Digital Commons Network^™

The Patient-Centered Medical Home And Diabetes Mellitus Outcomes: A Systematic Review, Lisa Sullivan Mcmanus

Walden Dissertations and Doctoral Studies

Ineffectively managed chronic diseases such as diabetes mellitus (DM) increase overall health care expenditures and negatively affects health outcomes such as exacerbations, functional decline, disability, and death. The purpose of this systematic review (SR) was to review the DM outcomes reported by patient-centered medical homes (PCMHs). The goal was to determine how care coordination and evidence-based clinical management impacted financial and health outcomes. The SR followed the Cochrane protocol and complied with the PRISMA evidence-based minimum set for reporting. Overall, DM management in the PCMH demonstrated statistically significant completion rates for essential screenings and preventive care, including HgA1c (p = …

Subsistence Farmers' Perceptions Of Pluralistic Agriculture Extension In Northern Ghana, Amos Kwame Egyir Baah

Walden Dissertations and Doctoral Studies

In 2013, the Ministry of Food and Agriculture of the Republic of Ghana implemented a reformed food and agriculture sector development policy (FASDEP II) to reduce poverty among the poorest subsistence farmers in the nation. These extension efforts have been unsuccessful. The purpose of this ethnographic case study was to understand the perceptions of subsistence farmers in the Savelugu-Nanton District (SND) who participated in FASDEP II on how the program had affected their ability to meet their subsistence needs. The theoretical framework of collaborative advantage was used to analyze farmers' opinions of how the decentralized, pluralistic extension policy did or …

Barriers To Mental Health Treatment Among Chronically Homeless Women: A Phenomenological Inquiry, Rebecca Keeler Spicer

Walden Dissertations and Doctoral Studies

Homeless women demonstrate higher rates of mental illness than homeless men. The combination of complex life circumstances, stigmas related to mental illness, and homelessness may cause homeless women with mental illnesses to face unique barriers that prevent them from accessing necessary mental health services. The purpose of this phenomenological study was to expand the body of literature on homeless women's experiences with the mental health system and to understand the barriers to treatment services. Guided by Young's critical social theory of gender, this study was designed to develop a better understanding of the support that may be in place to …

Self-Reported Health Status, Perceived Risk For Developing Breast Cancer, And Mammography Screening Use, Idara Sylvanus Mcpartling

Walden Dissertations and Doctoral Studies

Breast cancer is a widespread public health issue in the United States which affects all women. Although mammography is a proven screening tool, screening rates vary widely. Self-reported health status may play a role in how women perceive their risks for developing breast cancer, which may affect mammography use. The purpose of this cross-sectional survey study was to assess the association between self-reported health status and perceived risk for developing breast cancer, as well as perceived barriers towards mammography screening and use. Social action theory, which holds that social and the psychological factors influence health behaviors, served as the theoretical …

Obstetric Fistula: The Experiences Of Patients And Medical Personnel In Sierra Leone, Sheku Samba

Walden Dissertations and Doctoral Studies

Women face great risks in pregnancy and childbirth, especially in developing countries where there are very few skilled birth attendants and negligible government investments in maternal health programs. As a result, obstetric fistula (OF), a potentially fatal but preventable and treatable condition, affects some 3 million women and girls globally. In Sierra Leone, the prevalence of OF is extremely high, but the absence of quality data to inform decision-making, both on prevalence and risk factors, is a barrier to creating an environment for OF prevention and care. The purpose of this phenomenological study was to explore and document the barriers …

Type 2 Diabetes Mellitus And Colorectal Cancer Risk And Survival In Oman, Rose Ngozi Mafiana

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) and colorectal cancer (CRC) are 2 chronic diseases with common risk factors related to physical inactivity, obesity, and diet. Literature on T2DM as a risk factor for CRC development and survival in Oman is scarce. Using de-identified archival data provided by Sultan Qaboos University Hospital (SQUH) Oman, a retrospective, case-control, and time-to-event study designs were used to compare odds of developing CRC, and survival rates among adults with and without T2DM. The ecosocial theory provided the theoretical base for this research. Logistic regression was used to examine the odds of developing CRC among 114 cases …

Lived Experiences Of Individuals Quality Of Life On Prolonged Home Mechanical Ventilation, Munyaradzi Ephie Rwakonda

Walden Dissertations and Doctoral Studies

Improvements in technology have allowed people with tracheostomies to live at home on mechanical ventilation (HMV). Quality of life (QOL) for HMV users has been studied quantitatively, but few qualitative studies have been published. The purpose of this phenomenological study was to explore QOL for individuals with tracheostomies on prolonged HMV focusing on activities of daily living (ADLs) and the role of decision- making. The Roper, Logan, and Tierney activities of living theory were used to categorize activities. Ten participants, 18 years and older, with a tracheostomy and on HMV for at least 6 months were enrolled using purposive sampling. …

Instructional Strategies Of Effective Mathematics Teachers Of African American Upper Elementary Students, Susan Warthen

Walden Dissertations and Doctoral Studies

National assessments have revealed that African American students do not demonstrate proficiency in mathematics to the same degree as their White counterparts; however, some teachers are able to guide their African American students to mathematics success. The purpose of this qualitative case study was to determine the instructional strategies of teachers who have been successful in promoting mathematics achievement in African American students. This study was guided by a single research question that focused on the instructional strategies used by teachers whose African American upper elementary students demonstrated proficiency in mathematics on a state standardized test. Feuerstein's mediated learning experience …

Strategies To Improve Corporate Financial Investment In Care Coordination Programs, Shameka Coles

Walden Dissertations and Doctoral Studies

Key drivers for care coordination programs may include reducing inflated health care cost and improving the quality of care for high-risk populations. However, health care leaders lack methods to support financial investment in care coordination programs. The purpose of this single case study was to explore the strategies that health care leaders use to improve corporate financial investment in care coordination programs that include the triple aim of reducing cost, improving population health, and increasing patient satisfaction. The triple aim model provided the conceptual framework for the study in which 6 health care leaders from Southern California with experience garnering …

Cultural Sensitivity In The Performance-Based Learning Environment, Monique Matleen Hazzard-Robinson

Walden Dissertations and Doctoral Studies

The Georgia Department of Education requires students to earn 4 course credits in the area of mathematics in order to graduate from high school. Academic success for mathematics students in a school district in southern Georgia has been encumbered because teachers lack cultural competency in mathematics instruction, which has hindered minority students from developing reasoning, critical analysis, and problem-solving skills needed to earn these required math credits. The purpose of this project study was to examine teachers' perceptions of using culturally relevant teaching strategies to influence the academic performance of minority students in the mathematics classroom. The conceptual framework was …

Relationships Between Interprofessional Teamwork And Clinical Management Of, Jacqueline G. Stephens

Walden Dissertations and Doctoral Studies

Diabetes mellitus (DM) is a highly prevalent chronic disease that affects 29 million people in the United States including over 2 million veterans who receive care through the Veterans Administration. Patient-aligned care teams (PACTs) are an interprofessional teamwork system designed to improve outcomes of chronic illness, but empirical explorations of the efficacy of the PACTs have been insufficient. Utilizing the chronic care model, the purpose of this retrospective study was to determine if PACTs have been efficient in the diabetic management of veterans receiving care through a Southeastern VA. Medical records for 114 veterans with type 2 DM were randomly …

The Effect Of Cognitive Behavioral Therapy And Chiropractic Care On Stress Reduction, Tracee Felice Williams

Walden Dissertations and Doctoral Studies

Decreasing the impact of stressors on the body remains an important area of study for the affected population. While there is evidence showing that cognitive behavior therapy (CBT), a psychotherapy approach, results in decreased stress, little was found about the effects of chiropractic treatment (CC) on stress. The purpose of this quantitative archival study was to determine whether the combination therapy of CC and CBT was more effective in decreasing stress than CBT independently. Cognitive neuropsychology served as the theoretical lens. Client data from a mental health and chiropractic care center on the West coast (N = 112) were divided …

Relationship Between The California Drought And Almond Demand, Wayne E. Lacy

Walden Dissertations and Doctoral Studies

Areas of California's Central Valley are sinking at rates up to 1 foot per year due to subsidence caused, in part, by the state's years-long drought, challenging growers to locate additional water sources for their crops. Supply and demand theory guided this correlational study. The purpose of the study was to examine the financial impact of drought on almond demand. This study included annualized historical almond industry data for the United States (N = 97), downloaded from a United States Department of Agriculture database. The results of multiple linear regression analysis indicated that the model was capable of predicting almond …

Using Multi-Theory Model To Predict Low Salt Intake - Nigerian Adults With Hypertension, Christine Adekemi Dokun-Mowete

Walden Dissertations and Doctoral Studies

Hypertension is a chronic non-communicable disease and a major risk factor for cardiovascular diseases, renal malfunction, disability, and premature death. One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. There is need to develop and implement new evidence-based theoretical interventions to initiate and sustain behavior change in health education and promotion. Therefore, the quantitative cross-sectional method and design was used to investigate the adequacy of multi-theory model (MTM) constructs for the initiation and the sustenance of low sodium/salt intake behavior in hypertensive Nigerian adults. In addition, the impact of the MTM (initiation) …

The Effect Of Referral Source On Patient Participation In Diabetes Education Programs, Karyn Marie Gallivan

Walden Dissertations and Doctoral Studies

The goal of diabetes education programs (DEPs) is to improve patients' pattern-management habits for those with type 2 diabetes (T2D), though participation in DEPs is lower than expected due to low physician referral rates. This retrospective study examined secondary data of 162 T2D patients who had been referred to a DEP in a community center in RI to determine whether the source of referral affected patient attendance, participation persistence, and outcomes. Self-referred (n = 62) and physician-referred (n = 100) groups were analyzed for possible associations among the aforementioned variables. Chi-square (p = .04) and logistic regression (p = .04) …

Assessment Of Anxiety And Depression Among Breast Cancer Patients Undergoing Treatment In Ghana, Kofi Adesi Kyei

Walden Dissertations and Doctoral Studies

Breast cancer patients undergoing radiotherapy often experience severe levels of anxiety and depression. There is a gap in the research literature from Africa, particularly from Ghana, with few studies focusing on the assessment of anxiety and depression among breast cancer patients undergoing radiation treatment. A better understanding was essential to promote efforts to help breast cancer patients cope with their diagnosis and treatment and increase their overall quality of life. This mixed method study examined breast cancer patients in Ghana undergoing radiotherapy and their responses related to anxiety and depression through a concurrent triangulation involving an interview with selected professional …

Dietary Acculturation And Obesity In African Immigrant Adults, Stella Chinyere Onuoha-Obilor

Walden Dissertations and Doctoral Studies

Racial/ethnic groups are disproportionately affected by obesity and other risk factors for chronic diseases. African immigrants are an increasing segment of the U.S. population at greater risk for obesity than other immigrants living in the United States. Public health organizations that aid immigrants could benefit from information about changing dietary patterns. The purpose of this study was to explore the association between dietary acculturation and obesity among African immigrant adults living in the United States, controlling for length of stay, English proficiency, region of residence, and other sociodemographic factors. Acculturation theory guided this study. The research design was quantitative cross-sectional …

Development Of An Educational Program To Obtain And Maintain Healthy Weights Among 4th And 5th Grade Students, Stephanie Dean Black

Walden Dissertations and Doctoral Studies

Development of an Educational Program to Obtain and Maintain Healthy Weights Among 4th and 5th Grade Students

By

Stephanie D. Black

MSN, University of Phoenix, 2008

BSN, Southwest Baptist University, 2006

ASN, Southwest Baptist University, 2003

Capstone Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

October 2017

Obesity is prevalent in schoolchildren and increases risk of chronic diseases throughout the lifespan. Strategies are needed to address this growing health problem. Education in elementary schools targeting the topics of nutritional choices and prevention of obesity, particularly in 4th-5th grade population, is …

Sugar Intake And The Five Personality Traits Of Millennials, Flora Gashi

Walden Dissertations and Doctoral Studies

Sugar intake continues to be connected to an increased risk of heart diseases, diabetes, arthritis, and certain forms of cancers, depression, and schizophrenia. The purpose of the study was to examine if sugar intake is related to personality traits in the Millennial population. The health belief model was used as the theoretical framework for conducting the study. The research questions addressed in the current study were in regards to the relationships between Millennials daily sugar intake and openness, conscientiousness, extraversion, agreeableness, and neuroticism. This study was a cross-sectional design in which a panel of randomly selected United States Millennials (N …

The Soldier 360°Orgram: Strengthening Combat-Exposed, Noncommisioned U.S. Army Officers' Interpersonal Sensitivity, Anne Harper

Walden Dissertations and Doctoral Studies

Interpersonal sensitivity is a foundational component of interpersonal relationships. It encompasses an individual's self-concept and self-identity, which are formed as the individual develops. An individual's self-concept develops from the norms and mores of his or her society. Soldiers in the U.S. Army have been trained to form a repurposed self to engage in combat and work in combat-focused jobs. The consequence of this training in many cases has been diminished interpersonal sensitivity that has been detrimental to their interpersonal relationships. The Soldier 360° course is a comprehensive treatment program that takes a holistic approach to providing soldiers with self-empowering tools …

Differentiating Successful And Unsuccessful Nursing Students, Trilla Mays

Walden Dissertations and Doctoral Studies

Administrators of nursing programs in community colleges are aware of the need to retain and to graduate students to meet the growing demand for licensed practical nurses (LPNs). High attrition in a 2-year nursing program in South Carolina affected the number of students either graduating as a LPN after completing the third semester, or continuing in the program to become a registered nurse (RN). Guided by Jeffreys's nursing undergraduate retention and success model, this causal comparative study investigated the differences between students who were and were not successful in the initial 3 semesters of the program. Archival student records for …

Quality Improvement Through Evidence-Based Education: Advancing Obesity Awareness And Clinical Management Strategies For People Living With Mental Disorders, Ellis Ehizele Opusunju

Walden Dissertations and Doctoral Studies

People living with mental disorders (PLWMDs) are at an increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the general-population obesity rate is 36% compared to more than 50% for PLWMDs. Mental health professionals (MHPs), focused on addressing psychiatric conditions, seldom recognize and clinically manage obesity. Furthermore, this population is socioeconomically disadvantaged with poor dietary habits while consuming psychiatric medications that stimulate hunger, further exacerbating the risk for obesity. The Promoting Action on Research Implementation in Healthcare Services (PARISHS) framework guided this quality improvement project to improve obesity awareness and management …

Women And Coronary Artery Disease, Gwendolyn Yvonne Stancell-Smith

Walden Dissertations and Doctoral Studies

Heart disease, including coronary artery disease, affects approximately 42 million women in the United States. Many of those affected are not aware they have the condition. Contributing to the problem is the fact that women are more likely than men to be misdiagnosed and undertreated for heart disease. Morbidity and mortality are high in women affected by heart disease, making the problem important to address. The purpose of this project was to understand the coronary artery or heart disease risk and the treatment for the condition provided for 31 participants at a cardiology service in the Northeast U.S. The project …

Leadership Practices That Improve The Workplace Safety Environment, Nathan Nomore Chikono

Walden Dissertations and Doctoral Studies

Inadequate leadership is the reason workplace accidents in the mining industry remain high, making the industry one of the most hazardous operational activities in the world. Unsafe leadership practices may result in death or injury to workers. A group of 30 mining company leaders from 3 gold mines in Zimbabwe revealed an exception to these hazardous practices, however, notable through their outstanding safety improvement records. To better understand what these practitioners were doing, this multicase study research design explored their strategies to improve the workplace safety environment in the mines. Data were collected using audio-recorded semistructured interviews and document analyses. …

Bupivacaine With Fentanyl To Treat Labor Pain: A Quality Improvement Initiative, Irvin Lee

Walden Dissertations and Doctoral Studies

Epidurals used for labor are common regional anesthesia techniques that are easily placed and controlled, while providing the most reliable method of pain relief in obstetrics for parturient women. Local anesthetics, narcotics, and/or combinations of the two are administered through epidurals to treat labor pain. Hence, the choice of medication is important, as it can highly influence outcomes of pain relief. The purpose of this DNP project was to evaluate the effectiveness of a new service line medication, bupivacaine 0.1% with fentanyl 2mcg/ml, to treat labor pain in parturient women at a rural community hospital in southern California guided by …

10,000 Step Challenge For Bedside Registered Nurses Working 12 Hour Shifts, Katherine Louise Schnebly

Walden Dissertations and Doctoral Studies

Obesity is a pandemic that directly affects chronic health problems and mortality. Researchers have shown that more than 54% of nurses are obese. The increasing rate of obesity among nurses and the long hours they work make healthy lifestyles, including daily physical activity, difficult. Tracking daily activity using a pedometer or fitness application has shown improved awareness and sustainability of daily physical activity. This project was an investigation of the daily steps of bedside nurses working a 12-hour shift, and their subsequent awareness of their daily physical activity. Pender's Health Promotion Model was used to consider motivating factors for improving …

Wellness Education And Job-Related Injuries And Illnesses For Federal Employees, Eunice Scott

Walden Dissertations and Doctoral Studies

Work-related injuries and illnesses may lead to absenteeism, which affects the level of productivity. The purpose of this study was to determine the success of an employee workplace training program on work-related injury and illness rates at selected federal districts within a federal organization. Newman's model, which describes internal and external factors that may have an effect on an individual's health, was the framework that guided this project. A pre-post design was used to compare data from 2 publically available data sets, the Occupational Safety and Health Administration Illness and Injury and the Voice of the Employee Survey, for the …

The Influence Of Cardiovascular Disease Risk Factors On Exercise Participation, Chadrick Cooper

Walden Dissertations and Doctoral Studies

The study's purpose was to analyze whether the control (sustained healthy level) of independent cardiovascular disease risk factors could be used to significantly predict aerobic exercise status. The health belief and ecological model helped describe health awareness, autonomy, and ecological influences that could also influence the control of each risk factor. Multiple logistic regression analysis of behaviors and demographics was utilized to assess relationships of met aerobic recommendations to hypertension, diabetes, obesity, tobacco/alcohol use, diet, physical activity limitations, mood, and socio-economic status. The study consisted of 340 African American participants (37% male 63% female), between the ages of 30-64 who, …

The Impact Of Nursing Interventions On Pediatric Pressure Injuries, Charleen Singh

Walden Dissertations and Doctoral Studies

Hospitalized children are vulnerable to pressure injuries. Multiple methods are available to decrease pressure injuries. One specific method is the pediatric pressure injury prevention bundle, which includes device rotation, moisture management, positioning, skin assessment, and support surface management. Although this prevention bundle is available nationwide, it is not known if this type of bundled methodology helps decrease pressure injuries in hospitalized children. Secondary data regarding nursing interventions implemented as a bundle and pressure injury rates from a large pediatric hospital consortium were used to address this gap in the literature. The research questions explored the impact of the pressure injury …

Teacher Perceptions Of A Full-Service Community School Strategy For Language Arts Students, Jaclyn Marie Dorrman

Walden Dissertations and Doctoral Studies

Students of all abilities at a Full-Service Community School (FSCS) in northern New Jersey are not meeting federal and state accountability requirements in language arts. Research studies indicated that the FSCS strategy can improve instructional practices, which will improve academic success. For this qualitative case study, the purpose was to document and analyze the strengths and weaknesses of the FSCS academic component for language arts used by 8 teachers from kindergarten to 6th grade. The conceptual framework that guided this study was grounded in the central understanding of Vygotsky and the constructivist theory of Bruner. The perceptions of language arts …