Medicine and Health Sciences Commons^™

Diabetes Self-Management Education For Adults With Type 2 Diabetes Mellitus, Rondalyn Dennis-Bradshaw

Walden Dissertations and Doctoral Studies

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and …

The Role Of Religious Vaccination Exemptions In The Ocean County, New Jersey Pertussis Outbreak, Siobhan Bridget Pappas

Walden Dissertations and Doctoral Studies

Pertussis, also known as whooping cough, is a vaccine-preventable disease that is on the rise in the United States, a trend which has been attributed to vaccination exemption. Indeed, the pertussis outbreak that occurred in February, 2012 in Ocean County, New Jersey was associated with vaccine exemption. Considering that pertussis is deadly to young children, it is important to understand why this disease rate is on the rise. The research questions were focused on whether a relationship existed between pertussis status (no, yes) and exemption status (no, yes), sex (male, female), and county type (Middlesex, Ocean, or Other), using a …

Faculty Perspectives On Factors Impacting Work As Nurse Educators, Sharon Shockness

Walden Dissertations and Doctoral Studies

Job dissatisfaction among nursing faculty could have a significant impact on nursing faculty retention and student enrollment in nursing programs. The purpose of this qualitative instrumental case study was to gain insight into the perspectives of faculty members who teach nursing education in a university program. This study used Herzberg, Mausner, and Snyderman's motivation-hygiene theory to explore employee satisfaction and dissatisfaction in the workplace. The research question focused on the perspectives of nursing educators and challenges they face. Data were collected through individualized interviews with 15 nurse educators, using open-ended questions and reviewing relevant documents. The data were analyzed by …

Perceived Factors Contributing To Coronary Heart Disease In African American Women, Funmilola O. Sholanke

Walden Dissertations and Doctoral Studies

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to …

Bedside Nurses' Influence On Patients' Continuum Of Care Through Effective Discharge Teaching, Mary Ann Whicker

Walden Dissertations and Doctoral Studies

The evolution of person-centered healthcare reinforces the need for nursing to provide effective patient education. Literature suggests nurses desire to provide strong discharge education to patients, but are challenged by knowledge gaps and other barriers. This DNP project developed a plan for integrating teach-back on a 30-bed cardiac unit, focusing on heart failure patients. Following a logic model, the process improvement plan to implement teach-back includes education on teach-back, empowerment of unit champions to support the project and evaluation of effectiveness of the education plan and impact on heart failure patients. The sample size of 15 cardiac nurses provides a …

Quantitative Study Of Clostridium Difficile Incidence Related To Influenza And Antimicrobial Use, Eileen M. Yaeger

Walden Dissertations and Doctoral Studies

In the United States, influenza causes approximately 36,000 deaths and over 200,000 hospitalizations each year with elderly most often affected. Clostridium difficile infection (CDI) is another major health care challenge and pressing public health issue associated with 14,000 deaths and over 335,000 hospitalizations annually. The use of antibiotics has been implicated in the development of CDI. This study's purpose was to test the relationship of seasonal influenza incidence and antiviral/antibiotic use in CDI development among hospitalized patients. Grounded in the epidemiologic wheel model of man-environment interactions, this retrospective observational study described and analyzed data from a proprietary, laboratory, and pharmacy-based …

A Comparison Of Regional Health Care Structures For Emergency Preparedness, Leslie Porth

Walden Dissertations and Doctoral Studies

Since 2001, increased policy attention and federal funding mechanisms have required more effective disaster response by government actors and private sector organizations, including the health care system. However, there is limited scholarly evidence documenting which structural elements have been associated with efficacious regional coalitions. This study addressed the gap by examining whether the number of different participating disciplines (a proxy for coalition roles), community setting, and prior weather-related disaster declaration influenced the number of activities (a proxy for coalition responsibilities) conducted by the health care coalition. Social network theory was the theoretical lens with which the study results were used …

Increasing Knowledge About Alpha-1 Antitrypsin Deficiency In The Chronic Obstructive Pulmonary Disease Population, Maureen Ann Wentink Barta

Walden Dissertations and Doctoral Studies

The purpose of the project was to increase awareness about alpha-1 antitrypsin deficiency (AATD) in chronic obstructive pulmonary disease (COPD), particularly among those with a familial history of genetic factor AATD; an additional goal was to understand its relationship to COPD. COPD is the third leading cause of death in the United States, with more than half of COPD patients experiencing significant disabilities. Major causes for COPD include smoking, air pollution, secondary smoke, upper respiratory infections, hereditary factors, occupational factors, environmental factors, and socioeconomic factors. Genetic factors, however, also play a significant role in early onset COPD and in those …

Cultural Competence In Certified Registered Nurse Anesthetists, Martina Renee Steed

Walden Dissertations and Doctoral Studies

For several decades, the field of nursing has focused on the integration of cultural competence content into its prelicensure educational programs. Despite this focus, little is known about the cultural competence of nurses extending their education past initial licensure into an advanced practice nursing specialty, such as nurse anesthesia. Researchers in other fields have found that provider race and previous cultural competence training are associated with higher levels of cultural competence. This research, guided by the culture care diversity and universality theory, sought to determine the relationship between the two subscales, Cultural Awareness and Sensitivity (CAS) and the Cultural Competence …

Counselor Supervisors' Perceptions Of Tertiary Trauma, Eric David Jett

Walden Dissertations and Doctoral Studies

Vicarious trauma impacts counselors in various ways: by diminishing their feelings of importance in the profession, hindering their completion of adequate work with clients, and negatively affecting their personal life choices. Although numerous qualitative and quantitative studies have been conducted on vicarious trauma over the past 20 years, there is a rarity of research investigating the implications of trauma for counseling supervisors. The purpose of this study was to examine the lived experiences and perceptions of tertiary trauma among 11 counselor supervisors from Oklahoma and Missouri who were providing active supervision. This study was approached through a hermeneutic phenomenological methodology. …

Adult Attachment And Relationship Satisfaction Among Men Who Experienced Childhood Abuse, Selisha Nelson

Walden Dissertations and Doctoral Studies

Experiences of childhood physical and sexual abuse among men have not been sufficiently studied because many men are not forthcoming about experiences of abuse. This abuse is linked to aggressive behaviors, difficulty developing and maintaining close relationships, and various psychological disorders. Current research has not fully examined relationships between childhood abuse, adult attachment, and levels of relationship satisfaction among men. The purpose of this nonexperimental quantitative study was to evaluate the relationship between adult attachment as measured by the Relationship Scales Questionnaire and relationship satisfaction as measured by the Couples Satisfaction Index among men abused during childhood. Bowlby's theory of …

Relationship Between Modality And The Degree Of Knowledge Retention In Bioterrorism Training, Gaylon Rashun Crawford

Walden Dissertations and Doctoral Studies

A public health workforce must be trained to react quickly, especially in the case of terrorist attack. Political leaders and emergency management experts have often cited inadequate emergency training as a contributing factor in the public health system's failed preparations for a bioterrorist event. As a result of these failures, billions of dollars have been allocated towards correcting infrastructure deficiencies including training for public health nurses (PHNs), who are critical to a communitywide medical response. This quantitative study used Pearson's correlation and a multivariate regression analysis to evaluate the most effective modality of bioterrorism training (BTT) for PHNs working in …

Completion Of Preventive Health Care Actions By Older Women With Hiv/Aids, Patricia Kay Correll

Walden Dissertations and Doctoral Studies

The widespread use of highly active antiretroviral therapy (HAART) has resulted in longer lifespans for HIV seropositive women in the United States, during which preventive health care is recommended. Failing to complete recommended cancer screening tests can result in cancer being diagnosed at a later stage with a poorer prognosis. The purpose of the study, based on the ecosocial theory, was to describe the sociodemographic and clinical variables of HIV seropositive women who failed to complete recommended screening tests for breast, cervical, and colorectal cancers, and determine if the presence of hypertension, obesity, diabetes, depression, or tobacco use impacted the …

An Outcome Evaluation Of An Evidenced-Based Leadership Framework On Nursing Retention In A Tertiary Medical Center, Robbie Gail Robbie

Walden Dissertations and Doctoral Studies

An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 …

Strategies To Prevent The Unintentional Retention Of Foreign Objects In Surgical Patients, Leonard Harichand Ramdas

Walden Dissertations and Doctoral Studies

The Institute of Medicine's report in 2000, To Err Is Human: Building a Safer Health

System, highlighted the seriousness of medical errors in the U.S. health care system. The unintentional retention of foreign objects in surgical patients is one of those errors. At the time of this study, there was no standardized counting policy and process across operating rooms in the United States. The purpose of this project was to develop a best practice educational counting program to help prevent the unintentional retention of foreign objects in surgical patients. The Logic Model was used to guide the design of the …

The Effect Of A Drama On Young Adults' Attitudes About Domestic Violence, Regina Watson

Walden Dissertations and Doctoral Studies

Intimate partner abuse has been and remains a pervasive problem that has been documented in every race, religion, class, and level of education. This study presented the rationale for achieving positive social change by examining the problem through prevention rather than reaction and intervention. Although many theories of causation have been presented at various times, none has been proven or offers a complete explanation. Social ecological theory examines the interaction of individual, community, relational, and societal influences on the development of attitudes and behavior acceptance. This pre and post-survey group, quasi-experimental study examined the effects of an intervention on attitudes …

A Community Health Program To Reduce Cardiovascular Risk In Women, Xander Bacchus

Walden Dissertations and Doctoral Studies

Cardiovascular disease (CVD) is the leading cause of death among United States women. Regular aerobic exercise can significantly reduce CVD risk. This dissertation reflects one of the first studies of the efficacy of Community Health Programs (CHP) in promoting exercise among American women aged 25 to 65. Primary data used from a study involved a sample of 42 women aged 25 to 65 who attended a CVD and exercise-related CHP, while a 42-member control group merely received the CHP information in a printed form. A pretest was administered at the outset of the study, and a posttest was administered at …

Evaluation Of Post-Deployment Ptsd Screening Of Marines Returning From A Combat Deployment, Erika L. Hall

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to examine whether the post-deployment screening instrument currently utilized to assess active-duty Marines for symptoms of PTSD upon their return from a combat deployment can be solely relied upon to accurately assess for PTSD. Additionally, this study sought to compare the number of Marines who have sought trauma-related mental health treatment based on their answers on the Post-Deployment Health Assessment (PDHA) to the number who have sought trauma-related mental health treatment based on their answers on their PTSD Checklist - Military Version (PCL-M). The participants in this study were comprised of a sample …

Understanding Health Literacy Skills Of Patients With Cardiovascular Disease And Diabetes, Patrick J. Dunn

Walden Dissertations and Doctoral Studies

Health literacy is the ability to understand and act on health information and is linked to health outcomes. It is unclear how health literacy skills are developed in patients with complex conditions, such as cardiovascular disease and diabetes. The purpose of this grounded theory study was to gain perspectives of both patients and healthcare professionals on how health literacy skills were developed in patients with cardiovascular disease or diabetes. The research questions addressed how knowledge and skills were acquired, the role of digital tools, instructional strategies used by healthcare professionals, and how the instructional strategies of the healthcare professionals matched …

Ranking Small Business Resistance Criteria Toward The Affordable Care Act, Rakesh M K Gupta

Walden Dissertations and Doctoral Studies

Following the enactment of the Affordable Care Act (ACA) in 2010, politicians, media, and lobbyists rendered a number of conflicting and confusing interpretations of its merits and demerits. Such interpretations intensified the skepticism and concerns of small business enterprise (SBE) owners. The purpose of this study was to develop a representative, prioritized list of SBE owners' concerns or resistance factors. The goal was to create a useful guide for SBE owners who are seeking ways to reducing the adverse financial impact of the law. With social choice theory as the theoretical framework, 50 randomly selected SBE owners across 5 distinct …

Evaluation Of A Mobile Health Intervention To Improve Anti-Retroviral Treatment Retention In South Africa, Ambereen Jaffer

Walden Dissertations and Doctoral Studies

South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates …

Health Care Administration Faculty Perceptions On Competency Education, Graduate Preparedness, And Employer Competency Expectations, Wittney A. Jones

Walden Dissertations and Doctoral Studies

Health care administration programs have transitioned to using the competency approach to better prepare graduates for workplace success. The responsibility of preparing graduates lies with the program faculty, yet little is known about faculty perceptions of the competency approach. The purpose of this cross-sectional study was to assess the perceptions of graduate-level health care administration faculty about the competency approach, the approach's effect on graduate preparedness, and employer expectations. Adult learning theory and the theory of self-efficacy were used as the theoretical foundations for the study. Faculty demographics related to personal information, workplace/teaching experience, and program information served as the …

Facilitating Weight Tolerance Among Health And Fitness Majors Toward Obese Persons, Stephanie Boss

Walden Dissertations and Doctoral Studies

Weight bias exists in some health-related degree programs. Overweight and obese persons who experience weight bias in health-related services often delay or avoid medical attention altogether. Guided by the attribution theory, the purpose of this sequential explanatory study was to examine weight bias among health majors at a southwest regional university to illuminate how attitudes can affect the level of care provided to overweight persons. The Attitudes toward Obese Persons (ATOP) scores from a convenience sample of 184 health majors revealed that participants' scores were found to be significantly lower than the midpoint (60) of the ATOP scale, M = …

Nitrate In Private Wells:Knowledge, Oppinions,And Perceptions Of Stakeholders, Augustus D. Jaja

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to examine data describing nitrate concentration and cases of congenital cardiac defects. Residents with private wells and other stakeholders need data to make informed environmental decisions about the adverse health implications of nitrate contamination of private well water. Researchers have examined the exposure of nitrate in contaminated groundwater, but they have not examined nitrate levels in unregulated water systems. This gap in the literature highlighted the need to provide nitrate data for future research and private well users. Guided by the social ecological model, a quantitative, cross-sectional, nonexperimental design was used to survey …

Uric Acid Level Is Associated With Postprandial Lipemic Response To A High Saturated Fat Meal, Roy Gail Cutler

Walden Dissertations and Doctoral Studies

Hyperlipidemia caused by a diet high in saturated fat can lead to visceral fat weight gain, obesity, and metabolic syndrome. Being over-weight from visceral fat has been linked to increased risk of developing most age-related diseases and disability, along with a lower income potential and quality of life. However, researchers are just beginning to understand the biological mechanisms that regulate the conversion of excess calories into visceral fat storage rather than glycogen or muscle. Epidemiological studies have repeatedly shown a comorbid association between age-related diseases involving hyperlipemia and circulating levels of uric acid, but not a direct association. This study …

Psycho-Social Resilience And Risky Hiv Behaviors Among Black Males Who Have Sex With Males, Wilson Osaro Iyokho

Walden Dissertations and Doctoral Studies

The incidence rate of HIV among Black males having sex with Black males (BMSM) is high compared to that of other racial groups. Researchers have established the association between inappropriate sexual practices, age, income, and environmental determinants and HIV positive status among BMSM. Guided by resilience theory, the purpose of this study was to examine the relationship between HIV risk behavior and resiliency with the goal of identifying a new intervention to mitigate the HIV infection rate in the BMSM community. The theoretical framework used for this study was the resilience theory. This theory is concern with the phenomenon of …

Correlations Between Childhood Obesity And Obesogenic Environmental Variables Within Durham County, North Carolina, Eureka Capri Daye

Walden Dissertations and Doctoral Studies

The application of geographic information systems was used to map obesogenic conditions by zip code tabulation areas in Durham County, North Carolina and evaluated associations between those conditions and the understudied area of early childhood obesity. Of the thirty one percent of the children in Durham County, North Carolina who were considered obese in 2010, four hundred and thirty three (1:5) 2 - 4 year old children who received supplemental nutrition services for women, infants and children were obese with BMI levels greater or equal to the 95th percentile and were used as the criterion variable in the study (N=433). …

The Effect Of An Online Coping Skill Application On Relapsing-Remitting Multiple Sclerosis Sufferers, Jennifer H. Garrison

Walden Dissertations and Doctoral Studies

Many individuals with multiple sclerosis (MS) are classified as having relapsing-remitting MS (RRMS), a form of the illness that requires constant symptom management for suffers to achieve optimum outcomes. There are only a few community-based educational programs that exist to help RRMS sufferers cope with their illness; the effectiveness of those that have been fielded has not yet been adequately assessed. The research questions of this study were to determine if an online training development module would increase the coping skills of those affected by RRMS and if the online educational module would be more effective at improving the coping …

Prehospital Staffing And Road Traffic Accidents: Physician Versus Trained Nonphysician Responders, Timothy A. Grant

Walden Dissertations and Doctoral Studies

Road traffic deaths, which affect people in their productive years, are projected to be the third leading cause of death by the year 2030. While most studies have focused on road infrastructure and vehicle safety, this study examined something new: the impact of prehospital response to road traffic accidents on the rate of death. Some countries send physicians to the scene of an accident; some send paramedics or registered nurses. The question this research sought to answer was whether the use of physician responders resulted in a lower rate of death compared to the use of nonphysician responders. The literature …

Centering Pregnancy Implementation And Its Effect On Preterm Birth And Low Birthweight, Carole Ann Moleti

Walden Dissertations and Doctoral Studies

Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancy^TM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancy^TM program implementation plan, customized to meet the needs of a multisite urban hospital system, …