Medicine and Health Sciences Commons^™

New Graduate Residency Programs, Shareen Estelle Taylor

Walden Dissertations and Doctoral Studies

Nurses are the largest group of healthcare providers in most acute care hospitals, and the demand for registered nurses is expected to grow by 15% by 2026. The new graduate registered nurse (NGRN) is the supply that will fill the shortage; however, NGRNs are reportedly lacking in the ability to connect the lessons learned in the classroom with real patient care, unprepared for necessary skills, emotionally stressed, and have a high first-year turnover rate. Strategies such as nurse residency programs are needed to support NGRNs as these new nurses’ transition from academics to clinical practice. The purpose of this project, …

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 …

Population Density And Spatial Distribution Of Neglected Tropical Diseases In Sierra Leone, Abou B. Funna

Walden Dissertations and Doctoral Studies

Neglected tropical diseases (NTDs) are the most common health conditions affecting the poorest residents of sub-Saharan Africa (SSA). These infections affect an estimated 2 billion people worldwide, including 500 million people living in SSA. About 85% of NTD infections are a result of helminth infections; hookworm is also a common occurrence among SSA’s poorest people, especially children. Schistosomiasis is the 2nd most prevalent NTD after hookworm. This quantitative correlational study investigated population distribution and the spread of NTDs in Sierra Leone. The focus was on 5 major NTDs: ascariasis, hookworm, schistosomiasis, soil-transmitted helminthiasis, and trichuris. Data were obtained from the …

Comparison Of Health Factors And Outcomes Between Accredited And Nonaccredited Health Departments, Deborah Koester

Walden Dissertations and Doctoral Studies

The launch of the Public Health Accreditation Board in 2012 established national public standards. This study examined possible correlations between the accreditation status of local health departments and specific indicators for health, including communicable disease, disease prevention and health promotion, and maternal child health factors, and outcomes of premature death and infant mortality. The population for the intervention group included all 212 local health departments accredited from September 2012 through December 2017. Accredited health departments were matched with nonaccredited health departments based on population, rurality, agency type, governance authority, and state public health structure. Linear regression analysis was performed on …

Burden And Coping Strategies Of Caregivers Of Persons With Alzheimer's Disease, Annette Laverne Tucker Osborne

Walden Dissertations and Doctoral Studies

Alzheimer’s disease (AD) currently presents a huge burden to individuals and families, a burden that is increasing in incidence with the aging of the baby boomer generation. Caring for a spouse diagnosed with AD holds potentially severe negative consequences for the caregiver’s physical and psychological well-being. The current study used secondary data from the 2017 New York State Department of Health/Behavior Risk Factor Surveillance System to identify a relationship, if any, between the time and activities a caregiver spends with the AD person and the caregiver’s self-reported level of general and mental health. A logistic regression was used for RQ1 …

Experiences Of Postpartum Women With Nurse-Delivered Education And Postpartum, Krystal Evans

Walden Dissertations and Doctoral Studies

Postpartum depression affects many women globally, yet largely remains underdiagnosed. It is thus important for nurses to have all available tools when delivering education and care to the postpartum patient. Yet, there is a lack of information on the experiences of postpartum women related to postpartum education and postpartum depression. The purposes of this quantitative study, for which Beck's postpartum theory was the framework, were to explore postpartum women's perceptions of education experiences and to determine if a correlation exists between the satisfaction with education and scores on the Edinburgh Postnatal Depression Scale. Sixty study participants who were 6-8 weeks …

The Lived Experience Of Child Marriage And Its Health Effects Among Young Mothers In Nigeria, Anastasia Iliwo Ashi

Walden Dissertations and Doctoral Studies

Child marriage has life-threatening implications for the mental, physical, and psychological development of the girl-child. In Sub-Saharan Africa, and other resource poor settings, child brides and very young mothers undergo various negative experiences including economic hardship and health challenges such as obstetric fistulas, birth complications, and even death. The purpose of this phenomenological study was to describe the lived experiences of child marriage and its effect on maternal health among young mothers in Nigeria. The social ecological model provided the conceptual framework for this study. Ten young women ages 18-24 years who had been child brides when age 12-16 years …

Evidence-Based Colorectal Cancer Screening Staff Education, Chantal Navalah

Walden Dissertations and Doctoral Studies

Colorectal Cancer (CRC) is the leading cause of cancer-related death, although it is considered preventable with adequate routine screening. Despite the decline in prevalence and mortality of CRC in the United States, the African American population persist in having the highest rates of death and shortest survival for CRC. This doctoral project focused on the gastrointestinal (G.I.) staff knowledge gap about the importance of CRC screening to achieve better patient outcomes. The purpose of this project was to address the knowledge gap among the G.I staff as it relates to CRC screening. The health belief model served as a guide …

Program Evaluation Of A Home-Based Primary Care Practice And Patients With Heart Failure, Anne Rose Walsh

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects over 5.5 million adults in the United States with a prevalence of 10%'€“20% in older adults and accounts for 3% of all hospital admissions with a readmission rate as high as 25% within 1 month of discharge. Patients with HF account for approximately 42% of the doctor of nursing practice project site's patient population, and the health system has a 30-day readmission rate of 35% for patients with HF in 2 large hospitals. Thus, the health system loses almost $13 million per year in Medicare penalties. This retrospective quality improvement project reviewed the effectiveness of care …

Assisting Psychiatric Nurses In Managing Work Stress And Decreasing Callouts And Absenteeism, Prisca Njume

Walden Dissertations and Doctoral Studies

Management and reduction of work stress is important in promoting nurses' well'€being. Understanding how to decrease stress levels may allow nurses to provide better care, improve patient outcomes, and experience increased job satisfaction. The focus of this project was to empower psychiatric nurses to manage work-related stress and decrease callouts and absenteeism. Person-environment fit theory, job demand-control (support) theory, the job demands-resources model, and the effort-reward imbalance model were used to inform the project. Pretest and posttest data were collected from 61 nurses using the Perceived Stress Scale. Deidentified retrospective and prospective data of the number of callouts were also …

Nutritional Assessment Of Patients In The Intensive Care Unit, Jennifer Maureen Brown

Walden Dissertations and Doctoral Studies

Impaired nutrition is associated with prolonged hospitalization, poor patient outcomes, high mortality, and increased health costs. Nutritional assessment in intensive care unit (ICU) patients is important in recognition of changes in the patient’s nutritional status from admission to discharge and may promote early nutritional interventions by the health providers to prevent complications of poor nutrition. The purpose of this staff education doctoral project was to assess ICU nurses’ knowledge of nutritional assessment for critically-ill patients and to provide education on an assessment tool for patient nutritional assessment- the malnutrition universal screening tool (MUST). The guidelines from the American Society for …

Barcode Medication Administration In The Emergency Department To Mitigate Medication Errors, Holly Gauthier-Wetzel

Walden Dissertations and Doctoral Studies

Electronic health record systems (EHRs) have been adopted in healthcare facilities to unify the workflow process of healthcare professionals. Studies have demonstrated the addition of barcode medication administration (BCMA) software technology within the EHR has decreased medication errors within hospitals and long-term care facilities. However, limited research has been conducted to establish whether using BCMA in outpatient areas has had an influence on medication error rates. Literature reveals that many facilities have not adopted BCMA in outpatient areas. The purpose of this study was to investigate whether medication errors were mitigated after BCMA was implemented in the emergency department (ED). …

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 …

Staff Education On Fall Reduction Strategies For Residents Of A Long-Term Care Facility, Olivia C. Anaele-Nwogu

Walden Dissertations and Doctoral Studies

Fall-reduction programs are frequently ineffective in reducing falls among geriatric patients in long-term care (LTC) facilities. Multicomponent strategies have proved to be effective in reducing these falls. However, these strategies require staff education to ensure their success. The purpose of this project was to support the integration of multicomponent fall prevention strategies into practice by providing staff education focusing on the appropriateness use of hourly rounding and the 4Ps (pain, position, prompted voiding and placement) in addition to bed alarms to prevent falls among geriatric patients in the local LTC facility. The Johns Hopkins Nursing Evidence-based model was the conceptual …

Alternative Therapy For Veterans Diagnosed With Post-Traumatic Stress Disorder, Shannon Rae Hill

Walden Dissertations and Doctoral Studies

An increasing number of veterans diagnosed with post-traumatic stress disorder (PTSD) has led to an increased demand for treatment within the Veteran Affairs health care system. Presently, veterans diagnosed with PTSD receive psychotropic medications and intermittent therapy sessions. Nurses are challenged to educate veterans about other health care issues based on verbalized side effects from prescribed PTSD medications limiting veterans’ ability to focus. Identifying alternative treatment options may improve treatment choices, reduce side effects, and promote positive outcomes for veterans with PTSD. This systematic review provided evidence-based practice information by addressing whether alternative therapy such as biofeedback would improve the …

Lived Experiences Of African American Nursing Students In An Associate Degree Nursing Program, Monique Renee Merritt

Walden Dissertations and Doctoral Studies

Despite recognition of the barriers that African American nursing students encounter while pursuing nursing education, leaders of U.S. nursing programs continue to struggle to retain these students and promote their degree completion. Poor retention and lack of completion contributes to the unequal representation of African American nurses in the U.S. healthcare workforce compared to the overall population. The purpose of this qualitative study was to examine the experiences that helped to promote African American nursing students’ success or served as barriers to successful completion of an Associate Degree Nursing program. Tinto’s integration model was used as the theoretical framework. Semistructured …

Nurse Practitioner-Led Education Program For Heart Failure Patients, Shay Felecia Clarke

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects 5.7 million Americans and continues to be a leading cause of hospitalizations and deaths in the United States, posing an enormous burden on patients, families, and the health care system. Readmission rates for HF within 30 days post hospital discharge at small rural acute care facility in the southeast are consistently higher than the national average. The gap in nursing practice was the lack of up to date patient education postdischarge guidelines on HF for the socioeconomically disadvantaged, culturally diverse patient population located in this small rural town. The purpose of this project was to use …

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

Decreasing Thirty-Day Readmissions For Heart Failure Patients, Willybroad Che

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients have a 20-25% hospital readmission rate within the first month of discharge. Patients experiencing HF often have a decline in health resulting in frequent hospitalizations and encumbering symptoms including dyspnea, fluid retention, and orthopnea. HF is a common condition in nursing homes and accounts for a significant proportion of resident transfers to emergency departments. HF is considered one of the costliest diagnoses in the United States, estimated to cost the healthcare system billions of dollars annually. The purpose of this systematic review was to provide a synthesis of evidence-based literature on the current recommendations and strategies …

Perceptions Of Health Care Professionals Providing Smoking Cessation In Health Care Settings, Dr. Tenishia Tamika Edwards

Walden Dissertations and Doctoral Studies

Tobacco use affects many individuals in the United States and around the world, particularly those who have existing health disparities. Smoking cessation therapy is a process used by health care professionals (HCPs) to help aid in the reduction or elimination of tobacco use. HCPs providing this service in health care settings can reach patients directly while helping to decrease the mortality rate in those who use tobacco. The purpose of this phenomenological qualitative study was to identify HCPs’ perceptions of patient barriers to adherence to smoking cessation services and what can be done to improve smoking cessation in health care …

The Effectiveness Of The Biopatch Disc In Decreasing Mrsa In Peripherally Inserted Intravenous Catheters, Ketha Franklin

Walden Dissertations and Doctoral Studies

Methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant bacterial infection, is a pressing global health care issue that decreases patients’ quality of life and places a high burden on health care delivery systems. The purpose of this quality improvement evaluation project was to evaluate an infection prevention management program derived from evidence-based research to decrease the incidence of MRSA in peripherally inserted intravenous catheters (PIVs) in acute care settings through the utilization of the Biopatch disc. The practice-focused question addressed whether the use the Biopatch disc over a 6-month period in acute care would coincide with a reduction of the incidence of MRSA …

Potential Impacts Of Artificial Intelligence On Spine Imaging Interpretation And Diagnosis, David Howard Durrant

Walden Dissertations and Doctoral Studies

Spine and related disorders represent one of the most common causes of pain and disability in the United States. Imaging represents an important diagnostic procedure in spine care. Imaging studies contain actionable data and insights undetectable through routine visual analysis. Convergent advances in imaging, artificial intelligence (AI), and radiomic methods has revealed the potential of multiscale in vivo interrogation to improve the assessment and monitoring of pathology. AI offers various types of decision support through the analysis of structured and unstructured data. The primary purpose of this qualitative exploratory case study was to identify the potential impacts of AI solutions …

Lived Experiences Of African Americans 65 And Older After Rural Hospital Closures, Derrick Mike

Walden Dissertations and Doctoral Studies

African Americans 65 and older have had varied experiences due to losing immediate access to nearby hospitals for urgent treatment for emergency medical conditions. This phenomenological study was conducted to explore the lived experiences of those residing in areas after a rural hospital closure occurred. The hospital was the primary and nearest facility for receiving immediate access to urgent treatment. The research questions focused on the encounters experienced by the participants after the hospital closure. The Health Belief Model was the conceptual framework used for this study. The method and data analysis procedures included interviews, field notes, a life-course chart, …

Improving The Patient Experience With Communication, Pauline Adora Salmon

Walden Dissertations and Doctoral Studies

A quality patient experience is one of the highest priorities for hospitals as patients and families are looking to healthcare providers to meet their demands for quality service. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures the extent to which providers effectively communicate pertinent information such as communication about medications. On a 20-bed intermediate care unit, the HCAHPS item scores relating to nurse communication and communication about medicine were inconsistent and, on most occasions, were below the comparison benchmark of the 50th percentile when compared to other like hospitals. The purpose of this quality improvement project …

Systematic Literature Review On Fall Prevention In An Acute Care Hospital Setting, Sonia A. Hudson

Walden Dissertations and Doctoral Studies

Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the …

Examining Icu Nurses' Knowledge Of Ventilator-Associated Events And Ventilator-Associated Pneumonia, Dorothy J. Sanders-Thompson

Walden Dissertations and Doctoral Studies

Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test …

The Impact Of Human Resources On Nurses' Turnover Intention, Anita Estell Jackson

Walden Dissertations and Doctoral Studies

Nurse retention is of great concern to healthcare organizations including hospitals. With so many countries reporting a shortage in nursing personnel, healthcare organizations are now seeking ways to reduce this shortage. It is known that job satisfaction and turnover intention impact nurses' continued employment. However, the role of human resources (HR) impact on nurses' job satisfaction and turnover intention is unknown. The theoretical basis of this study came from the work of Bowen and Ostroff who argued the strength of HRM system regulates employee perceptions and outcomes within an organization. Therefore, the purpose of this study was to evaluate the …

Quality Initiative To Reduce Falls In An Acute Care Setting, Janet Maxine Belcher

Walden Dissertations and Doctoral Studies

Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the …

The Dietary Decision-Making Process Of Women In Nigeria, Gachomo Joanne Mapis

Walden Dissertations and Doctoral Studies

Nigerians have been opting for a more processed Western diet. These changes in dietary choices have aligned with obesity and undernutrition, attributable to micronutrient deficiencies or malnutrition. Many scholars have presented varying intervention strategies ranging from consumption of a variety of foods containing the necessary micronutrients to food fortification. The purpose of this grounded theory study was to explore the perceptions of women in an urban city in Nigeria on indigenous foods and Western dietary influences to determine social interactions, the consequence of the interactions, and the women’s current perceptions of food choices. The social-ecological model was used to explore …

Adolescent Substance Abuse Screening, Wesley W. Lynch

Walden Dissertations and Doctoral Studies

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse …