 12 year old boy about his perceptions of R&S. Then, a presentation of barriers to conducting research is made. Results of the child's perceptions included …

Determinants Of Health-Related Quality Of Life In Arab American Patients With Type 2 Diabetes, Yousef Zakarni Phd

Dissertations

HRQL is an important aspect of chronic illnesses such as diabetes and needs to be considered by healthcare providers. It is one of the most important outcomes of healthcare interventions, representing an integral public health goal in Healthy People 2000, 2010, and 2020. Arab Americans (AAs), one of the most rapidly growing minorities in United States, tend to have a high prevalence of type 2 diabetes. The purpose of this study was to describe determinants of HRQL, including social support attitude, religiosity, and select demographics for AA patients with type 2 diabetes. A descriptive correlational study using a cross sectional …

Developing A Clinical Nurse Leader Practice Model: An Interpretive Synthesis, Miriam Bender Phd

Dissertations

Objective: The Institute of Medicine's Future of Nursing report identifies the Clinical Nurse Leader (CNL) as an innovative and necessary new role for meeting higher healthcare quality standards. The American Association of Colleges of Nursing CNL White Paper defines core competencies necessary for practice. The literature documents preliminary evidence of improved outcomes associated with CNL integration into clinical microsystems. However, the CNL role is not yet clearly defined in terms of fundamental activities and responsibilities necessary to produce outcomes. Lack of practice clarity limits the ability to articulate, implement, and measure CNL-specific practice and outcomes. The purpose of this study …

Elevated Blood Glucose Levels In The Emergency Department: Missed Opportunity For Informing And Referring, Melissa D. Rouse Phd, Rn, Cns-Bc, Cen, Hacp, Cphq

Dissertations

The purpose of this research was to examine (1) the rates of elevated blood glucose ≥ 150 mg/dL in adults without a prior history of diabetes, receiving care for a non-diabetes related visit to the ED and (2) Emergency Department provider patterns for informing and referring discharged Emergency Department patients for follow-up of elevated random blood glucose levels. A descriptive, correlational, cross-sectional design, with purposive sample was used. Retrospective chart review was done for patients age 18 and older, treated in two EDs from March 1, 2010 through March 22, 2010. Significant relationships were found between blood glucose level and …

Relationship Of Internet-Delivered Mantram Repetition Program To Burnout, Stress Of Conscience, Spiritual Wellbeing, And Mindfulness In Healthcare Workers, Sheryl Leary Phd

Dissertations

This study evaluated the effect of the Mantram Repetition Program (MRP), an internet-delivered stress management course on burnout, stress of conscience, spiritual wellbeing, and mindfulness on a self-selected group of healthcare workers (HCWs). A quasi-experimental repeated measures design was used. Participants enrolled in a six-session MRP delivered over three months and completed baseline, post-course, and three-month post-course assessments. Measurement tools included the Maslach Burnout Inventory-General Survey (MBI-GS), the Stress of Conscience Questionnaire (SCQ), the Functional Assessment of Chronic Illness Therapy Spiritual Wellbeing Scale (FACIT-12), and the Mindfulness Awareness Attention Scale (MAAS). Statistically significant effects of the MRP showed a decrease …

Opening The Black Box: Understanding Adult Inpatient Falls, Laura M. Rogers

Dissertations

Within the United States, falls are the largest category of adverse events reported in hospitals. Injuries associated with falls include increased costs, extended length of stays, increased mortality and morbidity, and liability to hospitals. The purpose of this study was to discover, describe, and systematically analyze universal and diverse care meanings and expressions of adults experiencing a fall while hospitalized. The research was conceptualized with the ethnographic theoretical framework of Culture Care Diversity and Universality (Leininger 2001, 2006). Data collection took place in a large academic medical center, over a five month period and included 24 participants: eight adult inpatients …

Caregivers Of Older Adults: Burden, Perception Of Strain, And Health, Juana Ferrerosa Phd, Msn, Rn, Phn

Dissertations

Background: By the year 2030, the older population in the United States is projected to double from 35 to 70 million. Consequently, increasing the number of informal caregivers required to care for an aging population. Research suggests that levels of caregiver strain and their ability to cope can impact the health of caregivers. Tsai's (2003) Middle-Range Theory of Caregiver Stress guided this study and was modified to present an innovative approach which used perceived caregiver strain as a specific stressor in the Control Process of the model; it provided a basis for examining caregiver strain and its effect on the …

Early Identification Of At-Risk Lpn-To-Rn Students, Lisa K. Hawthorne Phd, Msn, Rn, Phn, Cne,

Dissertations

Nurse education programs are implementing standardized assessments without evaluating their effectiveness. Graduates of associate degree nursing programs continue to be unsuccessful with licensure examinations, despite standardized testing and stronger admission criteria. This problem is also prevalent for LPN-to-RN education programs due to a lack of research on this group of graduates, who by all accounts should be successful in nursing education based on their work experience and prior nursing education. Findings of this quantitative, non-experimental descriptive correlational study are presented to determine the effectiveness of standardized testing from Assessment Technologies Institute (ATI) as it relates to identifying at-risk LPN-RN students …

Risk Perception In Cardiovascular Disease, Michelle Ellen Block

Dissertations

Cardiovascular disease (CVD) remains among the leading causes of death in the United States despite widespread knowledge about risk factors as well as effective primary prevention strategies. Risk perception is a complex phenomenon that plays an important role in how persons view disease and ultimately how they make health behavior choices. This study is supported by the knowledge that few studies have examined how persons perceive cardiovascular risk or the variables thought to contribute to the formation of risk perception.

Purpose: The purpose of this study was to examine how accurately persons perceive personal risk for cardiovascular disease and identify …

Emergency Nurses' Knowledge, Attitudes And Preventive Practices Regarding Firearms And Firearm Injury Prevention For Children, Dorothy Ann Gomez

Dissertations

In 2010, there were 134 deaths attributed to unintentional firearm injuries of children under 19 year and 3,019 nonfatal injuries (CDC, 2011). Nurses are expected to identify potential dangers in the community and protect those at risk. It was found that there is limited research on the effectiveness of current firearm injury prevention practices of nurses. The study was designed to examine the knowledge, attitudes and practice characteristics of Emergency Nurses toward firearm prevention practices. A convenience sample of 189 emergency nurses completed a voluntary, anonymous survey on practices regarding childhood gun safety. Seventy-one percent of respondents agreed that firearm …

The Role Of The Nurse Practitioner In The Patient-Centered Medical Home, Patricia M. Sohn

Dissertations

The Patient Centered Medical Home (PCMH) was established to improve patient access to high quality, cost-effective primary care. Critical to this new model of care is the optimal utilization of nurse practitioners (NPs) in performing services traditionally offered by physicians. This study compared the roles of NPs and physicians in providing primary care in two PCMHs in a local health care system. During the calendar year 2011, a total of 50,471 patient visits occurred in the two PCMHs. Each PCMH consisted of a Traditional Clinic that saw patients on a scheduled basis and a Convenient Care Clinic that accepted walk-in …

The Feasibility Of An Advanced Practice Registered Nurse-Managed Adhd Resource Center In Missouri, Kara Janelle Stackley

Dissertations

The primary objective of this project was to develop a survey to determine provider receptiveness to referring patients to an advanced practice registered nurse-(APRN) managed center for the diagnosis and management of Attention Deficit/Hyperactivity Disorder (ADHD). A secondary aim of this project was to develop a business plan for the center, provided feedback from the survey was determined to be supportive. Physicians were more likely to use ADHD clinical guidelines (65%) in their practice and expressed greater comfort managing ADHD. Only 50% of APRNs use the clinical practice guidelines and 50% reported they were uncomfortable diagnosing and managing ADHD. Almost …

Identification And Management Of Vertebral Column Fractures In Primary Care, Christopher Richard Hemmer

Dissertations

The purpose of this project is to perform a program evaluation of current treatment patterns of primary care providers for osteoporotic vertebral compression fractures (VCF). VCF’s result in significant morbidity and long term sequelae following a VCF is not uncommon. Additionally, there is controversy regarding the diagnosis and management of this disorder, especially as these relate to the clinical practice guidelines. This practice evaluation project included a pre and post-test survey and a continuing education offering. Thirty-nine physicians and nurse practitioners completed the survey instruments and attended the continuing education sessions. The educational session resulted in improvement of the provider’s …

Vertical Violence And The Student Nurse: Is This Toxic For Professional Identity Development?, Sherri Williams Cantey

Dissertations

This narrative inquiry centers on student nurses’ stories of vertical violence perpetuated by clinical registered nursing staff and the meaning that students associate with this phenomenon. Student nurses are the very young and potentially impressionable members of our profession; therefore, a concern of this study was if vertical violence affects professional identity development for the student nurse. Additionally through stories revealed by these participants, this study attempted to explore whether perceptions of violence are believed to be a rite of passage into the profession. Students are the future of our profession, and it is important that this phenomenon be understood …

Public Health Nurse Decisions Regarding At-Risk Postpartum Case Closure, Denise K. Thompson Phd

Dissertations

During the late 19th century, public health nursing emerged in the United States as an autonomous nursing specialty providing maternal-child health (MCH) home visitation services. Present day MCH public health nurses (PHNs), guided by their predecessors, focus on health promotion and disease prevention in at-risk maternal-child populations. Health policies, funding streams, and local public health nursing protocols are examples of extrinsic factors that may affect length of home visitation services for at-risk women and their children. The purpose of this study was to better understand the factors related to variations in PHN decisions to terminate home visitation services for at-risk …

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 …