Digital Commons Network^™

Steps To Reducing Heart Failure Hospital Readmissions Through Improvement In Outpatient Care, Paticia Laubach Dunn

Walden Dissertations and Doctoral Studies

The outpatient care of the heart failure (HF) patient is fragmented due to the lack of evidence-based practice guidelines use. The primary goal of this project was to improve the care of the HF patient in the outpatient arena through use of clinical pathways using the logic model as the project framework. The intervention was carried out over a 4-week period on a convenience, random sample of patients (n = 80) attending a cardiology practice. The patients were recruited from 2 physicians' patient populations and were selected based on an adult diagnosis of HF, reduced ejection fraction of <40% at some point in time, and the New York Heart Association (NYHA) functional class II-V. Comparisons were made in the documentation of care between patients on or off the pathway. The intervention included documentation of patient education, care follow-up, medications, NYHA functional class, and symptom exacerbation, documented in the electronic medical record. The quality of care data were evaluated based on 3 of the Joint Commission core measures for outpatient care of the HF patient. Additional data were collected regarding use of the clinical pathway based on provider and week of implementation. Data were analyzed via a Chi-square test of independence comparing pathway use by provider and use of pathway as study progressed. The comparative results show statistically significant differences in use of the pathway by provider and a statistically significant increase in use during the project . The quality of care results varied in statistical significance. The pathway utilization increased over time and provided a method for standardizing documentation of care for the HF patient in this outpatient clinic, a benefit for HF patients and providers in this cardiology practice and beyond.

The Effects Of Barriers Toward Fighting Childhood Obesity Within Head Start, Vanessa Chaney

Walden Dissertations and Doctoral Studies

Childhood obesity is associated with significant morbidity and mortality and poses a health care burden. Child care facilities serve at the forefront in fighting childhood obesity among preschoolers. Since 2009, a significant shift has occurred in studying child care settings among children aged 3-5 in North Carolina and South Carolina in response to the rising rates of obesity in this population. Some of the hypothesized determinants of childhood obesity among preschoolers in North Carolina and South Carolina are outdoor activity, staff behavior, center's size and location. The purpose of this study was to investigate if significant relationships exist between childhood …

The Influence Of Nursing Home Administrator Turnover On Resident Quality Of Life, Juliet Iheoma Madubata

Walden Dissertations and Doctoral Studies

By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address …

Perceived Factors Contributing To Coronary Heart Disease In African American Women, Funmilola O. Sholanke

Walden Dissertations and Doctoral Studies

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to …

Case Study Of Parental Involvement For Enhanced Kindergarten Students' Development In Low Socioeconomic Households, Robyn Tresnak

Walden Dissertations and Doctoral Studies

Evidence suggests that parents in low socioeconomic households may have unaddressed educational needs about their children's development. The purpose of this case study was to discover innovative ways parents in a low socioeconomic community engaged in activities with their young children to influence academic and social development. Bronfenbrenner's ecological theory of human development and Epstein's parental involvement model, the family process model, and the family strength model were used to build the conceptual framework. Parents and educators were asked to describe parent-engagement opportunities that were provided within the kindergarten classroom. Data were collected using a focus group with 13 educators …

Speaking Their Language: Integrating Social Media Into Childbirth Education Practice, Deborah Weatherspoon, Christopher Weatherspoon, C. Ristau

Walden Faculty and Staff Publications

With the advancement of modern technology, the internet has become a standard platform for many forms of communication and education. The majority of pregnant females fall into the cohort known as Millenials and have experienced technology since early in life. Millenials consider technology as part of their everyday life and use it for personal interaction or a source of information. The established comfort with the use of technology combined with busy lifestyles, multiple commitments, transportation costs or logistics, childcare, or a desire for privacy, support the use of perinatal online learning. This article examines options that childbirth educators may consider …

Cyp2a6 Polymorphisms May Strengthen Individualized Treatment For Nicotine Dependence, Yawo M. Akrodou

Walden Faculty and Staff Publications

Each CYP2A6 gene variant metabolizes nicotine differently depending on its enzymatic activities. The normal nicotine metabolizer CYP2A6*1A is associated with high scores of nicotine dependence (5-10) on the Fagerström Test for Nicotine Dependence (FTND) scale because it encodes for enzymes that catalyze nicotine 100%. Slow nicotine metabolizers (i.e., CYP2A6*1H, CYP2A6*4A, CYP2A6*9, and CYP2A6*12A) are associated with underrated nicotine metabolizing activity (50%-75%), linking them to low scores for nicotine dependence (0-4) on the FTND scale. In a clinical trial involving the use of bupropion, people who were carriers of slow nicotine metabolizers were found to have a tendency to maintain abstinence …

The Environmental Health Of The Autistic Student In The Public School Classroom, Antonia Klein

Walden Dissertations and Doctoral Studies

Professionals have found autism to be an enigmatic condition. While necessary

biomedical research continues, a gap exists in the inclusion of parental opinions,

knowledge, and experiences in educational planning for their autistic children. The

purpose of this mixed methods study was to identify the factors that the parents felt

contributed to the academic success of their autistic child in the public school classroom

environment and ways in which their ideas might contribute to overall educational

planning and classroom design in structure, curriculum development, and intervention

strategies which might lead to reduced stress. Parental input was explored through

semistructured personal interviews …

Weight Management Counseling And Obesity Severity In Children With Special Health Care Needs, Adeola Sonaike

Walden Dissertations and Doctoral Studies

Epidemiologic surveillance indicates an increased susceptibility to obesity among children with special health care needs (SHCN) in comparison to children without. The present study investigated this disparity in weight severity between both groups, with a focus on the provision of obesity management counseling by physicians. This study consisted of a retrospective medical record review that acknowledged the effect of patient-provider interactions on health behaviors and risk perceptions. An independent sample t test compared the incidence of clinician-initiated obesity management counseling received by children with SHCN to that which was received by children without SHCN. This t test revealed a statistically …

The Effect Of An Online Coping Skill Application On Relapsing-Remitting Multiple Sclerosis Sufferers, Jennifer H. Garrison

Walden Dissertations and Doctoral Studies

Many individuals with multiple sclerosis (MS) are classified as having relapsing-remitting MS (RRMS), a form of the illness that requires constant symptom management for suffers to achieve optimum outcomes. There are only a few community-based educational programs that exist to help RRMS sufferers cope with their illness; the effectiveness of those that have been fielded has not yet been adequately assessed. The research questions of this study were to determine if an online training development module would increase the coping skills of those affected by RRMS and if the online educational module would be more effective at improving the coping …

Program For Healthcare Personnel To Improve Anti-Hypertensive Medication Adherence In Black Adults, Verena D. Johnson

Walden Dissertations and Doctoral Studies

Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience …

Learned Helplessness And Depression: Comparison Of Skilled Nursing And Assisted Living Facilities, Paul Lynn Susic

Walden Dissertations and Doctoral Studies

Research with geriatric populations suggests high levels of clinical depression and greater financial and psychological costs of treatment in long-term care facilities with more restrictive care. Research on learned helplessness, a construct separate from depression, suggests learned helplessness and perceived control are useful theories for the study of elder depression, but the relationship between depression and learned helplessness in this population is not clear. This cross-sectional quantitative study examined the relationship between depression and learned helplessness by comparing residents over age 65 in less restrictive assisted living (n =42) versus those in more restrictive skilled nursing facilities (n =63). Data …

A Mindfulness-Based Stress Reduction Psychoeducational Program In Postpartum Support Groups, Marina Pesserl

Walden Dissertations and Doctoral Studies

Postpartum Depression (PPD) affects 15% of women after childbirth. Its etiology includes psychoneuroimmunologic factors with long-lasting postpartum stressors that lead to allostatic overload. Using mindfulness-based stress reduction (MBSR) for PPD has not yet been studied. Addressing this literature gap, the potential benefits of including an 8-week MBSR component based on Beck's theory of PPD at support groups were examined in this phenomenological study based on a sample of 10 women and 2 group facilitators. Purposes of the study included describing the experience of PPD and the MBSR program, identifying the stage of behavioral change of the participants, and describing the …

Teachers' Perceptions Of Multimodal Literacies In Middle School Health Literacy Programs, Cynthia Darlene Jackson-Howard

Walden Dissertations and Doctoral Studies

Health literacy, defined as the ability to understand and use health information to make informed decisions, is critical to maintaining health; however, not all U.S. states mandate strategies to improve adolescents' health literacy. Moreover, many middle school teachers are often unaware of how their roles could improve the health literacy of their students. Multimodal literacies help students to create meaning through viewing print-based resources and using digital technologies. The purpose of this study was to investigate teachers' perceptions of the effectiveness of multimodal literacies on adolescents' overall health literacy via the introduction of health literacy programs into the curriculum. This …

Knowledge, Attitudes, Beliefs, And Behaviors Of Diabetes Among Afro-Caribbeans Near Brooklyn, Sophia I. Allen

Walden Dissertations and Doctoral Studies

Literature has found that some minority groups with diabetes have a negative perception of medical professionals when a health problem occurs. This trend is particularly problematic with the diabetes epidemic in the United States. African Americans are more than 2 times as likely to die from diabetes than are Whites, and diabetes prevalence has increased exponentially in New York City where a majority of Afro-Caribbeans live. To address this problem, a cross-sectional design was used to recruit Afro-Caribbeans diagnosed with type 2 diabetes across 7 churches to examine whether shared knowledge, attitudes, beliefs, and behaviors about diabetes screening and its …

Exploring The Lived Experiences Of Seniors Aging In Place, Magaly C. Dante

Walden Dissertations and Doctoral Studies

Baby boomers are living longer, and as they age, they will need more supportive services that may include housing, mobility, nutrition, personal care, or health care. Despite the studies that have been conducted on baby boomers aging in place (choosing to stay in their home versus move to an institution), the focus has been on the old and frail and very little has been done to address the lifestyle of active (physically functioning) baby boomers. The purpose of this phenomenological study was to understand the lived, shared experiences of active baby boomers regarding their beliefs and attitudes about aging in …

A Clinical Pathway Education Program For Pediatric Nurses, Lisa M. Scheiber-Case

Walden Dissertations and Doctoral Studies

Clinical pathways have been studied to promote best practices in nursing and enhance patient satisfaction. For 10 years a pediatric orthopedic surgical team at a Midwest hospital has not had a clinical pathway to treat or standardize care for adolescents following posterior spinal fusion surgery. Pain scores and patients' length of stay were collected using a retrospective chart review. This information was used to revise preoperative education materials and develop a visual poster. The purpose of this project was to identify and develop a way to educate the pediatric nursing staff on the use of the developed educational materials, poster, …

Skype As A Scaffolding Tool For Underprepared Freshmen English Composition Students, Conswellor Denise Ogden

Walden Dissertations and Doctoral Studies

Nontraditional students enrolled in online courses tend to drop out within their first year because they do not have the basic literacy skills or essential college skills needed for success. They often need the guidance of an online instructor. The purpose of this case study was to explore the perceptions of instructors and students about the effectiveness of Skype as a scaffolding tool for increasing academic achievement for underprepared students in online remedial English composition courses through interactions with their instructor. The conceptual framework included Bruner's cultural-psychological theory of education, Vygotsky's social constructivist theory, and Siemens's connectivism theory. The study …

Assessment Of Vitamin D Levels And Depression Among Adults In The United States, Troy Jean-Luc Owens

Walden Dissertations and Doctoral Studies

Vitamin D is essential to optimizing health; vitamin D deficiency (VDD) can increase risk of hypertension, cardiovascular disease, and insulin resistance. VDD occurs when individuals do not receive sufficient oral intake or obtain adequate sun exposure. Previous researchers indicated there is a relationship between VDD and depression, while others have indicated there is no relationship. The purpose of this study was to examine the relationship between vitamin D levels and depression, and how this relationship might be moderated by an individual's demographic characteristics (gender, age, smoking status, or marital status). This study was a quantitative data analysis of archival data …

The Association Between Exhaled Nitric Oxide In Exhaled Breath Condensate And Chronic Obstructive Pulmonary Disease, Colin Mitchell

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD), a progressive and nonreversible disease, is a leading cause of mortality and morbidity throughout the world. Detecting COPD early in the disease process will help in decreasing later stage COPD severity. Because airway inflammation is a hallmark of COPD, it has been proposed that measuring exhaled nitric oxide, a marker of inflammation, in exhaled breath condensate could prove to be an inexpensive and efficient method to detect COPD in outpatient settings. Using the hypothetico-deductive theory as a guideline, this study used secondary data from the National Health and Nutrition Examination Survey 2007 to 2010 to …

Psychosocial Predictors Of Successful Bariatric Surgery, Rodney D. Grim

Walden Dissertations and Doctoral Studies

Obesity is an epidemic that can lead to a wide range of physical and mental problems. When traditional weight-loss methods are not effective, bariatric surgery is a viable weight-loss option. While previous researchers have investigated the role of psychological factors in relation to obesity, few have investigated psychological factors as predictors of weight loss and complications after bariatric surgery. The purpose of this study was to determine the prevalence of psychological disorders/conditions (e.g., depression and abuse) in the study population, evaluate weight and psychosocial variables before and 6 months after weight-loss surgery, and identify psychosocial factors that are predictors of …

Indentifying Effective Communication Practices For Eliciting Parental Involvement At Two K-8 Schools, Karen Lynn Moore

Walden Dissertations and Doctoral Studies

Conventional wisdom suggests effective and timely school communications increase parental involvement. Guided by this wisdom and contemporary parental involvement theory, effective educational institutions have established systems that foster communication and collaboration between school representatives and the local community. Despite such efforts, research has revealed persistent declines in parental involvement within schools. This phenomenological study documented 16 parents' perceptions of communication between teachers and parents at 2 K-8 schools in the American southwest. Semi-structured interviews were used to explore parents' perceptions of the effectiveness of various school-based communication systems and the specific impact these systems had on parental involvement. NVivo software …

Factors Influencing Employee Participation And Nonparticipation In A Rural Hospital's Employer-Sponsored Wellness Program, Nicole Marie Kolacz

Walden Dissertations and Doctoral Studies

Employer-sponsored wellness programs are important tools for keeping employees healthy, reducing an organization's healthcare expenses, mitigating risk factors, and promoting health and well-being. Little research is available on the factors associated with employees' participation in wellness programs in rural hospitals. Pender's health promotion model was used to determine how employees who participated in a rural hospital's wellness program differed from those who did not participate in terms of demographics, perceptions of personal health, general health behaviors, health locus of control, self-motivation, and situational barriers. A descriptive, correlational replication with the Hallion and Haignere questionnaire was used to survey employees. Of …

Retail Distribution Within The New York City Organic Cacao Market, Omari Nekoro Williams

Walden Dissertations and Doctoral Studies

The purpose of this multiple case study was to explore strategies small physical commodities firm owners need to establish a distribution channel within the commodities market to enhance profits. The general business problem was that importing physical commodities from emerging markets was not profitable. The specific business problem was some small physical wholesale commodities firm managers lacked strategies to establish distribution channels for imported commodities. The information presented in this study is important to suppliers, manufacturers, distributors, and retailers of organic cacao products to identify strategies to enhance their distribution channels. Disruptive innovation and the theory of constraints grounded the …

Knowledge Of Diabetes Mellitus And Health-Preventive Behaviors Among African American Adults, Wanka Ndifor

Walden Dissertations and Doctoral Studies

The purpose of this study was to gain insight into the risk within the African American population of developing diabetes, its complications, and the benefits associated with timely management and treatment of diabetes. The study also looked at how such knowledge may be related to preventive health behaviors. The Risk Perception Survey-Developing Diabetes and the Behavioral Risk Factor Surveillance System questionnaires were employed in this study. The theoretical basis of this study was the health belief model. This was a cross sectional, quantitative study with 126 participants. Descriptive analysis was employed to calculate the mean scores and frequencies across each …

Graduate Nurse Pediatric Emergency Nursing Orientation Program, Mindi Lynne Johnson

Walden Dissertations and Doctoral Studies

Research has found that the turnover rate of graduate nurses within their first year is significantly high. Specialties such as pediatric and emergency nursing have even a higher turnover rate. It has been suggested that significant amounts of stress and lack of skills are responsible for the turnovers. This quality improvement project, which is theoretically based on Benner's novice to expert theory, will examine if a lack of a specialized pediatric emergency graduate nurse orientation program is a contributing factor. The purpose of the project is to improve retention of graduate nurses by implementing a specialized orientation program that focuses …

Relationships Between Specific Health-Related Fitness Components And Standardized Academic Achievement Tests, Tona Wilson

Walden Dissertations and Doctoral Studies

In an attempt to meet monetary-driven mandates to improve student achievement test scores, administrators are replacing physical education activities with subject matter classes in many American schools. This practice negates the positive contributions of physical activity to academic performance and student fitness. Guided by self-efficacy theory, this study assessed the impact of optimal versus minimal physical fitness state on student academic achievement. The study sample included 5,416 9th grade students from the same school district who completed a minimum of 5 of the 6 components of the FITNESSGRAM tests, and who also completed the math and English language arts (ELA) …

Relationships Between The Coordinated School Health Program And Childhood Obesity In Tennessee, Tekeela Shonta Green

Walden Dissertations and Doctoral Studies

Childhood obesity rates have increased nationwide, but rates of childhood obesity are higher in Tennessee (TN). The Coordinated School Health (CSH) Program is a multicomponent approach designed to improve academics and health in children in Tennessee; however, researchers have not evaluated the 8 components of the plan and the impact it has on weight in children. The purpose of the study was to determine if a relationship existed between the Coordinated School Health Program and obesity in children. The conceptual framework for this study was Bandura's social cognitive theory. One hundred forty CSH coordinators in TN were surveyed and the …

Weight Management Of Women Of Childbearing Age, Marcia Hagen

Walden Dissertations and Doctoral Studies

Black River Memorial Hospital identified obesity as a priority health concern in its rural service area; this concern was in line with the county's needs assessment. It was identified that women of childbearing age affect the lifestyle and health choices of their families and that they are at higher risk for the additional health risks associated with obesity affecting pregnancy and birth. Despite the identification of these risk factors, the factors that affect healthy weight management have not been well understood. Using the life course theory, a qualitative inquiry in the form of a structured interview was developed with local …

The Association Between Asthma Management And Routine Posture Exercise, Anne-Marie Lydie Coleman

Walden Dissertations and Doctoral Studies

Asthma cannot be cured, but it can be managed. Asthma management is a public health issue that is complex. Medication, asthma triggers, age, and the environment are all factors that impact asthma management. There is a gap in research in terms of what lifestyle characteristics need to be in place in order for adults to manage asthma. Shaw found that posture care is a lifestyle variable that should be explored as it relates to asthma management in older adults. The Life University Clinic (Marietta, GA) sees asthmatic patients daily and teaches them about a posture care routine through a program …