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Title: SUPERVISOR EXPECTATIONS, EVENT REPORTING, AND PATIENT SAFETY PERCEPTIONS: EXPLORING POTENTIAL MODERATORS AND MEDIATORS.
Creator: Hernandez, Claudia, Burke, Shawn, University of Central Florida
Abstract / Description: Given the high number of errors and negative events committed within medical settings, the emphasis on patient safety culture is becoming more prevalent. Despite this effort, underreporting has been and continues to be an issue in this area. Some research has shown a link between underreporting and lack of management responsiveness, but more work is necessary to identify reasons for underreporting and potential mitigating solutions. The objective of the present research is to answer questions...
Show moreGiven the high number of errors and negative events committed within medical settings, the emphasis on patient safety culture is becoming more prevalent. Despite this effort, underreporting has been and continues to be an issue in this area. Some research has shown a link between underreporting and lack of management responsiveness, but more work is necessary to identify reasons for underreporting and potential mitigating solutions. The objective of the present research is to answer questions regarding the impact supervisors have on staff's patient safety perceptions and event reporting, through the use of archival survey data collected with the AHRQ Hospital Safety Culture Survey (2004). Probable moderators and mediators of key relationships were explored as well. Results are presented and their implications are discussed herein.
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Date Issued: 2016
Identifier: CFH2000084, ucf:45551
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH2000084

Title: THE IMPACT OF INTRAORGANIZATIONAL TRUST AND LEARNING ORIENTED CLIMATE ON ERROR REPORTING.
Creator: Sims, Dana Elizabeth, Salas, Eduardo, University of Central Florida
Abstract / Description: Insight into opportunities for process improvement provides a competitive advantage through increases in organizational effectiveness and innovation As a result, it is important to understand the conditions under which employees are willing to communicate this information. This study examined the relationship between trust and psychological safety on the willingness to report errors in a medical setting. Trust and psychological safety were measured at the team and leader level. In addition,...
Show moreInsight into opportunities for process improvement provides a competitive advantage through increases in organizational effectiveness and innovation As a result, it is important to understand the conditions under which employees are willing to communicate this information. This study examined the relationship between trust and psychological safety on the willingness to report errors in a medical setting. Trust and psychological safety were measured at the team and leader level. In addition, the moderating effect of a learning orientation climate at three levels of the organization (i.e., team members, team leaders, organizational) was examined on the relationship between trust and psychological safety on willingness to report errors. Traditional surveys and social network analysis were employed to test the research hypotheses. Findings indicate that team trust, when examined using traditional surveys, is not significantly associated with informally reporting errors. However, when the social networks within the team were examined, evidence that team trust is associated with informally discussing errors was found. Results also indicate that trust in leadership is associated with informally discussing errors, especially severe errors. These findings were supported and expanded to include a willingness to report all severity of errors when social network data was explored. Psychological safety, whether within the team or fostered by leadership, was not found to be associated with a willingness to informally report errors. Finally, learning orientation was not found to be a moderating variable between trust and psychological safety on a willingness to report errors. Instead, organizational learning orientation was found to have a main effect on formally reporting errors to risk management and documenting errors in patient charts. Theoretical and practical implications of the study are offered.
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Date Issued: 2009
Identifier: CFE0002818, ucf:48050
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002818

Title: THE IMPACT OF A NURSE-DRIVEN EVIDENCE-BASED DISCHARGE PLANNING PROTOCOL ON ORGANIZATIONAL EFFICIENCY AND PATIENT SATISFACTION IN PATIENTS WITH CARDIAC IMPLANTS.
Creator: King, Tracey, Sole, Mary Lou, University of Central Florida
Abstract / Description: Purpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the...
Show morePurpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the process. The aim of this study was determine if implementation of a nurse-driven discharge planning protocol for patients undergoing cardiac implant would result in improved organizational efficiencies, higher medication reconciliation rates, and higher patient satisfaction scores. Methods: A two-group posttest experimental design was used to conduct the study. Informed consent was obtained from 53 individuals scheduled for a cardiac implant procedure. Subjects were randomly assigned to either a nurse-driven discharge planning intervention group or a control group. Post procedure, 46 subjects met inclusion criteria with half (n=23) assigned to each group. All subjects received traditional discharge planning services. The morning after the cardiac implant procedure, a specially trained registered nurse assessed subjects in the intervention for discharge readiness. Subjects in the intervention groups were then discharged under protocol orders by the intervention nurse after targeted physical assessment, review of the post procedure chest radiograph, and examination of the cardiac implant device function. The intervention nurse also provided patient education, discharge instructions, and conducted medication reconciliation. The day after discharge the principal investigator conducted a scripted follow-up phone call to answer questions and monitor for post procedure complications. A Hospital Discharge Survey was administered during the subject's follow-up appointment. Results: The majority of subjects were men, Caucasian, insured, and educated at the high school level or higher. Their average age was 73.5+ 9.8 years. No significant differences between groups were noted for gender, type of insurance, education, or type of cardiac implant (chi-square); or age (t-test). A Mann-Whitney U test (one-tailed) found no significant difference in variable cost per case (p=.437) and actual charges (p=.403) between the intervention and control groups. Significant differences were found between groups for discharge satisfaction (p=.05) and the discharge perception of overall health (p=.02), with those in the intervention group reporting higher scores. Chi square analysis found no significant difference in 30-day readmission rates (p=.520). Using an independent samples t-test, those in the intervention group were discharged earlier (p=.000), had a lower length of stay (p=.005), and had higher rates of reconciled medications (p=.000). The odds of having all medications reconciled were significantly higher in the intervention group (odds ratio, 50.27; 95% CI, 5.62-450.2; p=.000). Discussion/Implications: This is the first study to evaluate the role of the nurse as a clinical leader in patient throughput, discharge planning, and patient safety initiatives. A nurse driven discharge planning protocol resulted in earlier discharge times which can have a dramatic impact on patient throughput. The nurse driven protocol significantly reduced the likelihood of unreconciled medications at discharge and significantly increased patient satisfaction. Follow-up research is needed to determine if a registered nurse can impact organizational efficiency and discharge safety in other patient populations.
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Date Issued: 2008
Identifier: CFE0002188, ucf:47915
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0002188

Title: Social Media as a Healthcare Tool: Case Study Analysis of Factors Influencing Pediatric Clinicians' Behavioral Intent to Adopt Social Media for Patient Communication and Engagement.
Creator: Mustonen, Rachel, Hou, Su-I, Malvey, Donna, Gurupur, Varadraj, Wisniewski, Pamela, University of Central Florida
Abstract / Description: Social media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians' behavioral intent to adopt social media for patient engagement and communication. A new framework, the...
Show moreSocial media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians' behavioral intent to adopt social media for patient engagement and communication. A new framework, the Healthcare Social Media Adoption Framework (HSMA), guided this mixed-method approach to assess 7 factors identified by theory and literature as adoption influencers. A custom, web-based survey collected data from 60 full-time, pediatric clinicians (47 quantitative) at the case institution (a pediatric hospital). Additionally, individual interviews of 6 participants provided their prospective on using social media for patient communications and engagement. Results: Privacy concerns were the only statically significant factor; with an inverse relationship to positive adoption intent, indicating higher privacy concerns influence lower behavioral intent to adopt social media for patient engagement and communication. The qualitative analysis revealed privacy concerns encompass two themes, personal privacy for patient and providers (boundaries), and cybersecurity. The qualitative inputs also uncovered perceived unprofessionalism as a new factor influencing clinician adoption. The implications for these findings indicate a need for both healthcare organizations and healthcare regulators to establish cyber-security defenses for security and use protocols for privacy to aid the diffusion and adoption acceptance of social media use by pediatric healthcare professionals. This research has contributed in four areas: 1) fill a knowledge gap by identifying new factors that influence the behavioral intent of pediatric clinicians to adopt social media; 2) confirm/reject behavioral intent influences found in the literature; 3) formulated a new HSMA framework that measures functional, cognitive, and social aspects of social media adoption; and 4) prioritizes policies and global standard focus.
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Date Issued: 2018
Identifier: CFE0007062, ucf:51998
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007062

Title: A Root Cause Analysis of the Barriers to Transparency among Physicians: A Systemic Perspective.
Creator: Perez, Bianca, Liberman, Aaron, Oetjen, Dawn, Wan, Thomas, Abel, Eileen, University of Central Florida
Abstract / Description: Transparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis....
Show moreTransparency in healthcare relates to formally reporting medical errors and disclosing bad outcomes to patients and families. Unfortunately, most physicians are not in the habit of communicating transparently, as many studies have shown the existence of a large medical error information gap. Research also shows that creating a culture of transparency would mutually support patient safety and risk management goals by concomitantly reducing medical errors and alleviating the malpractice crisis. Three predictor variables are used to represent the various dimensions of the context just described. Perfectionism represents the intrapersonal domain, socio-organizational climate represents the interpersonal and institutional domains, and medico-legal environment represents the societal domain. Chin and Benne's normative re-educative strategy provides theoretical support for the notion that successful organizational change hinges upon addressing the structural and cultural barriers displayed by individuals and groups.The Physician Transparency Questionnaire was completed by 270 physicians who were drawn from a multi-site healthcare organization in Central Florida. Structural equation modeling was used to determine whether perfectionism, socio-organizational climate, and medico-legal environment significantly predict two transparency outcomes, namely, error reporting transparency and provider-patient transparency. Perfectionism and socio-organizational climate were found to be statistically significant predictors. Collectively, these variables accounted for nearly half of the variance in each transparency outcome. Within socio-organizational climate, policies had the greatest influence on transparency, followed by immunity and professional norms. Multiple group analysis showed that the covariance model developed in this study generalizes across gender, medical specialty, and occupation. In addition, group means comparisons tests revealed a number of interesting trends in error reporting and disclosure practices that provide insights about the behavioral and cognitive psychology behind transparent communication: 1) Physicians are more inclined to engage in provider-patient transparency compared to error reporting transparency, 2) physicians are more inclined to report serious errors compared to less serious errors, and 3) physicians are more inclined to express sympathy for bad outcomes than they are to apologize for a preventable error or be honest about the details surrounding bad outcomes. These results suggest that change efforts would need to be directed at medical education curricula and health provider organizations to ensure that current and future generations of physicians replace the pursuit for perfectionism with the pursuit for excellence. Also, a number of institutional changes are recommended, such as clearly communicating transparency policies and guidelines, promoting professional norms that encourage learning from mistakes rather than an aversion to error, and reassuring physicians that reporting and disclosure activities will not compromise their reputation. From the perspective of patient safety advocates and risk managers, the results are heartening because they emphasize a key principle in quality improvement - i.e., small changes can yield big results. From an ethical standpoint, this research suggests that healthcare organizations can inhibit (or facilitate) the emergence of professional virtues. Thus, although organizations cannot make a physician become virtuous, it is within their power to create conditions that encourage the physician to practice certain virtues. With respect to leadership styles, this research finds that bottom-up, grassroots change efforts can elicit professional virtues, and that culture change in healthcare lies beyond the scope of the medico-legal system.
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Date Issued: 2011
Identifier: CFE0004153, ucf:49083
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0004153

Title: ASSESSING ADULT ATTITUDES TOWARD END-OF-LIFE ISSUES AND ADVANCED DIRECTIVES AFTER IMPLEMENTING AN EDUCATIONAL INTERVENTION IN A WORKPLACE SETTING.
Creator: Tolbert-Jones, Marchina, Chase, Susan, University of Central Florida
Abstract / Description: Purpose: There is a lack of discussion regarding end-of-life care planning which results in low advanced directive execution (AD) rates. This can lead to decision making by family, friends, and the health care team on behalf of patients whose end-of-life care wishes are unknown. The purpose of this study was to determine the effectiveness of an educational intervention in the work setting to increase end-of-life discussions and the execution of advanced directives. Methods: A descriptive...
Show morePurpose: There is a lack of discussion regarding end-of-life care planning which results in low advanced directive execution (AD) rates. This can lead to decision making by family, friends, and the health care team on behalf of patients whose end-of-life care wishes are unknown. The purpose of this study was to determine the effectiveness of an educational intervention in the work setting to increase end-of-life discussions and the execution of advanced directives. Methods: A descriptive design was used in an occupational workplace setting at a local bottling company after appropriate IRB approval was obtained. An educational intervention based on the Five Wishes document was presented in an occupational health setting covering all shifts and employment categories. A pre-program questionnaire measured a lack of knowledge and understanding of end-of-life planning and advanced directives. A post-program questionnaire measured the increase in knowledge and understanding of end-of-life planning and advanced directives. A focus group was conducted with audio recording to describe personal experiences. The quantitative analysis used statistical procedures to describe and synthesize data and content analysis was conducted on the focus group data. Results: A sample of 78 participants was used to gather the quantitative data. Of the total participants, an overwhelming majority were male with ethnic backgrounds evenly represented. Most of the participants either were married and either were drivers, salespeople, or warehouse workers. More participants indicated no religious affiliation than any other affiliation, and the majority of participants indicated that they had a high school diploma. When questioned about their 1) knowledge of advanced directives, 2) whether or not they would consider executing an advanced directive, 3) whether or not they were likely to discuss end-of-life care with other, 4) whether they would be comfortable having someone make end-of-life decisions on their behalf, and 5) whether or not they believed that advanced directives were important, the majority of participants indicated that they strongly agreed or agreed. However, none of the participants had executed an advanced directive. Only 10.3% of participants had ever discussed ADÃ‚Â's with a healthcare provider. When the same participants were asked the same questions after the education portion of the study, data analysis of the pre- and post-program questionnaire mean scores, revealed a significant increase in scores on questions 1,2 and 3 (p <.05), and no significant increase on question 4 and 5 (p > .05). The implication of these findings suggest that an education intervention program in a workplace setting significantly increases end-of-life discussions and advanced directive execution rates. The Jones model of end-of-life education intervention and interpretation of the study are presented. Limitations of the study, as well as implications for nursing professionals and health care providers that will improve patient outcomes are presented. Discussion/Implication: The study shows that workplace education regarding Advanced Directives can lead to increase end-of-life discussions and increase advanced directive execution rates. Therefore, this education program at a worksite merits further research and may serve as a model program for other worksite settings.
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Date Issued: 2010
Identifier: CFE0003275, ucf:48564
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003275

Title: EFFECTS OF HEALTH INFORMATION TECHNOLOGY ADOPTION ON QUALITY OF CARE AND PATIENT SAFETY IN US ACUTE CARE HOSPITALS.
Creator: Seblega, Binyam, Zhang, Ning, University of Central Florida
Abstract / Description: The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid...
Show moreThe adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitalsÃ‚Â' performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis DonabedianÃ‚Â's structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT.
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Date Issued: 2010
Identifier: CFE0003327, ucf:48445
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003327

Title: THE EXPERIENCES OF HEALTH CARE PROVIDERS PROVIDING COMFORT FOR NURSING HOME PATIENTS AT THE END OF LIFE.
Creator: Baker, Herma, Rash, Elizabeth, University of Central Florida
Abstract / Description: Research shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nurses...
Show moreResearch shows that healthcare providers (HCPs) are not adequately prepared to provide comfort care for patients who are at the end of life. Since the 1990s, numerous legislative, research, and clinical initiatives have addressed concerns about improving care at the end of life. The purpose of this study was to describe the experiences of HCPs providing comfort for patients in the nursing home who are at the end of life. This study focused on physicians, nurse practitioners, nurses and nursesÃƒÂƒÃ‚Â‚ÃƒÂ‚Ã‚Â' aides at a central Florida nursing home. A descriptive qualitative design was done utilizing a focus group discussion, individual interviews, and a self-administered questionnaire. The findings indicated that a lack of facility support, inadequate staffing, inadequate end of life care education, family and patient denial of prognosis, as well as decreased primary care physician involvement affect the delivery of comfort care for patients at the end of life in the nursing home. This study supports the need for end of life education to HCPs and the need for adjustments in staffing to meet the complex needs of patients in the nursing home who are at the end of life. A new finding of this study reflects the use of an angel cart to aid in the provision of comfort care for patients at the end of life. Recommendations for future research were made based on study results
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Date Issued: 2010
Identifier: CFE0003305, ucf:48505
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0003305

Title: Determinants of hospital efficiency and patient safety in the United States.
Creator: Shettian, Kruparaj, Wan, Thomas, Noblin, Alice, Gurupur, Varadraj, Cobb, Enesha, Anderson, Kim, University of Central Florida
Abstract / Description: Hospitals engage in undertakings on a continual basis to enhance IT capabilities, diffusion of innovations, hospital-physician integration, and standardization to improve their performance. This empirical study explored the interdependence of three macro-level structural factors and their independent impact on the hospital performance measures efficiency and patient safety, with standardization as an important mediator. The researcher conducted a cross-sectional analysis of multiple data sets...
Show moreHospitals engage in undertakings on a continual basis to enhance IT capabilities, diffusion of innovations, hospital-physician integration, and standardization to improve their performance. This empirical study explored the interdependence of three macro-level structural factors and their independent impact on the hospital performance measures efficiency and patient safety, with standardization as an important mediator. The researcher conducted a cross-sectional analysis of multiple data sets from public user files on the acute care hospital industry. The theoretical underpinnings of the study included the structure-process-outcome theory and institutional isomorphism theory. The statistical analysis comprised confirmatory factor analysis (CFA) and covariance structural equation modeling (SEM). The study comprised data for 2,352 acute care hospitals in the United States, which represented more than half of the hospital population. As expected by the hypotheses, the study demonstrated that IT capability, hospital-physician integration, and innovativeness directly affect the variability in standardization, but they did not directly influence the variation in hospital efficiency and patient safety. This revealed that hospitals should focus on standardization because it is the mediating process between structural variables and performance variables. The results indicated a strong negative influence of standardization on hospital efficiency and a weak positive influence on patient safety. The study confirmed the triadic model that (")structure(") influences the process, which in turn influences organizational outcomes. As standardization through coercive, mimetic, and normative pressure mechanisms becomes more common through system integration and increased collaborative governance, more research on how the implementation of standards may perpetuate isomorphism or uniformity is imperative. The researcher recommends future studies to employ a longitudinal study design to explore the determinants of a variety of performance and outcome indicators, such as patient satisfaction, timeliness of care, the effectiveness of care, and equity/financial performance in addition to patient safety and hospital efficiency.
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Date Issued: 2017
Identifier: CFE0006794, ucf:51810
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006794

Title: An Empirical Evaluation of an Instrument to Determine the Relationship Between Second-Year Medical Students' Perceptions of NERVE VP Design Effectiveness and Students' Ability to Learn and Transfer Skills from NERVE.
Creator: Reyes, Ramsamooj, Hirumi, Atsusi, Sivo, Stephen, Campbell, Laurie, Cendan, Juan, University of Central Florida
Abstract / Description: Meta-analyses and systematic reviews of literature comparing the use of virtual patients (VPs) to traditional educational methods support the efficacy of VPs (Cook, Erwin, (&) Triola, 2010; Cook (&) Triola, 2009; McGaghie, Issenberg, Cohen, Barsuk, (&) Wayne, 2011). However, VP design research has produced a variety of design features (Bateman, Allen, Samani, Kidd, (&) Davies, 2013; Botezatu, Hult, (&) Fors, 2010a; Huwendiek (&) De Leng, 2010), frameworks (Huwendiek et al., 2009b) and...
Show moreMeta-analyses and systematic reviews of literature comparing the use of virtual patients (VPs) to traditional educational methods support the efficacy of VPs (Cook, Erwin, (&) Triola, 2010; Cook (&) Triola, 2009; McGaghie, Issenberg, Cohen, Barsuk, (&) Wayne, 2011). However, VP design research has produced a variety of design features (Bateman, Allen, Samani, Kidd, (&) Davies, 2013; Botezatu, Hult, (&) Fors, 2010a; Huwendiek (&) De Leng, 2010), frameworks (Huwendiek et al., 2009b) and principles (Huwendiek et al., 2009a) that are similar in nature, but appear to lack consensus. Consequently, researchers are not sure which VP design principles to apply and few validated guidelines are available. To address this situation, Huwendiek et al. (2014) validated an instrument to evaluate the design of VP simulations that focuses on fostering clinical reasoning. This dissertation examines the predictive validity of one instrument proposed by Huwendiek et al. (2014) that examines VP design features. Empirical research provides evidence for the reliability and validity of the VP design effectiveness measure. However, the relationship between the design features evaluated by the instrument to criterion-referenced measures of student learning and performance remains to be examined. This study examines the predictive validity of Huwendiek et al.'s (2014) VP design effectiveness measurement instrument by determining if the design factors evaluated by the instrument are correlated to medical students' performance in: (a) quizzes and VP cases embedded in Neurological Examination Rehearsal Virtual Environment (NERVE), and (b) NERVE-assisted virtual patient/standardized patient (VP/SP) differential diagnosis and SP checklists. It was hypothesized that students' perceptions of effectiveness of NERVE VP design are significantly correlated to the achievement of higher student learning and transfer outcomes in NERVE.The confirmatory factor analyses revealed the effectiveness of NERVE VP design was significantly correlated to student learning and transfer. Significant correlations were found between key design features evaluated by the instrument and students' performance on quizzes and VP cases embedded in NERVE. In addition, significant correlations were found between the NERVE VP design factors evaluated by Huwendiek et al.'s (2014) instrument and students' performance in SP checklists. Findings provided empirical evidence supporting the reliability and predictive validity of Huwendiek et al.'s (2014) instrument.Future research should examine additional sources of validity for Huwendiek et al.'s (2014) VP design effectiveness instrument using larger samples and from other socio-cultural backgrounds and continue to examine the predictive validity of Huwendiek et al.'s (2014) instrument at Level 2 (Learning) and Level 3 (Application) of Kirkpatrick's (1975) four-level model of training evaluation.
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Date Issued: 2016
Identifier: CFE0006166, ucf:51150
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006166

Title: The Effect of Public Information Sources on Satisfaction with Patient Search for a Physician.
Creator: Loyal, Michael, Wan, Thomas, Fottler, Myron, Noblin, Alice, Golden, Adam, University of Central Florida
Abstract / Description: The purpose of this research study is to examine the effect of public information sources on an individual's satisfaction with the search process undertaken to select a physician. A quasi-experimental research design was adopted to randomly divide the medical staff of a large central Florida medical group into control and intervention groups of approximately 77 physicians each. The intervention involved insertion of the website address to online physician report cards on to each intervention...
Show moreThe purpose of this research study is to examine the effect of public information sources on an individual's satisfaction with the search process undertaken to select a physician. A quasi-experimental research design was adopted to randomly divide the medical staff of a large central Florida medical group into control and intervention groups of approximately 77 physicians each. The intervention involved insertion of the website address to online physician report cards on to each intervention group physician's profile in the physician directory on the medical group's website. After two months, data were collected consisting of all individuals who had scheduled first-time appointments with one of the medical group's physicians during the two-month intervention period. A random sample of patients was drawn from each group and sample members were mailed a 62-item questionnaire along with a cover letter, summary of the research and postage-paid reply envelope. A total of 706 questionnaires were mailed and 61 completed questionnaires were returned, an 8.64% response rate.Intent-to-treat analysis was conducted using independent-samples t-tests to compare the research study's continuous variables' mean scores for control and intervention group participants. The analysis revealed no significant difference in scores for control and intervention groups with the exceptions that the control group was somewhat more committed to conducting a search and selecting a new physician. The control group said the physician's communications skills influenced their satisfaction with the search and selection of a new physician quite a lot while the intervention group said physician communication skills somewhat influenced their satisfaction with search and selection.Results of the covariance structure analysis demonstrated that information use and level of commitment to search and select a new physician independently predict search satisfaction. As information use and search commitment increase, a patient's satisfaction with the search increases as well. Furthermore, as information use increases, the variety of information sources relied upon or used also increases. The findings support the alternative hypothesis that the positive or direct effect of physician report cards is demonstrated in the time and cost of patient search for a physician for both intervention and control groups. One other alternative hypothesis was partially supported, i.e., the effect of household income is confirmed in patient search and satisfaction in selecting a physician. The alternative hypotheses that proposed that physician report cards are more likely to be used to search for a medical specialist and that physician experience, office location and accepted insurance effect patient search and selection of a physician were not tested. Two other alternative hypotheses were rejected. The research findings also indicated that predictors of health care information search satisfaction vary based upon the environment and contextual factors in which the search is conducted.
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Date Issued: 2013
Identifier: CFE0005030, ucf:49992
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005030

Title: Impact of Interruption Frequency on Nurses' Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting.
Creator: Campoe, Kristi, Talbert, Steven, Sole, Mary Lou, Andrews, Diane, Jentsch, Florian, University of Central Florida
Abstract / Description: Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of...
Show moreProblem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of interruption frequency on nurses' PCA interaction has not been fully measured or described.Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses' (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses' perceptions of the impact of interruption frequency.Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar's test, and Friedman's test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs' perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar's test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses' perception of interruption frequency: the nature of interruptions and nurses' reaction to the interrupted work environment.Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs' described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs' perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs' performance accuracy and cognitive workload.
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Date Issued: 2015
Identifier: CFE0005770, ucf:50099
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005770

Title: A Simulation-Based Evaluation Of Efficiency Strategies For A Primary Care Clinic With Unscheduled Visits.
Creator: Bobbie, Afrifah, Karwowski, Waldemar, Thompson, William, Elshennawy, Ahmad, Mikusinski, Piotr, University of Central Florida
Abstract / Description: In the health care industry, there are strategies to remove inefficiencies from the health delivery process called efficiency strategies. This dissertation proposed a simulation model to evaluate the impact of the efficiency strategies on a primary care clinic with unscheduled "walk-in" patient visits. The simulation model captures the complex characteristics of the Orlando Veteran's Affairs Medical Center (VAMC) primary care clinic. This clinic system includes different types of patients,...
Show moreIn the health care industry, there are strategies to remove inefficiencies from the health delivery process called efficiency strategies. This dissertation proposed a simulation model to evaluate the impact of the efficiency strategies on a primary care clinic with unscheduled "walk-in" patient visits. The simulation model captures the complex characteristics of the Orlando Veteran's Affairs Medical Center (VAMC) primary care clinic. This clinic system includes different types of patients, patient paths, and multiple resources that serve them. Added to the problem complexity is the presence of patient no-shows characteristics and unscheduled patient arrivals, a problem which has been until recently, largely neglected. The main objectives of this research were to develop a model that captures the complexities of the Orlando VAMC, evaluate alternative scenarios to work in unscheduled patient visits, and examine the impact of patient flow, appointment scheduling, and capacity management decisions on the performance of the primary care clinic system. The main results show that only a joint policy of appointment scheduling rules and patient flow decisions has a significant impact on the wait time of scheduled patients. It is recommended that in the future the clinic addresses the problem of serving additional walk-in patients from an integrated scheduling and patient flow viewpoint.
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Date Issued: 2016
Identifier: CFE0006443, ucf:51462
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006443

Title: AN INVESTIGATION OF THE ECONOMIC VIABILITY AND ETHICAL RAMIFICATIONS OF VIDEO SURVEILLANCE IN THE ICU.
Creator: Bagge, Laura, Heglund, Stephen, University of Central Florida
Abstract / Description: The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely...
Show moreThe purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs.. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.
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Date Issued: 2013
Identifier: CFH0004475, ucf:45138
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004475

Title: PERCEPTIONS OF SENIOR CITIZENS IN CENTRAL FLORIDA REGARDING QUALITY OF CARE UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA).
Creator: Nieves , Rafael, Sumner, Jennifer, University of Central Florida
Abstract / Description: On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their...
Show moreOn March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D [prescription drugs]; (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.
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Date Issued: 2013
Identifier: CFH0004468, ucf:45112
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFH0004468

Title: Computational Fluid Dynamics Study of Thromboembolism as a Function of Shunt Size and Placement in the Hybrid Norwood Palliative Treatment of Hypoplastic Left Heart Syndrome.
Creator: Seligson, John, Kassab, Alain, DeCampli, William, Mansy, Hansen, University of Central Florida
Abstract / Description: The Hybrid Norwood procedure has emerged as a promising alternative palliative first stage treatment for infants with Hypoplastic Left Heart Syndrome (HLHS). The procedure is done to provide necessary blood flow to the pulmonary and systemic regions of the body. The procedure can affect hemodynamic conditions to be pro-thrombotic, and thrombus particles can form and release from the vessel walls and enter the flow. Assuming these particles are formed and released from the shunt surface, a...
Show moreThe Hybrid Norwood procedure has emerged as a promising alternative palliative first stage treatment for infants with Hypoplastic Left Heart Syndrome (HLHS). The procedure is done to provide necessary blood flow to the pulmonary and systemic regions of the body. The procedure can affect hemodynamic conditions to be pro-thrombotic, and thrombus particles can form and release from the vessel walls and enter the flow. Assuming these particles are formed and released from the shunt surface, a Computational Fluid Dynamics (CFD) model can be used to mimic the patient's vasculature geometry and predict the occurrence of embolization to the carotid or coronary arteries, as well as the other major arteries surrounding the heart. This study used a time dependent, multi-scale CFD analysis on patient-specific geometry to determine the statistical probability of thrombus particles exiting each major artery. The geometries explored were of a nominal and patient specific nature. Cases of 90% and 0% stenosis at the aortic arch were analyzed, including shunt diameters of 3mm, 3.5mm, and 4mm. Three different placements of the shunt were explored as well. The intent of this study was to suggest best methods of surgical planning in the Hybrid Norwood procedure by providing supporting data for optimal stroke and myocardial infarction prevention.
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Date Issued: 2017
Identifier: CFE0006655, ucf:51232
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006655

Title: Catholic Healing Masses: Intersections of Health and Healing in Yucat(&)#225;n.
Creator: Draper, Suzanne, Reyes-Foster, Beatriz, Mishtal, Joanna, Matejowsky, Ty, University of Central Florida
Abstract / Description: The conception of illness and healing in contemporary Mexican Catholic discourse highlights both particular and ubiquitous instances of a health experience perceived locally and widespread. Catholic healing masses are utilized as supplemental methods of individual health restoration coupled with Western medicinal techniques in Catholic dramas. Aside from the spiritual and religious significance of this practice, the use of healing masses as an additional means to achieving an optimal health...
Show moreThe conception of illness and healing in contemporary Mexican Catholic discourse highlights both particular and ubiquitous instances of a health experience perceived locally and widespread. Catholic healing masses are utilized as supplemental methods of individual health restoration coupled with Western medicinal techniques in Catholic dramas. Aside from the spiritual and religious significance of this practice, the use of healing masses as an additional means to achieving an optimal health status implies that something is lacking in current biomedical models. The purpose of my research is to explore the humanistic terms under which healing masses operate and translate these terms into a biomedical conversation towards enhanced secular medical care
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Date Issued: 2014
Identifier: CFE0005484, ucf:50332
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0005484

Title: Physical-Virtual Patient Simulators: Bringing Tangible Humanity to Simulated Patients.
Creator: Daher, Salam, Welch, Gregory, Gonzalez, Laura, Cendan, Juan, Proctor, Michael, University of Central Florida
Abstract / Description: In lieu of real patients, healthcare educators frequently use simulated patients. Simulated patients can be realized in physical form, such as mannequins and trained human actors, or virtual form, such as via computer graphics presented on two-dimensional screens or head-mounted displays. Each of these alone has its strengths and weaknesses. I introduce a new class of physical-virtual patient (PVP) simulators that combine strengths of both forms by combining the flexibility and richness of...
Show moreIn lieu of real patients, healthcare educators frequently use simulated patients. Simulated patients can be realized in physical form, such as mannequins and trained human actors, or virtual form, such as via computer graphics presented on two-dimensional screens or head-mounted displays. Each of these alone has its strengths and weaknesses. I introduce a new class of physical-virtual patient (PVP) simulators that combine strengths of both forms by combining the flexibility and richness of virtual patients with tangible characteristics of a human-shaped physical form that can also exhibit a range of multi-sensory cues, including visual cues (e.g., capillary refill and facial expressions), auditory cues (e.g., verbal responses and heart sounds), and tactile cues (e.g., localized temperature and pulse). This novel combination of integrated capabilities can improve patient simulation outcomes. In my Ph.D. work I focus on three primary areas of related research. First, I describe the realization of the technology for PVPs and results from two user-studies to evaluate the importance of dynamic visuals and human-shaped physical form in terms of perception, behavior, cognition, emotions, and learning.Second, I present a general method to numerically evaluate the compatibility of any simulator-scenario pair in terms of importance and fidelity of cues. This method has the potential to make logistical, economic, and educational impacts on the choices of utilizing existing simulators.Finally, I describe a method for increasing human perception of simulated humans by exposing participants to the simulated human taking part in a short, engaging conversation prior to the simulation.
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Date Issued: 2018
Identifier: CFE0007750, ucf:52402
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0007750

Title: Identification of Areas of Patient Need Using the Cancer Support Source Program.
Creator: Ross, Emily, Cassisi, Jeffrey, Jensen, Bernard, Robinson, Diane, University of Central Florida
Abstract / Description: Understanding, screening, and providing resources for quality of life factors and psychosocial distress have become an important area of focus in cancer care. Negative consequences of poor quality of life and psychosocial distress have been widely studied in oncological research. The National Comprehensive Cancer Network, or NCCN, defines (")psychosocial distress(") as extending on a continuum, (")ranging from common normal feelings of vulnerability, sadness, and fears to problems that can...
Show moreUnderstanding, screening, and providing resources for quality of life factors and psychosocial distress have become an important area of focus in cancer care. Negative consequences of poor quality of life and psychosocial distress have been widely studied in oncological research. The National Comprehensive Cancer Network, or NCCN, defines (")psychosocial distress(") as extending on a continuum, (")ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis(") ((")National Comprehensive Cancer Network,(") n.d.). Findings have indicated the significant impact of poor quality of life and psychosocial distress in the cancer patient population. Elevated levels of psychosocial distress increases the risk of developing depression, anxiety, immune suppression, and may lead to high levels of stress. Studies have also revealed associations between increased psychosocial distress levels, relapse, treatment and healing outcomes, and survival rates (Anderson, Kiecolt-Glaser, (&) Glaser, 1994; Spiegel (&) Nemeroff, 1997). Evidence also shows that heightened psychosocial distress negatively influences a patient's capability to adhere to their medical plan and treatment (Allison et al., 1995; Pirl et al., 2007; Zabora, Brintzenhofeszoc, Curbow, Hooker, (&) Piantadosi, 2001). Attending to these negative outcomes of psychosocial distress and providing supportive care is a crucial action of oncology practice today. The American College of Surgeons Commission on Cancer responded to the imperative of addressing psychosocial needs in cancer care by mandating national cancer centers for accreditation purposes to screen for psychosocial distress and provide appropriate referral and resources (Standard 3.2). UF Health Cancer Center (-) Orlando Health began psychosocial distress screening on January 1st, 2015 with the utilization of the Web-based, HIPPA compliant, and action based Cancer Support Source Program. Patient data responses collected with the Cancer Support Source Program over the first calendar year of the implementation of the American College of Surgeons Commission on Cancer standards were analyzed for this research study. A sample of 317 patient data responses was included to conduct an exploratory factor analysis (EFA) on the Cancer Support Source Program test items. Specifically, a Principal Component Analysis (PCA) with an oblique rotational procedure (Promax) was conducted on the resulting data set for interpretation. Factorial interpretation was made to ascertain latent dimensions in the Cancer Support Source Program. A five factor structure model was found with adequate discriminant and face validity. Factors were grouped by conceptual basis and item-loading composition: Distress, Treatment Management and Decisions, Lifestyle, Relationship, and Substance Use. These factors were collectively termed the Concern Subscales. The Distress, Treatment Management and Decisions, and Lifestyle Factors were found to present the most psychometrically sound and internally consistent model. Further analysis was conducted to examine the resulting factorial structure model on four cancer location groups: breast, head and neck, lung, and gynecological cancer. Results displayed that no significant differences were found between cancer location groups and the five extracted factors. However, an ad hoc test (Tukey's HSD) revealed two significant differences between the Lifestyle Factor and cancer location groups at the p (<) 0.05 level. The Breast Cancer group's Lifestyle scores were higher than the Gynecologic Cancer group, and the Breast Cancer group scores were lower than the Lung Cancer group. Additionally, the action scores were summed to examine correlation between the five extracted Concern Subscales. A high correlation was found, indicating that the action items in the Cancer Support Source questionnaire correspond with the extracted Concern Subscales and do not need to undergo dimension reduction. Furthermore, a high correlation was also found with the extracted Distress Concern Subscale and the existing depression subscale in the Cancer Support Source Program.Results indicated that the Cancer Support Source Program could indeed benefit from dimension reduction to ascertain more parsimonious areas of need presented by the cancer patient population. The 25 single-items in the Cancer Support Source questionnaire may inhibit the ability to indicate other concerns that may be expressed by the patient. By identifying the latent dimensions in this exploratory endeavor, we were able to demonstrate how the Cancer Support Source questionnaire could be refined to include easily scored Concern subscales to better identify areas of need for each individual patient that is screened for psychosocial distress. These findings provide an opportunity to impact patient care, opportunities for referral, and resources for cancer care in a hospital setting using this psychosocial distress screening instrument.
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Date Issued: 2017
Identifier: CFE0006650, ucf:51254
Format: Document (PDF)
PURL: http://purl.flvc.org/ucf/fd/CFE0006650

patient safety (6)	+ -
patient (5)	+ -
Patient Safety (3)	+ -
patient satisfaction (3)	+ -
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error reporting (2)	+ -
human factors (2)	+ -
nurse (2)	+ -
outcomes (2)	+ -
perception (2)	+ -
quality (2)	+ -
quality of care (2)	+ -
"acute respiratory distress syndrome" (1)	+ -
"prone position" (1)	+ -
ACA (1)	+ -
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Advanced Directives (1)	+ -
Affect (1)	+ -
American College of Surgeons Commission on Cancer (1)	+ -
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Assessment (1)	+ -
Assessment of Extracellular Status in Hypertensive Hemodialysis Patients (1)	+ -
Cancer Support Source Program (1)	+ -
Catholicism (1)	+ -
Central Florida (1)	+ -
Clinical Reasoning (1)	+ -
Clinical Skills (1)	+ -
Comfort (1)	+ -
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Computational Fluid Dynamics (1)	+ -

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Honors Collection (12)	+ -

English (38)	+ -
Engilsh (1)	+ -

University of Central Florida (39)	+ -
Sole, Mary Lou (4)	+ -
Andrews, Diane (3)	+ -
Burke, Shawn (3)	+ -
Salas, Eduardo (3)	+ -

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