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The Experience Of Older Homeless Females With Type 2 Diabetes, Joan Jacqueline Downes

Walden Dissertations and Doctoral Studies

The purpose of this phenomenological study was to explore the experience of older homeless females who have type 2 diabetes mellitus. Women who have stable housing often find it difficult to manage their diabetes; for those who are homeless, managing the disease is even more difficult. This chronic disease has impacted people all over the world and decreased their quality of life. However, people who are homeless may be at a higher risk of this stressful illness. Managing glycemic levels is a crucial factor in decreasing the adverse results in type 2 diabetes. In this study, face-to-face interviews were conducted …

Substance Use Treatment Needs For Survivors Of Commercial Sexual Exploitation Of Children, Emma Elisa Riley-Horvath

Walden Dissertations and Doctoral Studies

Commercial Sexual Exploitation of Children (CSEC) is the sexual exploitation of minors

for commercial profit. The intersection between sex trafficking victimization and substance use has not yet been explored in clinical research and is not reflected in current clinical treatment of survivors when they exit their exploitation. The research question explored in this study focused on the substance use treatment considerations and challenges clinical social workers face when treating survivors of CSEC living in Massachusetts. Subquestions included understanding how cumulative trauma from CSEC impacts substance use treatment and how the coercive use of substances aimed at maintaining victim submission impacts …

Depression Screening For Bariatric Surgical Patients, Cova Teresa Stidham

Walden Dissertations and Doctoral Studies

Obesity in the United States has increased to epidemic numbers over the last decade. Practitioners need to reverse the trend. To address the problem of depression in obesity, a practice guideline from a bariatric clinic for under-served populations was proposed to an expert panel. The Spell Out on First Use (PHQ-9) screening is a valid and reliable self-screening tool to assist the practitioner in determining the level of depression if any. The PHQ-9 has nine questions. No formal screening existed at the bariatric clinic, and the practice guideline (with algorithm and revised workflow) was proposed for use at the clinic. …

Late-Stage Breast Cancer Diagnosis Among Haitian Women In The United States, Marie-Hortence Prosper

Walden Dissertations and Doctoral Studies

Breast cancer is the 2nd leading cause of death among women. While a significant amount of research has been done to understand the different disparities related to this disease, there is still more to learn about the relationship between a person's nationality and the staging of breast cancer. Using the Surveillance, Epidemiology, and End Results Program as the data source, this retrospective cohort study was aimed at assessing late-stage breast cancer among Caribbean immigrants, specifically comparing Haitian women with Americans and other immigrant populations in the United States. The research questions addressed the link between nationality and the likelihood of …

Factors Associated With Maternal Mortality In Greater Accra Ghana 2016: Case-Control Study, Edmund Sekyi Eghan

Walden Dissertations and Doctoral Studies

Maternal mortality is a critical area of concern globally, despite the availability of accessible preventive measures. The role of sociodemographic and service delivery factors in maternal mortality in the Accra Metropolitan Area of Ghana are important to examine. As part of the United Nations (UN) Millennium Campaign, the UN implemented 8 Millennium Development Goals (MDGs); maternal mortality reduction by 75% between 1990 and 2015 was among the fundamental MDGs to be achieved by 2015. The purpose of this case-control study was to use secondary data to assess the relationships between sociodemographic variables, service delivery factors, and maternal mortality among 8,171 …

Predictors Of Poor Pregnancy Outcomes Among Pregnant Women In Island Maternity, Nigeria, Letam Nwi-Ue

Walden Dissertations and Doctoral Studies

Pregnancy outcomes have improved tremendously in developed countries. Notwithstanding, it is still a huge challenge in developing countries, especially Sub-Saharan Africa. In 2015 in Nigeria, about 145 women died daily from pregnancy-related causes. Similarly, nearly 2,300 children under 5 years were lost in the same year. Nigeria consistently underperformed in some of the critical pregnancy indicators such as maternal and neonatal mortality, second worst only to India in the world. Studies on poor pregnancy outcomes are scarce in Nigeria. The purpose of this quantitative, retrospective cross-sectional study was to use local evidence to ascertain the risk factors that predict poor …

Acculturation And Diabetes Among New York's Bangladeshi Immigrants, Renee Mehrra

Walden Dissertations and Doctoral Studies

There are more than 3.4 million South Asians in the United States. Among this subgroup, Bangladeshis in New York have a high prevalence of Type 2 diabetes ranging from 15 to 24% compared to the general population. This study examined the effect of acculturation through length of stay in the United States and understanding of the English language, and the role of gender on self-efficacy (SE) and diabetes self-management among 336 New York Bangladeshi immigrants between the ages of 21 and 75 who had been diagnosed with type 2 diabetes with A1C -‰¥ 6.5%, as verified by their medical record …

Child Malnutrition In A Developing Country: A Persistent Challenge In Haiti, Jeanne M. Constant-Edma

Walden Dissertations and Doctoral Studies

Malnutrition is characterized by the insufficient intake of certain nutrients and the inability of the body to absorb or use these nutrients. This health problem continues to be a persistent challenge among children under 5 years of age in developing countries, including Haiti, despite food aid provided. The purpose of this study was to determine the association between dietary habits in children under 5 years of age in Haiti and their malnutrition status. Community organization theory was used to determine the association between determinants of health such as dietary habits, parents' knowledge and experience, cultural eating habits, socioeconomic status, and …

Preconception Health And Preterm Birth Differences Among U.S.-Born And Foreign-Born Black Women, Sheree Holmes Keitt

Walden Dissertations and Doctoral Studies

Foreign-born Black women giving birth in the United States have superior preterm birth outcomes compared to their U.S-born Black peers. Many studies have focused on tobacco use and medical risk factors, but few have focused solely on preconception health. The purpose of this study was to examine preconception health and preterm birth differences among U.S.-born and foreign-born Black women. Three theoretical frameworks guided this study: the life course theory, healthy migrant theory/immigrant paradox, and weathering theory. Primary research questions assessed (a) if there were an association between chronic preconception risk factors, prepregnancy obesity, diabetes, and hypertension, in U.S.-born and foreign-born …

Can Online Media-Literacy Education Mitigate The Effects Of A Toxic Media?, Patricia Tefo

Walden Dissertations and Doctoral Studies

Media-literacy education provides a way for people to assess and critically evaluate media images. Traditional media literacy programs have mitigated the negative effects of idealized media imagery such as reduced self-esteem, eating-disordered attitudes, and low body-satisfaction among women. Although education is moving increasingly to online platforms, the potential of media literacy education delivered online has not been evaluated. Based on social comparison and objectification theories, the purpose of this study was to quantitatively assess the comparative efficacy of online and face-to-face media literacy education programs. A quasi-experimental design using pre- and post-media literacy education program questionnaires was used. A mixed-method …

Body Weight Self-Perceptions And Experiences Of Nigerian Women Immigrants, Fatimah Binta Ali

Walden Dissertations and Doctoral Studies

Low-income immigrants in the United States experience declining health with increasing length of stay in the country. Their declining health over time has been associated with increased smoking, obesity prevalence, and higher risk for developing diabetes and heart disease. How immigrants perceive their body weight and size, influenced by social interaction, culture, gender, and acculturation is also significant to healthy weight maintenance. Not knowing one's healthy weight could result in body weight misperception and resistance to attaining a healthy weight. The aim of this qualitative study, based on the social constructivist framework, was to understand Nigerian women immigrants' (NWI's) body …

Effect Of Model Of Care And Comorbidities On Multiple-Drug-Resistant Tuberculosis Treatment In Nigeria, Oluremilekun Comfort Kusimo

Walden Dissertations and Doctoral Studies

Multidrug-resistant tuberculosis (MDR-TB) is a public health problem in several countries such as Angola, India, China, Kenya, and Nigeria. Due to the increasing high burden of MDR-TB, most of these countries do not have adequate capacities to manage MDR-TB patients effectively. This study investigated the effect of model of care; human immunodeficiency virus comorbidity; and demographic factors such as age, gender, and marital status on the treatment outcomes of MDR-TB patients in Nigeria. The study was based on the analysis of secondary data of 402 MDR-TB patients accessed from the data systems of the National Tuberculosis, Buruli Ulcer, and Leprosy …

Community Risk Factors And Health Inspection Violations In Mississippi Delta Census Tracts, Chrystal S. Early

Walden Dissertations and Doctoral Studies

A concerning public health issue in America is about food deserts urban and rural communities that lack grocery retailers that offer affordable, nutritious, and diverse foods. Empirical evidence has shown significant associations between neighborhood disadvantage/disorder risk factors of high poverty and high percentages of ethnic minority residents with presence/ absence of healthy food retailers in food deserts. The purpose of this quantitative correlational study, framed by the disparities in food safety conceptual model, was to examine if county-level poverty, number of African American residents, number of elderly (i.e., age 65 or older) residents, vehicle ownership, and crime rates were significantly …

Depression Screening In Poststroke, Shannah Lowe

Walden Dissertations and Doctoral Studies

Depression, a sequela of stroke, is underrecognized and underreported. The American Heart/Stroke Association estimated 1/3 of patients develop depression after a stroke. Depression after a stroke has negative influence on stroke recovery through decreased participation in rehabilitation, and increased morbidity and mortality. The American Heart/Stroke Association recommended that depression screening be conducted on stroke patient; however, there is a lack of guidance regarding the optimal time and tools for depression screening. The practice problem identified was the absence of depression screening in poststroke patients at the project site. The project question focused on identifying evidence-based approaches for depression screening in …

The Effects Of Breastfeeding Support On Women Enrolled For Wic Benefits, Judith Marie Khanuja

Walden Dissertations and Doctoral Studies

Breastfeeding has been shown to protect both the mother and infant, and health care professionals consider it to be the best choice for feeding an infant. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, referrals to other social service programs, and nutrition and breastfeeding education for enrolled families. However, community support for the breastfeeding woman once she leaves the hospital is limited, especially in Philadelphia, PA. The purpose of this mixed-methods study was to explore the impact of prenatal breastfeeding education and understand the role that members of the community play in the infant feeding …

Built Environments And Childhood Obesity Epidemic In The Immigrant Population, Monique M. Nurse

Walden Dissertations and Doctoral Studies

A lack of adequately built environments can negatively affect obesity rates among adolescents. The purpose of this quantitative cross-sectional study was to determine if there is a relationship between the presence of built environments and childhood obesity among the immigrant population living in Cobb County Georgia. The social ecological model was used to explain how environmental factors may influence behavior. The research questions addressed whether walkability and elements of built environments such as to healthy foods and access to parks and recreational areas of census tracts affect childhood obesity when adjusting for race/ethnicity and immigrant population in Cobb County. Data …

Standardized Clinical Guideline For Assessment, Documentation, And Treatment Of Statins, Esther Onyirimba

Walden Dissertations and Doctoral Studies

The purpose of this project was to develop a practice guideline for screening patients at risk for cardiovascular disease, educate the staff at the site about the guideline, and implement the guideline at a primary care clinic. The intention was to identify and treat patients at risk for cardiovascular disease to prevent occurrence of heart disease. Cardiovascular disease includes hypertension, coronary heart disease, heart failure, and stroke. Coronary heart disease is one of the leading causes of death in the Western world. The local practice problem and focus of this project was underprescribed statin therapy for patients at risk for …

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 …

The Influence Of Food Insecurity, Low-Income, And Race On Diabetes Self-Management Practices Among Women With Diabetes, Jill La Capria

Walden Dissertations and Doctoral Studies

Diabetes is a chronic condition affecting more than 30 million adults living in the United States. Diabetes self-management (DSM) can prevent or delay the complications of diabetes and improve clinical outcomes; however, data show that low-income, food insecurity, female gender, and race contribute to challenges performing effective DSM. The health belief model was the theoretical framework for this cross-sectional study, which examined how food insecurity, low-income, and race affect DSM activities in women with diabetes. The sample population from the 2017 Behavioral Risk Factor Surveillance System survey consisted of 1,842 women with diabetes who were 18 years of age or …

School Personnel Perspectives On Supporting Teachers Of Students With Social-Emotional And Academic Needs, Ana Elisa Lee

Walden Dissertations and Doctoral Studies

Thirty percent of elementary schools that serve underprivileged students in a Texas school district are considered low-performing according to state standards in the 2016 2017 school year. Little is known about the perspectives on the support teachers need while teaching students with high social-emotional and academic needs. The purpose of this general qualitative study was to examine perspectives on principal support for teachers who teach these populations. Data were collected through interviewing 9 teachers, 3 principals, 3 counselors, 3 instructional coaches, and 1 district academic leader. Social cognitive theory, role theory, and cognitive evaluation theory constituted the conceptual framework. Individual …

A Clinical Practice Guideline To Improve Education In The Heart Failure Population, Mailey L. Wilks

Walden Dissertations and Doctoral Studies

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, …

Trends In Prevalence And Predictors Of Undernutrition Among Children In South Central, Monica Kabahimba Zikusooka

Walden Dissertations and Doctoral Studies

Undernutrition is a global public health challenge. In Somalia, undernutrition is chronic with the situation often graded for emergency response. The purpose of this study was to provide contextual evidence regarding trends of prevalence and predictors of undernutrition in South Central Somalia. Following the UNICEF conceptual framework of determinants of undernutrition, the study examined which individual, household, and society factors were associated with undernutrition. Using secondary data from cross-sectional nutritional surveys implemented by the Somalia Food Security and Nutrition Analysis Unit from 2007 to 2012, a sample of 75,756 and 60,856 children aged 6-59 months was used in analyzing trends …

Nursing Education To Prevent Resident Falls In Long-Term Care, Henrietta Aguwa

Walden Dissertations and Doctoral Studies

Residents in nursing facilities are more prone to falls than those living in the community. Injuries resulting from falls impact residents, their families, and healthcare costs. The gap in nursing practice was the lack of a comprehensive fall-prevention program in a long-term care facility that had experienced high fall rates among residents. This project addressed whether an educational program using the American Medical Directors Association's clinical practice guideline and the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) toolkit for fall- prevention improved the self-efficacy of direct-care staff in preventing falls among residents in a …

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 …

Social Anxiety, Quality Of Life, And Healthy Lifestyle Behaviors Of Women With Infertility Problems, Esra Savaş

Walden Dissertations and Doctoral Studies

Not having a child has significant psychosocial effects on women experiencing infertility problems. There is a gap in research on social anxiety, quality of life, and healthy lifestyle behaviors of women during infertility, fertility treatment, and subsequent pregnancy. The purpose of this quantitative comparative study was to investigate the social anxiety, quality of life, and healthy lifestyle behaviors of Turkish women with infertility issues and Turkish women who conceived after infertility treatment, as measured by the Liebowitz Social Anxiety Scale, the Fertility Quality of Life Questionnaire, and the Healthy Lifestyle Behavior Scale II. The social support and stress buffering theory …

Post-Hurricane Sandy Coping Strategies And Resilience Factors Among People With Disabilities, Miriam Mukasa

Walden Dissertations and Doctoral Studies

People with disabilities are likely to experience difficulties overcoming the impact of natural disasters. Few scholars have focused on this population's ability to recover and handle stress following a natural disaster. The purpose of this phenomenological study was to explore and describe coping strategies and resilience factors that people with physical or mental disabilities used in the aftermath of Hurricane Sandy. Resilience theory was used as the theoretical framework. Through face-to-face interviews, 10 persons with disabilities shared their experiences of coping and resilience. A lens of interpretative phenomenological analysis was used to identify emergent themes related to persons with disabilities' …

Impact Of Food Insecurity On The Management Of Illness In Wayne County, Ohio, Bernadette Coleen Paul

Walden Dissertations and Doctoral Studies

The incidence of food insecurity coupled with poor management of illnesses poses a

public health challenge. Poor adherence to medication regimens is a contributor to poor

health outcomes, especially among the socioeconomically disadvantaged. Food insecurity

is a global health and nutrition problem that affects approximately 50 million people in

the United States. The number of food-insecure households in the United States has

increased by 12% since 1995, and so has the burden of management of illnesses. The cost

of healthcare has risen from 5% of the Gross Domestic Product (GDP) in 1960 to 20% of

the GDP currently. This quantitative …

Discharge Phone Call On Unplanned Readmission Due To Chemotherapy Among Cancer Patients, Denise Angelo Moreno Prudencio

Walden Dissertations and Doctoral Studies

The transition after hospitalization is a vulnerable period when adverse events like unplanned readmissions may occur. Unplanned readmissions with patients undergoing chemotherapy that are the result of gaps in communicating the discharge plan may be preventable. Several transitional care interventions have been explored, and one of these is the nurse discharge phone call. This project explored the effect of a nurse-led transitional discharge phone call within 30-days after hospital discharge on unplanned readmission due to chemotherapy among patients in the medical-oncology compared to patients without a nurse-led transitional discharge phone call. A nurse-led transitional discharge phone call was implemented within …

Staff Development Introducing Self-Care Within The Nurse Residency Curriculum, Lauren Elizabeth Rogers

Walden Dissertations and Doctoral Studies

Caregiver burnout is an issue for health care organizations, negatively influencing cost, engagement, and workforce stability. Nurse residency programs are intended to address the gap in practice between academia and clinical practice and provide social support during this transitional time. Self-care education can positively affect novice acute care nurses' transition into their new professional role while building connections with the health care organization during the first year of employment. The purpose of this project was to develop a staff educational module to address the nursing practice problem of evidence-based self-care education within a nurse residency curriculum at the doctoral site. …

Post-Hurricane Sandy Coping Strategies And Resilience Factors Among People With Disabilities, Miriam Mukasa

Walden Dissertations and Doctoral Studies

People with disabilities are likely to experience difficulties overcoming the impact of natural disasters. Few scholars have focused on this population's ability to recover and handle stress following a natural disaster. The purpose of this phenomenological study was to explore and describe coping strategies and resilience factors that people with physical or mental disabilities used in the aftermath of Hurricane Sandy. Resilience theory was used as the theoretical framework. Through face-to-face interviews, 10 persons with disabilities shared their experiences of coping and resilience. A lens of interpretative phenomenological analysis was used to identify emergent themes related to persons with disabilities' …