Medicine and Health Sciences Commons^™

Generic Drugs : Physician Prescribing Practices For Brand Name And Generic Medications, Tamuno Raymond George

Walden Dissertations and Doctoral Studies

Brand-name drug costs continue to create a burden for many US seniors who receive care from healthcare institutions. Generic medication is as therapeutic as is brand-name drugs and, in most cases, costs far less. Despite this cost difference, physicians continue to prescribe brand-name drugs. The purpose of this cross-sectional study was to explore physicians' patterns of prescribing brand-name drugs over generic drugs. This study was guided by the medical home model, which was developed in 1967 by the American Academy of Pediatrics. The study incorporated a purposeful sampling approach with a sample size of 151 physicians. Multiple linear regression was …

A Qualitative Examination Of Surviving Homeless In Alaska, Reynaldo Espera

Walden Dissertations and Doctoral Studies

The homeless population in Anchorage, Alaska faces many unique challenges. Over the past several winters, a number of homeless individuals have succumbed to the effects of exposure despite available cold weather services. This study investigated individual experiences within the homeless population of Anchorage, Alaska during times of inclement winter weather. Self-determination theory was used to explore motivations of behaviors of the population and to uncover the reasons why this population does not use cold weather services offered by the Municipality of Anchorage. The research questions addressed participant awareness of available cold weather services, survival strategies during inclement winter weather, and …

Time To Diagnosis Of Second Primary Cancers Among Patients With Breast Cancer, Edward Okezie Irobi

Walden Dissertations and Doctoral Studies

Many breast cancer diagnoses and second cancers are associated with BRCA gene mutations. Early detection of cancer is necessary to improve health outcomes, particularly with second cancers. Little is known about the influence of risk factors on time to diagnosis of second primary cancers after diagnosis with BRCA-related breast cancer. The purpose of this cohort study was to examine the risk of diagnosis of second primary cancers among women diagnosed with breast cancer after adjusting for BRCA status, age, and ethnicity. The study was guided by the empirical evidence supporting the mechanism of action in the mutation of BRCA leading …

Advanced Practitioner Provided Pre-Hospital Discharge Asthma Education, Lyndsay E. Gardner

Walden Dissertations and Doctoral Studies

Asthma is a leading cause of pediatric hospital admissions. Parents of children under the age of 18 with asthma require education to recognize and manage the signs and symptoms of the disease. Parent education has shown to decrease their children's hospital admission and readmission rates. The purpose of this pilot project was to develop an asthma educational module for the parents of children with asthma and obtain parent feedback on the content. Families with children under the age of 18 who had been admitted to the hospital with a diagnosis of asthma, an asthma exacerbation, or status asthmaticus were invited …

Health Literacy Program Proposal For Health Care Workers, Shevon Naomi Howard

Walden Dissertations and Doctoral Studies

Health information literacy influences patient health outcomes, yet almost 90% of adults

struggle to understand health information. This study explored the impact of an education course in health literacy on healthcare professionals' methods of providing information to patients in order to increase effective communication and improve patient outcomes. This study drew from an integrated theoretical framework that suggests development and validation of tools to measure health literacy. Access to and understanding of reliable, high-quality health care information equalizes many other variables that impact health outcomes, including age, economic class, and cultural background. This study analyzed survey data collected from 2 …

Experiences Of Heterosexual Couples Who Undergo Hiv Counseling And Testing In Nakuru-Kenya, Stephen Kinyua Mucheke

Walden Dissertations and Doctoral Studies

The increase in new human immunodeficiency virus (HIV) infections among heterosexual couples in Africa may reverse the gains made by HIV prevention programs. HIV screening among such couples remains low and understudied.This qualitative study focused on the motivations for HIV screening among heterosexual couples. The primary research goal was to examine the lived experiences of heterosexual couples who were screened for HIV and received their results in Nakuru-Kenya. The health belief model (HBM) served as the theoretical framework and as a basis for the secondary questions which sought to explore the participants' perceptions on HIV based on the constructs of …

Effectiveness Of Cognitive Screening For Heart Failure Patients, Comfort Nkengla

Walden Dissertations and Doctoral Studies

Cognitive impairment is commonly seen in the elderly population. It is unclear if cognitive deficit in heart failure (HF) patients is a primary factor for higher hospital readmission rates in this population. The Centers for Medicare and Medicaid Services have established strict guidelines for reimbursement on readmissions that occur within 30 days. It is imperative that organizations identify and rectify issues that impact readmissions. The aim of this project was to determine if there is a reduction in HF readmission after patients are screened for cognitive impairment. Orem's self-care model guided the project by providing a framework of inquiry regarding …

Perceptions Of Employed People With Narcolepsy, Chantelle L. Jones

Walden Dissertations and Doctoral Studies

Many companies have used perceptions of their employees to understand how sleep disorders affect their working environment. Sleep disorders have had an undesirable effect on employee performance and often result in employee modifications to accommodate their condition in the workplace. Though information is available concerning employees' experiences pertinent to working with sleep disorders, research focusing on how employees with narcolepsy perceive their work environment appears to be missing from the literature. The purpose of this study was to gain understanding of perceptions of employees with narcolepsy about their work environment and strategies that may influence others to promote positive health …

Effects Of An Integrated Electronic Health Record On An Academic Medical Center, Kenneth E. Koppenhaver Ii

Walden Dissertations and Doctoral Studies

The debate about healthcare reform revolves around a triple aim of improving the health of populations, improving the patient experience, and reducing the cost of care. A major tool discussed in this debate has been the adoption of electronic health record (EHR) systems to record and guide care delivery. Due to low adoption rates and limited examples of success, the problem was a lack of understanding by healthcare organizations of how the EHR fundamentally changes an organization through the interactions of people, processes, and technology over time. The purpose of this case study was to explore the people, processes, and …

Strategies Technology Development Marketing Leaders Used To Commercialize A New Product Innovation, Roxie Mooney

Walden Dissertations and Doctoral Studies

Strategies for commercialization of a new product innovation are critical for gaining a sustainable level of customer acceptance and financial performance. The purpose of this single case study was to explore the commercialization strategies used by 5 technology development marketing leaders from a healthcare company in Washington state. The conceptual framework for this study was commercialization of innovation theory (CoI). The data were collected through semistructured interviews and company documentation, and analyzed using Yin's 5-step data analysis process for case studies to identify and code themes. Analysis of data generated 3 major themes: strategies implemented during the prelaunch phase, strategies …

Patient Safety: Improving Medication Reconciliation Accuracy For Long-Term Care Residents, Annisa Leachman Stover

Walden Dissertations and Doctoral Studies

Patient Safety: Improving Medication Reconciliation Accuracy

for Long-Term Care Residents

by

Annisa L. Stover

MSN, Southern University, 2008

BSN, Our Lady of the Lake College, 2005

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2016

During transition of care, inaccurate medication reconciliation is associated with increased risk of adverse events for patients. Older adults are the population most often affected by medication errors, and long-term care facilities struggle to accurately document medication reconciliation. Errors are more common at hospital discharge, but the critical moment for detecting and resolving them …

Impact Of An Innovative Classroom On Bsn Students' Self-Efficacy And Academic Performance, Laurie Jo Singel

Walden Dissertations and Doctoral Studies

The critical shortage of registered nurses (RNs) in the United States has led to increased enrollment in nursing schools, but the number of graduates is still decreasing, as nursing students struggle and fail in upper division courses. There is a significant gap in knowledge concerning students' self-efficacy (SE) as a factor directly influencing students' academic performance. The problem examined in this correlational study was the impact of collaborative learning in an innovative classroom setting on Bachelor of Science in Nursing (BSN) students' SE and academic performance. Framed by Bandura's theory of SE, the research questions examined the relationship between students' …

Relationship Between Nurse Training And Physical Restraints In Nursing Homes, Terah Tessier

Walden Dissertations and Doctoral Studies

According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.3 million U.S. residents are residing in nursing homes. CMS enforced regulations in the Nursing Home Reform Act. Training in the use of restraints in nursing homes is monitored through the CMS standards. The purpose of this study was to determine whether there was a correlation between training standards of health care practitioners and their use of restraints in nursing homes based on the patterns of citations by RNs and CNAs. Data were collected from Kansas, Louisiana, and Ohio within the CMS Nursing Home Data Compendium. The key research …

The Perception Of African American Clergy Regarding Mental Health Services, Tamara White

Walden Dissertations and Doctoral Studies

The rise in diagnosable mental illness disorders in the United States is a major concern. However, researchers indicate that African Americans are far less likely to seek mental health treatment than Caucasian Americans. This qualitative, phenomenological study addressed a research gap regarding the beliefs, perceptions, stigmas, and practices of African American clergy regarding their promotion of mental health services. Two conceptual frameworks consisting of the sociocultural theory and the social learning theory guided the study. There were two research questions used to guide the exploration of the purposive sampling of 6 African American clergy from major African American denominations across …

Health Care Team Members' Perceptions Of Changes To An Electronic Documentation System, Carol Von Michaelis

Walden Dissertations and Doctoral Studies

Policy makers view electronic medical records as a way of increasing efficiency in the U.S. health care system. However, hospital administrators may not have the clinical background to choose a documentation system that helps the health care team safely increase efficiency. The purpose of this case study was to examine health care team members' attitudes and perceptions of quality of care and efficiency amid a documentation system change. The theory of change was the theoretical foundation for the study. The 6 research questions were designed to elicit information about what the health care team experienced when a documentation system changed …

Chronic Disease Management Of The Uninsured Patient At Ohio Free Clinics, James Benedict

Walden Dissertations and Doctoral Studies

Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low …

Perceived Barriers To Oral Health Care Access For Massachusetts' Underserved Parents, Doudelyne Cenafils-Brutus

Walden Dissertations and Doctoral Studies

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data …

Perceptions Of Infertility Among Arab Women In The U.S, Zena Hamdan

Walden Dissertations and Doctoral Studies

Infertility is a serious public health issue. Infertile couples may perceive infertility differently based on their own cultural background. There is a paucity of literature about how infertility is perceived among Arab women living in the United States. The purpose of this study was to be able to understand how Arab women who live in Dearborn, Michigan feel about infertility and to understand their concerns and worries about their health status. The primary research questions asked Arab women how they perceive infertility and how infertility may impact their future. This qualitative case study was guided by the social support theory …

Self-Care Activities And Nurse Manager Well-Being, Gretchen Eileen Johnson

Walden Dissertations and Doctoral Studies

The role of the nurse manager is important in organizations and influences outcomes such as the safety and quality of care provided on a unit, satisfaction, turnover of nursing staff, and overall health of the work environment. Stressors for managing nurses can impair physical and emotional health and lead to poor patient and staff satisfaction, safety, and outcomes. The evidence-based practice project will explore nurse managers' well-being and self-care activities. The theoretical framework of the project is the Relationship-Based Care Model as well as Kotter's change theory. The literature suggests that self-care activities can reduce stress and improve well-being. A …

History Of Pregnancy-Loss And Maternal Socioeconomic Factors As Predictors Of Under-Five Child Mortality, Henry Chukwunonso Debem

Walden Dissertations and Doctoral Studies

Nigeria is one of the countries with the highest Under-5 Mortality rates (U5M) estimated at 117 deaths/1000 live births. Despite public health control initiatives, no significant improvement in U5M has been demonstrated. The purpose of the study was to determine whether history of Adverse Pregnancy Outcomes (APO) and maternal socioeconomic factors could predict the death of children before their fifth birthday, using the life course health development and fetal programming theories. The study population was women in their reproductive age (15- 49 years). The study was a secondary data analysis of the datasets obtained from three Nigeria Demographic and Health …

African Americans' Understanding Of The Provisions Of The Affordable Care Act, Ewang Theo Epie-Alobwede

Walden Dissertations and Doctoral Studies

African Americans as a group tend to have numerous health issues, and by the time they seek healthcare, the conditions often advance into more serious ailments. Researchers have shown that cultural distrust of the U.S. healthcare system coupled with some discriminatory practices has hindered African Americans seeking care and taking full advantage of the healthcare system. With the introduction of the Patient Protection and Affordable Care Act (ACA), there is some confusion about the application of the law, resulting in many intended beneficiaries misinterpreting it, and not accessing quality healthcare. This interpretive phenomenological study explored how African Americans in the …

Nurses' Perceptions Of Supports And Barriers In Transitioning To The Nurse Faculty Role, Kelly Flanigan

Walden Dissertations and Doctoral Studies

This project study addressed nurses' perceptions of supports and barriers in transitioning from a clinician to a faculty role in a 3-year diploma nursing program located in Eastern Pennsylvania. This problem is significant at both the local and national level due to the shortage of qualified nursing faculty members. A qualitative case study design using in-depth interviews was used. The framework to guide the study was Schoening's Nurse Educator Transition (NET) Model. The guiding question addressed perceptions of new nursing faculty members regarding supports and barriers of transitioning to the faculty role. Interview questions focused on participants' identification of their …

Use Of Social Networking Websites And Receipt Of Cervical Cancer Screening, Patricia Drayton Drayton

Walden Dissertations and Doctoral Studies

Pap smear screening detects cervical cancer in its earliest stages, yet thousands of women in the United States die annually from this disease. Social networking websites commonly provide information about recommended health screenings. In this quantitative study, the Health Belief Model provided the theoretical framework to determine if the use of social networking websites affected nurses' decisions to receive Pap smear screening. A convenience sample of nurses was used, with the rationale that they were knowledgeable of and receptive to participating in a relevant health study. A total of 2,336 registered nurses practicing in Durham, North Carolina were invited to …

Risk Factors Associated With Severe Acute Respiratory Infections Cases, Ryan Gatdula Ortiguerra

Walden Dissertations and Doctoral Studies

The close proximity of the United States to the Mexican border poses a concern for communicable diseases because of the high flow of population movement. The purpose of this retrospective, quantitative study was to identify risks associated with respiratory diseases using an analysis of archived data from the Severe Acute Respiratory Illness (SARI) surveillance program. Based on the epidemiologic triangle theory, demographic and etiologic factors were analyzed to examine any associations with SARI in this population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336 (42.1%) testing positive for respiratory pathogens. Chi square analysis determined that age …

Strategies To Retain Employees In Clinical Laboratories, Amber Rose Phipps

Walden Dissertations and Doctoral Studies

With 30 million citizens gaining access to U.S. healthcare through the Affordable Care Act by 2016, healthcare managers need preanalytic employees to ensure quality healthcare services can be provided. The purpose of this qualitative single case study explored strategies used to retain preanalytic employees. The target population consisted of 10 clinical laboratory managers in a single community-based clinical laboratory in the mid-southern United States, selected because of prior success in improved employee retention strategies. The conceptual framework grounding this study was the theory of work adjustment. Data triangulation occurred from using semistructured interviews and company documents. All interpretations from the …

The Need For Soft Skills In A Medical Assistant Program, Micheal L. Randolph

Walden Dissertations and Doctoral Studies

There is a perceived soft skills problem within the medical assistant program (MAP) at a 2-year technical college in the Midwestern United States. Soft skills refer to relational skills such as practicing self-management, communicating with various groups, adapting to change, negotiating, and resolving conflict. The purposes of this intrinsic case study were to (a) understand the perspectives of faculty, staff, and leadership regarding students' soft skills ability within the study MAP and (b) identify important soft skills needed in the workplace. An integrative conceptual framework that drew upon vocational and organizational theories was used as a theoretical framework for the …

Symptom Presentation Frequency And Severity Associated With Adult Lyme Disease By Ross Scale Review, Vicki A. Stanavitch

Walden Dissertations and Doctoral Studies

Although Lyme disease is the most frequently reported vector-borne illness in the United States, recent evidence from the CDC suggests that Lyme disease incidence in the United States may be much higher than reported. Lyme disease symptoms can be mistaken for a wide variety of diseases, which can complicate the diagnosis. To date, no diagnostic criteria analysis has been conducted examining the association between sociodemographic variables (sex and age) and seasonality of infection with the severity and symptomology found in Lyme disease cases. Using the CDC's outbreak investigation model, a primary case/control study was conducted using the ROSS Scale to …

An Exploration Of Male Batterers' Perceptions Of A Standardized Batterers' Treatment Program, Dionne Lynn Spooner

Walden Dissertations and Doctoral Studies

The focus of this hermeneutic phenomenological, qualitative study was to gather an in-depth understanding of the lived experiences of male batterers participating in a standardized Duluth-model batterers' treatment group. The study had three main goals: (a) to understand the experience of male batterers participating in a standardized male batterers' treatment program, (b) to improve the treatment being provided to male batterers, and (c) to improve services to those impacted by domestic violence. Results from previous studies indicated that treatment for male batterers is ineffective and inconsistent and that the treatment provided, regardless of framework or modality, has little or no …

Association Between Haart And Metabolic Syndrome Components Among Hiv-Positive Adults In Southeastern Nigeria, Bridget Okiemute Amechi

Walden Dissertations and Doctoral Studies

Highly active antiretroviral therapy (HAART) contributes to metabolic disorders and the growing prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV)-infected patients. Hypertension, obesity, and hyperglycemia (components of MetS) are risk factors for cardiovascular disease. Studies have shown that HIV patients on HAART have a 2-fold risk of dying from MetS. There are no such studies in Umuahia; hence the need for this study to fill this gap. Using a sample size of 192 medical records of HIV-infected patients in Federal Medical Centre, Umuahia, and applying metabolic syndrome theory, this study examined the relationships among types of HAART regimen, …

An Evidence-Based Educational Intervention To Improve Nursing Staff's Critical Thinking And Decision-Making Skills, Rene Norene Barron-Kagan

Walden Dissertations and Doctoral Studies

An Evidence-Based Educational Intervention to Improve Nursing Staff's Critical Thinking and Decision-Making Skills

by

Rene N. Kagan

MSN, University of New Mexico, 2009

BS, University of Phoenix, 2000

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

September 2016

Hospitalized patients in acute care settings are at a high risk of developing health complications that can eventually lead to failure to rescue (FTR) situations. The aim of this project was to deliver a structured comprehensive medical-surgical competency plan for acute care nurses to detect deterioration in a patient's condition through the …