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Improving Outcomes For Congestive Heart Failure Patients, Diana Lee Collins

Walden Dissertations and Doctoral Studies

Managing patients diagnosed with congestive heart failure (CHF) requires coordination with subspecialties and frequent outpatient monitoring. The lack of communication among health care providers and patients can result in a gap in practice when managing patients with CHF in the outpatient setting. Guided by the chronic care model, this quality improvement project was an initiative to develop and implement a 6-week self-care management program provided by nurse practitioners in an outpatient primary care practice. The goal of the project was to improve the day-to-day self-care management of patients with CHF and addressed the practice-focused question of whether a 6-week CHF …

Association Of Dietary Intake With Suicidal Ideation Or Suicide Attempts In Adolescents, Zenobia J. Bryant

Walden Dissertations and Doctoral Studies

Suicide is among the leading cause of adolescent deaths worldwide and thus a significant public health concern. Risk factors for suicidal behavior include drinking alcohol, smoking, and engaging in risky sexual behaviors. One area of concern is dietary patterns and their association with depressive symptoms and suicidal ideation. Bandura's social cognitive theory emphasizes the assumption that one can perform specific actions to bring about desired outcomes. The primary research questions for this quantitative, retrospective, cross-sectional study concerned whether there is a statistically significant interaction between fruit and vegetable intake and suicidal ideation or suicide attempts. Data from 71,776 adolescents in …

Impact Of Self-Efficacy And Time On Skin Cancer Protective Behaviors, Abbie Goldbas

Walden Dissertations and Doctoral Studies

Skin cancer incidence is increasing while the rates of other cancers is declining. The purpose of this quantitative study was to determine whether health self-efficacy predicted skin cancer protective behaviors. The theory of health self-efficacy provided the framework for the study. Secondary data were collected from the 2008 and 2014 Health Information National Trends Surveys. The study sample included women 18-34 years of age because this population is especially vulnerable to skin cancer. Results of logistic regression analyses indicated that higher levels of health self-efficacy predicted greater sunscreen use, but higher health self-efficacy levels did not predict avoidance of tanning …

Effectiveness Of Pressure Ulcer Protocols With The Braden Scale For Elderly Patients In The Intensive Care Unit: A Systematic Review, Natalie A. Floyd

Walden Dissertations and Doctoral Studies

Each year, approximately 3 million people in the United States develop a pressure ulcer. Although a preventable complication, pressure ulcers are among the top 5 adverse outcomes in the acute care setting with the prevalence as high as 42% in the intensive care unit (ICU). The purpose of this systematic review was to evaluate the inclusion of the Braden Scale as part of a multicomponent pressure ulcer intervention protocol, or care bundle, to identify geriatric patients hospitalized in the ICU who were at risk for pressure ulcers. The Cochrane protocol guided this review; findings were reported according to the Preferred …

Using Social Cognitive Theory To Predict Counseling Behaviors In Registered Dietitians, Marianela Guerrero

Walden Dissertations and Doctoral Studies

Obesity and morbid obesity affect more than 30% of Americans, which emulates the rate of smoking as the leading preventable cause of disease and death in the United States. The prevalence of obesity among adults in the United States increased dramatically between 1980 and 2010 (16% to 36%). The integration of the social cognitive theory (SCT) constructs such as self-efficacy, self-control, environment and expectations in the study instrument allowed identifying the impact of personal, social and economic factors on Registered Dietitians (RDs) counseling behaviors with obese clients. The goal of this quantitative cross sectional study was to investigate the association …

Strategies To Reduce Information Technology Employee Absenteeism In The Manufacturing Industry, Camilla Henry

Walden Dissertations and Doctoral Studies

Employee absenteeism costs organizations billions of dollars annually in losses in revenue and productivity, temporary labor costs, and low morale. The purpose of this qualitative single case study was to explore the strategies information technology (IT) managers in the manufacturing industry used to reduce employee absenteeism. The theory of planned behavior provided the conceptual framework for the study. Data collection included semistructured interviews with 5 IT managers in Maryland and a review of organizational documents addressing nutritional education information, employee participation rates in health programs, and physical activity. Data were analyzed using compilation, disassembly, reassembly, interpretation, and development of conclusions. …

Young Women's Perceptions Of Factors Influencing Eating Disorders, Francisca Masawi

Walden Dissertations and Doctoral Studies

Eating disorders (EDs) cause irreversible physical damage, including organ failure and death. Although EDs receive considerable attention, the number of affected young women who seek help remains low. The purpose of this phenomenological study was to understand the sociocultural and socioenvironmental factors influencing ED development from the perspective of young women, and to explore why the rate of EDs continues to rise in this population. The sociocultural model served as a guide for the study. Ten young women 18-24 years old from Southwest Ohio participated in in-depth, semi structured, face-to-face interviews. Data coding and analysis revealed recurring themes, with findings …

Education Protocol For Type Ii Diabetes Mellitus, Raegan Elizabeth Quandt

Walden Dissertations and Doctoral Studies

Diabetes mellitus is one of the leading causes of death in the United States, contributing to rising health care costs and increased morbidity and mortality rates. Researchers demonstrated that aggressive heath measures involving ongoing diabetes self-management education are paramount in minimizing associated complications of diabetes. The management and prevention of diabetes is not standardized and providers within a health clinic in Illinois reported challenges in providing self-management education during scheduled patient appointments due to limited resources and time. The purpose of this DNP project was to develop a clinical practice guideline to be used by all providers within the health …

Reducing Home Health Copd-Related 30-Day Hospital Readmissions Using Telehealth Technology, Steven Eric Stammer

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a collection of chronic conditions that results in irreparable lung damage and stress to patients. COPD also has considerable financial impacts on health care entities due to frequent hospital readmissions of COPD patients. The Centers for Medicare and Medicaid Services penalize care entities for 30-day hospital readmissions. Many rehospitalizations attributed to COPD are due to exacerbations, often preceded by physiologic and emotional changes that can be monitored, allowing action to be taken to prevent readmissions. The practice problem for this quality improvement project explored whether the use of remote home monitoring of COPD patients …

Education Plan To Empower Wound Care Nurses For Evidence-Based Practice, Patricia Stevenson

Walden Dissertations and Doctoral Studies

Non-healing wounds can claim thousands of lives and costs billions of dollars each year, and nurse-led wound clinics are becoming necessary to fill a gap in care for patients with wounds. Even among certified wound nurses using evidence-based clinical protocols, key considerations of care are being missed. Therefore, this project was focused on developing and validating a new biofilm education module for certified or certification eligible wound care nurses. The aim of the module was to boost clinical assessment knowledge and improve patient outcomes. Benners skill acquisition model informed the development of this project. The design of the project also …

Health Care Facilities As A Predictor Of Breast Cancer Survival Rates, Elizabeth Natalie Webster

Walden Dissertations and Doctoral Studies

The disparity between survival rates for Black and White women with breast cancer is well documented and has been examined in terms socioeconomics, environment, tumor type, and genetics. However, there is little examination of the role of health care facilities in cancer disparities. Health care facilities are representative of societal norms and beliefs that include location, quality of care, finance, policies, and staffing; therefore, they are a proxy for social justice and social change. The purpose of this study was to examine correlations between health care facility type; social determinants of cancer such as poverty, culture, and social justice; and …

Teaching Heart Failure Patients A Low-Sodium Diet, Karen Faye Wright

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is a progressive medical condition affecting more than 7 million people in the United States (US) with 700,000 new cases reported annually. More than half of those treated for CHF are readmitted at least once a year. The problem addressed by this quality improvement initiative was lack of adherence to low sodium diet (LSD) among CHF patients, knowledge and skill deficit, and excessive 30-day CHF readmissions. The health belief model and the self-care deficit theory guide nurses in acquiring the skills needed to teach LSD. Twelve months of data were selected from 93 CHF readmissions from …

Association Between Androgen Deprivation Therapy For Prostate Cancer And Alzheimer's Disease, Gina Giannantoni-Ibelli

Walden Dissertations and Doctoral Studies

Alzheimer's disease (AD) is the most common progressive, neurodegenerative disease and form of dementia. The hallmarks of AD are extracellular accumulation of amyloid beta protein, resulting in neuritic, senile plaques and intracellular accumulation of tau protein. AD mainly arises from imbalance of amyloid beta protein production and its clearance in the brain. Testosterone modulates production of amyloid beta protein by decreasing its accumulation. Prostate cancer remains a substantial public health challenge in the United States. While androgen deprivation therapy (ADT) is an effective treatment for prostate cancer, it may be associated with cognitive impairment due to decreased levels of testosterone. …

Barriers To Oral Care Among African American Adolescents In Prince George's County, Maryland, Nkiruka Soribe Mcginnis

Walden Dissertations and Doctoral Studies

When adolescents forgo oral health treatment, factors that hinder them from obtaining these services put them at risk of detrimental consequences in their oral and overall health. The purpose of this qualitative phenomenological study was to identify the various barriers that adolescents encounter causing them to defer oral treatment. Through this study, public health officials, school health care providers, the state, and parents could be made aware of these factors and work together to implement programs and supplemental aid to help adolescents become more knowledgeable of the importance of oral care and encourage them to desire and seek treatment. The …

Improving Hand Hygiene In An Intensive Care Unit, Charles Chukwuemeka Njenje

Walden Dissertations and Doctoral Studies

Health-care-associated infections (HCAIs) affect hundreds of millions of people worldwide, causing morbidity and mortality among hospitalized patients. About 2 million patients suffer from HCAIs in the United States, and it is estimated that 99,000 of them die each year. Studies have indicated that transmission of health-care-associated microorganisms occurs through contaminated hands of health care workers. Hand hygiene (HH) is the single most effective way to prevent health-care-associated infections, yet health care workers' hand hygiene compliance remains low. One factor responsible for poor compliance with hand hygiene guide-lines are lack of knowledge of good hand hygiene and lack of hand hygiene …

Decreasing Acute Diabetes Complications Through Self-Management Education, Eugene O. Okafor

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a chronic disease that affects millions of people in the United States. The purpose of this project was to develop a guideline to help clinical staff provide clear and concise diabetes self-management instructions to patients in a community setting. Orem's self-care deficit theory (SCD) and health belief model (HBM) provided a platform to assess how patients' self-care deficit contributes to illness and the effect of patients' perception of illness. SCD theory and the HBM provided the framework for the development of the guideline to decrease diabetes acute complications through self-management education. The practice-focused question was whether the …

Knowledge And Attitudes Of Emergency Room Nurses Regarding Palliative Care Patients, Pearl Alethea Harrison

Walden Dissertations and Doctoral Studies

Palliative care (PC) is the comprehensive management of patients diagnosed with terminal illness. Care for PC patients focuses on relieving symptoms. The purpose of this study was to determine the difference between pretest and posttest scores on the Frommelt Attitude towards the Care of the Dying (FATCOD) and the Palliative Care Quiz for Nurses (PCQN) after an educational intervention to emergency department (ED) nurses. The framework for this project was Bandura's social cognitive theory. The FATCOD was used to assess ED nurses' attitudes toward PC, and the PCQN was used to assess ED nurses' knowledge about PC prior to the …

The Impact Of Mentoring On Social Excluded Adults In A Small Midwest City, Rose A. Hunt

Walden Dissertations and Doctoral Studies

Empirical data have indicated that a considerable amount of the world's population, 45.3 million in the United States, live in deplorable conditions, some of which are created by social exclusion. Social exclusion is a disenfranchisement experienced by individuals and families living in poverty conditions created by circumstances such as lack of education, lack of economic sustenance, unemployment, poor health, and other social ills. Mentoring is a multidimensional skills-development opportunity for disadvantaged youth, aspiring new professionals, employed individuals being promoted, and instructor-student relationships. There is the possibility that mentoring could be useful for other societal groups as well, particularly social excluded …

Women In Mississippi Undergoing Hysterectomies In Absence Of Comprehensive Informed Consent Law, Tammy Shaffer

Walden Dissertations and Doctoral Studies

Only three states have enacted informed consent laws aimed at providing more information concerning any alternative treatments for women who undergo hysterectomy. This study attempted to fill the research gap regarding consent laws and perceptions of women who underwent hysterectomy in a state with no informed consent laws. Supported by the health belief model (HBM), the research questions focused on the perceptions of women and their lived experiences. The purpose of this qualitative study was to examine the beliefs and attitudes of women in a state with no informed consent laws. Interviews were the main data collection technique. The participants …

Social Work Practice With Older Adults, Carley Yvonne Vailu'u

Walden Dissertations and Doctoral Studies

Social workers working for adult protective services (APS) face many clinical challenges to ensure the safety and well-being of older adult clients. APS social workers often interact with older adults who engage in self-neglecting behaviors that compromise their ability to function in a healthy and independent manner. The purpose of this research study was to explore challenges in direct social work practice to identify how APS services can be improved when working with the older adult population, particularly individuals who engage in hoarding behaviors. Using action research methodology, 2 focus groups were conducted to explore the experiences and knowledge of …

Evaluation Of Use Of Teach-Back For Patient Education, Tamara J. Orr

Walden Dissertations and Doctoral Studies

The focus of this quality improvement doctoral project was the evaluation of an organization's standardized use of the teach-back process for patient education implemented in February 2018. Teach-back is a process in which the patient restates the key concepts for self-management, so the nurse can assess the effectiveness of the teaching and learning process. The practice-focused question compared 4 questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey with literature and recommendations from major health care organizations. The Iowa Model was used to guide the project. The literature review was completed using the Cumulative Index to …

Female Caribbean Immigrants' Perceptions Of The Influence Of Immigration On Obesity, Kerryann Nelson

Walden Dissertations and Doctoral Studies

Obesity is a significant global issue, and its incidence has increased over time. A substantial percentage of the U.S. population suffers from this disease with a relatively high prevalence seen in individuals from the Caribbean. The purpose of this phenomenological study was to explore Caribbean women's perception of how migration to South Florida may have impacted the onset of obesity in this population. The social ecological model provided the framework for the study. Data were collected from 1-on-1 interviews held with 12 female participants between the ages of 18 and 35, who previously resided in the Caribbean at a healthy …

Success Factors Of Entrepreneurship In Emerging Rural Economies, Sultan Tahir Mehmood

Walden Dissertations and Doctoral Studies

One factor of the leadership stratagem is to account for the core values, operations, and growth of the organization. The purpose of this case study was to ascertain the financial strategies small business leaders incorporate to help ensure growth of small businesses. The conceptual framework of Schumpeter's innovation and entrepreneurship theory and the Grameen model were included to drive the scope and analysis of this study. A purposive sample of 8 leaders from successful small businesses in Islamabad contributed to a focus group session; 4 out of these participants originated from the finance and management department and 4 represented sales …

Comparing A General And Transitional Registered Nurse Orientation To Facilitate Quality Improvement, Kathryn R. Cortes

Walden Dissertations and Doctoral Studies

Most hospitals orient new graduate nurses and experienced nurses in the same generalized orientation programs. To address the cost of orientation to specialty units, a pediatric hospital developed a tailored transitional residency orientation program for experienced nurses. The purpose of this project was to describe, compare, and evaluate the existing generalized orientation program and the transitional orientation program to determine how the orientations differed in structure, process, and outcomes. Donabedian's model assessing quality of care services and Benner's novice-to-expert theoretical framework served as guides in evaluating the orientation outcomes. Qualitative data about residency classroom time, preceptor selection and time, mentor …

Developing Neonatal Gavage Tube Guidelines To Decrease Feeding Intolerance, Elizabeth Demeester Webster

Walden Dissertations and Doctoral Studies

A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating …

Public Elementary School Teachers' Experiences With Implementing Outdoor Classrooms, Lori Schultz Goff

Walden Dissertations and Doctoral Studies

Children experience limited time outdoors and have few opportunities for outdoor learning in schools, putting them at risk for being unprepared to engage in solving environmental and societal problems. Researchers have examined outdoor learning at the preschool and high school levels; elementary school experiences have been explored less frequently. Guided by a conceptual framework informed by social emotional learning (SEL), ecological literacy, and teacher self-efficacy, this study investigated public school elementary teachers' experiences with outdoor classrooms including barriers and supports to creating and using outdoor classrooms. A qualitative design using in-depth interviews with interpretive phenomenological analysis techniques was conducted with …

Mediating Effect Of Academic Self-Efficacy Between Teachers' Attitudes And Achievement Of Low-Income High School Students, Nickole Marie Cottrill

Walden Dissertations and Doctoral Studies

Researchers have found that low-income students have greatly suffered academically, yet there have been no advancements causing the academic achievement gap to close for any length of time. Using Bandura's social cognitive, self-efficacy, and academic self-efficacy theories as the foundation, this study explored the mediating effect of academic self-efficacy in the relationship between perceived teacher attitudes and perceived academic achievement in low-income high school students. Data were collected from 145 low-income high school students via an online survey geared towards their parents to ensure full parental consent. The survey included demographic questions, a perceived academic achievement question, the Classroom Teacher-Student …

Implementation Of A Standardized Approach To Diabetes Education, Stacey Williams Porter

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention (CDC) report that Type 2 diabetes

mellitus (T2DM) is a serious health issue affecting over 24 million Americans. Adults with T2DM are 2 to 4 times more likely to experience complications of the disease such as heart disease and stroke. Efforts are needed to control the condition and prevent the complications. At a local community hospital in the southeast United States, a 2-year assessment revealed over 10,000 patients admitted with diabetes or diabetes-related complications. Staff nurses at the site were responsible for diabetes self-management education for T2DM patients at discharge; however, no standardized …

Increasing Referrals Of Hospitalized Obese Patients, Tammy Elaine Cabrera

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise in the United States and globally, placing populations at

increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,

and other disease states. Literature review shows that there have been many different methods

utilized to halt obesity's progression, however rates continue to increase. The United States

Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other

agencies recommend obesity screening and counseling at every patient encounter, but most

hospitals do not have a current obesity policy in place to accomplish this task. The purpose of

this project is to …

Impact Of The Centering Pregnancy Model On Sustaining Normal Gestation Weight Gain, Hyacinth Dennis-Crooks

Walden Dissertations and Doctoral Studies

Obesity during pregnancy has increased in prevalence over the last decade and is associated with adverse outcomes for mothers and babies, especially Black mothers. In the local setting of this project, the group-centered centering pregnancy model (CPM) was implemented to improve outcomes of pregnancy. The model had not been evaluated for its effectiveness in reducing weight in Black pregnant women; therefore, there was a need for an evaluation of the effectiveness of the CPM in decreasing excessive gestational weight gain (EGWG). The health belief model was used to guide the project, which compared mothers' weights early in the 2nd trimester, …