Digital Commons Network^™

An Analysis Of Junior Enlisted Personnel Attrition In The U.S. Army, Posey Grier, Jr.

Walden Dissertations and Doctoral Studies

Junior enlisted personnel are the workforce of the U.S. Army and a recruiting pool for Warrant and Officer Candidate School training programs. Before fulfilling their initial obligation of 8 years, 25 to 30 percent of enlistees receive separation orders from the Army. Consequently, attrition in this group has created a substantial problem in maintaining a trained and ready Army. The purpose of this correlational study was to understand what factors contribute to unfilled service of enlisted personnel. Specifically, this study focused on the number of years of service before departure, the cause of the early separations, and the subcategories as …

Maintaining Confidentiality Among Hiv Infected Couples: Physicians' Patterns Of Decision In Nigeria, Francess Uju Ayaebene

Walden Dissertations and Doctoral Studies

Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided …

Understanding Social Workers' Roles Providing Case Management To Medicaid Managed Care Enrollees, Vontija Deeshawn Dean-El

Walden Dissertations and Doctoral Studies

Social workers often take on the role of providing case management to Medicaid recipients; however, there is little clinical research on social workers' perceptions of their case management role. The purpose of this study was to develop an understanding of the social worker case management role by exploring social workers' perceptions of their roles when providing case management to Ohio Medicaid managed care enrollees. This action research study was grounded in organizational role theory. A semi structured focus group was facilitated using open-ended questions related to social workers' role perceptions, role conflict, role ambiguity, case management, and managed care. Qualitative …

Impact Of English Language Teachers' Technology-Based Pedagogical Choices On Japanese University Students, Robert John Mcclung

Walden Dissertations and Doctoral Studies

Recent literature suggests that communicative language tasks widely used by English as a Foreign Language (EFL) teachers to try and improve Japanese students’ learning have had little effect on improving their language ability and their intrinsic motivation to improve. Consequently, a number of teachers are now using interactive technology in the classroom although it has not been systematically implemented or widely studied. Understanding the approaches of successful EFL teachers—specifically, how teachers using an andragogic approach through experiential learning might affect student engagement—was the purpose of this qualitative study. The conceptual framework focused on student-centered learning and included Knowles’s theory of …

Social And Structural Barriers To Safer Sex Among Heterosexual Female Sex Workers, Erika Nikole Harding-Davis

Walden Dissertations and Doctoral Studies

Individuals infected with HIV through heterosexual contact made up 24% (9,578) of all new infections in the United States. Female sex workers are at increased risk of getting HIV and other sexually transmitted infections (STI) because they may be more likely to participate in risky sexual behaviors including sex with multiple partners and condom-less anal/vaginal sex. Guided by the syndemic theory, the purpose of this study was to explore the relationships between social and structural factors (homelessness, substance use, immigration status, and use of healthcare) and risky sexual behaviors (condom-less vaginal sex and multiple sex partners) among female sex workers …

Post-Ebola Case Management Of Orphaned Young Adults In Rural Sierra Leone, Augustine Frazer

Walden Dissertations and Doctoral Studies

The 2014-2016 Ebola pandemic in Sierra Leone significantly increased the orphan population and the need for social support programs, especially for student-orphans in higher education. Poorly prepared disaster response managers have little knowledge about how college student-orphans experience social services. The purpose of this transcendental phenomenological study was to explore how post-Ebola student-orphans enrolled in an agricultural university in rural Sierra Leone experienced post disaster specialized case management to enhance student performance. Criterion sampling techniques including specific inclusion and exclusion criteria guided the recruitment, that included 10 research participants taking part in the semi structured interviews. Ecological system theory and …

Factors Affecting Health Care Access And Utilization Among U.S. Migrant Farmworkers, Melinda R. Kelly

Walden Dissertations and Doctoral Studies

There are over 3 million seasonal and migrant farmworkers in the U.S. agricultural industry with a significant percentage of farmworkers documented or native to the United States. Migrant farmworkers live below the federal poverty levels at high rates and experience low health care access and utilization. Guided by the fundamental cause theory, the purpose of this phenomenological study was to examine the lived experiences of migrant farmworkers and identify the factors impacting their health care access and utilization. Face-to-face interviews were conducted with 12 migrant farmworkers who had worked in Southwest Texas agricultural stream. Data were analyzed and coded to …

Cultivating Cultural Competence To Address Childhood Obesity In Ethnic Minority Youth, Tia Knight-Forbes

Walden Dissertations and Doctoral Studies

Obesity is an increasingly prevalent health issue, especially among children who live in high poverty, low income, and low education areas that lack needed resources and health care to promote quality of life. African American youth have a higher rate of obesity than other populations. The purpose of this project was to address an identified gap in practice by improving health care professionals' ability to provide culturally competent care to African American youth. An educational intervention framed by the Purnell model for cultural competence was developed to address the question, Will cultural competency staff education improve knowledge to prevent and …

Perceptions Of Barriers To Oral Care Among African American Families In Durham, North Carolina, Samuel Motto

Walden Dissertations and Doctoral Studies

Dental caries is one of the biggest issues of concern for healthcare providers in Durham, North Carolina due to the high prevalence of dental caries in African Americans. Many researchers have identified socio-economic, low income, poor education, psychological behavior, awareness, allied diseases, environment, unhealthy diet, obesity, type II diabetes, and inadequate health facilities as the possible reasons for its high prevalence, yet literature lacks information regarding how African Americans perceive the problem of oral health. Knowledge of the perceived factors may help to identify the actual cause of dental caries through the eyes of African Americans. The purpose of this …

Noncompliance With Follow-Up Visits In Primary Care, Amanda Michelle Northern

Walden Dissertations and Doctoral Studies

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided …

Socioeconomic Status, Water, Sanitation, Hygiene, And Economic Cost Of Childhood Diarrheal Diseases In Uganda, Sarah Birungi Nahalamba

Walden Dissertations and Doctoral Studies

Worldwide, diarrhea is the second leading cause of death in children aged under 5, yet it is both preventable and treatable. Several studies have established the effects of exposure to inadequate water, sanitation, and hygiene (WASH) on diarrhea prevalence, but little was known on how the interactions of socioeconomic status and WASH influence the economic cost of treatment of diarrhea. This retrospective cross-sectional survey study was focused on assessing the correlation between socioeconomic status, WASH, and household cost of treatment of diarrhea among children aged under 5 in Uganda using the multiple exposure-multiple effect model. Secondary data from the 2015/16 …

Patient Awareness And Knowledge Of Medically Induced Radiation Exposure, Travis L. Mann

Walden Dissertations and Doctoral Studies

The level of knowledge and awareness among patients about the concepts and implications of medical radiation is unknown. The purpose of this qualitative, case study was to explore patients' awareness and knowledge of information regarding this topic from their perspectives. The health belief model provided the framework for the study. A total of 20 individuals were recruited using purposive sampling. All participants were above the age of 18 in central North Carolina and had undergone or are currently undergoing medical radiation exams. Data were collected using semistructured interviews and analyzed using Yin's 5-phased cycle, which involved compiling, disassembling, reassembling, interpreting, …

Integrating Health Care Systems To Maintain Quality Care And To Manage Cost, Marilynn Noble

Walden Dissertations and Doctoral Studies

The rising cost of health care in the Philippines is a concern for the Department of Defense and TRICARE beneficiaries. The purpose of this quantitative cross-sectional research study was to determine the efficacy and acceptability of a different method to deliver health care to increase access to health care and decrease out-of-pocket costs while maintaining quality of care for TOP Standard beneficiaries who receive health care under the Philippine Demonstration. Secondary data was used to determine the acceptability of an alternative reimbursement methodology to decrease cost but maintain access to quality care. The Andersen's behavioral health care model and the …

Effect Of Mindfulness-Based Stress Reduction On Aggression In Adults With Intellectual Disabilities, William Sanchez

Walden Dissertations and Doctoral Studies

Individuals with intellectual developmental disabilities occasionally exhibit challenging behaviors through forms of aggression. Interventions, such as cognitive behavioral therapy, and applied behavioral analysis, have all been shown to be effective in reducing symptoms of aggression. This quantitative study used a secondary analysis of clinical records from an agency that provides day treatment services for adults with intellectual disabilities. To assess the effectiveness of a mindfulness-based stress reduction (MBSR) program in reducing aggression in this population, 18 individuals with various levels of intellectual disabilities participated in an 8-week MBSR while an additional 18 participants served as the wait list control group …

Oral Health Literacy And Oral Hygiene Habits In A Kentucky Appalachian Community, Katie D. Schill

Walden Dissertations and Doctoral Studies

This study sought to identify the level of oral health literacy held by people who live in transitional and distressed Kentucky Appalachian areas and if this effects how often they are using oral hygiene techniques. Data were also collected to describe the attitudes Kentucky Appalachian adults hold toward oral hygiene and oral health status. Current documentation shows that poor oral health remains a public health threat in this population despite efforts such as school-based sealant programs and increased dental insurance coverage. This study followed a quantitative design and 99 participants were polled using a survey specifically developed for this study's …

Development Of An Online Resource Manual And Online Protocol To Facilitate Care Coordination, Leonore Bingham

Walden Dissertations and Doctoral Studies

Persons with disabilities tend to be in poorer health compared to those without disabilities, and timely coordination of care is essential for maintaining optimal health and wellness. The problem addressed in the Care Coordination Referral Project was the lack of timely access to health care and preventive care services for clients with disabilities in the organization for which this project was developed. Using the appraisal of guidelines research and evaluation II model, the purpose of this DNP project was to analyze and synthesize the evidence-based literature to support the project and develop an online health care resource manual and protocol. …

The Lived Experiences Of Military Spouses Who Choose To Live Separately, Cortenia Lashea Just-Bourgeois

Walden Dissertations and Doctoral Studies

This qualitative study was designed and conducted to hear the voices of military spouses who chose to live separately from the active duty spouse. The study also sought to identify potential risks due to the separation and protective factors that were used to positively cope with separation. Previous studies have examined risk factors for military spouses as a result of military induced separation such as deployment. However, no study has been conducted regarding separation by choice of the military spouse and active duty service member. The theory of resiliency provided an understanding of the presence of protective factors and resiliency. …

Hemoglobin A1c And The Development Of Heart Disease In African American Men, Heather Walzel

Walden Dissertations and Doctoral Studies

Several studies have been conducted that link poor control of hemoglobin A1c (HbA1c) to an increased risk of heart disease. However, there are limited published studies that link HbA1c and heart disease based on ethnicity and gender. To address this gap in literature, the purpose of this study was to assess the association between HbA1c and heart disease in African American males (aged 30-64 years old) while controlling for education, income, and access to care. The research questions were focused on establishing an association between HbA1c values and heart disease in African American men through the lens of the health …

Physical Activity, Healthcare Use, And Medication Use In Diabetes Patients, Julie Kwon Evans

Walden Dissertations and Doctoral Studies

Physical Activity, Healthcare Use, and Medication Use in Diabetes Patients

by

Julie Kwon Evans

MS, The Chicago School of Professional Psychology, 2013

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Psychology

Walden University

November 2019

Compassion Fatigue In Registered Dietitians Who Treat Patients With Eating Disorders, Caryn Alyce Honig

Walden Dissertations and Doctoral Studies

Registered dietitians who treat patients with eating disorders may be at risk for developing compassion fatigue due to exposure to patients' chronic complications. Dietetic courses and programs do not comprise coping and resilience training, therefore, dietitians who work with these patients may need additional education. The purpose of this basic qualitative research study was to investigate the perceptions of practicing registered dietitians and dietetic educators on the risk of compassion fatigue, investigate ways to manage and prevent the development of compassion fatigue, and explore the possible need for professional education. Knowles's theory of andragogy provided the conceptual framework as perceptions …

Strategies For Nursing Staff Working In A Correctional Facility., Ima James

Walden Dissertations and Doctoral Studies

As primary care providers in correctional facilities, correctional nurses are expected to balance inmates' healthcare needs with the security demands of the facility. This project explored whether an evidence-based education program could provide strategies for promoting health, a healthy work environment, and a sense of well-being to improve the knowledge, coping skills, and well-being of nurses working in a correctional occupational setting. Twenty nurses participated in an educational intervention project that was guided by the transactional theory of stress. Using a pretest/posttest design, data were collected over a 2-week period and calculated using means and percentages. The descriptive statistics using …

Advanced Practice Nursing In Nigerian Healthcare: Prospects And Challenges, Raymond O. Chimezie, Sally N. Ibe

Journal of Sustainable Social Change

This study explored the prospects and challenges of introducing advanced practice nursing (APN) in the Nigerian health system. It sought to address the following: career pathways for registered nurses and midwives, advanced duties performed by them and the circumstances, their views and willingness for autonomous practice, and doctors’ degree of acceptance. Research population composed of registered nurses, midwives and medical doctors in primary healthcare. The conceptual framework for this study was based on the scope of practice, standards and competencies of the APN established by the International Council of Nurses (2008). A 12-item checklist of typical duties of APN from …

Awareness, Stress, And Income As Contributors In Medicare Part B Late Enrollment, Bishnu Hari Dhaurali

Walden Dissertations and Doctoral Studies

Medicare Part B is one of the federal health insurance programs available to senior citizens in the United States. Unlike Medicare Part A, Part B enrollment is not automatic, and those missing their initial enrollment period are assessed a 10% or more penalty in addition to their monthly premium rate for the rest of their lives. This problematic enrollment policy has impacted senior citizens who have missed Part B enrollment windows, creating for them an added financial burden when many are transitioning to fixed incomes. Guided by social construction theory and using a nonprobability, convenience sampling approach, the likelihood coefficient …

An Analysis Of Employee Motivation After Metamorphose, Conglomerated Public Health Care Systems, Aleta Marie Lymon

Walden Dissertations and Doctoral Studies

A global epidemic of metamorphosed, conglomerated health care systems changed the face of public health care organizations. The problem is, public health care organizations merge into new systems, but the culture for each merged organization has not been formed under the new system. Public administrators, health care workers and the Department of Health and Human Services are affected when there are issues in health care behavioral practices and performance outcomes. Research found that employee motivation is hard to achieve when there are issues within the internal structure of a new system. Using Herzberg's motivation-hygiene and Tajfel and Turner's social identity …

Cultural Competence Of Public Health Nurses Who Care For Diverse Populations, Althea Michelle Otuata

Walden Dissertations and Doctoral Studies

Despite advances in health, science, and technology, U.S. healthcare lags in providing access to care and quality care to racial and ethnic minorities. Cultural competence has been noted as a strategy to improve access and quality. The purpose of this project was to assess public health nurses' cultural competence before and after participating in cultural competence informational modules. Two conceptual models were used in this project for theoretical guidance: Leininger's cultural care diversity and universality theory and Campinha-Bacote's process of cultural competence. To assess the nurses' cultural competence, the Cultural Competence Self-Assessment Checklist questionnaire was e-mailed to 57 public health …