Targeting Loneliness In Older Adults With Weekly Socialization, Tanja Johnson

Dissertations

Problem: Loneliness related to social isolation among the older adult population has become an increasing health concern with few interventions available for the general population. Loneliness has been directly associated with depression, poorer physical health outcomes, and overall quality of life.

Methods: The purpose of this study is to evaluate loneliness in the older adult population residing in a senior living community in an urban area in Missouri. Weekly one-on-one socialization, ranging from 45-60 minutes, will be implemented over 6 weeks, with pre and post-intervention screening for loneliness with the 28-item Visit-A-Bit (VAB) screening tool. Approval was received by both …

Lost In Interpretation: The Lived Experience Of Nurse Interpreters In The Clinical Setting, Byron Batz

Dissertations

The use of language interpreters in the health care setting constitutes a vital part of provider-patient communication but remains a relatively unexplored phenomenon. Registered nurses (RNs) are often called upon to serve as interpreters when linguistically diverse patients constitute a large segment of the patient population. That RNs serve simultaneously in an interpreter role – in addition to clinical and advocacy roles – is a complex facet of contemporary nursing practice in a diverse U.S. culture. The purpose of this qualitative descriptive study was to examine the lived experience of RNs serving as interpreters in health care institutions in Southern …

Implementation Of A Vestibular Disorder Screening Tool In An Urgent Care, Kathleen A. Probst

Dissertations

Implementation of a Vestibular Disorder Screening Tool in an Urgent Care

Kathleen A. Probst

M.S.N., University of Missouri-Columbia, 2007

B.S.N., University of Missouri-Columbia, 2004

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

August 2023

Advisory Committee

Susan Dean-Baar, PhD, RN, CENP, FAAN

Chairperson

Jennifer Vines, DNP, MSN, RN

Troy Dinkel, MD

Copyright, Kathleen A. Probst, 2023

Abstract

Problem: Vestibular disorders disrupt everyday living and can cause reduced quality of life. Guidelines developed to screen for vestibular disorders are not efficient to use …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Evaluation Of An Education Program Implementation For Adults With Stage 4 And 5 Chronic Kidney Disease, Dana Marie Carter

Dissertations

Abstract

Problem: Patients with long-term medical conditions represent a significant public health issue. Therefore, patients diagnosed with a chronic illness must have a high level of health literacy (HL) to manage their condition effectively. This Quality Improvement (QI) project evaluated the impact of an existing education-based program for stage 4 and 5 chronic kidney disease (CKD) patients and its effect on laboratory values compared before and after an NP-led education program that included vascular access, and modality choices.

Methods: A retrospective chart review was completed on 20 patients with an inclusive diagnosis of CKD stage 4 or 5 from …

Implementation Of An Evaluation Of Davita Clabsi Protocol To Reduce Bloodstream Infections In Acute Hemodialysis Patients, Emmy Le

Dissertations

Abstract

Problem: Central line-associated bloodstream infection (CLABSI) is the primary cause of morbidity and mortality in End-Stage Renal Disease (ESRD) patients on hemodialysis. It is associated with severe medical conditions, prolonged hospitalization, and financial burden. Despite its convenience and simple operation, central venous catheter (CVC) account for 70% of all CLABSI occurrence and increase the risk for septicemia and death.

Methods: This quality improvement (QI) project utilized a descriptive observational pilot design to identify the effect of DaVita CLABSI Protocol on CLABSI occurrence rate. Quantitative data was collected retrospectively and prospectively via electronic medical record (EMR) review before and …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden

Dissertations

Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …

Initiation Of Procalcitonin Screening As A Marker In Antibiotic Therapy De-Escalation, Briana Kile

Dissertations

Problem: The overuse of antibiotics has created antimicrobial resistance (AMR)

resulting in treatment failure for bacterial infections. To combat AMR, clinicians should

only prescribe antibiotic therapy when clinically warranted. It is easy to misdiagnose a

viral infection. However, any delay in the initiation of antibiotic therapy in a bacterial

infection may lead to increased morbidity and mortality. These patients with non-specific

clinical symptoms may be misdiagnosed without a rapid and definitive diagnostic test.

Methods: This quality improvement (QI) initiative utilized an evidence-based clinical

guideline for procalcitonin (PCT) levels for antibiotic therapy de-escalation. WBC counts

were collected two-days and one-day before …

Left Ventricular Assist Device (Lvad) Driveline Infection Rates Between Two Different Dressing Methods, Gretchen Compton

Dissertations

Problem: Heart failure has a growing impact on Americans, and this contributes to an increased number of patients requiring treatment for advanced heart failure. Typical treatment options may include cardiac transplant or the implantation of a left ventricular assist device (LVAD). The use of an LVAD requires sterile management of an external driveline site. Driveline infections are a common complication in this patient population and can lead to chronic complications. There are no published guidelines on the management of the driveline site. This project aimed to provide evidence that can be used in the establishment of standardized guidelines for driveline …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

Palliative Care Screening For Persons Living With Dementia In A Nursing Home, Shanika S. Pruitt

Dissertations

Problem: Dementia is rapidly increasing as the people of the world mature and life expectancy increases. As the world ages and the prevalence of dementia increases, nursing home placement will and is the most sought place for care of this population. Dementia is under recognized as a terminal illness and palliative care is underutilized for nursing home residents with advanced symptoms of dementia.

Methods: This quality improvement (QI) initiative utilized a prospective, descriptive design. The Palliative Care Screening for the Elderly tool was administered to a purposive sample of persons living with dementia residing in the nursing home. Qualitative data …

Evaluation Of Pre-Procedural Phone Call Effectiveness Before A Colonoscopy, Rachel Schoelch

Dissertations

Abstract

Problem: Colorectal cancer is the third most diagnosed cancer in the United States (Gu et al., 2019). A colonoscopy procedure is the best diagnostic tool to evaluate the colon for pre-cancerous and cancerous polyps (Dang et al., 2020). Inadequate bowel preparation decreases colon visualization where adenomatous colon lesions may be missed.

Methods: Using an observational, pre/post design, a chart review was conducted for this QI project. Quantitative data comparing Boston Bowel Preparation Scale (BBPS) scores was collected on patients who received nurse-led phone calls one month prior to a colonoscopy, and patients who received phone calls one week prior …

Evaluating The Effects Of Mindstrong™ In Graduate Nursing Students, Syeda Shah

Dissertations

Abstract

Problem

A high rate of burnout and lack of resiliency is a major problem in nursing graduate students resulting in dropout and mental health issues. MINDSTRONG™ is an evidence-based cognitive behavioral skills-building program with the goal of building resiliency and decreasing burnout through coping skills to improve overall adult health and well-being.

Methods

A descriptive design using quantitative data analysis through pre, and post surveys was used. The surveys evaluated graduate nursing students’ burnout and resiliency after participating in MINDSTRONG™, a cognitive behavioral theory program, implemented by trained facilitators for seven sessions. The sample consisted of all six self-enrolled …

Intimate Partner Violence Education For Pregnant And Postpartum Adolescents And Young Adults, Tatiana Filajdic

Dissertations

Abstract

Problem The commencement of intimate partner violence (IPV) often begins with relationships during adolescence and young adulthood; hence, young age is a risk factor. Young adult females, pregnant and post-partum adolescents are at high risk of experiencing intimate partner violence (IPV).

Methods A prospective, descriptive design evaluating the impact of three IPV education sessions offered over a three-month period at a non-profit shelter specific for young adult, pregnant and post-partum adolescents.

Results Twelve participants attended the sessions (N=12), and seven (n=7, 61.5%) of shelter residents attended at least one IPV education session. A two-proportion z …

Enhancing Communication Between Nurses And Physicians On Patients With Sepsis, Jayne Ehirim

Dissertations

Abstract

Problem: The condition of sepsis is life-threatening, and its severity increases when there are delays in interventions. Communication challenges exist on medical-surgical units and are major contributors to poor management of patients with sepsis. Ineffective communication among health care team members continues to threaten patients` health outcomes. The purpose of this project was to implement a standardized form of communication between nurses and physicians of patients with sepsis.

Methods: An observational descriptive design with a retrospective chart review. A quality improvement PDSA cycle was used to implement an SBAR communication instrument.

Results: A total of 16 …

Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis

Dissertations

Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.

Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …

Antibiotic Administration Time During A Code Sepsis, Shemekia Ford

Dissertations

Problem: Sepsis is the leading cause of morbidity and mortality and antibiotic administration within 60-minutes is a priority. The purpose of this quality improvement project was to improve sepsis patient’s outcomes by administering parenteral antibiotics within 60-minutes of a code sepsis (CS) activation.

Method: Observational descriptive design utilizing a retrospective medical record review over a three-month period in 2020 and 2021. A purposive sampling of adult patients from a Midwestern, metropolitan, Level II trauma and medical center emergency department (ED) were selected.

Results: The administration of parental antibiotics once a sepsis bundle was activated was essentially 28-minutes in 2020 …

Intimate Partner Violence Education For High School Students, Morgan Foster

Dissertations

Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.

Methods An educational lesson plan for IPV was created for high school teachers.

Results …

Attitudes Toward Sars-Cov-2 In Frontline Healthcare Workers And First Responders, Michelle Tiffany Arrington

Dissertations

Problem: To date, little evidence exists to understand attitudes of SARS-CoV-2 in frontline healthcare workers (HCW) and first responders (FR), related to best practices in mitigating virus spread. The purpose of this project was to assess attitudes toward COVID-19 in young adults, ages 18-44 years old, who are frontline workers related to their adherence to PPE guidelines, social distancing, hand hygiene, community exposures, and vaccinations.

Methods: A descriptive survey design using five-point Likert scale questions and 26 open-ended questions and was implemented one-year after onset of the pandemic. A purposive sample working in a large, urban, Midwest metropolitan area was …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Integration Of Kansas City Cardiomyopathy Questionnaire-12 In Clinical Practice, Norman Njihi

Dissertations

Abstract

Problem: Congestive heart failure (CHF) is a high symptom disease in which patients tend to decompensate frequently, most often leading to hospitalization and poor quality of life.

Methods: This project involved educating nurses about using patient reported outcome(PRO) tools with an emphasis on the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Pre and post surveys using a Likert scale tool designed by the author were used to determine if a change in knowledge occurred. Satisfaction of the providers was assessed using a survey, also designed by the author. A retrospective review of 13 patients was done to establish patients’ baseline KCCQ-12. …

Utilization Of Asthma Guidelines In Primary Care, Kate R. Miller

Dissertations

Background: Chronic lower respiratory disease, including asthma, is the fourth leading cause of death in the U.S. Financially, asthma accounts for approximately 54 billion dollars in healthcare spending annually. The National Heart Lung and Blood Institute [NHLBI] established guidelines to reduce impairment and to reduce future asthma attacks.

Purpose: This Quality Improvement (QI) pilot implemented the Asthma Control Test (ACT) and the Asthma Action Plan (AAP) per NHLBI guidelines. This project aimed to increase provider use of the ACT and AAP to 50% in patients with a diagnosis of asthma over one month.

Methods: A convenience sample of six adult …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Bridging The Gap In Primary Care Of Inflammatory Bowel Disease (Ibd) Patients, Deanna Dial

Dissertations

Abstract

Problem. Patients in rural or medically underserved areas (MUAs) with inflammatory bowel disease (IBD) have limited access to primary care preventative services, making them even less likely to obtain preventative care, placing them at even greater risk for adverse health outcomes.

Methods. A two-phase retrospective chart review utilizing a convenience sample of patients diagnosed with IBD from a privately-owned gastroenterology office to evaluate the effectiveness of increasing preventative screenings for IBD patients. The first review included 53 patients seen from January to April 2019. A preventative screening

evaluation tool (PSET) was developed based on literature recommendations, including the American …

The Effects Of High Dose Intravenous Vitamin C In Cancer Patients, Bankole Aluko

Dissertations

Problem: Currently used standard treatments (Chemotherapy, radiation) in cancer patients are generally accompanied with side effects, which may include pain, nausea, vomiting, fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) during and after completion of treatments. High dose IV C may improve the anti-cancer action of chemotherapeutic agents by reducing side effects of fatigue, pain, nausea and vomiting and boosting immune cell functioning, and inhibiting angiogenesis (Mikirova, Casciari, & Hunninghake, 2019).The purpose of this quality improvement project was to explore whether high dose intravenous vitamin C (IV C) prevented major side effects that frequently occur with standard treatments in cancer patients and …

Evaluation Of A Type 2 Diabetes Mellitus Care Coordination Program, Carrie Smith

Dissertations

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators …

An Examination Of The Night Burn Clinic Transition To Nurse Practitioner Coverage, Kevin J. Maxwell Dnp, Fnp-Bc

Dissertations

Background/Significance: Burns are dynamic, evolving wounds requiring prompt attention and treatment (Morgan et al., 2018). Many studies have been conducted comparing physician outcomes to those of APNs showing no difference (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2011; Naylor & Kurtzman, 2010; Pioro et al., 2001; Roche, Gardner, & Jack, 2017; Spetz, Skillman, & Andrilla, 2017). Time delays which allow for progression of the injury have a negative impact on patient outcomes. Any pathway allowing for quicker review of the burn by a burn specialist should be welcomed (Kelly et al., 2013). APNs can augment physician efforts and expand access to …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …