Thesis (M.S.)--Boston University

Screening acute stroke patients for dysphagia (difficulty swallowing) is recommended within 24 hours due to risks of morbidity and mortality. A review of the international literature identified no universal consensus for a valid method of screening. This thesis describes a multi-method Action Research (AR) programme of study focused on the design, development and evaluation of a reliable and valid dysphagia screening tool (the ‘Head Dysphagia Screen for Stroke’ or HeDSS) for use by Registered General Nurses (RGNs). As a component of the assessment phase of the AR programme, a survey of dysphagia screening practices in England and Wales highlighted widely varied screening practices. Many of these practices were based on limited research evidence, reflecting the lack of consensus for valid dysphagia screening criteria reported in the literature. The design phase of the AR programme involved the development of the HeDSS tool, which centred on the use of research-based screening criteria. Focus group activity determined nurses’ perceptions of the design and subsequent refinement of the HeDSS tool. The intervention and evaluation phases of the AR programme followed three empirical stages. Stage one established the inter-rater reliability of the Speech and Language Therapist Researcher’s (SLTR’s) clinical dysphagia assessment, which acted as a reference standard against which the validity of the HeDSS tool was to be measured. Clinical judgements for the presence and absence of dysphagia in the same 30 referred patients were compared between the SLTR and a Speech and Language Therapist (SLT) of equivalent experience. Inter-rater reliability was substantial (k = .71). The second empirical stage established inter-rater reliability of the HeDSS measurement outcomes (indicative signs of dysphagia and appropriateness of referral for SLT clinical dysphagia assessment) when employed by two RGNs compared against the SLTR when screening two samples of 20 acute stroke patients. Rater agreement was substantial (k = .71 and k = .79, for detection of signs of dysphagia and k = .79 and k = .87 for appropriateness of referral). The final empirical stage evaluated the concurrent validity of the HeDSS tool measurement outcomes when employed by a second sample of two RGNs compared with the SLTR’s clinical dysphagia assessment outcomes in a sample of 100 acute stroke patients. The HeDSS tool measurement outcomes correlated highly with the clinical dysphagia assessment outcomes (sensitivity .88 - .96 and specificity .85 - .88 for detection of dysphagia; sensitivity .90 - .96 and specificity .84 - .88 for determining patients appropriate for assessment). Correlation coefficient measures confirmed high concurrent validity for the HeDSS tool (Phi ranged between .76 - .82). This study is the first in the UK to establish a reliable and valid dysphagia screening tool for use with acute stroke patients and has significantly advanced the professional knowledge base within this domain of practice. It is recommended that a multi-centred programme of research be undertaken to replicate this study with a larger nurse and patient sample.

Primary nursing is a system of delivering nursing care when one nurse is responsible and accountable for the assessment of the patient's needs as well as the planning, implementing and evaluating of the nursing care throughout the patient's hospitalization. These activities are done in collaboration with the patient and other members of the health team. This system is a relatively recent development in the field of nursing. There has been little research done to either describe or evaluate primary nursing, particularly in the area of psychiatry. This study was an attempt to include both patients and nurses in such an evaluation. A validated and reliable questionnaire was developed by the author to obtain data related to patients' and nurses’ perceptions of the occurrence, importance and satisfaction of specific primary nursing behaviours. The questionnaire was administered to twenty-nine patients and their primary nurses during the last week of the patient's hospitalization. Nurses and patients reported that primary nursing behaviours related to discharge had a low occurrence rate. However, they attributed a high degree of importance to these same behaviours. Both groups reported a low occurrence and importance score for primary nursing behaviours related to family involvement with the primary nurse and the patient's treatment program. Both nurses and patients agreed on the occurrence and importance of most of the primary nursing behaviours. There was less agreement in the area of satisfaction. / Applied Science, Faculty of / Nursing, School of / Graduate

Thesis (M.S.)--Boston University

Research has shown that many patients find it difficult to understand and retain information that is conveyed verbally by medical professionals. One solution to this problem is to give patients this information in a written form so that it can be reviewed when needed to maximize retention and understanding. When implementing this solution, care should be taken that the patient education materials (PEMs) are written in a way that is easily understood by the patient. PEMs should also be of good quality, meaning that they are comprehensive, without bias, evidence based, relevant, and balanced. Well written PEMs are especially important within the field of audiology as many patients find it particularly difficult to understand audiological and vestibular information. PEMs related to many different diagnoses and treatment within the field of audiology have been evaluated to ensure that they are appropriate for patients, but this evaluation has not yet been done for PEMs pertaining to benign paroxysmal positional vertigo (BPPV). BPPV is a common cause of dizziness where episodes are triggered by head movements such as tipping the head back. For this study, 11 PEMs pertaining to BPPV were gathered from professional organizations online and 3 were gathered from audiology clinics local to East Tennessee. Reading grade level was determined using the Fry Method and the Simple Measure of Gobbledygook (SMOG). Quality was determined using the DISCERN. The results of this study indicate that the current PEMs related to BPPV are not written at an appropriate reading level for patients as determined by the Agency for Healthcare Research and Quality (AHRQ). The conclusion of this study is that while some of the PEMs analyzed were found to be of good quality, many can and should be improved. Organizations such as the CDC and AHRQ have created materials to guide medical professionals through the process of improving their PEMs.

The attitudes and experiences of the health care team members involved in facial transplant surgery and patient care were explored in this study, which utilized a qualitative descriptive method. The Specific Aims of the study and the interview questions were guided by “Moore’s Ethical Criteria for Surgical Innovation.” Overall, the participants believed that the risk-benefit ratio of facial transplantation favored proceeding with the procedure in the clinical scenarios with which they had been exposed. The participant’s experience was challenging and rewarding, and they expressed personal fulfillment from the opportunity to be involved in the transformation of another human being’s life. Moreover, the entire effort exhibited highly effective team work which displayed esprit de corps, was guided by superior leadership, and illuminated the importance of the clinical, intellectual, and historical environment of the institution where the procedures took place. These components represent a “surgical innovation cluster,” a proposed framework for guiding surgical innovative efforts which represent major paradigmatic shifts in both scientific effort and social philosophy.

Thesis (M.S.)--Boston University

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Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01