Digital Commons Network^™

Understanding Health Literacy Skills Of Patients With Cardiovascular Disease And Diabetes, Patrick J. Dunn

Walden Dissertations and Doctoral Studies

Health literacy is the ability to understand and act on health information and is linked to health outcomes. It is unclear how health literacy skills are developed in patients with complex conditions, such as cardiovascular disease and diabetes. The purpose of this grounded theory study was to gain perspectives of both patients and healthcare professionals on how health literacy skills were developed in patients with cardiovascular disease or diabetes. The research questions addressed how knowledge and skills were acquired, the role of digital tools, instructional strategies used by healthcare professionals, and how the instructional strategies of the healthcare professionals matched …

Understanding The Impact Os Stress, Irrational Health Beliefs, And Health Behaviors Among Adults18-45, Toni Loe Rabalais

Walden Dissertations and Doctoral Studies

This study examined the role of stress on irrational health beliefs and health behaviors among individuals 18-45 years old. Previous research has shown that this age group reported higher stress levels, more physical symptoms of stress, and the highest level of negative health behaviors. The theoretical frameworks were health belief model, the transactional model of stress and coping theory, and Ellis's concept of irrational beliefs. A survey using 3 published instruments measured the perceived stress level, irrational health beliefs, and health behaviors of a sample of 97 individuals aged 18-45. The data were quantitatively assessed using a mediation model to …

A Staff Development Program: Diabetes And Tb Education And Screening, Relyndo Manalo Salcedo

Walden Dissertations and Doctoral Studies

There is a growing body of evidence on the positive association between diabetes and tuberculosis (TB), especially in populations with low socioeconomic status. According to the CDC and the WHO, diabetes is increasingly seen as a global epidemic, one that poses a threat to global TB control. The goal of this DNP project was to develop a program to educate clinical staff on the importance of early identification of diabetic and TB patients. The logic model was chosen as the framework for this project because it allows the planner to rationally observe each stage of a project's development. The program …

Rural Year-Round Growing To Ameliorate A Possible Negative Effect From Climate Change, Kimberlie A. Brussa

Walden Dissertations and Doctoral Studies

The Intergovernmental Panel on Climate Change (IPCC) suggested that, as the world population grows, food and water shortages will become even more serious issues (IPPC's 2014 predictions about the future effects of climate change (CC), Year-round growing (YRG) may provide a way for communities to extend growing seasons, expand local farm systems, and provide food year round. This case study included a detailed analysis of responses from representatives of all sectors of rural Mesa County, Colorado, regarding YRG and a local food and farm plan due to CC. The case was bounded by time (6 months of data collection) which …

Identifying Risk Factors For High Incidence Of Peripheral Intravenous Catheters Complications: Reducing Infiltration Rate Within The Hospital, Janise Marrisette Banks

Walden Dissertations and Doctoral Studies

This study addressed an increasing number of peripheral intravenous catheter infiltrations within hospitals, leading to problems such as phlebitis and cellulitis, which may result in a longer length of hospital stay. The purpose of this project was to determine how to reduce infiltrations in order to increase the longevity of the catheter. A quantitative, description design was used, guided by Abdellah's classification framework for identifying nursing problems. The target population was 50 patients experiencing incidents of peripheral intravenous catheter infiltration, identified in a patient safety event log used across a 252-bed hospital. Each incident was assessed for several risk factors, …

A Comparative Study Of Compliance Among Patients Attending An Opiate Outpatient Treatment Center In Rural Appalachia, Jerry Russell Morris

Walden Dissertations and Doctoral Studies

Adults with an opiate addiction have a higher rate of noncompliance with treatment, which limits its effectiveness and increases the burden of care for society. Effective treatment decreases emergency room visits, and overdoses. The tristate area of Kentucky, West Virginia, and Ohio has experienced increased opiate-related arrests and deaths. This study sought to measure the extent to which treatment type (medical treatment (MS) or faith-based component of service (FBS)) predicts compliance when measured by number of clean urine drug screens (UDSs) and number of kept pill count, over and above dual diagnosis, college education, and income. The on-site records of …

Social Ecological Influences Of Wic Programming Behavior Change Of Former Wic Participants, Joyce L. Terrell

Walden Dissertations and Doctoral Studies

The Special Supplemental Women, Infants, and Children (WIC) Program is one of many United States Department of Agriculture's (USDA) food subsidy programs that serves 8.6 million participants, deemed nutritionally at risk. WIC is designed to influence nutritional and health behaviors to a population least capable of functioning. The purpose of this study was to identify if participation in WIC's nutrition education activities and restricted use of food subsidy benefits had a post-factorial effect on their nutritional behaviors. This study provides data on Bronfenbrenner's social ecological influences and how it impacts on long-term behavioral change. A quantitative causal-comparative design utilizing a …

Parental Confidence In U.S. Government And Medical Authorities, Measles (Rubeloa) Knowledge, And Mmr Vaccine Compliance, Wendy Leonard

Walden Dissertations and Doctoral Studies

Parents' refusal to immunize their children with the measles, mumps, and rubella (MMR) vaccine has resulted in a surge of measles outbreaks in the United States. The purpose of this correlational study was to examine the relationships between parental knowledge and trust of the MMR vaccine, and their trust in government and medical authorities. The theoretical foundation for this study was the health belief model (HBM). This study determined if there was any relationship between general trust in doctors/governments (i.e., the predictor variable) and attitudes toward MMR vaccine (i.e., the sole dependent variable), and whether gender, age group, or level …

Evaluation Of Chlorhexidine Bathing Practices In Trauma/ Surgical Intensive Care Units, Kara Willett

DNP Projects

Central venous catheters (CVC) are vital in present-day medical practice, particularly in the intensive care unit (ICU). However, their use puts patients at risk for developing central line-associated bloodstream infections (CLABSIs) which are a major concern in today’s health care system. CLABSIs are a significant source of patient mortality, increased length of stay, and healthcare spending. The heightened awareness of these infections along with their escalating cost has amplified implementation of preventative protocols.This practice inquiry project includes three manuscripts, each of which discusses relevant aspects of CLABSIs prevention utilizing daily whole body chlorhexidine gluconate bathing inlcuding a review of literautre …

Treatment Outcomes For Opiate Addicted Pregnant Women, Jennifer L. Roth Parr

DNP Projects

The problem of opiate addiction is complex enough but compounded when the patient is pregnant. Substance use during pregnancy produces harmful and costly effects to both the mother and the fetus (Veilleux, Colvin, Anderson, York & Hines, 2010). The rate of opiate addiction among pregnant women in the U.S. has been increasing in epidemic numbers since the beginning of the 21st century. This paper looks at research on the origin of the problem, the demographics of the average pregnant opiate addicted patient, the effects on the woman and her unborn child, and available treatment options.

Primary Care Providers’ Knowledge And Experience With Pediatric Acute Watery Diarrhea And Hemolytic Uremic Syndrome, Krista Marie Cassel

DNP Projects

The purpose of this capstone is to investigate the potential for hemolytic uremic syndrome (HUS) risk reduction in children through the evaluation of current evidence as well as pediatric primary care providers' knowledge and experience with children at risk for HUS. The goals of this capstone are to 1) evaluate the current literature to determine best practice for prevention of HUS, 2) assess primary care provider knowledge of HUS and experience with children with acute watery, and 3) develop a guideline for the initial management and referral of these children at risk for HUS.

Development, Implementation, And Evaluation Of Refugee Health Literacy Program (R-Help), Cecilia A. Boateng

DNP Projects

Problem Statement: United States refugees often encounter significant barriers when adapting to their new host country; such as cultural and language barriers, and difficulty in navigating through the American healthcare system. For example, navigating through the American Pharmacy system to buy or refill medications is a great challenge for most refugees. To make matters worse, most refugees have difficulty understanding medications instructions which puts them at risk for making medication errors.

Purpose: The purpose of this study was to develop, implement, and evaluate the feasibility of delivering an evidence based health literacy medication educational program for all newly-arrived refugees attending …

An Evaluation To The Adherence Of A Sepsis Protocol At A Central Kentucky Community Hospital, Somer K. Robinson

DNP Projects

Background: Sepsis is defined as a “systemic response to an active infectious process in the host” and “represents the systemic inflammatory response to the presence of infection” (American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992, p.865). In 2008, an estimated 727,000 patients were hospitalized with a diagnosis of sepsis, an increase from 326,000 in 2000, or a 55% increase in prevalence over the eight-year period (Hall, Williams, DeFrances, & Golosinskiy, 2011). Early identification of sepsis with early and effective management strategies has been shown to improve patient outcomes and decrease mortality and prevent organ dysfunction (Levy …

Dual Component Educational Program To Improve Medical-Surgical Nurses’ Knowledge And Self-Efficacy Of Severe Sepsis And Septic Shock, Duska S. Bethel

DNP Projects

Sepsis is manifested by a spectrum of clinical signs and symptoms that are produced by an immune response to an infection. The continuum of sepsis ranges from simple sepsis to septic shock and without timely and appropriate intervention leads to death. The purpose of this practice inquiry project is to implement a dual component educational program at Baptist Health Madisonville, a hospital part of the Baptist Healthcare System in Madisonville, Kentucky, and evaluate the changes in nurse knowledge and self-efficacy levels after they receive didactic and interactive education. The first manuscript is an integrative literature review of studies published between …

Case 213: Primary Spenic Angiosarcoma, John J. Krol, Vera V. Krol, Adrian Dawkins, Halemane S. Ganesh

Radiology Faculty Publications

A 75-year-old woman with a medical history of gastroesophageal reflux disease and type II diabetes presented to the hospital with a 3-month history of gradually worsening headaches, vague upper abdominal pain, and lower back pain. The patient denied fevers, night sweats, contact with sick individuals, occupational exposure to infection, bleeding, immunodeficiency, intravenous drug use, alcohol or tobacco abuse, history of malignancy, family history of genetic disorders, and international travel. Physical examination revealed a skin-colored mass protruding from the right side of her forehead, but there were no other notable abnormalities. Her diabetes was managed with diet, and the only prescription …

Hiv Infrastructure Study Jackson, Mississippi, Susan S. Reif, Elena Wilson, Carolyn Mcallaster, Miriam Berger

Faculty Scholarship

No abstract provided.

Protein Intake And Hookworm Infection Susceptibility In Rural Ghanaian School- Age Children: A Mixed-Methods Study, Luis Enrique Maldonado-Vásquez

Public Health Theses

Background: Because human and animal cross-sectional studies cannot assess temporality, a longitudinal study is needed to assess the association between protein intake and hookworm infection susceptibility. Cultural preferences and belief systems have been noted to affect the intake of food in some African societies but extensive research has not been conducted to characterize them.

Methods: Children (n=274) 7-13 years of age who attended school in the Kintampo North Municipality of Ghana were screened for participation in a longitudinal study assessing the relationship between protein intake and hookworm infection susceptibility. Protein intake was calculated by 24-hour recalls. A qualitative sub-study recruited …

Association Between Pediatric Vaccination Rates And Patterns Of Pneumococcal Disease In Adults In The Pcv7 And Pcv13 Eras, Sundia Cassandra Pingali

Public Health Theses

BACKGROUND: Pneumococcal conjugate vaccine (PCV) is now recommended for use in adults in the United States. Because vaccination of children with PCVs protects adults from the targeted serotypes, local variations in PCV uptake among children could influence the effectiveness of direct immunization of adults. The effect of variations in PCV7 and PCV13 uptake in children will be compared to assess the possible effectiveness of PCV vaccination in adults.

METHODS: We obtained ZIP Code-level invasive pneumococcal disease (IPD) data from an active population-based surveillance system in Connecticut (1998-2013) and ZIP Code-level data on immunization with 3+ or 4+ doses of PCV …

Determinants Of Early Feeding Practices Among Hiv+ Mothers In Sub- Saharan Africa: A Realist Review, Camille Adrianne Pottinger

Public Health Theses

INTRODUCTION: Exclusive breastfeeding has been shown to provide many benefits that can be life saving for the infant and mother in low resource settings7. Although the potential effects of breastfeeding appear large, exclusive breastfeeding rates remain low in this area of the world, and are even lower among the HIV population8-10. It is important to understand what influences HIV + mothers to exclusively breastfeed, as well as formula feed and adhere to ARV (antiretroviral) medication while breast feeding in order to make comprehensive policy recommendations that are as culturally sensitive and practical as possible. The objective of this review is …

Assessment Of Foodnet Population Survey Respondents As A Control Group To Determine Stec Risk Factors, Maria Andrea Rincon

Public Health Theses

Introduction: Shiga toxin-producing Escherichia coli (STEC) are important foodborne pathogens, causing approximately 30 deaths a year in the US. Case-control studies to monitor risk factors are challenging; finding representative controls can be labor-intensive. The FoodNet Population Survey (FNPS) is conducted periodically and asks about foodborne disease risk factors.

Objectives: To determine leading risk factors for STEC in Connecticut using the 2006 FNPS participant responses as controls.

Methods: Cases were reported STEC cases in Connecticut 2000-2009 who were interviewed for risk factors following onset. Controls were respondents to the Connecticut portion of the 2006 FNPS. Comparable questions for exposure to dietary, …

Leptospira In The Environmental Reservoir: Quantification And Persistence Of The Pathogen In An Urban Slum Setting Of Endemic Transmission, Andrew Gustav Schneider

Public Health Theses

Introduction

The ecology of Leptospira, the spirochete agent for leptospirosis, in its environmental reservoir is poorly understood. We quantified the presence of pathogenic leptospires in soil and sewage from a high-risk slum community for leptospirosis, and characterized its persistence in this environment.

Methods

We collected soil and sewage samples from three sites within a slum community in the city of Salvador, Brazil, and measured the concentration of leptospires using real-time quantitative PCR targeting lipL32, a gene exclusively present in pathogenic Leptospira. Additionally, we investigated the persistence of L. interrogans serovar Copenhageni, the agent for urban leptospirosis, in soil and sewage …

Intersection Of Religious And Antiretroviral Experiences And Its Implications For Medication Adherence In Hiv Positive Individuals In León, Nicaragua, Kimberly Stephanie Vasquez

Public Health Theses

Worldwide, in 2012, there were about 35.3 million people living with HIV/AIDS (PLWHA).1 Antiretroviral (ARV) significantly improved the livelihood of PLWHA through virological suppression, which has reduced HIV related mortality rates, and decreased the risk of HIV transmission through vaginal and anal sex.2,3 Optimal ARV adherence, around 95%, is required to maintain virological suppression.29 In 2000, a review paper reported that nonadherence rates were around 50-70%.30 Suboptimal adherence can lead to increased mortality, HIV transmission, and ARV resistance.2,3 Global suboptimal illustrates the importance of identifying barriers and facilitators to ARV adherence.7 Research is urgently needed to determine important barriers and …

Namati: Innovations In Legal Disempowerment For Health? A Sierra Leonean Case Study, Ikenna Okezie Achilihu

Public Health Theses

Drawing on eleven weeks of fieldwork for Namati’s Health Accountability and Social Empowerment Program, this case study investigates whether Namati interventions reinforce existing formal and customary structures for the amelioration of grievances between health clinics, their associated staff, and intended beneficiaries. Furthermore, this study questions Namati’s role as an organization that fosters sustainable change at: the level of the grassroots in its ability to influence government health policy, and at the level of the elites in its ability to improve administrative and policy deficiencies in the area of health access. Finally, this study answers critical questions on the equity-enhancing effects …

Who Gets An Iud: The Impact Of Patient Race And Number Of Past Sexual Partners On Clinical Decisions To Prescribe Intrauterine Devices, Tiffany Nicole Bell

Public Health Theses

While disparities by race/ethnicity in reproductive and sexual health outcomes are well documented, the role that healthcare providers play in contributing to these disparities is only beginning to be explored. This investigation sought to examine medical and nursing students' bias surrounding the prescription of intrauterine devices (IUDs, i.e., long-acting reversible contraception) to adolescents based on the patient's race and sexual history. An online survey presented participants with a clinical vignette of an IUD-seeking sexually active adolescent, with the patient's race and number of past sexual partners systematically manipulated. Participants reported predictions about patient risk of getting pregnant with and without …

A Mathematical Investigation Of The Drivers Of Lyme Disease Ecology At Two Ecologically Contrasting Sites, Malia Joy Carpio

Public Health Theses

INTRODUCTION: Lyme disease is an emerging tick-borne disease of increasing concern in the United States. In order to create and to implement effective public health interventions for Lyme disease, there must be a better understanding of the factors driving pathogen transmission.

OBJECTIVES: The primary objectives of this study were to determine how presence/absence of “super-spreaders” and observed differences between two ecologically contrasting sites influence Borrelia burgdorferi transmission.

METHODS: A next generation matrix R0 model was parameterized with field data from an island site (Block Island, Rhode Island) and a mainland site (Connecticut) in order to generate R0 estimates. A local …

Five-Year Resistance Trends Of Bacterial Isolates In Kigali, Rwanda, Makeda Aminah Carroll

Public Health Theses

Antimicrobial resistance (AMR), the phenomenon of decreased sensitivity to pharmaceutical agents that kill or inhibit the growth of bacterial pathogens, is a serious threat to public health worldwide. Many countries, including Rwanda, lack current information on antibiotic sensitivity profiles that would greatly aide clinicians and policy-makers. The current study aims to describe the time trends of antibiotic sensitivity for the isolates of six different bacterial pathogens from patients at King Faisal Hospital in Kigali, Rwanda and to make inference about future patterns of drug resistance in the study setting, to guide physicians in their prescribing practices and provide baseline data …

Community Systems, Health Knowledge, And The Role Of Promotoras De Salud In Rural Bolivia, Jennifer Grasso

Public Health Theses

Community Health Worker (CHW) programs have had a positive impact on public health across many settings worldwide. However, due to the nature of their vocation and the challenging health infrastructure in which they often work, these individuals commonly face significant barriers that threaten their performance as health promoters, educators, and liaisons. This qualitative research study assessed the perceived challenges for volunteers of a rural Promotoras de Salud program in Bolivia. Data were collected by way of in-person interviews with 20 active Promotoras de Salud of ten communities in the north central region. Results showed that two commonly reported sources of …

Drug Use And Smoking Among Hospitalized Influenza Patients, Connecticut 2011-2014, Georgiana E. Green

Public Health Theses

INTRODUCTION: Globally, influenza is responsible for 3-5 million cases of severe illness annually. In the United States alone, it is estimated that flu-associated infections account for 3.1 million hospitalized days per year. While the overall impact of flu is relatively well-studied, severe influenza is not well-characterized among the substance abuser and smoker populations.

OBJECTIVES: This study characterizes the risks for and complications associated with serious influenza infection among the substance abuser and smoking populations within Connecticut.

METHODS: Data were obtained via retrospective medical chart review. Cases were individuals within New Haven and Middlesex counties hospitalized with a positive influenza test …

Sex Differences Among Adult Influenza Hospitalizations Associated With Age, Race, And Socioeconomic Status In 14 Us Sites, 2010-2012, Kelly Elizabeth Kline

Public Health Theses

BACKGROUND: Previous studies have shown sex differences in influenza hospitalizations, but sex differences across the United States by demographic characteristics have not been well-established. We investigated potential sex differences across 14 FluSurv-NET (FSN) sites that conduct active population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 76 counties in 2010-2012, stratifying by age, race, and census tract-level poverty.

METHODS: We used 6,292 laboratory-confirmed adult (>18 years) cases collected by the 14 FSN sites during the 2010-11 and 2011-12 influenza seasons linked to 2010 Census data to calculate overall age-adjusted and age-specific incidence and incidence rate ratios (IRRs) for sex …

Nursing Care At The End Of Life: What Every Clinician Should Know, Susan E. Lowey

Milne Open Textbooks

Nursing Care at the End of Life: What Every Clinician Should Know should be an essential component of basic educational preparation for the professional registered nurse student. Recent studies show that only one in four nurses feel confident in caring for dying patients and their families and less than 2% of overall content in nursing textbooks is related to end-of-life care, despite the tremendous growth in palliative and end-of-life care programs across the country. The purpose of this textbook is to provide an indepth look at death and dying in this country, including the vital role of the nurse in …