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Life Chaos As A Predictor Of Diet Quality In U.S. Adults, Heidi Barbara Buchert Egan

Walden Dissertations and Doctoral Studies

Poor diet quality is a source of morbidity and mortality within the United States. Previous researchers have examined psychosocial influences on diet; however, the relationship between life chaos, a psychosocial measure, and diet quality was not known. The purpose of this cross-sectional survey study was to use the Life Chaos Scale and the Healthy Eating Index-2010 to collect data on life chaos and diet quality, consistent with the biopsychosocial model of health, from a sample of 103 U.S. adults. Regression analysis was used to construct a predictive model. According to the study results, life chaos was not a significant predictor …

Nursing Pain Management In An Emergency Room With Hallway Overflow, Zaida Ruiz

Walden Dissertations and Doctoral Studies

Overcrowded emergency rooms (ERs) decrease the flow of nursing care creating a delay in nurse-administered pain management leaving patients in pain. The project-focused question asked if ER nurses felt that overcrowding in the ER led to inadequate pain management and if a clinical practice guideline (CPG) could be developed to promote effective pain management in the setting. Callista Roy's theory of human adaptation was used to guide the project. To prepare for CPG development, data from a simple random selection of 10 nurses who had worked in the ER for a minimum of 6 months was obtained from the practice …

Patient Satisfaction Management In Office Visits And Telehealth In Health Care Technology, Todd Price

Walden Dissertations and Doctoral Studies

Telehealth and remote medical treatments have begun to be more commonly used in healthcare systems. Researchers have theorized that providers' abilities to treat patients are not directly tied to the proximity of the patient to the doctor, but by the identification and treatment of the patient's symptoms. Although the treatment and cure rates are being established within individual health systems and professional medical associations, empirical research is lacking regarding patient satisfaction with this remote treatment situation. The purpose of this quantitative study was to address this gap by examining satisfaction ratings of patients between virtual provider visits and face-to-face provider …

Perceptions Of Obese African American Women Regarding Altering Traditional Soul Food Preparation, Patricia A. Young

Walden Dissertations and Doctoral Studies

The obesity epidemic continues to be a major concern in the United States. The World Health Organization reported that 1.4 billion adults were either obese or overweight. African American (AA) women have the highest incidence of obesity worldwide. The obesity rate among AAs has continued to rise over the past 2 decades. The problem is that AA women prepare and consume high caloric foods that contribute to obesity. This qualitative descriptive study explored the perceptions that obese AA women have about altering how they prepare soul food to make it a healthier soul food. The empowerment model and the health …

Early Interventionists' Perspectives Of Self-Efficacy With Neonatal Abstinence Syndrome, Adrienne Anderson

Walden Dissertations and Doctoral Studies

An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS) as a result of prenatal opioid exposure. Early intervention services are recommended for this population of children and families to mitigate developmental delays associated with NAS. The effectiveness of early intervention is dependent on the ability of interventionists who deliver these services. The purpose of this qualitative case study was to explore early interventionists' perspectives of self-efficacy when working with infants diagnosed with NAS and their families. Bandura's self-efficacy theory and Rotter's concept of locus of control provided the conceptual framework for this study. The study's guiding research …

Quantifying The Spectrum Of Depression, Octavious Bishop

Walden Dissertations and Doctoral Studies

Walden University

College of Social and Behavioral Sciences

This is to certify that the doctoral dissertation by

Octavious Bishop

has been found to be complete and satisfactory in all respects,

and that any and all revisions required by

the review committee have been made.

Review Committee

Dr. Thomas Edman, Committee Chairperson, Psychology Faculty

Dr. Ricardo Thomas, Committee Member, Psychology Faculty

Dr. Joanna Bissell-Havran, University Reviewer, Psychology Faculty

Chief Academic Officer

Eric Riedel, Ph.D.

Quantifying the Spectrum of Depression

by

Octavious Bishop

MA, University of Texas at Austin, 2008

BS, University of Texas at Austin, 2001

Dissertation Submitted in Partial Fulfillment …

Changes In Attitudes Towards Substance Use Among High School Students, Laura Sue Catherine Elias

Walden Dissertations and Doctoral Studies

Use of alcohol and illicit drugs during adolescent development can have negative effects on cognitive functioning and mental health. The purpose of this cross sectional study was to examine grade level, sex, athletic affiliation, and ethnicity as they relate to substance-using attitudes to isolate the period in which shifts in attitudes toward substance use in adolescents occur. The social learning theory provided the framework for the study. Participants included 276 high school students from a midsized Midwestern city. Students in the ninth, 10th, 11th, and 12th grades who participated in the study were asked to complete a brief electronic survey …

Second Grade Teachers' Perspectives On Differentiated Instruction, Alyssa Simmons

Walden Dissertations and Doctoral Studies

Despite various instructional efforts, the second grade students in a mid-sized Southwestern school district failed to progress in reading. Although differentiated instruction has been shown to improve literacy skills for young readers, many teachers at the study site did not differentiate instruction for all students. Grounded in theories of social constructivism and differentiated instruction, the purpose of this study was to investigate second grade teachers' perspectives about using differentiated literacy instruction and the effect of their teaching experience and participation in professional development on those perspectives. Data for this nonexperimental, causal-comparative study were collected from 93 second grade teachers via …

Minimizing Home Health Care-Acquired Pressure Injuries Through Effective Nursing Teamwork, Juliana Baah

Walden Dissertations and Doctoral Studies

Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients' skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain …

Meeting The Nutritional Needs Of Very Low Income Diabetic Patients, Mary Hossley

Walden Dissertations and Doctoral Studies

Adult Type II diabetes is an increasing public health problem, particularly among very low-income minority populations. The purpose of this study was to create a nutritional guide for a diabetic specific meal plan with an accompanying food pantry nutrition packet for very low-income Type II diabetic patients at a rural Mississippi Free Clinic. The practice-focused question is: Will a nurse-prepared nutritional guide with supplemental food packets improve the glucose control in low income diabetic patients? The gap in practice is that there has been no structured nutrition education guide and no food pantry support plan for Type II adult diabetics. …

Perceptions Among African American Women Welfare Recipients In Advocating For Welfare Reform, Linda Denise Scope

Walden Dissertations and Doctoral Studies

The 1996 Personal Responsibility and Work Opportunity Act (PRWORA) significantly affected many families by changing public assistance from an entitlement program to a work program for recipients and imposing a 60 month maximum period for receiving assistance. Unanticipated outcomes created deleterious results for many single parents. This multiple case study explored the experiences of four African American single mothers in the mid-Atlantic region of the United States receiving assistance regarding welfare reform, the welfare system and their perceptions of welfare advocacy. Black feminist and empowerment theories framed the study to examine how welfare policy changes affected African American women's families …

What Matters Most To Mayors Making Interlocal Agreement Decisions, Douglas C. Haney

Walden Dissertations and Doctoral Studies

Local governmental units in the United States are struggling to cope with dwindling public resources and surging public demands. They often turn to interlocal agreements (ILAs) as a collaborative means by which to more effectively serve their constituents. Unfortunately, many ILAs never materialize or fail prematurely. The purpose of this qualitative, phenomenological study was to explore the experiences of 13 purposefully selected mayors in the State of Indiana to discover what factors they considered important when making their ILA entry and continuation decisions. It utilized a conceptual framework based on the transaction costs theory, as informed by the utility maximization, …

Self-Disclosure Of Human Immunodeficiency Virus Status In Personal Relationships: Perceptions Of South Africans Living With Human Immunodeficiency Virus, Delile Gertrude Langeni

Walden Dissertations and Doctoral Studies

Despite enormous research on the experience of living with HIV, many questions remain regarding self-disclosure of HIV status to sexual partners by people living with HIV (PLWHIV), which is essential to reducing further infection. In this study, a phenomenological approach captured the experience of self-disclosure among South Africans living with HIV in Louwsburg, South Africa. The health belief model served as a theoretical framework, and in-depth interviews were conducted with 12 PLWHIV (8 women, 4 men) who self-disclosed their HIV status to their sexual partners. Their experiences were explored, discovering their illness, motives for self-disclosure, feelings regarding disclosing, responses of …

Complementary Infant Feeding Practices In Afghanistan, Hasibullah Na Niayesh

Walden Dissertations and Doctoral Studies

Children are at greater risk of malnutrition in Afghanistan than they are in many other countries. Malnutrition impairs the mental and physical growth of more than 50% of children in Afghanistan. It also exacerbates the risks of mortality by 45% in infants and children in Afghanistan. The purpose of this study was to determine the association between mothers' knowledge, attitudes, and practices regarding complementary feeding and malnutrition in children in Afghanistan. The precaution adoption process model served as a theoretical framework in this quantitative cross-sectional research study. Data analyzed were collected from 306 mothers and children at 6 randomly selected …

Socioeconomic Status And Cancer Risks In Employer-Insured Cancer Survivors, Christine Clinton

Walden Dissertations and Doctoral Studies

Chronic illnesses such as cancer continue to be among the costliest for employers who provide health insurance to their employees. Despite efforts to incorporate health improvement programs in the workplace, there are concerns about the effectiveness of these programs that do not always deliver a positive return on investment. Little is known about the specific socioeconomic status of employees for whom these workplace health improvement programs are designed for. Guided by the social-ecological model, this study sought to understand the relationship between cancer health risks about socioeconomic factors among cancer survivors in the employer-insured population. Data were extracted from the …

Breastfeeding Perceptions, Rates Of Initiation, And Duration Among Urban And Rural Women, Shaunta N. Rutherford

Walden Dissertations and Doctoral Studies

Breastfeeding is the optimal feeding method for infants up to the age of 2. Breast milk is suited to fulfill the nutritional needs of infants while providing immunological and neurological benefits. Breastfeeding rates of initiation and duration are low in the United States, especially in the state of Georgia. The purpose of this cross-sectional study was to investigate how breastfeeding initiation and duration, self-efficacy, perceptions, and community breastfeeding resources differ based on geographical location. The social ecological model was used as the theoretical framework for this study. An online and in-person survey that combined the Iowa Feeding Attitude Scale, Breastfeeding …

Clinical Practice Guideline For Differentiating Risk Factors For Avoidable And Unavoidable Pressure Ulcers., Vivian Suarez-Irizarry

Walden Dissertations and Doctoral Studies

Pressure ulcers (PUs) present intrinsic risk factors that are not consistently identified by clinical assessments. The objective of this project was to develop a clinical practice guideline (CPG) to provide nurses with guidance in identifying and differentiating how intrinsic and extrinsic risk factors are associated with populations at risk for developing avoidable and unavoidable PUs. CPG development followed a systematic method to search the literature, organize findings, and assess the strength of the resulting evidence and its applicability to the CPG. Quality of the CPG was assessed by a panel of 8 health care professionals using the Appraisal of Guidelines …

Improving Outcomes For Congestive Heart Failure Patients, Diana Lee Collins

Walden Dissertations and Doctoral Studies

Managing patients diagnosed with congestive heart failure (CHF) requires coordination with subspecialties and frequent outpatient monitoring. The lack of communication among health care providers and patients can result in a gap in practice when managing patients with CHF in the outpatient setting. Guided by the chronic care model, this quality improvement project was an initiative to develop and implement a 6-week self-care management program provided by nurse practitioners in an outpatient primary care practice. The goal of the project was to improve the day-to-day self-care management of patients with CHF and addressed the practice-focused question of whether a 6-week CHF …

Association Of Dietary Intake With Suicidal Ideation Or Suicide Attempts In Adolescents, Zenobia J. Bryant

Walden Dissertations and Doctoral Studies

Suicide is among the leading cause of adolescent deaths worldwide and thus a significant public health concern. Risk factors for suicidal behavior include drinking alcohol, smoking, and engaging in risky sexual behaviors. One area of concern is dietary patterns and their association with depressive symptoms and suicidal ideation. Bandura's social cognitive theory emphasizes the assumption that one can perform specific actions to bring about desired outcomes. The primary research questions for this quantitative, retrospective, cross-sectional study concerned whether there is a statistically significant interaction between fruit and vegetable intake and suicidal ideation or suicide attempts. Data from 71,776 adolescents in …

Impact Of Self-Efficacy And Time On Skin Cancer Protective Behaviors, Abbie Goldbas

Walden Dissertations and Doctoral Studies

Skin cancer incidence is increasing while the rates of other cancers is declining. The purpose of this quantitative study was to determine whether health self-efficacy predicted skin cancer protective behaviors. The theory of health self-efficacy provided the framework for the study. Secondary data were collected from the 2008 and 2014 Health Information National Trends Surveys. The study sample included women 18-34 years of age because this population is especially vulnerable to skin cancer. Results of logistic regression analyses indicated that higher levels of health self-efficacy predicted greater sunscreen use, but higher health self-efficacy levels did not predict avoidance of tanning …

Commentary: A New Model For Chronic Care To Improve Patient's Skill, Patrick Dunn, Scott Conard

Walden Faculty and Staff Publications

More effective treatment and increased survival from acute cardiometabolic conditions, such as heart attack and stroke, and an aging population has resulted in more people living with chronic conditions, such as coronary artery disease, heart failure, hypertension, high cholesterol, diabetes, and obesity1. With increased incentives to focus on the long-term outcomes of patients, we believe that there is an even greater need for more effective models for chronic care, both in research and in clinical practice2.

Effectiveness Of Pressure Ulcer Protocols With The Braden Scale For Elderly Patients In The Intensive Care Unit: A Systematic Review, Natalie A. Floyd

Walden Dissertations and Doctoral Studies

Each year, approximately 3 million people in the United States develop a pressure ulcer. Although a preventable complication, pressure ulcers are among the top 5 adverse outcomes in the acute care setting with the prevalence as high as 42% in the intensive care unit (ICU). The purpose of this systematic review was to evaluate the inclusion of the Braden Scale as part of a multicomponent pressure ulcer intervention protocol, or care bundle, to identify geriatric patients hospitalized in the ICU who were at risk for pressure ulcers. The Cochrane protocol guided this review; findings were reported according to the Preferred …

Using Social Cognitive Theory To Predict Counseling Behaviors In Registered Dietitians, Marianela Guerrero

Walden Dissertations and Doctoral Studies

Obesity and morbid obesity affect more than 30% of Americans, which emulates the rate of smoking as the leading preventable cause of disease and death in the United States. The prevalence of obesity among adults in the United States increased dramatically between 1980 and 2010 (16% to 36%). The integration of the social cognitive theory (SCT) constructs such as self-efficacy, self-control, environment and expectations in the study instrument allowed identifying the impact of personal, social and economic factors on Registered Dietitians (RDs) counseling behaviors with obese clients. The goal of this quantitative cross sectional study was to investigate the association …

Strategies To Reduce Information Technology Employee Absenteeism In The Manufacturing Industry, Camilla Henry

Walden Dissertations and Doctoral Studies

Employee absenteeism costs organizations billions of dollars annually in losses in revenue and productivity, temporary labor costs, and low morale. The purpose of this qualitative single case study was to explore the strategies information technology (IT) managers in the manufacturing industry used to reduce employee absenteeism. The theory of planned behavior provided the conceptual framework for the study. Data collection included semistructured interviews with 5 IT managers in Maryland and a review of organizational documents addressing nutritional education information, employee participation rates in health programs, and physical activity. Data were analyzed using compilation, disassembly, reassembly, interpretation, and development of conclusions. …

Young Women's Perceptions Of Factors Influencing Eating Disorders, Francisca Masawi

Walden Dissertations and Doctoral Studies

Eating disorders (EDs) cause irreversible physical damage, including organ failure and death. Although EDs receive considerable attention, the number of affected young women who seek help remains low. The purpose of this phenomenological study was to understand the sociocultural and socioenvironmental factors influencing ED development from the perspective of young women, and to explore why the rate of EDs continues to rise in this population. The sociocultural model served as a guide for the study. Ten young women 18-24 years old from Southwest Ohio participated in in-depth, semi structured, face-to-face interviews. Data coding and analysis revealed recurring themes, with findings …

Education Protocol For Type Ii Diabetes Mellitus, Raegan Elizabeth Quandt

Walden Dissertations and Doctoral Studies

Diabetes mellitus is one of the leading causes of death in the United States, contributing to rising health care costs and increased morbidity and mortality rates. Researchers demonstrated that aggressive heath measures involving ongoing diabetes self-management education are paramount in minimizing associated complications of diabetes. The management and prevention of diabetes is not standardized and providers within a health clinic in Illinois reported challenges in providing self-management education during scheduled patient appointments due to limited resources and time. The purpose of this DNP project was to develop a clinical practice guideline to be used by all providers within the health …

Reducing Home Health Copd-Related 30-Day Hospital Readmissions Using Telehealth Technology, Steven Eric Stammer

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a collection of chronic conditions that results in irreparable lung damage and stress to patients. COPD also has considerable financial impacts on health care entities due to frequent hospital readmissions of COPD patients. The Centers for Medicare and Medicaid Services penalize care entities for 30-day hospital readmissions. Many rehospitalizations attributed to COPD are due to exacerbations, often preceded by physiologic and emotional changes that can be monitored, allowing action to be taken to prevent readmissions. The practice problem for this quality improvement project explored whether the use of remote home monitoring of COPD patients …

Education Plan To Empower Wound Care Nurses For Evidence-Based Practice, Patricia Stevenson

Walden Dissertations and Doctoral Studies

Non-healing wounds can claim thousands of lives and costs billions of dollars each year, and nurse-led wound clinics are becoming necessary to fill a gap in care for patients with wounds. Even among certified wound nurses using evidence-based clinical protocols, key considerations of care are being missed. Therefore, this project was focused on developing and validating a new biofilm education module for certified or certification eligible wound care nurses. The aim of the module was to boost clinical assessment knowledge and improve patient outcomes. Benners skill acquisition model informed the development of this project. The design of the project also …

Health Care Facilities As A Predictor Of Breast Cancer Survival Rates, Elizabeth Natalie Webster

Walden Dissertations and Doctoral Studies

The disparity between survival rates for Black and White women with breast cancer is well documented and has been examined in terms socioeconomics, environment, tumor type, and genetics. However, there is little examination of the role of health care facilities in cancer disparities. Health care facilities are representative of societal norms and beliefs that include location, quality of care, finance, policies, and staffing; therefore, they are a proxy for social justice and social change. The purpose of this study was to examine correlations between health care facility type; social determinants of cancer such as poverty, culture, and social justice; and …

Teaching Heart Failure Patients A Low-Sodium Diet, Karen Faye Wright

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is a progressive medical condition affecting more than 7 million people in the United States (US) with 700,000 new cases reported annually. More than half of those treated for CHF are readmitted at least once a year. The problem addressed by this quality improvement initiative was lack of adherence to low sodium diet (LSD) among CHF patients, knowledge and skill deficit, and excessive 30-day CHF readmissions. The health belief model and the self-care deficit theory guide nurses in acquiring the skills needed to teach LSD. Twelve months of data were selected from 93 CHF readmissions from …