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Retaining Teaching Hospital Nonacademic Nurse Educators: Addressing Burnout And Building Workforce Resilience, Walter Guevara

Walden Dissertations and Doctoral Studies

Burnout and high turnover intentions among nonacademic nurse educators (NANEs) in academic teaching hospitals pose a critical challenge for healthcare administration, threatening workforce stability, nursing education capacity, and healthcare outcomes. The purpose of the integrative review was to examine evidence-based strategies to reduce burnout and enhance resilience among NANEs, thereby improving retention, well-being, and workforce sustainability. An integrative literature review was conducted using the Johns Hopkins Evidence-Based Practice appraisal tools and 49 sources published between 2020 and 2025 were found to match criteria and quality for thematic analysis. Guided by Herzberg’s two-factor theory, a thematic analysis was used to synthesize …

Staff Education To Implementation Of Fall Prevention Education To Improve Fall Prevention Knowledge Among Nurses And Cnas In A Nursing Home, Margret Nkechi Anabaronye

Walden Dissertations and Doctoral Studies

This project was a staff education initiative designed to enhance fall-prevention knowledge among nurses and certified nursing assistants (CNAs) in a nursing home setting. The practice problem addressed was the high incidence of patient falls among older adults, which is a persistent safety concern in caregiving facilities since it leads to injury, decreased quality of life, and heightened healthcare costs. The project aimed to determine whether implementing a fall-prevention educational initiative would enhance staff knowledge and confidence levels on fall prevention. Analytical strategies used in this project included quantitative pre- and posttests and descriptive statistics to measure changes in participants’ …

Staff Education To Improve Knowledge Of Standardized Scheduling In A Certified Home Health Agency, Roger Nounamo Kamkoumeu

Walden Dissertations and Doctoral Studies

In this staff education project, I addressed the concerning rate of missed patient visits in home healthcare settings. At the practicum site, there has been no education program addressing scheduling and communication best practices for staff. The practice-focused question guiding this project was: Among nursing staff in a home health agency, does implementation of a staff education program on a standardized scheduling and reminder protocol, improve staff knowledge of missed visit reduction practices? The purpose of the project was to evaluate the effectiveness of the staff training on staff knowledge of scheduling, communication, and reminder protocols for the reduction of …

Relationship Between Sociodemographic Factors And Opioid Overdose Mortality In Milwaukee County, 2020-2021, Elizabeth David

Walden Dissertations and Doctoral Studies

Opioid overdose deaths increased significantly from 2020 to 2021, with Milwaukee County experiencing higher rates than the national and state averages. African American and Hispanic residents faced disproportionately high fatal overdose rates. The purpose of this quantitative retrospective cross-sectional study was to examine the associations among socioeconomic status, race, age, access to treatment (measured by emergency medical services [EMS] naloxone administration), and opioid overdose mortality among underserved minority populations in Milwaukee County. Guided by the social-ecological model, the study analyzed data from the Milwaukee Health Department and the Milwaukee County Medical Examiner's Office across 34 ZIP codes. Inclusion criteria for …

African American Experiences Accessing Mental Health Services In Rural Communities, Danielle O. Keith-Alexandre

Walden Dissertations and Doctoral Studies

African American communities have exhibited greater vulnerability in psychological functioning and well-being, and usage of mental health services for evaluation and treatment are lower than for other groups, due to a range of barriers, including geographic location and lack of access. There is a lack of research on the difficulties African Americans face in accessing mental health services in U.S. rural communities. The purpose of this qualitative study was to explore, from a phenomenological approach, the lived experiences of African American adults residing in rural Pennsylvania mid-U.S. Eastern Coastal communities in regard to accessing mental health services. The social-ecological model …

Self-Care Behavior And Diabetes Knowledge In African American Women With Type 2 Diabetes, Rena Renee Barron

Walden Dissertations and Doctoral Studies

African American women experience a disproportionate burden of Type 2 diabetes, and limited evidence exists regarding the relationship between diabetes knowledge and self-care behaviors, particularly among African American female veterans. The purpose of this quantitative, cross-sectional study was to examine the relationship between diabetes knowledge and diabetes self-care among African American women with Type 2 diabetes, including a subsample of African American female veterans, and to evaluate whether the COVID-19 pandemic (2017–2019 vs. 2021–2023) moderated this relationship. Additional variables included age, marital status, physical health, and mental health. Guided by the social-ecological model, de-identified data from the Behavioral Risk Factor …

Relationship Between Hospital Case Management Leadership Style And Employee Engagement, Malinda Ellis

Walden Dissertations and Doctoral Studies

Employee engagement among hospital-based nurse case managers is important because these nurses support discharge planning, utilization management, care coordination, and safe patient transitions. Although leadership style has been studied in nursing, limited research has examined its relationship to engagement among nurse case managers. The purpose of this quantitative, nonexperimental, correlational study, using House’s path-goal theory, was to examine the relationship between transformational, transactional, and laissez-faire leadership styles and employee engagement among hospital-based nurse case managers. Data were collected from 89 registered nurse case managers in acute care settings in the United States, who completed the Multifactor Leadership Questionnaire, Short Form, …

Social Workers’ Perceptions Of Pediatric Hiv Disclosure Process, Colleen Myrie

Walden Dissertations and Doctoral Studies

Although the social problem of pediatric HIV disclosure has been studied by researchers internationally, there remains a gap in the experiences of social workers in facilitating this process. The purpose of this generic qualitative study was to explore the experiences and perceptions of social workers in the United States regarding the disclosure process for HIV positive children. This study was grounded in Rosenstock’s health belief model, which posits that an individual will take necessary action to prevent or manage a disease based on their perceptions of health. This model was effective in helping to identify what social workers think about …

Knowledge Of Parents About Thalassemia In Tabuk City: A Cross-Sectional Study, Sawsan Mohammed Alblewi, Amirah M. Alatawi, Ehab Mahmoud Hanafy, Faisal Mayudh Althobaiti, Abdulelah Hamad Al-Balawi, Faisal Mohammed Alamrani, Yazeed Mahmoud Ajwah, Omar Muslih Albalawi, Mohammed Majed Alquayr, Sultan Ibrahim Alhamdi

Makara Journal of Health Research

Background: Thalassemia is a common inherited blood disorder and remains a significant public health concern in Saudi Arabia. Parental knowledge is essential for effective prevention, screening, and early intervention. This study aimed to assess the knowledge of thalassemia among parents in Tabuk City, Saudi Arabia, and identify factors associated with knowledge levels.

Methods: A cross-sectional study was conducted among 392 parents residing in Tabuk City between March and May 2025. Data were collected using a validated Arabic questionnaire distributed online. Knowledge was assessed using 21 items covering general thalassemia knowledge, thalassemia major, carrier status, and prevention. Knowledge levels …

Frailty And Activities Of Daily Living In Older Adults In Primary Care: A Cross-Sectional Study, Öznur Adadıoğlu, Ahmet Seven, Esin Danç

Makara Journal of Health Research

Background: This study aimed to examine frailty status and activities of daily living among older adults.

Methods: This descriptive and cross-sectional study was conducted with 306 voluntary participants aged 65 years and older who were registered at a primary healthcare center in a city in Türkiye. Data were collected using the Participant Information Form, the FRAIL Scale, and the Katz Index of Activities of Daily Living.

Results: Among the participants, 36.9% were non-frail, 42.2% were pre-frail, and 20.9% were frail. The mean Katz Index score was 5.42 ± 1.35. The mean scores of activities of daily living …

Osteoporosis Knowledge, Health Beliefs, And Calcium Intake Among Malaysian Chinese Adults In Perak: A Cross-Sectional Study, Thean Hui Ru, Nurul Aimi Ab Kadir, Fatin Izzaty Mohd Shahrin

Makara Journal of Health Research

Background: The Malaysian Chinese population records the highest national prevalence of osteoporotic hip fractures. This study investigated the relationships between osteoporosis knowledge, health beliefs, and calcium intake among Malaysian Chinese adults.

Methods: A cross-sectional study was conducted among 205 Malaysian Chinese adults in Kampar, Perak, using the adapted Osteoporosis Prevention and Awareness Tool (OPAAT), Osteoporosis Health Belief Scale (OHBS), and a 30-item Food Frequency Questionnaire (FFQ).

Results: Participants demonstrated low osteoporosis knowledge (6.84 ± 2.92), with low perceived susceptibility (14.87 ± 5.00), moderate perceived seriousness (17.81 ± 5.20), and barriers to calcium intake (15.61 ± 4.15), and …

Internet Use And Decision-Making Processes Among Pregnant Women: A Cross-Sectional Study, Ayça Balmumcu, Endam Çetinkaya Ak, Sabriye Uçan Yamaç

Makara Journal of Health Research

Background: The coronavirus disease 2019 (COVID-19) pandemic restricted access to in-person health services, especially in rural areas. This increased reliance on the internet for health information and decision-making was particularly notable among pregnant women. This study aimed to investigate the role of internet use in decision-making among pregnant women.

Methods: This analytical, cross-sectional study examined 384 pregnant women living in a rural district of Turkey who attended family health centers for prenatal care. Data were collected using the Internet Decision-Making Scale in Pregnancy and a questionnaire assessing internet use patterns during the pandemic.

Results: Pregnant women demonstrated …

E-Health Literacy And Cyberchondria Severity Among Adolescent High School Students: A Cross-Sectional Study, Seyda Çavmak, Adem Bilgin

Makara Journal of Health Research

Background: Amid rapid digitalization and the growing use of artificial intelligence-based search engines, adolescents increasingly seek health information online. This study examined the relationship between high school students' e-health literacy and their cyberchondria tendencies.

Methods: This quantitative, cross-sectional study included 683 students from public high schools in Mersin, Türkiye. Data were collected using a Demographic Information Form, the e-Health Literacy Scale (eHEALS), and the Cyberchondria Severity Scale Short Form (CSS-12). Descriptive statistics, comparative tests, and Pearson correlation were applied (p < 0.05).

Results: Students' e-health literacy and cyberchondria severity were moderate. Significant positive correlations emerged between e-health literacy …

E-Cigarette Awareness, Usage Patterns, And Sociodemographic Determinants Among Malaysians Adolescents: A Cross-Sectional Study, Izdihar Kamal, Nabilah Mohd Abd Wahab, Nurul Mawaddah Mohammad, Rashidi Ahmad, Muhammad Khalis Abdul Karim, Hatikahaty Mohd Diah, Munirah Ahmad Dahari, Nur Biha Mohamed Nafis, Mohd Faris Abdullah Sani, Sulayman Muhammad Kabeer, Nur Biha Mohamed Nafis, Juliana Mohd Radzi

Makara Journal of Health Research

Background: Electronic cigarette (e-cigarette) use among Malaysian adolescents is rising rapidly, raising significant public health concerns. This study assessed awareness, understanding of risk, and e-cigarette use among secondary school students in Negeri Sembilan, Malaysia, and identified sociodemographic predictors of use.

Methods: A cross-sectional survey was conducted among 323 students from three government secondary schools using a validated questionnaire. Data were then analyzed using descriptive statistics and logistic regression.

Results: Nearly one-third (31.9%, N = 103) reported prior e-cigarette use. Although 63.2% (N = 204) demonstrated good awareness, only 14.6% (N = 47) understood associated health risks. Peers …

Validity And Reliability Of The Turkish Nursing Students’ Self-Perceptions About Safe Medication Management, Derya Şimşekli, Bedriye Cansu Koyunoğlu, Elanur Yilmaz Karabulutlu

Makara Journal of Health Research

Background: Safe medication management is central to nursing education and patient safety. To the best of our knowledge, there is currently no validated Turkish instrument specifically designed to assess nursing students’ self-perceptions regarding safe medication management. This study aimed to evaluate the validity and reliability of the Turkish version of the Nursing Students’ Self-Perceptions about Safe Medication Management (NURSPeM).

Methods: This methodological study was conducted at a single university using convenience sampling. Data were collected from a sample of 400 nursing students using the NURSPeM. Construct validity was examined with confirmatory factor analysis (CFA). Internal consistency was evaluated …

Needlestick Injury Risk And Preventive Behaviors Among Nursing Students, Angga Wilandika, Riandi Alfin, Rosa Intan Khoerunnisa

Makara Journal of Health Research

Background: Needlestick injury (NSI) remains a persistent occupational safety risk for nursing students during clinical practice, with implications for worker safety, patient care, and healthcare safety systems. Understanding preventive safety behavior within clinical training environments is essential for improving workplace safety in healthcare settings.

Methods: A cross-sectional study was conducted among nursing students undertaking hospital-based clinical placements. Using a purposive sampling, participants completed a structured self-administered questionnaire assessing NSI exposure, preventive safety behaviors, clinical supervision, safety training, and perceived safety within the clinical learning environment. Data was analyzed to identify patterns of NSI risk and associated preventive behaviors. …

Assessing Healthcare Access Among Overweight And Obese Individuals In Türkiye Using Latent Variable Modeling, Banu Beyaz Sipahi

Makara Journal of Health Research

Background: Overweight and obesity are critical determinants of healthcare access, yet evidence on how the COVID-19 pandemic reshaped these dynamics in Türkiye remains limited. This study investigates whether the early post-pandemic recovery period altered healthcare access patterns for individuals with excess weight.

Methods: Using nationally representative microdata from the 2014, 2016, 2019, and 2022 Turkish Health Surveys, we constructed a latent Healthcare Access Index based on six indicators of unmet care needs. Probit models were estimated to assess associations between BMI categories and healthcare access, controlling for socioeconomic and demographic factors. The 2022 wave serves as the early …

Physical Activity Intensity And Memory In Middle-Aged And Older Adults In China, Simi Tang, Yucheng Gao

Makara Journal of Health Research

Background: Memory decline represents a major challenge in aging populations, and physical activity may help preserve cognitive function. However, evidence on whether different activity intensities are associated with memory remains inconclusive.

Methods: Using five waves of the China Health and Retirement Longitudinal Study (2011–2020), this study investigated the association between physical activity intensity and memory among middle-aged and older adults in China. Individual fixed-effects models were applied to control for unobserved time-invariant heterogeneity. The outcome was memory score, and the main predictors encompassed high-, moderate-, and low-intensity physical activities.

Results: Based on 52,135 person–wave observations from 21,423 …

Rodrigo’S Weather Report: Is The Sky Falling?, Richard Delgado

Minnesota Journal of Law & Inequality

In the latest installment of the Rodrigo series, the main character and his straight man discuss what has come to be called sanewashing, focusing on the Administration’s many contrived emergencies to accomplish objectives that would otherwise be flatly illegal.

Comments Re: Commonsense Policy Options To Lower Drug Prices For Patients, Fred D. Ledley M.D., Edward Zhou Pharm. D.

CISI Publication

Thank you for the opportunity to provide written comment in response to the Senate Finance Committee Minority Staff’s “Request for Information: Commonsense Policy Options to Lower Drug Prices for Patients.” We are answering as academic researchers with experience in medicine and the biopharmaceutical industry. This comment will focus on sections I and III of the RFI.

We applaud the accomplishment of the Inflation Reduction Act (IRA) in establishing the precedent for the government to negotiate “fair market” prices for drugs on terms that address both patients’ needs for affordability and industry’s need for a reasonable return on investment. Our analysis …

Lightweight End-To-End Cryptographic Framework With Semantic Qos For Ar-Based Telesurgery, Pavan Kumar Satram

Masters Theses

This thesis presents the design, implementation, and evaluation of a lightweight end-to-end cryptographic framework integrated with a semantic quality-of-service classification system for augmented reality based telesurgery. Telesurgery can deliver expert surgical care to underserved populations, but adoption has been limited by unresolved cybersecurity, network performance, and resilience challenges. The core tension is that strong encryption adds latency that may exceed the clinical safety threshold, while unencrypted systems remain vulnerable to attacks that could endanger patients during live procedures.

The framework addresses this tension through a dual-edge security middlebox that performs per-flow encryption using semantically selected ciphers: AES-128-GCM for latency-critical haptic …

Staff Education On Frailty And Senior Surgical Safety, Kimberly Buhay Gibu

Walden Dissertations and Doctoral Studies

This staff education doctoral project addressed a practice gap involving limited education on frailty assessment and senior surgical safety within the general surgery department of a large, integrated healthcare system. Frailty is associated with increased postoperative complications, hospitalizations, readmissions, and mortality among older adults, making early recognition essential to improving surgical outcomes. The practice-focused question project was: Does education on frailty screening and senior surgical safety improve the knowledge, confidence, and intent of general surgery staff in a large, integrated health system? The purpose was to develop, implement, and evaluate an evidence-based educational intervention. The project was guided by the …

Improving Hypertension Control Through Increased Follow-Up Frequency In Rural Adult Patients, Clarissa Renea King

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project centered on the implementation of an organizational change initiative to improve hypertension control among adults aged 18 years and older in a rural primary care setting, where barriers to healthcare contribute to poorer outcomes. The practice-focused question asked whether more frequent follow-up visits improve hypertension control rates in rural adults. Interventions included increased follow-up visits for uncontrolled hypertension, patient education, home blood pressure monitoring, and staff education on accurate blood pressure measurement techniques. The project involved a pre-/post- evaluation design and analysis of deidentified organizational quality data. Findings show that the baseline hypertension …

Staff Education To Improve Blood Pressure Reassessment And Referral Practices In An Urgent Care Setting, Carolyn Denise Kluttz

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education and quality improvement initiative designed to improve blood pressure (BP) reassessment and referral compliance among adult patients presenting with elevated BP readings in an urgent care setting. Elevated blood pressure is frequently identified during urgent care visits; however, provider responses and follow-up recommendations are often inconsistent, creating missed opportunities for early identification and intervention. The practice-focused question guiding this project was: In adult patients presenting to urgent care settings, how does implementing a standardized nurse-led hypertension screening and referral protocol, compared with usual care, affect the identification and follow-up …

Staff Education On Improving Medication Adherence, Oneil Dobgima Galega

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project addressed a practice gap in an outpatient behavioral health setting involving inconsistent use of structured communication strategies to support medication adherence among psychiatric patients. Although nurses routinely provided medication instructions, approaches such as motivational interviewing and psychoeducation were underutilized, limiting patient engagement, understanding, and adherence, and ultimately affecting care continuity and outcomes. The purpose of the project was to improve psychiatric nurses’ knowledge and intent to use motivational interviewing and psychoeducation to enhance medication adherence. The guiding practice-focused question examined whether a structured educational intervention could strengthen nurses’ competencies in these communication strategies. …

Exploring The Experiences And Support Needs Of African Immigrant Families Raising Children With Autism Spectrum Disorder In Ohio, Linda Nkoumba Eteki

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD) presents unique challenges for families; however, African immigrant parents raising children with ASD in Ohio experience additional difficulties related to cultural stigma, systemic inequities, and limited access to culturally responsive services. This social work practice problem is important because it reflects disparities in diagnosis, intervention, service access, and family support that align with social work’s commitment to equity, advocacy, and social justice. The purpose of this qualitative study was to explore the experiences of African immigrant families raising children with ASD in Ohio and to examine how they describe autism-related stigma, caregiving challenges, and interactions with …

Openness To Experience And Creative Capacity Among Active First Responders, William Reagan

Walden Dissertations and Doctoral Studies

Because emergency services demand adaptive, creative problem-solving within procedurally rigid cultures, this study examined whether Openness to Experience predicted creative capacity among active first responders and whether age or tenure moderated that relationship. A cross-sectional design used N = 117 first responders from eight agencies. Openness was measured with the Big Five Inventory-2 (percentile ranks); creativity was assessed with the Divergent Association Task (DAT; n = 116) and the Consensual Assessment Technique (CAT; n = 111). Covariates were age, tenure, rank, gender, and, for 46 participants at one agency, a dispatch-derived operational exposure score. In the full sample, Openness did …

Local Farming Sustainability Nongovernment Organization’S Perceived Driving Forces For A Crisis Management Plan, Nthonoki Cynthia Tsepe

Walden Dissertations and Doctoral Studies

Nongovernmental organizations (NGOs) operate in increasingly volatile environments characterized by financial uncertainty, political pressures, and climate-related disruptions; however, many lack formalized crisis management systems. The absence of structured crisis governance exposes organizations to operational instability, financial risk, and reputational damage. The purpose of this qualitative force field analysis study was to explore a local farming sustainability NGO’s perceived driving and restraining forces for developing a formal crisis management plan. Guided by Burnett’s crisis management model and Lewin’s force field analysis framework, data were collected from nine organizational leaders involved in governance and operational decision making. Round 1 included open-ended online …

Strategies For Reducing Employee Turnover In Retail Business, Mia Bulger

Walden Dissertations and Doctoral Studies

Strategies for Reducing Employee Turnover in Retail Business by Mia S. Bulger MS, University of Phoenix, 2022 BS, Clark Atlanta University, 2005 Qualitative Pragmatic Inquiry Business Research Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Business Administration Walden University August 2026

African American Fathers’ Experiences Of Emotional Distress Within The Context Of Black Masculinity After Their Children’S Autism Diagnosis, John Notice

Walden Dissertations and Doctoral Studies

Although parental experiences following a child's autism spectrum disorder (ASD) diagnosis have been examined, mothers’ experiences have garnered the most exploration, with comparatively less attention given to fathers’ experiences. There was a gap in knowledge, in particular, on how African American (AA) fathers experience their children's ASD diagnoses while navigating emotional distress within the context of Black masculinity. The purpose of this generic qualitative study was to explore how AA fathers experienced their children's ASD diagnoses while navigating emotional distress within the context of Black masculinity. Crenshaw's intersectionality theory served as the conceptual framework. Data were collected by conducting semistructured …