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Description
This thesis highlights the impact that nursing and collaborative care can have for patients in the acute care setting who have a mental illness, with a specific focus on Obsessive-Compulsive Disorder and related disorders. Holistic care for patients admitted into the acute care setting with a comorbidity of OCD includes exploration of nursing interventions and collaborative therapies, namely journaling, mindfulness or meditation, breathing, self-help methods, exercise, massage, acupuncture or electroacupuncture, yoga, and nutrition. Each intervention was evaluated in the context of how a nurse can apply or facilitate the intervention in an acute care setting. Nurses and health professionals are encouraged to utilize these interventions and to be creative in their treatments, taking into consideration all aspects of a patient: mental, physical, and otherwise.
ContributorsGilmore, Alyssa Fay (Author) / Hagler, Debra (Thesis director) / Guthery, Ann (Committee member) / Edson College of Nursing and Health Innovation (Contributor) / Sanford School of Social and Family Dynamics (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
This study examined the differences in mental and behavioral treatment outcomes between use of Telehealth and in-person appointments in effort to mitigate discrepancies that may lessen treatment efficacy.
ContributorsStreiff, Abigail (Author) / Chia-Chen Chen, Angela (Thesis director) / Guthery, Ann (Committee member) / Barrett, The Honors College (Contributor) / School of Molecular Sciences (Contributor) / School of Human Evolution & Social Change (Contributor)
Created2023-05
Description
Objective: To assess the attitudes and knowledge of behavioral health technicians (BHTs)
towards opioid overdose management and to assess the effect of online training on opioid
overdose response on BHTs’ attitudes and knowledge, and the confidence to identify and
respond to opioid overdose situations.
Design/Methods: Pre-intervention Opioid Overdose Knowledge Scale (OOKS) and Opioid
Overdose Attitude Scale (OOAS) surveys were administered electronically to five BHTs in
2020. Data obtained were de-identified. Comparisons between responses to pre-and post-surveys
questions were carried out using the standardized Wilcoxon signed-rank statistical test(z). This
study was conducted in a residential treatment center (RTC) with the institutional review board's
approval from Arizona State University. BHTs aged 18 years and above, working at this RTC
were included in the study.
Interventions: An online training was provided on opioid overdose response (OOR) and
naloxone administration and on when to refer patients with opioid use disorder (OUD) for
medication-assisted treatment.
Results: Compared to the pre-intervention surveys, the BHTs showed significant improvements
in attitudes on the overall score on the OOAS (mean= 26.4 ± 13.1; 95% CI = 10.1 - 42.7; z =
2.02; p = 0.043) and significant improvement in knowledge on the OOKS (mean= 10.6 ± 6.5;
95% CI = 2.5 – 18.7; z =2.02, p = 0.043).
Conclusions and Relevance: Training BHTs working in an RTC on opioid overdose response is
effective in increasing attitudes and knowledge related to opioid overdose management. opioid
overdose reversal in RTCs.
ContributorsQuie, Georgette (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-12
Description
Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma
often exhibit behaviors that make educating them challenging. Preschool teachers at a
southwestern United States preschool receive no training related to childhood trauma and
resilience. The purpose of this project was to educate preschool teachers on trauma and
resilience to improve attitude related to educating children with trauma. Following Arizona State
University Internal Review Board approval, preschool teachers were recruited from a non-profit
metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience
Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]),
one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC
questionnaire at two and six weeks. Seven teachers (n=7) participated in pre-training
questionnaires, and three of these teachers (n=3) participated in both post-training
questionnaires. All participating teachers were female and Caucasian. Average age of
participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years
(SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training
ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six
weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25). Clinical significance included
improved teacher awareness of childhood trauma and improved ability to interact with children
exposed to trauma. Teachers exhibited high resilience scores. Additional research needed
related to further address educating preschool teachers related to trauma informed care, related to
building resilience in children, and related to the impact of teacher resilience on trauma informed
care.
ContributorsChristmas, Melissa (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-12
Description
Sedation exists along a continuum; and, it is impossible to predict a patient’s exact response to a medication administered to induce any level sedation. Under the direction of a licensed independent practitioner (LIP), registered nurses (RN) in the Emergency Department (ED) have been permitted to administer propofol for time-sensitive, moderate sedation procedures (e.g. orthopedic reductions). In 2019, this changed when a Board of Nursing (BON) in the Southwestern United States posted an Advisory Opinion (AO) limiting the circumstances under which acute care RNs could administer propofol. The purpose of this doctoral project was to revise the 2019 AO to remove specific medication names and to generate recommendations for aligning hospital-based adult sedation policies and procedures (P&P) with the revised AO. In May 2020, the BON enacted the revised AO. Enactment endorses RNs practicing at the top of their scope and justifies amending existing hospital-based sedation P&Ps. Not restricting nurses’ scope of practice according to medication name supports medication selection based on patient condition and clinical situation and safeguards provision of timely, personalized healthcare to communities statewide.
ContributorsBonefield, Brittany A. (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-18
Description
Solo private physician-owned clinics report lower rates of electronic health record (EHR) use. Lack of use of an EHR results in billing penalties, revenue losses, and may affect quality of care. An EHR provides a concise recollection of a patient’s complete medical history, and any pertinent exam information clearly and succinctly. The aim of this pilot project was to support a small solo private physician-owned clinic transition from paper-based charting to an EHR. The pilot assessed through a validated survey EHR readiness and confidence of the employees at the beginning of the change process (pre-intervention) and at 16 weeks (post-intervention). During the 16-weeks, interventions in the form of transition assistance included vetting an EHR modality for the practice, virtual training via EHR modules, weekly check-ins with stakeholders, and organizational planning and scheduling with staff. EMR-based goal setting with EHR rollout deadlines was also provided. Results noted confidence decreased pertaining to EHR transitioning over the 16 weeks. Unforeseen barriers and challenges likely led to reduced confidence and provided information on future transition supports needed for the practice. The findings of this pilot are beneficial in gaining insight on how to enhance readiness in an outpatient clinic for EHR readiness. This information is utilized as a guide for small privately-owned outpatient clinics in their organizational transition from paper-charting to EHR. The results of this pilot project provide evidence-based data on the demands of system-wide organizational change.
ContributorsLong, Dana (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-22
Description
Purpose: To assess the burnout levels of mental health workers and to evaluate the effectiveness
of promoting self-care practices in improving their well-being and resiliency.
Background and Significance: Burnout is highly prevalent among mental health workers due to
the nature of their work and the population of patients they serve. Turnover has been a
significant problem within this specialty for decades. Before the COVID-19 pandemic, the
mental health workforce was projected to experience shortage by 2025. The pandemic will likely
worsen this. Evidence from literature supports the effectiveness of promoting self-care towards
the development of resiliency and well-being in addressing burnout among healthcare workers.
Methods: The Maslach Burnout Inventory – Human Services Survey (MBI-HSS) was used to
assess the burnout levels of mental health workers in a psychiatric hospital in Arizona pre- and
post-intervention. Educational modules were provided for each participant to review. They were
asked to perform at least one self-care activity and to utilize the tools in the Provider Resilience
application every week for four weeks.
Results: Pre-intervention surveys indicated moderate levels of emotional exhaustion (m=20.71)
and depersonalization (m=9.29) and high levels of personal accomplishment (m=28.71).
Improvements were seen on emotional exhaustion (m=18.86), depersonalization (m=6.43), and
personal accomplishment (m=33.86) were seen post-intervention.
Conclusion: Although the results were not statistically significant due to small sample size, the
improvements seen on two out of three components of burnout (emotional exhaustion and
depersonalization) indicated that awareness of burnout levels and self-care practices contribute to
improving the well-being of mental health workers.
ContributorsLim, Jerica Elaine M. (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Objective: Attention Deficit Hyperactivity Disorder is a pervasive neurodevelopmental disorder among children. Research has shown that young girls are underserved in diagnosing and treating ADHD or never diagnosed compared males. Utilizing the Health Promotion Model, this project aims to determine if primary care providers are aware of sex differences in ADHD and if a brief education on sex differences in ADHD affects the primary care setting's screening rate.
Design/Methods: With the Arizona institutional review Boards' approval, primary care providers (PCP) in a Southwest family practice in Arizona (n=35) are provided with virtual education on sex differences in ADHD. Pre- post-intervention surveys were electronically administered to five PCPS. Data were deidentified. A two-tailed paired t-test was conducted to examine the mean difference of responses.
Results: Analysis of responses demonstrate that primary care providers are well aware of sex differences in ADHD but screened less for ADHD before the education intervention. Major themes emerged from provider comments on ADHD symptom recognition, time constraints, and increased screening to identify girls in the primary setting. A significant increase in ADHD screening is seen four weeks post-intervention t(4) = -6.32, p = .003.
Conclusion: Future research is needed to identify other factors that could strengthen ADHD screening during well-child visits overall. Also, the use of a pediatric screener which can highlight inattentive symptoms would assist in the process of identifying girls with ADHD.
ContributorsO'Connell, Roseann (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-27
Description
A federally qualified health center in the southwest United States serves low-income, uninsured communities. By provider reports, unprescribed antibiotic use is common in this clinic’s population, promoting development of antibiotic resistant bacteria. Antibiotics are widely available in Mexico and may be sold illegally in the United States without a prescription. This project’s purpose is to identify social risks and opportunities for antibiotic education. A telephone survey was administered to patients at least 18 years of age. The 32-item survey included a demographic questionnaire created for this project, the PRAPARE social determinants of health questionnaire, and the Eurobarometer antimicrobial resistance questionnaire. Any social risks identified were forwarded to clinic staff for referral. The survey was completed in English or Spanish, per the participant’s preference. A total of 20 surveys were completed. Low education level and unemployment were the most common social risks identified. Spanish language, housing and food insecurity, and difficulty meeting basic needs were associated with overall higher social risks. An antibiotic knowledge gap was identified, and self-medication with antibiotics was confirmed as a behavior within the population. Although no determinants for antibiotic misuse were identified, all participants indicated preference for provider-based education. This FQHC has an opportunity to develop a provider-based educational intervention. The length of the survey and the telephone format, required due to COVID-19 restrictions, were significant limitations, impacting recruitment. Further research is needed to determine the most effective way of delivering education. The clinic is continuing to administer the PRAPARE survey, expanding data on social risks.
ContributorsMiranda, Sarah (Author) / Tharalson, Erin (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-28
Description
As the incidence of acute and chronic wound conditions rises and wound dressing protocols become more complex, uninsured patients lacking access to specialty wound care are challenged to manage their own wounds. Understanding multistep dressing change protocols may be inhibited by low health literacy. Low health literacy is associated with reduced disease knowledge and self-care. Little evidence of health literacy effects on wound patients is available nor are literacy-sensitive educational interventions that address wound knowledge and self-care. Improved outcomes occur in all health literacy levels in other diseases with the use of literacy-sensitive educational interventions that incorporate more than one literacy strategy over multiple sessions. To examine the effectiveness of a literacy-sensitive wound education intervention on wound knowledge and self-care, an evidence-based pilot project was conducted in an urban wound clinic.
A convenience sample of 21 patients received a literacy-sensitive wound education intervention consisting of spoken and written communication over several sessions. Instruments measured health literacy level, wound knowledge, dressing performance, and wound healing status. There was a significant increase in wound knowledge scores in all literacy groups from baseline to visit two (p < .01) and four (p < .01). Dressing performance scores remained consistently high through visit four in all literacy levels. All participant’s wounds progressed toward wound healing significantly from baseline to visit two (p < .01) and four (p < .01). Incorporation of a literacy-sensitive education intervention with supportive literacy aids over several sessions supports improved wound knowledge and dressing self-care and can affect healing in patients of all health literacy levels.
ContributorsTharalson, Erin (Author) / Root, Lynda (Thesis advisor)
Created2018-04-20