Digital Commons Network^™

Support Of Maternity Care Practices To Increase Breastfeeding Among First-Time Mothers, Jessica Strauch

Walden Dissertations and Doctoral Studies

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding …

The Impact Of Immigration Variables On Tuberculosis Rates In South Carolina, Lisa J. Dimitriadis

Walden Dissertations and Doctoral Studies

After HIV/AIDS, tuberculosis (TB) is the deadliest single infectious agent worldwide; globally in 2013, 1.5 million people died of the disease. Although TB infection rates in the United States are low compared to that of other countries, TB still remains a threat to public health in the U.S., especially among immigrant populations. The main purpose of this study was to investigate the correlations between the independent variables of immigration status, years of residence, and race/ethnicity and the dependent variable of TB infection within South Carolina between 2006 and 2012. To examine these possible relationships, this quantitative study employed the ecological …

Predictors Of Knowledge Of Stroke And Intent To Call 911 Among African Americans, Hyacinth Idu Hyacinth

Walden Dissertations and Doctoral Studies

Stroke is associated with significant health disparity and predominantly affects the elderly. Stroke outcome is significantly improved if an individual is able to get "clot-bursting" medication. A significant predictor of an on-time arrival to the emergency room for treatment in the event of a stroke is the ability to accurately recognize stroke signs and symptoms. The purpose of this study was to determine the factors (demographic, socioeconomic, and educational) that predict the knowledge of stroke signs/symptoms and intent to call 911 in the event of a stroke. The study was grounded in the social ecological theoretical model and analyzed archived …

A Proposal For The Development And Validation Of A Diabetic Self-Management Education (Dsme) Program, Melissa Sue Garrison

Walden Dissertations and Doctoral Studies

The World Health Organization has estimated that by 2030, approximately 350 million people will be diagnosed with Type 2 diabetes mellitus (T2DM). Currently, 18.8 million people are diagnosed with T2DM. An additional 7 million people have high blood sugar but have yet to have an official diagnosis of diabetes. The literature supports early identification and prevention are key to reducing the severity of T2DM its complications. The Health Belief Model, the Chronic Care Model and Orem's Theory of Self-Care guided the current proposal, whose purpose was to develop and validate a new T2DM DSME module. A validation of the DSME …

Exploring Yoga As A Holistic Lifestyle For Sustainable Human And Environmental Health, Julia A. Leischner

Walden Dissertations and Doctoral Studies

Improved health indicators, mental and physical health outcomes, and sustainable lifestyle practices have been found among yoga practitioners. The purpose of this study was to examine the impact of mixed styles of yoga practice on the health and behaviors of yoga practitioners. The relationship between yoga and body mass index (BMI), self-reported disease diagnosis, participation in other types of physical activity, adoption of healthy and sustainable lifestyle and dietary behaviors, perceived improvements in medical conditions that yoga was used to treat, quality of life resulting from yoga practice, and the reasons for beginning and continuing yoga were observed and tested …

Correctional Nurses' Knowledge And Perceptions Of Methicillin-Resistant Staphylococcus Aureus, Deborah Winbush

Walden Dissertations and Doctoral Studies

Since 1999, Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have occurred in many correctional facilities. Even after the Federal Bureau of Prisons developed clinical practice guidelines on the management of MRSA within correctional facilities, the prevalence of MRSA decreased only insignificantly. Other researchers suggested infection control compliance was equally as important as developing clinical practice guidelines in reducing the incidence of MRSA. Several studies identified the healthcare professionals' nonadherence and inconsistencies to clinical practice guidelines as contributors to MRSA transmission. Accordingly, this project was designed to develop evidence-based recommendations for improving nurse professionals' adherence to MRSA practice guidelines in correctional settings. Using …

Why Some Women Eat Too Much: A Qualitative Study Of Food-Dependent Women, Gigi Van Ostrand

Walden Dissertations and Doctoral Studies

Obesity has become a worldwide epidemic and limiting one's food intake, or dieting, is usually unsuccessful. The purpose of the study was to explore the effect of food addiction (FA) on the current clinical and behavioral epidemic of obesity. FA, synonymous with food-dependency, is tentatively defined as an eating disorder based on substance dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Measurement of FA has been operationalized by the Yale Food Addiction Scale (YFAS) by applying the diagnostic criteria of substance dependence to eating behaviors. This study was based on the biological theory of chemical addiction …

The Association Of Maternal Health Literacy Levels And Preterm Birth, Aimee Moynihan

Walden Dissertations and Doctoral Studies

According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this …

A Transition-To-Practice Residency That Supports The Nurse Practitioner In A Critical Access Hospital, Nancy Jean Stock

Walden Dissertations and Doctoral Studies

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to …

Technology As A Health Intervention And The Self-Efficacy Of Men, Karen Denise Maxwell

Walden Dissertations and Doctoral Studies

Mortality rates in the United States are higher for men than they are for women as a result of chronic diseases such as heart disease, cancer, and diabetes. Despite these disproportionate rates, few health interventions are targeted to men, and limited knowledge exists regarding the specific components needed to design technology health tools to appeal to men. The purpose of this quantitative study was to examine the relationship between the use of technology health tools and the role of self-efficacy in men and the influence on participation in healthy lifestyle behaviors. A quasi-experimental design was used to analyze data collected …

Practice Guidelines For Self-Management Of Osteoarthritis Pain In The Home-Based Settings, Oyesola Omowunmi Akintan

Walden Dissertations and Doctoral Studies

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI …

Facilitating Weight Tolerance Among Health And Fitness Majors Toward Obese Persons, Stephanie Boss

Walden Dissertations and Doctoral Studies

Weight bias exists in some health-related degree programs. Overweight and obese persons who experience weight bias in health-related services often delay or avoid medical attention altogether. Guided by the attribution theory, the purpose of this sequential explanatory study was to examine weight bias among health majors at a southwest regional university to illuminate how attitudes can affect the level of care provided to overweight persons. The Attitudes toward Obese Persons (ATOP) scores from a convenience sample of 184 health majors revealed that participants' scores were found to be significantly lower than the midpoint (60) of the ATOP scale, M = …

Best Predictors Of A Person's Long-Term Success With Quitting Tobacco, Nhu-Tam P. Villar

Walden Dissertations and Doctoral Studies

Smoking relapse rates among tobacco users remain high after quit attempts, with or without interventions. Though researchers have examined stress-related factors contributing to high relapse rate, little empirical research has concentrated on variables predicting long-term quit maintenance. The purpose of this study was to determine the predictability of stress management tools, including exercise motivation, eating behaviors, social support, and self-compassion, as well as the significant combined variance of these variables, in a person's long-term maintenance with tobacco use abstinence. Bandura's social cognitive theory was used to highlight the factors contributing to health behavior such as tobacco use. This study involved …

Correlations Between Childhood Obesity And Obesogenic Environmental Variables Within Durham County, North Carolina, Eureka Capri Daye

Walden Dissertations and Doctoral Studies

The application of geographic information systems was used to map obesogenic conditions by zip code tabulation areas in Durham County, North Carolina and evaluated associations between those conditions and the understudied area of early childhood obesity. Of the thirty one percent of the children in Durham County, North Carolina who were considered obese in 2010, four hundred and thirty three (1:5) 2 - 4 year old children who received supplemental nutrition services for women, infants and children were obese with BMI levels greater or equal to the 95th percentile and were used as the criterion variable in the study (N=433). …

Steps To Reducing Heart Failure Hospital Readmissions Through Improvement In Outpatient Care, Paticia Laubach Dunn

Walden Dissertations and Doctoral Studies

The outpatient care of the heart failure (HF) patient is fragmented due to the lack of evidence-based practice guidelines use. The primary goal of this project was to improve the care of the HF patient in the outpatient arena through use of clinical pathways using the logic model as the project framework. The intervention was carried out over a 4-week period on a convenience, random sample of patients (n = 80) attending a cardiology practice. The patients were recruited from 2 physicians' patient populations and were selected based on an adult diagnosis of HF, reduced ejection fraction of <40% at some point in time, and the New York Heart Association (NYHA) functional class II-V. Comparisons were made in the documentation of care between patients on or off the pathway. The intervention included documentation of patient education, care follow-up, medications, NYHA functional class, and symptom exacerbation, documented in the electronic medical record. The quality of care data were evaluated based on 3 of the Joint Commission core measures for outpatient care of the HF patient. Additional data were collected regarding use of the clinical pathway based on provider and week of implementation. Data were analyzed via a Chi-square test of independence comparing pathway use by provider and use of pathway as study progressed. The comparative results show statistically significant differences in use of the pathway by provider and a statistically significant increase in use during the project . The quality of care results varied in statistical significance. The pathway utilization increased over time and provided a method for standardizing documentation of care for the HF patient in this outpatient clinic, a benefit for HF patients and providers in this cardiology practice and beyond.

The Effects Of Barriers Toward Fighting Childhood Obesity Within Head Start, Vanessa Chaney

Walden Dissertations and Doctoral Studies

Childhood obesity is associated with significant morbidity and mortality and poses a health care burden. Child care facilities serve at the forefront in fighting childhood obesity among preschoolers. Since 2009, a significant shift has occurred in studying child care settings among children aged 3-5 in North Carolina and South Carolina in response to the rising rates of obesity in this population. Some of the hypothesized determinants of childhood obesity among preschoolers in North Carolina and South Carolina are outdoor activity, staff behavior, center's size and location. The purpose of this study was to investigate if significant relationships exist between childhood …

The Influence Of Nursing Home Administrator Turnover On Resident Quality Of Life, Juliet Iheoma Madubata

Walden Dissertations and Doctoral Studies

By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address …

Perceived Factors Contributing To Coronary Heart Disease In African American Women, Funmilola O. Sholanke

Walden Dissertations and Doctoral Studies

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to …

Case Study Of Parental Involvement For Enhanced Kindergarten Students' Development In Low Socioeconomic Households, Robyn Tresnak

Walden Dissertations and Doctoral Studies

Evidence suggests that parents in low socioeconomic households may have unaddressed educational needs about their children's development. The purpose of this case study was to discover innovative ways parents in a low socioeconomic community engaged in activities with their young children to influence academic and social development. Bronfenbrenner's ecological theory of human development and Epstein's parental involvement model, the family process model, and the family strength model were used to build the conceptual framework. Parents and educators were asked to describe parent-engagement opportunities that were provided within the kindergarten classroom. Data were collected using a focus group with 13 educators …

The Environmental Health Of The Autistic Student In The Public School Classroom, Antonia Klein

Walden Dissertations and Doctoral Studies

Professionals have found autism to be an enigmatic condition. While necessary

biomedical research continues, a gap exists in the inclusion of parental opinions,

knowledge, and experiences in educational planning for their autistic children. The

purpose of this mixed methods study was to identify the factors that the parents felt

contributed to the academic success of their autistic child in the public school classroom

environment and ways in which their ideas might contribute to overall educational

planning and classroom design in structure, curriculum development, and intervention

strategies which might lead to reduced stress. Parental input was explored through

semistructured personal interviews …

Weight Management Counseling And Obesity Severity In Children With Special Health Care Needs, Adeola Sonaike

Walden Dissertations and Doctoral Studies

Epidemiologic surveillance indicates an increased susceptibility to obesity among children with special health care needs (SHCN) in comparison to children without. The present study investigated this disparity in weight severity between both groups, with a focus on the provision of obesity management counseling by physicians. This study consisted of a retrospective medical record review that acknowledged the effect of patient-provider interactions on health behaviors and risk perceptions. An independent sample t test compared the incidence of clinician-initiated obesity management counseling received by children with SHCN to that which was received by children without SHCN. This t test revealed a statistically …

The Effect Of An Online Coping Skill Application On Relapsing-Remitting Multiple Sclerosis Sufferers, Jennifer H. Garrison

Walden Dissertations and Doctoral Studies

Many individuals with multiple sclerosis (MS) are classified as having relapsing-remitting MS (RRMS), a form of the illness that requires constant symptom management for suffers to achieve optimum outcomes. There are only a few community-based educational programs that exist to help RRMS sufferers cope with their illness; the effectiveness of those that have been fielded has not yet been adequately assessed. The research questions of this study were to determine if an online training development module would increase the coping skills of those affected by RRMS and if the online educational module would be more effective at improving the coping …

Program For Healthcare Personnel To Improve Anti-Hypertensive Medication Adherence In Black Adults, Verena D. Johnson

Walden Dissertations and Doctoral Studies

Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience …

Learned Helplessness And Depression: Comparison Of Skilled Nursing And Assisted Living Facilities, Paul Lynn Susic

Walden Dissertations and Doctoral Studies

Research with geriatric populations suggests high levels of clinical depression and greater financial and psychological costs of treatment in long-term care facilities with more restrictive care. Research on learned helplessness, a construct separate from depression, suggests learned helplessness and perceived control are useful theories for the study of elder depression, but the relationship between depression and learned helplessness in this population is not clear. This cross-sectional quantitative study examined the relationship between depression and learned helplessness by comparing residents over age 65 in less restrictive assisted living (n =42) versus those in more restrictive skilled nursing facilities (n =63). Data …

A Mindfulness-Based Stress Reduction Psychoeducational Program In Postpartum Support Groups, Marina Pesserl

Walden Dissertations and Doctoral Studies

Postpartum Depression (PPD) affects 15% of women after childbirth. Its etiology includes psychoneuroimmunologic factors with long-lasting postpartum stressors that lead to allostatic overload. Using mindfulness-based stress reduction (MBSR) for PPD has not yet been studied. Addressing this literature gap, the potential benefits of including an 8-week MBSR component based on Beck's theory of PPD at support groups were examined in this phenomenological study based on a sample of 10 women and 2 group facilitators. Purposes of the study included describing the experience of PPD and the MBSR program, identifying the stage of behavioral change of the participants, and describing the …

Teachers' Perceptions Of Multimodal Literacies In Middle School Health Literacy Programs, Cynthia Darlene Jackson-Howard

Walden Dissertations and Doctoral Studies

Health literacy, defined as the ability to understand and use health information to make informed decisions, is critical to maintaining health; however, not all U.S. states mandate strategies to improve adolescents' health literacy. Moreover, many middle school teachers are often unaware of how their roles could improve the health literacy of their students. Multimodal literacies help students to create meaning through viewing print-based resources and using digital technologies. The purpose of this study was to investigate teachers' perceptions of the effectiveness of multimodal literacies on adolescents' overall health literacy via the introduction of health literacy programs into the curriculum. This …

Knowledge, Attitudes, Beliefs, And Behaviors Of Diabetes Among Afro-Caribbeans Near Brooklyn, Sophia I. Allen

Walden Dissertations and Doctoral Studies

Literature has found that some minority groups with diabetes have a negative perception of medical professionals when a health problem occurs. This trend is particularly problematic with the diabetes epidemic in the United States. African Americans are more than 2 times as likely to die from diabetes than are Whites, and diabetes prevalence has increased exponentially in New York City where a majority of Afro-Caribbeans live. To address this problem, a cross-sectional design was used to recruit Afro-Caribbeans diagnosed with type 2 diabetes across 7 churches to examine whether shared knowledge, attitudes, beliefs, and behaviors about diabetes screening and its …

Exploring The Lived Experiences Of Seniors Aging In Place, Magaly C. Dante

Walden Dissertations and Doctoral Studies

Baby boomers are living longer, and as they age, they will need more supportive services that may include housing, mobility, nutrition, personal care, or health care. Despite the studies that have been conducted on baby boomers aging in place (choosing to stay in their home versus move to an institution), the focus has been on the old and frail and very little has been done to address the lifestyle of active (physically functioning) baby boomers. The purpose of this phenomenological study was to understand the lived, shared experiences of active baby boomers regarding their beliefs and attitudes about aging in …

A Clinical Pathway Education Program For Pediatric Nurses, Lisa M. Scheiber-Case

Walden Dissertations and Doctoral Studies

Clinical pathways have been studied to promote best practices in nursing and enhance patient satisfaction. For 10 years a pediatric orthopedic surgical team at a Midwest hospital has not had a clinical pathway to treat or standardize care for adolescents following posterior spinal fusion surgery. Pain scores and patients' length of stay were collected using a retrospective chart review. This information was used to revise preoperative education materials and develop a visual poster. The purpose of this project was to identify and develop a way to educate the pediatric nursing staff on the use of the developed educational materials, poster, …

Skype As A Scaffolding Tool For Underprepared Freshmen English Composition Students, Conswellor Denise Ogden

Walden Dissertations and Doctoral Studies

Nontraditional students enrolled in online courses tend to drop out within their first year because they do not have the basic literacy skills or essential college skills needed for success. They often need the guidance of an online instructor. The purpose of this case study was to explore the perceptions of instructors and students about the effectiveness of Skype as a scaffolding tool for increasing academic achievement for underprepared students in online remedial English composition courses through interactions with their instructor. The conceptual framework included Bruner's cultural-psychological theory of education, Vygotsky's social constructivist theory, and Siemens's connectivism theory. The study …