Medicine and Health Sciences Commons^™

Quality Improvement Initiatives And Interventions For Decreasing Falls In The Hospital Setting, Fredlyn Lolange

Walden Dissertations and Doctoral Studies

Patient falls in health care settings are a widespread and severe problem, and they often happen as a result of a complex set of causes. In the United States, between 3.3 and 11.5 falls occur per 1,000 patient days. Reducing the incidence of falls in a health care setting would bring significant positive change and decrease the incidence of harm to patients in the hospital setting. This staff education project’s purpose is based on addressing falls, a safety concern and a health issue that continues to put patients at an increased risk. Theories used to inform the project include the …

Examination Of Exposure Types Association With Stigma And Impacts On Sharps Injury Reporting In Ambulatory Surgical Centers, Timothy William Lynch

Walden Dissertations and Doctoral Studies

Public health depends on the efficiency of work delivery among healthcare workers (HCWs) and their positive goal orientation in healthcare. Effective minimizing of needlestick and sharp injuries (NSSIs) and timely reporting are fundamental to meeting public health goals. The specific research problem addressed through this study is whether the independent variable of exposure type (needle stick injury, splash exposure injury, other sharp injuries) has an association with stigma associated with sharps injury reporting (dependent variable) among HCWs in ambulatory surgical centers. A quantitative, cross-sectional design involving secondary data analysis was used. Regression was used to analyze pre- and post-workshop survey …

Relationship Between Homelessness, Substance Use, Employment, Living On A Reservation And Tuberculosis Among Northern Plains Native Americans, Darla Mccloskey

Walden Dissertations and Doctoral Studies

Native Americans in the Northern Plains have a long history of tuberculosis (TB) infections. There is limited research on the causes of latent TB infections (LTBI) and TB in this population. The purpose of this quantitative study was to assess the relationship between latent TB and factors of homelessness, substance use, employment, living on a reservation, and active or latent TB among this population using the eco-social theory as the theoretical framework. Data from 146 TB cases of Native Americans living in the Northern Plains and diagnosed with TB from 1999 to 2019 were analyzed using chi-square tests that showed …

Perceptions Of Women Of Color Improving Patient Outcomes Through Hospital Leadership Advancement, Benita A. Mclarin

Walden Dissertations and Doctoral Studies

Women of color have been underrepresented in hospital leadership positions and face challenges in advancing their careers. The benefit to hospitals providing women of color with training and support to move into leadership positions may be improved patient outcomes. Grounded in the interactional model of cultural diversity framework, the purpose of this basic qualitative study was to explore the perceptions of women of color advancing in leadership roles in hospitals and their impact on patient outcomes. The study participants included 16 women of color in leadership positions from hospitals in a western U.S. state. Data were collected through semi structured …

Registered Nurses’ Perceptions Regarding Postoperative Pain Management And Opioids For Adolescents, Susan Miller

Walden Dissertations and Doctoral Studies

More than 2.4 million children undergo surgery annually in the United States and many experience postoperative pain. Poor pain management causes negative outcomes to both the individual and society. Increased rates of prescription drug misuse and rising death rates for adolescents from drug overdoses underscore the need for improvements in pain management. However, there is a lack of research, limited guidelines, and significant provider variability in managing adolescents’ acute postoperative pain. The purpose of this qualitative study was to explore the topic of acute postoperative pain management for adolescents through the lens of registered nurses (RNs). Nurses play an essential …

Referral Source, Visit Modality, And The Delivery Of Diabetes Education In Pennsylvania, Alan Minor

Walden Dissertations and Doctoral Studies

Diabetes education is a principal component of optimal diabetes care that is often underutilized despite the known benefits that include reductions in complications as well as improved glycemic control and self-management knowledge. The purpose of this quantitative study was to examine the association between the completion of diabetes education, referral source, and visit modality. Because the completion of diabetes education is multifaceted, Levesque’s theoretical framework of health access, which incorporates dimensions of the accessibility of services and the abilities of potential users in the utilization of health services, was used to ground the study. A retrospective chart review was conducted …

Comparison Of Cultural Self-Efficacy Between Urban And Rural Nurse Educators, Denise Rene Morris

Walden Dissertations and Doctoral Studies

Integration of an inclusive educational environment requires nursing faculty to embrace a transformational change in academics. The cultural interactions of an educator teaching in an urban district may differ from the relations experienced by a rural nurse educator. The purpose of this quantitative study, guided by Bandura’s social cognitive theory, was to determine whether there is a difference between the cultural self-efficacy scores of nurse faculty teaching in a rural location compared to those in an urban location as well as whether the demographics of age, ethnic background, and years in the nursing profession predict cultural self-efficacy scores. Nursing faculty …

Health Education Needs For Mortality Surveillance In Machakos County, Kenya, James S. Mwanza

Walden Dissertations and Doctoral Studies

Reporting mortality information is the primary data source from which evidence can be drawn to monitor disease trends and inform public health policy to improve population health. Still, only two-thirds of expected annual deaths are reported globally. Health education and promotion play a significant role in empowering communities to uptake public health services such as mortality surveillance. This qualitative descriptive study aimed to understand health workers’ (HWs’) perspectives regarding the need for health education to support mortality surveillance in Machakos County, Kenya. The capabilities, opportunities, and motivation for the behavior change model guided the study. Semi-structured interviews were used to …

Pancreatic Cancer: Quantitative Study Investigating The Regional Risk Factors In North Carolina, Holly Marie Myers

Walden Dissertations and Doctoral Studies

Pancreatic cancer is the fourth-leading cause of cancer-related deaths in the United States, killing more than 90% of individuals diagnosed within 5 years. Due to the lack of signs and symptoms, 82% of all pancreatic cancer cases are diagnosed in terminal stages. As such, the most powerful method to reducing the morbidity and mortality of pancreatic cancer is to further investigate the risk factors. According to the theoretical framework of the ecosocial theory, long-term exposure to exposures to unfavorable socioecological and environmental factors serve as a “web of causation” for adverse health outcomes. Using data from the North Carolina Department …

Cross-Functional Team Collaboration For Enhancing Timely And Effective Emergency Department Care, Osaigbovo Osemwegie

Walden Dissertations and Doctoral Studies

AbstractMany US hospitals report overcrowding in the emergency department (ED) with increased ambulance diversion. Operating at overcapacity risks staff members' ability to provide timely and effective emergency care to patients, exposing them to poor health outcomes. The purpose of this quantitative study was to evaluate whether a correlation exists between cross-functional team collaboration and timely and effective ED care for patients who left 548 national hospital EDs before being seen between 2020 and 2021. The study's independent variable was cross-functional team collaboration, and the dependent variables were Centers for Medicare and Medicaid Services (CMS) Quality Measure scores: left before being …

Doctoral Study Effects Of Mandatory Staffing Requirements On Quality Indicators In Long-Term Care, Melissa Reed

Walden Dissertations and Doctoral Studies

Long term care facilities continue to struggle to improve the quality of care, which affects publicly reported data and reimbursement. The purpose of this study was to evaluate if state-mandated staffing ratios affected Centers for Medicare and Medicaid Services (CMS) survey ratings for CMS Region 7, which consisted of Iowa, Kansas, Missouri, and Nebraska. The theoretical framework was grounded by Donabedian’s quality theory, which described quality is made up of the elements of structure, process, and outcomes. This study included two research questions evaluating if there was a correlation between minimum staffing ratios and quality of care in long-term care …

Reducing Same-Day Procedure Cancellations At An Interventional Spine And Pain Management Center, Adriene Smith

Walden Dissertations and Doctoral Studies

AbstractReducing Same-Day Procedure Cancellations at an Interventional Spine and Pain Management Center by Adriene Smith

Walden UniversityOctober 2023   Abstract The practice problem at a local interventional spine and pain management center was that the nurses lacked sufficient knowledge of the facility’s preoperative screening tool. The problem resulted in inadequate patient preparation for surgical procedures that led to a 33% same-day surgery cancellation rate. A staff education project was conducted to educate the nurses on how to properly use the facility’s preoperative screening tool and assess their knowledge of common blood thinner medications included in the preoperative screening process. Failure to …

Patterns Of Parent Behavior Related To Childhood Physical And Mental Abuse, Cassondra J. Widrick-Phillips

Walden Dissertations and Doctoral Studies

The issue of child abuse is a growing concern in society. However, the limited amount of research available on parent–child relationships poses a challenge in terms of developing effective prevention strategies. The aim of the study was to analyze the connection between a parent who is abusive and their child who is being abused. The main objective of the study was to identify if the gender of the parent had a relationship with abusing the child of the same or different gender. Bowen’s family systems theory was used to support the study because of the assumption that family relationships are …

African American Women’S Experiences Coping With Stress Through Community-Based Services, Delisa V. Procks

Walden Dissertations and Doctoral Studies

Few studies have studied how community-based services (CBS) work to mitigate the strong Black woman image (SBWI) coping mechanism for Black women to improve their mental health. The purpose of this generic, qualitative study was to understand the experiences of 10 African American women, ages 18 and older, who identified with the SBWI and had received CBS to address their stress-related coping strategies. Transactional theory of coping with stress and the SBWI approach was used as the framework to help explain how stress in terms of the SBWI impacted the response of the African American women within their environment. Data …

Oncology Nurses, Compassion Fatigue And General Health: A Mixed-Methods Study, Michelle Rampersad

Walden Dissertations and Doctoral Studies

Current literature on compassion fatigue is expansive, but there is a lack on the relationship between compassion fatigue and general health complaints in oncology nurses; how they perceive compassion fatigue and its relation to their general health. Using Pender’s health promotion model, this mixed methods study addressed how oncology nurses perceive compassion fatigue and whether a correlation exists between compassion fatigue and general health complaints. Data were collected from a sample of 55 oncology nurses through two separate Survey Monkey links. All 55 participants completed quantitative data points including a demographic questionnaire, the Professional Quality of Life 5 tool, and …

Cardiomems Staff Education To Improve Use Of Pulmonary Artery Sensor Data In An Emergency Department, Betty Sue Reynolds

Walden Dissertations and Doctoral Studies

Assessing volume status in patients with congestive heart failure (CHF) remains a difficult task. Newer technology, such as CardioMEMS, allows providers to download pulmonary artery pressure measurements from an implanted sensor. In a large rural emergency department (ED), lack of staff education on CardioMEMS made the device useless when a patient presented to the ED. The purpose of this project was to develop a staff education in-service to address the gap in practice. The theory used to guide development of an effective curricular program and instruction method was Knowles’ theory of andragogy. Application of the analysis, design, development, implementation, and …

Education To Increase Nurse Knowledge And Compliance With Social Determinants Of Health Screening, Bonnie Rieger

Walden Dissertations and Doctoral Studies

To provide holistic care and ensure positive patient health outcomes, the social determinants of health (SDOH) must be addressed. Research demonstrates that while medical care is a contributor to wellness, the SDOH serve an influential role in patient health outcomes. There is limited literature describing how to best educate practicing nurses about SDOH concepts. The purpose of this DNP project was to provide an educational intervention to increase inpatient staff nursing knowledge of the SDOH. Sources of evidence used to create the education module included scholarly literature describing the SDOH concepts and their application to patient, community, and population health. …

Catheter Associated Urinary Tract Infection Prevention Education, Mary Jo Roskos

Walden Dissertations and Doctoral Studies

AbstractCatheter associated urinary tract infections (CAUTIs) are infections that happen in the urinary tract in men and women when foley catheterization is not done using strict aseptic techniques. Bacteria can then travel up the urinary catheter into the bladder; therefore, contaminating urine in the bladder. This project site’s nursing staff was experiencing a lack of knowledge regarding CAUTI prevention. This lack of knowledge on the importance of sterile technique when inserting urinary catheters can lead to CAUTIs. The project question for this project addressed whether the educational program on the importance of a strict sterile technique on urinary catheter insertion …

Factors Associated With Intent To Quit Smoking Among U.S. Adult Smokers, Patrese Ann Nesbitt

Walden Dissertations and Doctoral Studies

Smoking and tobacco use continue to be a public health issue for over 40 million Americans, which explains the appropriateness and abundance of smoking cessation programs throughout the United States. The purpose of this quantitative correlational study was to examine the associations between independent variables of marital status, advice from a medical clinician, and use of community smoking cessation resources and the dependent variable of intent to quit smoking, controlling for race, ethnicity, gender, and age. The theory of reasoned action was used to guide the study. Data from the National Adult Tobacco Survey (N = 12,357) were analyzed using …

An Association Of The Transgenerational Implications Of Redlining And Obesity On Pediatric Type Ii Diabetes, Carlin Dexter Nelson

Walden Dissertations and Doctoral Studies

s the prevalence and incidence of childhood obesity has increased, so has the number of cases of pediatric Type 2 diabetes mellitus (T2DM). Although made unconstitutional in 1968, the transgenerational implications of redlining can be observed in disinvestments resulting in neighborhood detraction. Utilizing the 2019–2020 National Children’s Health Survey, the purpose of the study was to evaluate the relationship between obesity, T2DM, and neighborhood detraction elements as well as assessed indicators of T2DM in non-institutionalized children 6 through17 years of age (N = 34,725). The social determinants of health perspective served as the conceptual framework for the study. Results indicated …

Sexually Transmitted Disease Awareness Amongst Adolescents 13 To 18 Years Of Age, Ngwanma Nwokoro

Walden Dissertations and Doctoral Studies

Abstract Sexually transmitted infections or diseases (STIs/STDs) acquired through sexual activities lead to compromised sexual health. The adolescent population is at high risk of acquiring STIs/STDs due to their lack of knowledge. The gap in practice was that the nurse practitioners (NPs) were deficient in standard of care; adolescent patients lacked consistent evaluation, education, or documentation of the education in their medical records. The practice-focused question focused on the evaluation of the effectiveness of a quality improvement (QI) initiative that incorporated the use of the American Association for Pediatrics screening and Center for Disease Prevention and Control (CDC) treatment guidelines …

Predictors Of Retention Among Individuals With Hiv Initiating Antiretroviral Therapy In Ghana, Ivy Ama Okae

Walden Dissertations and Doctoral Studies

Abstract Managing HIV requires lifelong therapy. Retaining clients on lifelong therapeutic antiretroviral therapy (ART) ensures the suppression of viral replication and better health outcomes. The time of the start of ART management is also a factor in determining better health outcomes for persons living with HIV. This study examined the association between initiation criteria (treat all, Option B+, and CDC T-cell count < 500) and retention on ART at 12 months for 17,974 randomly selected clients in the Ghana Health Service's HIV patient electronic database. Analyses controlled for age, gender, educational status, alcohol use, treatment/adherence monitoring, and tuberculosis disease treatment. Bronfenbrenner's ecological systems theory guided the interpretation of the findings. Results shows that retention was positively associated with all treatment initiation criteria. Clients initiated with CD4 count ≤ 500 criteria seemed to be retained at 12 months on ART at a higher rate than initiation criteria based on Option B+ and treat all. The study results may contribute to positive social change by supporting CD4 testing for clients before initiation of ART to improve retention and ensure the availability and use of adherence counseling, no tuberculosis disease and its prevention, and low use of alcohol among people living with HIV. The results of this study may also provide opportunities for public health policy intervention efforts requiring a personalized, group-based approach to service delivery at the intrapersonal level, interconnected with interpersonal, meso, and meta factors at the community level.

Staff Education On Diabetes Self-Management For Patients, Happiness Ifeoma Oguariri

Walden Dissertations and Doctoral Studies

AbstractDiabetes mellitus, a disease in which the body does not metabolize, store, and excrete. glucose appropriately, presents an economic and health burden in the United States. Summary of recent evidence shows that nurses lack adequate education in providing. diabetes self-management education to patients. Research also shows that providing. nurses with education increases their knowledge of the disease and empowers them to teach their patients self-care. Framed within the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this Doctor of Nursing Practice program was to plan, implement, and evaluate a staff education. program on diabetes self-management. …

A Quantitative Study On Molecular Cluster Detection In Virally Suppressed Communities, Mariska Belinda Osborne-Wells

Walden Dissertations and Doctoral Studies

Viral suppression within human immunodeficiency virus (HIV) care and treatment planning is the gold standard of care for most providers when engaging with their patients. In many settings, the patient has received a positive lab that is indicative of HIV antibodies being detected; this in turn means they need additional medical attention to manage the infection. Upon receiving linkage to care services and attending an initial appointment, an initial genetic sequence is usually completed to assess the patient’s strain of HIV and how antiretroviral medications may antagonize or complement the HIV strain. It is possible that access, bias, and colorism …

Differences In Phq-9 Depression Severity Between Adults Receiving Ketamine Or Ketamine-Assisted Psychotherapy, Sophie Lake Oswin

Walden Dissertations and Doctoral Studies

Treatment-resistant depression (TRD) affects roughly 2.8 million or 1.1% of the United States population. Many traditional treatments of mental disorders including various types of psychotherapy and pharmacotherapy do not provide adequate symptom reduction for clients, and many clients diagnosed with TRD seek out nontraditional treatments such as ketamine and psychedelics for their antidepressant effects. Due to the dissociative nature of psychedelic medication wherein resistance is reduced, and a trance-like state is induced, ketamine-assisted psychotherapy (KAP) has great potential as an adjunct to ketamine therapy. Procedures of KAP have been in development for the last 7 years and a consensus on …

Hiv Testing And Counseling Uptake Predictors Among University Students In Southwest Cameroon., Lilian Belole Motia Pencille

Walden Dissertations and Doctoral Studies

AbstractDespite public health efforts to increase human immuno-deficiency virus testing and counseling (HTC) uptake, screening among college students remains low and understudied. The purpose of this cross-sectional correlational quantitative study was to explore the relationship between the constructs of the health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy) and HTC uptake while controlling for age, sex settlement type, relationship status, area of residence, religious affiliation, and level of education. Four hundred and eighty-seven (N = 487) university students in Southwest Cameroon were recruited using a convenience sampling method. Data were collected using …

Factors Impacting College Students’ Receipt Of Human Papillomavirus Vaccination, Joy Yvette Payne

Walden Dissertations and Doctoral Studies

Less than half of U. S. students entering college have had a human papillomavirus (HPV) vaccination, placing them at risk for HPV-related cancers. This study’s purpose was to identify predictors of HPV vaccination initiation in college students. Andersen’s behavioral model of health services use was used to examine the differences in predisposing, enabling, and need factors in U.S. college students ages 18–26 years who received an initial HPV vaccination in college compared to those who never received an HPV vaccination. The study was a quantitative, cross-sectional survey design using multivariable logistic regression for data analyses. Data were collected through an …

The Motivations And Work-Life Balance Of Paid Home-Based Caregivers Of Clients Experiencing Dementia, Cheraire Lyons

Walden Dissertations and Doctoral Studies

With an expected increase in demand for professional caregivers for the growing older adult and aging population, caregivers need balance in their lives so they can provide quality patient care. The purpose of this qualitative multiple case study was to explore what motivates paid, professional home-based caregivers of clients with dementia to maintain their work–life balance. The caregiver ambition framework was the guide for exploring home-based caregivers’ work life issues along with caregivers’ motivations for work–life enrichment. Interview data were collected from five interviews that were analyzed first manually by exploring the transcribed interviews for commonly seen words and phrases. …

Educating Acute Care And Emergency Nurses On Infant Safe Sleep Practices, Kimberly Catherine Mackeil-White

Walden Dissertations and Doctoral Studies

Rates of infant deaths due to sudden infant death syndrome, asphyxia, and sudden unexplained infant death dropped significantly during the original marketing and education push for infant safe sleep practices during the 1990s following the recommendations from the Center for Disease Control and the American Academy of Pediatrics, but a plateau has occurred with no further recent decreases. Safe sleep practices are inconsistent in the practicum site and guidelines for safe sleep practices do not exist. Although aware of the concepts, staff do not consistently educate families about maintaining the practices within the hospital environment, as evidenced by non-compliance with …

Associations Between Socioecological Factors And Breastfeeding Duration Among Obese Mothers In Mississippi, Maria Mercedes Miranda Porter

Walden Dissertations and Doctoral Studies

There is a growing obesity pandemic in the United States. Low breastfeeding duration rates and socioecological factors lead to obesity in the most southern states. Overweight and obese breastfeeding mothers have not been primarily studied. There is mixed information regarding duration of breastfeeding, BMI, and heart health, as well as a lack of quantitative analyses involving reducing obesity rates in mother-child dyads. The purpose of this quantitative cross-sectional study was to investigate whether there were any associations between breastfeeding duration and BMI, heart health problems, breastfeeding support, and eating and exercise among Mississippi overweight and obese postpartum women based on …