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College of Nursing > Student ResearchAnchor
Janette Denny
Defense Term: Summer 2016
Grad Term: Summer 2016
Dissertation Title: The Effectiveness of an Intervention Designed to Improve Chlorhexidine (CHG) Bathing Technique in Adults Hospitalized in Medical Surgical Units
Central line associated bloodstream infections (CLABSIs) are one of the most fatal types of healthcare associated infections (HAIs) and their economic impact is significant. Although some studies have found no signification reduction in CLABSI rates with chlorhexidine gluconate (CHG) bathing; good evidence exists to support the use of CHG bathing as an intervention to reduce CLABSIs (Bleasdale et al., 2007; Climo et al., 2009; Climo et al., 2013; Montecalvo et al., 2012). CHG bathing performance may influence the effectiveness of the CHG bathing protocol.
The purpose of this study was to determine the effect of a targeted educational approach involving simulation on the delivery by nursing assistants of a CHG bathing protocol. The study aims were (1) to compare the effectiveness of removal of simulated skin microbes by nursing assistants who receive training for a CHG bathing protocol with simulation training to simulated skin microbe removal by nursing assistants who receive training for a CHG bathing protocol without simulation training and (2) to examine the influence of a demographic factor, years of practice as a nursing assistant on the percentage of simulated microbes present following performance of bathing.
Thirty nursing assistants volunteered for this study and were randomized to either the intervention group (training for a 2% CHG cloth bathing protocol with simulation training) or the control group (training for a 2% CHG cloth bathing protocol without simulation training). For aim (1) an independent t-test (inferential tests of group differences) was used to examine if there was any difference between the intervention group and the control group on the percentage of microbes remaining on the mannequin post bathing. For aim (2) a Pearson correlation was computed to assess the relationship between years of practice as a nursing assistant and the percentage of microbes remaining post bathing.
Results showed no statistically significant differences between the two groups on demographic factors. For aim (1) the t-test revealed a statistically significant (p < .001) difference between the intervention group and the control group on the percentage of simulated microbes remaining on the mannequin post bathing. For aim (2) there was no correlation between the years of practice as a nursing assistant and the amount of microbes left on the mannequin post bathing (p=.709).
This study provided an innovative method of assessing the percentage of simulation microbes remaining on the mannequin and made it possible to quantitatively measure bathing performance. Monitoring the compliance with CHG bathing is an important component when evaluating the effectiveness of a CHG bathing protocol. The findings of this study suggest that simulation training was an added benefit to the nursing assistants who received it, as they performed better than those who did not receive simulation training.
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Johanna Wilson
Defense Term: Summer 2016
Grad Term: Summer 2016
Dissertation Title: Cardiovascular Disease Risk Scores and Novel Risk Factors in Relation to Race and Gender
The use of cardiovascular risk scores remains the foundation for risk stratification to guide clinical management. Clinicians have access to several cardiovascular risk scores in practice settings. While having several risk scores with different risk factors may provide more information, it does not imply accuracy of the cardiovascular risk score used to calculate individual patient cardiovascular risk. The objective of this study was to compare the Framingham Risk score, Reynolds Risk scores, and the Pooled Cohort Risk Equation (3 commonly used equations) scores with respect to ability to predict cardiovascular events in a diverse ethnic population. Additionally, the potential predictive utility of three novel risk factors (carotid intima media thickness, peripheral arterial tonometry and vasa vasorum) was examined in relation to ability to improve 10-year cardiovascular risk prediction.
A secondary analysis of the longitudinal prospective study cohort known as Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) was conducted. The cardiovascular risk scores of study participants who did and did not experience a cardiovascular event composite index consisting of myocardial infarction, death, stroke, acute ischemic stroke, or revascularization were assessed using methods of calibration and discrimination overall and by race and gender. When examining performance of the 3 risk scores, the overall 10-year absolute predicted cardiovascular risk varied substantially (e.g. approximately 2-fold) and this wide variation in predicted 10-year cardiovascular risk was present across race and gender. Nonetheless, despite the wide variation in estimates of absolute risk, the 3 cardiovascular risk score equations were strongly associated with future cardiovascular risk overall and by race and gender. There was some indication that the Reynolds risk score was the most accurate measure of future cardiovascular risk. The 3 novel risk factors examined did not significantly improve 10-year cardiovascular risk prediction above and beyond the standard demographic and clinical variables used in these well-known equations.
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Marian Hardwick
Defense Term: Spring 2016
Grad Term: Spring 2016
Dissertation Title: Examination of the Use of Accelerated Resolution Therapy (ART) in the Treatment of Symptoms of PTSD and Sleep Dysfunction in Veterans and Civilians
Posttraumatic Stress Disorder (PTSD) is a prevalent anxiety disorder that is debilitating to both veterans and civilians following one or more traumatic events. Sleep disturbances are hallmark features of PTSD. Sleep disturbances and PTSD remain two significant PTSD-related issues that continue to plague veterans returning from active duty, thereby preventing full reintegration into society. The same problem exists for civilians. This research was conducted as a previously collected pilot study data and a secondary data analysis. The purpose of the study consisted of: 1) examining the impact of treatment with Accelerated Resolution Therapy (ART) on symptoms of PTSD and sleep disturbances; 2) examining the relationships and treatment response among both subjective and objective measures of sleep function; and 3) comparing the relationship between PTSD and sleep disturbances among military versus civilians, including the effects of treatment with ART.
The study represents one of only a few studies consisting of subjective measures of PTSD (PCL checklist) and sleep quality (Pittsburgh Quality Sleep Index (PSQI)), and objective measurement of sleep function by use of electroencephalography (EEG) testing and based on a 30-minute nap protocol. The aims of this study were to: 1) investigate the effects of ART on comorbid PTSD and sleep disturbances in U.S. veterans measured both subjectively (self-report) and objectively (sleep EEG data) from previously collected pilot study data; 2) assess the relationships between objective and subjective measures of sleep disturbances before and after treatment with ART for symptoms of PTSD in U.S. veterans from previously collected pilot study data; and 3) compare self-report PTSD and sleep disturbances symptoms between civilians and veterans before and after treatment with ART using a secondary analysis from two previously conducted studies.
For Specific Aims 1 and 2, the methods consisted of previously collected pilot study data of 8 veterans who were treated with ART at the University of South Florida, College of Nursing. For Specific Aim 3, data were pooled from two completed studies of ART directed by Dr. Kevin Kip that included civilians (n=75) and veterans (n=50) who were treated for PTSD. Data analysis for Aim 1 included the use of paired t tests to compare PSQI score and each stage of sleep measured from qEEG (Delta, Theta, Alpha, Beta, Gamma) before and after treatment with ART. For Aim 2, Pearson correlation was used to assess the relationship between objective measurement of sleep disturbances and subjective sleep quality before and after ART. For Aim 3, multiple linear regression models were fit with PSQI (sleep) score as the dependent variable, PCL (PTSD) score as the primary independent variable, along with a main effect term for military status (civilian versus military) and an interaction term (military status * PCL score).
Results for aims 1 and 2 showed the mean age of the sample to be 37.6 years, 87.5% male, 87.5% White (non-Hispanic), 87.5% had experienced prior combat, 50% had experienced 5 or more traumatic memories that impacted their lives, and 87.5% had previous treatment for PTSD. Sample mean scores were above established screening criteria for PTSD (PCL-M = 63.7), sleep disturbance (PSQI = 14.5), and Center for Epidemiologic Studies Depression Scale (CES-D = 28.9). For Aim 1, after treatment with ART, the mean score on the PSQI dropped 4.88 points, mean score on the PCL-M dropped -30.13 points, thereby indicating significant reductions in sleep dysfunction and symptoms of PTSD. Mean Delta 1.5-3.5 Hz waves increased pre/post by 299.89 (p=.032), and Theta 4-6.5 Hz waves increased pre/post mean by 83.07 (p<0.001), both indicative of improved sleep quality. Results for Aim 2 showed statistically significant strong inverse correlations between PSQI and Theta 1.5-3.5 Hz waves (r=-0.79) and PSQI and Alpha 8-11 Hz waves (r=-0.89) at baseline. Post-ART, non-significant trends were observed for higher PSQI scores and higher Beta (conscious, alert) waves. For Aim 3, mean age of military participants (n=50) was 41.9 years versus 40.4 years among civilians (n=75, p=.439). For the military cohort, 18% were female compared to 80% among civilians (p<0.001), with lower Hispanic ethnicity among military compared to civilian participants (12% vs. 27%, p=0.04). In multiple regression analysis, change in PCL score was a strong predictor of change in PSQI score, regardless of military status PCL.
In summary, within the setting of PTSD, military participants tend to present with different traumatic exposures and worse sleep quality compared to civilian counterparts. In spite of these differences, the treatment protocol with ART demonstrated similar level of benefit (reduction in symptoms of PTSD and sleep disturbance) for both military and civilian personnel. Thus, nurses caring for individuals with PTSD, whether military or civilian, need to routinely assess sleep disturbances and initiate an open dialogue regarding these conditions. In return, nurses will be able to provide patients with resources to help them better understand and address these concerns, including after experiencing restless nights of sleep. Lastly, nurses should recognize the bi-directional temporal relationship between PTSD and sleep disturbances places. This places a premium on assessing these conditions collectively, rather than as discrete, independent clinical conditions.
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Li-Ting Huang
Defense Term: Spring 2016
Grad Term: Spring 2016
Dissertation Title: Investigating the Mutual Effects of Depression and Spiritual Well-Being on Quality of Life in Hospice Patients with Cancer and Family Caregivers Using the Actor-Partner Interdependence Model
The World Health Organization and the leading hospice organizations have emphasized the inclusion of family caregivers of hospice patients with cancer into end-of-life care, as these two dyad members may spiritually and emotionally influence each other. Given that depression and spiritual needs, which are prominent in these pairs, may impair quality of life (QOL) of hospice dyads, examining mutuality within dyads is imperative to develop a more accurate model that includes family caregivers. Therefore, the purpose of the study was to elucidate the importance of mutual effects within hospice dyads by examining the contribution of depression and unmet spiritual needs on their personal and their counterparts’ QOL. Structural equation modeling was used to integrate the feature of actor and partner effects in the Actor-Partner Interdependence Model. After eliminating outliers, the final sample was comprised of 660 hospice dyads in which the majority of hospice patients were white (97%) and male (56.6%) with a mean age of 73 years. Most of the family caregivers were white (95.9%) and female (73.5%) with a mean age of 65 years. On average, hospice patients reported a depression score of 4.00 (SD = 1.53), and their family caregivers had a significantly lower mean depression score of 3.65 (SD = 1.48). With respect to their spiritual needs, 25.5% of hospice patients indicated going to religious services was an unmet need, and about 13% of family caregivers also reported that going to religious services was an unmet spiritual need, followed by being with friends, laughing, thinking happy thoughts, and being around children. The results of structural equation modeling revealed that depression and spiritual needs in cancer patients and family caregivers exhibited significant actor effects on the individual’s QOL after controlling for the partner effects. Among the spousal pairs, depression in family caregivers exhibited a positive partner effect on hospice patients’ functional well-being (β = .15, p < .05), implying that as depressive symptoms increase, hospice patients’ functional well-being increases. This study supported the need for considering both as one unit and the mutuality inherent in dyads. The findings of the study suggest the importance of consistent assessment in emotional and spiritual well-being for hospice patients as well as family caregivers, as their concerns may be transmitted to each other due to mutuality existing within the dyads.
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Li-Ting Huang
Defense Term: Spring 2016
Grad Term: Spring 2016
Dissertation Title: Investigating the Mutual Effects of Depression and Spiritual Well-Being on Quality of Life in Hospice Patients with Cancer and Family Caregivers Using the Actor-Partner Interdependence Model
The World Health Organization and the leading hospice organizations have emphasized the inclusion of family caregivers of hospice patients with cancer into end-of-life care, as these two dyad members may spiritually and emotionally influence each other. Given that depression and spiritual needs, which are prominent in these pairs, may impair quality of life (QOL) of hospice dyads, examining mutuality within dyads is imperative to develop a more accurate model that includes family caregivers. Therefore, the purpose of the study was to elucidate the importance of mutual effects within hospice dyads by examining the contribution of depression and unmet spiritual needs on their personal and their counterparts’ QOL. Structural equation modeling was used to integrate the feature of actor and partner effects in the Actor-Partner Interdependence Model. After eliminating outliers, the final sample was comprised of 660 hospice dyads in which the majority of hospice patients were white (97%) and male (56.6%) with a mean age of 73 years. Most of the family caregivers were white (95.9%) and female (73.5%) with a mean age of 65 years. On average, hospice patients reported a depression score of 4.00 (SD = 1.53), and their family caregivers had a significantly lower mean depression score of 3.65 (SD = 1.48). With respect to their spiritual needs, 25.5% of hospice patients indicated going to religious services was an unmet need, and about 13% of family caregivers also reported that going to religious services was an unmet spiritual need, followed by being with friends, laughing, thinking happy thoughts, and being around children. The results of structural equation modeling revealed that depression and spiritual needs in cancer patients and family caregivers exhibited significant actor effects on the individual’s QOL after controlling for the partner effects. Among the spousal pairs, depression in family caregivers exhibited a positive partner effect on hospice patients’ functional well-being (β = .15, p < .05), implying that as depressive symptoms increase, hospice patients’ functional well-being increases. This study supported the need for considering both as one unit and the mutuality inherent in dyads. The findings of the study suggest the importance of consistent assessment in emotional and spiritual well-being for hospice patients as well as family caregivers, as their concerns may be transmitted to each other due to mutuality existing within the dyads.
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