Digital Commons Network^™

Perceptions Of Fear Of Falling In Older Adults, Ken Germano

Walden Dissertations and Doctoral Studies

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence …

Decreasing Hospital Admission Rates In Long-Term Care, Melanie R. Meissner

Walden Dissertations and Doctoral Studies

Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best …

An Interprofessional Collaborative Approach To Fall Prevention Education, Lisa Prince-Clark

Walden Dissertations and Doctoral Studies

Hospital falls among medical-surgical inpatients are a safety concern. Inpatient falls that lead to significant injuries may be reduced by fall intervention education, which can lead to the preparedness of the patient and care providers. Orlando's deliberative nursing process theory and the plan-do-check-act model were applied to address the project practice-focused question that explored whether the education of staff nurses on fall prevention interventions would reduce the incidence of falls during a 2-month period. The purpose of the project was to implement and evaluate nursing staff education on the Morse fall scale, an evidence-based fall-prevention intervention. Evaluation of staff nurse …

Training Satisfaction Of Behavioral Health Providers Treating Older Adult Substance Use, Claudia Lpc Crosse-Wynn

Walden Dissertations and Doctoral Studies

Substance use disorders among the baby boomer generation are steadily increasing, but knowledge and training satisfaction regarding older adult substance use disorders among behavioral health providers (BHPs) has not been explored. Using the Kirkpatrick evaluation model, this quantitative study involved an examination of the knowledge and training satisfaction of four behavioral provider groups: addiction counselors, licensed professional counselors, marriage and family therapists/social workers, and psychologists. Each participant (N = 154) completed a demographic questionnaire, satisfaction questionnaire, and the Alcohol and Older Adult Questionnaire to measure knowledge level on older adult substance use disorders. The results showed that licensed professional counselors …

Experiences And Attitudes Of Older Homeless Women Toward Healthcare Access, Mary Ann Mueller

Walden Dissertations and Doctoral Studies

Homelessness among older women is a growing problem in many metropolitan areas of the United States. Researchers have indicated that health issues and problems accessing basic care are connected. Older homeless women face increased health issues, multiple challenges related to accessing basic care, and low incomes which put them at higher risk of becoming homeless, staying homeless, and delaying medical treatment. The homeless who lack fulfillment of social support and timely medical care are considered repetitive users of the emergency department and hospital stays. The purpose of this phenomenological study was to explore the experiences and beliefs of older homeless …

African American Sibling Relationships When Caring For An Alzheimer’S Parent, Cynthia M. Smith

Walden Dissertations and Doctoral Studies

Alzheimer’s disease (AD) is the most commonly occurring form of dementia that affects African Americans at 2 to 3 times higher rate than other ethnic or racial groups in the United States. As the number of older African Americans with AD grows rapidly so will the need for daily supports; therefore, informal caregivers, such as an adult offspring, often assume the role of filial caregiver. Focusing on the unique patterns of caregiving among African Americans, this generic qualitative study may help explain the adult offspring’s perspective on sibling relationships as they function in the role of primary filial caregiver. Equity …

Instrumental Role Modeling And The Sensitive Topic Of Obesity: A Grounded Theory, Tulie Blot Gay

Walden Dissertations and Doctoral Studies

The nurse practitioner (NP) role is more prominent now than ever before in primary healthcare, positioning them as providers who defend initiatives and ongoing health agendas. Obesity is among those agendas. The concept of instrumental role modeling was explained as a combination of understanding and physical presence that gives meaning and quality to inspire change. It implied that health professionals are not merely insightful clinicians but suggested their expertise is complimented by demonstrations of wellness in knowledge and practice. This topic of weight was perceived as sensitive but must be addressed. In this grounded theory study, the perspectives of NPs …

Educating Staff Nurses For Successful Patient Discharge, Julie First-Williams

Walden Dissertations and Doctoral Studies

The definition of a successful discharge is a discharge that results in patients successfully managing a chronic disease for at least 30 days without requiring an acute inpatient hospitalization. Many chronic disease readmissions are preventable. Successful discharge planning takes a multidisciplinary team that includes nurses who assess the discharge plan and provide additional education where needed. The purpose of this project was to determine staff nurses' understanding of their role in discharge education. Dorothea Orem's self-care deficit theory guided the project and root cause analysis was used in the development of the problem statements. Staff nurses (n=12) from evening and …

The Use Of Compassionate Release Policies For Elderly Offenders, Lindsey Martin

Walden Dissertations and Doctoral Studies

This research examined the use of compassionate release policy in response to the fastest-increasing segment of the prison population- elderly offenders. Though this policy is an approach to this problem, there was little available research regarding which correctional organizations in the United States adopt compassionate release and how it is used. The purpose of this nonexperimental comparative quantitative study was to examine the use of the policy in neighboring and distant state correctional systems relative to those organizations that used the policy more frequently to determine if the leader-laggard theory of policy diffusion was an effective policy-implementation framework. The research …

Experiences And Challenges Of Social Workers Providing Services To Elderly Veterans, Maritza Rivera-Moret

Walden Dissertations and Doctoral Studies

The social work practice problem of this doctoral action research project was the unmet mental health needs of veterans 65 and older in Puerto Rico. This action research project explored the experiences and challenges of social workers when they offer mental health services to veterans 65 and older. This study was framed using social support theory, integrating the 3 core elements of tangible support, emotional support, and informational support. The data collection technique included a semistructured interview protocol used in a focus group setting. Purposive sampling was used to identify 9 participants who were licensed social workers in Puerto Rico. …

Effects Of Stigma On The Use Of Spirituality By Older Black Men Living With Hiv, Warren Lee Miller

Walden Dissertations and Doctoral Studies

Previous research on HIV stigma and the use of spirituality by people living with HIV/AIDS is scarce. Moreover, the research with older Black men who have sex with men (BMSM) is scant. The focus of this qualitative transcendental phenomenological study was to examine the lived experiences of BMSM living with HIV aged 50 and older with encounters of HIV stigma on the use of spirituality. The research questions were designed to explore the lived experiences of aging, HIV stigma, and spirituality. Conceptually, this study was framed within the minority stress theory and the HIV stigma framework. Data were collected through …

A Nursing Education Program To Decrease Use Of Psychotropics Among Dementia Patients, Tami Felicia Blackmon

Walden Dissertations and Doctoral Studies

Dementia, a clinical condition that affects the psychological ability of patients, is distinguished by a significant overall decline in cognitive function that results in distorted perception. Guiding nursing practice in the long-term care (LTC) setting to decrease the unnecessary use of psychotropics is critical because doing so relates to the patients' quality of life and safety. In the LTC facility that served as the practicum site for this study, there was an observed overuse of psychotropic medications in the care of patients with dementia. The practice-focused question guiding this project asked whether a nursing staff development program would decrease the …

Dementia-Spcific Education In An Assisted Living Facility, Sharon Dianne Samarin

Walden Dissertations and Doctoral Studies

Providing competent, high-quality, and person-centered care is important in the healthcare environment, including the care for the aging and training of those who provide care. A knowledge gap in dementia-specific training was identified at an assisted living facility. The purpose of this project was to answer the question whether a dementia-specific educational staff training program would improve staff members' knowledge and application of dementia-specific competencies as well as caring behaviors. Watson's theory of human caring, the theory of planned behavior, and Leininger's framework of culture care were used to inform this project. The educational project evaluated the success of implementing …

Benefits Of Prayer On Depression In Elderly Adults, Jared Errol Leet

Walden Dissertations and Doctoral Studies

Depression in the elderly population is a growing concern in the United States. A decrease in depression in the elderly could lead to greater quality of life and reduced cost of healthcare services. The Sense of Coherence Theory was utilized as the theoretical foundation for this study. The purpose of this study was to use archival data to analyze differences in depression scores by groups based on prayer (yes/no) and over time (wave 1/wave 2 of data collection) when controlling for amount of time spent in prayer by category, gender, and ethnicity. The data were retrieved from the National Archive …

Usefulness Of Medication Scanners In Clinical Practice: A Systematic Review, Laura Leonard Cure

Walden Dissertations and Doctoral Studies

Thousands of people die each year due to preventable medication errors. Barcode medication administration (BCMA) systems can reduce medication errors at the point of care, thus increasing patient safety. The purpose of the project was to gather evidence regarding BCMA usefulness in reducing medication errors. Kurt Lewin's 3-step change theory was used to guide this project. The nature of this project was a systematic review of the literature pertaining to the effectiveness of using BCMA systems to reduce medication errors in at the point of care in the hospital setting. The Johns Hopkins nursing evidence-based practice model and tool kit …

The Experiences And Perceptions Of African American Women Who Reside In Nursing Homes, Lakeisha De Lon Riley

Walden Dissertations and Doctoral Studies

The purpose of this qualitative case study was to examine the experiences and perceptions of African American women who reside in a nursing home and to understand African American women's decisions for admitting to the facility. Social Learning Theory was applied to answer the question of how African American women's experiences and perceptions toward long-term care influence healthcare decisions and admission to a nursing home. Eleven participants interviewed in the study were at least 60 years old, admitted into the facility within the past two years and who had not previously resided in a nursing home. Yin's five step approach …

Well-Being Among Parents Of Young Adults With Intellectual Disabilities When Transitioning From High School, Teshawnia Thompson

Walden Dissertations and Doctoral Studies

Transition out of high school for young adults with intellectual disabilities (IDs) has been described as a stressful time for individuals and their families, with increased demands for caregiving and parental support. A lack of research is associated specifically with those individuals with moderate IDs and their parents' experiences of well-being during the transition process. The purpose of this phenomenological study was to understand how parents of young adult-aged children with moderate IDs experience well-being as their child transitions from high school to adulthood. Ryff's model of psychological well-being was used as the conceptual framework to better understand and explore …

Enhancing The Nurse Aide Student's Knowledge Of Evidence-Based Geriatric Care Practices, Vivienne Mcdaniel

Walden Dissertations and Doctoral Studies

Certified nurse aides provide approximately 65% of care to more than 1.4 million older adults residing in nursing homes who have been diagnosed with 1 or more chronic illnesses or debilitating conditions. Licensed nurses rely on nurse aides to report potentially harmful status changes in geriatric residents. Nurse aides often receive limited education and do not have a structured care process to guide them in their practice in the geriatric population. The purpose of this educational quality improvement project was to develop a geriatric-specific nurse aide care process to increase the knowledge of student nurse aides regarding processes to identify …

Implications For Public Policy Regarding Gay Seniors Living In Suburban Florida, Brian Fuss

Walden Dissertations and Doctoral Studies

In less than 20 years over 6 million lesbian, gay, bisexual, and transgender (LGBT) individuals will be over 65 years old designated as seniors according to the Older Americans Act. When public policies for the aging population are implemented, LGBT individuals are forgotten, especially those living in nonmetropolitan areas. Using a purposeful convenience sample and a phenomenological approach 7 gay seniors residing in Florida suburban areas were interviewed to explore their lives as they age. Aging policies were investigated through the social construction of deservedness lens to ascertain individual political power while exploring (a) the challenges of living in suburban …

Type 2 Diabetes Management For Geriatric Veterans, Fachecia L. Fort

Walden Dissertations and Doctoral Studies

Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project …

Nonpharmacological Behavioral Interventions For Patients With Dementia: An Integrative Literature Review, Michelle Monique Spears

Walden Dissertations and Doctoral Studies

The use of antipsychotic medications in older adults with dementia increases risk of

mortality; therefore, it is critical that nurses use nonpharmacological interventions in dementia care. The nurses' role is integral to implementation of treatment strategies to dementia patients and efforts to improve care in patients with dementia using a nonpharmacological approach are necessary. Therefore, guidelines outlining nonpharmacologic dementia care management will enable nurses to provide a wider spectrum of care to dementia patients. The purpose of this project was to make recommendations for the development and implementation of interdisciplinary practice guidelines to standardize care in the organizational setting. An …

A Grounded Theory Of Millennials Job-Hopping, Deborah L. Rivers

Walden Dissertations and Doctoral Studies

Corporations are finding it challenging to attract and retain the top talented Millennials. Their frequent job-hopping is costing the U.S. economy $30.5 billion annually despite corporations' best efforts to retain them. The central research question concerns the decision-making process that Millennials use to decide whether to job-hop or stay with an organization. The purpose of this qualitative study was to develop a theory that explains the Millennials' process for deciding whether to job-hop or stay with an organization. The conceptual framework for this grounded theory research is generational theory, Herzberg's hygiene and motivational factors, and psychological contract theory. The data …

A Causal Layered Analysis Of Assistive Technology For The Cognitively Impaired Elderly, Dariusz J. Ropiak

Walden Dissertations and Doctoral Studies

Assistive technology may delay cognitively impaired elders' need for long-term institutionalization, and the promote independence. Its use is on the rise, yet the gap between the needs of the cognitive impaired elderly and what developers of the assistive technologies design, manufacture, and implement, remains to be filled. Using Inayatullah's 6-pillar approach, as the guide to the future of assistive technology, the purpose of this qualitative study was to explore how assistive technologies may fulfill the daily functional needs of the cognitively impaired elderly with Alzheimer's or other dementia by 2037. Data were collected from a focus group of 10 seniors …

Improving Nursing Knowledge, Satisfaction, And Retention In Long Term Care, Ghislaine Barry

Walden Dissertations and Doctoral Studies

Through advancements in modern medicine, human beings worldwide are living longer. The increase in life expectancy creates a need for a more qualified and knowledgeable nursing workforce for the delivery of quality geriatric health care. Although nurses are the primary care providers for vulnerable older adults, they are generally not well trained or prepared in geriatric care. Therefore, the purpose of the project was to develop an education program aimed at improving nursing knowledge of geriatric care in the long-term care (LTC) setting. The goal of the project was to answer the research question: What impact would attendance in the …

Impact Of Osteoarthritis Self-Efficacy Toolkit On Adults With Osteoarthritis, Connie Hutley Kiser

Walden Dissertations and Doctoral Studies

Over 26 million U.S. citizens have a form of arthritis; osteoarthritis (OA) is the most common form. Self-efficacy (SE) is defined as a psychological construct which identifies an individual's confidence when performing a behavior. SE is deemed a vital judge of self-management (SM) in those with OA. The purpose of this evidence-based practice, quality improvement project was to improve SE in OA patients. The identified gap in nursing practice was the lack of SE in OA patients. The project question asked whether a toolkit with information regarding SE in OA can improve SE of management of disease-associated symptoms in adults …

Diabetes Self-Management Problems Of Older, Low-Income African American Women, Pearlean Day Day

Walden Dissertations and Doctoral Studies

Type 2 diabetes disproportionately affects low-income African American women, age 50 years and older: 30% to 40% of this population has this chronic disease. Two significant factors affecting poor diabetes practice adherence are food insecurity and depression; another is obesity. The purpose of this quantitative correlational study was to determine if either food insecurity or depression significantly affect Type 2 diabetes self-management practices; and/or if food insecurity significantly influences practice adherence indirectly, through the mediator of depression, while controlling for obesity. The research questions were aligned with the theoretical pathways posited in Matthews's reserve capacity model (RCM) and used the …

Quality Improvement Initiative To Reduce Fall Risk In The Snf, Ramona C. Lancaster

Walden Dissertations and Doctoral Studies

Residents who fall in SNF either sustain significant decline to quality of life or die from their injuries. The average fall costs about $34,000 per incident. On average, 19.8% of residents fall at least once per month. The purpose of this project was to assess, identify, and advance nursing practice to decrease falls by evaluating current facility standard of practice, fall policy, procedures, and protocol. The objective was to create actions that would close the communication gap between clinicians and residents. This project encourages clinicians to intertwine resident feedback and strategies into the plan of care to help reduce fall …

Development Of A Guideline For Hospice Staff, Patients, And Families On Appropriate Opioid Use, Trenika Alexander-Goreá

Walden Dissertations and Doctoral Studies

There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand …

Initial Findings Of A Medicare Annual Wellness Visit Program, Hesper B. Nowatzki

Walden Dissertations and Doctoral Studies

Despite the emphasis of benefits on preventive health, many older adults are not receiving the recommended age specific, evidence based screenings and vaccinations. The Medicare Annual Wellness Visit (AWV) is designed to address modifiable risk factors with aging adults and close gaps in care not captured in routine office visits. Although a free Medicare benefit to patients, and a reimbursable service to health care providers, participation in the AWV is low nationwide. The purpose of the project is to introduce an AWV program to a rural health clinic in Northwest Illinois that has a population consisting of over 25% of …

Perceptions Among Senior Consumers Regarding Stereotyping In Magazine Advertisements, Greg Milsom

Walden Dissertations and Doctoral Studies

Marketing decision makers often employ stereotypes in their advertising messages, but constant exposure to negative messages is offensive to older consumers and contributes toward ageism. The general problem is that many senior adults feel dissatisfied with advertising directed toward them and may not purchase products that they could otherwise enjoy. Based on the tenets of social identity theory, the purpose of this study was to explore the perceptions of a group of senior consumers toward the stereotypes used to portray older adult models featured in magazine advertisements by uncovering the factors that influence purchasing decisions and the stereotypes that are …