Digital Commons Network^™

Decreasing Thirty-Day Readmissions For Heart Failure Patients, Willybroad Che

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients have a 20-25% hospital readmission rate within the first month of discharge. Patients experiencing HF often have a decline in health resulting in frequent hospitalizations and encumbering symptoms including dyspnea, fluid retention, and orthopnea. HF is a common condition in nursing homes and accounts for a significant proportion of resident transfers to emergency departments. HF is considered one of the costliest diagnoses in the United States, estimated to cost the healthcare system billions of dollars annually. The purpose of this systematic review was to provide a synthesis of evidence-based literature on the current recommendations and strategies …

Risks For Hiv Infection Among Adolescent Girls And Young Women In Mozambique, Isabelle Casavant

Walden Dissertations and Doctoral Studies

Adolescent girls and young women (AGYW) living in Sub-Saharan African countries constitute 17% of the population, yet they account for one third of all new human immunodeficiency virus (HIV) infections. To prevent HIV infections among AGYW, it is necessary to understand why they are disproportionally infected. The purpose of the dissertation was to identify risk for HIV among AGYW living in a southern district of Mozambique. The analysis was driven by the Modified Socio Ecological Model and performed using a quantitative dataset collected for the Chokwe Combination Prevention of HIV (N=3354). Logistic regression analysis was conducted to assess whether an …

Investigating Active Learning In Inclusion And Resource Language Arts Classrooms, Haley Cooper

Walden Dissertations and Doctoral Studies

At the study site, middle school students with disabilities continue to demonstrate reading deficits. Because the lack of growth in the reading skills of students with disabilities has negative consequences for the students and for the school, it was paramount to investigate if the instructional design decisions made by teachers influence the reading growth of these students. The central purpose of this qualitative case study was to use the interactive-constructive-active-passive (ICAP) framework to analyze if teachers are assigning learning activities that compel students with disabilities to engage in active learning during reading instruction. Three research questions guided the investigation of …

Predictors Of The Health Effects Of Marijuana Use On The Hepatic Function, Makafui Kokou Gbogbo

Walden Dissertations and Doctoral Studies

The quantity of marijuana use, the length of time it was used, and the age of initiation of the drug are at the core of the discussions about the potential health effects of marijuana use on the liver. Results of recent studies regarding how the drug affects human health have resulted in a number of conflicting conclusions. Nevertheless, based on these findings, marijuana users are being denied liver transplants. The objective of this study was to identify predictors of the health effects of marijuana on the liver and provide guidance in the care management of marijuana users. To address the …

Factors Associated With Steady Employment Among Felons, Rosalind Holley

Walden Dissertations and Doctoral Studies

Research has shown that a felony conviction record negatively impacts an individual’s employment prospects. Although stable employment has been shown to reduce recidivism, the stigma associated with being labeled a felon is a significant barrier to employment for this population. This phenomenological study, guided by Roy’s adaptation model, labeling theory, and social identity theory, explored the lived experiences of individuals with a felony conviction in seeking and obtaining employment postconviction. Participants were recruited from the Adult Probation offices of the Community Supervision and Corrections Department of Brazoria County near Houston, Texas. Six adult males who were currently on adult community …

Revisions Of A Clinical Practice Guideline For Diabetes Management Protocol, Daniel O. Huston

Walden Dissertations and Doctoral Studies

Management of type 2 diabetes mellitus (T2DM) is essential from cost and treatment perspectives. In 2017, costs associated with diabetes management in the United States amounted to approximately $327 billion. The treatment of T2DM has been in a dynamic state for the past several years with the arrival of new classes of medications and new data supporting the use of diabetes medications to reduce risks from cardiovascular disease and slow the decline of renal function. This project explored the current evidence on treatment of T2DM to support changing either the flow of the current protocol algorithm or the medications identified …

Impact Of Race-Related Stress And Intraracial Microaggressions On Self-Efficacy Of African Descendants, Samina Long

Walden Dissertations and Doctoral Studies

Race-related stress such as ancestral trauma and experiences of out- and in-group microaggressions can be intergenerationally transmitted from parent to child. The current study was conducted to address the need for research on race-related trauma and out- and in-group discrimination by providing evidence-based research on whether African descendants experiencing and witnessing race-related stress and intraracial microaggressions results in low self-efficacy. The purpose of this quantitative, multiple regression design was to explore the relationships among race-related stress, intraracial microaggressions, and self-efficacy, which may provide clarity on the psychological impact of these stressors. This study addressed the question of whether race-related stress …

Early-Career Child Care Teachers' Perceptions Of Their Training Experiences, Teri M. Peasley

Walden Dissertations and Doctoral Studies

In a Midwest state, child care teachers who enter the workforce with only a high school diploma or GED credential are not required to complete child development training before being placed in a classroom. Child care teachers need foundational knowledge to provide quality care and education to young children. The purpose of this qualitative phenomenological study was to explore how early-career child care teachers with no advanced education in child development experience training upon entering the workforce. Personal narratives are scarce in existing research, and understanding the perspectives of child care teachers provided an opportunity to consider appropriate training and …

Strategies To Sustain Funding In The Nonprofit Sector, Mark Sami

Walden Dissertations and Doctoral Studies

Nonprofits provide much needed services to communities, especially to the poor and

vulnerable population, but the majority are operating in an environment of uncertainty

because of scarcity of resources. It is imperative that nonprofit managers implement

strategies to ensure the sustainability of their organizations. Grounded in the general

systems theory, the purpose of this qualitative multiple case study was to explore

strategies that nonprofit managers use to sustain funding in the nonprofit sector. The

study participants were 3 nonprofit managers, including 2 from the Caribbean, and 1

from the United States. Data were collected from semistructured interviews and a review …

Leadership Strategies For Improving Employee Retention In The Fast Food Industry, Hope J. Stallworth

Walden Dissertations and Doctoral Studies

The turnover of skilled employees in the fast food industry results in significant yearly financial losses to organizations across the United States. Applying the findings in this study may help business leaders improve best practices in fast food industries in order to minimize employee turnover. Grounded in the expectancy motivation theory, the purpose of this qualitative single case study was to explore strategies 5 transformational business leaders in southern Mississippi used to improve employee retention in a fast food restaurant. Data collection included semistructured face-to-face interviews and an assessment of the company’s documents (e.g., employee handbook, training manual, and vision …

Practitioners’ Perceptions Of Medical Compliance Among Homeless Clients With Hiv And A Mental Health Diagnosis, Kyle Samuel Berkley

Walden Dissertations and Doctoral Studies

Previous research on HIV medical adherence has focused on incentive-based interventions, while previous research with the chronically homeless has focused on substance abuse, mental illness, and health disparities. This qualitative study focused on the experiences and perceptions of medical providers in a metropolitan area who work on medical adherence with homeless people living with HIV and mental illness. Ecological systems theory provided foundation to explore how medical providers form interventions based on clients’ ecosystems. The data were collected via audio-recorded, semi-structured interviews with 15 case managers, mental health therapists, nurses, and primary care physicians who worked at outpatient medical centers. …

Aligning Workforce Training Center Curricula With Local Business Needs, Elizabeth P. Burns

Walden Dissertations and Doctoral Studies

Many cities in the United States have experienced job loss due to a shift from industrial-based to information and service economies, as well as the outsourcing of labor jobs to overseas locations. In the absence of industrial jobs once occupied by low-skilled workers, the problem that compelled this study was a perceived gap between the skills required by the employers who now hire such workers and the actual skills those workers have. The purpose of this qualitative case study was to explore the espoused skills required by employers in a rural region of the southeastern United States to inform the …

Relationship Between Skepticism And Nursing Experiences When Treating Chronic Noncancer Pain Patients, Emily Jabour

Walden Dissertations and Doctoral Studies

Chronic pain is common, costly, challenging to manage, and affects patients’ quality of life. High confidence is placed in the nurses caring these patients. Nurses displaying skepticism or doubt about patients’ motives for seeking pain treatment contribute to the challenges of effective pain management. The purpose of this quantitative study was to determine if there was a relationship among the nurses’ professional skepticism, level of compassion, and years of experience during the treatment of chronic noncancer pain patients in the acute care setting. The communications model of pain guided the understanding of factors influencing nursing treatment of this patient population. …

The Promotion Of Safety And Quality In Fall Prevention, Sheila J. Mercado

Walden Dissertations and Doctoral Studies

Falls in a hospital setting are considered one of the most frequent, preventable adverse events that need to be addressed through the creation of safer environments. Nurses play a key element in the prevention and management of injuries related to falls. The focus question for this quality improvement initiative (QII) was whether an evidence-based QII program could reduce falls in the inpatient population. The objective of the project was to improve the practices related to fall prevention to reduce the number of inpatients falls. The change model of Kotter and the Preventing Falls in Hospitals: A Toolkit for Improving Quality …

Highly-Skilled Black African Immigrant Women’S Narratives On Healthcare Workplace Experiences And Socioeconomic Integration, Nse Evelyn Obot

Walden Dissertations and Doctoral Studies

Many highly skilled Black African immigrants are concentrated in low-wage positions among occupations in the healthcare industry. This education–occupation mismatch has contributed to substantial labor market hurdles affecting socioeconomic integration in the host country. The purpose of this qualitative narrative inquiry study was to gain a deeper understanding of highly skilled Black African immigrant women’s daily experiences within the U.S. healthcare workplace and the implication of these experiences on their socioeconomic integration. A qualitative narrative inquiry was conducted involving 7 highly skilled Black African immigrant women in the U.S. healthcare workplace. The study was framed by 2 fundamental concepts: talent …

Enhancing Nurse- Patient Communication Through Commit To Sit, Cherrielyn E. Quiambao

Walden Dissertations and Doctoral Studies

The patient experience is considered by healthcare policy experts as one of the essential components of healthcare quality. The project site implemented a program called “Commit to Sit” to help promote direct bedside communication with patients. This quality improvement project examined the impact of the Commit to Sit program on patient experience in an acute care setting. The purpose of this evaluation focused on determining whether communication between the frontline nurses and patients improved through the implementation of “Commit to Sit” campaign on a pilot unit in a community hospital. The Duffy’s Quality Caring Model was utilized because it encourages …

Living With Multiple Sclerosis, William Witt

Walden Dissertations and Doctoral Studies

Background: Continuity of care is a crucial characteristic of high quality multiple sclerosis (MS) care. Nevertheless, experiences of MS patients with continuing care are currently understudied, particularly through in-depth methods, such as qualitative approaches. This is despite the significance of continuity of care in improving patient satisfaction and the quality of life of patients with chronic diseases.

Aim: To examine the experiences and perceptions of MS patients with continuity of care through a critical exploration of their lives following hospitalization for an exacerbation.

Design of the study: Qualitative using phenomenological approach.

Participants: Eight participants living with MS. All participants were …

Impact Of Nursing Education On Dysphagia Screening Knowledge, Jeanette Doreen Brumm

Walden Dissertations and Doctoral Studies

Dysphagia is a common, life-threatening complication potentially experienced by patients with acute stroke. Complications related to dysphagia can lead to aspiration pneumonia, morbidity, and mortality. Thus, early identification of dysphagia is necessary for improving patient outcomes and avoiding adverse health consequences. Nurses have the unique opportunity to impact patient care by increasing knowledge of evidenced-based treatment of dysphagia in acute ischemic stroke patients. Therefore, the project question asked whether Registered Nurse (RN) dysphagia education could improve nursing knowledge of dysphagia screening. The purpose of this project was to increase RN knowledge regarding dysphagia screening using the Yale Swallow Protocol (YSP). …

Canadian Postsecondary Leaders’ Understanding And Promotion Of Social Justice And Educational Equity, Pamela Jacqueline Cawley

Walden Dissertations and Doctoral Studies

Canadian universities are educating an increasingly diverse student body and have a role in rectifying inequities and educating students to contribute to a democratic and inclusive society, but little is known about how mainstream leaders understand such leadership. The purpose of this study was to examine how mainstream Canadian postsecondary leaders in Canada describe and understand their leadership related to social justice and educational equity. Critical social theory and applied critical leadership theory guided this study. This basic qualitative study using semistructured interviews explored how 11 mainstream postsecondary leaders have understood and promoted social justice and educational equity. Data analysis …

Hiv/Sti Screening, Testing, And Prophylaxis Among Sexual Assault Survivors In U. S. Emergency Departments, Elizabeth A. Cita

Walden Dissertations and Doctoral Studies

Use of HIV screening/testing and prophylaxis has been found to be low in the general emergency department (ED) population. Less is known about the use of HIV/sexually transmitted infection (STI) screening, testing, and prophylaxis among sexual assault survivors who present to EDs. The main research questions asked whether there was a relationship between race, socioeconomic status (SES), geographic region, or age, HIV/STI, treatment, and prophylaxis among sexual assault survivors that present to U.S. EDs. This study was a secondary analysis of data collected in the NHAMCS years 2010 to 2016 and included 112 geographic primary sampling units, about 480 hospitals. …

Dispositional Self-Control And Motherhood: An Investigation Into Recidivism, Corliss Crawford-Bayles

Walden Dissertations and Doctoral Studies

The goal of many female offenders when released from prison is reunification with their children. However, resumption of motherhood is a gendered challenge that may increase the risk of recidivism. The purpose of this research was to investigate whether resuming custody of minor children would increase the risk of recidivism or support and maintain desistence. This research is grounded in feminist theory, identity theory, and self-control theory with a quasi-experimental design. The key research question, whether motherhood increased the risk of recidivism, was investigated using a researcher-generated, 18-question research questionnaire. Additionally, the Dispositional Self-Control (DSC) scale consisted of 17 questions …

Educational Program For Decreasing Catheter-Associated Urinary Tract Infections, Josephine Crentsil

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infection (CAUTI) is the most common hospital-acquired illness. Insertion and maintenance of urinary catheters are critical factors that predispose patients to CAUTI. Studies have shown that many nurses have a knowledge deficit regarding evidence-based practices in the insertion and management of urinary catheters, which can help prevent CAUTI. This is a concern because nurses are typically the first point of contact with patients and are responsible for the promotion of evidence-based practice and preventative measures. Therefore, this project aimed to develop an educational intervention for nurses with a focus on proper insertion and maintenance of indwelling urinary …

Improving Glycemic Control For Post-Orthopedic Surgery Patients With Type 2 Diabetes, Allison Dale

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a growing problem within the United States and a leading cause of mortality. The complications and comorbidities associated with type 2 diabetes cause a great financial and resource burden on the healthcare system, and cause negative mental and physical health outcomes for the individual living with it. The complications of poor glycemic control are especially notable following a surgical procedure that requires an inpatient stay. The practice problem for this project is glycemic control following an orthopedic surgery requiring hospitalization. To further analyze the practice problem and to create a clinical practice guideline a robust literature …

Succession Planning Strategies In Faith-Based Nonprofits: A Comparative Case Study, Vasudev Das

Walden Dissertations and Doctoral Studies

Although 75% of United States nonprofit leaders planned to vacate their leadership positions in 2013, 77% of nonprofit organizations, including faith-based nonprofits, operated without succession plans. Grounded by the frameworks of Charan, Drotter, and Noel’s leadership pipeline and Vroom’s expectancy, the purpose of this comparative case study was to compare effective succession planning strategies of faith-based nonprofit leaders in Maryland and Pennsylvania. The research questions addressed the succession planning strategies of faith-based nonprofit leaders. Data collection and triangulation included semi-structured face-to-face and telephone interviews of purposeful snowball samples of six participants in each of two organizations. Data analysis was by …

Chronic Pain Management In The Primary Care Setting, Rebecca Ann Day

Walden Dissertations and Doctoral Studies

Chronic pain is pain that lasts longer than 12 weeks, affects an individual physically in some mental or psychological way, influences an individual’s job performance, and may create a social complication over time. Ensuring the best possible care for the patient’s pain with the least possible complications is the responsibility of the health care provider, including nurse practitioners. Providing a clinical practice guideline (CPG) for the management of chronic pain in the primary care setting was the focus of this project. The comfort theory model was used as a framework for this project as well as the basis of nursing …

Educating Registered Nurses On Decreasing Missed Care Events, Marie St. Clair Dixon-Brown

Walden Dissertations and Doctoral Studies

Abstract

Missed care or partially completed nursing care is a prevalent problem in healthcare with negative consequences for patients, nurses, and healthcare organizations. This project was developed to address a gap in practice by providing staff education regarding the current evidence about missed care along with practical evidence-based strategies to decrease missed care events. Kalisch’s missed nursing care model framed the project. The staff education program used a PowerPoint presentation with interactive discussion and role-play opportunities for nurse participants to engage in and employ strategies to prevent missed care events. A 10-item multiple-choice post-education quiz and 4-point Likert-type program evaluation …

Perceptions Of Influence Of The Wage Gap On Immigrant Ghanaian Women’S Career Aspirations, Daniel Otoo Kwasi Djan

Walden Dissertations and Doctoral Studies

Wage inequality and gender-based career advancement barriers have plagued immigrant women in the United States since world war II. The Equal Pay Act was enacted to address wage inequalities but did little to fix the concerns of the wage gap and promotional barriers for women in the United States. This generic qualitative study addressed a research gap about perceptions of influence of the wage gap on immigrant women’s career aspirations to address the documented problem of income disparity. The theoretical framework guiding the study consisted of feminist and conflict theories . The main research question concerns immigrant Ghanaian women’s perceptions …

Staff Education On Depression Screening In An Outpatient Psychiatric Setting, Naiga Dohnji

Walden Dissertations and Doctoral Studies

Depression is among the common mental illnesses in the United States affecting 1 in 10 Americans. The U.S. Preventive Services Task Force recommended screening for depression irrespective of the risk factors. Yet, providers struggle to implement depression screening. Inadequate use of Patient Health Questionnaire-9 (PHQ-9) screening tool to identify and manage depression can lead to poor patient outcomes. PHQ-9 is valid and reliable tool used to diagnose depression and monitor treatment response. The purpose of this project was to develop, deliver, and evaluate an educational program for providers on the use of the PHQ-9 screening tool for the identification of …

The Association Between Central Line Insertion Practices And Central Line-Associated Bloodstream Infections, Mona Elgowainy

Walden Dissertations and Doctoral Studies

Healthcare-associated infections, specifically central line-associated bloodstream infections (CLABSI), continue to remain a serious public health concern in the United States. Though CLABSI can often be prevented, healthcare professionals struggle to have a positive impact on CLABSI rates. The primary purpose of this study was to determine whether CLIP Bundle adherence has an impact on CLABSI standardized infection ratio (SIR) rates in various patient care areas in California. The research questions were focused on assessing whether there was an association between patient care areas, CLABSI rates, and CLIP Bundle adherence scores. A quantitative, cross-sectional study design utilizing secondary data was used …

The Perceived Impact Of Curricular Maps On Student Retention At A Community College, Amy Ertwine

Walden Dissertations and Doctoral Studies

The problem at a community college in a state in the Eastern region of the United States is the lack of evaluation of the effect of Guided Pathways implementation on student retention in the local setting. Retention efforts are a concern of administrators of community colleges across the United States. To help students succeed, faculty often give students a specified set of core courses and a specific or even prescribed pathway to complete general education requirements. The community college incorporated Guided Pathways into retention efforts in Fall 2015. Over the past 4 years, the college has undertaken more activities focusing …