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AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY
Title
AN EVALUATION OF TRACHEOSTOMY CARE ANXIETY RELIEF THROUGH EDUCATION AND SUPPORT (T-CARES): A PILOT STUDY.
Creator
Crosby, William, Sole, Mary Lou, University of Central Florida
Abstract / Description
Background: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver...
Show moreBackground: Home care of a patient with a tracheostomy after surgery for head and neck cancer requires the caregiver to be proficient with new equipment and required skills. The responsibility of managing an artificial airway, may lead to an increase in caregiver anxiety. Education of caregivers varies; it is often a 1:1 impromptu instruction provided by the patient's nurse and/or respiratory therapist. The purpose of this study was to evaluate the effect of the T-CARES course on caregiver anxiety and tracheostomy suctioning competency. Method: A quasi-experimental non-randomized control group design was used. The independent variable was method of instruction (T-CARES versus standard). Dependent variables were caregiver anxiety and tracheostomy suction competence. Caregivers (n=12) self selected into groups based on availability to attend T-CARES course. The control group was to receive the unit-based standard of education. The experimental group participated in the T-CARES course. Only one person chose to be in the control group; therefore, data were analyzed for the experimental group only (N=11). The T-CARES course, created by the researcher, was standardized and instructor-led; it incorporated media and simulated practice. Caregiver anxiety for both groups was obtained before (State/Trait Anxiety) and after (State Anxiety) tracheostomy care instruction was provided. Tracheostomy suctioning competence was assessed using a standardized checklist for participants in the T-CARES study group only. Demographic data were summarized with frequencies and descriptive statistics. Given the small sample size, non-parametric statistics were used for data analysis. Results: Data were analyzed from the experimental group only (n=11). The majority of caregivers were women (n=7), white/caucasian (n=10), married (n=8), employed full time (n=7), and were high school graduates or higher (n=10). The mean age of participants was 50.8 years. Seven of the participants reported previous caregiver experience. Mean score of caregiver trait anxiety was 36.8. Mean caregiver state anxiety score was 50.5 before, and 34.3 after the T-CARES intervention. A Related-Samples Wilcoxon Signed Rank Test was performed on the pre and post T-CARES intervention state anxiety scores. The T-CARES intervention significantly reduced anxiety (p=.008). Tracheostomy suctioning competency for 9 of the participants was evaluated upon completion of T-CARES. Mean score was10.8 skills performed correctly out of a possible 14. Caregivers' responses regarding their biggest fear/concern about tracheostomy care included "not doing it right," "trach coming out or being blocked," "hurting the patient," and "not being able to help in an emergency." Participants' suggestions for future improvements were creation of a Spanish language course and the addition of supplementary training to include CPR, First Aid, and the management of feeding tubes. Discussion: Research supported the hypothesis that the T-CARES course would be successful in reducing state anxiety. The T-CARES course also had a positive impact on tracheostomy suctioning competency, though without a control group it is difficult to quantify the effect. The continued development and dissemination of T-CARES to all tracheostomy patients and their caregivers may ease their transition home. The views expressed are those of the author and do not reflect the official policy or position of the US Air Force, Department of Defense or the US Government.
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Date Issued
2012
Identifier
CFH0004138, ucf:44824
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004138
THE RELATION BETWEEN OPTIMISM AND JOB PERFORMANCE: AN APPLIED SETTING
Title
THE RELATION BETWEEN OPTIMISM AND JOB PERFORMANCE: AN APPLIED SETTING.
Creator
Davis, Mary, Wooten, William, University of Central Florida
Abstract / Description
Research on cognitive ability measures consistently concludes that they are predictive of employee performance. While accounting for only about 9% of the variance in performance, however, cognitive ability measures are not sufficient. Alternative measures, such as measures of personality constructs, must be included to fully predict employee performance. The research on personality measures suggests that they are marginally predictive of employee performance. Research also suggests that...
Show moreResearch on cognitive ability measures consistently concludes that they are predictive of employee performance. While accounting for only about 9% of the variance in performance, however, cognitive ability measures are not sufficient. Alternative measures, such as measures of personality constructs, must be included to fully predict employee performance. The research on personality measures suggests that they are marginally predictive of employee performance. Research also suggests that predicative accuracy of personality measures can be enhanced when the measure is specific to the situation (i.e., stress measure are more predictive of performance in high stress situations compared to moderate or low stress situations). The current study compares a specific measure of a personality construct, the Seligman Attributional Style Questionnaire (a measure of optimism), with a broad, general measure of personality, the Gordon Personal Profile-Inventory, comparing jobs specifically requiring higher levels of optimism versus jobs that do not require high levels of optimism. The results suggest that the use of the SASQ under situationally specific conditions does not result in greater predictive accuracy that the more generic GPPI. In addition, neither measure resulted in significant correlations with employee performance. The study generally confirmed the literature on the limited utility of personality measures in predicting performance. It also raised questions about how situational specificity is operationized.
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Date Issued
2006
Identifier
CFE0001262, ucf:46930
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001262
ADVANCES IN FIRE DEBRIS ANALYSIS
Title
ADVANCES IN FIRE DEBRIS ANALYSIS.
Creator
Williams, Mary, Sigman, Michael, University of Central Florida
Abstract / Description
Fire incidents are a major contributor to the number of deaths and property losses within the United States each year. Fire investigations determine the cause of the fire resulting in an assignment of responsibility. Current methods of fire debris analysis are reviewed including the preservation, extraction, detection and characterization of ignitable liquids from fire debris. Leak rates were calculated for the three most common types of fire debris evidence containers. The consequences of...
Show moreFire incidents are a major contributor to the number of deaths and property losses within the United States each year. Fire investigations determine the cause of the fire resulting in an assignment of responsibility. Current methods of fire debris analysis are reviewed including the preservation, extraction, detection and characterization of ignitable liquids from fire debris. Leak rates were calculated for the three most common types of fire debris evidence containers. The consequences of leaking containers on the recovery and characterization of ignitable liquids were demonstrated. The interactions of hydrocarbons with activated carbon during the extraction of ignitable liquids from the fire debris were studied. An estimation of available adsorption sites on the activated carbon surface area was calculated based on the number of moles of each hydrocarbon onto the activated carbon. Upon saturation of the surface area, hydrocarbons with weaker interactions with the activated carbon were displaced by more strongly interacting hydrocarbons thus resulting in distortion of the chromatographic profiles used in the interpretation of the GC/MS data. The incorporation of an additional sub-sampling step in the separation of ignitable liquids by passive headspace sampling reduces the concentration of ignitable liquid accessible for adsorption on the activated carbon thus avoiding saturation of the activated carbon. A statistical method of covariance mapping with a coincident measurement to compare GC/MS data sets of two ignitable liquids was able to distinguish ignitable liquids of different classes, sub-classes and states of evaporation. In addition, the method was able to distinguish 10 gasoline samples as having originated from different sources with a known statistical certainty. In a blind test, an unknown gasoline sample was correctly identified from the set of 10 gasoline samples without making a Type II error.
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Date Issued
2007
Identifier
CFE0001642, ucf:47242
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0001642
Pre and Post Implementation Evaluation of an Emergency Department Severe Sepsis Alert and Practice Protocol
Title
Pre and Post Implementation Evaluation of an Emergency Department Severe Sepsis Alert and Practice Protocol.
Creator
Williams, Darleen, Andrews, Diane, Sole, Mary Lou, Parrish, Gary, University of Central Florida
Abstract / Description
ABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated...
Show moreABSTRACTSevere sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis.This study evaluated the time to first antibiotic administration, total ED and hospital length of stay (LOS) and mortality of severe sepsis patients either with a severe sepsis alert (SSA) activated or no alert activated that were admitted to the hospital through the ED. A retrospective review of the electronic medical record (EMR) was conducted to gather the required data across three time cohorts: base line/time zero (T0), six months prior to the implementation of EDSSAPP; Time one (T1) the first six months following initial EDSSAPP implementation; and Time two (T2), six months following reinstatement of the corporate sepsis committee. The most significant finding of this study was the increased number of Severe Sepsis Alerts activated in time cohort T2 (n=113) compared to T1 (n=19). Another important finding was the decreased mortality in T2 (16.4%) compared to T0 (22.7%) and T1 (33%). Overall, the number of ED patients with severe sepsis who received antibiotics within the EDSSAPP required 60 minutes did not consistently improve across the three time cohorts, T0 (81.8%), T1 (71.7%) and T2 (80.6%).The hospital LOS of stay was increased by almost 1.5 days between those patients with a severe sepsis alert activated in T1 (9.00 days) compared to time T2 (10.48 days). There was no significant decrease in the ED LOS across time cohorts and between groups of patients who had a SSA activated versus no alert activated. However, there was a 1 hour and 28 minute decrease in ED LOS in patients who had a severe sepsis alert activated in T1 compared to T0. In addition, there was a 1 hour and 52 minutes decrease in ED LOS between patients who had a SSA activated compared to those who had no alert activated in T2.While EDSSAPP data does not demonstrate the statistically significant results that was expected, the challenges related to adherence by providers to EDSSAPP is as it is seen in the literature. Increased awareness via consistent communication of on-going audit results to ED personnel will heighten their awareness for severe sepsis and EDSSAPP. Improved collaborative efforts with the interdisciplinary team are needed to refocus everyone's efforts to increase early recognition that is followed by appropriate treatment interventions and documentation is essential. Lastly, the development of a formal process to follow up with individual providers as close to real time as possible following a SSA that includes accountability for care provided and related documentation would also contribute to both awareness and adherence.
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Date Issued
2015
Identifier
CFE0005739, ucf:50075
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005739
Home Care Quality Effects of Remote Monitoring
Title
Home Care Quality Effects of Remote Monitoring.
Creator
Williams, Cynthia, Wan, Thomas, Oetjen, Dawn, Burg, Mary Ann, Zhang, Ning, University of Central Florida
Abstract / Description
Despite concerted efforts to decrease costs and increase public health, the embattled U.S. health care system continues to struggle to alleviate these widespread issues. Because the problem of hospital utilizations among patients with heart failure is posited to increase as the population ages, innovative methodologies need to be explored to mitigate adverse events. Remote monitoring harnesses the strength of advanced information and communication technology to affect positive changes in...
Show moreDespite concerted efforts to decrease costs and increase public health, the embattled U.S. health care system continues to struggle to alleviate these widespread issues. Because the problem of hospital utilizations among patients with heart failure is posited to increase as the population ages, innovative methodologies need to be explored to mitigate adverse events. Remote monitoring harnesses the strength of advanced information and communication technology to affect positive changes in health care quality and cost. By reaching across geographical boundaries, remote monitoring may support increased access to less costly services and improve the quality of home health care.The purpose of the study was to examine the home care quality effects of remote monitoring technology in patients with heart failure and to provide an economic justification for its adoption and diffusion. It compared remote monitoring as a potential intervention strategy to a standard no-intervention group (without remote monitoring). Specifically, it analyzed remote monitoring as a viable strategy to decrease hospital readmissions and emergency department visits. It also compared the cost of remote monitoring against the current standard-of-care. The theoretical framework of Donabedian's Quality Model was used in the evaluation of remote monitoring. A retrospective posttest only, case control study design was used to test the degree which remote monitoring was effective in promoting health care quality (hospital readmissions and decreased emergency department visits). Retrospective chart reviews were performed using electronic medical records (EMR). Analysis of Variance, Path Analysis, Automatic Interaction Detector Analysis (Dtreg), and Cost Outcomes Ratio were used to test the hypotheses and validate the proposed theoretical model.No significant difference was noted in remote monitoring and usual care groups. Results suggested that remote monitoring does not statistically lead to a decrease in heart failure-related hospital readmissions and all-cause emergency department visits. Results of the cost ratio analysis suggested that there was no statistically significant difference in the net income between usual care and remote monitoring; however, data suggest that there were significant increases in cost and intensity of nursing utilization for the remote monitoring intervention. The Automatic Interaction Detector Analysis showed that the unfavorable results in hospital readmissions were due to a decrease in collaborative care and patient education prior to the recommendation for hospitalization. The role of nursing care, whether in hospital or community-based care, in heart failure management is critical to quality outcomes. As the field continues to consider the use of technology in health care, decision makers should think through the process of patient care such that preventable hospital readmissions are decreased and patients received quality care.
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Date Issued
2014
Identifier
CFE0005442, ucf:50383
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0005442
Examining the Influences of the Bottoming Out Experience and the Turning Point on the Early Recovery Process from Substance Dependence Using Structural Equation Modeling
Title
Examining the Influences of the Bottoming Out Experience and the Turning Point on the Early Recovery Process from Substance Dependence Using Structural Equation Modeling.
Creator
Depue, Mary, Hagedorn, William, Lambie, Glenn, Young, Mark, Conley, Abigail, Finch, Andrew, University of Central Florida
Abstract / Description
Considering the prevalence of addiction issues within the U.S., this study focused on the topic of recovery from drug and alcohol dependence in order to add to current literature. Prevention and recovery services are two of the most common ways of combating the addiction issue, and counselors are at the forefront of both movements. The bottoming out experience (BOE) and the turning point (TTP) are two common lay terms of factors within changing addictive behaviors, yet the connection of these...
Show moreConsidering the prevalence of addiction issues within the U.S., this study focused on the topic of recovery from drug and alcohol dependence in order to add to current literature. Prevention and recovery services are two of the most common ways of combating the addiction issue, and counselors are at the forefront of both movements. The bottoming out experience (BOE) and the turning point (TTP) are two common lay terms of factors within changing addictive behaviors, yet the connection of these constructs to recovery remains unstudied and unknown. The current study tested a model that levels of the BOE and the TTP are predictive of early recovery (ER).The data from this study was obtained from a national dataset previously collected from 230 grant-funded addiction treatment centers that utilize the Global Assessment of Individual Needs (GAIN) assessment instrument. A review of the literature gaps, coupled with available data, influenced decisions on research design and statistical analysis procedures. As clear definitions of the BOE, TTP, and ER have not been discovered through research, a descriptive, correlational research design was chosen in order to understand not only what constitutes a BOE, TTP, and ER, but also to discover the relationships between the BOE, TTP, and ER in their natural state. The purpose of correlational studies is to investigate the relationship between two or more variables without researcher manipulation and such designs are common in the counseling and counselor education research field (Heppner, et al., 2008). Because correlational research is exploratory in nature, structural equation modeling (SEM) was utilized to understand the components of each construct and was used to test the hypothesis of the relationships between the BOE, TTP and ER. Although SEM is a confirmatory technique, it is frequently used in an exploratory manner because it combines elements of confirmatory factor analysis and multiple regressions and allows for various possibilities of the relationships between constructs and variables (Schrieber, et al., 2006). The literature on ER, BOE, and TTP provides enough evidence to test a theoretical model, which is the purpose of SEM. The hypothesized model assessed data at intake for the BOE, TTP and ER. Once constructs were delineated through measurement models/CFA, SEM path analysis was used to understand how the constructs related to one another. The first three hypotheses were rejected in the study, and measurement model modifications were conducted, which yielded good fit indices. Results from Hypothesis One indicated that hypothesized factors did not load on the BOE, and instead, the BOE at the intake level was a measurement of mental health severity. Results from Hypothesis Two indicated that hypothesized factors did not load on TTP; however, TTP did resulting factor structure created through model modification contained factors of awareness, motivation, and support. Results from Hypothesis Three also indicated that hypothesized indicators did not load into ER; however the resulting factor structure contained indicators of abstinence and environmental support. Lastly, Hypothesis Four yielded three resulting models, all of which had good fit indices. Therefore, hypothesis four was accepted. It is noteworthy that direct effects were not all significant, and the p value in all final models was significant. There was not a significant relationship between the BOE and ER at the intake level; however, there was a significant relationship between the BOE and TTP, as well as TTP and ER at the intake level. The direct effects between the BOE and ER may have had a role in the significant p values, as well as the large sample size. Within the three resulting models, the BOE had significant relationships with TTP, spiritual support, and motivation. Both spiritual support and motivation also had significant relationships with ER. Therefore, the results from the current study support that there are existing relationships between the BOE and TTP; however, the relationship between the BOE and ER at the intake level was not significant.
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Date Issued
2013
Identifier
CFE0004672, ucf:49862
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004672
Deconstructing Differences in Effectiveness of Teachers of Tenth Grade Non-Proficient Readers in One Florida School District
Title
Deconstructing Differences in Effectiveness of Teachers of Tenth Grade Non-Proficient Readers in One Florida School District.
Creator
Williams, Mary, Taylor, Rosemarye, Doherty, Walter, Murray, Barbara, Baldwin, Gordon, Zugelder, Bryan, University of Central Florida
Abstract / Description
Despite an intense focus and considerable financial commitment to remediate non-proficient readers in high school, the large suburban school district that was the target of this study had been unable to consistently improve student achievement in the lowest 25% of students as measured by outcomes on the FCAT Reading. Scholarly literature on high school reading had focused mostly on evaluation of curriculum rather than on teacher practices. A clear understanding of these differences in...
Show moreDespite an intense focus and considerable financial commitment to remediate non-proficient readers in high school, the large suburban school district that was the target of this study had been unable to consistently improve student achievement in the lowest 25% of students as measured by outcomes on the FCAT Reading. Scholarly literature on high school reading had focused mostly on evaluation of curriculum rather than on teacher practices. A clear understanding of these differences in practice will inform future decisions related to staffing, scheduling, and professional learning. This study sought to identify the underlying professional and instructional differences between the most effective and least effective teachers of tenth grade intensive reading courses through teacher and principal/assistant principal surveys along with teacher evaluation data. This study revealed with regards to a teacher's preparation to teach reading (research question one), that years of experience in the classroom and years of experience as a high school reading teacher were the only significant factors that influenced a teacher's effectiveness. For research questions two and three; which had to do with the beliefs and professional practices of the teacher, the educationally relevant belief that the more effective teachers were more confident about their abilities than their less effective peers was noted. Research question four provided the data with regards to the general classroom teaching strategies and the adolescent reading strategies the effective teachers employed. This data revealed that the more effective teachers implemented posting and communicating daily and long term learning goals more frequently than their less effective peers. In addition, the general classroom teaching practices of efficient use of learning time, establishing and maintaining classroom routines, and checking for understanding proved to be educationally relevant. Additionally, the adolescent reading strategies of sustained silent reading, paired/partner readings, and students reading one-on-one with teacher, were educationally relevant as well. Finally, in regards to research question five, it was of statistical significance that administrators valued the use of the general classroom teaching strategy of posting and communicating daily and long term learning goals and were able to recognize the use of this strategy when observing and evaluating the teachers.?
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Date Issued
2013
Identifier
CFE0004960, ucf:49573
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004960