Medicine and Health Sciences Commons^™

How Heroin-Addicted Offenders Experience Sobriety Upon Release From Jail, Rebecca Lynn Foster

Walden Dissertations and Doctoral Studies

Heroin addiction is a growing epidemic in the United States. The need for proper treatment programs accessible by heroin users who wish to or are mandated to participate in recovery programs is a growing need, and pathways to sobriety for ex-offenders have presented in literature as understudied. The purpose of this study was to examine heroin-addicted offenders' experiences prior to and after release on their paths to sobriety. This study followed a qualitative phenomenological approach based on the theory of personal causation, which posits that individuals see events in life as either driven by themselves or caused by others, both …

Relationship Between Health Care Costs And Type Of Insurance, Macey Buker

Walden Dissertations and Doctoral Studies

Continued escalation in health care expenditures in the United States has led to an unsustainable model that consumes almost 20% of GDP. Policymakers have recognized the need for industry reform and have taken action through the passage of the Affordable Care Act (ACA). The purpose of this quantitative, longitudinal study was to examine the relationship between the type of health insurance and health care costs. Mechanism theory and game theory provided the theoretical framework. The analysis of secondary data from the Healthcare Cost and Utilization Project included a sample of 1,956,790-inpatient hospital stays from 2007 to 2014. Results of one-way …

Effects Of Lifestyle Changes On The Health Of African Americans With Type 2 Diabetes, Charles Duro

Walden Dissertations and Doctoral Studies

African Americans are adversely affected by Type 2 diabetes at a greater rate than their European American counterparts; however, research on the effects of Type 2 diabetes on African Americans is limited. Lifestyle modifications that include the incorporation of physical activity and dietary changes can help patients with Type 2 diabetes better manage their disease and improve their overall quality of health. The purpose of this phenomenological study was to explore the experiences of African Americans with Type 2 diabetes who incorporated these self-management behaviors, discerning if they had improved health and quality of life. The self-efficacy framework was applied …

Primary Care Nurse Practitioners And Organizational Culture, Leanne Christine Rowand

Walden Dissertations and Doctoral Studies

Nurse practitioners (NPs) were introduced to the British Columbia healthcare system 12 years ago. Integration challenges related to infrastructure and relationships between administrators and physicians continue. The purpose of this project was to understand how nurse practitioners, working in primary care roles, experience the organizational climate within their healthcare agency. Kanter's empowerment theory guided this project. Data were collected using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. A total of 64 NPs relayed their degree of perceived organizational support. NPs scored highest on Autonomy and Independent Practice (Mean [M] = 3.54, Standard Deviation [SD] = 0.59). Organizational Support and …

Barriers To Preventive Healthcare For Immigrants In Michigan, Sondos Ghazi Al-Hachim

Walden Dissertations and Doctoral Studies

The Affordable Care Act expanded insurance coverage to the general population; however, expanding insurance coverage to immigrants might not be sufficient to improve utilization of annual physical preventive exams. This study evaluated adult Michigan immigrants' individual demographics, perceptions, and behaviors, as well as the collective cultural and system characteristics that might act as barriers to the utilization of annual physical preventive exams. Ken Wilber's integral operating system model for medicine conceptual framework was used to create a comprehensive map of factors and bring more clarity and understanding to the barriers to annual physical preventive exam. The quantitative survey was the …

Managerial Strategies For Improving Employee Engagement: A Single Case Study, Ann-Marie Alcala

Walden Dissertations and Doctoral Studies

In 2013, 1% of Medicare reimbursements were withheld from U.S. hospitals, with a

proposed cap of 2% in 2017 for redistribution to those hospitals that improve overall care and patient satisfaction. The purpose of this single case study was to explore the engagement strategies that some hospital middle managers used to improve employee performance to increase patient satisfaction. The sample included 4 health care middle managers in 1 hospital in northeast Connecticut. The conceptual framework that grounded this study was Kahn's personal engagement theory. Data were collected via semistructured interviews, participant observations, and review of hospital and public government documents. …

Chronic Kidney Disease Awareness And Quality Of Care In Abuja Nigeria, Patience Eze

Walden Dissertations and Doctoral Studies

Chronic kidney disease (CKD) is a non-communicable progressive disease that can lead to kidney failure or end-stage renal disease. In Nigeria, many people do not have access to health care due to extreme poverty, which means that those suffering from diabetes or high blood pressure, or both diseases, which have been identified as the 2 main risk factors, may not know their health status. The purpose of this phenomenological study was to explore the level of CKD awareness among Nigerians and if cultural beliefs affect individuals' health seeking behaviors because of the diverse nature of the Nigerian population. The protection …

Nurse Practitioner Navigator Policy And Procedure Protocols In Private Practice, Wendy Grose

Walden Dissertations and Doctoral Studies

In 2010, the Patient Protection and Affordable Healthcare Act (PPACA) implemented changes to reduce healthcare spending that incorporated Centers for Medicare and Medicaid (CMS) incentive programs to reduce 30-day readmission rates in seniors with heart failure. This project includes a policy and procedure for private practice using a nurse practitioner navigator (NPN) led multidisciplinary team (MDT) for the patient-centered medical home (PCMH) to improve communication between hospitals and PCMH to decrease readmission rates in seniors with heart failure (HF). This practice change will provide an implementation and evaluation plan along with plans for future expansion. Meetings were held twice weekly …

The Barriers And Quality Of Care Issues For Individuals Diagnosed With 22q11.2 Deletion Syndrome, Barbara Bavette Miller

Walden Dissertations and Doctoral Studies

Individuals diagnosed with 22q11.2 deletion syndrome (22q) have many barriers and quality of life issues associated with the condition. Without an obvious anomaly, affected individuals may live years without a proper diagnosis. The purpose of this qualitative case study research was to explore perceptions of caregivers of individuals with 22q. Uncertainty in illness theory was used as it describes the inability to find answers with unpredictable medical issues. The central research question focused on at how challenges associated with a 22q diagnosis are addressed. Interviews were conducted with 10 caregivers. Guided by the uncertainty in illness theory, data analysis was …

Leadership Development For The Formal Nurse Leader, Lori Neu

Walden Dissertations and Doctoral Studies

Nurse leaders are essential to the advancement of healthcare because of their ability to bridge the gap of knowledge between clinical practice and the business of healthcare. Developing nurse managers is imperative to the future of nursing given their influential role in healthcare. The central topic of exploration in the project was how nurse managers use the American Organization of Nurse Executives (AONE) Nurse Manger Inventory Tool to assess their management skills after exposure to the leadership development program currently available to them. In this project, the novice to expert theory was used to evaluate the existing leadership development program …

Initial Findings Of A Medicare Annual Wellness Visit Program, Hesper B. Nowatzki

Walden Dissertations and Doctoral Studies

Despite the emphasis of benefits on preventive health, many older adults are not receiving the recommended age specific, evidence based screenings and vaccinations. The Medicare Annual Wellness Visit (AWV) is designed to address modifiable risk factors with aging adults and close gaps in care not captured in routine office visits. Although a free Medicare benefit to patients, and a reimbursable service to health care providers, participation in the AWV is low nationwide. The purpose of the project is to introduce an AWV program to a rural health clinic in Northwest Illinois that has a population consisting of over 25% of …

U.S Marine Corps Veterans' Perceptions Of Screening For Posttraumatic Stress Disorder, Tiffany Lawing Schweitzer

Walden Dissertations and Doctoral Studies

Posttraumatic stress disorder (PTSD) is a serious issue for post-deployment United States Marine Corps (USMC) veterans, especially because PTSD can increase the risk of suicide. Marines are screened post-deployment, yet little is known about Marine veterans' perceptions of the PTSD screening process. The purpose of this phenomenological study was to explore USMC male veterans' perceptions of the Post- Deployment Health Reassessment (PDHRA). The social cognitive theory constructs of a triadic relationship among person, environment, and behavior were the framework for understanding this population's perceptions of the PDHRA and potential stigma. Two research questions focused on how people, culture, and behavior …

Restaurant Management Strategies To Comply With Food Safety Regulations, Dr. Carlos Juan Calcador

Walden Dissertations and Doctoral Studies

The recent economic crisis in Puerto Rico has created decreased health department fiscal capabilities, adding more responsibilities to health department officials in charge of restaurant inspections without adding more operational funds, which in turn led to less regulatory capacity. This situation instigated increased food safety regulation violations, and food safety legislation changes, imposing more economic pressure to restaurant owners, which leads to a lack of restaurant sustainability. The purpose of this case study was to explore strategies six business visionaries, smart entrepreneurs, who have positioned themselves as successful restaurateurs, in the restaurant industry in Puerto Rico. They were key factors …

Vicarious Trauma Coping And Self-Care Practices Among Trauma Therapists., Annette Zaccari

Walden Dissertations and Doctoral Studies

Therapists who specialize in trauma therapy are indirectly exposed traumatic events presented by clients within the therapeutic relationship. The potential consequences for trauma therapists may be the risk of vicarious trauma. Effective coping and self-care are essential in the practice of trauma work. The research question for this study is: Do coping skills and self-care practices in trauma therapists moderate the disruptive effect of vicarious trauma on the fulfillment of their psychological needs (trust/dependence and control)? The purpose of this research study was to examine quantitatively, the role of trauma therapists' beliefs in the effectiveness of coping skills and time …

Strategies To Improve Employee Engagement In A U.S. Federal Government Agency, Patrick L. Hyde

Walden Dissertations and Doctoral Studies

Nearly half of all frontline leaders in U.S. federal agencies during 2015 were unprepared to improve employee engagement. The lack of successful strategies to improve employee engagement in federal government agencies has led to decreased operational performance. Guided by the employee engagement theory as the conceptual framework, the single case study design was selected to explore the successful strategies that frontline leaders use to improve employee engagement at a federal agency in central Maryland. Data collection involved face-to-face, semistructured interviews with 4 frontline leaders and federal agency documents indicating employee engagement. The data analysis process included Yin's 5-step method and …

Health System Predictors Of Access To Maternal Health Medicines In Low And Middle Income Countries, Chinonso Esther Nnorom

Walden Dissertations and Doctoral Studies

The strength of health systems predict access to medicines that prevent death from pregnancy related complications (essential maternal health medicines). But little is known about the relative impact of each health system building block on access. This quantitative cross-sectional study applied Ishikawa model to examine the relative effect of health systems governance, facilities, service delivery, financing and medicine procurement and distribution (independent variables), on availability, affordability and accessibility (dependent variables) of maternal health medicines in resource poor settings. Data analyzed was pulled from 37 WHO pharmaceutical country profiles and USAID MCHIP survey that assessed national programs for the prevention and …

Collaborative Strategies Used To Reduce Billing Administrative Cost, Stella Fayomi-Olaleye

Walden Dissertations and Doctoral Studies

Billing inefficiencies represent 80% of wasteful healthcare administrative costs that are projected to reach $45 billion by 2018. Potentially, a reduced billing administrative cost is estimated to yield an annual savings of $60 billion that could fund other societal needs such as jobs, wage increases, and education. Through the conceptual framework of iceberg change management model, this single case study explored collaborative strategies 3 healthcare billing managers in Dallas, Texas successfully used to reduce billing administrative costs. Data were collected through semistructured interviews and the review of company documents. Using Yin's procedure of examining, comparing, categorizing, and coding data, the …

Health Literacy Of Nursing Students And Their Awareness Of Patient Literacy Needs, Jennifer Potter

Walden Dissertations and Doctoral Studies

Research has suggested that providers of health services must be aware of health literacy tools as elements of communication with patients. Poor health literacy is an epidemic that affects quality of care. The purpose of this study was to examine the functional health literacy of associate-degree nursing (ADN) students and their awareness of patients' health literacy needs. This correlational study was designed to examine the relationship between the functional health literacy of ADN students and their awareness of their patients' health literacy needs using the asset model and the health literate care model. A convenience sample of 131 ADN students …

Patients And Nurses Attitudes To Hysterectomy And Postoperative Pain Management, Blessing Agu

Walden Dissertations and Doctoral Studies

Over 500,000 hysterectomies are performed yearly in the United States, and they often result in a moderate to severe amount of pain. Nurses play a significant role in postoperative pain management. However, studies have shown that despite technological advances and nurses' theoretical knowledge of pain, postoperative pain management remains a challenge among healthcare providers. The purpose of this study was to examine how nurses' and patients' attitude towards abdominal hysterectomy can impact postoperative pain management and hospital length of stay after a hysterectomy. Informed by the theory of reasoned action, the study examined the differences in the nurses' and patients' …

Impact Of Emergency Department Patient Flow Model And Triage Level On Patient Wait Times, Joann Lynn Featherstone

Walden Dissertations and Doctoral Studies

Some hospital emergency departments (EDs) are negatively affected by extended patient wait times, resulting in reduced hospital profitability. Therefore, it is critical hospital leaders understand factors impacting ED average patient wait times. Grounded in the business process improvement theoretical framework, the purpose of this causal comparative study was to examine the impact of an ED rapid evaluation unit (REU) patient flow model and emergency severity index (ESI) on average weekly patient wait times. Data collection comprised a census of 26 archival data records pre and postimplementation of an ED REU patient flow model from a hospital ED in Upstate New …

The Relationship Between Technology Threat Avoidance And Innovation In Health Care Organizations, Melvin R. Fenner Jr

Walden Dissertations and Doctoral Studies

Most leaders of healthcare delivery organizations have increased their rate of technological innovation, but some still struggle to keep pace with other industries. The problem addressed in this study was that senior leaders in some rural ambulatory healthcare facilities failed to innovate, even with recent healthcare technological innovations, which could lead to increased medical errors and a loss of efficiency. The purpose of the study was to examine if a relationship exists between the avoidance of technology threats by senior leaders in ambulatory healthcare organizations and the innovation propensity of the organization. Technology threat avoidance theory served as the theoretical …

Health Disparity In Preventive Care Among Nigerian Immigrants In The United States, Loveday E. Nwobilor

Walden Dissertations and Doctoral Studies

The roles of immigration status in preventive health care services among Nigerian immigrants in the United States were investigated in this quantitative, cross-sectional survey study. About 260,724 Nigerian immigrants reside in the Unites States, but many do not complete lifesaving preventive health services such as immunization and screening, a major factor contributing to the rise in the cost of healthcare resultant from their use of emergency room services. This study investigated the extent to which immigration status independently explains the relationship between health disparities and risks in non-completion of preventive health care among Nigerian immigrants in the United States by …

Leadership Strategies For Addressing U.S. Pharmaceutical Drug Shortages And Supply Chain Disruptions, Adrian Grant Scioli

Walden Dissertations and Doctoral Studies

Health care providers in the United States expend more than $400 million in unnecessary direct costs annually managing the effects of widespread drug shortages. Based on the theory of complexity and complex adaptive systems, the purpose of this exploratory multiple case study was to identify the strategies that health care pharmaceutical procurement leaders from the Eastern region of the United States use to address widespread drug shortages. Data were collected from 5 semistructured interviews with pharmaceutical procurement leaders, recorded field notes, and a review of public documents from company websites. Data analysis included deductive and open coding techniques. Emergent themes …

Implementation Of An Early Progressive Mobility Program In The Intensive Care Units, Rene Merced Rodriguez

Walden Dissertations and Doctoral Studies

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk …

Dimensions Of Nurse-Physician Communication, Rachel Malek Hamdan

Walden Dissertations and Doctoral Studies

Hospital leaders set quality and safety as high priorities in their strategic goals. Improving the quality and safety of patient care requires improving internal processes that have direct implications for patient care. Hospital leaders need to improve health care providers' communication as part of improving quality and safety. The problem addressed in this study was the lack of strategies health care administrators use to guide nurse-physician communication patterns in a university medical center in the Middle East. The purpose of this qualitative case study was to explore communication strategies that health care administrators use to guide nurse-physician communication. Relational coordination …

Geospatial Analysis Of Spatial Patterns Of U.S. Hospital Readmission Rates, Yamei Wang

Walden Dissertations and Doctoral Studies

Unplanned hospital readmission after a recent hospitalization is an indication of poor healthcare quality and a waste of healthcare resources. The Centers for Medicare and Medicaid Services (CMS) initiated the Hospital Readmission Reduction Program (HRRP) to improve healthcare quality and reduce costs; however, studies found the risk adjustment method used in calculating the standardized readmission rate was less accurate without hospital region or community factors. Accordingly, this cross-sectional quantitative study was designed to examine spatial patterns in hospital readmission rates following Andersen's behavioral model of health service utilization. This study was the first geospatial analysis on risk standardized hospital readmissions …

Strategies To Overcome The Nursing Shortage, Edward A. Mehdaova

Walden Dissertations and Doctoral Studies

Nursing shortage is a growing problem in the healthcare industry as hospital leaders are experiencing difficulties recruiting and retaining nurses. Guided by the PESTEL framework theory, the purpose of this case study was to explore strategies healthcare leaders use to overcome a nursing shortage. Participants were 5 healthcare leaders who have the knowledge and experience in recruitment and retention of registered nurses in a healthcare facility in Seattle, Washington. Data were collected through audio-recorded semistructured interviews and document review of the Hospital Employee Education and Training Program. Data analysis consisted of documenting the data, organizing and categorizing the data, connecting …

Factors Associated With Provider Utilization Of The Heath Information Exchange In The State Of Hawaii, Kris K. Wilson

Walden Dissertations and Doctoral Studies

In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians' use of a HIE in the U.S. …

Length Of Stay And Reimbursement Rates For Medicare Patients, Wandella Ezell

Walden Dissertations and Doctoral Studies

Medicare reimbursement rates across the United States have varied by as much as 49-130% across healthcare facilities. Geographic adjustments and severity of medical diagnoses attribute to some dissimilarity; however, the source of longer hospitalization and higher re-admission rates among Medicare patients requires financial consistency. The research encompassed (N = 3000) patients with hypertension as the focus for the study because this is a critical group of Medicare patients with a chronic disease that has been identified as a silent killer. The principal goal that drove this research study was to explain the variations in length of stay for Medicare patients …

Identifying Communication Barriers And Trust Issues Of Black Women Seeking Preventive Health Services In Houston, Texas, Melissa E. Shelton

Walden Dissertations and Doctoral Studies

Black women mortality rates are perceived to be impacted by communication barriers, trust issues, and the lack of quality preventive health services. The purpose of this phenomenological study was to explore communication barriers and trust issues perceived by Black women when seeking preventive health services. HMB was used to identify public attitudes around receiving preventive health services and to construct each question based on perceived susceptibility and perceived severity of communication barriers and trust issues. An ecological model of the communication process was used as a framework to identify fundamental relationships between the Black female patients and health care providers. …