Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Implementing A Telephone Triage System, Joanyett Mays-Scott

Master's Projects and Capstones

Implementing a Telephone Triage System

Abstract

Introducing a telephone triage system requires conscientious regard to the organizational configuration and culture, staff abilities and experience, observed need and expected outcomes, staffing issues, and the physical location in which the system will be introduced (Murdoch et al., 2015). For this microsystem A SWOT analysis and microsystem assessment were performed. This community health center’s goal was to have standardized, evidence-based triage protocols followed by the nursing staff and the contracted nursing staff. The workflow was introduced in a series of lunch and learns provided by clinical nurse managers. Once workflows were established a …

Blood Pressure And Job Domains Among Hotel Housekeepers, Marie-Anne Sanon Rosemberg Phd, Mn, Rn, Bidisha Ghosh Ms., John Shaver Bsn, Maria Militzer Ma, Julia Seng Phd, Cnm, Faan, Marjorie C. Mccullagh Phd, Rn, Aphn-Bc, Cohn-S, Faaohn, Faan

Journal of Health Disparities Research and Practice

Hotel housekeepers have challenging working conditions, putting them at risk for poor health such as hypertension. Despite their risks, few studies have measured their blood pressure (BP). The purpose of this study was to explore hotel housekeepers’ blood pressure and the associations between work and BP. Methods: A community engagement approach was used to recruit study participants. Data sources included questionnaires, and BP measurement. Results: Over 25% of the 39 hotel housekeepers reported hypertension diagnosis and/or antihypertensive medication used. Across the job domains, job satisfaction was correlated with diastolic BP, and workload was correlated with systolic BP. There were difference …

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 …

Analyzing The Medical Definition Of Death In Criminal Homicide Prosecution, Mariah Wood

Nursing ETDs

I investigated the use of the medical definition of human death in the criminal justice system and the impact of this definition on the prosecution of criminal homicide. The units of design for this research were two violent crimes cases investigated by the Homicide Unit of the Albuquerque Police Department. Data was collected from officer interviews, case files, Office of the Medical Investigator reports, media and social media.

I identified the themes of pursuit of justice, frustration, and family from the collected data. Key findings include that the medical definition of human death causes confusion and delay in the criminal …

Traumatic Brain Injuries: A Telehealth Alternative For Veterans, Jessica Dickman

Dissertations

Problem: Traumatic Brain Injuries (TBI) are known as the signature wound of veterans serving in Operation Enduring Freedom (OEF) and the Operation Iraqi Freedom (OIF). After the initial TBI diagnosis, outpatient TBI follow-up rates are reported to be approximately 9% less in the Veteran Healthcare Administration (VA) system when compared to the private sector. The purpose of this quality initiative was to decrease the rate of missed appointments among OEF/OIF veterans using a telehealth alternative.

Methods: The Plan-Do-Study-Act (PDSA) method was used to implement a consistent process for the telehealth visit option. A retrospective medical record review over the same …

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 …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Nurse-Led Triage Clinic In An Hiv Supportive Housing Apartment Community, Sally Breen

Dissertations

Problem: HIV-positive persons living in supportive housing who were otherwise homeless are reported to have better health outcomes than those who remain homeless. This was a quality improvement project to obtain baseline information regarding the implementation of onsite nursing services for individuals and their families residing in an HIV-positive supportive housing apartment community in an urban Midwestern city. Methods: A nurse triage clinic was implemented in partnership with the Doorways organization. Two registered nurses staffed the clinic two days per week. Data was collected on demographics and clinic utilization over a nine-week period. Results: Of the apartment residents, N=95, the …

Aligning With Patient-Centered Medical Home Standards: Depression Screening In Women's Health, Charity Galgani

Dissertations

Problem: The Patient Centered Medical Home (PCMH) model of care improves health care quality and patient experience of care, and decreases costs. Depression screening is a requirement for becoming a PCMH. The purpose of this quality initiative was to obtain baseline data to describe depression screening rates among female adult patients receiving women’s health care within a Midwestern public health department seeking PCMH recognition.

Methods: The study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A retrospective medical record review was used to assess the rate of depression screening utilizing the PHQ-2 and PHQ-9 tools, and …

Implementing A Caps Simulation To Increase Nursing Education Practice Students’ Self-Awareness Of Attitudes And Beliefs About Poverty, Melissa Ehmke

Dissertations

Problem. The purpose of this project is to determine if college students who are currently in nursing school, will benefit from the addition of a poverty simulation to positively influence their self-awareness and individual-level beliefs and attitudes towards poverty, therefore being able to serve those in poverty fully and guide them to appropriate resources.

Methods. Bachelor of Science in Nursing (BSN) and Doctoral Nursing Practice (DNP) students participated in a three-hour Community Action Poverty Simulation (CAPS). A twenty-one item Attitude Toward Poverty Scale short form (ATPS) survey was completed pre and post-simulation participation.

Results. Significant improvements resulted in three of …

Moodle-Based Chlamydia Awareness Project To Increase Intention To Test In College Freshmen Males: A Dnp Scholarly Project, Adam Burri

Doctor of Nursing Practice Scholarly Projects

In 2016, there were over 1.5 million cases of chlamydia reported in the United States with prevalence rates highest in people under 25 years of age (Centers for Disease Control and Prevention, 2017). Researchers have suggested that college aged adults (age 18-25) should be targeted for chlamydia educational programs because these individuals are lacking in knowledge about chlamydia prevention, infection, symptoms, and screening methods (Goundry, Finlay, & Llewellyn, 2013; Rutledge, Siebert, Chonody, & Killian, 2011). This scholarly project utilized a quasi-experimental, single-group pretest-posttest design and used a modified version of the Sex, Drugs, and Rock’n’Roll Questionnaire designed by Lim et …

Open Space, Thin Blankets, And Snores: An Examination Of Sleep In Young Adults Experiencing Homelessness, Claire Olivia Moore

Honors Projects

Sleep has been identified as a public health concern, especially among college students and young adults, which are defined here as adults ages 18-25 years old. Individuals who are homeless also face specific challenges to getting high quality, restful sleep. The purpose of this review is to investigate the potential health burden of impaired sleep quality in young adults experiencing homelessness. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ebscohost, Medline, Google Scholar, and PsychInfo databases were searched using the following terms independently and in combination: sleep, sleep quality, young adults, college students, emerging adults, sleep hygiene, homeless, …

Care For Inmates With Mental Illness: What Can Nurses Do?, Rebecca K. Sakai

Honors Projects

This paper serves to inform nurses of the medical and psychiatric treatment that inmates with mental illness receive and to offer suggestions for treatment interventions. Current practice includes mental health screens, psychotropic medication administration, psychiatric departments, and administrative segregation. The recommended interventions include providing therapy (including Cognitive Behavioral Therapy and Group Therapy), decreasing administrative segregation, implementing reintegration programs, and training and collaborating with correctional officers.

The Effect Of Mantram Repetition On Qol In Low-Income, Urban Dwelling Older Adults, Marissa Katerina Mackiewicz

Dissertations

Background: Quality of life is an important concept of increasing significance for the healthcare in the United States, especially when taken in perspective of the aging population. Low-income, urban dwelling older adults are challenged in a number of ways that may negatively impact their QOL. This unique group is prone to report lower QOL, therefore, interventions targeted to improve QOL are timely. The purpose of this study was to describe the effect of mantram repetition (MR) on QOL in a sample of low-income, urban dwelling older adults.

Methods: A quasi-experimental pre-posttest study was conducted using a sample population of low-income …

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 Assessment Of Maternal Mortality In Papua New Guinea: An Explanatory Sequential Mixed Methods Approach, Jennifer Litau

Adventist Human-Subject Researchers Association

Research into the serious manifestation of maternal mortality in Papua New Guinea is essential for formative knowledge and intervention. Explanatory sequential mixed methods approach employed first involved SPSS analyses of Gulf Provincial Hospital’s obstetric data revealing high rates of home deliveries by mothers. Interviews in high incidence communities provided explanations and mortality experiences.

The Clinical Nurse Leader As Outcomes Manager: Optimizing Screening Mammography In An Outpatient Breast Center, Yao Luo

Master's Projects and Capstones

The Clinical Nurse Leader as Outcomes Manager: Optimizing Screening Mammography in an Outpatient Breast Center

Abstract

This clinical nurse leader (CNL) practice improvement project was conducted in an outpatient breast center that is part of a community safety-net hospital. The patient population consists of a large proportion of disadvantaged, low income, low English literacy, and high-risk women over 445 years of age. Recent observations and baseline data from the breast center and the mobile mammography van indicated that five to eight radiologic views were taken during a routine mammogram in a subset of screening patients which exceeds the standard set …

Advanced Access: Creating An Infrastructure For Success In Primary Care, Kimberly D. Perris

Doctor of Nursing Practice (DNP) Projects

The Humboldt Independent Practice Association (IPA) has sought to improve the health of Humboldt County through practice transformation efforts. To date, Humboldt IPA’s primary care practice, the Priority Care Center, is building a foundation toward an Advanced Access model of care with an overarching aim of effectively improving access to quality care in Humboldt County. The 10 Building Blocks of High Performing Primary Care Practices framework set the stage for the intervention and was used as a roadmap to build an infrastructure for success. Team-based care was highlighted as the project relied on having systems and processes that empower the …

Decreasing Environmental Health Risks In The Philippines: Implementation Of A Culturally Appropriate Screening Tool, Alyssa Samson

Doctor of Nursing Practice (DNP) Projects

Objectives: The purpose of this DNP project was to increase the knowledge of environmental health risk factors in the Philippines among nurses and doctors located within that healthcare system. The overall goal was to educate providers on local environmental health risks, provide training for the use of a screening tool (Tagalog Environmental Health and Safety Assessment Tool [TEHSAT]), and provide resources aimed at increasing screening of at risk populations and provide opportunities for education and health promotion.

Methods: This project included a two-part educational training session. The first part included a preliminary presentation on environmental health and the use of …

Addressing Disparities Among The Homeless Population With Type Ii Diabetes Through The Use Of Educational Programs, Allison Moses

Senior Honors Projects, 2010-2019

Background: The homeless population is exposed to many difficulties and barriers while attempting to manage Type II Diabetes Mellitus (DMII), which involves complex medication regimens and dietary and exercise modifications. The aim of this literature review is to increase awareness among healthcare professionals, to improve their understanding and ability to educate the homeless population, to help reduce health disparities and promote chronic disease management.

Methods: Access to two electronic search engines, CINAHL and PubMed, was obtained through James Madison University’s Library Database. The Ratings System for Level of Evidence was used to determine articles for inclusion based on reliability, sample …

Sun Prevention Fun (Spf): A Multicomponent Sun Prevention Program For Children In Kindergarten And First Grade, Sarah Gouker

Evidence-Based Practice Project Reports

Skin cancer is an important topic in the United States due to the recent increase in cost and mortality. The purpose of this evidence-based practice (EBP) project was to determine if the early implementation of a multicomponent sun prevention program positively impacted kindergarten and first grade students’ knowledge and behavioral intentions to practice safe sun techniques after a one week period. Kotter’s Model of Change and the ACE Star model were utilized to guide this EBP project. An exhaustive review of the literature yielded 12 articles which were used to develop best practices for education on sun safety. The quality …

Oral Health Literacy In Parents And Care Providers Of Young Children, Rachel Nye

Doctor of Nursing Practice Scholarly Projects

Tooth decay ranks first as the most common chronic disease in childhood (U.S. Department of Health and Human Services [HHS], 2000). In addition to the morbidity directly related to cavities, there are a myriad of other systemic implications of this disease. The purpose of the study was to determine baseline oral health literacy levels for a sample of pediatric caregivers living in the Upper Peninsula and to determine the impact of a community based education program on these levels. The program was offered at three locations. A paired sample t-test of sixty-four complete data sets demonstrated a statistically significant increase …

Evidence-Based Study Of Medication Compliance Project In Hiv Prevention Using Pre-Exposure Prophylaxis (Prep) Antivirals For Hiv-Negative Males, Ming-Chun Ho

Doctoral Projects

In 2012, emtricitabine/tenofovir was the only Food and Drug Administration-approved medication for pre-exposure prophylaxis (PrEP) used in human immunodeficiency virus (HIV) prevention. To date, there is little research on open-label and mixed-payer characteristics supporting medication compliance of men who have sex with men (MSM). The purpose of this research was to describe individual demographic variables associated with PrEP medication adherence and to examine the effect of a follow-up phone call from a nurse once a month for 3 months. A total of 30 MSM were recruited and data were collected using a demographic questionnaire, medication adherence tool and follow-up phone …

Sexually Transmitted Infection Risk Reduction For College Students, Mary Kathryn Dowling

Doctoral Projects

University students have been assessed through many sexual health lenses, but there is a paucity of research on the sexual health of community college students. This population may provide good access to at-risk youth, and opportunity to reverse steep climbs in sexually transmitted infection (STI) rates. This research project pilot tests a theory-based intervention employing social facilitation to reduce STI risk among college students. Fifty students were recruited from Human Sexuality courses to participate in a 60-minute workshop. Pre- and post-testing measured for change in STI knowledge, attitude towards safer sex, and self-efficacy for engaging in safer sex practices.

A …

Adolescent Sexual Health: Provider Evaluation Of A Sexual History Tool At A School-Based Health Clinic, Gillian Marie Williams

Doctoral Projects

There is a growing concern within the United States in regard to sexual behavior within our adolescent population. Sexually transmitted infections (STIs) have always been a concern, however, there has been a steady increase since 2014 in the three nationally reportable diseases of chlamydia, gonorrhea, and syphilis. According to the CDC (2017), 15-24 years old account for half of all the new STI s. There is a need to provide more sexual health to adolescents during their health visits. It is also imperative to understand the beliefs and attitudes of providers with providing these types of exams and asking questions …

Emergency Preparedness Among College Students At The University Of Arkansas, Mary Gadberry

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Students at the University of Arkansas could be susceptible to multiple forms of disaster including severe winter weather, earthquakes, tornadoes, lightning, floods, toxin release, radiological release from nuclear power plant, infectious diseases, food contamination, fires, active shooters, and bomb threats (Federal Emergency Management Agency [FEMA], 2013). The unpredictability of natural disasters, coupled with the increase in targeted school violence, served as the impetus for various federal initiatives intended to protect university populations (FEMA, 2003). The purpose of this study was to determine the emergency preparedness levels of college students at the University of Arkansas. Only 50% of students were concerned …

Pornography As A Public Health Issue: Promoting Violence And Exploitation Of Children, Youth, And Adults, Elisabeth Taylor

Dignity: A Journal of Analysis of Exploitation and Violence

The pornography industry is expanding exponentially as a result of ongoing technological advances. The ability to stream videos over the internet and the ubiquity of the smart phone have meant that pornography producers are able to use algorithms to target potential consumers, to cultivate new sexual tastes and to deliver content to a more diverse audience over mobile devices. The advent of virtual reality pornography with interactive sex toys and sex robots imbued with artificial intelligence promises to unleash a further step-change in the extent to which pornography influences ‘real-world’ sexual culture. The critical analysis of pornography undertaken over decades …

Most Effective Interventions For Disaster Relief Preparation, Elizabeth Keating, Faith Edwards, Cheryl Swanson Phd, Rn

Anna Vaughn School of Nursing Undergraduate Work

Because disasters are sometimes unpredictable and difficult to measure, it is exceedingly important to have properly trained healthcare professionals that are prepared for a variety of natural and manmade crises. Victims affected by disasters may be numerous and have severe injuries, but nurses, as first-responders, with proper education and experience can drastically reduce the amount of casualties in a particular disaster. However, it is clear that nurses currently feel unprepared in the event of a natural or manmade disaster, and therefore need more training and preparation for such occurrences. This systematic research review set out to find the most effective …