Digital Commons Network^™

Effect Of Therapeutic Alliance Of Clients On Methadone Maintenance Treatment Outcomes, Teresa Lyn Fresquez

Walden Dissertations and Doctoral Studies

Opioid abuse costs affect the majority of the adult population in our society directly or indirectly. The current prevailing medical treatment for opioid addiction is methadone maintenance treatment (MMT). MMT reduces infectious disease spread, illicit drug use, criminal activity, and overdose potential. MMT is only as effective as the length of time a client remains active and compliant with the program. In previous studies, therapeutic alliance (TA) has been shown to positively influence the effectiveness of substance abuse treatment. However, a gap exists in research in regards to the impact of TA on the effectiveness of MMT outcomes. The theoretical …

Managerial Strategies For Improving Employee Engagement: A Single Case Study, Ann-Marie Alcala

Walden Dissertations and Doctoral Studies

In 2013, 1% of Medicare reimbursements were withheld from U.S. hospitals, with a

proposed cap of 2% in 2017 for redistribution to those hospitals that improve overall care and patient satisfaction. The purpose of this single case study was to explore the engagement strategies that some hospital middle managers used to improve employee performance to increase patient satisfaction. The sample included 4 health care middle managers in 1 hospital in northeast Connecticut. The conceptual framework that grounded this study was Kahn's personal engagement theory. Data were collected via semistructured interviews, participant observations, and review of hospital and public government documents. …

Improving Breastfeeding Knowledge Of Staff Nurses, Patience Sirri Mbonifor

Walden Dissertations and Doctoral Studies

The World Health Organization advocates that newborn babies require exclusive breastfeeding until 6 months of age to attain a desired level of growth. Despite this recommendation, exclusive breastfeeding rates continue to be at low levels globally. The purpose of this DNP project was to examine best practices for increasing the breastfeeding knowledge of health care workers, and to understand how breastfeeding is promoted in different healthcare systems. The Critical Appraisal Checklist and the Cochrane Handbook for Systematic Reviews framed this systematic literature review. Additionally, Melnyk's levels of evidence was used to evaluate each article. Articles for inclusion were limited to …

Impact Of The Childcare Setting And Caregiver Education On Toddler Language Environment, Snejana Nihtianova

Walden Dissertations and Doctoral Studies

Young children's early language development is strongly related to their school performance, and slow language growth may predict later academic problems. The link between the language quality and amount of speech that children hear and their language development is well documented; however, the factors that impact variability in linguistic input are not well understood. The purpose of this quantitative study was to assess the association between childcare settings and childcare provider education level and toddlers' language environment. The study sample consisted of 29 Bulgarian children. The study used a new technology called Language Environment Analysis, which is the preferred method …

Role Of The Nurse During Disaster Preparedness: A Systematic Literature Review And Application To Public Health Nurses, Elizabeth Rivera-Rodriguez

Walden Dissertations and Doctoral Studies

After the 2001 attacks on the World Trade Center, public health garnered more attention. This event forced public health nurses to acquire new roles needed to respond to disasters. The purpose of this project was to synthesize the current evidence related to the role of nurses during disaster preparedness and apply that evidence to public health nurses. The practice question focused on the role of nurses during disasters which were not a part of their normal daily activity. The Fineout-Overholt, Melnyk, Stillwell, and Williamson hierarchy for grading evidence was the theoretical framework used. A systematic literature review was conducted to …

Predictors Of Job Satisfaction Among County Jail Correctional Officers, Richara Simmons

Walden Dissertations and Doctoral Studies

Job satisfaction among jail correctional officers is important because it ensures the continuity of officers who can promote and maintain a safe environment inside the jail for all staff and inmates. Most job satisfaction studies on correctional officers, however, are focused on prison officers and not county jail officers. The purpose of this correlational study was to test and extend Herzberg's Motivation-Hygiene theory by exploring job satisfaction and motivation among jail correctional officers in Miami-Dade Florida. Survey data were collected from 149 correctional officers using Specter's (1994) Job Satisfaction Survey. Data were analyzed through correlational and multiple regression analyses. Findings …

Strategies Clinic Managers Use To Reduce Missed Medical Appointments, Sophea Ey Skym

Walden Dissertations and Doctoral Studies

Patients who miss their medical appointments increase health care costs for themselves and for clinics. The purpose of this qualitative, single exploratory case study was to explore strategies health care clinic managers use to reduce medical no-shows for patient-scheduled appointments. Change management theory guided the scope and analysis. The data collection included a single clinical operations manager who have strategies to mitigate no-shows for patient-scheduled appointments participated in a semistructured interview in southeastern Virginia, the direct observation of 2 office workers in their natural setting of scheduling appointments, and for methodological triangulation, a review of organizational archival documents about missed …

Working Alliance Between Interpretive And Noninterpretive Therapy Services For Deaf Individuals, Sherri Lee Spain

Walden Dissertations and Doctoral Studies

Deaf individuals typically have access to 2 types of therapeutic services: interpretive (with an interpreter) and noninterpretive (with a sign-fluent therapist). Previous research indicates that the presence of an interpreter may hinder development of working alliance and attachment. There is a lack of empirical evidence assessing the effect of working alliance and attachment based on whether or not therapy incorporates an interpreter. The working alliance theory and the attachment theory were the theoretical foundations for this study. This study examined the difference between the strength of working alliance and attachment to the therapist given the presence or absence of an …

Education And The Development Of On-Farm Identity: Dairy Farm Women's Experiences, Amy Leigh Spangenberg

Walden Dissertations and Doctoral Studies

Women throughout the world have found emancipation through education. Yet, there has been no research on the role that education plays in dairy farm women's primary, on-farm identity development and how farm women's identities develop. The purpose of this phenomenological study was to examine dairy farm women's perceptions of previous learning (education) and its influence on their primary, on-farm identity development. The feminist standpoint theory provided the framework for this study. A homogeneous, purposeful sample of 10 active dairy farm women were interviewed using individual, face to face, semistructured questions to answer the question: What are dairy farm women's perceptions …

Strategies To Improve Millennial Employee Engagement In The Luxury Resort Industry, Kei-Lin Cerf

Walden Dissertations and Doctoral Studies

Millennials are estimated to compose half of the workforce by 2020. Many hospitality researchers have studied Millennial employee engagement, but less is known about how to apply strategies that are authentically engaging for Millennials. The purpose of this study was to explore Millennial employee engagement strategies. The research questions for this study were used to examine the engagement strategies of luxury resort leaders and how Millennial employees perceived engagement. A single case study design was used to gather interview, questionnaire, and company document data from employees of a luxury resort in Hawai`i. Kahn's employee engagement theory served as the basis …

Social Media Strategies For Increasing Sales, Loretta N. Ezeife

Walden Dissertations and Doctoral Studies

Social media have transformed business commerce and consumer communication, yet organizational leaders lack clear strategies for using social media platforms to their advantage. The purpose of this qualitative multicase study was to explore social media marketing strategies for increasing sales. The relationship marketing conceptual framework grounded this study. Data collection included semistructured interviews with 5 organizational leaders from 5 different organizations in the San Francisco, California, Bay Area and a review of participants’ documents including marketing materials, social media posts, and published sales reports. Data analysis included coding, categorization, and identification of major themes. The thematic assessment approach revealed 5 …

The Relationship Between Depressive Symptoms And Levels Of Lifestyle Activity Among Community-Dwelling Older Adults, Michael D. Gatson

Walden Dissertations and Doctoral Studies

Identifying depressive symptoms in community-dwelling elders has been problematic, due to a lack of resources and training for health clinicians. Previous researchers have indicated that older adults who engage in physical activities can prevent, or mitigate depression, but no model has included this variable in conjunction with factors such as lifestyle or sociodemographic characteristics. In this study, a predictive design was used with a regression analysis. The purpose of this quantitative study was to investigate the relationship between depressive symptoms and the different factors identified in the literature as significant contributors to its prevalence among older community-dwelling adults. Erikson's theory …

Income, Education, Age, And Physical Activity Among Physically Disabled African American Women, Sherèè Johnson Johnson

Walden Dissertations and Doctoral Studies

This study was designed to identify possible risk factors about physical activity in middle-aged disabled African American women (AAW) aged 45 to 64 years. Disabled middle-aged AAW has a disproportionate prevalence of obesity and chronic illness than nondisabled women. Most disabled middle-aged AAW leads a sedentary lifestyle, and they do not meet the recommended physical activity (PA) guidelines. Little is known about this group, and a social ecological model was used to explain PA patterns. Data were extracted from the 2009 Behavioral Risk Factor Surveillance System (N = 1,599) for women who responded yes to indicate that they needed specialized …

Reducing Stigma And Encouraging Help Seeking Intentions Through A Mental Health Literacy Program, Nicole Loreto

Walden Dissertations and Doctoral Studies

Many individuals do not seek help for a mental health problem due to stigma and fear of rejection by peers and family. Researchers have highlighted that the age group least likely to seek help is youth. Stigma acts as an important barrier to help-seeking. Evidence indicating how mental health literacy can reduce stigma and encourage help-seeking remains inconclusive. In this study, the health belief model was used to understand how college students perceived an individual's susceptibility to mental illness and the barriers associated with seeking help. A posttest-only randomized controlled trial evaluated the impact of the Is It Just Me? …

The Molecular Epidemiology Of Tuberculosis In South Carolina, 2005-2011: Estimates Of Recent Transmission And Risk Factors For Genotype Clustering, Amy Kathleen Roach

Walden Dissertations and Doctoral Studies

Because tuberculosis (TB) is a public health threat that continues to elude elimination in the United States, there is a need to identify contributing factors that may have implications for targeted control measures. Molecular studies of genetic clustering are crucial for pinpointing these contributing factors. It is for this reason this study was conducted. This was a non-experimental, cross-sectional population-based molecular epidemiological study of TB in SC from 2005 to 2011. Its purpose was to estimate the proportion of TB that may be due to recently acquired infection and to determine the risk factors associated with the genetic clustering of …

The Effect Of Volunteer Demographics On Nonprofit Volunteer Retention, Keri Vanoverschelde

Walden Dissertations and Doctoral Studies

Nonprofit organizations rely upon volunteers to assist in achieving their mission and reaching strategic operational goals. As the volunteer population in the United States has decreased, nonprofit organizations are challenged to recruit and retain volunteers. To improve operational efficiencies in nonprofit volunteer management, organizations need to implement more effective strategies to assign roles to volunteers and develop a better understanding of how those roles fit into volunteers' lives and the value systems of individual volunteers. The functional theory of volunteer behavior characterizes the values, understanding, social, career, protective, and enhancement functions as they relate to an individual's motivation for volunteering. …

Understanding Rural Appalachian Ohio Educators' Perceptions Of Students Of Poverty, Angela Dawn Hicks

Walden Dissertations and Doctoral Studies

In a rural elementary school, characterized by high poverty levels in Appalachian Ohio, school personnel were concerned that student literacy and math proficiency levels remained low during 2005-2015 and teachers had not been able to close the achievement gap between economically disadvantaged students and non-economically disadvantaged students despite a focus on literacy and math professional development (PD) provided by the district. Administrators were concerned that teachers' perceptions, and beliefs about students of poverty might contribute to students' underachievement. The purpose of this study was to understand teachers' perceptions of students living in poverty. Guided by Gorski's equity literacy theory, research …

Health Portal Functionality And The Use Of Patient-Centered Technology, Anita Joyce Simmons

Walden Dissertations and Doctoral Studies

Health portals are dedicated web pages for medical practices to provide patients access to their electronic health records. The problem identified in this quality improvement project was that the health portal in the urgent care setting had not been available to staff nor patients. To provide leadership with information related to opening the portal, the first purpose of the project was to assess staff and patients' perceived use, ease of use, attitude toward using, and intention to use the portal. The second purpose was to evaluate the portal education materials for the top 5 urgent care diagnoses: diabetes, hypertension, asthma, …

Strategies For Recruiting And Retaining Rural Emergency Department Physicians, Wanda C. Fleming

Walden Dissertations and Doctoral Studies

Recruiting and retaining physicians to work in rural emergency departments (EDs) have reached a crisis level, threatening the availability of services to rural residents. In this study, a case study design was used to explore strategies that rural ED administrators use to recruit and retain physicians to work in their facilities. The study population consisted of 5 rural hospital administrators operating EDs in central Mississippi. These administrators were charged with the responsibility to recruit and retain ED physicians.

The on-going staffing of ED physicians, with no lapses in coverage, was evidence that these administrators successfully recruited and retained ED physicians …

American Indians' Perceptions Of Obesity And Its Effects On Healthy Lifestyles, Morgan J. Foster

Walden Dissertations and Doctoral Studies

A disproportionate number of American Indians are overweight or obese and have a higher risk of other health concerns compared to the general United States population. Researchers conducting anthropometric studies have found that American Indians have higher body mass indices and worse health than most of the general United States population. There is, however, a gap in the literature regarding American Indians' perceptions, beliefs, opinions, and attitudes of obesity and its effects on their health. The purpose of this qualitative study was to determine whether American Indians view obesity as a major health concern. Focus groups and key-informant interviews were …

Toolkit For Implementation Of Temporal Artery Thermometers For Neonates, Linda Hargreaves

Walden Dissertations and Doctoral Studies

Accurate temperature assessment is essential in neonatal patients and allows for prompt recognition of illness. Temperature can be measured by rectum, which is subject to injury, axillary, which is time-consuming, and temporal artery, which is safe and fast. The purpose of this evidence-based practice quality improvement project was to create an educational toolkit for nurses teaching temporal artery thermometers for routine temperature measurement on neonates, to establish the content validity of the toolkit, and to make recommendations for implementation of the toolkit. The format applied was the Kellogg Logic Model that proceeded from the assumption, to planned work, and results. …

The Perceptions And Experiences Of African American Parents In The Management And Care Of Obese Children, Priscilla Ann Huggins

Walden Dissertations and Doctoral Studies

Childhood obesity is a global concern among all ethnic groups. Childhood obesity is a problem that continues into adulthood, exacerbating the incidence of diseases such as diabetes or heart disease. The purpose of this phenomenological study was to explore, understand, and describe the perceptions and experiences of African American parents in the management and care of their obese or overweight children. This study used the health-belief model (HBM) as its theoretical foundation, focusing on the constructs of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. This research study used an interview tool and an 8-item …

Diabetes Self Care Behaviors And Social Support Among African Americans In San Francisco, Liseli Inonge Mulala

Walden Dissertations and Doctoral Studies

Both Type 1 and Type 2 diabetes are significant public health issues that affect people of all races; Type 2 diabetes disproportionately affects African Americans with higher diagnosis, morbidity, and mortality than it affects Caucasians, and Type 1 has been increasing in incidence. Diabetes self-care activities (DSCAs) and social support have been shown to help in managing both types, which can reduce morbidity and mortality. African Americans with diabetes in San Francisco have higher rates of complications, hospitalizations, and emergency room visits secondary to diabetes. This study assessed whether a relationship exists between emotional support, practical support, affirmational support, informational …

Predictors Of Mastectomy In Male Breast Cancer, Esther Opara

Walden Dissertations and Doctoral Studies

Male breast cancer (MBC) is rare, and research on the predictors of MBC has been limited because of inadequate funding in and outside of the United States. One goal of this study was to eradicate the stereotyping of breast cancer as a female disease. The emergence of medical technology and education to benefit the public will help to ensure greater health awareness at the individual, community, and global levels. The purpose of this study was to understand the influence of the predictors of age; race (Black, White, and Other); and grade of cancer (I, II, or III) on the outcome …

Influence Of Personal Experience On Workplace Bullying Behavior, Sandra Trott

Walden Dissertations and Doctoral Studies

Workplace bullying has detrimental effects on victims and organizations. Research from the bully's perspective is lacking resulting in unknown causes for the aggressive behavior. Research indicates some child bullies have histories of maltreatment and that bullying may persist throughout adulthood. The purpose of this non-experimental quantitative study was to examine associations between workplace bullying and childhood abuse/neglect, actual or perceived current victimization, attachment style, and the desire to gain social dominance. An examination of the possible influence of social dominance on the relationship between abuse and workplace bullying was also included. Social dominance theory and attachment theory provided the framework …

An Integrated Approach To Malaria Prevention And Control In Rural Cameroon, Naomi Chuiwo Azunie

Walden Dissertations and Doctoral Studies

Malaria is a life-threatening parasitic disease spread to humans through bites of an infected mosquito. In rural Cameroon, malaria is one of the major causes of morbidity and mortality. Several studies have examined the use of various malaria preventive tools; however, there is insufficient literature available on use of an integrated approach to prevent and control malaria in rural Cameroon. The aim of this study was to provide information necessary for bridging the gap in understanding the proper use of insecticide treated nets (ITNs) and antimalarial drugs and the roles of education and socioeconomic status in malaria prevention and control …

Experiences Of Public Agency Managers When Making Outsourcing Decisions, Shakeel Baig

Walden Dissertations and Doctoral Studies

Managers in state transportation agencies in the United States must frequently choose between using the talents and abilities of in-house staff or outsourcing for road and bridge design projects. Budgetary crises have strongly affected funding for transportation infrastructure. Facing budgetary pressures to suppress costs, managers must frequently make the choice of outsourcing a project or performing it in-house. Yet, decision-making models for these decisions are inadequate. The purpose of this phenomenological study was to explore and describe the lived experiences of public agency managers when making decisions to outsource the core government functions such as road and bridge design projects. …

Employees' Organizational Commitment And Turnover Intentions, Andrea Annette Bonds

Walden Dissertations and Doctoral Studies

Employees who want to leave their companies may exhibit low morale and commitment to organizations, which may affect the way employees interact with customers. The purpose of this correlational study was to examine the relationship between employees' affective, continuance, and normative commitment to their organizations and their turnover intentions. The target population consisted of individuals with 2 or more years of call center experience who resided in the United States. Meyer, Allen, and Smith's 3-component model of commitment provided the study's theoretical framework. A purposive sampling of participants, which included a targeted audience and individuals who accessed the survey from …

Nursing Informatics Competency Program, Kristina Ann Dunn

Walden Dissertations and Doctoral Studies

Currently, C Hospital lacks a standardized nursing informatics competency program to validate nurses' skills and knowledge in using electronic medical records (EMRs). At the study locale, the organization is about to embark on the implementation of a new, more comprehensive EMR system. All departments will be required to use the new EMR, unlike the current policy that allows some areas to still document on paper. The Institute of Medicine, National League of Nursing, and American Association of Colleges of Nursing support and recommend that information technology be an essential core competency for nurses. Evidence of the need for nursing informatic …

Exercise Adherence Among Active Working Women, Roxane Evonne Hearn

Walden Dissertations and Doctoral Studies

Low levels of exercise adherence has contributed to the increased prevalence of heart disease, cancer, and diabetes in American women. These low levels, coupled with high exercise program dropout rates, point to a need for strategies to increase exercise frequency in women who exercise, but not enough to improve their health and reduce risks. Real-time interventions, such as text messaging, could be useful in improving the cognitions that regulate adherence. Using a snowball sampling strategy, a cross-sectional sample of working women (N =130), ages 18-64, in the volitional stage of exercise behavior, completed a 60-item survey on exercise behavior. Social …