Medicine and Health Sciences Commons^™

The Relationship Between Stressors And Intent To Leave Nursing Homes Among Directors Of Nursing, Crystal R. Williamson

Journal of Sustainable Social Change

According to the Centers for Medicare and Medicaid Services, some nursing homes have been ranked worst in the nation when rating the quality of resident care. The purpose of this study was to determine the relative strength of workplace stress, job satisfaction, organizational support, and personal data (number of years employed, age, highest education level) in predicting director of nursing (DON) intentions to leave the position. This information contributes to social change because it is important to know that DONs need to experience general satisfaction in order to maintain stable leadership that positively contributes to the quality of care in …

An Outcome Evaluation Of An Evidenced-Based Leadership Framework On Nursing Retention In A Tertiary Medical Center, Robbie Gail Robbie

Walden Dissertations and Doctoral Studies

An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 …

Factors Relating To Underrepresentation Of Black American Women In Health Care Administration, Alquietta Lavayle Brown

Walden Dissertations and Doctoral Studies

There is a low representation of Black American women (BAW) in health care senior leadership. With the high level of health problems found among the Black community, diversifying the executive leadership with BAW may be instrumental in increasing provider trust and reducing discriminatory action. Using critical race theory as the conceptual framework, this study examined the experiences, perceptions, and influential or deterrent factors inhibiting advancement of BAW in the health care field. Inquiry centered on factors related to lack of advancement, experiences at different stages of career progression, and strategies impacting career advancement. A qualitative research design using a transcendental …

Nonattendance Rates And Barriers To Health Care In Outpatient Clinic Settings, Susan Louise Geiger

Walden Dissertations and Doctoral Studies

Lower socioeconomic status, ethnicity, and race are associated with reduced health care use in the United States. Patients who continually miss their appointments suffer significant negative results, including a disruption in continuity of care, complications with their chronic illnesses, and an increase in hospital readmissions. The health belief model was used as the theoretical support for this project that investigated the underlying causes of no-shows at an urban hospital-based outpatient clinic in the United States. It used a quantitative, descriptive design and examined a minority, underserved, and underinsured population that was receiving care at the research site and had a …

Climate Change Implications For Health-Care Waste Incineration Trends During Emergency Situations, Emilia Mmbando Raila

Walden Dissertations and Doctoral Studies

Healthcare waste (HCW) incineration practices in the global South countries are among the major sources of black carbon (BC) emissions or smoke. This study analyzes HCW incineration trends during emergency situations and smoke from HCW incineration processes in Haiti. The study was prompted by the current arguments about the climate change and the growing health effects associated with BC emissions. The conceptual framework was based on both adverse health effects from BC emissions exposure and climate change potential of BC emissions. Therefore, the goal was to determine whether cardboard HCW sharps containers emit lower BC emissions to the atmosphere during …

Health Care Administration Faculty Perceptions On Competency Education, Graduate Preparedness, And Employer Competency Expectations, Wittney A. Jones

Walden Dissertations and Doctoral Studies

Health care administration programs have transitioned to using the competency approach to better prepare graduates for workplace success. The responsibility of preparing graduates lies with the program faculty, yet little is known about faculty perceptions of the competency approach. The purpose of this cross-sectional study was to assess the perceptions of graduate-level health care administration faculty about the competency approach, the approach's effect on graduate preparedness, and employer expectations. Adult learning theory and the theory of self-efficacy were used as the theoretical foundations for the study. Faculty demographics related to personal information, workplace/teaching experience, and program information served as the …

African American Eighth Grade Students' Attitudes Toward Hiv/Aids In The District Of Columbia, Enock Kolawole Adewuyi

Walden Dissertations and Doctoral Studies

The group most affected by HIV/AIDS, according to the Centers for Disease Control and Prevention (CDC), is African Americans. The purpose of this study was to explore the knowledge of HIV/AIDS held by African American children as a first step towards developing prevention strategies for these youths. In order to bridge the knowledge-behavior gap, this study sought to investigate the attitude towards HIV/AIDS of African American 8th grade students. The study involved secondary data from the 2012 District of Columbia (DC) Middle School Youth Risk Behavior Survey, obtained from the District of Columbia Office of Superintendent of Education (OSSE). Guided …

Barriers To Receiving The Influenza Vaccine In Adults 65 Years And Older, Melissa Madalone

Walden Dissertations and Doctoral Studies

Vaccination is regarded by many as the most effective means of reducing influenza infection and disease; however, many people in the United States are hospitalized from flu-related illness each year. Adults 65 years and older account for more than half of these hospitalizations and almost all flu-related deaths. This project aimed to identify barriers to receiving the influenza vaccine among the adult population (> 65 years of age) in a community setting. The goal was to develop a teaching tool that would assist practitioners towards improving influenza vaccination rates among this population. The Health Belief Model was the theoretical framework …

Differentiating Demographic Factors In Latino Patients With Type 2 Diabetes, Carol Lynne Manning

Walden Dissertations and Doctoral Studies

The American Diabetes Association (ADA) data suggest that Latinos share a greater burden of disease than do non-Latino Whites with type 2 diabetes. As a result of poor glycemic control, Latinos also suffer consequences such as blindness, kidney disease, and limb amputation more often than do other ethnic groups. The purpose of this study was to compare demographic factors of Latinos with well-controlled type 2 diabetes, as measured by a HgbA1c of 7 or less (n = 118) to Latinos not well controlled (n = 105). This cross sectional study used a secondary data set with a sample selected from …

Multiple Regression Analysis Of Factors Concerning Cardiovascular Profitability Under Health Care Reform, Gordon Brian Wesley

Walden Dissertations and Doctoral Studies

Cardiovascular (CV) patients receive one-third of the care and account for $444 billion of the health care costs in the United States. The cardiovascular service line (CVSL) in hospitals contributes to the profitability influenced by elements of resource dependence theory (RDT). The purpose of this study was to understand whether the regression model of hospital characteristics and outcomes would predict profitability in a CVSL through the cost-to-charge ratio (CCR). The use of a general linear model and multiple regression analysis to examine the 2012 National Inpatient Sample from the Healthcare Cost and Utilization Project allowed estimates from a weighted sample …

Diabetes Self-Management Education Program, Lesa Faye Williams

Walden Dissertations and Doctoral Studies

Diabetes is a devastating disease in American. The disease can cause chronic health comorbidities, and untreated diabetes has negative consequences for individuals and on our nation's economy. Newly diagnosed diabetics often have a lack of knowledge about the disease process. The purpose of this project was to design and implement a diabetes educational program to enhance participants' knowledge about diabetes management and self-care using the Health Belief Model. Diabetes Self-Management Education (DSME) is critical in improving patient outcomes and the prevention of diabetes related complications. Participation in a standardized diabetic educational intervention will improve patient knowledge, as measured by a …

An Examination Of Physician Resistance Related To Electronic Medical Records Adoption, Terrence Duncan

Walden Dissertations and Doctoral Studies

The 2009 American Recovery and Reinvestment Act, signed under the Obama administration, mandated physicians to complete certification for electronic medical records (EMRs). Despite these mandates and the increased access to information technology, slow adoption rates persist on the use of EMRs. Guided by the theory of planned behavior and the technology acceptance model, the purpose of this quantitative study was to examine the relationship between the independent variables perceived ease of use, perceived usefulness, perceived behavioral control, perceived social influence, attitudes toward EMR, and the dependent variable user acceptance. This study identified physicians in the United States as end-users of …

Leadership Strategies To Influence Employee Engagement In Health Care, John David Vizzuso

Walden Dissertations and Doctoral Studies

Hospitals are in a precarious financial position with declining reimbursement, eroding profit margins, and low patient satisfaction. The Patient Protection and Affordable Care Act of 2010 reform may decrease hospital reimbursement by $500 billion from 2010 to 2020, while low patient satisfaction may decrease profitability for hospitals by 27%. Employee disengagement may decrease patient satisfaction and consumer loyalty. The purpose of this phenomenological study was to explore the lived experiences of health care leaders as they worked to engage employees and provide better patient care. Improving patient care provides opportunities to capture new market shares, which increases sustainability of health …

Mental Health Therapists' Attitudes On Adoption Of Evidence-Based Practices And Organizational Culture, Jennifer Guerguis

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) in mental health was initiated in the United States due to state legislation. The EBP implementation process is complex due to multiple factors related to organizational culture. Mental health agencies implementing EBP processes can expect significant personnel changes due to higher turnover rates, which may have a negative effect on the quality of services. The purpose of this study was to investigate the relationship between providers' attitudes toward the adoption of EBPs and organizational culture. The theoretical framework for this study was organizational culture theory and the Denison organizational culture model. This correlational and predictive study examined …

The Effect Of The Implementation Of Relationship-Based Care On Patient Satisfaction, Laura Ellen Field

Walden Dissertations and Doctoral Studies

The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide …

Regression Analysis Of Cloud Computing Adoption For U.S. Hospitals, Terence H. Lee

Walden Dissertations and Doctoral Studies

Industrial experts agree that cloud computing can significantly improve business and public access to low cost computing power and storage. Despite the benefits of cloud computing, recent research surveys indicated that its adoption in U.S. hospitals is slower than expected. The purpose of this study was to understand what factors influence cloud adoption in U.S. hospitals. The theoretical foundation of the research was the diffusion of innovations and technology-organization-environment framework. The research question was to examine the predictability of cloud computing adoption for U.S. hospitals as a function of 6 influential factors: relative advantage, compatibility, complexity, organizational size, structure, and …

Third-Degree Family Health History And Perception Of Disease Risk, Liana Carrasco Romero

Walden Dissertations and Doctoral Studies

Chronic diseases are a significant cause of illness and mortality in the United States. Hereditary predisposition to chronic diseases is a useful indicator for identifying people at risk for disease development. An ideal tool for determining this predisposition is the CDC, NIH, and AAFP recommended third-degree family health history (FHH). The aim of this quantitative, cross-sectional study, based on the theoretical frameworks of social constructivism and the health belief model, was to assess the possible influence between the completed third-degree FHH and the participant's perception of disease risk. Two-hundred seventy-three participants were recruited from health care facilities and from the …

The Relationship Between Information Technology And Organizational Effectiveness As Perceived By Health Care Providers, Christian Chikwem Ukaga

Walden Dissertations and Doctoral Studies

The U.S. Congress has made health information technology a central component of the national quest to improve health care delivery. The problem addressed in this study was the uncertainty among healthcare providers regarding the benefits of health care information technology adoption relative to healthcare delivery processes and outcomes. The purpose of the study was to understand the effectiveness of information technology as perceived by healthcare providers. The research questions were designed to investigate the relationship between health information technology and organizational effectiveness, exchange of information, organizational process, organizational productivity, and direct personal care. Sociotechnical systems theory and Donabedian's framework for …

Incorporating Ada Best Practice Guidelines In Electronic Medical Records To Improve Glycemic Management In Hospitals, Jennifer Claudette Benjamin

Walden Dissertations and Doctoral Studies

Aggressive management of diabetes using American Diabetes Association (ADA) best practice guidelines in hospitalized patients reduces morbidity and mortality. Inpatient electronic medical records systems improve care in chronic diseases by identifying care needs and improving the data available for decision making and disease management. The purpose of this quality improvement project was to evaluate the impact of ADA best practice guidelines of glycemic management once they have been entered into the electronic medical record (EMR) of hospitalized diabetics. Kotter's organizational change process guided the project. The project question investigated whether nurses' use of ADA Best Practice Guidelines incorporated into the …

A Comparison Of Regional Health Care Structures For Emergency Preparedness, Leslie Porth

Walden Dissertations and Doctoral Studies

Since 2001, increased policy attention and federal funding mechanisms have required more effective disaster response by government actors and private sector organizations, including the health care system. However, there is limited scholarly evidence documenting which structural elements have been associated with efficacious regional coalitions. This study addressed the gap by examining whether the number of different participating disciplines (a proxy for coalition roles), community setting, and prior weather-related disaster declaration influenced the number of activities (a proxy for coalition responsibilities) conducted by the health care coalition. Social network theory was the theoretical lens with which the study results were used …

One Hospital's Patient Satisfaction Plans In Response, Valerie A. Smart Shoup

Walden Dissertations and Doctoral Studies

Recent changes in the Centers for Medicare and Medicaid Services (CMS) reimbursement programs resulted in $1 billion in payments to hospitals based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Approximately 50% of the 3,000 hospitals currently receiving Medicare supplements may receive increases in reimbursement payments while 50% will receive decreases in payments. This case study explored how one hospital team in North Texas achieved high HCAHPS scores. The primary provider theory, Deming's model of plan-do-study-act (PDSA), and disruptive innovation theory framed the study. The data collection process included administrator interviews (n = 7), hospital document analysis …

Differences Between For-Profit And Nonprofit Hospitals: Perceived Quality And Access, Michael Ray Eiland

Walden Dissertations and Doctoral Studies

Despite a large body of literature addressing the issue, questions remain about whether nonprofit hospitals provide more community benefit than do for-profit hospitals. This lack of information impacts governments, hospitals, and the healthcare industry, as stakeholders attempt to generate requirements to which hospitals should adhere to maintain nonprofit status, and thus tax exemption. This study addressed this lack of information by examining U.S. hospitals through the lens of stewardship theory to determine whether nonprofits are better stewards of the public good than for-profits, and thus likely to provide higher quality and access. The study applied logistic regression to Centers for …

Exploring Strategies For Implementing Barcode Medication Administration Systems, Julie A. Frederick

Walden Dissertations and Doctoral Studies

The number of medication errors associated with preventable deaths in healthcare facilities remains at a high rate for healthcare leaders. Practices of medication delivery remain similar to those 10 years ago. Hospitals that have implemented barcoding medication administration systems have reported a decrease in medication errors ranging from 60% to as high as 93%. Despite this utility of barcoding, only 50% of U.S. hospitals have implemented barcode medication administration. This comparative case study explored the strategies hospital leaders used to implement barcode medication administration systems, utilizing the sociotechnical theory for a conceptual framework. Face-to-face, semistructured interviews were used to identify …

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 …

The Design And Implementation Of A Relationship-Based Care Delivery Model On A Medical- Surgical Unit, Paula Ann Rodney

Walden Dissertations and Doctoral Studies

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit

by

Paula A. Rodney

MSN, California University of Pennsylvania, 2011

BSN, University of Virginia, 1979

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

April 2015

Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were …

Diffusion Of Electronic Health Records In Rural Primary Care Clinics, Patricia Lynn Mason

Walden Dissertations and Doctoral Studies

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 …

Factors Motivating Employee Participation In Employer-Sponsored Health Awareness Programs, Markanthony Henry

Walden Dissertations and Doctoral Studies

Employers adopt worksite health promotions to reduce the incidence of preventable diseases, reduce healthcare costs, reduce absenteeism and presenteeism, and improve productivity. The purpose of this qualitative phenomenological study was to explore the motivational factors affecting employee participation in employer-sponsored health awareness programs. The theory of planned behavior grounded the study and formed the conceptual framework. Data collection occurred through semistructured interviews with 24 participants in the northeastern United States with lived experiences in worksite health promotion. Participants answered open-ended interview questions regarding the motivations for engaging in health promotions. Data were transcribed and coded for trends and themes. During …

The Influence Of On-Site Surgical Pathology Services In Rural Hospitals On Physician Satisfaction, Belinda D. Presley

Walden Dissertations and Doctoral Studies

Abstract

There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional …

Ranking Small Business Resistance Criteria Toward The Affordable Care Act, Rakesh M K Gupta

Walden Dissertations and Doctoral Studies

Following the enactment of the Affordable Care Act (ACA) in 2010, politicians, media, and lobbyists rendered a number of conflicting and confusing interpretations of its merits and demerits. Such interpretations intensified the skepticism and concerns of small business enterprise (SBE) owners. The purpose of this study was to develop a representative, prioritized list of SBE owners' concerns or resistance factors. The goal was to create a useful guide for SBE owners who are seeking ways to reducing the adverse financial impact of the law. With social choice theory as the theoretical framework, 50 randomly selected SBE owners across 5 distinct …

Developing An Online Direct-Assessment Competency-Based Masters Of Healthcare Administration: Insights, Challenges, And Lessons Learned, Lisa Monica Mcintyre-Hite, Mountasser Kadrie Dr., Heather Pederson, Terry Hudgins

Walden Faculty and Staff Publications

In response to the increasing complexity in healthcare delivery environments, there is evidence from literature and the healthcare industry to indicate healthcare employers are seeking graduates in healthcare administration programs who have strong core competencies and proven problem solving skills. The purpose of this article is to describe the unique challenges and opportunities related to developing a direct-assessment, competency-based online Master’s in Healthcare Administration program. The United States Department of Education (2013) provided general guidelines for direct-assessment programs noting that, instead of measuring student learning via credit hours, learning is measured via direct assessment measures like “projects, papers, examinations, presentations, …