DNP, Otterbein University, 2023, Nursing

Medical errors account up to 250,000 patient deaths annually. Research suggests medical errors are attributable to poor healthcare team communications. The Institute of Medicine posits that communication and teamwork are essential components to safe and successful health care environments. According to the Joint Commission poor communication is considered the root cause of nearly 80% of all serious medical errors. Consequently, the Department of Defense and Agency for Healthcare Research and Research created a team-based training program, known as TeamSTEPPS®, which has shown to improve team communication, performance, effectiveness, patient safety, satisfaction, and health outcomes in healthcare settings. Despite evidence supporting TeamSTEPPS®, one family practice clinic was not practicing standardized team communications and at an increased risk for potential miscommunications, medical errors, and adverse patient health outcomes. Consideration of perceptions and attitudes of staff before implementing system process changes like TeamSTEPPS® is important to ensure program success. Thus, the project's purpose was to assess and describe the staff attitudes, perceptions, and intent to make change, regarding team communication as it relates to clinic patient care and safety. The descriptive scholarly project focused on staff questionnaire responses about perceived team communications and intent to change communication processes in a clinic setting. A systematic data review indicated 86% of respondents agreed the clinic was at risk for committing medical errors, 71% strongly agreed a standardized communication method would benefit the clinic, and 64% of respondents remained neutral regarding to the staff receiving TeamSTEPPS®. Thus, more research is warranted before effective implementation and sustainment can occur at the clinical project site.

Committee: Chai Sribanditmongkol (Advisor); Regina Prusinski (Committee Member); Joy Shoemaker (Committee Member) Subjects: Nursing

Ph.D., Antioch University, 2014, Leadership and Change

In Making Space for Dying: Portraits of Living with Dying, I describe the everyday lived experience of dying and the care culture within freestanding, community-based, end-of-life residences (CBEOLR) utilizing portraiture and arts-based research. I craft four case studies into "portraits," based on interviews, on-site visits, up-close observation, and field notes. In the person-centered portraits, I reveal the inner landscape of two terminally ill women, with data represented in poetry. In the place-centered portraits, I "map" the social topography of two CBEOLRs to illustrate how lives and care of the dying are emplaced, from the perspectives of community leaders, residence staff, volunteers, family members, and residents, with data presented as aesthetic (storied) narrative. Collage and photographs further enhance the text. Little has been written about the meaning of home and the centrality of a home-like environment in the healthcare milieu, specifically in the context of the end-of-life care setting. My research helps to fill a gap in understanding care culture in the freestanding CBEOLR, a care-setting genre rarely examined in the literature. Additionally, my study develops the notion of a "good place to die" and introduces the Home for the Dying, a CBEOLR model unique to New York State. Lastly, building on the literature on liminality, and informed by clinical practice as an oncology social worker, my study specifically highlights the terminal stage of cancer and introduces the concept terminal liminality, characterized by descent. Two broad dimensions emerged: Nesting-in-Being and Nesting-in-Place. Together, these dimensions created a framework for exploring care culture and ways of working with existential suffering. The bird's nest, as a utilitarian though temporal structure, provided an elegant metaphor for the special end-of-life residence. Three linked sub-themes related to care culture emerged, Nest of Simple Things (meaning making), Nest of Belonging (open full item for complete abstract)

Committee: Carolyn Kenny PhD (Committee Chair); Alan E. Guskin PhD (Committee Member); Carol S. Weisse PhD (Committee Member); Timothy E. Quill MD (Other) Subjects: Aging; Behavioral Sciences; Families and Family Life; Gerontology; Health Care; Individual and Family Studies; Medicine; Oncology; Public Health; Social Psychology; Social Work

DNP, Walsh University, 2023, Nursing

Nurses that care for pediatric patients with behavioral disorders and aggression in a non-psychiatric setting face unique challenges. Pediatric nurses are usually not trained to care for children with aggression and behavioral outbursts, which result in high rates of burnout. Providing formal trauma-informed patient care education and training to pediatric nurses can improve their confidence and the quality of care in managing patient aggression. The purposes of this study were to a.) examine if Welle behavioral-management training is effective in improving pediatric nurse confidence in the management of pediatric aggression in a non-psychiatric setting and b.) examine the relationship between demographic characteristics and nurse confidence. A convenience sample of 13 registered nurses employed on the pediatric medical-surgical unit who received the Welle training educational intervention were recruited to participate in this study. A one-group pretest post-test study design was used to assess registered nurses' level of confidence in managing pediatric patients with aggression before and after the Welle training. To measure nurse confidence in the management of pediatric aggression, The Incidence of and Attitudes Toward Aggression in the Workplace questionnaire was administered before and up to two weeks after the Welle training. Results indicate that the Welle training was effective in improving nursing confidence scores in the management of patients with aggression. Findings from this study provide information on how training and education can improve nurse confidence scores in the management of pediatric aggression. These findings can be useful when designing nursing orientation programs and standardizing aggression management education across health systems.

Committee: Shelly Amato-Curran PhD, APRN-CNS,CRRN (Committee Co-Chair); Janeen Kotsch PhD, MSN/Ed, RN, CNE (Committee Chair) Subjects: Behavioral Sciences; Nursing

DNP, Kent State University, 2022, College of Nursing

Type II diabetes mellitus is a rapidly growing, long-term medical condition impacting societies worldwide. The duration of hyperglycemia is a strong predictor of adverse outcomes and imposes enormous clinical and public health concerns. Capturing these individuals early in disease onset may reduce disease progression, future medical complications, and economic burden. Using a standardized diabetes screening protocol has been shown to improve the early identification of high-risk individuals who may otherwise go undiagnosed for years to come. This quality improvement project examined the impact of primary care clinicians using the American Diabetes Association Diabetes Risk Test and the incidence of chronic hyperglycemia screening and diagnosis in these individuals. Despite the low adherence (16%) to administering the screening tool and low clinician compliance (43.5%) for ordering additional screening measures when indicated, 52 (61.6%) of the 84 individuals who met inclusion criteria during the intervention period were diagnosed with new-onset chronic hyperglycemia. In contrast, 20 (22.5%) of the 89 individuals during the retrospective period. The results confirm a statistical significance (p-value < .001) in the frequency and accuracy of patients diagnosed with prediabetes or diabetes between groups. This quality improvement project supports utilizing the American Diabetes Risk Test as a standardized screening tool in primary care settings to identify high-risk asymptomatic individuals. Adding a diabetes screening protocol in one primary care clinic can influence the integration of the protocol system-wide using the electronic health record to better capture a more significant number of high-risk individuals in little to no time.

Committee: Louise Knox (Committee Chair); Denise Pacholski (Committee Member); Kimberly Cleveland (Committee Member) Subjects: Nursing

Master of Public Administration (MPA), Wright State University, 2011, Public Administration

Using a comparative framework and based on interviews with the primary actors involved in the debate for and against humane farm animal standards in Ohio, this thesis examines the roles of special and public interest groups, bureaucrats, technocrats, and the public in the rulemaking process of the Ohio Livestock Care Standards Board. This study finds that the creation of the board as a policy solution was likely impossible without the efforts of a policy entrepreneur and a “fixer;” that the board's relevance relies on a problem-setting approach to developing standards that includes a multitude of interests; and that continued public interest group pressure prevents the board from being captured by special interests. The author concludes that Ohio's approach, slightly modified, can be used as a model for other states and that a collaborative process, accountable to the public, can result in strong public policy recommendations even when interests seem divergent.

Committee: Myron A. Levine PhD (Committee Chair); Jack L. Dustin PhD (Committee Member); Jerri Killian PhD (Committee Member) Subjects: Public Administration; Public Policy

MS, University of Cincinnati, 2009, Allied Health Sciences : Nutrition

Objective: Assess the feasibility and efficacy of an ongoing randomized control trial currently in progress at the Drake Center in Cincinnati, Ohio, to determine the effects of EPA + DHA on inflammation, infections, weaning, length of stay and mortality among mechanically ventilated patients in a LTACH setting.Subjects: Thus far, there have been three patients to complete the study. All three were females, two were Caucasian and one was African American. Their ages were 58, 42, and 53. All three were diagnosed with Respiratory Failure, though each one's conditions stemmed from a different initiating event. In addition, the screening results for the first 32 patients screened for study enrollment are presented. Of these patients, 17(53%) were male, 15(47%) were female, and the average age of those patients screened who met the age criteria was 56.1± 5.99. Potential participants were assessed based on five inclusion criteria and eleven exclusion criteria. Overall, a history of ventricular tachycardia or atrial fibrillation was the most commonly indicated reason for exclusion (n=13) followed by a treatment dosage of heparin or coumadin (n=11), and an aPTT>33.5s (n=10). Study Design: Double-blind, randomized, placebo-controlled trial. Methods: Study participants were randomized to either a study group or a placebo control group. Subjects randomized to the study group received 8g of fish oil per day in divided doses administered through enteral tube every 6 hours for 14 days. Saline was administered to those in the control group in the same manner. The primary and secondary measures being investigated in this study include the inflammatory markers IL-6, IL-8, and LTB4, infectious events, weaning, length of stay, and mortality. Results: The study records for the first three patients to complete the trial indicated that the study protocol was followed completely and appropriately. Each of the participants weaned successfully and were eventually discharged, but only one of (open full item for complete abstract)

Committee: Sarah Couch PhD (Committee Chair); Dunning Kari PhD (Committee Member) Subjects: Nutrition