Digital Commons Network^™

Chronic Pain Management In The Primary Care Setting, Rebecca Ann Day

Walden Dissertations and Doctoral Studies

Chronic pain is pain that lasts longer than 12 weeks, affects an individual physically in some mental or psychological way, influences an individual’s job performance, and may create a social complication over time. Ensuring the best possible care for the patient’s pain with the least possible complications is the responsibility of the health care provider, including nurse practitioners. Providing a clinical practice guideline (CPG) for the management of chronic pain in the primary care setting was the focus of this project. The comfort theory model was used as a framework for this project as well as the basis of nursing …

Educating Registered Nurses On Decreasing Missed Care Events, Marie St. Clair Dixon-Brown

Walden Dissertations and Doctoral Studies

Abstract

Missed care or partially completed nursing care is a prevalent problem in healthcare with negative consequences for patients, nurses, and healthcare organizations. This project was developed to address a gap in practice by providing staff education regarding the current evidence about missed care along with practical evidence-based strategies to decrease missed care events. Kalisch’s missed nursing care model framed the project. The staff education program used a PowerPoint presentation with interactive discussion and role-play opportunities for nurse participants to engage in and employ strategies to prevent missed care events. A 10-item multiple-choice post-education quiz and 4-point Likert-type program evaluation …

Perceptions Of Influence Of The Wage Gap On Immigrant Ghanaian Women’S Career Aspirations, Daniel Otoo Kwasi Djan

Walden Dissertations and Doctoral Studies

Wage inequality and gender-based career advancement barriers have plagued immigrant women in the United States since world war II. The Equal Pay Act was enacted to address wage inequalities but did little to fix the concerns of the wage gap and promotional barriers for women in the United States. This generic qualitative study addressed a research gap about perceptions of influence of the wage gap on immigrant women’s career aspirations to address the documented problem of income disparity. The theoretical framework guiding the study consisted of feminist and conflict theories . The main research question concerns immigrant Ghanaian women’s perceptions …

Staff Education On Depression Screening In An Outpatient Psychiatric Setting, Naiga Dohnji

Walden Dissertations and Doctoral Studies

Depression is among the common mental illnesses in the United States affecting 1 in 10 Americans. The U.S. Preventive Services Task Force recommended screening for depression irrespective of the risk factors. Yet, providers struggle to implement depression screening. Inadequate use of Patient Health Questionnaire-9 (PHQ-9) screening tool to identify and manage depression can lead to poor patient outcomes. PHQ-9 is valid and reliable tool used to diagnose depression and monitor treatment response. The purpose of this project was to develop, deliver, and evaluate an educational program for providers on the use of the PHQ-9 screening tool for the identification of …

The Association Between Central Line Insertion Practices And Central Line-Associated Bloodstream Infections, Mona Elgowainy

Walden Dissertations and Doctoral Studies

Healthcare-associated infections, specifically central line-associated bloodstream infections (CLABSI), continue to remain a serious public health concern in the United States. Though CLABSI can often be prevented, healthcare professionals struggle to have a positive impact on CLABSI rates. The primary purpose of this study was to determine whether CLIP Bundle adherence has an impact on CLABSI standardized infection ratio (SIR) rates in various patient care areas in California. The research questions were focused on assessing whether there was an association between patient care areas, CLABSI rates, and CLIP Bundle adherence scores. A quantitative, cross-sectional study design utilizing secondary data was used …

The Perceived Impact Of Curricular Maps On Student Retention At A Community College, Amy Ertwine

Walden Dissertations and Doctoral Studies

The problem at a community college in a state in the Eastern region of the United States is the lack of evaluation of the effect of Guided Pathways implementation on student retention in the local setting. Retention efforts are a concern of administrators of community colleges across the United States. To help students succeed, faculty often give students a specified set of core courses and a specific or even prescribed pathway to complete general education requirements. The community college incorporated Guided Pathways into retention efforts in Fall 2015. Over the past 4 years, the college has undertaken more activities focusing …

Reducing Congestive Heart Failure Hospital Readmission Through A Practice Guideline, Michelle Hamric

Walden Dissertations and Doctoral Studies

Patients with congestive heart failure (CHF) are at increased risk for hospital readmission within 30 days of discharge. The gap in practice involves the coordination of care for patients with CHF in the transition from hospital to home. Patients with CHF are at increased risk for hospital readmission due to barriers involving self-care, communication, and coordination of care. The purpose of this project was to implement a clinical practice guideline (CPG) that used a predictive tool and clinical pathway for coordination of care for CHF patients at increased risk for hospital readmission within 30 days. The DNP project involved using …

Implementing A Diabetes Optimization Protocol For Elective Surgery Patients, Barbie Denise Harbaugh

Walden Dissertations and Doctoral Studies

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Public Health Care Policies And Their Impact On Patient Satisfaction, Bryan John Henderson, Ph.D.

Walden Dissertations and Doctoral Studies

Health care is a trillion-dollar industry, but without public policies in place to support a sustainable health care system, life would decline. For instance, health care providers now receive decreased payments from federal agencies if their health facility scores do not meet national benchmarks. The purpose of this retrospective, quantitative, comparative study was to examine the extent to which patient satisfaction was impacted by national public health policies in the United States and Canada. The research questions related to how health care reimbursement policies and patients’ financial responsibility of both the eastern United States and eastern Canada would predict country-specific …

African American College Students’ Attitudes Toward Help Seeking For Mental Health Illness, Sylvia Krow

Walden Dissertations and Doctoral Studies

Past research has shown that African Americans are less likely to seek treatment for mental health illness compared to individuals in other ethnic groups. Research has also revealed that African American college students’ attitudes, perceptions, and stigmas against mental illness impacts their willingness to seek treatment for mental illness. The purpose of this quantitative, nonexperimental, correlational study was to investigate the predictive relationships between ethnic identity, perceptions of mental illness, stigma and attitudes toward seeking professional help for mental illness among African American college students attending Historically Black colleges and universities. The research question addressed the predictive relationships between ethnic …

Employee Engagement In The Federal Sector: An Exploration Of Communication, Respect, Motivation, And Encouragement, Jody Mcdaniel

Walden Dissertations and Doctoral Studies

The purpose of this qualitative case study was to investigate and deepen the understanding of employee engagement in the multigenerational workforce of a federal agency. Organizational culture in combination with the dispersion of staff across multiple generations presented the opportunity to inform the case study through scientific management theory and the theory of generations as well as concepts regarding organizational change, employee satisfaction, and organizational leadership. Research questions involved investigating factors influencing the reduction in employee satisfaction and engagement, the impact of generational differences, and the role leadership plays in altering employee engagement. Survey questions were developed based on 4 …

Strategies For Reducing Employee Turnover In Small- And Medium-Sized Enterprises, Tijani Mohammed

Walden Dissertations and Doctoral Studies

Employee turnover leads to increased operational costs and workloads and affects sales performance. Reducing employee turnover is essential for managers of small and medium sized enterprises to minimize costs and increase sales performance. Grounded in the job embeddedness theory, the purpose of this qualitative multiple case study was to explore strategies managers of small and medium sized enterprises use to reduce employee turnover that negatively affects sales performance. The participants consisted of 3 managers of small and medium sized enterprises in the Bronx, New York. Data were collected using semistructured, face-to-face interviews, and a review of organizational documents. A thematic …

Examining Barriers Impacting Women’S Promotion Into C-Suite Positions In Higher Education, Lynette Johnson Nelson

Walden Dissertations and Doctoral Studies

The United States Department of Labor indicated that women represent 46.8% and men represent 53.2% of the United States’ 16 years and older civilian labor force. An estimated 52% of adult women compared to 48% of men participating in the civilian labor force held a bachelor’s degree or higher, and women represented 47% of the management and professional sector’s positions. Women occupy 25% of C-suite positions in the Standard & Poor 500 companies. In higher education, 30% of college presidents are women. Women continue to face several barriers as they try to move into senior executive leadership positions. The specific …

Special Operations Forces Culture And Implications For Interagency Collaboration, Bradley Rhinelander

Walden Dissertations and Doctoral Studies

The Horn of Africa exemplifies maritime instability due to regional climate, environmental, economic, food, and security issues. Future global challenges require collaborative approaches between U.S. government and military organizations to span organizational boundaries and leverage the strengths and insights of diverse organizations. The purpose of this research was to examine organizational culture and identity, as manifested in organizational literature, to identify opportunities and challenges to interagency networks and collaboration in the realm of confronting wicked problems around the globe. The research questions focus on the cultural and normative elements of organizational identity as manifest in the context of organizational literature. …

Using Patient-Staff Ratio To Improve Patient Care Outcomes, Fadekemisola Oludayo Timothy

Walden Dissertations and Doctoral Studies

The persistence of nurse scarcity has been documented by many researchers as the leading problem in the critical care setting. A high nurse to patient ratio leads to poor healthcare outcomes associated with increased nurse burn out, medical errors, and low-quality care services. Solving the issue of nurse scarcity is still a challenge due to lack of an effective multidimensional staffing model. In this project, a multidimensional staffing model was developed based on the relationship between patient-to-staff ratio, together with and other factors in the care environment which impacts patient outcome. The project was framed on Donabedian's structure, process, and …

Educational Program On Human Immunodeficiency Virus For Clinic Staff, Margaret Ayoade

Walden Dissertations and Doctoral Studies

Medical assistants (MAs) and nurses provide primary care to patients infected with the human immunodeficiency virus (HIV). However, differences in their standard workflow were observed to affect the provision of preventive care. This warranted intervention due to prevalence of ongoing HIV-related stigma that affects HIV prevention and care. The practice-focused question asked whether an educational program could fill an identified gap in knowledge to assuage the fears of MAs and nurses providing care to HIV-positive patients. The project was guided by Kolb’s experiential learning theory and Lewin’s change theory. The purpose was to develop an educational program to educate the …

Preparing Clinical Faculty To Teach And Reinforce Hourly Rounding, Lisa Bailey

Walden Dissertations and Doctoral Studies

A gap exists in the knowledge of clinical faculty teaching prelicensure students about hourly rounding. The purpose of this project was to develop an educational program to prepare clinical faculty teaching student nurses to conduct hourly rounding. Hourly rounding trained faculty ensure safe practice by students and adherence to hospital policies. Hourly rounding includes the 4 Ps, which entails the assessment of “potty”, pain, position, and possession/periphery. Models and theories used to inform the project included the American Academy of Pediatrics’ 10-step process for developing training courses, Knowles’ theory of adult learning, Kirkpatrick's evaluation model, and the Accreditation Commission for …

Guiding The Future Of The Supply Chain With Succession Planning, Dana Martin Beal

Walden Dissertations and Doctoral Studies

Some supply chain leaders in the transportation sector lack the succession planning strategies needed to fill leadership positions. The failure to create succession planning strategies will negatively impact an organization’s supply chain through tacit knowledge loss. Grounded in the social exchange theory, the purpose of this qualitative exploratory single-case study was to explore the succession planning strategies transportation industry supply chain business leaders use to fill organizational leadership positions to reduce tacit knowledge loss. The participants consisted of 6 supply chain leaders working in the Northeastern region of the United States who successfully utilize succession planning strategies to fill leadership …

The Relationship Between Multifaceted Motivational Factors And Academic Achievement, Sandra Luann Beasley

Walden Dissertations and Doctoral Studies

The United States has yet to reach the White House’s 2020 goal of attaining the top international ranking in college degree attainment among young adults. Researchers have investigated the academic performance variables associated with timely degree attainment for first-year college students. Prior research has indicated that poorly motivated students are likely to struggle academically, experience academic stress, and drop out of school. However, it remains unknown which types of motivation significantly affect academic achievement. The purpose of this study was to better understand which Reiss basic desires of motivation predict undergraduate academic achievement. An additional purpose of this study was …

Homelessness And Hiv Risk: Experiences, Perceptions, And Beliefs Of Transgender Youth, Darcia Bryden-Currie

Walden Dissertations and Doctoral Studies

Human ImmunodeficiencyVirus (HIV) continues to be a public health concern in the United States, with increased rates of infection among transgender youth. The phenomenon of homelessness is also a significant challenge for transgender youth. Gender expression often results in stigma, and discrimination, many trans youth experience poverty, rejection, and low self-esteem, which are precursors to homelessness. The purpose of this qualitative phenomenological study was to explore the influence that homelessness has on sexual risk associated behaviors in transgender youth. The theoretical framework that guided this study was Bandura’s social cognitive theory. The research questions sought to explore how this population …

Impact Of Leadership Changes On Employee Engagement In A Behavioral Health Organization, Martina Burnett

Walden Dissertations and Doctoral Studies

The increased need for patient care at the target behavioral health organization (BHO) required greater employee engagement to provide better services. Identifying strategies that are helpful for health care leaders to engage employees is beneficial to ensuring better patient care. A case study was conducted to determine whether changes in leadership in the social work department (SWD) of the BHO had an influence on employee engagement. The Baldrige excellence framework and its criteria for performance excellence were used to examine the behaviors of leaders and the ways their performance and work processes sustained the BHO during organizational changes. Data were …

Third Grade Math Teachers’ Perceptions Of Their Preparedness To Teach The Standards For The Staar Math Test, Diana L. Everman

Walden Dissertations and Doctoral Studies

Teacher professional development (PD) is acknowledged as an effective approach for changing teachers’ beliefs, practices, and behaviors to raise student academic achievement. A rural school district identified that 3rd grade math teachers felt inadequately prepared to teach the College and Career Readiness and Academic Standards (CCRS) standards for the state math assessment (STAAR). The purpose of this basic qualitative study was to explore third grade math teachers’ perceptions of their preparedness to meet the demands of the new third grade STAAR math test. Vygotsky’s constructivist theory from an adult learning perspective and Bandura’s self-efficacy theory guided the study. The research …

Maternal And Infant Birth Characteristics As Predictors Of Sudden Unexpected Infant Death, Betty Jean Ezell

Walden Dissertations and Doctoral Studies

Sudden Unexpected Infant Death (SUID) is a public health issue recognized by the United States Centers for Disease Control and Prevention (CDC) as the sudden and unexpected death of a baby less than 1 year old, often during sleep, with no obvious cause. Despite known SUID risk factors for infants and mothers, there is limited research on combinations of infant birth characteristics and mother demographics that could be indicative of a higher risk of infant death. The purpose of this cross-sectional quantitative study was to examine the extent to which infant birth characteristics, delivery characteristics, month prenatal care began, and …

Association Between Mental Health Problems, Substance Use, And Social Support In Youth, Venida Gray

Walden Dissertations and Doctoral Studies

Mental health problems are a major public health concern and may be associated with substance use among youth. Youth who receive inadequate social support are at risk of experiencing mental health problems and engaging in substance use. The purpose of this study, guided by the relational regulation theory of social support and the self-medication theory, was to determine whether there was an association between mental health problems, social support, and substance abuse among middle school (MS) and high school (HS) students and whether this association varies with age, using secondary data from the Maine Integrated Youth Health Survey This study …

Experiences And Challenges Of Social Workers Working With Transitioning And Postmilitary Service Members Who Have Mental Health Issues, Joyce M. Hewitt

Walden Dissertations and Doctoral Studies

Active duty service members, veterans, and their family members are faced with a myriad of problems including mental health issues, substance abuse issues, traumatic brain injury, suicide, family integration issues, and family distress. Understanding the organizational, environmental, and person-centered factors that affect the delivery of mental health care treatment to active duty service members, veterans, and their families is urgent to this unique population for social work practitioners (licensed master, advanced, & clinical). This project explored the experiences and challenges that social work practitioners (licensed master, advanced, & clinical) have in providing effective services for mental health care treatment to …

Traumatic Early Life Stress In The Developing Hippocampus: A Meta-Analysis Of Mri Studies, Sharon Johnson

Walden Dissertations and Doctoral Studies

Advancements in neuroimaging techniques afford researchers the opportunity to examine the actual brains of living persons, which exponentially contributes to new insights regarding brain and behavior phenomena. However, empirical studies investigating stress and the hippocampus attend primarily to adult populations - less on children and adolescents. Covariates such as the type of trauma, the duration and severity of the abuse, genetic predispositions, gender, poverty, and age often present as confounding factors that muddle the attempts to establish linkages between interpersonal, environmental, and neurobiological correlates. Although researchers primarily agree that traumatic early life stress (TELS) has some impact on early brain …

The Influence On Employee Engagement Of Employee Negative Perceptions Of Leader Actions, Vickki Gamol Johnson

Walden Dissertations and Doctoral Studies

In 2018, only 34% of U.S. workers reported that they were engaged in their jobs, up from 31.5% just 4 years prior. Employee engagement, organizational well-being, and leader actions are significant to companies and brands in a highly competitive, modern business environment. The alarmingly low rate of employee engagement resulted from negative perceptions of leaders. The purpose of this qualitative study was to explore the phenomenon of disengagement through the lived experiences of employees in the public sector who had negative perceptions of their leaders. The conceptual lens was Herzberg’s theory mapped onto Maslow’s hierarchy to address the research question …

A Multiple Case Study Of School Administrators On Use Of Disciplinary Measures, Michele L. Jones-Pace

Walden Dissertations and Doctoral Studies

Disproportionately high rates of out-of-school suspension and expulsion of African American children represent an ongoing issue in the U.S. public school system. Bronfenbrenner’s ecological theory was used as the theoretical framework for this multiple case study. The research question focused on the perceptions, perspectives, and experiences of a purposeful sample of 7 high school principals and what they believed were the reasons for persistently high rates of out-of-school suspension for African American students. The principals represented Title I and non-Title I schools located in urban, rural, and suburban regions of a southern state. Data from individual interviews and archival data …

African American College Students’ Perspectives Of Academic Challenges To Graduation, Bobby Calvin Luckett

Walden Dissertations and Doctoral Studies

Even though the enrollment numbers of African American students are comparable to other racial/ethnic groups at a university in the midwestern United States, the problem investigated through this study was that African American students were graduating at a slower rate compared to other groups. The purpose of this study was to explore the perceptions of African American university students about the academic challenges they faced as they worked towards graduation as well as their experiences with and suggestions to improve institutional support to meet these challenges. The study was based on Tinto’s retention theory. For this basic qualitative study, data …

Budget Support And Quality Of Public Governance In West Africa, Ademonkoun Rodolphe Godfried Missinhoun

Walden Dissertations and Doctoral Studies

Donors have been increasingly using budget support since 2000 to associate development aid delivery with improved development institutions and good policies that will ensure aid effectiveness, in particular in West Africa Economic and Monetary Union (WAEMU) countries. There is however little evidence that budget support promotes good policies and institutions in WAEMU countries. The purpose of this quantitative research was to explore relationships between budget support as an official development assistance modality and public expenditures efficiency as an indicator of public governance quality. The aid effectiveness theoretical framework developed by Cordello and Dell ’Ariccia informed research questions to determine whether …