Matching Items (82)
Description
Background: Workplace violence (WV) is a significant problem in healthcare that affects the nurses' physical and mental health and impacts patient care. This is costing healthcare organizations millions of dollars for damage control as there is a lack of prevention. Hence, this evidence-based practice project uses the theory of planned behavior and nursing process discipline theory to explore the effectiveness of screening patients for violence.
Method: After an aggregate IRB approval, a violence screening tool with high sensitivity and specificity, Broset Violence Checklist (BVC), was implemented twice daily and as needed for 15 days with 275 adult patients in a neurology/telemetry unit to help identify patients at high-risk for violence. All interventions and procedures were based on established policies, not the BVC score.
Results: A generalized estimating approach with a logit link and linear regression was used for data analysis. Of the 1504 BVC screenings completed, 43 violent incidents were reported, with interventions recorded in 106 (7.1%) screenings. Patients with a BVC score of <2 required an intervention 16 times (1.2%), and BVC score of >2 required an intervention 90 times (54.2%), OR= 17.95 (95% CI: 3.55 to 90.84), p< 0.001.
Discussions: Total BVC score, male gender, and older age were highly predictive of violence. Also, as the BVC score increased above 1, additional interventions were utilized.
Conclusion: The BVC has value, indicating that patients who score above 1 can pose enough threat to require an intervention. Thus, uncovering risks and identifying the potential for violence is essential to diminishing harm and WV.
ContributorsSilwal, Sadikshya (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-05-01
Description
Background: Obesity is a known comorbidity for chronic disease and is responsible for 47% of related medical costs. Recognizing the complex etiology of obesity, the need for an effective and comprehensive screening tool will assist primary care providers in assessing their patient's needs and facilitating success in managing their weight and health. Primary care providers (PCP) have limited knowledge of current evidence in obesity treatment. The project guides the form of tools to help identify the patients' self-efficacy, change readiness, and insurance reimbursement.
Methods: Expedited IRB approval was obtained, allowing for data analysis from completed de-identified screenings, surveys, and medical records gathered between September 2022 and April 2023. Screenings including Weight Efficacy, Lifestyle long-form (WEL-LF), and Stages Of Change Readiness And Treatment Eagerness Scale In Overweight And Obesity (SOCRATES-OO) were used to assess the effectiveness of the treatment plan. Russwurm and Larrabee's model for evidence-based practice change was chosen for the project's framework. The provider was given a guide for obesity management with tips for billing insurance. A convenience sample of eight patients met with the providers over three months as part of their obesity management treatment plan.
Results: The pre and post-screenings collected from the remaining participants (n=8) showed no statistical differences. However, the satisfaction and feedback survey from patients (n=8), provider (n=1), and office staff (n=4) showed improved quality of care and greater confidence in the provider's part in initiating and managing their patient's chronic obesity.
Conclusion: Improving PCPs' knowledge of Obesity treatment improves patient care. Expanding this project to a larger scale and disseminating the information can impact patients' lives positively.
Keywords: Obesity; self-efficacy; readiness for change; stages of change; primary care, Weight Efficacy Lifestyle questionnaires
ContributorsBrock-Andersen, Marian (Author) / Moffett, Carol (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
Description
Nonadherence to psychiatric medications was identified as an issue worldwide and in a non-profit organization for women recovering from substance use disorders (SUD) in the southwestern United States. Non-adherence is associated with increased hospitalizations and relapse. A literature review indicated that motivational interviewing (MI) was an evidence-based intervention for increasing psychiatric medication adherence in women recovering from SUD. This project aimed to assess if training the organization staff on MI, would impact their beliefs, knowledge, and comfort of using MI on their clients with non-adherence. The Theory of Planned Behavior is the underlying principle of the project. A recruitment flyer was sent to the organization via email, and interested staff attended the training on the basics of MI via a PowerPoint presentation through video conferencing. Pre-, post-, and one-month follow-up questionnaires were provided to assess participants' knowledge, familiarity, and comfort with MI. The questionnaires consisted of the reliable/validated Beliefs About Medication questionnaire (BMQ) and questions about MI. Participants were deidentified for data collection. A Friedman's test and descriptive statistics were used for analysis. 17 staff participated; five one-month follow-ups were completed. Participants believed medication was more beneficial than harmful and necessary for improvement-nonsignificant: Friedman test p = .179. Upon follow-up, 40% reported being comfortable using MI while 60% reported they had not used MI yet. MI training may improve staff comfort and ability to address medication nonadherence. A larger sample may lead to significant and generalizable results.
ContributorsDarko-Amoako, Princess (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
Description
Loneliness and depression in older adults are under-recognized public health concerns that increase risks for all-cause mortality, medical morbidity, and rising healthcare costs. This quality improvement project assessed whether smartphone Mindfulness software mitigated self-reported feelings of loneliness and depression among community-dwelling older adults. Nine participants aged 65 and older, living at home, experiencing loneliness or depression, and owning a smartphone were recruited using newsletters and fliers. A short demographics questionnaire and two valid and reliable instruments, namely the University of California Los Angeles Loneliness Scale (UCLA V3) and Geriatric Depression Scale (GDS), were used in pre-intervention and four weeks post-intervention. Participants downloaded the UCLA Mindful app on their smartphones after attending a 20-minute Mindfulness education at a local church banquet room. Participants used the UCLA Mindful software twice weekly for ten minutes for four weeks. Of the nine participants, three completed the study. A two-tailed paired sample t-test and descriptive analysis were used to evaluate the efficacy of the UCLA Mindful smartphone software. The results of the two-tailed paired sample t-test were not statistically significant for the UCLA V3 Loneliness scale (p=.220) and GDS (p=.208) due to the small sample size. Although the results were negligible, participants nevertheless reported favorable impacts. Future research with a larger sample size is encouraged.
ContributorsMurdock, J. Kristine (Author) / Guthery, Ann (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-26
Description
Breast or formula feeding is a personal and challenging decision for any new parent. Breastfeeding goes beyond the mother-baby dyad, having profound implications across different societal contexts, including financially and medically. Although a natural form of feeding, breastfeeding can be difficult and isolating if it does not come easily. A mother's first contact for help is usually at her newborn's first primary care appointment. However, these appointments are insufficient in allowing the healthcare provider to answer breastfeeding concerns or questions. A quality improvement project was conducted at a pediatric primary care clinic in the southeast valley of Arizona after approval was granted by an Institutional Review Board. Eight participants were recruited, and four completed the project. This project focused on extending the newborn appointment by 15 minutes to provide an educational resource binder and address breastfeeding questions. The Bristol Breastfeeding Assessment Tool (BBAT) was utilized to determine the mother's self-efficacy towards breastfeeding since the Theory of Self-Efficacy was the foundation for this project. Weekly follow-up telephone calls were conducted to address the mother's questions. The project concluded at the one-month appointment, where BBAT was performed again. The BBAT scores demonstrated an increase in breastfeeding self-efficacy. The participants were also evaluated if the project aided their breastfeeding journey. Every participant was breastfeeding by the one-month appointment except one who was not exclusively breastfeeding. In addition, all preferred the extended-length newborn appointments, educational binder, and weekly phone calls. Qualitative theming supported the use and continuation of the project for future mothers.
ContributorsScott, Taryne (Author) / Bay, Sarah (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-28
Description
Problem Statement: The onset of the COVID-19 pandemic led to intense challenges for health care providers. Outpatient primary care practices rapidly moved from in-person practice to video-conferencing telehealth appointments. This shift requires study, particularly how this has impacted the lived experience of providers.
Purpose: This project aims to explore primary care provider satisfaction with telehealth in the wake of the COVID-19 pandemic.
Methods: A point-in-time survey was administered to primary care providers at a large university health system. Participants were recruited at a monthly provider meeting and invited to complete an anonymous online survey. Satisfaction with video-conferencing patient visits was explored via Likert scale and write-in responses. Providers highlighted specific complaints, problems, and successes that impacted their practice and patients. Aggregate health data from this organization was also obtained for comparison. Statistical analysis was performed and recommendations made for future practice.
Findings: The provider experience of telehealth was overwhelmingly positive. 85% (n=11) of providers agreed or strongly agreed that telehealth allows them to manage their patients effectively. Lack of physical exam findings was the most commonly cited concern (n=9). 100% (n=13) of providers would like to continue seeing patients via telehealth in the future.
Conclusion: Videoconferencing appointments in university health primary care promote high provider satisfaction. Future policies and innovations should support the use of a telehealth platform.
ContributorsMcKernan, M. Katherine (Author) / Nunez, Diane (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
Description
Background: The cost of health care for end-stage kidney disease patients has exponentially increased over the years, costing 91,000 annually per patient. Peritoneal dialysis has proven to be a cost-effective renal replacement therapy compared to in-center hemodialysis. Quality evidence from a systematic literature review indicates that peritonitis is one of the leading causes of patients' ability to maintain peritoneal dialysis. Evidence suggests that enhanced patient education on infection control practices beyond standard education effectively reduces peritonitis incidents.
Methods: Enhanced education on infection control practices was delivered to 18 peritoneal dialysis patients in Southern Arizona through the application of determinants of the Health Belief Model utilizing the principles of the ADKAR framework. Data analysis will be available through facility-specific quality metrics of decreased peritonitis and modality loss episodes. Each of these measures is to have data compared to pre/post-intervention.
Results: All participants in the study were able to sustain peritoneal dialysis as their renal replacement therapy. Of the 18 participants, one patient episode of peritonitis occurred three months before the intervention, and zero episodes were reported during the first three months of monthly infection control education. Facility-specific peritonitis and modality loss measures are not available until after project publication.
Conclusion: To decrease peritonitis rates and modality loss, the intervention will continue for eight to 12 months to determine success. More time is needed to determine if patients adhere to monthly infection control practices taught during enhanced education.
ContributorsSchneeweis, A. Danielle (Author) / Rauton, Monica (Thesis advisor) / College of Nursing and Health Innovation (Contributor)
Created2023-04-29
Description
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by progressive autoimmune destruction of insulin-producing pancreatic β-cells. Genetic, immunological and environmental factors contribute to T1D development. The focus of this dissertation is to track the humoral immune response in T1D by profiling autoantibodies (AAbs) and anti-viral antibodies using an innovative protein array platform called Nucleic Acid Programmable Protein Array (NAPPA).
AAbs provide value in identifying individuals at risk, stratifying patients with different clinical courses, improving our understanding of autoimmune destructions, identifying antigens for cellular immune response and providing candidates for prevention trials in T1D. A two-stage serological AAb screening against 6,000 human proteins was performed. A dual specificity tyrosine-phosphorylation-regulated kinase 2 (DYRK2) was validated with 36% sensitivity at 98% specificity by an orthogonal immunoassay. This is the first systematic screening for novel AAbs against large number of human proteins by protein arrays in T1D. A more comprehensive search for novel AAbs was performed using a knowledge-based approach by ELISA and a screening-based approach against 10,000 human proteins by NAPPA. Six AAbs were identified and validated with sensitivities ranged from 16% to 27% at 95% specificity. These two studies enriched the T1D “autoantigenome” and provided insights into T1D pathophysiology in an unprecedented breadth and width.
The rapid rise of T1D incidence suggests the potential involvement of environmental factors including viral infections. Sero-reactivity to 646 viral antigens was assessed in new-onset T1D patients. Antibody positive rate of EBV was significantly higher in cases than controls that suggested a potential role of EBV in T1D development. A high density-NAPPA platform was demonstrated with high reproducibility and sensitivity in profiling anti-viral antibodies.
This dissertation shows the power of a protein-array based immunoproteomics approach to characterize humoral immunoprofile against human and viral proteomes. The identification of novel T1D-specific AAbs and T1D-associated viruses will help to connect the nodes in T1D etiology and provide better understanding of T1D pathophysiology.
AAbs provide value in identifying individuals at risk, stratifying patients with different clinical courses, improving our understanding of autoimmune destructions, identifying antigens for cellular immune response and providing candidates for prevention trials in T1D. A two-stage serological AAb screening against 6,000 human proteins was performed. A dual specificity tyrosine-phosphorylation-regulated kinase 2 (DYRK2) was validated with 36% sensitivity at 98% specificity by an orthogonal immunoassay. This is the first systematic screening for novel AAbs against large number of human proteins by protein arrays in T1D. A more comprehensive search for novel AAbs was performed using a knowledge-based approach by ELISA and a screening-based approach against 10,000 human proteins by NAPPA. Six AAbs were identified and validated with sensitivities ranged from 16% to 27% at 95% specificity. These two studies enriched the T1D “autoantigenome” and provided insights into T1D pathophysiology in an unprecedented breadth and width.
The rapid rise of T1D incidence suggests the potential involvement of environmental factors including viral infections. Sero-reactivity to 646 viral antigens was assessed in new-onset T1D patients. Antibody positive rate of EBV was significantly higher in cases than controls that suggested a potential role of EBV in T1D development. A high density-NAPPA platform was demonstrated with high reproducibility and sensitivity in profiling anti-viral antibodies.
This dissertation shows the power of a protein-array based immunoproteomics approach to characterize humoral immunoprofile against human and viral proteomes. The identification of novel T1D-specific AAbs and T1D-associated viruses will help to connect the nodes in T1D etiology and provide better understanding of T1D pathophysiology.
ContributorsBian, Xiaofang (Author) / LaBaer, Joshua (Thesis advisor) / Mandarino, Lawrence (Committee member) / Chang, Yung (Committee member) / Arizona State University (Publisher)
Created2015
Description
Current research on criminal case processing typically examines a single decision-making point, so drawing reliable conclusions about the impact that factors such as defendants’ race or ethnicity exert across successive stages of the justice system is difficult. Using data from the New York County District Attorney's Office that tracks 185,275 diverse criminal cases, this study assesses racial and ethnic disparity for multiple discretionary points of prosecution and sentencing. Findings from multivariate logistic regression analyses demonstrate that the effects of race and ethnicity vary by discretionary point and offense category. Black and Latino defendants were more likely than White defendants to be detained, to receive a custodial plea offer, and to be incarcerated—and they received especially punitive outcomes for person offenses—but were more likely to benefit from case dismissals. The findings for Asian defendants were less consistent but suggest they were the least likely to be detained, to receive custodial offers, and to be incarcerated. These findings are discussed in the context of contemporary theoretical perspectives on racial bias and cumulative disadvantage in the justice system.
ContributorsKutateladze, Besiki L. (Author) / Andiloro, Nancy R. (Author) / Johnson, Brian D. (Author) / Spohn, Cassia (Author) / College of Public Service and Community Solutions (Contributor)
Created2014-08-01
Description
Simons and Burt's (2011) social schematic theory (SST) of crime posits that adverse social factors are associated with offending because they promote a set of social schemas (i.e., a criminogenic knowledge structure) that elevates the probability of situational definitions favorable to crime. This study extends the SST model by incorporating the role of contexts for action. Furthermore, the study advances tests of the SST by incorporating a measure of criminogenic situational definitions to assess whether such definitions mediate the effects of schemas and contexts on crime. Structural equation models using 10 years of panel data from 582 African American youth provided strong support for the expanded theory. The results suggest that childhood and adolescent social adversity fosters a criminogenic knowledge structure as well as selection into criminogenic activity spaces and risky activities, all of which increase the likelihood of offending largely through situational definitions. Additionally, evidence shows that the criminogenic knowledge structure interacts with settings to amplify the likelihood of situational definitions favorable to crime.
ContributorsSimons, Ronald (Author) / Burt, Callie (Author) / Barr, Ashley B. (Author) / Lei, Man-Kit (Author) / Stewart, Eric (Author) / College of Public Service and Community Solutions (Contributor)
Created2014-11-01