Public Health and Community Nursing Commons^™

Tobacco Use And Nicotine Withdrawal Among Patients With Mental Illness, Yazan Daher Al-Mrayat

Theses and Dissertations--Nursing

People with mental illness (MI) are disproportionately affected by tobacco use compared to the general population. In fact, it is estimated that people with MI consume approximately 44% of cigarettes smoked in the United States. Moreover, the MI population is at greater risk for the negative social, economic, and health consequences associated with tobacco use and are reported to have 25-year shorter life expectancies than the general population. The impact of tobacco use is further noticeable among patients with MI who require psychiatric hospitalization. Quitting smoking in this population has been linked to fewer discharges against medical advice, better quality …

Best Youth Education Methods For Sexually Transmitted Infection Prevention, Caitlin F. Walchonski

All Graduate Theses, Dissertations, and Other Capstone Projects

Sexual health education in the United States is inconsistent; information and methods vary from one location to another. Education plays a large role in developing safe sex practices, and despite the sexual education efforts, rates of sexually transmitted infections have risen for five consecutive years in the United States. A systematic literature review was conducted to determine the best methods for educating adolescents to promote behaviors to enhance sexual health. Multiple types of interventions have been studied including cognitive behavioral interventions, comprehensive sexual education, parent and teen dyad education, and abstinence only education. Sexual behavior is influenced by a variety …

Cost-Effectiveness Of A Mobile Health-Supported Lifestyle Intervention For Pregnant Women With An Elevated Body Mass Index, Elizabeth O'Sullivan, Salwa Rokicki, Maria Kennelly, Kate Ainscough, Fionnuala M. Mcauliffe

Articles

Objective To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care.

Methods We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost‐effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG …

Assessment Of Structural Competency In Baccalaureate Nursing Students: A Descriptive Study, Elle J. Del Gallo

Senior Honors Projects, 2010-2019

Cultural competence has been investigated extensively in nursing education to better prepare nurses to care for individuals of diverse backgrounds. While developing cultural competence is important to address individual care needs, it may not address the social and structural factors that influence health. Structural competency describes the ability to assess not only cultural factors that affect health disparities, but also structural inequalities and stigmas that can alter a patient’s presenting symptoms and risk for certain diseases.

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 …

Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant

Doctoral Projects

Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.

Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

Translation And Validation Of The Hplp-Ii From English To Armenian, Zoya Minasyan, Leslie C. Hussey

Journal of Excellence in Nursing and Healthcare Practice

As the focus of healthcare shifts toward the social determinants of health, more information about health disparities between different ethnic communities is needed. The Health Promoting Lifestyle Profile II (HPLP-II) is an instrument that measures health promotion behavior across various cultural lines. This article describes the translation and validation of the HPLP-II from English to Armenian for the purpose of studying health promotion behavior among the hypertensive and normotensive Armenian American population and addressing health disparities among this community. Translating the HPLP-II required a multistep process to capture cultural linguistic adjustment. First, the researcher, a local bilingual professor, and a …

Challenges To Diabetes Self-Management For Adults With Type 2 Diabetes In Low-Resource Settings In Mexico City: A Qualitative Descriptive Study, Robin Whittemore, Mireya Vilar-Compte, Selene De La Cerda, Denise Marron, Rosabelle Conover, Roberta Delvy, Annel Lozano-Marrufo, Rafael Pérez-Escamilla

Department of Public Health Scholarship and Creative Works

Background: The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods: This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results: The …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

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

Dissertations

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

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

Perceptions Of Health Practices And Interactions With The Us Healthcare System Among Bhutanese Refugees: A Qualitative Approach, Amy E. Szajna

Journal of Refugee & Global Health

Purpose

The aim of this pilot study was to explore health practices of Bhutanese refugees and their interactions with the US healthcare system and providers.

Methodology

Researchers conducted 12 in-depth interviews and 7 patient-provider observation units as part of this descriptive qualitative study.

Results

Participants identified individual definitions of health and behaviors they value to maintain health. They identified significant trust and faith in their healthcare provider and valued provider-directed suggestions. Participants cited concerns with patient-provider communication resulting from limited English proficiency and frequent changes in primary care providers.

Discussion

This study is useful to inform further research and potential …

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

Dissertations

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

Childhood Obesity: Getting Back To The Basics, Fanny Powell

DNP Qualifying Manuscripts

Childhood obesity is an epidemic that affects the nation. The Centers for Disease Control and Prevention (CDC) (2015) states that over the past thirty years, the prevalence of childhood obesity has more than doubled in younger children and quadrupled in adolescents (CDC, 2015). Although obesity is a multifactorial health issue that is affected by genetics, metabolic factors, socioeconomic factors, and lifestyle choices (Stanford, 2018), a majority of pediatric obesity is as a result of consuming more energy than the body utilizes. There are both immediate and long-term consequences of obesity that negatively affect a child’s health which may carry over …

The Perception Of Iron-Deficient Anemia In Bolgatanga, Ghana Among Women Of Childbearing Age, Sydney Albrecht

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Objective: To understand the perception of anemia among the women of childbearing age in Bolgatanga, Ghana, and to correlate the reasoning with the high incidence of anemia in the area.

Method: This research was a qualitative study consisting of 67 interviews over the course of the three weeks that were spent in Bolgatanga. 50 of these interviews were women of childbearing age (15-49), 6 were health professionals, and 11 were women older than the age range provided. Interviews were taken from the maternity clinics nearby as well as from women in a rural area that was a 10-minute taxi ride …

Early Identification Of Frailty Predictors In A Vowed Religious Community Of Catholic Men: A Strategy For Successful Aging In Place, Julia Senn-Reeves

Graduate Theses, Dissertations, and Capstones

Background: The population in the United States is aging and experiencing age- and disease-related changes, leading to increased frailty, as well as increased disability, morbidity, and mortality. Timely recognition of these vulnerabilities, and intervention implementation, are crucial to prevent adverse outcomes and to support successful aging in place. Purpose: The purpose of this project is to develop and implement a multifaceted assessment process to identify early predictors of frailty among members of a vowed religious community of Catholic men to ultimately support successful aging in place. Participants: A single vowed religious community of Catholic men in the United States, living …

Implementation Of A Nurse-Led Transitional Care Model For Older Adults With Copd Admitted To Home Health, Michelle Ryan Hunt

Doctor of Nursing Practice Projects

Problem Description: The importance of management of chronic disease and preventing rehospitalization has been identified at national and local levels. Chronic obstructive pulmonary disease (COPD) is one of the chronic diseases with notable rates of emergency department use and recurrence of hospitalizations.

Rationale: Implementation of transitional care models have been successful for health care organizations in chronic disease management.

Interventions: The health-social partnership transitional care management program (HSTCMP) was used to design a transitional care model process pilot for a home health agency (HHA) within a health system. This process used a multidisciplinary team led by a registered nurse for …

Built Food Environment And Perinatal Depression: An Integrative Literature Review, Rachel N. Mileski

Grace Peterson Nursing Research Colloquium

Background: Built food environment contributes to food access and insecurity, which impactsmaternal health due to increased rates of perinatal depression.

Objectives: The purpose of this integrative literature review will be to (1) identify contributing factors of built food environments in communities that increase the rate of perinatal depression and (2) evaluate the current intervention programs and methods addressing these factors in order to provide recommendations for further research.

Method: An integrative literature review will be used, in accordance with the Ecological Model, to evaluate contributing factors and suggestions.

Results: Findings from this integrative literature review revealed a link that connects …

Organizational Wellness Programs As Internal Social Marketing: A Literature Review Of Feasible Approaches, Faith Bontrager Rn, Bsn, Kimball P. Marshall Ph.D.

Atlantic Marketing Association Proceedings

No abstract provided.

The Impact On Cost, Quality, And Patient Satisfaction When Delivering Care To Acutely Ill Adults In An At-Home Care Model Versus An Inpatient Hospital Setting., Franchesca M. Adams

Honors Theses and Capstones

The impact on cost, quality, and patient satisfaction when delivering care to acutely ill adults in an at-home care model versus an inpatient hospital setting. Hospital level care for certain acute conditions can be safely delivered in the patient’s home while lowering the cost per episode of care, maintaining or improving patient experience, and improving safety and patient/care giver education as well as care coordination, at the Critical Access Hospital (CAH) level.

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

The Effect Of A School Nurse Intervention Program On Student Absenteeism In Jefferson County Public Schools: A Pilot Study, Eva Stone

DNP Projects

Background: School attendance has a significant impact on student achievement. In early grades, students who miss 10% or more of school are considered chronically absent and at risk to be behind in reading. High school students with similar attendance patterns are less likely to enroll and stay in college after graduation. Evidence shows that the presence of school nurses can result in improved school attendance.
Purpose: The purpose of this pilot project was to implement a targeted school nurse intervention at an elementary, middle and high school in Jefferson County. The intervention included assessment by a registered nurse for children …

Provider Adherence To National Heart, Lung, And Blood Institute’S Guidelines On Screening, Diagnosis, And Treatment Of Hypercholesterolemia In The Pediatric Population Aged 9-11 Years, Alanna Cox

DNP Projects

Purpose: High cholesterol levels have been directly linked to atherosclerosis, which is a leading cause of cardiovascular disease (CVD). Risk factors that accelerate the development of atherosclerosis, such as high cholesterol can begin in childhood. The purpose of this project was to evaluate provider adherence to the National Heart, Lung, and Blood Institute’s (NHLBI) Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, specifically the guidelines on universal lipid screening in children aged 9-11 years. The objectives were: 1) determine the rate of lipid screening in children 9-11 years old; 2) determine the number of children who …

Video-Based Diabetes Education For A Culturally Diverse Population, Heather Harris

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Immigrants and refugees represent an underserved population in need of quality, accessible, and culturally appropriate healthcare and education. Diabetes is a chronic condition frequently seen in this population. The author utilized the Wagner Chronic Care Model (CCM) as a theoretical framework for planning diabetes education delivery in this diverse population. Studies report significant health disparities in diabetes care and subsequent poor diabetes quality indicators in refugees and immigrants. Research has found that culturally sensitive diabetes education can improve diabetes outcomes in ethnically diverse populations. The author implemented a translational project to develop and evaluate a video-based diabetes health education intervention …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Changing Health Care Policy By Utilizing Kingdon's Policy Stream Theory, Brittney Welch

Graduate Theses, Dissertations, and Capstones

The purpose of this paper is to describe the policy process of changing current regulations regarding rural health clinics (RHCs). Using Kingdon’s Policy Stream Theory for guidance, the change project was designed to amend current regulations regarding the directorship of the RHCs, consequently allowing Nurse Practitioners (NP) to act as medical directors for rural health clinics (RHCs). This change fulfills the Institute of Medicine’s charge to have nurses work to the highest level of their education, as well as a defined need to fill a gap in the health care system by decreasing rural health disparities. The Rural Health Care …

Permanent Housing And On-Site Nursing Care: Effects On Homeless Individuals With Hiv And Other Cormorbidities, Lynelle Hinden

Dissertations

Abstract

Problem. Providing housing to otherwise homeless individuals who are HIV/AIDS-positive has been demonstrated to improve control of the disease. This was a healthcare quality initiative to review the viral load and Cluster of Differentiation Protein Four positive (CD4+) counts over time of residents in an urban housing facility for HIV/AIDS-positive individuals. Also, a nurse-run clinic was introduced for residents, especially those with comorbidities such as hypertension and diabetes.

Methods. A repeated measures design was utilized. Viral loads and CD4+ counts were retrospectively reviewed from facility records at entrance into and five-years later at the facility. Additionally, measurements of blood …

Increasing Follow-Up In College Students With Latent Tuberculosis Infection, Emily Middleton, Dnp, Aprn, Ccrn, Kathy James, Dnsc, Aprn, Faan, Kimberly Woodruff, Md, Mph

Doctor of Nursing Practice Final Manuscripts

Around 13 million people in the United States have latent tuberculosis infection (LTBI) with a 5-10% chance of developing active tuberculosis (TB) in their lifetime if not treated (Center for Disease Control, 2015). At a University Student Health Center (SHC), there is a matriculation requirement for TB testing for students that screen as high risk. Many students have these testing requirements performed at outside clinics, including foreign clinics, and follow-up regarding education about LTBI and treatment recommendations was often missing. The purpose of this evidence-based practice (EBP) project was to increase follow-up, education, and treatment options after diagnosis of LTBI. …

An Exploration Of Barriers To Health Care Access Among Uninsured Patients: Using The Moderating Effect Of Patients’ Enablement, Enedelia L. Jessup

Electronic Theses and Dissertations

ABSTRACT On March 23, 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) to increase value of care, improve clinical outcomes, decrease health care costs, and increase affordability in health care access. The purpose of the study attempts to examine the moderating effects of patient enablement impacting barriers, low socio economic status, and unmet basic needs, toward health care access in uninsured populations post ACA. Only certain aspects of patient enablement in self-management of an individual’s health care goals have been conducted with uninsured populations with barriers toward health care access. The research design was a quantitative, exploratory, …

Factors Associated With Household Contacts' Tuberculosis Testing And Evaluation, Elvy G. Barroso

Dissertations, Theses, and Capstone Projects

Contact investigation (CI) is one of the core elements of tuberculosis (TB) control. It is intended to achieve early identification of contacts who may have been exposed to a patient with infectious active TB and contacts who may benefit from treatment for latent tuberculosis infection (LTBI). LTBI is an infection in which the Mycobacterium tuberculosis organisms cause no signs and symptoms but the infection can be reactivated and develop into full-blown active TB disease. Failure to be identified as a contact is the primary reason for disease development in more than half of TB patients, thus a complete and timely …