Medicine and Health Sciences Commons^™

Strategies To Address Substance-Abusing And Substance-Impaired Healthcare Professionals, Anna Marie Smith, Douglas G. Campbell

International Journal of Applied Management and Technology

This research explored strategies used by some healthcare leaders to address substance abusing and impaired healthcare professionals. The conceptual framework for this qualitative case study was the concept of due diligence. Data were collected from 40 managers and supervisors, 3 executives, and company documents, and analyzed to reveal elements of a comprehensive strategy. A effective comprehensive strategy consists of policies that address the causes, the short term and long term aspects, and both the ethical and legal aspects. Policies and procedures are equally applied, are easily accessible, are well communicated, are supported by training, provides positive encouragement. provides a path …

Human Resource Strategies Used To Retain Millennials In Hospitals, Thomas F. Turner

Walden Dissertations and Doctoral Studies

Lead hospital human resource managers (HRMs) experience new recruitment, retention, and training costs for Millennial employees to close the skill gaps and address challenges from Baby Boomer employees retiring. The median turnover rate of 3 years for Millennial workers in hospitals is more than 3 times higher than older workers at hospitals. The purpose of this qualitative multiple case study was to identify retention strategies hospital HRMs use to address the retention of millennial generational employees beyond 3 years. Transformational leadership theory was the conceptual framework for the study. The data collection process included semistructured interviews and a review of …

Evidence-Based Strategies For Improving Medication Adherence Among Psychiatric Patients: A Systematic Review, Omah S. Tsikada

Walden Dissertations and Doctoral Studies

Nonadherence to psychotropic medications among patients with serious and persistent psychiatric disorders, including bipolar disorder and schizophrenia, is approximately 70%. Nonadherence is a common barrier to the treatment of individuals with mental health disorders. However, there is limited awareness of evidence-based interventions and strategies to address this problem. Therefore, the question for this project asks whether a systematic review can identify strategies to improve adherence of psychotropic medications among individuals with serious and persistent mental illness. The purpose of this systematic review was to explore the evidence-based strategies that can aid in increasing medication adherence in patients with mental health …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

Quality Of Life For Persons With Chronic Disease Utilizing Mobile Integrated Healthcare, Dr John Robert Ash

Walden Dissertations and Doctoral Studies

The use of mobile integrated healthcare-community paramedicine (MIH-CP) has the potential to be integrated into existing chronic disease management initiatives as a means of reducing unnecessary hospitalizations and costs as well as improving quality of life (QOL). The purpose of this study was to analyze the relationships between demographics, noncommunicable disease type (NCD), and changes in self-perceived, self-reported QOL for those who have participated in an MIH-CP program. The research design for this study was a pretest/posttest design using secondary data that were obtained from a research partner using the MIH-CP intervention and collecting QOL data using the Euroqol QOL …

Impact Of Advanced Access Scheduling On Missed Appointment Rates In Primary Care, Helen Yvonne Krippel

Walden Dissertations and Doctoral Studies

A major problem encountered within outpatient physician offices are missed appointments. Missed appointment research revealed how no-show rates remain a focus for healthcare administrators as decreasing no-show rates may reverse harmful health consequences. The purpose of this study, which also addressed the research gap, was to determine if there was an association between advanced access scheduling and no-show rates for patients scheduled with preferred primary care physicians versus nonpreferred primary care physicians. The health belief model was the conceptual framework as missing a prescheduled appointment is a health behavior. The 1st and 2nd research questions examined whether there was a …

Pharmacy Manager Strategies For Reducing Financial Losses From Adverse Drug Events By Polypharmacy Patients, Francis Rudden

Walden Dissertations and Doctoral Studies

Every year over 100,000 deaths occur in the U.S. from adverse drug events derived from medication errors. Medication errors account for an annual cost of $100 to $200 billion. Healthcare pharmacists lack strategies to reduce adverse drug events and medication errors from taking place. Grounded in complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies to reduce advere drug events and medication errors. The participants were 5 pharmacist managers in a county in central Florida. These pharmacists were from different community pharmacies, and each had a minimum of 5 years’ experience in the …

The Impact Of Digital Self-Scheduling On No-Show Event Rates In Outpatient Clinics, Karen M. Marhefka

Walden Dissertations and Doctoral Studies

The failure of patients to keep scheduled appointments results in significant loss of revenue due to decreased administrative efficiency, expensive clinical resource time, disruptive continuity of care between the patient and the provider, and reduced quality of care. The purpose of this quantitative study was to explore the use of digital self-scheduling as an emerging alternative to traditional office-assisted scheduling methods and determine if its use has an impact on reducing the occurrence of no-show events. The theoretical framework used for the study was the Consumer Behavior Theory. Three years of de-identified secondary data were collected from a large, adult …

Respiratory Therapists' Roles In Reducing 30-Day Readmission Rates For Patients With Copd, Soumaya M. Osen

Walden Dissertations and Doctoral Studies

Since 2014, hospital administrators initiated several measures to reduce the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD). The research problem was that the respiratory therapists (RTs) were excluded from the discharge planning teams in many hospitals while 20% of patients with COPD continue to be readmitted within 30-day post discharge. The purpose of this qualitative study was to seek understanding of the care managers’ perceptions regarding the potential role of the respiratory therapists in the discharge planning for patients with COPD. The theoretical framework for this study was the systems theory in management. The research questions …

The Complete Care Model: Improving Diabetic Patient Outcomes In Correctional Facilities, Chad Williams

Walden Dissertations and Doctoral Studies

Diabetes is a growing problem, becoming an increasing concern within prisons. Research suggests that as many as 4.9% of the inmate population is diagnosed with diabetes. To provide constitutionally required healthcare to the inmate population, corrections officials must identify a validated diabetes treatment modality geared toward improving diabetes outcomes. The purpose of this quantitative study was to evaluate the impact of a patient centered medical home (PCMH) based model of healthcare within the California Correctional Health Care Services (CCHCS) on diabetic prisoners. Using the social construct theory as the framework, the research questions were focused on determining whether there was …

Fall-Related Patient Education: An Essential Feature Of A Fall Prevention Program, Immaculata Okonkwo

Walden Dissertations and Doctoral Studies

This project documented the evaluation of a voluntary patient falls prevention education

program (VPFPEP) of a rehabilitative facility in a Mid-Atlantic US state and ascertained

its sustainability. The project was designed using the customized Moore et al. evaluation

model and Lippitt’s planned theory of change to encourage patient engagement in

physical activity (PA) through fall prevention education to allay patients’ fear of falling.

The sample included patients who opted into the facility’s VPFPEP. Evaluation was

performed using run charts to visually and quantitatively monitor trends and patterns of

fall incidents over time. Run charts also facilitated comparison of injuries sustained …

Leadership Strategies To Achieve Organizational Excellence, Cherron Lakisha Blakely

Walden Dissertations and Doctoral Studies

Inadequate quality management tools and processes can lead to inefficient hospital operations and poor organizational performance. Community hospital leaders who fail to improve operations and organizational performance risk negatively impacting patient care and profitability. Grounded in the theory of high-performance work systems (HPWS), the purpose of this qualitative single case study was to explore strategies community healthcare leaders use to effectively employ quality management approaches to improve operations and achieve organizational excellence. The participants comprised 5 community healthcare leaders in the northeast United States who effectively used quality management approaches to improve operations and achieve organizational excellence. Data were collected …

Measuring Knowledge Of Chronic Kidney Disease (Ckd) Among Community College Students, Jacquelyn Caldwell Moore

Walden Dissertations and Doctoral Studies

Chronic Kidney Disease (CKD) once detected is easily treated; however, it has become a major health problem associated with increased morbidity and mortality rates, creating an economic burden worldwide. While approximately 24 million Americans over the age of 20 suffer from CKD, there is a lack of awareness among the general population. Using a pre/post assessment, this quantitative study measured the impact of a 75-minute workshop on 126 community college students' knowledge of kidney disease, perception of its severity, and perceived susceptibility. The theoretical framework for the study was the health belief model, which suggests that individuals will make positive …

Exploring Family-Centered Care From The Perspectives Of Home-Health Physical Therapists, James Mathews

Walden Dissertations and Doctoral Studies

Older adults may need, or desire, caregiver and family involvement to avoid hospitalizations and institutionalizations. The caregivers of these older adults have the highest rates of burnout, injury, and turnover. Family-centered care (FCC) involves collaboration between healthcare practitioners, patients, family members, and caregivers. FCC is both established and effective in pediatric care settings. There is a paucity of evidence on how FCC is applied to older adult populations. Home health physical therapists (HHPTs) work with older adults in their homes and train both family members on how to safely handle and manage the care-dependent older adult. The purpose of this …

Strategies For Implementing The International Organization For Standardization 15189 For Medical Laboratories, Wilson Mtotela

Walden Dissertations and Doctoral Studies

Inadequate quality management systems (QMS) in medical laboratories result in errors, which cost the United States healthcare industry approximately $29 billion per year. Healthcare managers who fail to implement the International Organization for Standardization (ISO) 15189 QMS are at high risk of managing costs. Grounded in Lewin’s 3-step organizational change model and the force field analysis, the purpose of this qualitative multiple case study was to explore strategies healthcare managers use to design, develop, and implement an ISO 15189 QMS using a mentorship approach. The participants comprised 5 healthcare managers from the United Republic of Tanzania, East Africa, who implemented …

Effective Strategies To Reduce Employee Absenteeism Amongst Canadian Female Employees, Sue Haywood

Walden Dissertations and Doctoral Studies

High absenteeism in female employees costs Canadian hospitals millions of dollars annually. Leaders of Canadian hospitals who lack strategies to reduce absenteeism in female employees witness significant financial losses in their organizations. Grounded in Herzberg's two-factor theory, the purpose of this multiple case study was to explore strategies Canadian hospital leaders used to reduce absenteeism in female employees. Data were collected from semistructured interviews, annual reports, and publicly available datasets relating to hospital retention strategies and were analyzed using a thematic analysis. Four themes on strategies to reduce absenteeism emerged: creating a supportive stance towards absenteeism, investing in mental health …

Relationship Between Nurse Job Satisfaction Variables And Voluntary Turnover Intention, Mmayen Monday Nnah

Walden Dissertations and Doctoral Studies

Increased turnover among hospital nurses has adverse business outcomes. Hospital nurse managers are concerned with minimizing turnover to reduce hospital costs, lower risk to patients, and positively impact hospital performance. Grounded in motivation-hygiene theory, the purpose of this quantitative correlational study was to examine the relationship among nurses' views of the quality of work environments, level of management support, opportunities for promotion, and nurses' voluntary turnover intentions. Data were collected from nurses with registered nurse status or a bachelor of science in nursing degrees working in hospital settings in the United States (N = 82), who completed the Job Satisfaction …

Disparities In The Qulaity Of Bariatric Care Among African American Women, Tracey S. White

Walden Dissertations and Doctoral Studies

Improving the quality of health care in the United States has been an ongoing challenge for decades. As health care providers seek to provide unsurpassed levels of health care, disparities continue to exist among races. Racial and ethnic disparities in the quality of health care persist that affect African American women disproportionally. The purpose of this study was to explore the lived experiences of African American women with regard to quality health care following bariatric surgery. Using a phenomenological approach, semistructured interviews were conducted with 10 African American women who had suboptimal weight loss outcomes following bariatric surgery. Data from …

A Health Care Management Organization's Internal Controls Strategy For Managed Care, Elizabeth E. David

Walden Dissertations and Doctoral Studies

A lack of effective operational internal controls among health management organization (HMO) leaders could lead to poor operational practices, mismanagement of the government's health care funds, increased health care spending, and a negative impact on patient health outcomes. Grounded in transformational leadership theory, the purpose of this qualitative, single case study was to explore successful internal control strategies used by leaders at a southeastern Pennsylvania HMO. Data were collected from semistructured interviews with 5 participants who held positions of director or above within the organization for at least 3 years, had institutional knowledge, and had responsibility for overseeing the organization's …

Managerial Competencies Driving Successful Change Initiatives: A Multiple Case Study Of Healthcare Administrators, William King Selsor

Walden Dissertations and Doctoral Studies

Healthcare administrators’ competencies for driving successful strategic change initiatives in healthcare organizations remain outdated and limited in the management literature. The purpose of this qualitative, multiple case study was to explore the perceptions of healthcare administrators on the specific nature of management competencies needed to drive successful strategic change initiatives within healthcare organizations. To address the research problem and purpose of the study, qualitative data were collected from multiple sources of evidence, including semi-structured interviews with seven healthcare administrators, archival data, and reflective journaling notes. This study was framed by Kash, Spaulding, Johnson, and Gamm’s conceptual framework, the comparison of …

Impact Of Social Economic Factors On U. S. Veterans’ Access To Care, William Kwaku Adjei Ofori

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD), the leading cause of death worldwide, affects about 8.45 million United States veterans, individuals honorably discharged from the active military, naval services, and air services. The purpose of this study was to determine whether veterans’ access to care is associated with income level determinants, such as job status, education level, and location. Using the social cognitive theory as the framework, the study examined the extent to which income level and the other social determinants, impacted access to care for veterans with CHD. The 2016 Behavioral Risk Factor Surveillance System, the nation’s leading data system was the …

Changes In Operating Performance In Rural Hospitals From 2012 To 2019, Oluwaseyi Tami Young-Harry

Walden Dissertations and Doctoral Studies

Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American …

Incivility Among Nurses, The Influence Of Structural Empowerment: A Systematic Review, Jennifer Gardner

Walden Dissertations and Doctoral Studies

Workplace nurse-on-nurse bullying is a well-known phenomenon in health care organizations at both national and global levels. Healthcare organizations struggle to find effective solutions to help nurses to mitigate bullying and incivility and create safer work environments. The purpose of this systematic literature review doctoral project was to critically appraise the literature to find the best research evidence to show that higher levels of structural empowerment lead to lower levels of incivility and increase nurses’ ability to create safer and more positive work environments. Kanter’s theory of structural empowerment served as the theoretical framework for this review. The evidence-based question …

Impact Of Medicare Utilization On Mortality And Readmission Rates Of Heart Failure Patients 65 Years And Over, Joanna Alexander

Walden Dissertations and Doctoral Studies

Roughly 25% of individuals 65 years and over hospitalized with heart failure are readmitted within 30 days after discharge. Elderly individuals identified with heart failure possess a 5-year mortality approaching 50%. The purpose of this study was to determine if there is a relationship between Medicare-covered services for care, mortality rates, and readmission rates for beneficiaries 65 years and over with heart failure. To address this topic, the chosen approach was retrospective and quantitative. The theoretical foundation was the Chronic Care Model. The research questions sought to determine if there is a relationship between the Medicare-covered services for care and …

Understanding Behavioral Health Stigma Within The Healthcare Workforce, Jason Robert Martin

Walden Dissertations and Doctoral Studies

Individuals who seek mental health treatment in the United States face significant barriers. One such barrier is the belief that those seeking mental health treatment are subpar people with some moral failure. One area where this phenomenon exists is the behavioral healthcare workforce. This study was conducted to understand the phenomenon of stigma that behavioral healthcare leaders exhibit toward behavioral healthcare patients using the Baldrige framework as its conceptual framework. Using a qualitative approach and case study design, interviews were conducted with 6 leaders within a large healthcare system in the suburbs of a major metropolitan area to evaluate their …

Influence Of Supervisor Support And Resilience On Productivity And Turnover Intentions In Pediatric Health Care, Adrienne Y. Martin

Walden Dissertations and Doctoral Studies

Workplace violence has become a critical safety issue in the health care setting, often leading to increased stress levels and employees that feel unsupported and inadequately prepared; which leads to increased turnover, and subsequently, diminished overall organizational productivity and poorer patient outcomes. The purpose of this study was to examine whether supervisor support and resilience affect productivity and turnover intent related to professional role and work experience following workplace violence in the pediatric health care setting. Organizational support theory and the framework of the resilience model provided the theoretical structure for this study. Data were collected through anonymous surveys with …

Public Stigma, Familiarity With Mental Illness, And Attitudes Toward Seeking Mental Health Services, Eugenia Combie-Knowles

Walden Dissertations and Doctoral Studies

Public stigma and adverse beliefs and attitudes toward individuals with mental illness can negatively influence help seeking. The purpose of this quantitative cross-sectional study was to assess associations and the effect of stigmatized attitudes toward mental illness and familiarity with mental illness on help-seeking attitudes in three community health clinics in the Bahamas. Attribution theory and theory of planned behavior provided the framework for the study. Data were collected from a convenience sample of 366 individuals who completed a self-administered questionnaire consisting of sociodemographic questions, the Attribution Questionnaire that assessed stigmatizing attitudes and beliefs toward individuals with mental illness, and …

Leadership Strategies To Maintain Hospital Business Office Productivity During A Merger, Scott Alan Hughes

Walden Dissertations and Doctoral Studies

In 2017, healthcare system mergers in the United States set a record with 115 deals made and 11 involved sellers with net revenue of at least $1 billion; however, it is common for hospital business office productivity to suffer during a merger. Grounded in the theory of business process re-engineering, the purpose of this qualitative single case study was to explore strategies hospital leaders in the southeastern United States used to maintain business office productivity as they completed a merger. A review of documentation from archival records supplemented in-depth interviews with 7 purposively selected hospital leaders. Yin’s 5-step analysis guided …

Structural Predictors Of Lights And Sirens Use By Emergency Medical Services, Justin Alex Sleffel

Walden Dissertations and Doctoral Studies

Ambulances regularly respond to scenes and transport patients while using lights and sirens (L&S), which are associated with an increased risk of vehicle crashes. The use of L&S persists, despite the risks, which impact emergency medical service (EMS) workers, patients, and other drivers and pedestrians on U.S. roadways. To understand the factors associated with ambulance crashes while using L&S, this study applied the Donabedian model to the problem. The purpose of this study was to investigate the association between 3 organizational structural factors—organizational type, organizational status (staffing model), and level of service—and ambulance crash rates while using L&S. This study …

Relationship Between Hospital Performance And Medicare Reimbursement Penalties, Ashley Bays

Walden Dissertations and Doctoral Studies

Medicare reimbursement penalties are a financial concern for health care leaders when hospitals underperform in the specific measures of hospital performance defined by the Hospital Value-Based Purchasing Program. Grounded in the general contingency theory, the purpose of this correlational study was to determine the relationship between the measures of hospital performance, clinical care, person and community engagement, safety, efficiency and cost reduction, and Medicare reimbursement penalties. Secondary data from the Centers for Medicare and Medicaid Services were collected from 420 acute care urban hospitals designated as teaching facilities with a bed size between 100–299 beds for the fiscal year 2019. …