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Behavioral Modification And Relapse Rates In Opioid-Dependent Pregnant Women Managed With Subutex, Tammy Lynn Minor

Walden Dissertations and Doctoral Studies

Behavioral Modification and Relapse Rates in

Opioid-Dependent Pregnant Women Managed with Subutex

by

Tammy Minor

MSN, Walden University, 2009

BSN, Marshall University, 1986

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

March 2016

Opioid dependency affects not only the individual who is dependent on opioids but negatively impactsalso the family unit, the community, and society as a whole. Opioid use in the prenatal period can have devastating effects on both the mother and the fetus. The purpose of this paper is to perform a secondary analysis of the effectiveness of …

An Obesity Needs Assessment With African American Adults In Central Virginia, Nicole Michelle Brown

Walden Dissertations and Doctoral Studies

The risk for obesity is especially prevalent among African American adults in Central Virginia, who have one of the highest rates of obesity in the nation. Efforts to address obesity in African American adults through diet, weight reduction, and increased physical activity in settings such as schools, worksites, healthcare organizations, churches, and communities, are among the initiatives of Healthy People 2020. The objective of this project, conducted with 91 African American adults (33 females and 58 males) in central Virginia, was to complete a community needs assessment that related to obesity among members of an African American church. The needs …

Diabetes Mellitus Type 2: A Quality Improvement And Patient Safety Initiative, Remeliza Navarrete Tukay

Walden Dissertations and Doctoral Studies

The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using …

Influence Of Teacher Participation On Student Fitness And Student Participation In Physical Education, Whitney Morris

Walden Dissertations and Doctoral Studies

Physical activity plays a key role in the health of children. Childhood obesity is increasing in the United States, and children are spending less time being physically active. Active participation by a physical education (PE) teacher in physical activities has been suggested as a means of promoting student fitness. The purpose of this quasi-experimental quantitative study was to determine whether modeling of physical activity by a PE teacher would increase student participation and physical fitness. Bandura's social learning theory provided the theoretical framework for the study. Participants included 311 4th and 5th grade elementary students enrolled in physical education classes. …

Developing A Guideline For Care Of Students With Diabetes, Rita Ozioma Onwenna-Aninyei

Walden Dissertations and Doctoral Studies

Diabetes mellitus (DM) is one of the most common chronic diseases affecting children under the age of 20, and it often leads to serious complications. In recent decades, there has been an increase in incidence of both types of DM among U.S. children. Having this chronic condition not only negatively impacts the health of these children but also their academic achievements. School health nurses struggle to manage these children appropriately and safely. The purpose of this project was to develop an evidence- based guideline for a standardized process in which school nurses coordinate the school and student health care teams …

Exploring An African American Principal's Cultural Leadership Effects On Closing The Achievement Gap, Doristine Cornelius

Walden Dissertations and Doctoral Studies

Closing the achievement gap is a key concern for educational leaders. Research has indicated that principals’ actions directly and indirectly influence student learning. The purpose of this case study was to explore cultural leadership in an urban Mississippi high school from an African American’s racialized perspective. The cultural competency/proficiency theory provided the conceptual framework for this study. Successful leadership practices of this African American principal were examined through the principal and through the perceptions of teachers and the assistant administrator. A researcher-developed questionnaire was content validated and given to a purposeful sample of 17 individuals: the principal, assistant principal, and …

Promoting Diabetes Self-Managment Eduaction And Training In Out-Patient Clinics, Inemesit Godwin Udo

Walden Dissertations and Doctoral Studies

Abstract

Type 2 diabetes mellitus (T2DM) is a long term metabolic disorder characterized by high blood sugar, insulin resistance, and relative lack of insulin. T2DM is a leading cause of cardiovascular disease, blindness, kidney failure, lower-limb amputation, and other complications that are costly to patients and the U.S. health care system. Lack of knowledge and underdeveloped skills for self-management of diabetes continues to be the biggest problem for patients with T2DM. Using a team approach and Rosswurm and Larrabee's (1999) conceptual model as a framework, the purpose of this doctorate of nursing practice quality improvement project was to develop an …

Impact Of Medicare And Medicaid Beneficiaries With Selected Conditions On Emergency Department Utilization, John K. Amoh

Walden Dissertations and Doctoral Studies

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 …

Effect Of Reduced-Fee Dental Hygiene Treatment And Oral Health Perceptions Among Socioeconomically Deprived Persons, Janeime Necole Asbury

Walden Dissertations and Doctoral Studies

Access to oral health care remains problematic for millions of Americans. Factors such as socioeconomic status, age, race, and lack of dental insurance benefits inhibit the ability of many to obtain preventative oral health care. The aim of this study was to explore the effect of preventive oral health treatment and education at reduced-fee dental hygiene facilities on the oral health behaviors and perceptions of socioeconomically deprived persons within the state of Georgia. This study was based on the health belief model constructs. A convenience sample of 102 participants was recruited from the individuals who visited two dental hygiene colleges …

Gestational Age, Birth Weight, And Incidence Of Adult Type 2 Diabetes Among Southeast Alaska Natives, Renee Elaine Crawford

Walden Dissertations and Doctoral Studies

American Indian and Alaska Native adults are 2.6 times more likely to have adult onset diabetes resulting from higher weight at birth. Pregnant women, providers, and Indian Health Service administrators may benefit from timely information during pregnancy to intervene and prevent Type 2 diabetes. The purpose of this study was to examine the role of birth weight in the development of Type 2 diabetes among Southeast Alaska (SEA) Natives. Guided by the socioecological model, this study examined the extent to which birth weight and gestational age predict the incidence of Type 2 diabetes. The study used a quantitative research design …

Influences Of Nutritional Food Label Understanding In African-American Women With Obesity, Cynthia Jean Hickman

Walden Dissertations and Doctoral Studies

Nutritional food label understanding (NFLU) in African American Women (AAW) is a philosophy that addresses obesity. Public health efforts have implemented nutritional and caloric information to packaged and restaurant foods to improve nutrient and calorie literacy. Research suggest NFLU might have a minimal effect on reducing obesity. However, it is not known how obese AAW born during the baby-boom era (51 to 64 years of age) perceive NFLU in relation to their dietary behaviors. The purpose of this phenomenological study was to understand the lived experience of obese AAW regarding NFLU from a cognitive and behavioral perspective. Twelve, AAW answered …

Sustainability Challenges For Maize And Cassava Farmers In Amankwakrom Subdistrict, Ghana, Franklin Komla Atadja

Walden Dissertations and Doctoral Studies

Agricultural system in Ghana underperformed because of limited financing, which constrained some small-scale maize and cassava farmers. The purpose of this case study design was to explore the methods that some small-scale maize and cassava farmers in Amankwakrom Subdistrict used in obtaining farm financing. Two themes from the literature review were a lack of collateral for small-scale farm financing and the small-scale farmers cooperative associations' role in farm financing. Regional-scale management sustainability index formed the conceptual framework for this study. Data collection included semistructured face-to-face interviews with 8 fluent English speaking small-scale maize and cassava farmers who have obtained farm …

Effect Of Genetic Background Combined With Excessive Media Screen Time On Markers Of Cardiovascular Risk In United States Youth Aged Newborn To 20 Years, Maria Moroni

Walden Dissertations and Doctoral Studies

Time with media screens (television, computers, videogames, cell phones, and tablets) is the primary activity of youth, second only to sleeping, and represents a major risk factor for cardiovascular diseases (CVD). Additionally, the populations with highest rates of screen time are also those most at risk of CVD from genetic predisposition (i.e., Blacks, Hispanics). The purpose of this descriptive, correlational study, based on cross-sectional analysis of archived data from the 2009 - 2010 NHANES for United States youth, newborn to 20 years old, was to determine whether the combination of media screen time with genetic background is a better predictor …

Risk Factors For Measles Among Hiv-Infected Children In Uganda, Miriam Nanyunja

Walden Dissertations and Doctoral Studies

Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age …

Socioecological Determinants Of Obesity Among Hispanic Parents/Child Caregivers In Aurora, Illinois, Deanna Marie Sommers

Walden Dissertations and Doctoral Studies

Obesity has increased during the past 30 years in the United States. Obese adults and children are at risk for cardiovascular disease, diabetes, hypertension, and comorbidities. Parents and child caregivers play key roles in the decisions of family health. Studies exploring sociodemographic and socioecological factors associated with obesity among U.S. Hispanic parents and child caregivers are lacking. Guided by the socioecological model, this study examined the following factors: gender; acculturation; dietary intake of fat, sugar, fruits, and vegetables; and role as food purchaser/food preparer that influenced obesity. A 3-paper-based survey, consisting of a demographic survey, the Block Fat-Sugar-Fruit-Vegetable Screener and …

Donor Coordination And Health Aid Effectiveness In The Nigerian Health Sector, Ifeoma Edna Uduji

Walden Dissertations and Doctoral Studies

Development partners and donors increasingly acknowledge the importance of coordinating their activities to achieve the outcome of the official development assistance to developing countries. Although stakeholders have recognized the importance of harmonizing donors and development partners' efforts in the Nigerian health sector, little research has addressed the influence of coordination on the health aid effectiveness. This qualitative case study determined the influence of coordination among the donors and development partners involved in the HIV/AIDS, malaria, and nutrition program on the outcome of these programs in Nigeria. Data were collected through interviews with 22 program officers participating in the health programs …

Experiences Of Chronic Disease Self-Management Program Leaders, Laketa Monique Hillman

Walden Dissertations and Doctoral Studies

Chronic conditions are public health threats. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based disease management program that addresses personal self-management of chronic conditions. The CDSMP involves peer trainers who instruct and assist with chronic disease preventive measures. Although disease management demonstrates promise to improving patient self-maintenance, previous researchers have not evaluated how the program affects program leaders. The purpose of this study was to discover how self-help leaders feel about the CDSM program. The overarching research question asked about perspectives that self-help leaders had toward the program. Through a narrative qualitative approach, the perceptions of peer leaders were …

Implementation And Evaluation Of Dietary Modification With Gestational Diabetes, Celia T. Ojeaga

Walden Dissertations and Doctoral Studies

Gestational diabetes mellitus (GDM) negatively affects the health of both mothers and babies, and is the most common pregnancy complication in the United States. Many dietary modification programs for pregnant women diagnosed with GDM rely on a one-size-fits-all approach to menu planning. The purpose of this project was to develop a diet modification program for GDM management using a patient-centered approach. The project objective was to develop the policies, procedures, and supporting documents needed to implement a successful GDM management program for pregnant women receiving antenatal care at an obstetrical clinic. The developed program incorporated strategies for clinic nursing staff …

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

Walden Dissertations and Doctoral Studies

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

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

Walden Dissertations and Doctoral Studies

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

Professional Development Of Head Start Teachers In Emotional And Instructional Support, Marilyn Mcleod Harris

Walden Dissertations and Doctoral Studies

In the southwest region of Tennessee, a local Head Start program classroom assessment scoring system's (CLASS) scores fell in the lowest 10% among national Head Start programs in emotional and instructional support. Since 2012, the Office of Head Start has released reports showing that the average Head Start program has low performance CLASS emotional and instructional support scores. The purpose of this exploratory case study was to investigate the professional development of local Head Start teachers with low CLASS scores in emotional and instructional support. Knowles's adult learning theory of andragogy was the overall conceptual framework and the concentrated theory …

A Multiple Case Study On Leader Support, Breastfeeding, And Work Commitment, Lisa Marie Rancourt

Walden Dissertations and Doctoral Studies

In the United States, over 50% of women return to paid work after becoming mothers. Mothers who breastfeed are more likely to stop working than peers who chose to use infant formula. The purpose of this research was to explore work commitment among new mothers during the first year of their infant's life. Many of these mothers had skills that were imperative to organizational success, making their retention a priority. The relationship between leadership support for dual roles as mothers and employees had not received attention previously in the literature. This multiple case study analyzed the perceptions of new mothers …

Bone Health Education For Osteoporosis Risk Reduction In Premenopausal Women: A Quality Improvement Project, Gloria Nichols Nichols

Walden Dissertations and Doctoral Studies

In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical …

Predictors Of Excessive Alcohol Consumption Among U.S. Business Travelers, Jennifer Clore Barrickman

Walden Dissertations and Doctoral Studies

Excessive alcohol consumption (EAC) is an important public health problem. Several researchers have examined work-related influences on EAC, but few have investigated the predictors of EAC related to business travel. This study measured the association between EAC and frequency of business travel, duration of business travel, and job industry among U.S. business travelers. Research was conducted within the social-ecological theoretical framework. Snowball sampling was used to gather data from 187 business travelers. Data were evaluated using bivariate analysis to assess the association between measures of EAC and each independent variable. Multiple logistic regression was used to adjust for covariates. Respondents …

Training And Experiences Of General Educators Who Have Students With Externalizing Behaviors, Sheila Ruann Lachelt

Walden Dissertations and Doctoral Studies

In California classrooms, general education teachers have experienced stress due to an increasing number of students with emotional and behavioral disorders (EBD). This study used a hermeneutical phenomenological inquiry approach to explore teachers' perspectives of their pre-service professional development (PD), in-service PD, and classroom experiences with students who have externalizing EBD. The theoretical framework centered on social constructivism. Research questions addressed the teachers' perceptions of their pre-service and in-service PD on students with EBD and their experiences with students' externalizing behaviors. Twenty California general education teachers, each from a different school district, volunteered to participate in face-to-face interviews. Stratified purposeful …

Standardized Assessments, Care Planning, And Improved Quality Of Life For Residents Of Adult Family Homes, John A. Rogers

Walden Dissertations and Doctoral Studies

Quality of life for adults living in adult family homes requires further attention as the elderly population continues to grow and moves from minority to majority. There is a lack of data on residents in adult family home settings and their quality of life. The purpose of this project was to identify if individualized nursing care plans had an impact on the residents' quality of life in the adult family home. In this study, a registered nurse assessed the residents to create an individualized nursing care plan that would be implemented to improve quality of life. These care plans were …

Bedside Nurse Recognition Of Delirium In The Medical-Surgical Setting, Bridget Ann Denzik

Walden Dissertations and Doctoral Studies

Delirium in adults aged 65 and older is a common occurrence in the acute care setting and is often unrecognized by bedside nurses. Delirium can trigger a negative cascade of events resulting in an increase in morbidity and mortality, functional decline, longer length of stay, and high rates of post hospital institutionalization and has a significant socioeconomic impact. The purpose of this quality improvement project was to establish a solid foundation using scholarly literature to support the development of a delirium prevention, recognition, and treatment program in the medical-surgical acute care setting applying the program logic framework. The goal was …

Risk Of Alzheimer's Disease Among Older Hispanic/Latinos With Diabetes, Kathy Bianco

Walden Dissertations and Doctoral Studies

Alzheimer's disease (AD) is the 6th leading cause of death in older Americans. Currently there is no cure for AD, and even though the specific cause is unknown, diabetes mellitus type 2 (DM2) is regarded as a risk factor. Hispanics have a higher incidence of DM2 and possibly AD. I chose a life course theoretical model for this quantitative cross-sectional study to illuminate the variables most pertinent to a pathway from good health to poor health. The variables chosen were hypertension (HTN), obesity, smoking, stroke, dyslipidemia, and lower educational attainment. The research questions were used to examine biologic, metabolic, sociologic, …

Type 2 Diabetes Prevention And Management In A Primary Care Clinic Setting, Ada Nwachuku Nwachuku

Walden Dissertations and Doctoral Studies

Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the …

Using Sbar To Decrease Transfers From The Long-Term Care To The Emergency Room, Phyllis Marie Bowers Garrett

Walden Dissertations and Doctoral Studies

Care of the elderly, long-term care resident in the emergency department is an issue of importance because of the overall impact on healthcare costs, potential for negative outcomes for the resident, and the loss of revenue. The purpose of this project was to decrease avoidable transfer of residents to the Emergency Department. Using the Antecedent, Target, Measurement logic model, poor quality assessment data was deemed the antecedent of the avoidable transfer. The goal of the project was the implementation of a standardized process of assessment that would have decreased avoidable transfer of the resident. The project would have involved training …