Latinas’ lack of knowledge regarding cervical cancer screening (CCS) guidelines has a significant impact on CCS adherence and ultimately impacts their health outcomes related to cervical cancer. Studies have demonstrated that small media, culturally relevant educational interventions are highly effective in improving Latinas’ knowledge of CCS (Moran et al., 2016; Thompson et al., 2019; Warner et al., 2018). The purpose of this scholarly project was to implement and evaluate the efficacy of a small media educational intervention on Latinas’ knowledge of CCS and human papillomavirus (HPV) and evaluate the participants’ satisfaction with the intervention. A convenience sample of 50 Hispanic female patients between the ages of 21-65 was obtained from a community health center in the Southeast region of the United States. The fotonovela utilized in the Thompson et al. (2019) study was the intervention used for this project; it was offered in Spanish and English and included information on CCS and HPV. A pre- and post-test questionnaire assessing the participants’ CCS and HPV knowledge was administered. In addition, the post-questionnaire included questions that evaluated the participants’ satisfaction with the fotonovela. Following implementation of the fotonovela, participants significantly increased their average post-test CCS and HPV knowledge scores (Pre: 50.6; Post: 83.6, p<.000). All 50 participants (100%) reported overall satisfaction with the fotonovela. The findings of this project were both statistically and clinically significant indicating that the fotonovela is an effective and favorable educational intervention, thus its implementation is warranted in healthcare settings that provide care to Latinas.
While research on the ethical decision-making process in counseling continues to evolve, ethical violations committed by counselors persist, evidenced by an increase in the number of adverse incidents resulting in closed insurance claims and millions of dollars paid to the public on behalf of counselors (Healthcare Providers Service Organization, 2019). Knowledge of ethical codes and legal statutes, along with available decision-making models have been insufficient in guiding counselors’ ethical decision-making (Burns, 2019; Burns & Cruikshanks, 2019; Lambie et al., 2010; Lambie et al., 2011). Other factors must be considered to better understand this complex process. The purpose of this study was to examine how spiritual intelligence, meditation practice, clinical experience, and ethical climate were related to moral and ethical reflectivity among counselors in North Carolina. A simultaneous multiple linear regression was utilized to examine the role of counselors’ (n = 700) spiritual intelligence, meditation practice, clinical experience, and quality of the ethical climate to predict their moral and ethical reflection. Results indicated that spiritual intelligence, meditation, and ethical climate were significantly positively correlated with moral and ethical reflectivity. Additionally, the model accounted for 12% of the variance in moral and ethical reflection. Implications for the field of counseling are discussed.
Introduction: Postoperative delirium is a common cognitive complication characterized by an abrupt disturbance in brain function after surgery. It occurs in 15 to 25% of patients undergoing major elective surgeries and up to 50% of patients who have had high-risk procedures such as cardiac surgery or hip fracture repair. Postoperative delirium can result in negative outcomes such as increased healthcare costs, increased length of stay, and lasting cognitive impairment. Although nurses play a critical role in recognizing delirium, the complication remains under-recognized and poorly managed. This finding emphasizes the need for improved delirium recognition and management strategies; therefore, educational initiatives designed to improve delirium care are necessary for nurses caring for patients with this complication.
Objectives: This study evaluated the effect of structured delirium education on nursing knowledge, recognition, and management of delirium.
Methods: This quality-improvement project utilized the Nurses’ Delirium Knowledge Assessment (NDKA) tool, a 36-item scale divided into three subscales, to evaluate medical-surgical nurses’ knowledge before and immediately following the implementation of an on-demand web-based delirium education module. Participation in this study was voluntary and consisted of nurses working on two surgical units. Assessment scores were evaluated pre-and post-education and the Wilcoxon signed-rank test was used to detect significant changes.
Results: Sixteen nurses participated in the study. Overall mean scores improved from 67.99% on the pre-assessment to 81.84% on the post-assessment. Subscale mean scores also improved and were as follows: knowledge of assessment tools and scales 71.84% pre and 87.5% post, general knowledge of delirium 75.89% pre and 85.71% post, and risk factors for delirium 56.25% pre and 72.32% post.
Conclusion: The educational intervention provided in this study increased nurses’ knowledge and recognition of delirium, validating similar findings in the literature. An educational intervention delivered via electronic format is an effective method to provide delirium education to nurses. Improving nursing knowledge of delirium is essential in improving patient outcomes.
ABSTRACT
VICTORIA MARIE POILLUCCI. Breaking Down Barriers to Early Goals-of-Care Discussions with Terminally Ill Cancer Patients (Under the direction of DR. KELLY POWERS)
Opportunities to discuss options for care when faced with a life limiting disease is the right of all patients. Yet, healthcare provider feelings of awkwardness, fear of diminishing hope, and fear of failing to cure can result in missed opportunities to explore what patients really want for end-of-life care. Because these Goals-of-Care Discussions are not occurring, patients often receive unwanted and expensive care. The purpose of this quality improvement project was to evaluate the effect of education on oncology providers’ self-efficacy for Goals-of-Care Discussions, and to explore barriers and opportunities to promote completion of earlier Goals-of-Care Discussions. Two white board scribe videos were created to educate providers and for consideration for future use to show patients as an ice breaker to begin these difficult conversations. The sample included 66 Oncologists, Nurse Practitioners, and Physician Assistants from a large academic cancer center in the southeast United States. A Wilcoxon Signed Rank test showed a statistically significant immediate improvement in the oncology provider’s self-efficacy after viewing the videos (p<.001). Thematic analysis revealed 5 themes: lack of sufficient clinic time, provider comfort level, documentation as key to communication, protocol development, and oncologist versus palliative care (whose job is it?). Education for healthcare providers and tools to help initiate conversations with patients can help improve self-efficacy in conducting Goals-of-Care Discussion. Future research is needed to look at the cost of unwanted care and how developing a comfort level with having discussions surrounding end-of-life can reduce healthcare costs and improve patient centered care.
Federal legislation has mandated students with and without disabilities be prepared for college and careers (ESSA, 2015; IDEA, 2004). Students with high-incidence disabilities experience less success than their peers without disabilities (Newman et al., 2011). Initially, college and career readiness efforts lacked a focus on students with disabilities (e.g., Conley 2007, 2008), but recent efforts have increased the focus on students with disabilities (e.g., Morningstar et al., 2017). The predictors of post-school success appear to be a viable option to bridge both efforts. Students with high-incidence disabilities spend at least part of their day in general education classes (NCES, 2017), but general education teachers report wanting additional information to prepare students with high-incidence disabilities for college and careers (Kwiatek, 2017). General educators identified the predictors of post-school success as relevant, important, and feasible for implementation (Kwiatek et al., 2021). Coupling the alignment between secondary transition and college and career readiness, the predictors of post-school success appear to be an ideal option to provide general educators with professional development to prepare students with high-incidence disabilities for college and careers. The purpose of this dissertation was to examine the effects of an asynchronous online intervention (i.e., General Educators Now Embedding Research [for] Adult Life in Educational Design [GENERAL ED]) on general education teachers’ knowledge of research-based, in-school predictors of post-school success. Results indicated a functional relation between the asynchronous online intervention and increased knowledge of three predictors of post-school success. Effect sizes were large for increased knowledge of the predictors of post-school success. Additional measures included application; confidence; generalization; and social validity (i.e., feasibility evaluation, intervention rating scale). Finally, limitations, suggestions for future research, and implications for practice will be discussed.
Cancer is one of the most common causes of mortality in homeless adults. When a homeless person is hospitalized, they typically return to the streets, making recovery difficult. Conducting a needs assessment survey of homeless patients who are newly diagnosed with cancer was the first step towards evaluating how they can receive safe and cost-effective healthcare. Collection of information was from three perspectives: the patient, the oncology provider, and costs. Nine qualitative interviews with homeless individuals focused on concerns and barriers to care. Ten qualitative interviews with Medical Oncologists as well as a 20 question Survey Monkey was sent to all providers and focused on current treatment of their homeless patients. Lastly, a retrospective cost analysis examined costs of inpatient and outpatient care during chemotherapy. Two themes emerged from the patient interviews: Barriers to care and Someone to help. Three themes emerged from the oncology interviews: I worry about everything, Making decisions, and Care after chemotherapy. Half of the 19 providers who responded to the Survey Monkey questions indicated that they would revise treatment plans because of homelessness. All providers stated they would utilize a housing first option if available for their homeless patients. The retrospective cost analysis of 53 homeless patients with cancer over a 5-year period showed cost savings from inpatient vs outpatient treatment which totaled $9.0 million dollars. Drawing up a proposal to share with stakeholders is needed to develop a plan to help this population which may include a housing first/respite home as a solution.
Commercial wearable devices that collect health and fitness data are widely used. These devices sense and collect a variety of personal data, which can be shared by users with other people and with third parties. Yet, the collection of personal data by these sensor devices and the sharing of it poses several risks, including stalking, secondary use, aggregation, and inferences. In this dissertation, I present a new and an increased understanding of fitness tracker users’ sharing practices, concerns, awareness, and needs. The main goal is to design controls and features that empower users over the sharing and privacy of their information.
My research utilized different approaches, including semi-structured interview, survey, and participatory design studies. Overall, the findings uncover several sharing patterns by fitness tracker users, with practices in each pattern based on the intended audiences. While users do not consider much of the data collected by their devices sensitive, they have concerns about the possibility of abusing their data. However, users have limited awareness about the potential to infer personal information from the primary data collected by activity trackers. My research provides several factors that might impact users’ perceptions and attitudes towards inferences in the context of IoT wearable devices. Lastly, my research presents a set of taxonomies for sharing and privacy controls and mechanisms in fitness tracker platforms and contributes several design guidelines.
Background: Work in palliative care can be a rewarding experience in helping those suffering with complicated illnesses, it can also expose those involved to significant work stress, potentially leading to burnout. Palliative medicine is a medical specialty wherein clinicians provide care for the medical, psychosocial and spiritual needs of seriously ill patients, and facilitate their understanding and coping skills through the illness progression. These clinicians are especially vulnerable to frequent exposure to traumatic situations due to the high density of complicated patients under their care, placing them at risk for burnout.
Objective: The objective of this quality improvement project was to better understand burnout levels in palliative nurse practitioners and nurses in a large inpatient, academic hospital system and to determine the feasibility and effectiveness of implementing mindfulness meditation to reduce burnout levels.
Design: The Maslach Burnout Inventory (MBI) was used to assess burnout pre and post implementation of a brief, self-guided mindfulness intervention via smartphone application. The intervention was performed individually, remotely, and asynchronously with volunteers.
Setting/participants: A total of 12 palliative care nurse practitioners and nurses volunteered from an inpatient palliative care group within a large healthcare system in North Carolina. Results: MBI domains analysis revealed a statistically significant decrease in emotional exhaustion (Pre: 2.2; Post: 1.5; p=.016). The depersonalization domain (emotional disconnect) score did not show a statistically significant decrease in the post-intervention score, but a numerical decrease was reported (Pre: 0.82; Post: 0.65). The personal accomplishment domain score did not show any significant change (Pre: 4.6; Post: 4.5). The reflective questions indicated that many participants felt the mindfulness exercise was feasible, tended to feel calmer, were more relaxed, and were satisfied with the intervention. This correlates to the statistically significant result on the emotional exhaustion subscale, leading to the conclusion that the mindfulness intervention was valuable to those who participated and had efficacious results.
Conclusion: The information gained from this project is vital to better understanding burnout in palliative clinicians given its consequences are detrimental to healthcare systems, patient care and clinicians themselves. By developing evidence-based interventions and training, burnout could be prevented, thereby promoting longevity and satisfaction of clinicians in palliative care. If burnout can be eased, seasoned clinicians can be retained, leading to reduced financial burden on the healthcare system and improved patient care and satisfaction.
This dissertation explores the cybersecurity risk disclosure and the information an organization signals via disclosure contents. Extant literature acknowledges the ability of the cybersecurity risk disclosure to predict subsequent related outcome (i.e., realization of breach incident). However, little research has addressed whether the disclosure signals important information about the IT Risk Culture governing the organization. To fill this gap, I examine cybersecurity risk disclosures using textual analysis and clustering techniques to analyze the IT Risk Culture of a sample of organizations between the years 2011 – 2019. Three classifications of IT Risk Culture are identified. I find that a certain IT Risk Culture, evidenced by the vulnerability and the propensity for risk transfer (i.e. cybersecurity insurance) expressed in the cybersecurity risk disclosure, is associated with subsequent cybersecurity breach. Additionally, the disclosure of Corporate Social Responsibility activity is found to be associated with a second classification of IT Risk Culture, one in which there is no significant association with subsequent cybersecurity breach. This dissertation contributes to holistic risk management literature by employing a systems perspective of IT Risk Culture to analyze related disclosures. Findings contribute greatly to the understanding of IT Risk Culture classification, predominant risk response behavior and the likelihood of subsequent related outcomes.
Introduction: A high-functioning interdisciplinary team is needed to achieve optimal team and patient outcomes in the provision of care for intensive care patients. The difference between a high functioning and suboptimal interdisciplinary team manifest as variations in team outputs. Identification of key characteristics of high functioning teams can be used to assess and evaluate current interdisciplinary teams for potential areas of optimization. Methods: This study is a quality improvement needs assessment of the current interdisciplinary team performance in the neuroscience intensive care unit (NSICU) at a large academic medical center. This project employed a mixed method design, using quantitative methods for collected survey data and qualitative methods for thematic analysis of open-ended responses. Results: The survey had a 59.5% response rate, with 84 team members completing the survey. The majority of participants were registered nurses (n=51), followed by providers (n=21), and then other therapist members (n=12). Five themes were identified from open-ended responses regarding strengths and barriers to team effectiveness: structure, roles, the rounding processes, engagement, and team interactions. Within these themes, the needs of the team included: a shared decision-making model, improved engagement of staff members, improved team stability, clearly defined roles, interventions to improve the rounding process, and further evaluation of team interactions. Discussion: Assessment and diagnosis are the first steps in approaching optimization of the interdisciplinary team. Each interdisciplinary team is unique. Understanding the needs of the team is essential to creating a high functioning team. Key words: Interdisciplinary, Multidisciplinary, Team, Quality improvement, Team processes
