Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Teresa J. Kelechi

Second Advisor

Martina Mueller

Third Advisor

Bernice Coleman

Abstract

Purpose: This dissertation was designed to build my expertise in working with large datasets and to apply that knowledge to congenital heart disease patient problems. Relationships in a large dataset were examined using a nursing theory approach to identify relationships that would benefit from further research as a preliminary skill-building step. Outcomes from transcatheter (TC) and hybrid pulmonary valve replacement (PVR) versus surgical PVR were explored in the literature and finally in a study to begin to provide information to help health care providers tailor education and recommendations to patients/families selecting a treatment strategy for pulmonary regurgitation and/or stenosis. Design: A quasi-meta-analysis (Manuscript I) was undertaken to compare outcomes from TC and surgical PVR using the Wilson and Cleary (1995) conceptual model of health-related quality of life (HRQOL). In Manuscript II the Omaha System was used to analyze data from an existing leg ulcer database (no appropriate congenital heart disease database was available) to increase my skills at handling large databases and applying nursing theory to identify relationships that would benefit from further research. Visualization techniques (heat maps) were then used to examine new relationships among the variables. Models were developed to test the relationships between variables in predicting adherence to leg ulcer treatment and predicting leg ulcer development. Gaps identified in the literature from Manuscript I and the skills learned from the Manuscript II project were then used to design a single-center study to examine TC (n=32) and hybrid (n=15) PVR outcomes (procedural, mid-term, heart remodeling/function, arrhythmia, symptom, functional, and HRQOL as well as cost outcomes) (Manuscript III). The results were compared to the surgical literature and TC and surgical meta-analysis outcomes. Findings: Gaps identified in the quasi-meta-analysis (Manuscript I) were that hybrid PVR outcomes were limited to procedural outcomes. There were limited symptom and HRQOL outcomes for both TC and hybrid PVR. There were few reports of diastolic heart function for either TC or surgical PVR. The study (Manuscript III) showed hybrid PVR had similar heart remodeling outcomes as TC. There were no changes in heart function, arrhythmias, or exercise capacity for TC or hybrid PVR; this was similar to surgical PVR outcomes. Dyspnea and exercise intolerance decreased. Functional class improved but was only significant in the TC group which compares to surgical PVR. Length of stay was significantly shorter for TC and hybrid PVR than surgical PVR but costs were higher. Manuscript II demonstrated that the Omaha System was useful in aligning nursing theory and terminology to identify patterns between psychosocial characteristics and leg ulcers that could be investigated further. These skills in extracting and categorizing variables were used in designing the study reported in Manuscript II. Conclusions: The findings from Manuscripts I and III should help health care providers to begin to educate patients/families about the best PVR treatment options given individual patient anatomy, physiology, and preferences. Manuscript II demonstrated that the Omaha System was useful with large datasets to link theory and data to identify potential new hypotheses to test. This theory could be used to identify possible hypotheses to test with congenital heart disease databases.

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