Medicine and Health Sciences Commons^™

Moral Distress Experienced By Behavioral Health Clinicians Who Have Worked With Maternal, Opioid-Using Clients, Jill Lee-Hubble

Walden Dissertations and Doctoral Studies

Moral distress (MD) is a concept that has been well studied in nursing and other medical fields as a precursor to provider burnout. Understanding how MD impacts behavioral health (BH) clinicians provides insights for counselor educators and supervisors to identify clinical situations that often lead to MD. This qualitative phenomenological study explored how MD was experienced by five BH clinicians who have worked in residential and hospital settings providing counseling to maternal, opioid-using clients. Interpretive phenomenological analysis (IPA) informed the research methodology and data analysis. Substance use during pregnancy is highly stigmatized in society; thus, a feminist conceptualization was integrated …

Successful Allocation Of Funds In Managed Health Care Programs Revenue, Sherri Jean Loveall

Walden Dissertations and Doctoral Studies

Managed care leaders of independent physician associations (IPAs) lack strategies for allocating existing funds to avoid business closure. Medical providers are concerned with the quality of care for patients if the allocation of funding is not executed correctly. Grounded in the competing values framework (CVF), the purpose of this qualitative single case study was to explore strategies managed care leaders of IPAs use to allocate funds to avoid business closure. Participants were six executive leaders of an IPA in Los Angeles, the United States, who successfully managed the allocation of funds in a managed healthcare system. Data were collected from …

Healthcare Literacy Strategies To Mitigate Healthcare Utilization And Rising Costs, Stella Obiageli Maduka

Walden Dissertations and Doctoral Studies

Low health literacy can adversely affect individuals and groups without access to health information. Health insurance leaders who lack strategies to decrease low health literacy may lose their ability to provide quality health services and control care costs. Grounded in the health belief model and the Andersen health service model, the purpose of this qualitative multiple case study was to identify the strategies private health insurance leaders use to increase medical utilization to reduce healthcare costs. The three participants were from two private insurance companies in Las Vegas, Nevada. Data were gathered through semistructured, open-ended interviews via videoconferencing, a review …

Hospital Ownership And Type As Predictors Of 30-Day Psychiatric Readmissions And Follow-Up, Zacquia Mckinley

Walden Dissertations and Doctoral Studies

Studies have suggested that differences in hospital ownership structures impact the rates of 30-day hospital readmission and 30-day hospital follow-up in patients with psychiatric diagnoses. The purpose of this quantitative study was to examine the relationship between hospital ownership, hospital type, rates of 30-day psychiatric readmission, and rates of 30-day follow-up for psychiatric patients. This study drew on Donabedian's conceptual model of hospital quality assessment and used ANOVA testing for the four research questions concerning whether there is a significant relationship between 1) hospital ownership and inpatient psychiatric patient readmission within 30 days of discharge, 2) hospital type, and inpatient …

Exploring African American Single Mothers’ Experiences With Child Welfare System, Paul J. Melbourne

Walden Dissertations and Doctoral Studies

African Americans are overrepresented in the child welfare system in New York City (NYC). They face racial and ethnic bias, complex procedures, and policies that govern child welfare. The main research question for this study explored the experiences of African American single mothers with the child welfare system. This qualitative study was guided by policy feedback theory; data were gathered from 10 African American single mothers who have had experiences with child welfare investigation within the past 10 years. Participants were interviewed using semistructured questions designed to capture their experiences with the child welfare system. The data were coded for …

Cognition, Neurocognitive Disorder, Psychotropic Group Of Medication, And Fall Among Canadians Aged 65+ Years, Victoria Elaki Momoh

Walden Dissertations and Doctoral Studies

Despite the high incidence of fall among the elderly in residential care, this problem has been minimally explored and reported. This study examined the association between (cognitive performance, dementia, four groups of psychotropic medication-hypnotics, antidepressants, antianxiety medication, and antipsychotics) and fall among Canadian elderly in residential care. A multi–variate logistic regression was used for the analysis. The Social Cognitive Theory was used to interpret the findings of an analysis on 180,231 Canadian residents from 2018–2019. Cognitive performance at intact level (OR=1.114, p<0.001), cognitive performance at moderate level (OR=1.192, p<0.001), dementia diagnosis (OR=1.075, p<0.001), antipsychotics (OR=2.571, p<0.001), antidepressants (OR =1.486, p<0.001) and antianxiety prescription (OR=3.284, p<0.001) increased the odds ratio of fall. However, cognitive performance at severe level (OR=0.898, p<0.001), no dementia diagnosis (OR=0.001, p<0.001) and hypnotics prescription (OR=0.389, p<0.001) decreased the odds ratio of fall. Findings indicate that cognitive performance at the intact and moderate levels, antianxiety, antipsychotic and antidepressant medications and dementia were strong predictors of fall among the elderly in residential care in Canada. A limitation of the study was that the dataset used captured data from 7 out of 13 Canadian provinces and territories therefore, limiting external validity. The potential positive social change impact of this study is that it would guide caregivers, enhance fall prevention practices and decrease fall occurrence in this population.

Body Satisfaction And Self-Efficacy As A Predictor For Obesity Among African American College Women, Sacha Nicole Morris-Dorsey

Walden Dissertations and Doctoral Studies

African American women have the highest rates of obesity when compared to any ethnic group in the United States, and the rates of obesity among this population are expected to continue to increase. In this study, social cognitive theory was used to predict the connection between body satisfaction, self-efficacy, and obesity in 18–24-year-old African American women attending college. The data were analyzed using multiple regression, while controlling for demographic variables, to determine if body satisfaction (Body-Esteem Scale for Adolescents and Adults) and self-efficacy (The Eating Self-Efficacy Scale) predicted obesity among African American women in college. Thirty-three participants completed the survey. …

Predictors Of Perceived Anxiety Disorder Stigma In Adults With Anxiety Disorders, Dr. Shawn Nabors

Walden Dissertations and Doctoral Studies

Licensed professional counselors strive to eliminate systemic barriers to mental health treatment. Perceived anxiety disorder stigma may be a barrier to mental health treatment for those who are affected by this type of stigma. This quantitative correlational study examined whether factors such as age, gender, and level of education predict perceived anxiety disorder stigma in a population of adults in the U.S. who had been diagnosed with anxiety disorders as measured by the Generalized Anxiety Stigma Scale (GASS). Goffman's theory of social stigma served as the theoretical framework for this study. An existing data set of 82 adults diagnosed with …

Competency-Based E-Learning Module For Nurses In A Multi-Service-Line Surgical Unit, Exequiel P. Naculangan

Walden Dissertations and Doctoral Studies

Negative patient outcomes have been attributed to surgery-related complications. A gap was identified in an acute care unit in southern Texas because postoperative surgical complications were above acceptable rates. The purpose of this Doctor of Nursing Practice project was to educate staff nurses on the provision of evidence-based postsurgical care. This doctoral project was conducted to determine whether completion of a learning module would increase nurses’ level of knowledge in acute postoperative care. The project was grounded on Knowles’s adult learning theory and the Dreyfus model of skill acquisition. Learning material using competency-based education was developed using the analyze, design, …

Effects Of The Hospital Readmissions Reduction Program On Copd Readmissions And Costs., Heather O'Connell

Walden Dissertations and Doctoral Studies

Readmissions for chronic obstructive pulmonary disease (COPD) are a major contributor to healthcare costs and patient outcomes. The Hospital Readmissions Reduction Program (HRRP) by the Centers of Medicare and Medicaid was implemented to decrease high rates of readmissions for serious medical problems, including COPD. The purpose of this study was to determine whether HRRP resulted in reductions in readmissions and costs for COPD patients. The Donabedian model was used as the theoretical framework to investigate three research questions concerning whether there are statistically significant differences in terms of readmission rates, total charges, and primary type of insurance payment before and …

Development Of An Insomnia Assessment Guideline For Bipolar Disorder, Daniel Oyewusi Oyewole

Walden Dissertations and Doctoral Studies

AbstractBipolar disorder (BD) affects more than 1% of the world’s population regardless of race, sex, ethnicity, or socioeconomic status. BD is a severe and chronic mental illness characterized by insomnia, depressed and elevated mood, racing thoughts, mood swings, anxiety and depression, and suicide. Insomnia is prevalent in BD and occurs across all stages of BD, yet no guidelines exist. The clinical practice guideline entitled the Insomnia Assessment Guideline for Bipolar Disorder (IAGBD) was developed using best-practice evidence from the published literature. The IAGBD is a step-by-step process for assessing insomnia in bipolar patients. Clinicians follow a series of questions in …

Role Of Hypertension In Low-Birth-Weight Racial Disparities Among Virginian Women, Ashli Owen

Walden Dissertations and Doctoral Studies

Low birth weight (LBW) is a leading cause of infant mortality globally, but it disproportionately burdens the Black community in the United States, with a rate twice that of White women. Further, hypertensive disorders of pregnancy (HDsP) increase LBW incidence. The purpose of the study was to assess the association between HDsP and LBW, maternal race and LBW, and the moderation effect of HDsP on race and LBW on Black and White women in Virginia. The theoretical framework for this study was based on the lifecourse health development model, which states that health should be viewed as an outcome of …

Associations Of Fast-Food Zoning Policy And Cardiovascular Disease In African American Communities, Starrlett Pena-Johnson

Walden Dissertations and Doctoral Studies

Cardiovascular disease (CVD) remains a major public health concern, causing one in every four deaths in the United States. Despite availability of effective disease management, African Americans bear the burden of incidence and mortality as CVD prevails as the primary cause of disparities in life expectancy, stroke, and heart failure. This cross-sectional study investigated fast-food restaurant (FFR) availability and socioeconomic status (SES; income, occupation, and education) to predict CVD risk scores in African Americans residing in Jackson, Mississippi. The social construction of target populations theory was used to inform this study. Using hierarchical multiple linear regression, a secondary data analysis …

Beliefs, Skill Sets, And Behaviors Of Police Officers Regarding Mental Health Treatment, Kareem C. Puranda

Walden Dissertations and Doctoral Studies

Current law enforcement training assumes that police officers can manage their mental health with minimal support. This cultural attitude creates a fear of being unfit if police officers seek assistance for their mental health. Law enforcement suicide rates have outnumbered duty-related deaths in recent years. Statistics show that police officers are twice as likely to die by suicide for reasons related to stress. Mental health treatment is the ideal solution, but research has shown that police officers often reject treatment due to stigma. This qualitative study aimed to examine factors that hindered law enforcement officers from obtaining mental health treatment. …

Association Of The Use Of Combination Therapy Self-Management Of Prediabetes And Type-2 Diabetes Mellitus In Adults, Celestina Reed

Walden Dissertations and Doctoral Studies

Diabetes is a long-lasting chronic health condition that encompasses three types: Type 1, Type 2, and gestational diabetes. The disease affects how the body breaks down food into energy. It is an insulin-deficient disease and causes heart disease, vision loss, and kidney disease. Investigators of the Centers for Disease Control and Prevention and the American Diabetes Association evaluated patient treatment preferences to determine the upsurge in patient health-related quality of life (HRQOL) and optimum health. The literature revealed that patients' preferences consisted of therapies and achievable goal setting using the health belief model (HBM) framework. This quantitative research aimed to …

Staff Education On Perinatal Depression, Kirenia Santiuste

Walden Dissertations and Doctoral Studies

Perinatal depression (PND) is a global mood disorder affecting women transitioning into parenthood and is closely related to extensive psychosocial and financial consequences for the family. Ten to twenty percent of new mothers in the US are affected by PND in the year after giving birth. The problem identified for this Doctor of Nursing Practice project was the need for staff education on knowledge of and screening for PND in the obstetrical clinic for which the project was developed in a southeastern state of the US. Using the analysis, design, development, implementation, and evaluation model, the purpose of this Doctor …

Health Educator Experience: Recommendations For Physical Activity For Mental Health In Women, Patricia Schneider

Walden Dissertations and Doctoral Studies

Mental health issues, specifically anxiety and depression, continue to be a public health crisis in the United States. Despite the established therapies of pharmacology and cognitive behavioral therapy, not all patients seek or find relief using these methods. Therefore, other treatment strategies need to be studied. The purpose of this basic qualitative study was to understand the experiences of health educators who use physical activity as a strategy for anxiety and depression management among middle-aged women as well as their own attitudes, norms, and perceived behavioral controls. The theory of planned behavior (TPB) was leveraged as the theoretical foundation for …

Increasing Nurse Leader Knowledge And Awareness Of Information And Communication Technologies, Cory Stephens

Walden Dissertations and Doctoral Studies

Due to the recent coronavirus disease (COVID-19) pandemic, rapid technological innovation and nursing practice transformation exposed a deepening divide in the knowledge and awareness of information and communication technologies (ICT) among nurses. This technological skills gap undermines the benefits of ICT to nursing practice such as increased nurse satisfaction, improved care quality, and reduced costs. Nurse leaders are positioned to promote the use of ICT among nurses but may suffer from the same knowledge deficit of ICT as their followers. Guided by Locsin’s technological competencies as caring in nursing theory, Staggers and Parks’ nurse-computer interaction framework, and Covell’s nursing intellectual …

Relationship Between Ceo Gender, Hospital Size, And Urban, Rural Location, Levinda Walpole

Walden Dissertations and Doctoral Studies

Leadership diversity concerning gender is important in the health care sector because diversity encourages problem solving from different perspectives. The purpose of this quantitative correlational study was to examine whether there was a relationship between CEO gender and the size of nonprofit hospitals and rural/urban location of hospitals in Texas. The independent variables were hospital bed size, which was categorized according to various groupings, and rural/urban areas in Texas. The dependent variable was gender (male and female). The theoretical framework that grounded this study was the perspective of organizational culture and the leader’s role based on the competing values framework. …

Services For Homeless Veterans: A Study Of Access To Benefits, Sheryl Maddox Williams

Walden Dissertations and Doctoral Studies

AbstractHomelessness among veterans in the United States is a multifaceted social and health concern that has continued to increase despite immense efforts to minimize and eliminate this issue. Numerous organizations have dedicated resources; however, many veterans do not use benefits and resources that are available to them, and homelessness remains a health and social concern. The purpose of this study was to explore and describe how individual and interpersonal barriers, community factors, organizational structure, and existing policies for assistance are perceived by support staff that work with veterans with mental disorders who are homeless or at risk of becoming homeless. …

Opioid Naloxone Education Clinical Practice Guideline, Tat'yana Sahleem Alethia Worthy

Walden Dissertations and Doctoral Studies

As a result of an institution-wide campaign to train providers on the administration of opioid reversal agents within a large medical center in the northeastern United States, the practice problem emerged that there was no patient/family education document for healthcare providers to use as a guide to educate patients on opioid risk and proper administration of naloxone to prevent opioid overdose in the outpatient setting. This scholarly project used an interprofessional team to develop comprehensive opioid naloxone education guidelines to close the gap in clinical practice. The purpose of this project was to develop a patient education clinical practice guideline …

Gestational Weight Gain, Level Of Education, And Infant Mortality Among African American Women, George Lee Amanambu

Walden Dissertations and Doctoral Studies

Abstract

African American (AA) women in Mississippi have a higher burden of infant mortality, especially those with low income and educational levels, as compared to other regions of the country. However, it is unknown if abnormal gestation weight gain (GWG) is contributing to this increased burden. This quantitative cross-sectional study examined the association between GWG (25-35lbs), level of education, income, and infant mortality among AA women with normal prepregnancy body weight who were between 30 to 47 years old in the state of Mississippi from 2016 to 2018. Biopsychosocial and ecosocial models were used as the theoretical foundation to design …

Generational Differences In Nursing Turnover, Adam Bennett

Walden Dissertations and Doctoral Studies

Nursing is currently the largest job category in U.S. health care requiring proper recruitment and retention of nurses. As the current generation of nurses ages out of the workforce due to retirement, new nurses will need to cover the gaps in the workforce. The purpose of this quantitative correlational study was to examine the relationship between voluntary turnover, involuntary turnover, and career change among nurses who were born between 1980 and 1995 (Millennials) and those born between 1965 and 1979 (Generation X). The theoretical framework was Mannheim’s theory of generations. Secondary data were collected from exit interviews with 811 respondents …

Factors That Determine Utilization Of The Canadian School-Based Human Papilloma Virus Vaccine Programs, Diane Gloria Brown

Walden Dissertations and Doctoral Studies

Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the world and is the known causative agent of many HPV-associated cancers in both males and females. HPV vaccination rates in Canada are significantly lower than other developed countries and this finding is poorly understood as Canadian adolescents have access to free-of-charge HPV vaccines through school-based vaccination programs. This quantitative descriptive study used an online survey to collect data from 992 eligible respondents. This study identified predisposing, enabling, and need factors characterized by the Andersen behavioral model of health services use which facilitate or impede the use of …

Secondary Data Analysis Of The Association Of Screen Time With Selected Health Behaviors, Kellany Cadogan Noland

Walden Dissertations and Doctoral Studies

The noticeable disparity in youth access of preventive healthcare and youth’s tendency towards excessive screen time have been linked to poor health outcomes. This issue prompted the current study, which had three core purposes: to identify associations between screen time and selected health behaviors, to identify target sociocultural and personal determinants of youth health, and to provide evidence to prompt innovation in promoting youth health via screen-based strategies. The social cognitive theory provided a context for triadic reciprocity between youth personal factors, environmental factors, and behaviors. A quantitative secondary analysis was completed using SPSS-27 to identify whether there was an …

Nurses' Experiences Caring For Patients With Opioid Use Disorder, Pamella Maureen Campbell

Walden Dissertations and Doctoral Studies

Over the past 2 decades, opioid use in the United States has taken thousands of lives, reached the level of epidemic in 2017, and has been an area of study among scholars. The problem is health care professionals, including nurses, lack training on how to care for people with opioid use disorder (OUD). Nurses are at the frontline of patient care and understanding the nurses’ experiences in the care of patients with OUD may help to improve the patients’ quality of care. The purpose of this qualitative descriptive study was to develop an understanding of the experiences of nurses with …

Fall Clinical Practical Guideline In A Psychiatric Hospital, Wendy Carroll Smith

Walden Dissertations and Doctoral Studies

Psychiatric hospitals are a unique environment and therefore pose unique challenges in preventing falls. Current evidence suggests that multidisciplinary committees to update clinical practice guidelines (CPG) will reduce falls and improve patient care in the acute inpatient psychiatric setting. The purpose of this study was to examine current evidence and develop new CPG with a goal to decrease falls in an inpatient psychiatric hospital. The Iowa model collaborative was used as a framework to develop the CPG to promote quality care and serve as an implementation model that supports the training of evidence-based practice. The methodology, design, and data analysis …

Fortitude, Spiritual Fortitude, And The Cancer Care Continuum In African American Breast Cancer Survivors, Karen Y. Boone

Walden Dissertations and Doctoral Studies

African American breast cancer survivors (AABCS) struggle with physical, emotional, psychological, spiritual, and financial challenges. Navigating these challenges can require the use of inner resources such as fortitude and spiritual fortitude. Using Folkman and Lazarus’ transactional model of stress and coping as the theoretical framework, the purpose of this study was to examine fortitude and spiritual fortitude as coping responses by African American women living with breast cancer and whether fortitude and spiritual fortitude were associated with phases of the cancer care continuum. A quantitative nonexperimental cross-sectional design was used for primary data collection that involved using Pretorius’ Fortitude Questionnaire …

The Impact Of Electronic Health Records Meaningful Use On Patient Safety And Satisfaction, Paulette Brown

Walden Dissertations and Doctoral Studies

AbstractThe widespread adoption of electronic health records (EHRs) is encouraged because of their potential to improve the quality of care provided. It was unknown to what extent the meaningful use of EHRs would impact patient safety and satisfaction in general and specialty hospitals. The researcher’s purpose for this quantitative correlational research was to examine the impact of meaningful EHR use of EHRs on patient safety and satisfaction outcomes in general and specialty hospitals in Philadelphia (PA). The constructs of the institutional theory guided the study. The hypotheses that guided the study included (a) Meaningful EHR use positively influences patient satisfaction …

The Relationship Between First Case On-Time Starts, Turnover Times, And Operating Room Productivity, Rhafia Bucoy

Walden Dissertations and Doctoral Studies

Operating room (OR) managers struggle to manage day-to-day surgical operations while meeting and exceeding organizational productivity amid the COVID-19 pandemic. The deferral of surgeries contributes to millions of backlogs of surgical case volume and unintended negative consequences. Grounded in the proposition that first-case on-time starts (FCOTS) and turnover time (TOT) are correlates of OR productivity, the purpose of this quantitative correlational study was to examine the relationship between FCOTS, TOT, and OR productivity. Archival data from 136 electronic surgical records were collected from two free-standing ambulatory surgery centers and analyzed using multiple regression. The results of the one-service, eye-specialized, ambulatory …