Medicine and Health Sciences Commons^™

Successful Strategies For Financial Sustainability In Nursing Homes, Renee Walthour

Walden Dissertations and Doctoral Studies

From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of …

Exploring Management Practices Of The Health Care System For Contractors, Gary L. Williams

Walden Dissertations and Doctoral Studies

Researchers have found that military members serving in war experienced changes in physical and mental health. Military members' healthcare is managed by the Department of Defense. The problem was that management practices of the system for providing long-term healthcare for employees of a contracting company working in foreign combat zones is either minimal or nonexistent. The purpose of this case study was to explore ways that contractor managers and government managers can work together to provide healthcare for those contract employees who will be deployed with the U.S. military. The primary research question was to determine what managers of contractors …

The Effectiveness Of Screening For Comorbid Depression Among Outpatients With Chronic Diseases In Maryland, Linda Hasssan Allibalogun

Walden Dissertations and Doctoral Studies

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients …

Inpatient Rehabilitation, Diabetes, And The Risk Of Clostridium Difficile Infection, Kerry A. Flint

Walden Dissertations and Doctoral Studies

Clostridium difficile is a frequent cause of healthcare-associated infections (HAI) and is associated with increased risk of morbidity and mortality. Studies suggest environmental and host characteristics increase patient's susceptibility to C. difficile infection (CDI). However, few studies have examined the risk of CDI among those with diabetes or patients in the acute rehabilitation (AR) setting. A case-control study, using secondary data (n = 473), evaluated the relationship between CDI and diabetes and identified modifiable environmental exposures. An ecosocial framework was used to examine the relationship between these two complex diseases among hospitalized patients in an AR setting. Results of the …

Implementation Of A Standardized Approach To Diabetes Education, Stacey Williams Porter

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention (CDC) report that Type 2 diabetes

mellitus (T2DM) is a serious health issue affecting over 24 million Americans. Adults with T2DM are 2 to 4 times more likely to experience complications of the disease such as heart disease and stroke. Efforts are needed to control the condition and prevent the complications. At a local community hospital in the southeast United States, a 2-year assessment revealed over 10,000 patients admitted with diabetes or diabetes-related complications. Staff nurses at the site were responsible for diabetes self-management education for T2DM patients at discharge; however, no standardized …

Facebook, Parent-Child Relationships, And Emotion Regulation In An Adolescent Sample, Lauren Nicole Crandall

Walden Dissertations and Doctoral Studies

Social networking has become an integral part of daily communication and information sharing. Although researchers continue to explore the fields of social networking and emotion regulation separately, there is a lack of research bridging these areas of interest, particularly in the adolescent population. The purpose of this study was to examine the predictive relationship between the environmental and social variables of Facebook use, online social connectedness, and quality of parent-child relationship with adolescent emotion regulation. Fogel's social process theory of emotion provided the framework for this study and allowed for examination of the social networking environment. Research questions addressed independent …

Strategies For Shipping Temperature-Sensitive Medical Devices Using Cognitive Mapping, Eric C. Guynes

Walden Dissertations and Doctoral Studies

Supply chain management (SCM) practitioners who ship temperature-sensitive diagnostic medical devices (DMDs) to clinicians must use effective cold chain management (CCM) strategies to avoid temperature excursions that contribute to medical device errors. Such errors have caused patient harm and death, which costs the U.S. health care system billions of dollars per year. The purpose of this qualitative multiple case study was to explore strategies for selecting and managing cold chain shipping solutions (CCSSs) requiring SCM executives to trade cost for regulatory compliance and predictability when mitigating temperature variations that occur during shipping. The conceptual framework for the study was the …

Strategies To Implement Innovations In Hospitals, Schola Mutumene Kabeya

Walden Dissertations and Doctoral Studies

The Patient Protection and Affordable Care Act, which promoted quality of care, started the transformation of healthcare systems in the United States. The purpose of this qualitative multiple case study was to explore clinical practice innovation strategies used by hospital middle managers to improve quality of care and profitability. Pettigrew's theory was the conceptual framework for this study. Participants were 8 middle managers from 2 high-performing hospitals in the southwestern region of the United States. Data were collected from semistructured interviews, personal notes, and review of the hospital's publicly reported documents and literature. Member checking and methodological triangulation increased the …

Cultural Competence To Decrease Advanced Stage Breast Cancer Diagnosis In An Appalachian Kentucky Population, Deborah Heard Stakelin

Walden Dissertations and Doctoral Studies

Despite American College of Radiology guidelines for breast cancer screening, the Appalachian Kentucky population has an increasing number of advanced stage breast cancer diagnoses related to a delay in mammogram screening initiation. A potential contributing factor for the delay in screenings is a lack of culturally competent care to support the need for early detection of breast cancer in the identified population. The purpose of this staff education project was to improve the knowledge base and skill set of health care employees concerning the most advantageous practice to increase cultural competence in the health care setting. A practice-focused question related …

Effects Of Menafrivac® Introduction In The African Meningitis Belt, 2010-2017, Andre Arsene Bita Fouda

Walden Dissertations and Doctoral Studies

Meningococcal meningitis is a burden in the African meningitis belt. Before 2010, Neisseria meningitidis serogroup A (N. meningitidis A) was the predominant pathogen causing deathly epidemics. MenAfriVac® vaccine protects against N. meningitidis A. It was introduced in 2010 into highest meningitis risk health districts. There was limited data on the effects of MenAfriVac®, mainly on the degree of relationship between N. meningitidis A and the MenAfriVac® immunization. The social ecological model was used as a theoretical framework for this study. The purpose of this quantitative study was to assess the effectiveness of MenAfriVac® from 2010 to 2017 in 21 out …

Increasing Referrals Of Hospitalized Obese Patients, Tammy Elaine Cabrera

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise in the United States and globally, placing populations at

increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer,

and other disease states. Literature review shows that there have been many different methods

utilized to halt obesity's progression, however rates continue to increase. The United States

Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other

agencies recommend obesity screening and counseling at every patient encounter, but most

hospitals do not have a current obesity policy in place to accomplish this task. The purpose of

this project is to …

Usefulness Of Medication Scanners In Clinical Practice: A Systematic Review, Laura Leonard Cure

Walden Dissertations and Doctoral Studies

Thousands of people die each year due to preventable medication errors. Barcode medication administration (BCMA) systems can reduce medication errors at the point of care, thus increasing patient safety. The purpose of the project was to gather evidence regarding BCMA usefulness in reducing medication errors. Kurt Lewin's 3-step change theory was used to guide this project. The nature of this project was a systematic review of the literature pertaining to the effectiveness of using BCMA systems to reduce medication errors in at the point of care in the hospital setting. The Johns Hopkins nursing evidence-based practice model and tool kit …

Health Seeking Behavior In African American Women, Lorretta Larmond-Hyman

Walden Dissertations and Doctoral Studies

Disparities exist in the health-seeking behavior of African American (AA) women in the United States. Specifically, AA women 40 years and older often do not adhere to guidelines for breast cancer screening because of demographic and socioeconomic factors that have impacted health disparities. The purpose of this study was to research negative health-seeking behavior toward early-stage breast cancer detection in AA women 40 years and older. The main research questions addressed whether there is a relationship between negative health-seeking behavior, operationally defined as lack of a personal doctor, lack of health insurance, and lack of doctor visits within the past …

Using A Quality Workbook Committee To Improve Nurse-Sensitive Patient Indicator Scores, Nicole Robinson

Walden Dissertations and Doctoral Studies

Health care providers gather and track quality patient indicator scores to monitor patients' safety and outcomes and decrease the number of adverse events. Nursing leaders implemented a Quality Workbook Committee (QWC) within a hospital setting to improve patient outcomes and the facility's reported scores for nurse-sensitive patient indicators. The practice-focused question for this quality improvement evaluation project examined whether the implementation of the QWC improved nurse-sensitive patient indicator scores. Watson's theory of human caring was used to evaluate the gap in practice, and Rosswurm and Larabee's model for evidence-based practice change provided guidance for planning the project. Sources of evidence …

Evaluating Parents' Decisions Regarding Recommended Childhood Vaccinations, Jennifer Kline

Walden Dissertations and Doctoral Studies

Vaccinations are among the greatest accomplishments of public health. However, many parents are choosing not to vaccinate. The purpose of this study was to explore the association between social media influence and parents' decisions to vaccinate their children. The health belief model indicates that individuals' likelihood of engaging in a health-related behavior is determined by their perceptions of susceptibility, severity, benefits, and barriers. The research questions addressed whether there is an association between parents' perception of their children's disease susceptibility and their decisions about vaccination, and whether there is an association between exposure to messaging from social media and parents' …

Cross Contamination In Levered Endoscopes, Ernest Lowell Thomason Jr.

Walden Dissertations and Doctoral Studies

Contamination is a prevalent issue with reprocessed levered endoscopes. The number of infections caused by resistant enterobacteriaceae in patients due to contaminated endoscopes increased to the point that the United States Food and Drug Administration released a safety alert to health care facilities that perform endoscopic retrograde cholangiopancreatography (ERCP). The purpose of this descriptive project was to evaluate if levered endoscopes used in ERCP procedures met high level disinfection criteria, were properly processed, and were germ free after reprocessing. The project was supported by 2 theories: the middle range theory of patient advocacy and the germ theory. Data (counts and …

Small Business Marketing Strategies For Physical Therapy Practice Owners, Matthew Lane Daugherty

Walden Dissertations and Doctoral Studies

The United States economy depends on small businesses, which represent 99% of all businesses in the United States, yet approximately 50% of small businesses cease operations in the first 5 years. The purpose of this multiple case study was to explore the marketing strategies used by owners of small businesses to develop and maintain their organization through the initial 5 years of business operation. The population included 5 physical therapy business owners in northeastern Florida who had sustained their business for a minimum of 5 years. The conceptual framework for this study was the brand equity model, and data were …

Exploring Disaster Preparedness For The Aging Population, Gladysmarie W.R. Harris

Walden Dissertations and Doctoral Studies

Older adults are encountering harsh recovery after disasters, and compounding this problem is the lack of research on older adults' perceptions on disaster preparedness as aging affects the ability to react to emergency situations. To partially address that gap, the purpose of this general qualitative research study was to use Rotter's spectrum of locus of control theory to examine the level of preparation regarding disaster preparation of older adults who were living independently in single-family homes in a state affected by Hurricane Sandy. Data were collected through a qualitative survey distributed to adults aged 65 to 80-years (N=88) and publicly …

Predictors Of Nutritional Counseling Among Adolescents By Physicians In California, Jean Kigozi

Walden Dissertations and Doctoral Studies

The prevalence of obesity in the United States was stable at 17% from 2011-2014 among approximately 13 million children and adolescents 12-19 years of age, according to the Centers for Disease Control and Prevention. Nutritional counseling has been recommended, and while most physicians agree that it is necessary, it is not happening consistently. The purpose of this study was to examine the association between dietary intake, physical activity, and body mass index (BMI) characteristics of youth 12-17 years old in California and the receipt of nutritional counseling. Social cognitive theory guided this quantitative cross-sectional analysis of archived data from 814 …

Stress Reduction Strategies For Improving Private Security Officer Performance, Khalil Ibrahim Al-Mulla

Walden Dissertations and Doctoral Studies

The impact of occupational stress on employees' health and work performance costs U.S. companies $300 billion annually; work-related stress is an issue for private security organizations all over the world. The purpose of this single case study was to explore strategies private security organizational leaders used to mitigate private security officers' occupational stress. The study participants were 4 leaders of a private security organization in Bahrain who had a minimum of 5 years of experience in the private security field and had addressed occupational stress successfully. The human capital theory was the conceptual framework used for this study. Data were …

Cesarean Births Rates After Implementation Of Labor Management Guidelines, Margie Allyn Bridges

Walden Dissertations and Doctoral Studies

Cesarean birth rates are associated with increased maternal morbidity. This project evaluated a quality improvement (QI) initiative implemented to reduce cesarean births among Nulliparous Term Singleton Vertex (NTSV) obstetric populations, the largest contributor to cesarean births. Variations in labor management practice contribute to cesarean birth rate; implementation of labor management bundles have been endorsed to influence practice- and system-level changes in the promotion of vaginal births. The problem addressed in this project was an organizational NTSV cesarean section rate of 30%. The purpose of the project was to use secondary data to evaluate a previously implemented labor management bundle at …

Examining Trauma Exposure, Organizational Climate, And Job Outcomes In Child Welfare, Shano Rodgers

Walden Dissertations and Doctoral Studies

Exposure to traumatic situations is routine for child welfare workers in California, and the attrition rate for newly hired social workers in some states is estimated to be nearly 50% in the 1st year of employment. Prior research has indicated that reasons for dissatisfaction included dysfunctional organizational climate and culture. The purpose of this study was to examine the extent to which trauma exposure contributed to secondary traumatic stress and intent to quit and to examine the degree to which organizational climate moderated the exposure among direct service child welfare employees. Kurt Lewin's field theory, Figley's theory of secondary traumatic …

A Structured Weight Loss Program To Combat Obesity In Women, Tara English

Walden Dissertations and Doctoral Studies

Rates of obesity and the associated comorbidities continue to increase for women in the United States. Despite information available, efforts at weight loss are often unsuccessful because women lack integral knowledge of how to approach the various components essential for weight loss. This doctoral project was created to address the practice question of whether obesity can be reduced through a step-wise weight loss program that identifies essential elements to reduce weight in menopausal age women. Guided by the information-motivation-behavioral skills model, this project led 17 volunteer participants from a Northwest, Florida primary care clinic through 6 weeks of protocols supplemented …

Using Diabetes Self-Management Education To Enhance Adolescent Transition, Jessica Adkins

Walden Dissertations and Doctoral Studies

Type 1 diabetes is a long-term diagnosis, the prognosis of which is directly related to the patient's ability to self-manage the disorder. Adolescents are not currently taught how to manage diabetes; instead, parents and educators expect self-management to be more of a learned behavior from their parents. The purpose of this project was to create a quality improvement plan which the regional pediatric diabetes center study site could implement to improve adolescent glycemic control. Orem's self-care theory was used as theoretical framework for the design and evaluation of the project. The practice-focused question for this doctoral project was: Can a …

Association Between Adaptive Sports Programs And Quality Of Life Among Amputee Veterans, Sean V. Seay

Walden Dissertations and Doctoral Studies

Adaptive sports programs (ASPs) are important for enhancing the physical, psychological, and social aspects of life for amputee combat veterans while reducing the risk of depression and anger. Although the role of ASPs in improving quality of life (QoL) has been researched in relation to amputee combat veterans of World War II, the Korean War, and the Vietnam War, there has been limited examination of the role of ASPs in improving QoL among veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation Noble Eagle (OND). Therefore, the purpose of this study was to assess the effects of …

Black Individuals' Lived Experiences With Racial Microaggressions And Implications In Counseling, Letitia V. Browne-James

Walden Dissertations and Doctoral Studies

The problem of racial microaggressions in the United States has important implications for counseling due to the mental and physical health concerns individuals who experience them may develop. Although the current literature addresses racial microaggressions among Black individuals and implications for counseling, no qualitative studies that included the voices of Black individuals using relational cultural theory were found. Therefore, the purpose of this study was to explore the lived experiences of Black individuals who have encountered racial microaggressions and learn their perspectives on what counselors can do to help them in counseling. Adding this perspective will help fill this gap …

The Relationship Of Location And Educational Achievements To Vision Impairment In Asians, Sonali Trivedi

Walden Dissertations and Doctoral Studies

Introduction: Increasing incidence of vision impairment in the United States reinforces the urgent need for research and public health awareness. Eye diseases are of common concern in Asian and other ethnic groups globally. Glaucoma, cataracts, macular degeneration, myopia, and retinitis are types of eye diseases and common causes of vision impairment in Asians. This study addressed the current gap in knowledge regarding vision impairment prevalence among Asian-Americans by geographical location and level of education. Socio-ecological theory was used as the theoretical foundation.

Method: A cross-sectional secondary dataset from U.S. Census Bureau included 3,916,947 participants' survey responses from 2011 through 2015 …

Congregational Health Promotion By African American Female Pastors In The Christian Faith, Arlene Obazee

Walden Dissertations and Doctoral Studies

Health disparities have mostly affected African Americans who are poor, uninsured, under insured and unemployed. This population of African Americans seek spiritual solace and social counseling from their pastors, and church-based health promotion (CBHP) offers the opportunity to reach millions of the U. S. Black population. The lack of studies on female African American pastors implementing congregational health promotion activities influenced this study. This qualitative study helped in understanding the experiences, perspectives, and influences of 13 female African American Christian pastors on health-related issues within their congregation. Feminist theory and CBHP model guided this qualitative case study. Open-ended interview questions, …

Emergency Room Nurse Perceptions Of Emotional Intelligence, Ingrid Astralaga

Walden Dissertations and Doctoral Studies

The delivery of quality care has been a priority for the health care industry in the United States. Researchers have established positive correlations between the levels of emotional intelligence of registered nurses and their clinical performances. However, new evidence suggests the need to enhance the use of emotional intelligence (EI) in high-risk clinical units. With the intent to understand the use of EI, a phenomenological research approach was used to identify the emergency room nurse's understanding of EI. The Four-branch Model of Emotional Intelligence was used as the theoretical framework, while the research question identified the emergency room nurse's perception …

Staff Educational Program To Prevent Medication Errors, Rita Chinyere Hawthorne-Kanife

Walden Dissertations and Doctoral Studies

Medication administration errors (MAEs) may lead to adverse drug events, patient morbidity, prolonged hospital stays, and increased readmission rates, and may contribute to major financial losses for the health system. MAEs are the most common type of error occurring within the health care setting leading to an estimated 7,000 patient deaths every year. Interventions have been designed to prevent MAEs including education for nurses who administer medications; however, little effort has been made to design systematic educational programs that are based on local needs and contexts. The purpose of this project was to identify internal and external factors related to …