Digital Commons Network^™

Water Sustainability Leadership Fostering Stakeholder Engagement, Rosa Elena Bustillos Wong

Walden Dissertations and Doctoral Studies

Water conservation management and water use behaviors of U.S. citizens are critical to secure water for future generations. An American citizen consumes approximately 88 gallons of water per day. On a local scale, a Florida citizen uses 134 gallons per day and wastes 71% of the total municipal drinking water provision in landscape activities. The problem addressed in this study was that administrators working on water conservation programs undergo difficulty fostering stakeholder engagement to advocate a water use behavioral change. The purpose of this qualitative exploratory multiple case study was to understand how citizen water use behaviors influence stakeholder water …

Treatment Plans For Diabetes Management During Hurricane Maria In Puerto Rico, Joel De La Cruz Oller

Walden Dissertations and Doctoral Studies

The purpose of this study was to evaluate the health outcomes of diabetic patients in Puerto Rico, before, during, and after Hurricane Maria, in 2017. The Department of Health in Puerto Rico provided the secondary data for the variables low-density lipoproteins (LDL) cholesterol, hemoglobin A1C (HbA1c), mortality, and consumer price index (CPI). The inclusion criteria were participants for whom electronic data were available before, during, and after Hurricane Maria; the sample size was 450. The theoretical framework for this investigation was the health outcomes and impact assessment. The data were analyzed by univariate and analysis of variance (ANOVA) to compare …

Gratitude Among Mothers Raising A Child With Special Health Care Needs, Keli Jean Kleindorfer

Walden Dissertations and Doctoral Studies

For a mother raising a child with special health care needs (CSHCN), maintaining positive feelings of gratitude can become challenging because of the stress associated with caregiving, as well as the consequences of unmanaged stress, which include decreases in both physical and psychological health and well-being. Chronic, unmanaged stress has been associated with various health issues that can be severe and potentially life-threatening. The purpose of this phenomenological study was to examine how mothers raising a CSHCN experience gratitude. A secondary purpose was to identify possible barriers to experiencing gratitude, which, when implemented as a coping style, may decrease the …

Improving Nursing Knowledge Of Heart Failure Discharge Self-Care Instructions, Maria Patricia Picar Deza

Walden Dissertations and Doctoral Studies

Patients with heart failure (HF) have recurrent symptoms that lead to frequent hospital readmissions. Moreover, HF is one of the leading causes of 30-day hospital readmissions. Evidence shows that patients with a high level of HF self-care have decreased readmissions. HF self-care education is commonly delivered by the nurse at hospital discharge, and the patient’s transition to self-care is a critical point in the continuum of care. However, nurses must be knowledgeable of patient self-care in HF to effectively convey this information to the patient upon discharge. Therefore, this staff education project question asked whether nursing knowledge of HF patient …

Meat Intake And Prostate Cancer In African American Men, Uchenna Njoku

Walden Dissertations and Doctoral Studies

African American men have more prostate cancer and are more than twice as likely to die of the disease as Caucasian men, and the reasons for this racial disparity have not been clarified. Identifying lifestyle and dietary risk factors of prostate cancer is an important public health issue. Studies on the association between meat intake and prostate cancer risk have produced inconsistent results. The purpose of this cross-sectional quantitative study was to determine whether there is an association between total meat intake and total prostate cancer risk among African American men when controlling for age, income, educational level, physical activity, …

Behavioral, Demographic, And Clinical Determinants Of Hiv Serostatus In Zambian Women, Debebe Masresha Gebreyohannes

Walden Dissertations and Doctoral Studies

The rate of human immunodeficiency virus (HIV) infection shows a diminishing trend at the global level while it shows increasing in intensity of mortality, morbidity, and burden in Sub-Saharan Africa. The intertwined behavioral, demographic, and clinical determinants fueled the incidence of infections in Zambian women. The purpose of this study was to determine the association between demographic, behavioral, and clinical determinants with HIV serostatus in Zambian women. With the conceptual framework of the World Health Organization’s Commission for Social Determinants of Health (CSDH) and quantitative method of MANOVA, this study examined Zambian Demographic Health Survey data for Zambian women of …

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 …

Experiences Of Low Socioeconomic Community College Students Anticipating Transition To A 4-Year University, Richard Hayward

Walden Dissertations and Doctoral Studies

Low socioeconomic status students in the United States are facing declining completion rates for the attainment of 4-year degrees, which may have consequences for their economic well-being. The purpose of this study was to understand lower socioeconomic status students’ experiences regarding a sense of belonging, academic advising, and college preparedness while attending community college and transitioning to a 4-year university. The conceptual framework for this study was grounded in Strayhorn’s findings pertaining to a sense of belonging, Bandura’s social cognitive theory, Adelman’s momentum theory, and Schlossberg, Waters, and Goodman’s transition theory. This basic qualitative study used interviews with 11 community …

Exploring Health Literacy In The Acute Care Setting In A Rural Border Region, Shiloh Williams

Walden Dissertations and Doctoral Studies

Health literacy is important to ensuring patients have the necessary knowledge and skills needed to actively participate as a member of their own healthcare team. Patients with low health literacy are at increased risk for poor outcomes and limited participation in decisions affecting their health or treatment plan. Using the Social Ecological Model (SEM) as a framework, the purpose of this study was to determine the relationship between medical-surgical registered nurses, medical-surgical patients and the registered nurse’s (RN) assessment of their patient’s health literacy of those who live in a rural-border region. The study’s sample consisted of 84 pairs of …

Risk Factors For Polysubstance Abuse: A National Secondary Data Analysis Study, Dakota Mcmurray

Walden Dissertations and Doctoral Studies

Substance abuse is a serious public health problem in the United States and globally. Abuse of more than one substance is considered polysubstance abuse and can cause more harm than abuse of only one substance. Polysubstance abuse compounds the problems of addiction because of the variety of substances that may be used and the resulting side effects. This quantitative cross-sectional secondary data analysis, guided by the socio-ecological theory, assessed patient characteristics and how predictive they were for polysubstance abuse. The study sample of 986 patients was analyzed by binomial logistic regression to assess the association between patient-related factors and polysubstance …

The Relationship Between Spirituality And Mental Health Among Kidney Dialysis Patients, Eddy Darcy Perez

Walden Dissertations and Doctoral Studies

The 9th leading cause of death in the United States is kidney disease. An estimated 37 million Americans in the United States, or about 15% of the adult population, have some level of chronic kidney disease. Kidney disease is multifaceted and has implications for both physical and psychological health of a patient. However, research on kidney dialysis patients has primarily focused on physical health. Grounded in social learning theory, this quantitative study used a correlational research design to examine the relationship between spirituality and mental health in 128 kidney dialysis patients with end-stage renal disease. Kidney dialysis patients at kidney …

Calworks Participation And Poverty Rates In Multigenerational Families, Destiny Wray Lovato

Walden Dissertations and Doctoral Studies

The State of California aids more than a million individuals under the California Work Opportunity and Responsibility to Kids (CalWORKs) program at a cost of billions of dollars each year. Although adult recipients are given supportive services and offered various programs in a motivational attempt to achieve self-sufficiency, the needs of children, who are the highest population group living in poverty, are not currently addressed. The absence of programs and services targeted to children may perpetuate the generational cycle of poverty. Yet researchers have not yet examined the underlying reasons behind multiple generations receiving CalWORKs and the continuation of poverty …

Measuring Knowledge Of Chronic Kidney Disease (Ckd) Among Community College Students, Jacquelyn Caldwell Moore

Walden Dissertations and Doctoral Studies

Chronic Kidney Disease (CKD) once detected is easily treated; however, it has become a major health problem associated with increased morbidity and mortality rates, creating an economic burden worldwide. While approximately 24 million Americans over the age of 20 suffer from CKD, there is a lack of awareness among the general population. Using a pre/post assessment, this quantitative study measured the impact of a 75-minute workshop on 126 community college students' knowledge of kidney disease, perception of its severity, and perceived susceptibility. The theoretical framework for the study was the health belief model, which suggests that individuals will make positive …

Evaluating The Hospitals General Service Readiness Index In Guinea For Enhancing Their Performances, Mohamed Elmahady Camara

Walden Dissertations and Doctoral Studies

The healthcare system of Guinea has reported low scores on service availability and readiness assessment (SARA); the scores indicated the low availability of quality drugs, vaccines, medical equipment, and other technologies and involves a continuous history of poor quality-performance metrics. Thus the operational health problems in Guinea could be summarized as health problems (high rate of maternal, neonatal, and infant mortality, high prevalence of communicable and non-communicable diseases) and health system problems (lack of appropriate governance). Therefore, amelioration of the quality of health care and patient safety is needed. The objective of this study was to consider Guinea hospital performance …

Getting The End Of Life Care Conversation Started, Lisa Ann Mccabe-Evans

Walden Dissertations and Doctoral Studies

AbstractEducation is needed among the health care collaborative team to address the lack of end of life conversation, the underutilization of hospice leading to patients’ end of life wishes not being met, the increased depression among bereaved loved ones, and the increased health care costs at the end of life. Nurses reduce the patient’s physical and emotional stress by helping guide conversations and answer questions to meet the needs of patients and their loved ones. This project addressed the practice-focused question to determine if nursing knowledge and expressed intentions about end of life care increase as shown via the difference …

Chronic Care Model For Management Of Diabetes Mellitus, Junecia White

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a serious chronic disease affecting individuals at various stages of life. More than 114 million Americans are at risk of developing complications of diabetes. It is the leading cause of kidney failure, nontraumatic lower-limb amputations, heart disease, stroke, and new cases of blindness among adults in the United States. This quality improvement project sought to understand if important clinical indicators of diabetes mellitus such as HbA1c, blood pressure, serum cholesterol, high-density lipoprotein, low-density lipoprotein, serum creatinine; and estimated glomerular filtration rate would improve after implementation of a team-based guideline-informed approach to diabetes care management. The chronic care …

Juvenile Recidivism After Release From A Juvenile Detention Center In Atlanta, Georgia, Jacquelyn Monique Nelson

Walden Dissertations and Doctoral Studies

After undergoing a form of rehabilitation (i.e., youth detention centers in Georgia), statistics show that juveniles have a 65% chance of reoffending within 3 years after being released. The Georgia Juvenile Justice System’s $300 million annual budget raises concerns about the acts of juvenile recidivism. The purpose of this research was to understand why juveniles reoffend after being in a juvenile detention center in Atlanta, Georgia. The conceptual framework for this study was centered on the alternative to youth detention centers. The research question addressed factors that led juvenile delinquents to reoffend after receiving an alternative treatment. This study had …

Perceptions Of Fruits And Vegetables Amongst Supplemental Nutrition Assistance Program Recipients, Latasha Shanelle Reddick

Walden Dissertations and Doctoral Studies

Supplemental Nutrition Assistance Program (SNAP) benefits are the primary source of food for Georgians with an annual income under the federal poverty level. This program provides monthly monetary benefits to allow the purchase of food through an Electronic Benefits Transfer (EBT) card. Georgia SNAP beneficiaries do not receive nutrition counseling or have purchasing restrictions associated with their benefits. Previous research has indicated that there is a significant benefit to eating fruits and vegetables. The purpose of this qualitative study was to apply the health belief model theory to understand the viewpoint of Georgia SNAP beneficiaries regarding fruits and vegetables. Data …

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Sustainable Building Certification In Healthcare And Patient Satisfaction, Brian Jay Goehner

Walden Dissertations and Doctoral Studies

Eco-friendly healthcare delivery concepts are becoming more accepted as hospital leaders seek to control energy costs, mitigate contributions to climate change, and preserve scarce resources. Leadership in Energy and Environmental Design (LEED) offers healthcare leaders a framework for designing and constructing sustainable facilities that meet efficiency goals. The purpose of this quantitative cross-sectional study was to build an understanding of whether LEED certification influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. Using complex systems theory as the framework, the research questions were focused on exploring if higher levels of LEED certification led to greater HCAHPS overall hospital …

Eating Disorders And The Gap Of Education, Sara Jane Camden

Walden Dissertations and Doctoral Studies

Eating disorders are described as excessive dieting, limiting food intake, and withholding of food. Over 30 million people suffer from eating disorders. Some people may also have preconceived notions that this disease is easily fixable and that eating more and stopping dieting will solve the problem. Registered nurses struggle with having preconceived ideas, a lack of confidence in their assessment skills, and fear of using the eating disorder diagnosis. Barriers that have surrounded the eating disorder mental health disease need to be addressed. The staff development project was based on the question if nursing knowledge would improve on eating disorders …

Minority Pregnant Women Perspective On Health Disparities And Health-Related Outcomes, Lorna Robinson

Walden Dissertations and Doctoral Studies

Health agencies have recognized persistent health care disparities as the primary causes of mortality among minority populations. The emphasis of published studies on the health of minority women in the United States has revealed a knowledge gap in prioritizing prenatal care (PNC). The purpose of this narrative descriptive study was to explore access disparities in PNC and the effect the overall experience had on first-time pregnant minority women in receipt of PNC. The health services utilization framework provided the theoretical lens to analyze and interpret the findings of this study. The key research questions explored how the self-reported experiences of …

Hiv Knowledge And Behaviors Among Young People In Kenya And Lesotho, Beatrice Ochieng

Walden Dissertations and Doctoral Studies

Sub-Saharan Africa (SSA) has a great burden of human immunodeficiency virus (HIV) and high new HIV infection rates among youths age 15-24 years. Suboptimal practice of HIV risk-reducing sexual behaviors among youths threatens to reverse the gains made in preventing the spread of HIV in SSA. The purpose of this quantitative cross-sectional study was to investigate the effects of comprehensive knowledge of HIV transmission and prevention, on individuals’ attitude toward people living with HIV, and ability to obtain condoms (if needed) on practice of HIV risk-reducing sexual behaviors, in adolescents age 15-19 years and young adults age 20-24 years in …

Mothers’ And Community Stakeholders’ Perspectives About The Vitamin A Supplementation Program In Nigeria, Olufolakemi Mercy Anjorin

Walden Dissertations and Doctoral Studies

Vitamin A deficiency (VAD) affects about one third of children under the age of five in Nigeria. There is low uptake of biannual Vitamin A supplementation (VAS) used since year 2010 as the national response to addressing VAD among children 6 to 59 months. Yet, there is limited research on barriers or facilitators to uptake of VAS. The purpose of this study was to examine the perspectives of stakeholders about the VAS program in Nigeria. The theoretical underpinning was the social marketing framework. The central question related to the views of stakeholders toward the VAS program, and their perception about …

Use Of Spanish Audio Podcast To Educate Visually Challenged Hispanics With Diabetes, Baiju Issac

Walden Dissertations and Doctoral Studies

Diabetes is the leading cause of death among the Hispanic population, requiring solutions at the individual, community, and population levels. Self-management helps to manage diabetes and prevent complications, but it is a challenge in nursing practice. Health care providers use printed information to teach patients about self-management of diabetes. However, patients with visual impairment are not able to use these resources. Limited English proficiency, low health literacy, and visual challenges result in the underutilization of health care services within Hispanic communities. Therefore, the purpose of this study was to develop a Spanish audio podcast and lesson plan as teaching tools …

A Systematic Review Of The Literature On Bedside Shift Reports, Dana Wickersheim

Walden Dissertations and Doctoral Studies

AbstractIn 2017, The Joint Commission issued a sentinel event alert regarding inadequate nurse hand-off communication. Inadequate hand-off communication can lead to medication errors, delay in treatment, falls, and wrong-site surgery. To help ensure safe handoff of care between nurses by involving the patient and family, bedside shift report was created. Bedside shift report was developed to help improve patient safety and quality, patient experience of care, nursing staff satisfaction and time management, and accountability between nurses. Despite the implementation of bedside shift report in nursing practice, it continues to be inconsistently applied, which poses risks to patients and can lead …

Preventing Aspiration Pneumonia Using An Aspiration Prevention Protocol, Lee James-Pettway

Walden Dissertations and Doctoral Studies

Hospital-acquired pneumonia, which includes aspiration pneumonia (AP), is a preventable condition that is costly to all healthcare institutions (more than $17,000 to $ 30,000 per episode), because insurance no longer covers the cost of hospital-acquired harms. Each episode in the hospital setting can lead to patient complications, increased use of antibiotics, patient mortality, as well as decreased patient survey scores. Several factors put patients at risk of developing AP, and screening for these risk factors on admission and implementing preventative nursing interventions can decrease the incidence. Based on an extensive literature review, an evidence-based, clinical practice guideline (CPG) was identified …

Preschool Teacher Perspectives Of Crisis Preparedness, Sara Ann Machado

Walden Dissertations and Doctoral Studies

The purpose of this study was to understand the perspectives of preschool teachers

regarding school-based emergency planning in independently funded childcare centers.

Current research has investigated perspectives of crisis preparedness by a variety of

school staff but has not yet included the extent to which preschool teachers feel prepared

to handle a school crisis event. This study was based on the integrated model of school

crisis preparedness and intervention proposed by Jimerson, Brock, and Pletcher. This

study examined how preschool teachers describe the effect of crisis preparedness drills

and training on their ability to handle school crisis events prior to, …

Barriers To Mental Health Services Related To Stigma In Northern California, Kandalena Ary

Walden Dissertations and Doctoral Studies

California Senate Bill 1041 recognized mental health as a contributing barrier for individuals struggling to achieve independence from aid through the California Work Opportunity and Responsibility to Kids (CalWORKs) program to meet the needs of the state's low-income families while reducing barriers to self-sufficiency. As mental health illnesses continue to increase, the engagement and utilization of services have not increased. The purpose of this study was to explore county policy infrastructure addresses making mental health services known, accessible, and increase participation to decrease barriers in utilization of available resources. The research questions were used to examine the effectiveness of processes …

Physician–Patient Communication: Association With Health Literacy In African Americans Living With Type 2 Diabetes Mellitus, Brittany Egeh

Walden Dissertations and Doctoral Studies

Health literacy is needed throughout care to understand basic health, prevent diseases, understand diagnoses, and treatment and management of complicated diseases, such as Type 2 diabetes mellitus (T2DM). Inadequate physician–patient communication is related to medication errors and overall understanding of basic health information in chronic condition such as T2DM. The purpose of this study was to examine the association between physician–patient communication and health literacy, glycemic control, diabetic knowledge, and demographics. The target population consisted of African Americans, ages 18-75, diagnosed with T2DM. Primary data were collected from a family medicine clinic using 4 questionnaires: s-TOFHLA (short form of functional …