Medicine and Health Sciences Commons^™

Improving Nursing Knowledge, Satisfaction, And Retention In Long Term Care, Ghislaine Barry

Walden Dissertations and Doctoral Studies

Through advancements in modern medicine, human beings worldwide are living longer. The increase in life expectancy creates a need for a more qualified and knowledgeable nursing workforce for the delivery of quality geriatric health care. Although nurses are the primary care providers for vulnerable older adults, they are generally not well trained or prepared in geriatric care. Therefore, the purpose of the project was to develop an education program aimed at improving nursing knowledge of geriatric care in the long-term care (LTC) setting. The goal of the project was to answer the research question: What impact would attendance in the …

Development Of Patient-Centered Team-Based Care Certification, Stephanie Lynn Stewart

Walden Dissertations and Doctoral Studies

Accountable care units (ACU-?¢) provide a new model for integrated patient care. The ACU-?¢ promotes patient centeredness in nursing units as team members work collaboratively with physicians to improve patient outcomes and reduce unwarranted variations. A health system in the southeastern United States incorporated the ACU-?¢ as part of their care model. These units were held accountable for their clinical, service, and cost outcomes but lacked a validation process to demonstrate the effective utilization of their data. The purpose of this DNP project was to create a patient centered care (PCC) certification process, guided by the Donabedian model, that would …

Meeting The Nutritional Needs Of Very Low Income Diabetic Patients, Mary Hossley

Walden Dissertations and Doctoral Studies

Adult Type II diabetes is an increasing public health problem, particularly among very low-income minority populations. The purpose of this study was to create a nutritional guide for a diabetic specific meal plan with an accompanying food pantry nutrition packet for very low-income Type II diabetic patients at a rural Mississippi Free Clinic. The practice-focused question is: Will a nurse-prepared nutritional guide with supplemental food packets improve the glucose control in low income diabetic patients? The gap in practice is that there has been no structured nutrition education guide and no food pantry support plan for Type II adult diabetics. …

A Staff Educational Initiative To Improve The Use Of Childhood Obesity Guideline Recommendations, Kris Kuhlmann Louque

Walden Dissertations and Doctoral Studies

Obesity affects one out every six children in the United States, which places them at risk for other chronic conditions such as cardiovascular disease, diabetes, and continued obesity into adulthood. Considering military children are more likely to enter the Armed Forces than their civilian counterparts, an increase in obesity among military families decreases the number of potential future military recruits who are physically eligible to serve. Despite this growing epidemic, providers report a lack of education and a low self-efficacy in the treatment of this condition. This doctorate of nursing practice study addresses this educational gap by attempting to improve …

Health Literacy Best Practices In Policy Development, Stacie Lee Trueheart

Walden Dissertations and Doctoral Studies

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and …

African American Women Caring For Loved Ones With Alzheimer's Disease And Dementia, Lisa M. Forbes

Walden Dissertations and Doctoral Studies

Abstract

In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the …

Evaluating A Discharge Bundle For Chronic Obstructive Pulmonary Disease, Sharon Scardina Jones

Walden Dissertations and Doctoral Studies

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the leading causes of hospital readmissions within 30 days. Frequent readmissions negatively affect hospital reimbursements and patient outcomes. Creative strategies, such as COPD care bundles, have been shown to reduce readmission rates according to existing studies. A COPD discharge bundle was developed and implemented at 1 community hospital in response to an identified problem with COPD readmissions. Evaluation of this quality improvement initiative was the purpose of this project study. The practice-focused question was: Have 30-day readmission rates changed following the implementation of a COPD discharge bundle prior to …

Trauma-Informed Education Toolkit For Screening Pediatric Victims Of Sexual Abuse And Maltreatment, Analena Michelle Lunde

Walden Dissertations and Doctoral Studies

The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the …

Challenges Of Aging With The Hiv Virus And Comorbidities, Rommie Navylia Abele

Walden Dissertations and Doctoral Studies

Since the introduction of antiretroviral therapy, the survival rate of infected HIV patients has been on the rise with a predicted increase by 2030. The longer a person lives with the virus, the more prone to HIV-associated chronic diseases he or she becomes, but it is not clear whether these diseases are solely from aging with the virus or from long-term use of antiretroviral therapy. Scientists demonstrated that the introduction of antiretroviral therapy led to an increased life expectancy yet early onset of comorbidities; however, they failed to address the challenges that people 50 years old or older face, as …

Veterans With Chronic Back Pain Managed In Primary Care: Patient Aligned Care Team, Bonnie Grimes

Walden Dissertations and Doctoral Studies

Chronic pain affects approximately 100 million adults in the United States annually, and costs exceeding $635 billion. Pain is the most common complaint in primary care, and chronic pain accounts for up to 16% of emergency room visits. Additionally, chronic pain accounts for 25% of missed workdays annually. Veterans are particularly vulnerable to chronic pain and have an increased incidence of chronic non-cancer pain. Chronic pain for veterans cost the Veterans Administration (VA) about $385 billion each year. This project evaluated the Patient Aligned Care Team (PACT) model to manage chronic lower back pain (CLBP) at a VA primary care …

Perceived Usefulness And Perceived Ease Of Use Impact On Patient Portal Use, Dasantila Sherifi

Walden Dissertations and Doctoral Studies

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, …

Catheter-Associated Urinary Tract Infection In New York And North Carolina, Kehinde O. Abiodun

Walden Dissertations and Doctoral Studies

In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples' health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost …

Self-Disclosure Of Human Immunodeficiency Virus Status In Personal Relationships: Perceptions Of South Africans Living With Human Immunodeficiency Virus, Delile Gertrude Langeni

Walden Dissertations and Doctoral Studies

Despite enormous research on the experience of living with HIV, many questions remain regarding self-disclosure of HIV status to sexual partners by people living with HIV (PLWHIV), which is essential to reducing further infection. In this study, a phenomenological approach captured the experience of self-disclosure among South Africans living with HIV in Louwsburg, South Africa. The health belief model served as a theoretical framework, and in-depth interviews were conducted with 12 PLWHIV (8 women, 4 men) who self-disclosed their HIV status to their sexual partners. Their experiences were explored, discovering their illness, motives for self-disclosure, feelings regarding disclosing, responses of …

Streamlining Hospital Administrative Procedures To Reduce Costs, Dr. Claret Onukogu

Walden Dissertations and Doctoral Studies

Americans spent nearly $2.6 trillion, or $8,000 per person for medical and administrative costs in 2010. By 2015, healthcare spending in the United States increased to 5.8% reaching $3.2 trillion or $9,990 per individual. By tackling healthcare administrative costs, it is estimated that healthcare providers could reduce these costs by $20 billion yearly. This case study explored strategies for streamlining hospital administrative procedures to reduce costs. The business process reengineering model formed the conceptual framework for this study. Data were gathered through semistructured face-to-face interviews guided by open-ended questions with a purposeful sample of 4 hospital managers in Atlanta, Georgia. …

Complementary Infant Feeding Practices In Afghanistan, Hasibullah Na Niayesh

Walden Dissertations and Doctoral Studies

Children are at greater risk of malnutrition in Afghanistan than they are in many other countries. Malnutrition impairs the mental and physical growth of more than 50% of children in Afghanistan. It also exacerbates the risks of mortality by 45% in infants and children in Afghanistan. The purpose of this study was to determine the association between mothers' knowledge, attitudes, and practices regarding complementary feeding and malnutrition in children in Afghanistan. The precaution adoption process model served as a theoretical framework in this quantitative cross-sectional research study. Data analyzed were collected from 306 mothers and children at 6 randomly selected …

Management Of Chronic Kidney Disease By Advanced Practice Nurses, Anthony C. Amagwu

Walden Dissertations and Doctoral Studies

Despite best available care, uncontrolled chronic kidney disease (CKD) - a complex disease that impacts millions in the United States, will eventually progress to end stage renal disease which is associated with high morbidity and mortality. New evidence suggests management of earlier stages of CKD is effective in delaying disease progression. This project evaluated the impact of a CKD class, led by a nephrology nurse practitioner, on preventing disease progression in advanced CKD patients with diabetes and hypertension. The purpose of the class was to validate the need for the advanced practice nurse (APN) in the care continuum of CKD. …

Strategies To Prevent And Reduce Medical Identity Theft Resulting In Medical Fraud, Junior V. Clement

Walden Dissertations and Doctoral Studies

Medical identity fraud is a byproduct of identity theft; it enables imposters to procure medical treatment, thus defrauding patients, insurers, and government programs through forged prescriptions, falsified medical records, and misuse of victim's health insurance. In 2014, for example, the United States Government lost $14.1 billion in improper payments. The purpose of this multiple case study, grounded by the Health Insurance Portability and Accountability Act as the conceptual framework, was to explore the strategies 5 healthcare leaders used to prevent identity theft and medical identity fraud and thus improve business performance in the state of New York. Data were collected …

Increasing Knowledge About Food Allergy Management In The Preschool Setting, Katherine Mizell Crow

Walden Dissertations and Doctoral Studies

The prevalence of food allergies is a growing concern in the United States. Approximately 8% of the pediatric population has some form of food allergy. Many of these children are either in the preschool and primary school setting, which is where the majority of allergic reactions occur. If the symptoms of a food allergy reaction are not treated within minutes of exposure, the results can be damaging or fatal. Evidence continues to demonstrate that preschool and school personnel do not feel trained or prepared should a severe reaction arise. The purpose of this evidence-based project was to determine if the …

Association Between Altitude And Bronchopulmonary Cancer, Hung Ching

Walden Dissertations and Doctoral Studies

As a validation study, this study addressed an under-researched area of bronchopulmonary cancer mortality and incidence. The association between altitude and bronchopulmonary cancer mortality and incidence was investigated using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The theoretical framework for my study was Bronfenbrenner's ecological model. This model emphasizes the relevance of social and physical environments that influence patterns of disease and injury and shape responses to these patterns of disease and injury. The age-adjusted bronchopulmonary cancer mortality and incidence rates per 100,000 people in the highest elevation and lowest elevation states …

Socioeconomic Status And Cancer Risks In Employer-Insured Cancer Survivors, Christine Clinton

Walden Dissertations and Doctoral Studies

Chronic illnesses such as cancer continue to be among the costliest for employers who provide health insurance to their employees. Despite efforts to incorporate health improvement programs in the workplace, there are concerns about the effectiveness of these programs that do not always deliver a positive return on investment. Little is known about the specific socioeconomic status of employees for whom these workplace health improvement programs are designed for. Guided by the social-ecological model, this study sought to understand the relationship between cancer health risks about socioeconomic factors among cancer survivors in the employer-insured population. Data were extracted from the …

Understanding Use Of Care For African Immigrants With Autistic Children, Leahnata Davies

Walden Dissertations and Doctoral Studies

The number of African immigrants in the United States is increasing. The incidence of children diagnosed with autism spectrum disorder in the United States is also on the rise. Despite these increases, little information exists about the adequacy of care for African immigrants with autistic children in the United States. The purpose of this grounded theory study was to understand the factors that affect use of care for African immigrants with autistic children in the United States. Using Aday-Anderson model of health care utilization framework, this study focused on African immigrants in the United States who had children with Autism …

Nursing Leadership And Employee Satisfaction Perception In A Virtual Work Environment, Angelique Duffy

Walden Dissertations and Doctoral Studies

Virtual team leaders in health care must have the right resources available to help them effectively perform their jobs. Better performance from the leader may lead to greater employee satisfaction. The problem addressed by this study was the impact of leadership style on employee satisfaction of virtual nurses. The purpose of this quantitative correlational study was to investigate the relationship between the leadership styles of virtual nursing environment leaders as perceived by virtual employee nurses and the nurses' satisfaction as measured by the Multifactor Leadership Questionnaire-short form. Building on the theoretical foundation of Bass's 1990 work, this study examined the …

Creation Of A Diabetic Health Literacy Program For Staff Of A Rural Federally Qualified Healthcare Center, Cathy Jones

Walden Dissertations and Doctoral Studies

Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase …

Length Of Pretrial Detainment For Inmates With Mental Illness, Maria Pereira-Sosa

Walden Dissertations and Doctoral Studies

There has been an increase in the number of individuals with mental illness being housed in correctional facilities over the last 50 years. In this study, the length of pretrial detention was compared for inmates who have a mental illness and are compliant with psychiatric medications, inmates who have a mental illness and are noncompliant or not prescribed psychiatric medication, and inmates with no mental illness. I also examined if inmates who have a mental illness have less severe charges and if there was a difference in the classification of mental health diagnoses for inmates who are and are not …

Breastfeeding Perceptions, Rates Of Initiation, And Duration Among Urban And Rural Women, Shaunta N. Rutherford

Walden Dissertations and Doctoral Studies

Breastfeeding is the optimal feeding method for infants up to the age of 2. Breast milk is suited to fulfill the nutritional needs of infants while providing immunological and neurological benefits. Breastfeeding rates of initiation and duration are low in the United States, especially in the state of Georgia. The purpose of this cross-sectional study was to investigate how breastfeeding initiation and duration, self-efficacy, perceptions, and community breastfeeding resources differ based on geographical location. The social ecological model was used as the theoretical framework for this study. An online and in-person survey that combined the Iowa Feeding Attitude Scale, Breastfeeding …

Cultural Perspectives On African American Adolescent Sexual Risk Behavior In Central Mississippi, Debra Suzette Smith

Walden Dissertations and Doctoral Studies

In 2015, Mississippi had the 3rd highest adolescent birth rate in the United States, high rates of sexually transmitted diseases, and enduring racial disparities between African American and White teenagers. Few researchers have described the immediate cultural environment to determine how it may influence the sexual behaviors and attitudes of African American teens. The purpose of this qualitative ethnographic study was to describe the sociocultural environment of African American adolescents in Mississippi that influences their sexual behavior by exploring the knowledge, feelings, experiences and beliefs of African American adults. The social cognitive theory was used as a theoretical framework to …

Development Of A Staff Education Module On Adolescent Obesity, Deborah Ann Stallworth

Walden Dissertations and Doctoral Studies

Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in …

Clinical Practice Guideline For Differentiating Risk Factors For Avoidable And Unavoidable Pressure Ulcers., Vivian Suarez-Irizarry

Walden Dissertations and Doctoral Studies

Pressure ulcers (PUs) present intrinsic risk factors that are not consistently identified by clinical assessments. The objective of this project was to develop a clinical practice guideline (CPG) to provide nurses with guidance in identifying and differentiating how intrinsic and extrinsic risk factors are associated with populations at risk for developing avoidable and unavoidable PUs. CPG development followed a systematic method to search the literature, organize findings, and assess the strength of the resulting evidence and its applicability to the CPG. Quality of the CPG was assessed by a panel of 8 health care professionals using the Appraisal of Guidelines …

Improving Outcomes For Congestive Heart Failure Patients, Diana Lee Collins

Walden Dissertations and Doctoral Studies

Managing patients diagnosed with congestive heart failure (CHF) requires coordination with subspecialties and frequent outpatient monitoring. The lack of communication among health care providers and patients can result in a gap in practice when managing patients with CHF in the outpatient setting. Guided by the chronic care model, this quality improvement project was an initiative to develop and implement a 6-week self-care management program provided by nurse practitioners in an outpatient primary care practice. The goal of the project was to improve the day-to-day self-care management of patients with CHF and addressed the practice-focused question of whether a 6-week CHF …

Association Of Dietary Intake With Suicidal Ideation Or Suicide Attempts In Adolescents, Zenobia J. Bryant

Walden Dissertations and Doctoral Studies

Suicide is among the leading cause of adolescent deaths worldwide and thus a significant public health concern. Risk factors for suicidal behavior include drinking alcohol, smoking, and engaging in risky sexual behaviors. One area of concern is dietary patterns and their association with depressive symptoms and suicidal ideation. Bandura's social cognitive theory emphasizes the assumption that one can perform specific actions to bring about desired outcomes. The primary research questions for this quantitative, retrospective, cross-sectional study concerned whether there is a statistically significant interaction between fruit and vegetable intake and suicidal ideation or suicide attempts. Data from 71,776 adolescents in …