Nursing Commons^™

Raising Children With Type 1 Diabetes And Celiac Disease: Parental Experiences, Kerri Louise Erickson

Theses and Dissertations

The purpose of this qualitative descriptive study was to examine parental experiences and challenges raising children with both T1DM and CD. Twenty-six families, including 30 parents (25 mothers, 4 fathers, and one custodial grandmother), participated in a 30-60 minute audio-recorded interview designed to explore parental experiences raising children with both T1DM and CD. Participants were asked IRB approved open-ended questions about their experiences raising a child with both diseases. Direct quotations best representing categories/sub-categories were identified through selective coding. Analysis revealed seven main themes: Six themes parents are concerned about, including (a) their child's health complications, b) the challenges of …

Breastfeeding Influencing Factors In Thai Adolescent Mothers, Supannee Kanhadilok

Theses and Dissertations

Background: Breastfeeding is well established as the optimal method for ensuring healthy infant nutrition. However, many adolescents remain unaware of the role of breastfeeding. Adolescent mothers continue to have the lowest rate of breastfeeding in many countries including Thailand, with only 17% of Thai adolescent mothers continuing to breastfed at 6 months postpartum. Objective: Examine factors influencing breastfeeding behaviors in adolescent mothers, particularly those in Thailand. Methods: This dissertation project involved two research studies focusing on breastfeeding influencing factors in adolescent mothers. The first study was an integrative review of 22 articles published in 2000-2012. The findings revealed that personal …

Predictors Of Agitation In The Critically Ill, Ruth Burk

Theses and Dissertations

BACKGROUND: Agitation is a common complication in the intensive care unit (ICU) manifested in behavior and actions that range from simple apprehension or anxiety to frankly combative behavior.5 Agitation is associated with significant adverse outcomes.1-3 Studies report up to 71% of ICU patients have some degree of agitation during their ICU stay and that agitation is observed 32% of the time.3;4 Potential causes of agitation in critically ill patients are numerous; however, data about factors that predict agitation are limited. OBJECTIVE: The specific aim of this study was to identify predictors of agitation on admission to the ICU as well …

Management Of The Medically Fragile Child In The K- Fifth Grade Classroom Setting, Mandy M. Cranney

Theses and Dissertations

The aim of this focused project was to explore perceptions and identify needs of teachers of medically fragile children (MFC), in the grade setting, with the hope of designing educational modules to be utilized as supportive measures by the teachers for the classroom setting. The focused project consisted of an extensive literature review of medical fragility in school age children as well as a literature review of teachers' perceptions and needs identified in the past. Nola Pender's Health Promotion Model served as the conceptual framework in designing the study. Two focus groups were conducted among grade teachers enrolled in Masters …

A Comparative Effectiveness Study Of Continuous Positive Airway Pressure (Cpap) Related Skin Breakdown When Using Different Nasal Interfaces In The Extremely Low Birth Weight (Elbw) Neonate, Katherine Newnam

Theses and Dissertations

Nasal continuous positive airway pressure (CPAP) is reportedly superior to mechanical ventilation in the neonatal population by reducing bronchopulmonary dysplasia (BPD). The neonate is vulnerable to injury secondary to immature physiological systems and skin structures and the current CPAP devices place constant pressure on nares, nasal septum and forehead, increasing injury risk. Through the framework of comparative effectiveness research an examination of nasal interfaces currently used during neonatal CPAP was conducted in an effort to provide scientifically supported recommendations and improve clinical outcomes. The primary aim of this study was to determine differences in the frequency, severity and specific types …

Rural School Employees' Awareness And Perceptions Of Adult Vaccinations: A District-Wide Study, Eli Gary Thornton

Theses and Dissertations

As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, …

Caregiver Burden And Sibling Relationships In Families Raising Children With Disabilities, Diane W. Allred

Theses and Dissertations

The purpose of this study was to examine sibling relationships and caregiver burden in families raising children with disabilities (CWD). In order to determine (a) are there differences in caregiver burden according to parent gender and types of disability (b) are there differences in sibling relationships according to parent gender and type of disability and (c) is there a relationship between caregiver burden and sibling relationships after controlling for CWD and sibling gender and age, and type of disability? After IRB approval, 166 families living in the west and raising typically developing children (TDC) or a CWD participated. Disabilities included …

Vaccination Perceptions And Barriers Of School Employees: A Pilot Study, Kim Cranney Houle

Theses and Dissertations

Schools are group settings where vaccine-preventable diseases can spread quickly, especially if vaccination rates are suboptimal. Vaccination of school children has been the subject of many studies; however, data are lacking regarding the vaccination status, vaccination perceptions, and potential barriers to vaccination for school employees. Method: A questionnaire was developed to measure school employees' perceptions,awareness of current vaccination status, and potential barriers to vaccinations. This study included a convenience sample of 277 employees from a small urban school district located in central Utah. Results: Adult vaccination knowledge is lacking in the school employee population, with over half believing they were …

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women, Amanda Thomas Langford

Theses and Dissertations

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease characterized by symptoms of urinary urgency, frequency, bladder pain, and chronic pelvic pain in the absence of known pathology. Selection of appropriate treatments depended on the severity of the patient's symptoms and patient's preference. This review found that it is important for providers and patients to set realistic goals for symptom improvement when starting a new treatment.

The purposes of this project was to 1) conduct a substantive literature review on treatment guidelines for IC/PBS, 2) analyze the literature for comparing oral pharmacological interventions and behavioral interventions for IC/PBS, and 3) …

The Use Of Ultrasound As An Adjunct To X-Ray For The Localization And Removal Of Soft Tissue Foreign Bodies In An Urgent Care Setting, Stacy Lane Merritt

Theses and Dissertations

Embedded soft tissue foreign bodies are common complaints of patients presenting to rural urgent care centers. The removal of soft tissue foreign bodies present challenges for the healthcare provider when objects are radiolucent and cannot be identified on readily available diagnostic imaging modalities such as plain radiographs (X-rays). Ultrasound has been introduced in the literature as a useful adjunct to X-rays for the localization and removal of soft tissue foreign bodies. The purpose of this research utilization project was to report the use of bedside ultrasound by healthcare providers as an adjunct to X-ray for the localization and removal of …

Foot Assessment In The Dialysis Unit, Karen Robertson

Theses and Dissertations

ABSTRACT In 2010 the number of patients requiring renal replacement therapy in the United States increased by 1% to 593,086. This number was comprised of 593,086 in center hemodialysis patients, 179,361 functioning kidney transplants, and 29,773 peritoneal dialysis patients.

A principal difficulty in the end stage renal disease (ESRD) population is lower extremity amputation from vascular complications and nonhealing wounds. The incidence of nontraumatic lower extremity amputation among the end stage renal disease population in the United States is ten times higher when compared to the general public. Mortality rates for ESRD patients following amputation are elevated with less than …

Prevention Of Skin Breakdown In The Pediatric Intensive Care Unit, Lydia H. Palmer

Theses and Dissertations

Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock & Maylor, 2004). Development of skin …

A Pilot Intervention To Engage Nurses To Lead Transformation Of The Workplace, Molly Patton

Theses and Dissertations

The often toxic work environment in which nurses practice contributes to decreased well-being, job dissatisfaction, and poor retention rates, while negatively impacting quality and patient safety. Most leadership programs and resources target nurses in formal leadership positions and are exclusive of the bedside nurse. The purpose of this research utilization project was to determine immediate and short-term outcomes of an educational leadership workshop for nurses, including intent to change the work environment and subsequent action to change the work environment. The goal was to develop, deliver, and evaluate an evidence-based educational intervention to empower nurses at all levels of care …

Improving The Diagnostic Accuracy Of Failure-To-Rescue, Amelia Marie Joseph

Theses and Dissertations

The ability to successfully rescue patients from complications has been shown to be a good measure of quality care processes in hospitals. Failure-to-rescue (FTR) has been defined using secondary International Classification of Disease (ICD-9 CM) codes. Studies of FTR using these codes have demonstrated satisfactory accuracy when compared to clinical events documented in the medical record. However, a subset of the original codes for FTR, thought to be sensitive to nursing care, have failed to show the same level of accuracy. This study examined the possibility of using clinica lpredictors to identify failure-to-rescue.

Secondary analysis of a previous dataset was …

Emergency Department Triage Acuity Ratings: Embedding Esi Into The Electronic Medical Record, Candace Whitfield

Theses and Dissertations

A need for improvement in the triage process was identified in the ED of a southeastern healthcare facility. Lewin's Change Theory guided the implementation of an evidence-based quality improvement project (QIP) to improve the efficiency of the triage process using and embedded Emergency Severity Index (ESI) triage acuity-level assistant template in the electronic medical record (EMR). The target interventions were ED throughput times, the number of patients left without being seen (LWOT), and RN satisfaction.

Methods included the implementation of education interventions for all ED RNs that included a presentation, use of ESI algorithm badges for each nurse, and weekly …

Text Messaging As Adjunct To Community Based Weight Management Program, Claudia Bouhaidar

Theses and Dissertations

Obesity ascending rates are still a public health priority. The primary aim of the study was to evaluate the effect of tailored text messages on body weight change in overweight and obese adults in a community based weight management program. A secondary aim was to detect behavioral changes in the same population. The study design was quasi-experimental with pre and posttest analysis, conducted over 12 weeks. A total of 28 participants were included in the analysis. Body weight, eating behaviors, exercise and nutrition self-efficacy, attitude toward mobile technology, social support and physical activity were assessed at baseline and at 12 …

Perceived Stress And Surgical Wound Cytokine Patterns, Valentina Lucas

Theses and Dissertations

Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed …

"Being Certain": Moral Distress In Critical Care Nurses, Marian Baxter

Theses and Dissertations

Published literature has focused on understanding moral distress from a descriptive standpoint. Missing from the literature is an exploration of the role a nurse can play in his/her/own moral distress.A qualitative study with an interpretive design incorporated Clandinin and Connelly' narrative methodology. Results highlighted assumptions were made by participants in the absence of resources, which led them to" know the right action to take" from their own perspective.

Heart Failure Symptom Clusters And Functional Status, Janet Herr

Theses and Dissertations

Abstract HEART FAILURE SYMPTOM CLUSTERS AND FUNCTIONAL STATUS Janet Kay Herr Ph.D A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University 2012 Major Director: Dr. Jeanne Salyer, Ph.D., R.N., F.N.A.P Associate Professor, Adult Health & Nursing Systems Clinical assessment of heart failure includes symptom identification and the evaluation of the relationship of symptoms to functional status. Symptom clusters are groups of at least 2 or 3 co-occurring symptoms that are related but are independent of other groups of symptoms. The objectives of this study are to: …

Relationship Of Demographic Characteristics And Bmi With Health Literacy In Pacific Islander Care-Giving Adults, Sharla E. Morgan

Theses and Dissertations

Purpose: Health literacy and obesity are major global issues. Vulnerable populations, such as those with low health literacy, have the highest rates of obesity. Native Hawaiian and other Pacific Islander (NHOPI) nations have the highest prevalence of obesity in the world. This study describes the relationship between health literacy and demographic variables in a sample of NHOPI caregiving adults. Methods: We conducted a correlational study of 364 NHOPI adults. Each was a caregiver of at least one NHOPI child. Data were collected at grocery stores and a preschool in two Hawaiian Islands (n=209) and at NHOPI events in Utah (n=155). …

Evaluating The Effectiveness Of A Workshop/Support Group For Parents Raising Children With Type 1 Diabetes, Christina Marie Yazzie

Theses and Dissertations

The purpose of this study was to evaluate the effectiveness of a workshop/support group for parents raising children with type 1 diabetes mellitus (T1DM). Diagnosis of a chronic disease in a child generally arouses acute anxiety and stress in parents. Parental stress when raising a child with type 1 diabetes is often centered on worry about their child's health and parents' ability to maintain the care activities needed by these children. Parents are the primary caregivers of children with Type 1 diabetes, and the effect of stress on parents can impact the health of both children and parents. The present …

The Relationship Between Select Demographic Characteristics And Body Mass Index Among Native Hawaiian And Other Pacific Islander Caregiving Adults, Katrina Duncan

Theses and Dissertations

Purpose: Native Hawaiian and other Pacific Islanders (NHOPIs) have the highest prevalence of overweight and obesity in the world. This study identified the proportion of our NHOPI sample in each body mass index (BMI) category and explored relationships between demographic characteristics and BMI. Design: This descriptive correlational study included 364 NHOPI caregiver adults in Utah (n=155) and Hawaii (n=209). We gathered demographic information with a questionnaire. Height and weight were measured for BMI calculations. Results: According to the CDC's BMI categories, 84.3% of our sample was overweight (BMI=25.0-29.9) or obese (BMI ≥30). Participants in Utah had significantly higher BMIs than …

Emergency Department Nurses' Suggestions For Improving End-Of-Life Care, Robert D. Wood

Theses and Dissertations

Introduction: Death is not an uncommon outcome for patients who seek immediate care in an emergency department. Although death is common in the emergency department there is little literature regarding end-of-life care in the emergency department. The purpose of this research study is to determine what changes emergency nurses would suggest to improve end-of-life care for dying patients and their families in emergency departments.

Background: A national, geographically dispersed, random sample of 1000 emergency nurses were sent a questionnaire entitled, "Emergency Nurses' Perceptions of End-of-Life Care." Inclusion criteria included nurses who were members of the Emergency Nurses Association, could read …

Postpartum Depression In Immigrant Hispanic Women: A Comparative Community Sample, Laura Mae Shellman

Theses and Dissertations

Purpose: This study was initiated to verify whether a remarkably high rate of postpartum depression (PPD), previously found in immigrant Hispanic women receiving health care at a community clinic, would also be found in a community sample with a similar demographic.

Data Sources: Sixty immigrant Hispanic women who had recently given birth were recruited from local community settings. The Beck Postpartum Depression Screening Scale-Spanish version (PPDS-S) and the General Acculturation Index (GAI) were used to screen for PPD symptoms and to collect demographic data. These data were then compared with previously published data from the community clinic sample.

Conclusions: Sixty …

Symptom Clusters In Lung Cancer Patients, Debra Rattican

Theses and Dissertations

SYMPTOM CLUSTERS IN LUNG CANCER PATIENTS By Debra Rattican, PhD, RN A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2012 Major Director: Debra E. Lyon, PhD. Professor and Chair Family and Community Health Nursing The purpose of the study was to examine selected relationships among symptoms common to individuals with lung cancer. The specific aims were: 1) To examine the relationship between the symptoms of dyspnea and anxiety in patients with lung cancer. 2) To examine the relationships among the symptoms of dyspnea, anxiety, and …

Predictors Of Sexual Relationship Power, Communication And Sexual Decision Making Among Latino Couples, Yui Matsuda

Theses and Dissertations

Unintended pregnancy (UP) is increasing among Latinos in the United States. Unintended pregnancy contributes to many negative consequences for infants, mothers and families. Concurrently, various factors affect Latino couples’ sexual relationship power, communication and decision making about family planning, including sexual relationship power, relationship commitment, dyadic adjustment, individual background, and cultural characteristics. Previous research has not focused on understanding the factors that affect Latino couples’ sexual relationship power, communication and sexual decision making from each partner’s perspective. The purpose of this study was to examine the association between sexual relationship power, communication, and sexual decision making from each partner’s perspective …

The Effect Of Oral Care On Intracranial Pressure In Critically Ill Adults, Christina Szabo

Theses and Dissertations

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960’s when ICP monitoring was first introduced in the clinical setting. Until recently few studies have specifically examined the effect of oral care on ICP and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions …

Opioid Withdrawal Signs And Symptoms In The Pediatric Patient During Opioid Tapering, Deborah Fisher

Theses and Dissertations

Opioids are used routinely in the pediatric intensive care population for analgesia, sedation, blunting of physiologic responses to stress, and safety. In children, physical dependence may occur in as little as two to three days of continuous opioid therapy. Once the child no longer needs the opioid, the medications are reduced over time. A review of the literature revealed that the majority of the published studies used either a neonatal opioid assessment tool or no assessment tool. A subsequent international survey of pediatric providers found a wide range of opioid tapering practices and sporadic use of opioid withdrawal instruments to …

Biobehavioral Correlates In Fibromyalgia, Ann Trivigno Mcnallen

Theses and Dissertations

Introduction: Fibromyalgia (FMS) is a chronic pain syndrome characterized by non-restorative sleep, and fatigue. Over 75% of individuals with FMS complain of poor sleep quality and fatigue. These have been ranked by patients with FMS as having great impact on quality of life. A literature review suggested that poor sleep quality may be a predictor of increased stress and FMS symptom onset in those affected. However, no experimental studies have demonstrated a causal relationship between poor sleep and stress in people with FMS. Methods: Using a single stage cross-sectional design, the primary study aim was to compare 25 women with …

The Determinants Of A Nurse's Discretionary Decision To Respond To Situations That Place Patients At Risk For Safety Events But Requires A Response That Is Beyond The Scope Of Nursing Practice, Kathy Baker

Theses and Dissertations

A nurse’s contribution to patient safety in regards to early detection of issues in the clinical setting is undisputed (Redman, 2008). If these patient situations require a response that is beyond the scope of nursing practice, in most instances nurses are not sanctioned to intervene without physician consultation (Gaba, 2000). The evidence in the nursing literature does suggest that some nurses exercise professional discretion and are, at times, making the decision to initiate interventions independently (Benner, Hooper-Kyriakidis, & Stannard, 1999; Hutchinson, 1990; Tiffany, Cruise, & Cruise, 1988). The focus of this inquiry was to examine the determinants of a nurse’s …