Medicine and Health Sciences Commons^™

"Evaluation Of Medication Adherence Through The Use Of Home Assisted Telemanagement", Kingsley Ezihe Ngameduru

Walden Dissertations and Doctoral Studies

Medication nonadherence can have serious consequences for patient outcomes. Home-automated telemanagement systems have supported increased levels of adherence among patients. This project explored whether the use of a home telemanagement program (HTM) would improve medication adherence in clinic patients diagnosed with hypertension (HTN). The health belief model, social learning theory, the self-regulation model and the theory of reasoned action guided this project. Providers in a primary care clinic completed the 4-question Morisky, Green, and Levine adherence scale with 50 HTN patients previously enrolled in a HTM. Survey results revealed that after 2 years in the program, patients were still forgetting …

Interprofessional Intentional Empathy Centered Care (Ip-Iecc) In Healthcare Practice, Deepy Sur

Walden Dissertations and Doctoral Studies

Training interprofessional healthcare teams continues to advance practice for patient-centered care. Empathy research is also advancing and has been explored in social work, psychology, and other healthcare areas. In the absence of understanding empathy in an interprofessional setting, educators are limited in preparing teams to develop empathy as part of core competencies This grounded theory study explored for a theory of how interprofessional healthcare teams conceptualize and operationalize empathy in their practice. Azjen's theory of planned behavior and Barrett-Lennard's cyclical model of empathy framed the study. Data were collected using 6 focus groups and 24 semistructured interviews of varied healthcare …

Associations Between Income, Acculturation, Country Of Origin, And Type Ii Diabetes Among African Immigrants To Ontario, Canada, Girma Aman Goshe

Walden Dissertations and Doctoral Studies

Diabetes has become a longstanding public health challenge around the world. Over the last 3 decades, the number of people with Type II diabetes (T2DM) has grown to an epidemic level in Canada. Prior research indicated African immigrants residing in Ontario, Canada experienced a 2-4 times higher prevalence of T2DM than Canadian-born individuals. The social determinants of health theoretical framework guided this study assessing the relationship of the risk factors with T2DM. A quantitative, cross-sectional design was employed using the 2007-2014 Canadian Community Health Survey data. The random sample included 1,526 African immigrants residing in Ontario, Canada. Descriptive, bivariate, and …

A Phenomenological Study Of Lived Experiences Of Transport Nurses Experiencing Patient Death, Joshua B. Wall

Walden Dissertations and Doctoral Studies

Experiencing a patient death can directly affect the well-being of health care professionals; however, this phenomenon and the effects of patients' deaths are not well understood in the transport setting. Transport nurses work in unique settings with complex patients and significant autonomy in determining the plan of care; therefore, the experiences of other health care professionals may not be applicable in this environment. The purpose of this qualitative study was to explore the lived experiences of transport nurses who have experienced patient death using Husserl's life-world and phenomenological philosophies as a theoretical framework. Semistructured interviews were completed with 8 transport …

Perceptions Of Fear Of Falling In Older Adults, Ken Germano

Walden Dissertations and Doctoral Studies

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence …

Community Health Worker's Perceptions Of Integration Into The Behavioral Health Care System, Juliette Swanston Jenkins

Walden Dissertations and Doctoral Studies

Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence …

The Influence Of Food Insecurity, Low-Income, And Race On Diabetes Self-Management Practices Among Women With Diabetes, Jill La Capria

Walden Dissertations and Doctoral Studies

Diabetes is a chronic condition affecting more than 30 million adults living in the United States. Diabetes self-management (DSM) can prevent or delay the complications of diabetes and improve clinical outcomes; however, data show that low-income, food insecurity, female gender, and race contribute to challenges performing effective DSM. The health belief model was the theoretical framework for this cross-sectional study, which examined how food insecurity, low-income, and race affect DSM activities in women with diabetes. The sample population from the 2017 Behavioral Risk Factor Surveillance System survey consisted of 1,842 women with diabetes who were 18 years of age or …

Advanced-Beginner Registered Nurses' Perceptions On Growth From Entry Level, Brenda Mason

Walden Dissertations and Doctoral Studies

Many entry-level nurses are not prepared to handle medical emergencies. Although responsible for managing the care of individuals with complex medical conditions, many of these nurses compromise the safety of patients due to a lack of experience and an inability to apply clinical judgment. The purpose of this study was to explore the perceptions of registered nurses about their transition from entry-level to advanced beginner. Bandura's social cognitive theory, along with Colaizzi's descriptive method of data analysis, provided a basis for this phenomenological study. Research questions focused on challenges that entry-level nurses have experienced with problem-solving and complex patient care …

A Quality Improvement Evaluation Of Patient Experience Through The Enhanced Recovery Program, Sarah Orozco

Walden Dissertations and Doctoral Studies

The purpose of this project was to evaluate the effectiveness of adopting clinical care bundles for the enhanced recovery program (ERP) at the project site. The practice-focused questions explored whether care bundles from the enhanced recovery program (ERP) would achieve positive postoperative patient care experiences when compared to the traditional surgical care pathways. The concepts, models, method, and theories used for this project include the Iowa model, the plan-do-study-act model, lean methodology, Donabedian's framework, and Watson's theory of caring. The sources of evidence included the facility site analysis report to evaluate surgical inpatient complications, morbidity, and mortality rates. Over 100 …

Demographic, Behavioral, And Cultural Factors On Chlamydia Trachomatis Infection, Philis Grace Palmer

Walden Dissertations and Doctoral Studies

Chlamydia trachomatis is a sexually transmitted disease, and its incidence has been increasing in recent years in the U.S. population. Certain demographic factors have been identified as posing an increased risk to acquire this disease. The purpose of this mixed-methods research was to examine how population demographics (quantitative section) and cultural and behavioral factors (qualitative section) affect risk for contracting chlamydia trachomatis in the Miami-Dade, Florida area. The theory of reasoned behavior was the theoretical framework of the study. The quantitative component used secondary data from Jackson Health System (2012- 2018) pertaining to 333 Miami-Dade young adult individuals with incidents …

Noise Pollution/Reduction Education For Frontline Staff In The Acute Care Setting, Lopa Patel

Walden Dissertations and Doctoral Studies

Noise levels in hospital settings have risen beyond the recommended range of 35-40 decibels, resulting in poor patient healing outcomes and other health conditions ranging from sleep deprivation, anxiety, agitation, delirium, depression, and high heart rate and blood pressure. These negative patient health experiences are evidenced by poor scores for the Hospital Consumer Assessment of Healthcare Providers and Systems, which are indicators of patients' perceptions of care. This project explored whether an educational activity for 48 direct care staff, who include registered nurses and nursing assistants, in a cardiac unit on the impact of noise pollution on patient healing would …

The Effects Of Sexual Education On Sexual Behaviors Of Adolescents In Rural Jamaica, Deborah Simmonds

Walden Dissertations and Doctoral Studies

Adolescent pregnancy and the sexual behaviors of adolescents continue to be robust public health and social problems in Caribbean countries such as Jamaica. Numerous researchers have conducted studies on the impact of sex education on sexual behaviors and pregnancy patterns among adolescents with mixed results (i.e., a lack of knowledge) especially in rural communities. The purpose of this study was to ascertain the impact of school- or home-based sex education on sexual behavior and pregnancy patterns of adolescents aged 15 —19 years in the rural community of St. Thomas, Jamaica. The parental expansion of the theory of planned behavior and …

Reducing Door-To-Provider Times By Using Nurse Practitioners In Triage, Megan Lynnell Anderson

Walden Dissertations and Doctoral Studies

Increased patient wait times it the emergency department (ED) have been linked to poor patient outcomes and adverse health care events. The purpose of this quality improvement project was to determine if placing a nurse practitioner (NP) in the triage area would reduce door-to-provider times and improve patient throughput within the ED. The primary question for this quality improvement project was whether the use of NPs in the triage area would improve patient throughput and decrease wait times in the ED. A secondary question identified was if implementing an NP in the triage area would decrease patient length of stay …

Perceptions Of Access To Healthcare In Cameroon By Women Of Childbearing Age, Wenceslaw Chap Chapnkem

Walden Dissertations and Doctoral Studies

Increased poverty and unemployment rates, minimal investment in social amenities, a shortage of healthcare professionals, poor infrastructure, inadequate social services, and poor institutional and political leadership have weakened the healthcare status of Cameroon's women who have reached the age of childbearing. The World Health Organization expressed increased urgency for healthcare providers and patients to develop new healthcare policies to eliminate health-related disparities. The aim of this phenomenological study was to examine the perceptions of women of childbearing age living in Mamfe rural community in regard to Cameroon's healthcare system and its impact on their lives. The theoretical foundation of the …

Implementation Of A Transcultural Nursing Education Program To Improve Nurses' Cultural Competence, Ann Marie Elizabeth Edwards

Walden Dissertations and Doctoral Studies

The exponential growth of culturally diverse populations in the United States has led to a multicultural patient population while the nursing workforce remains predominantly White. At the project site, managers identified that staff nurses struggled to deliver culturally competent care. The purpose of this project was to improve the cultural competence of registered nurses (RNs) through a transcultural nursing education program. Leininger's transcultural nursing theory guided the project. Sources of evidence used to develop a face-to-face educational program included peer-reviewed journals, credible websites, and the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-R tool. Aggregate pretest and …

Evidenced-Based Staff Education Program For Novice Perioperative Nurses, Marjorie Jasinski

Walden Dissertations and Doctoral Studies

Knowledge of surgical procedures, instruments, and supplies is essential to the perioperative nurse working in the operating room (OR). Nursing school curricula do not specifically educate surgical nurses; therefore, it is difficult to fill open OR positions with experienced perioperative nurses. The purpose of this doctoral project was to develop a perioperative educational program for RNs newly hired in the OR. The practice-focused question asked whether an evidence-based staff education program for the novice perioperative nurse would increase the nurse's knowledge of OR procedures and protocols for patient management. The novice-to-expert framework was used to explore how adult learners acquire …

Acuity-Based Nurse Staffing And The Impact On Patient Outcomes, Sara Kollman

Walden Dissertations and Doctoral Studies

The costs of healthcare in the United States are of national concern. The systematic review of the literature (SRL) explored the practice-focused nursing question regarding the relationship between the use of acuity-based staffing (ABS) models and positive patient outcomes. Analyzing the impact of ABS models on patient quality outcomes and the potential economic value could provide evidence essential for the healthcare executives responsible for fiscally prudent labor management and for creating an evidence-based business case for adequate, patient-centric nurse staffing. The synergy model for patient care and Covell's nursing intellectual capital theory guided the doctoral project. The Preferred Reporting Items …

Association Of Adaptive Early Phase Study Design And Late Phase Study Results In Oncology, Donna Elise Levy

Walden Dissertations and Doctoral Studies

This quantitative study assessed the association of the design methods used for early phase oncology studies (adaptive versus traditional) and the outcome of late stage clinical trials. Differences by cancer type and by drug classification were also assessed. The theoretical and conceptual frameworks used were the general systems theory and the design and evaluation of complex interventions, respectively. Units of analysis were individual oncology studies in the ClinicalTrials.gov database and Bayesian logistic modeling was applied on a random sample of 381 studies initiated after November 1999 to December 2016. When assessing study design and outcome, there were lower odds of …

Experiences And Attitudes Of Older Homeless Women Toward Healthcare Access, Mary Ann Mueller

Walden Dissertations and Doctoral Studies

Homelessness among older women is a growing problem in many metropolitan areas of the United States. Researchers have indicated that health issues and problems accessing basic care are connected. Older homeless women face increased health issues, multiple challenges related to accessing basic care, and low incomes which put them at higher risk of becoming homeless, staying homeless, and delaying medical treatment. The homeless who lack fulfillment of social support and timely medical care are considered repetitive users of the emergency department and hospital stays. The purpose of this phenomenological study was to explore the experiences and beliefs of older homeless …

Assessing Medical Expenditure Disparities Among U.S. Adults With Hiv Or Cardiovascular Diseases, Lorraine Nnacheta

Walden Dissertations and Doctoral Studies

Older adults with infectious and chronic diseases, such as cardiovascular disease and human immunodeficiency virus (HIV), are at high risk for associated chronic comorbidities, which are associated with increased medical expenditures to cover treatment costs. The purpose of this study was to investigate (a) whether adults 65 or older with either HIV or cardiovascular disease were predisposed to increased medical expenditures versus adults 64 and younger, and (b) the impact of race and type of health service used on total direct medical expenditures incurred among adults with HIV or cardiovascular disease. A quantitative, deductive, retrospective cross-sectional design was used, and …

A Narrative Study Focusing On Survivors Of Forced Labor Trafficking, Taras Nk Raggio

Walden Dissertations and Doctoral Studies

Throughout history, the media's rendering of slavery depicts vulnerable groups caught in a network of trafficking looking for a better life. Scholars of trafficking cite challenges in understanding the health care needs of domestic forced labor trafficking survivors in the United States. Seminal trafficking findings have shown that variations of trafficking affect the survivors' health after surviving trafficking. Therefore, in this qualitative, narrative inquiry I sought to understand how 8 survivors of forced labor trafficking, ages 25 years and older, described their health following trafficking beyond 5 years. The theory of social constructionism constituted the theoretical foundation, and the salutogenic …

Doctor Of Nursing Practice Roles In Academia, Jodi Renee Raisor

Walden Dissertations and Doctoral Studies

Over 15,000 master’s and doctoral degree students in the United States were denied admission to nursing schools in 2014 because of insufficient nursing faculty. In 2016, over 64,000 undergraduate and graduate students were unable to gain admission to nursing school due to the effects of faculty shortages. This project explored the role of the Doctor of Nursing Practice (DNP)-prepared nurse in academic settings using a systematic review of the literature to determine the role of DNP-prepared nurses in academia. Souza’s systematic review model and Melnyk’s levels of evidence were used to guide the search, review, and the selection of scholarly …

Experiences And Perceptions Of Staff Providing Substance Use Disorder Treatment For Adolescents, Connie Jean Rendleman

Walden Dissertations and Doctoral Studies

Substance Use Disorder (SUD) is associated with high mortality rates and remains a public health concern in the United States. Although, numerous interventions are offered for adolescents struggling with substance misuse, minimal research is available on the effectiveness of treatments to reduce recidivism. Researching the most effective treatment offered to adolescents is crucial to treatment adherence and recovery. The purpose of this study is to determine the most effective SUD treatment for adolescent patients by exploring the perceptions and experiences of treatment therapists providing treatment. The trans-theoretical model was used with elements of the social cognitive theory as a guide …

Tobacco Treatment Education Module For Nurses Working In The Inpatient Psychiatric Setting, Marchell Rene Spielmann

Walden Dissertations and Doctoral Studies

Tobacco use among people with mental illness remain a significant problem in the western United States. At the project site, there is widespread tobacco use among patients with mental illness and lack of training for nurses to address the issue. The purpose of this project was to educate nurses working in the acute psychiatric setting about evidence-based tobacco treatment interventions. The practice-focused question addressed whether a tobacco education program would increase nurses' knowledge, confidence, and skills to provide tobacco treatment interventions to patients with a mental illness. Self-determination theory and the transtheoretical model of change provided the theoretical framework for …

Opioid Abuse In Rural Communities Among Adolescents With Bipolar Disorder, Sherlina Daishernai Holland

Walden Dissertations and Doctoral Studies

Abstract

Low population density in rural areas makes it difficult to deliver services to people with mental health problems and nonmedical prescription opioid abuse remains a problem in the United States. The purpose of this cross-sectional study was to determine whether a parent's socioeconomic status affected care opportunities for children 12 to 17 years of age and whether bipolar disorder increased the likelihood of substance abuse in those children. The theory of reasoned action/planned behavior provided the framework for the study. Secondary data from the Interuniversity Consortium for Political and Social Research 36361 data system, specifically the National Survey on …

The Effects Of Breastfeeding Support On Women Enrolled For Wic Benefits, Judith Marie Khanuja

Walden Dissertations and Doctoral Studies

Breastfeeding has been shown to protect both the mother and infant, and health care professionals consider it to be the best choice for feeding an infant. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, referrals to other social service programs, and nutrition and breastfeeding education for enrolled families. However, community support for the breastfeeding woman once she leaves the hospital is limited, especially in Philadelphia, PA. The purpose of this mixed-methods study was to explore the impact of prenatal breastfeeding education and understand the role that members of the community play in the infant feeding …

An Investigation Of The Help-Seeking Attitudes Of African American Christian Churchgoers, Kristi Madison

Walden Dissertations and Doctoral Studies

The Black Church has been a powerful support system for African Americans, providing economic, and psychological support in addition to meeting spiritual and religious needs. African American church leaders continue to provide a multitude of services to the community; however, research has shown that African American Protestant Christian churchgoers'€™ preference for informal supports may exacerbate some symptoms of mental illness as people may postpone seeking formal help. Utilizing a nonexperimental, cross-€sectional design, this study examined the relationship between these churchgoers'€™ attitudes toward religious help-€seeking and attitudes toward professional help-€seeking. One hundred four African American Protestant Christian churchgoers in the mid-Atlantic …

Employee Retention Strategies For Executive Operation Leaders In An Academic Nursing Environment, Polly Castro Ramos

Walden Dissertations and Doctoral Studies

Employee attrition affects organizations in the form of lower productivity, decreased profitability, and reduced sustainability. In 2014, business owners lost over $11 billion in tangible and intangible assets due to the inability to retain employees. Using the social exchange theory as the conceptual framework, the purpose of this multiple case study was to explore effective employee retention strategies used by business leaders in an academic nursing environment. The study encompassed participants from 3 of the United States: Texas, Kentucky, and Florida. Participants were purposefully selected because of their experience in implementing effective employee retention strategies. Data were collected via semistructured …

Parent Perceptions Of Biofeedback Treatment Effectiveness For Pediatric Migraine, Andrea Grando Weber

Walden Dissertations and Doctoral Studies

Gate control theory posits the idea that the brain and spinal cord have the ability to control the perception of pain sensation throughout the body. Biofeedback provides a proven way to teach a person how they may control their heart rate, breathing, and skin temperature. Through this process, individuals learn to lessen their migraine frequency and intensity. There are no studies to date that have measured the effectiveness of biofeedback in conjunction with medication for migraines in children despite established evidence of success in adults. In this study, an online format via SurveyMonkey was used to document the perceptions of …

Nursing Program Progression Requirements And Student Success At A U.S. Community College, Deborah Joleen Cipale

Walden Dissertations and Doctoral Studies

Although licensed registered nurses (RNs) comprise a significant percentage of the U.S. health care workforce, there is a lack of qualified nurses to meet patient needs. This shortage is expected to intensify as practicing nurses leave the profession. The problem that prompted this study was that an attrition-reduction program implemented in the nursing program at a U.S. midwestern community college did not show a reduction in the average attrition rate. The academic integration construct of Tinto's theory of student departure was used to examine archival academic performance records of 145 students enrolled in the local program from 2010 to 2012. …