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Association Between Androgen Deprivation Therapy For Prostate Cancer And Alzheimer's Disease, Gina Giannantoni-Ibelli

Walden Dissertations and Doctoral Studies

Alzheimer's disease (AD) is the most common progressive, neurodegenerative disease and form of dementia. The hallmarks of AD are extracellular accumulation of amyloid beta protein, resulting in neuritic, senile plaques and intracellular accumulation of tau protein. AD mainly arises from imbalance of amyloid beta protein production and its clearance in the brain. Testosterone modulates production of amyloid beta protein by decreasing its accumulation. Prostate cancer remains a substantial public health challenge in the United States. While androgen deprivation therapy (ADT) is an effective treatment for prostate cancer, it may be associated with cognitive impairment due to decreased levels of testosterone. …

Barriers To Oral Care Among African American Adolescents In Prince George's County, Maryland, Nkiruka Soribe Mcginnis

Walden Dissertations and Doctoral Studies

When adolescents forgo oral health treatment, factors that hinder them from obtaining these services put them at risk of detrimental consequences in their oral and overall health. The purpose of this qualitative phenomenological study was to identify the various barriers that adolescents encounter causing them to defer oral treatment. Through this study, public health officials, school health care providers, the state, and parents could be made aware of these factors and work together to implement programs and supplemental aid to help adolescents become more knowledgeable of the importance of oral care and encourage them to desire and seek treatment. The …

Improving Hand Hygiene In An Intensive Care Unit, Charles Chukwuemeka Njenje

Walden Dissertations and Doctoral Studies

Health-care-associated infections (HCAIs) affect hundreds of millions of people worldwide, causing morbidity and mortality among hospitalized patients. About 2 million patients suffer from HCAIs in the United States, and it is estimated that 99,000 of them die each year. Studies have indicated that transmission of health-care-associated microorganisms occurs through contaminated hands of health care workers. Hand hygiene (HH) is the single most effective way to prevent health-care-associated infections, yet health care workers' hand hygiene compliance remains low. One factor responsible for poor compliance with hand hygiene guide-lines are lack of knowledge of good hand hygiene and lack of hand hygiene …

Decreasing Acute Diabetes Complications Through Self-Management Education, Eugene O. Okafor

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a chronic disease that affects millions of people in the United States. The purpose of this project was to develop a guideline to help clinical staff provide clear and concise diabetes self-management instructions to patients in a community setting. Orem's self-care deficit theory (SCD) and health belief model (HBM) provided a platform to assess how patients' self-care deficit contributes to illness and the effect of patients' perception of illness. SCD theory and the HBM provided the framework for the development of the guideline to decrease diabetes acute complications through self-management education. The practice-focused question was whether the …

Knowledge And Attitudes Of Emergency Room Nurses Regarding Palliative Care Patients, Pearl Alethea Harrison

Walden Dissertations and Doctoral Studies

Palliative care (PC) is the comprehensive management of patients diagnosed with terminal illness. Care for PC patients focuses on relieving symptoms. The purpose of this study was to determine the difference between pretest and posttest scores on the Frommelt Attitude towards the Care of the Dying (FATCOD) and the Palliative Care Quiz for Nurses (PCQN) after an educational intervention to emergency department (ED) nurses. The framework for this project was Bandura's social cognitive theory. The FATCOD was used to assess ED nurses' attitudes toward PC, and the PCQN was used to assess ED nurses' knowledge about PC prior to the …

The Impact Of Mentoring On Social Excluded Adults In A Small Midwest City, Rose A. Hunt

Walden Dissertations and Doctoral Studies

Empirical data have indicated that a considerable amount of the world's population, 45.3 million in the United States, live in deplorable conditions, some of which are created by social exclusion. Social exclusion is a disenfranchisement experienced by individuals and families living in poverty conditions created by circumstances such as lack of education, lack of economic sustenance, unemployment, poor health, and other social ills. Mentoring is a multidimensional skills-development opportunity for disadvantaged youth, aspiring new professionals, employed individuals being promoted, and instructor-student relationships. There is the possibility that mentoring could be useful for other societal groups as well, particularly social excluded …

Women In Mississippi Undergoing Hysterectomies In Absence Of Comprehensive Informed Consent Law, Tammy Shaffer

Walden Dissertations and Doctoral Studies

Only three states have enacted informed consent laws aimed at providing more information concerning any alternative treatments for women who undergo hysterectomy. This study attempted to fill the research gap regarding consent laws and perceptions of women who underwent hysterectomy in a state with no informed consent laws. Supported by the health belief model (HBM), the research questions focused on the perceptions of women and their lived experiences. The purpose of this qualitative study was to examine the beliefs and attitudes of women in a state with no informed consent laws. Interviews were the main data collection technique. The participants …

Social Work Practice With Older Adults, Carley Yvonne Vailu'u

Walden Dissertations and Doctoral Studies

Social workers working for adult protective services (APS) face many clinical challenges to ensure the safety and well-being of older adult clients. APS social workers often interact with older adults who engage in self-neglecting behaviors that compromise their ability to function in a healthy and independent manner. The purpose of this research study was to explore challenges in direct social work practice to identify how APS services can be improved when working with the older adult population, particularly individuals who engage in hoarding behaviors. Using action research methodology, 2 focus groups were conducted to explore the experiences and knowledge of …

Evaluation Of Use Of Teach-Back For Patient Education, Tamara J. Orr

Walden Dissertations and Doctoral Studies

The focus of this quality improvement doctoral project was the evaluation of an organization's standardized use of the teach-back process for patient education implemented in February 2018. Teach-back is a process in which the patient restates the key concepts for self-management, so the nurse can assess the effectiveness of the teaching and learning process. The practice-focused question compared 4 questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey with literature and recommendations from major health care organizations. The Iowa Model was used to guide the project. The literature review was completed using the Cumulative Index to …

Female Caribbean Immigrants' Perceptions Of The Influence Of Immigration On Obesity, Kerryann Nelson

Walden Dissertations and Doctoral Studies

Obesity is a significant global issue, and its incidence has increased over time. A substantial percentage of the U.S. population suffers from this disease with a relatively high prevalence seen in individuals from the Caribbean. The purpose of this phenomenological study was to explore Caribbean women's perception of how migration to South Florida may have impacted the onset of obesity in this population. The social ecological model provided the framework for the study. Data were collected from 1-on-1 interviews held with 12 female participants between the ages of 18 and 35, who previously resided in the Caribbean at a healthy …

Success Factors Of Entrepreneurship In Emerging Rural Economies, Sultan Tahir Mehmood

Walden Dissertations and Doctoral Studies

One factor of the leadership stratagem is to account for the core values, operations, and growth of the organization. The purpose of this case study was to ascertain the financial strategies small business leaders incorporate to help ensure growth of small businesses. The conceptual framework of Schumpeter's innovation and entrepreneurship theory and the Grameen model were included to drive the scope and analysis of this study. A purposive sample of 8 leaders from successful small businesses in Islamabad contributed to a focus group session; 4 out of these participants originated from the finance and management department and 4 represented sales …

Comparing A General And Transitional Registered Nurse Orientation To Facilitate Quality Improvement, Kathryn R. Cortes

Walden Dissertations and Doctoral Studies

Most hospitals orient new graduate nurses and experienced nurses in the same generalized orientation programs. To address the cost of orientation to specialty units, a pediatric hospital developed a tailored transitional residency orientation program for experienced nurses. The purpose of this project was to describe, compare, and evaluate the existing generalized orientation program and the transitional orientation program to determine how the orientations differed in structure, process, and outcomes. Donabedian's model assessing quality of care services and Benner's novice-to-expert theoretical framework served as guides in evaluating the orientation outcomes. Qualitative data about residency classroom time, preceptor selection and time, mentor …

Developing Neonatal Gavage Tube Guidelines To Decrease Feeding Intolerance, Elizabeth Demeester Webster

Walden Dissertations and Doctoral Studies

A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating …

Public Elementary School Teachers' Experiences With Implementing Outdoor Classrooms, Lori Schultz Goff

Walden Dissertations and Doctoral Studies

Children experience limited time outdoors and have few opportunities for outdoor learning in schools, putting them at risk for being unprepared to engage in solving environmental and societal problems. Researchers have examined outdoor learning at the preschool and high school levels; elementary school experiences have been explored less frequently. Guided by a conceptual framework informed by social emotional learning (SEL), ecological literacy, and teacher self-efficacy, this study investigated public school elementary teachers' experiences with outdoor classrooms including barriers and supports to creating and using outdoor classrooms. A qualitative design using in-depth interviews with interpretive phenomenological analysis techniques was conducted with …

Mediating Effect Of Academic Self-Efficacy Between Teachers' Attitudes And Achievement Of Low-Income High School Students, Nickole Marie Cottrill

Walden Dissertations and Doctoral Studies

Researchers have found that low-income students have greatly suffered academically, yet there have been no advancements causing the academic achievement gap to close for any length of time. Using Bandura's social cognitive, self-efficacy, and academic self-efficacy theories as the foundation, this study explored the mediating effect of academic self-efficacy in the relationship between perceived teacher attitudes and perceived academic achievement in low-income high school students. Data were collected from 145 low-income high school students via an online survey geared towards their parents to ensure full parental consent. The survey included demographic questions, a perceived academic achievement question, the Classroom Teacher-Student …

Implementation Of A Standardized Approach To Diabetes Education, Stacey Williams Porter

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention (CDC) report that Type 2 diabetes

mellitus (T2DM) is a serious health issue affecting over 24 million Americans. Adults with T2DM are 2 to 4 times more likely to experience complications of the disease such as heart disease and stroke. Efforts are needed to control the condition and prevent the complications. At a local community hospital in the southeast United States, a 2-year assessment revealed over 10,000 patients admitted with diabetes or diabetes-related complications. Staff nurses at the site were responsible for diabetes self-management education for T2DM patients at discharge; however, no standardized …

Increasing Referrals Of Hospitalized Obese Patients, Tammy Elaine Cabrera

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise in the United States and globally, placing populations at

increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,

and other disease states. Literature review shows that there have been many different methods

utilized to halt obesity's progression, however rates continue to increase. The United States

Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other

agencies recommend obesity screening and counseling at every patient encounter, but most

hospitals do not have a current obesity policy in place to accomplish this task. The purpose of

this project is to …

Impact Of The Centering Pregnancy Model On Sustaining Normal Gestation Weight Gain, Hyacinth Dennis-Crooks

Walden Dissertations and Doctoral Studies

Obesity during pregnancy has increased in prevalence over the last decade and is associated with adverse outcomes for mothers and babies, especially Black mothers. In the local setting of this project, the group-centered centering pregnancy model (CPM) was implemented to improve outcomes of pregnancy. The model had not been evaluated for its effectiveness in reducing weight in Black pregnant women; therefore, there was a need for an evaluation of the effectiveness of the CPM in decreasing excessive gestational weight gain (EGWG). The health belief model was used to guide the project, which compared mothers' weights early in the 2nd trimester, …

A Policy Feedback Theory Approach To Food Assistance Program Distribution Mechanisms, Ahmad Sabbagh

Walden Dissertations and Doctoral Studies

Many families that experience hunger in the United States rely on Food Assistance Programs to meet their daily nutrition needs. However, these programs do not always meet the needs of these individuals, as has been the case for individuals living under higher than expected levels of poverty in the Great Lakes region of the United States. Using policy feedback theory (PFT), the purpose of this case study was to explore the experiences of individuals from a county in the Great Lakes region of the United States, who depend on the federal Food Assistance Program, with particular attention given to evaluate …

Predictors Of Nutritional Counseling Among Adolescents By Physicians In California, Jean Kigozi

Walden Dissertations and Doctoral Studies

The prevalence of obesity in the United States was stable at 17% from 2011-2014 among approximately 13 million children and adolescents 12-19 years of age, according to the Centers for Disease Control and Prevention. Nutritional counseling has been recommended, and while most physicians agree that it is necessary, it is not happening consistently. The purpose of this study was to examine the association between dietary intake, physical activity, and body mass index (BMI) characteristics of youth 12-17 years old in California and the receipt of nutritional counseling. Social cognitive theory guided this quantitative cross-sectional analysis of archived data from 814 …

A Structured Weight Loss Program To Combat Obesity In Women, Tara English

Walden Dissertations and Doctoral Studies

Rates of obesity and the associated comorbidities continue to increase for women in the United States. Despite information available, efforts at weight loss are often unsuccessful because women lack integral knowledge of how to approach the various components essential for weight loss. This doctoral project was created to address the practice question of whether obesity can be reduced through a step-wise weight loss program that identifies essential elements to reduce weight in menopausal age women. Guided by the information-motivation-behavioral skills model, this project led 17 volunteer participants from a Northwest, Florida primary care clinic through 6 weeks of protocols supplemented …

Reading Achievement Of Middle School Boys In Single-Gender And Coeducational School, Jean Hunter-Batty

Walden Dissertations and Doctoral Studies

The problem addressed in the study was the lack of evidence on the efficacy of the single-gender educational model as compared to the coeducational model in increasing reading achievement for middle school boys in the local school district. Leaders in the district implemented the single-gender model to address the problem of an ongoing reading achievement gap among middle school boys and girls. The gap has also been noted nationally and leads to limited reading-dependent opportunities for boys. The purpose of this quantitative study was to compare the two educational models to determine whether the single-gender model offered advantages over the …

The Relationship Of Location And Educational Achievements To Vision Impairment In Asians, Sonali Trivedi

Walden Dissertations and Doctoral Studies

Introduction: Increasing incidence of vision impairment in the United States reinforces the urgent need for research and public health awareness. Eye diseases are of common concern in Asian and other ethnic groups globally. Glaucoma, cataracts, macular degeneration, myopia, and retinitis are types of eye diseases and common causes of vision impairment in Asians. This study addressed the current gap in knowledge regarding vision impairment prevalence among Asian-Americans by geographical location and level of education. Socio-ecological theory was used as the theoretical foundation.

Method: A cross-sectional secondary dataset from U.S. Census Bureau included 3,916,947 participants' survey responses from 2011 through 2015 …

Stakeholder Perceptions Of Gun Violence Perpetrated By Young Men, Birda Garrett

Walden Dissertations and Doctoral Studies

In three low socioeconomic urban communities of Greenwood (pseudonym), young men's lack of education provides dim prospects of employment, possibly causing the young men to turn to gun violence. The purpose of this study was to understand the perceptions of concerned clergy, law officials, and members of a Neighborhood Watch organization regarding the factors that contribute to gun violence in the southern communities in the United States. The conceptual framework for this study was Bandura's modeling theory. The central research question addressed how the community stakeholder groups described their perceptions regarding gun violence among young male adults. For this qualitative …

The Influence Of School Discipline Approaches On Suspension Rates, Donna Christy

Walden Dissertations and Doctoral Studies

A free and appropriate public education is promised to every child in the United States. However, zero tolerance school discipline policies have broken that promise, pushing students out of the classroom and into the school-to-prison pipeline. Despite the growing body of research demonstrating negative social and economic impacts of exclusionary discipline, public school administrators have been slow to adopt innovative policies that provide rehabilitative alternatives. The purpose of this study was to compare, using the consequences of innovations application of Rogers's diffusion of innovations theory, the impact of various school district approaches to school discipline on suspension rates while controlling …

Association Between Body Mass Index And Depression On Hbaic Control Among Veterans, Opokua Osei-Yeboah

Walden Dissertations and Doctoral Studies

The study investigated the association between body mass index (BMI) and depression based upon glycated hemoglobin levels (HBA1C) among United States veterans. Based on Bandura's social cognitive theory, a cross-sectional analysis examined the association between BMI and depression on HBA1C regulation, and if the interaction between BMI and depression affects HBAIC regulation among veterans. Multiple regression analysis was used to test the multivariate associations between depression and BMI on the outcome variable of HBA1C. Linearity, normality, and homoscedasticity were assessed using normal probability plots and residual analysis. Durbin-Watson statistics were used to test for autocorrelations, and variance inflation factor was …

Educating Primary Care Nurses On Phosphorus Management In Chronic Kidney Disease Patients, Lilian Somuah

Walden Dissertations and Doctoral Studies

Fifteen percent of adults in the United States have been diagnosed with chronic kidney disease (CKD). CKD is the slow, progressive, and irreversible loss of kidney function. The most effective means of controlling CKD is by managing dietary phosphorus intake. It is important that staff nurses be educated about effective patient education tools to improve dietary phosphorus management. The purpose of this project was to educate primary care nurses about phosphorus management in CKD patients through the introduction of the phosphorus pyramid as a visual tool. The project sought to understand if an educational intervention regarding phosphorus management in CKD …

Predictors Of Blood Pressure And Lipids Levels Among African Americans, Frank Lanor

Walden Dissertations and Doctoral Studies

African Americans disproportionately develop cardiovascular disease risk factors including high blood pressure and high cholesterol levels in comparison to European Americans. The purpose of this study was to examine the associations of diet quality and physical activity with blood pressure levels and cholesterol levels among African Americans. The social ecological model was the theoretical foundation for the study. Research questions were designed to examine the extent to which diet quality and physical activity predict blood pressure levels and cholesterol levels. The research design was quantitative cross-sectional secondary analysis of 959 participants. After controlling for demographic factors, body mass index, and …

A Patient-Centered Approach To Diabetes Education In A Rural Clinic, Paul Okpuzor

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disease impacting more than 8.3% of adults in the United States. Diabetes-related care accounts for more than 11% of all patient care expenditures. The purpose of this project was to identify the primary concerns of members of the T2DM patient population in an underserved clinic in rural southcentral United States and to make recommendations for a staff diabetes education program to address these concerns. Orem's theory of self care outlined the importance of educating and supporting patients in their efforts to manage their own healthcare. Knowles's assumptions of how adult's learn …

A Community Oriented Solution To Access To Care, Margaret Louise Thornell

Walden Dissertations and Doctoral Studies

Access to primary health care services is a significant issue for many communities seeking to improve the health of their populations. This single case study describes the 12-year journey of 2 adjoining rural counties in 2 states towards meeting the primary and specialty care needs of the uninsured and underinsured population. Data were triangulated using historical documents, first-person interviews, and health utilization data. The community leadership moved through various models including a free clinic and a university-sponsored health center before finally establishing a federally qualified health center, which now serves 40,000 citizens in these counties. The site is now hosting …