Digital Commons Network^™

New Graduate Residency Programs, Shareen Estelle Taylor

Walden Dissertations and Doctoral Studies

Nurses are the largest group of healthcare providers in most acute care hospitals, and the demand for registered nurses is expected to grow by 15% by 2026. The new graduate registered nurse (NGRN) is the supply that will fill the shortage; however, NGRNs are reportedly lacking in the ability to connect the lessons learned in the classroom with real patient care, unprepared for necessary skills, emotionally stressed, and have a high first-year turnover rate. Strategies such as nurse residency programs are needed to support NGRNs as these new nurses’ transition from academics to clinical practice. The purpose of this project, …

Human Resource Strategies Used To Retain Millennials In Hospitals, Thomas F. Turner

Walden Dissertations and Doctoral Studies

Lead hospital human resource managers (HRMs) experience new recruitment, retention, and training costs for Millennial employees to close the skill gaps and address challenges from Baby Boomer employees retiring. The median turnover rate of 3 years for Millennial workers in hospitals is more than 3 times higher than older workers at hospitals. The purpose of this qualitative multiple case study was to identify retention strategies hospital HRMs use to address the retention of millennial generational employees beyond 3 years. Transformational leadership theory was the conceptual framework for the study. The data collection process included semistructured interviews and a review of …

Comparison Of Health Factors And Outcomes Between Accredited And Nonaccredited Health Departments, Deborah Koester

Walden Dissertations and Doctoral Studies

The launch of the Public Health Accreditation Board in 2012 established national public standards. This study examined possible correlations between the accreditation status of local health departments and specific indicators for health, including communicable disease, disease prevention and health promotion, and maternal child health factors, and outcomes of premature death and infant mortality. The population for the intervention group included all 212 local health departments accredited from September 2012 through December 2017. Accredited health departments were matched with nonaccredited health departments based on population, rurality, agency type, governance authority, and state public health structure. Linear regression analysis was performed on …

Burden And Coping Strategies Of Caregivers Of Persons With Alzheimer's Disease, Annette Laverne Tucker Osborne

Walden Dissertations and Doctoral Studies

Alzheimer’s disease (AD) currently presents a huge burden to individuals and families, a burden that is increasing in incidence with the aging of the baby boomer generation. Caring for a spouse diagnosed with AD holds potentially severe negative consequences for the caregiver’s physical and psychological well-being. The current study used secondary data from the 2017 New York State Department of Health/Behavior Risk Factor Surveillance System to identify a relationship, if any, between the time and activities a caregiver spends with the AD person and the caregiver’s self-reported level of general and mental health. A logistic regression was used for RQ1 …

Experiences Of Postpartum Women With Nurse-Delivered Education And Postpartum, Krystal Evans

Walden Dissertations and Doctoral Studies

Postpartum depression affects many women globally, yet largely remains underdiagnosed. It is thus important for nurses to have all available tools when delivering education and care to the postpartum patient. Yet, there is a lack of information on the experiences of postpartum women related to postpartum education and postpartum depression. The purposes of this quantitative study, for which Beck's postpartum theory was the framework, were to explore postpartum women's perceptions of education experiences and to determine if a correlation exists between the satisfaction with education and scores on the Edinburgh Postnatal Depression Scale. Sixty study participants who were 6-8 weeks …

The Lived Experience Of Child Marriage And Its Health Effects Among Young Mothers In Nigeria, Anastasia Iliwo Ashi

Walden Dissertations and Doctoral Studies

Child marriage has life-threatening implications for the mental, physical, and psychological development of the girl-child. In Sub-Saharan Africa, and other resource poor settings, child brides and very young mothers undergo various negative experiences including economic hardship and health challenges such as obstetric fistulas, birth complications, and even death. The purpose of this phenomenological study was to describe the lived experiences of child marriage and its effect on maternal health among young mothers in Nigeria. The social ecological model provided the conceptual framework for this study. Ten young women ages 18-24 years who had been child brides when age 12-16 years …

Evidence-Based Colorectal Cancer Screening Staff Education, Chantal Navalah

Walden Dissertations and Doctoral Studies

Colorectal Cancer (CRC) is the leading cause of cancer-related death, although it is considered preventable with adequate routine screening. Despite the decline in prevalence and mortality of CRC in the United States, the African American population persist in having the highest rates of death and shortest survival for CRC. This doctoral project focused on the gastrointestinal (G.I.) staff knowledge gap about the importance of CRC screening to achieve better patient outcomes. The purpose of this project was to address the knowledge gap among the G.I staff as it relates to CRC screening. The health belief model served as a guide …

Program Evaluation Of A Home-Based Primary Care Practice And Patients With Heart Failure, Anne Rose Walsh

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects over 5.5 million adults in the United States with a prevalence of 10%'€“20% in older adults and accounts for 3% of all hospital admissions with a readmission rate as high as 25% within 1 month of discharge. Patients with HF account for approximately 42% of the doctor of nursing practice project site's patient population, and the health system has a 30-day readmission rate of 35% for patients with HF in 2 large hospitals. Thus, the health system loses almost $13 million per year in Medicare penalties. This retrospective quality improvement project reviewed the effectiveness of care …

Assisting Psychiatric Nurses In Managing Work Stress And Decreasing Callouts And Absenteeism, Prisca Njume

Walden Dissertations and Doctoral Studies

Management and reduction of work stress is important in promoting nurses' well'€being. Understanding how to decrease stress levels may allow nurses to provide better care, improve patient outcomes, and experience increased job satisfaction. The focus of this project was to empower psychiatric nurses to manage work-related stress and decrease callouts and absenteeism. Person-environment fit theory, job demand-control (support) theory, the job demands-resources model, and the effort-reward imbalance model were used to inform the project. Pretest and posttest data were collected from 61 nurses using the Perceived Stress Scale. Deidentified retrospective and prospective data of the number of callouts were also …

Nutritional Assessment Of Patients In The Intensive Care Unit, Jennifer Maureen Brown

Walden Dissertations and Doctoral Studies

Impaired nutrition is associated with prolonged hospitalization, poor patient outcomes, high mortality, and increased health costs. Nutritional assessment in intensive care unit (ICU) patients is important in recognition of changes in the patient’s nutritional status from admission to discharge and may promote early nutritional interventions by the health providers to prevent complications of poor nutrition. The purpose of this staff education doctoral project was to assess ICU nurses’ knowledge of nutritional assessment for critically-ill patients and to provide education on an assessment tool for patient nutritional assessment- the malnutrition universal screening tool (MUST). The guidelines from the American Society for …

Barcode Medication Administration In The Emergency Department To Mitigate Medication Errors, Holly Gauthier-Wetzel

Walden Dissertations and Doctoral Studies

Electronic health record systems (EHRs) have been adopted in healthcare facilities to unify the workflow process of healthcare professionals. Studies have demonstrated the addition of barcode medication administration (BCMA) software technology within the EHR has decreased medication errors within hospitals and long-term care facilities. However, limited research has been conducted to establish whether using BCMA in outpatient areas has had an influence on medication error rates. Literature reveals that many facilities have not adopted BCMA in outpatient areas. The purpose of this study was to investigate whether medication errors were mitigated after BCMA was implemented in the emergency department (ED). …

Evidence-Based Strategies For Improving Medication Adherence Among Psychiatric Patients: A Systematic Review, Omah S. Tsikada

Walden Dissertations and Doctoral Studies

Nonadherence to psychotropic medications among patients with serious and persistent psychiatric disorders, including bipolar disorder and schizophrenia, is approximately 70%. Nonadherence is a common barrier to the treatment of individuals with mental health disorders. However, there is limited awareness of evidence-based interventions and strategies to address this problem. Therefore, the question for this project asks whether a systematic review can identify strategies to improve adherence of psychotropic medications among individuals with serious and persistent mental illness. The purpose of this systematic review was to explore the evidence-based strategies that can aid in increasing medication adherence in patients with mental health …

Staff Education On Fall Reduction Strategies For Residents Of A Long-Term Care Facility, Olivia C. Anaele-Nwogu

Walden Dissertations and Doctoral Studies

Fall-reduction programs are frequently ineffective in reducing falls among geriatric patients in long-term care (LTC) facilities. Multicomponent strategies have proved to be effective in reducing these falls. However, these strategies require staff education to ensure their success. The purpose of this project was to support the integration of multicomponent fall prevention strategies into practice by providing staff education focusing on the appropriateness use of hourly rounding and the 4Ps (pain, position, prompted voiding and placement) in addition to bed alarms to prevent falls among geriatric patients in the local LTC facility. The Johns Hopkins Nursing Evidence-based model was the conceptual …

Alternative Therapy For Veterans Diagnosed With Post-Traumatic Stress Disorder, Shannon Rae Hill

Walden Dissertations and Doctoral Studies

An increasing number of veterans diagnosed with post-traumatic stress disorder (PTSD) has led to an increased demand for treatment within the Veteran Affairs health care system. Presently, veterans diagnosed with PTSD receive psychotropic medications and intermittent therapy sessions. Nurses are challenged to educate veterans about other health care issues based on verbalized side effects from prescribed PTSD medications limiting veterans’ ability to focus. Identifying alternative treatment options may improve treatment choices, reduce side effects, and promote positive outcomes for veterans with PTSD. This systematic review provided evidence-based practice information by addressing whether alternative therapy such as biofeedback would improve the …

Lived Experiences Of African American Nursing Students In An Associate Degree Nursing Program, Monique Renee Merritt

Walden Dissertations and Doctoral Studies

Despite recognition of the barriers that African American nursing students encounter while pursuing nursing education, leaders of U.S. nursing programs continue to struggle to retain these students and promote their degree completion. Poor retention and lack of completion contributes to the unequal representation of African American nurses in the U.S. healthcare workforce compared to the overall population. The purpose of this qualitative study was to examine the experiences that helped to promote African American nursing students’ success or served as barriers to successful completion of an Associate Degree Nursing program. Tinto’s integration model was used as the theoretical framework. Semistructured …

Nurse Practitioner-Led Education Program For Heart Failure Patients, Shay Felecia Clarke

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects 5.7 million Americans and continues to be a leading cause of hospitalizations and deaths in the United States, posing an enormous burden on patients, families, and the health care system. Readmission rates for HF within 30 days post hospital discharge at small rural acute care facility in the southeast are consistently higher than the national average. The gap in nursing practice was the lack of up to date patient education postdischarge guidelines on HF for the socioeconomically disadvantaged, culturally diverse patient population located in this small rural town. The purpose of this project was to use …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

Decreasing Thirty-Day Readmissions For Heart Failure Patients, Willybroad Che

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients have a 20-25% hospital readmission rate within the first month of discharge. Patients experiencing HF often have a decline in health resulting in frequent hospitalizations and encumbering symptoms including dyspnea, fluid retention, and orthopnea. HF is a common condition in nursing homes and accounts for a significant proportion of resident transfers to emergency departments. HF is considered one of the costliest diagnoses in the United States, estimated to cost the healthcare system billions of dollars annually. The purpose of this systematic review was to provide a synthesis of evidence-based literature on the current recommendations and strategies …

Perceptions Of Health Care Professionals Providing Smoking Cessation In Health Care Settings, Dr. Tenishia Tamika Edwards

Walden Dissertations and Doctoral Studies

Tobacco use affects many individuals in the United States and around the world, particularly those who have existing health disparities. Smoking cessation therapy is a process used by health care professionals (HCPs) to help aid in the reduction or elimination of tobacco use. HCPs providing this service in health care settings can reach patients directly while helping to decrease the mortality rate in those who use tobacco. The purpose of this phenomenological qualitative study was to identify HCPs’ perceptions of patient barriers to adherence to smoking cessation services and what can be done to improve smoking cessation in health care …

The Effectiveness Of The Biopatch Disc In Decreasing Mrsa In Peripherally Inserted Intravenous Catheters, Ketha Franklin

Walden Dissertations and Doctoral Studies

Methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant bacterial infection, is a pressing global health care issue that decreases patients’ quality of life and places a high burden on health care delivery systems. The purpose of this quality improvement evaluation project was to evaluate an infection prevention management program derived from evidence-based research to decrease the incidence of MRSA in peripherally inserted intravenous catheters (PIVs) in acute care settings through the utilization of the Biopatch disc. The practice-focused question addressed whether the use the Biopatch disc over a 6-month period in acute care would coincide with a reduction of the incidence of MRSA …

Evaluating The Effects Of A Total Joint Education Class On Patient Outcomes, Kevin Marshall

Walden Dissertations and Doctoral Studies

As the population ages and as people live longer, there is a growing demand for total hip and total knee procedures. Possible outcomes for these procedures is a postoperative joint infection (PJI) that can cause long postoperative lengths of stay (LOS) in the hospital. The PJIs can also negatively impact the quality of life for the patient. Using the roadmap of the continuous quality improvement theory, the purpose of this quantitative study was to examine the relationship between the independent variables (joint education class participation, body mass index [BMI], A1c, and smoking) and dependent variables (PJI and LOS). To evaluate …

Decreasing Hiv Stigmatization For Care Of Young Men Of Color Who Have Sex With Men, Alethea Arnett Miller

Walden Dissertations and Doctoral Studies

HIV-related stigma from healthcare provider attitudes, beliefs, perceptions, or misconceptions has been a barrier to healthcare delivery. This project was conducted to examine whether an HIV-related stigma education provided to healthcare clinic staff with a focus on advance practice registered nurses can improve knowledge and empathy toward young men of color who have sex with men (MSM), which can lead to improved overall quality of healthcare through increased health behaviors and retention in care. An educational intervention was conducted utilizing a blended-learning environment focused on social cognitive theory to influence social behavior change among healthcare professionals, increasing their exposure, knowledge, …

Fertility Treatments Of Women In Nigeria: Using Long Versus Short Protocols, Michael Egwu

Walden Dissertations and Doctoral Studies

A global estimate indicates that over 70 million heterosexual married couples live with the burden of infertility, and Nigeria accounts for about 30%. Although protocols exist, it appears there are no standardized treatment guidelines for practicing fertility experts in Nigeria. This study, therefore, aimed to determine which protocol provides a better outcome across a given population of infertile women in Nigeria as a method to move towards developing standardized treatment guidelines. The study was grounded using the Patient-Centered Care Treatment Model, and the method of inquiry was a retrospective, cross-sectional, quantitative, and nonexperimental technique, and the influence of the patient’s …

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Health Behaviors Of Fruit And Vegetable Consumption, Physical Activity, And Breast Cancer Among African American Women, Nicole Ekoue

Walden Dissertations and Doctoral Studies

Breast cancer incidence is suddenly increasing among African American women. Recent studies indicate that health behaviors are thought to confer important health benefits and have the potential to lowering breast cancer incidence. Guided by the social ecological model, the purpose of this quantitative, cross-sectional study was to investigate the association between health behaviors of fruit consumption, vegetable consumption, and physical activity and breast cancer after adjusting for age, body mass index, and smoker status. Social support and income level were assessed as modifiers. Using the 2012 to 2017 Health Information and National Trends Survey data, this study was conducted with …

Impact Of Advanced Access Scheduling On Missed Appointment Rates In Primary Care, Helen Yvonne Krippel

Walden Dissertations and Doctoral Studies

A major problem encountered within outpatient physician offices are missed appointments. Missed appointment research revealed how no-show rates remain a focus for healthcare administrators as decreasing no-show rates may reverse harmful health consequences. The purpose of this study, which also addressed the research gap, was to determine if there was an association between advanced access scheduling and no-show rates for patients scheduled with preferred primary care physicians versus nonpreferred primary care physicians. The health belief model was the conceptual framework as missing a prescheduled appointment is a health behavior. The 1st and 2nd research questions examined whether there was a …

The Effects Of A Clinical Coaching Education On Clinical Faculty’S Coaching Behaviors, Kara L. Kaldawi

Walden Dissertations and Doctoral Studies

New graduates’ readiness to provide safe nursing care is a goal of nursing programs and employers. However, new graduate nurses do not always have the skills to make decisions in the clinical setting during a patient situation, which can result in poor patient outcomes. But clinical coaching is a faculty teaching framework that promotes the development of clinical reasoning through the deliberate practice of questioning and feedback after a patient situation. Thus, the purpose of this study was to determine whether participation in a clinical coaching education program improved the coaching behaviors of clinical nurse educators. Knowles’ theory of adult …

A Systematic Review Of Structured Communication Among Interprofessional Teams, Angeleta Zipporah Robinson

Walden Dissertations and Doctoral Studies

A leading cause of errors in health care settings is failure of interprofessional teams to communicate effectively. Ineffective communication has been associated with delays in treatment, omission of care, readmissions, and adverse and sentinel events. These incidents cost billions of dollars per year and with current reimbursement processes, health care organizations are now incurring the cost of such errors. The purpose of this project was to promote effective communication between nurses and physicians to reduce errors by standardizing the interaction among team members during interdisciplinary rounds and patient handoffs to increase the nurse communication HCAHPS scores, the physician communication HCAHPs …

Pharmacy Manager Strategies For Reducing Financial Losses From Adverse Drug Events By Polypharmacy Patients, Francis Rudden

Walden Dissertations and Doctoral Studies

Every year over 100,000 deaths occur in the U.S. from adverse drug events derived from medication errors. Medication errors account for an annual cost of $100 to $200 billion. Healthcare pharmacists lack strategies to reduce adverse drug events and medication errors from taking place. Grounded in complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies to reduce advere drug events and medication errors. The participants were 5 pharmacist managers in a county in central Florida. These pharmacists were from different community pharmacies, and each had a minimum of 5 years’ experience in the …

The Impact Of Mental Health First Aid Training On Law Enforcement Officer Mental Health Literacy, Cindy J. Blankenship

Walden Dissertations and Doctoral Studies

An increasing number of juvenile offenders with untreated mental health issues are entering the justice system. Lack of adequate training of criminal justice personnel enhances the possibility of this population being arrested which is creating an overwhelming problem for stakeholders. This study sought to determine if the implementation of Mental Health First Aid (MHFA) Training impacted law enforcement officers’ (LEOs’) mental health literacy. This mixed-methods study used a quasi-experimental, one-group, pretest-posttest design, with a qualitative survey. Participants consisted of a sample of 28 LEOs from a rural Southeastern United States law enforcement agency. Study findings indicated that MHFA training increased …