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Primary Care Physicians’ Attitudes, Beliefs, And Actions Toward Geriatric Treatment, Andrea Renee Holzner

Walden Dissertations and Doctoral Studies

AbstractIn the United States, an estimated 49.2 million older adults seek specialized geriatric medical treatment from a primary care physician (PCP). Due to a nationwide geriatrician deficit resulting from significant aging population growth, PCPs now manage specialized geriatric issues, such as Alzheimer’s disease, cognitive assessments, and physiological impairments, such as Parkinson’s, due to non-normative aging. Although PCPs may take geriatric courses, geriatric specialization is beyond a normative primary care medical practice. The purpose of this generic qualitative study was to explore primary care physician attitudes, beliefs, and actions, toward geriatrics and to expand the understanding of primary care physicians’ geriatric …

Homeowners’ Lived Experience In Developing And Using Accessory Dwelling Units In Ireland, Geraldine Mary Hurley

Walden Dissertations and Doctoral Studies

Researchers have explored the role of accessory dwelling units (ADUs) as a form of housing since at least the 1970s. Such exploration has taken place across a number of different disciplines, including gerontology, housing affordability, and urban planning. The literature tends to focus on specific policies, however, rather than on the lived experience of the homeowners impacted by those policies. Ireland’s national and local governments have yet to acknowledge the potential use of ADUs as a contributing solution to ongoing problems with housing supply, housing affordability, and homelessness, despite a government-declared national housing crisis. Formal research on ADUs in the …

Reducing Fall Rates At A Long-Term-Care Facility, Francis Ortego

Walden Dissertations and Doctoral Studies

In the United States, older adults often experience fall events that may result in physical, mental, and financial hardship. Since the project site was experiencing a significant number of patient falls, a fall-prevention quality improvement (QI) program was implemented. Guided by the diffusion of innovation theory and the plan-do-study-act (PDSA) model, the purpose of this doctoral project was to evaluate the effectiveness of that program to determine if the monthly fall rate in the facility would decrease during the next 6 months. The project site provided deidentified data in the form of monthly fall-rate totals as collected from the long-term-care …

Nursing Staff Education Fall Prevention Program At A Skilled Nursing Facility, Solomon Lomo

Walden Dissertations and Doctoral Studies

Falls have negative effects on the confidence, function, and quality of life in older adults and are major cause of injury and death among this population. The quality assurance report in a long-term care facility identified an average of 10 falls per week in the last quarter of 2017. The facility has a person-centered policy, which creates fall prevention challenges when usual fall protective practices are prohibited. The purpose of this education program was to educate staff nurses working with patients in a long-term care facility on additional evidenced based practices to prevent falls and injuries without compromising the person-centered …

The Systemic Experiences Of Social Workers In An Inpatient, State Psychiatric Hospital, Kesia Gwaltney

Walden Dissertations and Doctoral Studies

The National Alliance on Mental Illness surmised that 1 in 25 (9.8 million) adults in the United States are diagnosed with a serious mental illness annually. Of the 9.8 million people diagnosed, approximately 63% of them are psychiatrically hospitalized with repeat hospitalizations within 1 year of discharge. Social workers play a vital role in the treatment modalities of the patients they serve in the psychiatric hospital; however, there is no research that examined the professional systemic experiences of social workers in state, inpatient psychiatric hospitals and how these experiences may affect treatment outcomes of patients as it relates to frequent …

An Educational Program For Nursing Home Nurses On Sepsis In Older Adults, Wendy Belden

Walden Dissertations and Doctoral Studies

Elderly nursing home patients’ high rates of hospitalization due to sepsis impact their morbidity and mortality and significantly cost the U.S. healthcare system. Skilled nursing facility (SNF) nurses who have the knowledge to assess older adults for signs and symptoms of sepsis and communicate findings to providers are instrumental in providing improved care for patients. The purpose of this doctoral project was to provide a group evidence-based educational intervention on sepsis care of older adults geared toward nurses working in SNFs. The practice-focused question asked whether an educational intervention focused on the signs and symptoms of sepsis in the elderly …

Staff Education On Medication Screening Tool For Nursing Home Residents, Jinkee Sarah Beltran

Walden Dissertations and Doctoral Studies

The prevalence of potentially inappropriate medications (PIMs) among nursing home residents continues to be high. Researchers have demonstrated that the use of a medication screening tool identifying PIMs can improve medication safety among older adults. Screening tools, such as the Beers criteria and the Screening Tool for Older Persons’ Prescriptions (STOPP), are evidence-based guidelines that use several validated criteria to identify PIMs in older adults’ medication regimens. While the use of these tools is standard in the acute care setting, limited studies have been conducted regarding their use in the nursing home setting. The purpose of this project was to …

Content Analysis Of Ethics Curriculum Requirements In Undergraduate Social Work Programs, Debra Evonne Thrower

Walden Dissertations and Doctoral Studies

Due to recent mandates of the 2015 Council on Social Work Education (CSWE) Educational Policies and Accreditation Standards, social work ethics education has received considerable attention. These standards have increased the focus on ethical education requirements in bachelor’s and master’s curricula. However, research regarding approaches that undergraduate institutions use to implement the required content remains limited. The purpose of this qualitative study was to examine ethics education requirements in the syllabi from practice courses at CSWE-accredited undergraduate social work programs. Common morality theory and curriculum theory were theoretical frameworks that guided examination of the phenomenon. Data were collected from 51 …

Systematic Review Of Falls Among Older Individuals In The Long- Term Care Settings, Nonyelum Patience Odenigbo

Walden Dissertations and Doctoral Studies

Falls are common in the older population and can result in disability, increased dependence, or mortality. Falls have received increased attention in the literature as the most common cause of injuries among older individuals. The incidence of falls in the older population has a positive correlation with adverse health issues necessitating major lifestyle adjustments. The problem is magnified for older patients in long-term care settings where they are 3 times more susceptible to falls. The purpose of this project study was to conduct a systematic review of the literature to understand the impact and incidence of fall rates among older …

Exploring The Effectiveness Of The Psychiatric Emergency Response Team At A Washington State Hospital, Laura Kay Schilling

Walden Dissertations and Doctoral Studies

Patient-to-staff assaults have become a barrier to workplace safety at U.S. psychiatric hospitals. Assaults on staff result in loss of productive social service for the mentally ill; increases in labor, industrial, and medical costs from claims; and psychological scars, such as posttraumatic stress disorder, that may never completely heal. The purpose of this quantitative study was to explore the effectiveness of the Psychiatric Emergency Response Team (PERT) at the Washington state hospital in reducing patient assaults on staff. There is very little research to substantiate the effectiveness of the PERT program as a conduit of workplace safety in psychiatric institutional …

Clinical Practice Guideline: Early Screening For Dementia In Diabetes Mellitus, Angelyn Levell-Smith

Walden Dissertations and Doctoral Studies

AbstractDiabetes mellitus (DM) is a recognized cognitive impairment risk factor. Even with hyperglycemia being a modifiable risk factor in dementia, primary care is without an evidence-based screening tool to screen patients with diabetes for cognitive abilities. Current literature supports developing an evidence-based standardized guideline for early screening for cognitive impairment in elderly patients with DM. The purpose of this doctor of nursing practice (DNP) clinical practice guideline (CPG) project was to develop an evidence-based CPG for early screening of dementia in patients with DM, providing a means for early recognition of cognitive decline in these patients, making early intervention more …

Improving Effective Pain Assessment And Management In Elderly Patients, Omotola A. Adebayo

Walden Dissertations and Doctoral Studies

Inadequate management of pain is common in the elderly, and the negative implications are often profound. Untreated pain has been associated with negative consequences such as depression, anxiety, sleep disruption, weight loss, and limitations in the performance of daily activities and functions. The purpose of this educational project was to improve the assessment and management of pain of elderly patients residing in long-term care facilities (LTCFs). The project question examined the effects of staff education on the nursing staff’s knowledge of pain assessment and management. Nonlicensed personnel are at the forefront of providing direct patient care in LTCFs. Knowles’s theory …

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

Walden Dissertations and Doctoral Studies

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

Education Toolkit On Restraint Reduction In The Intensive Care Unit, Sharon Watkins

Walden Dissertations and Doctoral Studies

The use of physical restraints in hospitals has been in practice for the better part of a century despite the many adverse effects it can have on patients. Socially, restraint use can strip the patient of their dignity in addition to their freedom. This evidence-based project was to build a toolkit to educate intensive care unit (ICU) nurses regarding the negative effects physical restraint use can have on their patients and to present alternatives to their use. Tools developed from prior research were included in the toolkit, and the Neuman systems model was applied to the overall education project. The …

Pain Assessment Strategies For People With Cognitive Impairment In Nursing Home Settings, Meskelo Tsegaye Bobo

Walden Dissertations and Doctoral Studies

Assessment of pain in patients with a diagnosis of dementia or cognitive impairment continues to be underdiagnosed as there are no objective ways of assessing their pain. Available evidence also indicates that these patients are not receiving satisfactory pain management. Due to a lack of self-reporting of pain, accurate assessments of pain are challenging. This systemic review aimed to find a pain assessment strategy effective in identifying pain in patients with a diagnosis of dementia. Kolcaba's theory of comfort was used as the theoretical framework for the study. The databases of Medline, Cochrane Database of Systematic Reviews, Embase, and Cumulative …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …

Effectiveness Of A Standardized Fall Assessment Tool In Reducing Falls Among Elder Home Health Clients, Terica M. Woods

Walden Dissertations and Doctoral Studies

Because of the physiological changes that occur with the normal aging process, falls tend to have more serious consequences in individuals age 65 and older. The purpose of this systematic review of literature was to analyze studies that addressed the impact of a multifactorial fall risk assessment tool on decreasing falls in the elderly home health patient population following hospitalization. The conceptual model for this project was Roper, Logan, and Tierney’s activity of daily living model. A narrative analysis was used to analyze 16 selected articles from the CINAHL, ProQuest and MEDLINE databases. Results indicated that implementing fall assessment tools …

Fall-Related Patient Education: An Essential Feature Of A Fall Prevention Program, Immaculata Okonkwo

Walden Dissertations and Doctoral Studies

This project documented the evaluation of a voluntary patient falls prevention education

program (VPFPEP) of a rehabilitative facility in a Mid-Atlantic US state and ascertained

its sustainability. The project was designed using the customized Moore et al. evaluation

model and Lippitt’s planned theory of change to encourage patient engagement in

physical activity (PA) through fall prevention education to allay patients’ fear of falling.

The sample included patients who opted into the facility’s VPFPEP. Evaluation was

performed using run charts to visually and quantitatively monitor trends and patterns of

fall incidents over time. Run charts also facilitated comparison of injuries sustained …

Work Adjustment And Family Caregiver Engagement In The Healthcare Transaction, Cynthia Uecker

Walden Dissertations and Doctoral Studies

Unpaid family caregivers in the U.S. now exceed 40 million people, and the question of how to effectively support the family caregiver is now decades old. Healthcare’s dominant perspective is reasonable because healthcare sees the family caregiver in the healthcare transaction. The research consistently reports caregivers cite lack of information and training as a primary reason for feeling the healthcare provider is non-supportive. This qualitative phenomenological study employed semi-structured interviews to explore whether non-supportive might represent a disconnect between caregiver and the healthcare provider purposes with respect to the caregiver role. The theory of work adjustment provides context for considering …

Adhesive Transparent Chlorohexidine Gluconate Tegaderm™ Gel Dressing For Central Venous Catheter, Peter Kimiti Mwangi

Walden Dissertations and Doctoral Studies

Central-line-associated bloodstream infections (CLABSIs) occur during the insertion or change of the dressing of the central venous catheter (CVC) and are reportable healthcare-associated infections at the state and the national level. The purpose of this systematic review of the literature was to evaluate and synthesize available evidence to establish the effectiveness of using an adhesive transparent chlorohexidine gluconate (CHG) Tegaderm™ gel dressing for CVC in the prevention of CLABSIs. The logic model was used as a framework to guide the review of the literature to establish how an intervention that is not currently practiced can contribute to CVC prevention of …

Implementing Aromatherapy For Falls Reduction In The Inpatient Hospice Population, Kimberly Kay Pistek

Walden Dissertations and Doctoral Studies

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted …

Caregiver Review Of Nonpharmacological Interventions For Behavioral Symptoms Associated With Dementia, Karla Chaney Ballew

Walden Dissertations and Doctoral Studies

Alzheimer’s disease (AD) is the most common form of dementia and affects an individual’s overall cognitive function, including orientation, memory, and executive function. Most AD patients in the United States reside in residential care facilities or private homes under the care of individuals with little education on the challenges of the AD patient. Among the challenges faced by caregivers are behavioral and psychological symptoms related to dementia (BPSD). Education has been shown to improve caregivers’ treatment of BPSD in AD patients and to improve caregiver retention. The purpose of this project was to develop an evidence-based education module guided by …

Mental Health Counselors’ Experiences In Personal Counseling, Torrie Gilden

Walden Dissertations and Doctoral Studies

In various aspects of the counseling profession, instructors, supervisors, and colleagues often recommended that their fellow counselors engage in personal counseling for professional development and personal wellness. However, the existing literature has yet to explore the lived experiences of mental health counselors in personal counseling. The purpose of this transcendental phenomenological study was to explore the lived experiences of mental health counselors in personal counseling. Purposeful sampling was used to select 7 licensed mental health counselors in a Northwestern state. Data collection methods included semistructured interviews in person and via Zoom, an online video conferencing format. Interpretive phenomenological analysis was …

Exploring Social Worker Knowledge, Conceptualization, And Use Of Cultural Humility In Hospice, Shelby L. Schiller

Walden Dissertations and Doctoral Studies

This capstone project examined social workers’ knowledge, values, and beliefs as related to the concept of cultural humility to determine how hospice care professionals treat patients’ cultural preferences and traditions with respect and sensitivity at the end of life; as such practices have the ability to improve the hospice experience. Research questions addressed in the study (a) how social workers in Nevada define cultural humility in the context of hospice social work practice, (b) the values or principles hospice social workers in Nevada consider most important in providing culturally appropriate care to hospice patients, and (c) the ways hospice social …

Staff Education Intervention To Enhance Care Planning For Older Adults, Mozhgan Peiravi

Walden Dissertations and Doctoral Studies

The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study's project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether …

Developing A Clinical Practice Guideline For Improving Communication During Transitions Of Care, Darla P. Hardy

Walden Dissertations and Doctoral Studies

Transition of care refers to the movement of patients between health care settings; it occurs each time patients move between providers within the same setting or between settings based on the patient's acute or chronic health care needs. Care transition includes the efficient and accurate exchange of information needed to provide high-quality continuity of care. A rural community hospital in in the northeastern region of the United States has a skilled nursing facility and an acute care hospital on one campus. This project focused on the development of a clinical practice guideline (CPG) for the hospital to improve communication during …

Unmet Support Needs Of Informal Caregivers Of Older Adults, Julie Ann Smith Hinders

Walden Dissertations and Doctoral Studies

Due to projected growth of the 65-and-older population and concerns of an impending care gap, reliance on informal caregivers is expected to increase. Improving support for informal caregivers is viewed as a national priority, yet research related to the unmet support needs of informal caregivers is limited. The purpose of this cross-sectional correlational study was to examine predictive relationships between contextual factors (caregiving relationship and type of illness) and environmental factors (rurality) and the unmet support needs (classes, service access, support groups, counseling, and respite) of informal caregivers of older adults. The theoretical framework was Bronfenbrenner's ecological systems theory. Archival …

An Aging Workforce And The Technology Gap: An Exploratory Multiple Case Study, Julie Sulene Francis-Pettway

Walden Dissertations and Doctoral Studies

A gap exists in the literature on the actual experiences of older workers with information and communication technology adoption in technology-infused workplaces. To inform organizations on how to more effectively support this employee group's adoption of technology, the purpose of this qualitative exploratory multiple case study was designed to gain a deeper understanding of the daily experiences of older workers when adopting and adapting to information and communication technologies in a technology-infused workplace. This study is framed by, first, the selection-optimization-compensation framework for successful aging and, second, the age-inclusive training design framework. Semistructured interviews with 8 participants, observational field notes, …

Thirty-Day Readmission Risk Factors Of African American Adult Copd Patients With Tracheostomies, Shekeita Gibson

Walden Dissertations and Doctoral Studies

The purpose of this study was to assess the association between hospital readmission and demographic variables (age, BMI, gender, income, marital status, comorbidities, and smoking history), and size and type of tracheostomy among African American chronic obstructive pulmonary disease (COPD) patients with tracheostomies. The Andersen model was the theoretical framework for this quantitative study. Secondary data were obtained from a long-term acute care facility. The sample comprised 438 African American adult patients admitted between 2010 and 2017. Logistic regression was used to analyze each research question and assess the odds of 30-day hospital readmission. The results indicated that the odds …