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Improving Chronic Kidney Disease Care with Group Visits
Title
Improving Chronic Kidney Disease Care with Group Visits.
Creator
Montoya, Vicki, Sole, Mary, Norris, Anne, Wink, Diane, Abbott, Lionel, University of Central Florida
Abstract / Description
First year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self...
Show moreFirst year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self-manage CKD negatively influence a patient's ability to follow provider recommendations. The group visit (GV) intervention has demonstrated improvements in disease-related outcomes through increased levels of patient knowledge, self-efficacy, and disease self-management for other chronic diseasses such as diabetes and congestive heart failure (CHF). No data are available for the use of GVs in CKD.The purpose of the study was to develop and test a nurse practitioner-facilitated chronic CKD GV model versus usual nephrology care for Stage 4 CKD patients (knowledge, self-efficacy/self-management, physiological data, and satisfaction). As classified by the National Kidney Foundation's (NKF) staging system, Stage 4 CKD is considered severe kidney disease, with a decrease in the functional capacity of the kidney as determined by a glomerular filtration rate (GFR) of 15-30 ml/min. It is common for patients with Stage 4 CKD to progress to Stage 5 CKD/end-stage renal disease (ESRD), requiring dialysis or transplantation to survive.Preliminary instrumentation and feasibility studies were conducted prior to a pilot study of a CKD GV model. The development and validation of the Stage 4 CKD Knowledge Instrument was completed with 59 Stage 4 patients. Findings supported reliability (Kuder-Richardson-20 [KR] = .89) and content validity (I-CVI = .97, S-CVI= 1.0) Feasibility of the CKD GV model was assessed with a single group, pretest-posttest design using a convenience sample of eight Stage 4 patients. Results demonstrated an improvement in knowledge of CKD from a median of 69% to 86% (p =.012). No improvements were noted in self-efficacy scores (p = .230). GV satisfaction ranged from very good to excellent. Feasibility was supported by a high retention rate (100%). No barriers to participant recruitment or GV implementation were encountered.The pilot study used a two-group, repeated measures experimental design, with a sample of 30 Stage 4 CKD patients from two office locations of an outpatient nephrology practice. Patients were randomized to the GV intervention or to usual nephrology care. CKD-knowledge, self-efficacy, and self-management scores were collected at baseline, six months, and nine months. Physiological data were measured at baseline, six months, and nine months. GV satisfaction was obtained after the completion of GVs (six months). Nephrology practice satisfaction was obtained from by both groups at nine months. MANOVA for repeated measures was calculated for data collected at the three time points.Twenty-six of 30 patients completed the study, with four patients ineligible to complete the study due to progression to ESRD and dialysis initiation. GV attendance was 92%. CKD knowledge was statistically improved for both groups (F(1.498, 34.446) = 6.363, P = .008). While not statistically significant, a favorable upward trend in the mean scores for the subscales of self-management (communication, partnership in care, and self-care) was demonstrated in the GV patients, with a lack of improvement found in the usual care group for these subscales. Self-efficacy scores revealed a non-significant improvement in mean scores for the GV patients during the GVs, not seen with usual care patients. GV satisfaction was again high with the vast majority of patients requesting use of GVs in their future nephrology care. Current methods of intervention in the Stage 4 CKD population have made little impact on reducing first-year ESRD mortality and morbidity rates. Opportunities to intervene in the poor outcomes begin in the predialysis care of Stage 4 patients. Based on the documented success of multidisciplinary approaches in predialysis care, of GVs in other chronic diseases, and of chronic illness care based on the CCM, a high probability for success exists with the application of GVs in CKD. Although limited by a small sample size, promising improvements in the subscales of disease self-management, self-efficacy, CKD knowledge, and high satisfaction with the GV model for GV participants were revealed in this study. Further research is warranted for the CKD GV model on a larger randomized sample in other locations. Much needed data would be provided on which to base decisions for use of the CKD GV intervention in the predialysis care of Stage 4 patients.
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Date Issued
2013
Identifier
CFE0004724, ucf:49827
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004724
THE ROLE OF CHILD LIFE SPECIALISTS IN MEETING THE NEEDS OF CHILDREN WITH CHRONICALLY ILL SIBLINGS
Title
THE ROLE OF CHILD LIFE SPECIALISTS IN MEETING THE NEEDS OF CHILDREN WITH CHRONICALLY ILL SIBLINGS.
Creator
Mathis, Jenna, Culp, Anne, University of Central Florida
Abstract / Description
The purpose of this study was to explore the needs and concerns of siblings of children hospitalized with a chronic illness and to discuss the role that Child Life Specialists play in helping these siblings cope. With there being very few research studies in the fields of child development and child life regarding psychosocial development of siblings of chronically ill children, I felt it pertinent to conduct an exploratory study that would provide relevant and factual information to both...
Show moreThe purpose of this study was to explore the needs and concerns of siblings of children hospitalized with a chronic illness and to discuss the role that Child Life Specialists play in helping these siblings cope. With there being very few research studies in the fields of child development and child life regarding psychosocial development of siblings of chronically ill children, I felt it pertinent to conduct an exploratory study that would provide relevant and factual information to both fields that could inspire further research in both fields. I predicted that my results would show many similarities among Child Life Specialists' perceptions related to their experiences with siblings and would solidify the role that they play in meeting the needs of siblings, furthermore validating their worth in the hospital setting and in aiding in the psychosocial development of hospitalized children and their families. Face-to-face and telephone interviews, with 10 Child Life Specialists from three central Florida pediatric hospitals, were conducted, transcribed, and analyzed. Through this study, I have discovered that Child Life Specialists employ a variety of methods in meeting the needs of siblings of children diagnosed with a chronic illness. I have also discovered that Child Life Specialists perceive themselves as being able to make a positive impact in the life of children with chronically ill siblings in regard to their psychosocial development and coping. Further research in this area is needed.
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Date Issued
2015
Identifier
CFH0004777, ucf:45379
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004777
Bridging the Gap Between Hospital and School: Addressing the Academic and Social-Emotional Needs of Students with Chronic Illness
Title
Bridging the Gap Between Hospital and School: Addressing the Academic and Social-Emotional Needs of Students with Chronic Illness.
Creator
Eggert, Nicole, Hopp, Carolyn, Vitale, Thomas, Trimble Spalding, Lee-Anne, Taylor, Dalena, University of Central Florida
Abstract / Description
This dissertation in practice examined the literature and a sample of existing programs that addressed the educational and social-emotional challenges of students with chronic illness in order to bridge the gap between hospital discharge and school re-entry. Literature showed that the hospital homebound setting was problematic for chronically ill students due to minimal hours of academic instruction and little interaction with peers. Students with chronic illness were at higher risk for...
Show moreThis dissertation in practice examined the literature and a sample of existing programs that addressed the educational and social-emotional challenges of students with chronic illness in order to bridge the gap between hospital discharge and school re-entry. Literature showed that the hospital homebound setting was problematic for chronically ill students due to minimal hours of academic instruction and little interaction with peers. Students with chronic illness were at higher risk for maladaptive behaviors, lower educational attainment, and higher use of social services. Programs created at other facilities to address this problem were visited and reviewed for pertinent information such as funding sources, location, division of responsibility, and relationships with school districts. Those findings were incorporated into a hospital-based learning center model designed to address both the academic and social-emotional needs of elementary students using the Positive Youth Development (PYD) framework. The design process included a focus group of hospital professionals (music therapy, child life, and family-centered care), school district partners (literacy), university partners (art), and parents of chronically ill students. The focus group reviewed the model and provided feedback on the design based on their expertise and modifications were made by the researcher to the design. Webex-Teams, an online meeting platform, was used for stakeholders to review modifications to the physical layout and analyze a proposed sample interdisciplinary session plan. The final model design included five components: literacy, art, music therapy, play, and technology, a physical floorplan, and an interdisciplinary session plan to address the academic and social well-being of chronically ill students that can be replicated at any hospital facility.
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Date Issued
2019
Identifier
CFE0007625, ucf:52529
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007625
Pre-service teacher perceptions on the education of children with critical illness and preparation to teach mathematics to children with critical illness.
Title
Pre-service teacher perceptions on the education of children with critical illness and preparation to teach mathematics to children with critical illness.
Creator
Fralish, Bethany, Nickels, Megan, Bush, Sarah, Kelley, Michelle, University of Central Florida
Abstract / Description
This research study presents data on three pre-service elementary teachers in an ethnographic study outlining the experiences of the pre-service elementary teachers during the semester of their first education internship. During the first internship semester, the three pre-service teachers completed a 12-week internship placement, 6-weeks at a hospital-based school program and 6-weeks at a brick-and-mortar public school, and three co-requisite courses (i.e., elementary mathematics methods,...
Show moreThis research study presents data on three pre-service elementary teachers in an ethnographic study outlining the experiences of the pre-service elementary teachers during the semester of their first education internship. During the first internship semester, the three pre-service teachers completed a 12-week internship placement, 6-weeks at a hospital-based school program and 6-weeks at a brick-and-mortar public school, and three co-requisite courses (i.e., elementary mathematics methods, diagnostic and corrective reading, and teaching exceptional students). The data collected includes the pre-service teacher applications to participate in internship at the hospital-based school program, pre-interview questionnaire, end-of-day reflections, post-interview questionnaire, and background information questionnaire. The questions of study were: (1) How prepared do pre-service teachers feel to educate children with critical illness and address the needs of children with critical illness in the classroom as a result of completion of a 6-week internship at a hospital-based school program? (2) How prepared do pre-service teachers feel to teach mathematics to children with critical illness after completing a 6-week internship at a hospital-based school program? The results show that the participants' reported an increase in preparation to teach children with critical illness and teach them mathematics, but their views about the education of children with a critical illness and mathematics remain consistent. Thus, the results illuminated two themes across all participants: 1) children as a homogenous group 2) procedural mathematics. Study implications include the need to add specific professional learning on the educational impacts of a critical illness and the need to involve pre-service teachers in reflective practices of what they learn and observe and how that informs actions in the classroom.
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Date Issued
2019
Identifier
CFE0007804, ucf:52354
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0007804
THE USE OF MOBILE APPLICATIONS IN PREVENTIVE CARE AND HEALTH-RELATED CONDITIONS: A REVIEW OF THE LITERATURE
Title
THE USE OF MOBILE APPLICATIONS IN PREVENTIVE CARE AND HEALTH-RELATED CONDITIONS: A REVIEW OF THE LITERATURE.
Creator
Ringer, Naomi, D'Amato-Kubiet, Leslee, University of Central Florida
Abstract / Description
The purpose of this review of literature was to understand the role of mobile device applications in health related conditions and to analyze their effects on health outcomes related to the management of chronic illnesses. Implications for future use of applications in client-centered care and interpretation of the data by health care providers was also explored. Peer-reviewed, English-language research articles published from 2008 to present were included for synthesis. Study results...
Show moreThe purpose of this review of literature was to understand the role of mobile device applications in health related conditions and to analyze their effects on health outcomes related to the management of chronic illnesses. Implications for future use of applications in client-centered care and interpretation of the data by health care providers was also explored. Peer-reviewed, English-language research articles published from 2008 to present were included for synthesis. Study results revealed positive outcomes when health-related mobile applications were used in practice and support clinicians' use of mobile applications as a tool for monitoring symptoms and communicating with individuals. The literature indicated nurses play a significant role in providing feedback, which reinforces self-care strategies and adherence, with the potential for improving outcomes. Additional research is needed to evaluate the long-term effects of applications on patient outcomes, nurses' perspectives, and feasibility of implementation into practice.
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Date Issued
2014
Identifier
CFH0004660, ucf:45280
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0004660
SPIRITUALITY AND EXPECTATIONS OF CARE PROVIDERS OF OLDER PATIENTS WITH CHRONIC ILLNES IN NORTH CENTRAL FLORIDA
Title
SPIRITUALITY AND EXPECTATIONS OF CARE PROVIDERS OF OLDER PATIENTS WITH CHRONIC ILLNES IN NORTH CENTRAL FLORIDA.
Creator
Sherman, Myra, Wink, Diane, University of Central Florida
Abstract / Description
A qualitative design was used to explore the use of spirituality and prayer by older adults who have chronic illness and reside in a rural community. Thirteen individuals responded to a flyer soliciting participation in a study of the use of spirituality as part of health care. Participants were at least 60 years of age, had at least one chronic illness and resided in North Central Florida. Twelve participants then responded to six open-ended questions based on an adaption of an instrument...
Show moreA qualitative design was used to explore the use of spirituality and prayer by older adults who have chronic illness and reside in a rural community. Thirteen individuals responded to a flyer soliciting participation in a study of the use of spirituality as part of health care. Participants were at least 60 years of age, had at least one chronic illness and resided in North Central Florida. Twelve participants then responded to six open-ended questions based on an adaption of an instrument used by Dr. Shevon Harvey in her doctoral dissertation. The data was analyzed to identify themes and answer four research questions. The four research questions were 1) how do older adults living with chronic illness describe spirituality? 2) how do older adults use spirituality while living with chronic illness? 3) how can health care providers assist older individuals with chronic illness to meet their spiritual needs?, and 4) do patients feel that their spiritual needs are being addressed during their outpatient health care? The interview responses demonstrated that several different practices, including prayer and scripture readings as well as adherence to medication, diet, and exercise recommendations were used as coping mechanisms by study participants. The majority of participants want their health care providers to address spirituality and/or refer them to spiritual advisors for counseling. The study showed that some participants stated that their spiritual needs were met, but there were some who did not want spirituality addressed in the outpatient setting. Four themes were identified, which suggest that 1) spiritual practices were frequently used coping measure for these individual with chronic illness, 2) health care providers are supportive of their patients' spirituality, 3) participants with chronic illness consider adherence to medication, diet, and exercise a coping measure, and 4) participants with chronic illness want their health care providers to recognize their spiritual needs. The findings indicated that individuals who self identify as individuals from whom spiritual life is important and who have chronic illnesses and have spiritual needs that can be addressed in the outpatient setting. The findings also demonstrated use of non spiritual coping measures and the importance of health care provider's acceptance of spirituality in this specific population. Recommendations for further research are made.
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Date Issued
2011
Identifier
CFE0003740, ucf:48794
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0003740
DEMAND STUDY FOR DENTAL HYGIENE BACHELOR DEGREE PROGRAM
Title
DEMAND STUDY FOR DENTAL HYGIENE BACHELOR DEGREE PROGRAM.
Creator
Driscoll, Annelise, Liberman, Aaron, University of Central Florida
Abstract / Description
The following is a study to determine if sufficient demand exists to start a Bachelor of Science and Master of Science degree program in dental hygiene through a joint agreement for completion degrees between Valencia Community College and the University of Central Florida. To accomplish this objective two survey instruments were administered to randomly selected licensed dentists and dental hygienists in the state of Florida. Dental hygienists represented the potential student base for the...
Show moreThe following is a study to determine if sufficient demand exists to start a Bachelor of Science and Master of Science degree program in dental hygiene through a joint agreement for completion degrees between Valencia Community College and the University of Central Florida. To accomplish this objective two survey instruments were administered to randomly selected licensed dentists and dental hygienists in the state of Florida. Dental hygienists represented the potential student base for the proposed programs, and dentists represented the potential and prospective employers of graduated students of the proposed programs. To determine demand and demand characteristics, one survey instrument was mailed to 1,000 dental hygienists who were randomly selected using SAS software from a population of N=12,066 dental hygienists actively licensed to practice in the state of Florida. This sample of hygienists was approximately 8.3% of the total population. Of the 1,000 samples, 134 (or 13.4%) were returned. Of the 134 surveys returned, 123 (n=123) were included in this study. Eleven surveys were not included because of a majority of missing data or because the respondent indicated he or she already possessed a Bachelor or Master degree. A Likert-scale questionnaire was sent to each group of actively licensed dentists and actively licensed dental hygienists from the state of Florida. Responses from dental hygienists were overwhelmingly positive towards the addition of the Bachelor of Science degree program with an online distance-learning component. Those in favor of the Bachelor of Science degree program also provided a favorable response towards adding a Master of Science degree program in dental hygiene. The dentists, as potential future employers, also showed strong support in their responses for the additional degree programs with an additional management track component and believed it would elevate the professional standards of the dental hygiene field.
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Date Issued
2009
Identifier
CFE0002842, ucf:48048
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0002842
Zora
Title
Zora.
Creator
Tyrrell, Genevieve, Roney, Lisa, Rushin, Patrick, Scott, John, University of Central Florida
Abstract / Description
This mixed-media memoir uses a variety of forms from short epigrammatic essays to straightforward stories and graphic narratives to explore the author's coming-of-age experiences augmented by chronic illness. Trying to succeed in the film industry, romance, and family situations, the young female narrator navigates the often unexpected or disappointing consequences of having an autonomic nervous system disorder. Relationships between conflicting identities emerge(-)between healthy versus sick...
Show moreThis mixed-media memoir uses a variety of forms from short epigrammatic essays to straightforward stories and graphic narratives to explore the author's coming-of-age experiences augmented by chronic illness. Trying to succeed in the film industry, romance, and family situations, the young female narrator navigates the often unexpected or disappointing consequences of having an autonomic nervous system disorder. Relationships between conflicting identities emerge(-)between healthy versus sick self, projected/envisioned versus actual self, and tough versus vulnerable self(-)as the narrator journeys toward a more complete and accepting self-understanding.
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Date Issued
2013
Identifier
CFE0004763, ucf:49777
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004763