Medicine and Health Sciences Commons^™

Standardized Communication At The Bedside: A Review For Reimplementation, Eunice Rosas

Walden Dissertations and Doctoral Studies

This paper discusses a developmental, interdisciplinary quality improvement project that seeks to improve healthcare communication by standardizing clinician communication across all levels of care. The purpose of this project was to develop an organizational policy and interdisciplinary practice guidelines to standardize the patient handoff at the bedside. The initiative intended to use processes already in place in the organization and to integrate the knowledge from a literature review to plan the implementation of bedside handoff procedures. The quality improvement project process included assembling an interdisciplinary committee; reviewing relevant peer-reviewed literature; and developing policy, relevant guidelines, as well as long-term plans …

Beyond Breastfeeding: Exploring The Influence Of Maternal Control Over Child Health Behavior Among African American Women Infants And Children Nutritional Supplementation Program Participants, Maria Wilson

Walden Dissertations and Doctoral Studies

The health benefits of breastfeeding exceed well beyond the first few years of an infant's life. Breast milk is often referred to as liquid gold because of its extensive protective properties that promote child growth and development. Unfortunately, African American women have the lowest breastfeeding rates compared to any other racial group. Given that African American children are disproportionately affected by the current obesity epidemic in the United States, there may be a link between a mother's preference to breastfeed her infant and her influence over her child's eating behaviors and physical activity levels. Guided by social cognitive theory, the …

Professionals' Perspective On Mental Health Courts, Martha M. Amos

Walden Dissertations and Doctoral Studies

In recent years, the percentage of incarcerated individuals with mental illness has dramatically increased. It is very hard to provide treatment and care for these defendants in jails or prisons. Currently, there are more mentally ill individuals incarcerated than in psychiatric hospitals. Furthermore, as budget cuts are being decided, urban and rural communities in America are looking at ways to help the mentally ill by initiating a mental health court (MHC) or continuing to fund an already existing MHC. Guided by the therapeutic jurisprudence theory, the purpose of this study was to elicit the opinions from MHC professionals regarding the …

Impact Of Training On Kin Caregivers' Use Of Discipline Practices, Bertha Ansley

Walden Dissertations and Doctoral Studies

Research has shown that child abuse is a serious public health issue that may warrant child welfare agency intervention and removal of children from their homes. Placement with kin caregivers is considered the least restrictive placement option by social workers. It has been recognized that kin caregivers require some type of formal parental training to prepare them to care for relative children. A large city implemented the Caring for Our Own training program as prelicensing training to prepare relatives for roles as kin caregivers. Prior to this study, no research had assessed whether this training program adequately addressed caregivers' ability …

Development Of A Transformational, Relationship-Based Charge Nurse Program, Kimetha D. Broussard

Walden Dissertations and Doctoral Studies

Leaders of a rural Southwest Oklahoma hospital requested the development of an evidence-based program that could transform unit charge nurses into effective leaders in order to improve the leadership of direct care nurses. Nursing executive leadership discovered staff members were demonstrating high levels of stress, dissatisfaction, and burnout. Press-Ganey survey results revealed that staff felt they were not supported and did not believe nurses cared for patients' or other co-workers' well-being or safety. The Hospital Consumer Assessment of Healthcare Providers and Systems outcome scores, which were below hospital and national desired benchmarks, revealed that patients were not satisfied with the …

A Nursing-Driven Pathway To Lung Cancer Screening; A Push For Prevention, Teresa Elizabeth Giamboy

Walden Dissertations and Doctoral Studies

Lung cancer affects many individuals each year and accounts for many deaths around the globe. Lung cancer screening is a preventative health measure that has the ability to detect lung cancer earlier. The purpose of this project was to focus on the education of nursing staff within a community health system, with subsequent implementation of an electronic health record clinical decision support system, to create a direct referral pathway to lung cancer screening, delivered through patient education. The concept of prevention was the framework for this project design, which was further organized around the plan-do-study -act model, while taking into …

Evaluation Of The Safety Of Mri Scanning Of Patients With Mr Conditional Pacemakers, Shelly Lynn Mcgurk

Walden Dissertations and Doctoral Studies

Magnetic resonance imaging (MRI) of patients with cardiac implantable electronic devices (CIED) has been associated with risks such as device/lead movement, device dysfunction, and lead heating. New technological advancements have made it possible for MRI to be safely performed when adhering to an evidence-based protocol; however, this practice has not yet been widely adopted. The purpose of this practice-focused question project was to examine the safety of MRI as a diagnostic modality for the aggregate population of adult patients with MR conditional pacemakers when a nurse-practitioner-led, evidence-based protocol was used. The Iowa model served as the guide for implementation of …

Nursing Staff Responsiveness To Patients And Hourly Rounding, Lucretia Wilson Wilson

Walden Dissertations and Doctoral Studies

The Center for Medicare/Medicaid Services reduced the hospital's reimbursement by $500,000 due to patient care linked to the poor outcomes of marginal fall rates and low patient satisfaction survey scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The scores for fiscal years 2013 and 2014 for the medical-surgical unit fluctuated between 40-42.9%, without significant improvement, while the house-wide scores were 63.17%. To address the problem, a quality improvement project (QIP) was implemented. An evidence-based (EB) hourly rounding intervention was initiated following an education program for nursing staff (n=47) tailored to enrich patient communication. The …

Influence Of Media Messages On Obesity And Health Perceptions Among African American Women, Carolyn Grant

Walden Dissertations and Doctoral Studies

African American women have the highest prevalence of overweight and obesity in the United States, thus increasing their risks for chronic diseases. Their understanding of their health status and response to it could be triggered by messages in the media, yet few researchers have examined this topic with African American women. The purpose of this phenomenological study was to explore how advertisement and editorial content in media contributed to perceptions African American women have about overweight and obesity. Following the theoretical foundation of the social cognitive theory, the research questions explored what messages study participants encountered and which messages prompted …

Care Coordination For Better Outcomes, Chad Dunavan

Walden Dissertations and Doctoral Studies

A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated …

Association Between Physician Characteristics And Surgical Errors In U.S. Hospitals, Obumneke A. Amadi

Walden Dissertations and Doctoral Studies

The high incidence of medical and surgical errors in U.S. hospitals and clinics affects patients' safety. Not enough is known about the relationship between physician characteristics and medical error rates. The purpose of this quantitative correlational study was to examine the relationship between selected physician characteristics and surgical errors in U.S. hospitals. The ecological model was used to understand personal and systemic factors that might be related to the incidence of surgical errors. Archived data from the National Practitioner Data Bank database of physician surgical errors were analyzed using bivariate and multivariate logistic regression analyses. Independent variables included physicians' home …

Using Music Intervention To Reduce Anxiety And Agitation For Dementia Residents In Long Term Setting, Sonia Brown

Walden Dissertations and Doctoral Studies

Abstract

Dementia is one of the degenerative conditions that present in old age with a decline in cognitive function resulting in changes in personality and the ability to carry out activities of daily living and social functions. Dementia is usually associated with behavioral disturbances that include anxiety and agitation that pose a challenge for family members or caregivers in an alternate home or care-related facility. The purpose of this project was to design and implement a quality improvement program to evaluate music therapy intervention for residents in a long-term care who have dementia. The aim was to evaluate if music …

Introducing The Health Coach Method Of Motivational Interviewing To Medical Assistants To Improve The Patient Care Approach, Allison Marlene Souza

Walden Dissertations and Doctoral Studies

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into …

Spiritual Leadership: Achieving Positive Health Outcomes In African-American Christian Churches, Cynthia Bracey

Walden Dissertations and Doctoral Studies

In the United States, African-American residents are an underserved population with evidence of higher health disparities than those associated with any other race, contributing to escalating health care costs. Despite the absence of health promotion and wellness training, pastors in predominately Black churches accept the responsibility for addressing more than the spiritual needs of their church members. The purpose of this qualitative grounded theory research study was to explore the perspectives of African-American Christian pastors on giving health guidance and their lived experiences as health promotion advocates. A total of 10 African-American Christian pastors were voluntarily recruited from 3 southern …

The Effects Of Hurricane And Tornado Disasters On Pregnancy Outcomes, Kenneth E. Christopher

Walden Dissertations and Doctoral Studies

Maternal prenatal exposure to hurricanes and tornadoes could contribute to an increased risk for adverse birth outcomes. Little is known about the effects of Hurricane Katrina of August 2005, on pregnancy outcomes in Mississippi. Additionally, little is known about the influence of the April 2011 Alabama tornado disaster on births in that state. The purpose of this study was to bridge this knowledge gap by examining the relationship between maternal prenatal exposure to these storms and adverse infant health outcomes. The theoretical framework guiding this retrospective, cross-sectional study was the life course approach. Data for this investigation included 2,000 records …

A Minority Perspective On The Public Health Response To The Obesity Epidemic, Rickey L. Ford

Walden Dissertations and Doctoral Studies

Obesity is currently viewed as one of the most important health concerns in the United States. Researchers have minimally investigated perspectives surrounding obesity within the African-American female population. This lack of research presented a gap in knowledge concerning the perceived social, environmental, and cultural influences of obesity within this population. The research questions asked African-American females about their views toward these influences. This research was guided by tenets of the social cognitive theory and the transtheoretical model for behavioral change. Thirteen African-American females participated in the interviews. The data collected were reviewed and coded using word frequencies and themes. Findings …

Association Between Age-Related Macular Degeneration And Sleep-Disordered Breathing, Jeffrey A. Nau

Walden Dissertations and Doctoral Studies

Age-related macular degeneration (AMD) is a chronic, irreversible disease that robs individuals of vision, quality of life, and independence. It is the leading cause of blindness in industrialized countries. Sleep-disordered breathing (SDB) is a condition characterized by repeated episodes of apnea and/or hypopnea, insomnia, short sleep duration, and/or sleep disturbances (snoring, gasping, etc.). Because SDB has been shown to cause chronic hypoxia resulting in oxidative stress on the retina, it has been proposed that SDB may be associated with AMD. Based on the life course theory of chronic disease, this quantitative, cross-sectional study used data from the 2005-2008 National Health …

Exploring The Role Of Faith In Survival Of Breast Cancer, Franklin D. Lewis, Jr.

Walden Dissertations and Doctoral Studies

In 2013, approximately 232,340 women were diagnosed with breast cancer, and an estimated 39,620 women would die as a result of breast cancer. Stage I breast cancer can often be treated, but Stage IV breast cancer presents more difficulties in treatment, as it spreads to the bones, liver, or other areas of the body. Consequently, women with Stage IV breast cancer have very low 18 month and 5-year survival rates. According to some statistics, 79.5% of the United States population claim to be Christian. Much of this segment of the population uses faith to guide most aspects of their lives, …

Implementation Of An Early Progressive Mobility Program In The Intensive Care Units, Rene Merced Rodriguez

Walden Dissertations and Doctoral Studies

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk …

Identifying Stressors Experienced By Single Fathers Who Are Parenting In New York City, Stacey Theresa Melhado

Walden Dissertations and Doctoral Studies

Fathers face difficulties when taking on the single parent role, including having to prove their ability to care for their children alone. Existing research does not address issues concerning single fathers and the stressors they experience in raising their children. This study addresses these issues and helps researchers understand single fathers by using a qualitative approach to understand their perception of parenting. Fourteen participants from New York City participated in semi-structured interviews to elicit information about this phenomenon. This study focused on experiences the men have while being a single parent, the impact of living in New York City on …

Perceptions Of Childhood Obesity Among African Americans In A Low-Income Community, Cotella Wilkes Wilkes

Walden Dissertations and Doctoral Studies

Childhood obesity is a prevalent chronic condition affecting millions of children and adolescents in the United States and is rising in record-breaking numbers among African Americans in low-income communities. Guided by the social cognitive theory, the purpose of this evidence-based project was to understand the impact of an educational intervention on parents' perceptions of childhood obesity risk factors, weight status, and prevention strategies in a rural South Carolina community. A convenience sample of parents who attended a church-based community health promotion service in a low-income area (n = 10), aged 28 to 54, completed The Childhood Obesity Perceptions survey before …

A Guide To Common Skin Disorders While Pregnant, Debra Henline Sullivan, Virginia Sullivan

Walden Faculty and Staff Publications

During pregnancy, mothers strive to maintain good health and to promote the health of their babies. Having a chronic or acute skin condition during pregnancy could cause fear that treating these conditions could cause harm to their unborn child (American Academy of Dermatology [AAD], 2016). Women will need and seek guidance before and during their pregnancies as well as during lactation, when skin disorders affect them. The childbirth educator would benefit from a basic knowledge base to answer questions that may arise regarding various skin problems during the childbirth experience. This article will define and discuss treatment for some of …

Relationship Between Assisted Reproductive Technology And Risk Of Stillbirth, Jeani Chang

Walden Dissertations and Doctoral Studies

Assisted reproductive technology (ART) is an infertility treatment used to assist women to become pregnant. Although the procedure is safe, there are gaps in understanding the association between treatment and adverse pregnancy outcomes (e.g., stillbirth) in the United States. The purpose of this study was to investigate the relationship between stillbirth delivery and ART. The 2 research questions addressed the association between methods of conception (ART versus non-ART) and the delivery of a stillbirth, and the association between multiple gestation pregnancy and risk of stillbirths. Retrospective cohort data from the States Monitoring ART collaborative were analyzed using Pearson's chi squared …

Attitudes And Perceptions Of Mental Health Treatment For Native American Clients, Beverly Elaine Johnson

Walden Dissertations and Doctoral Studies

The need for mental health service is increasing in American Indian/Alaska Native (AI/AN) communities. While research has examined the availability, access, and effectiveness of provided services to the AI/AN, very little is known about the influence of the attitude and perceptions of both clinicians and clients in their therapeutic relationship in the treatment process. Using the frameworks of liberation, oppression, and trauma theory, this qualitative phenomenological study explored mental health service delivery and utilization issues within an AI/AN community. Data were collected through semistructured interviews with 14 clinician and client participants. The data were sorted into themes and subthemes and …

Low Health Literacy And Preoperative Instruction Compliance Among Patients Undergoing Surgical Procedures, Mariefel Casino Paqueo

Walden Dissertations and Doctoral Studies

In addition to cancelations and delays of needed surgical procedures, serious or fatal complications can occur when patients with low health literacy do not comply with preoperative instructions. The purpose of this quality improvement project was to provide more insight about ways to decrease on cancelled and delayed surgical procedures in low health literacy patients' due to noncompliance with preoperative fasting instructions. The project was informed by the reach, effectiveness, adoption, implementation, and maintenance model (King, D. K., Glasgow, R. E., and Leeman-Castillo, B. (2010). The project question centered on whether health literate preoperative fasting instructions could decrease cancellations and …

The Association Between Dietary Flavonoid Intake And Chronic Obstructive Pulmonary Disease, Systemic Inflammation, And Comorbidity Burden, Tennador Sanderson

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. Dietary habits may have an impact on COPD through anti-inflammatory mechanisms. For this cross-sectional secondary data analysis study, the advanced model of the epidemiology triangle was used as a guide to assess the association between total daily flavonoid intake and COPD diagnosis, COPD severity, systemic inflammation, and comorbidity burden. Data from over 5,100 male and female participants aged 30 and older were obtained from the 2007-2010 National Health and Nutrition Examination Survey. The prevalence of COPD was 5.2% according to spirometry data. Multiple …

Using Nursing Simulation To Improve Early Recognition Of Emergent Situations, Carlene Blais

Walden Dissertations and Doctoral Studies

Nurses' ability to recognize and respond to postoperative patients who require emergent medical care and need immediate assistance during a code blue in the first 10 minutes is essential to improve patient outcomes. This is particularly important for the project site, a 44-bed inpatient surgical specialty hospital located in the Northeast, providing care for patients with head and neck cancer, as the hospital does not have an internal code blue response team. An adjacent facility responds to all code blue emergencies and takes approximately 10 minutes for the team to respond. The purpose of this DNP project was to develop …

Rural Jail Administrators Perceptions Of Take-Home Naloxone To Control Opioid Overdoses, Jaclyn Woollett

Walden Dissertations and Doctoral Studies

Opioid overdoses and overdose deaths have increased significantly throughout the United States. Naloxone distribution has become a harm reduction strategy that has proven effective in reducing opioid overdoses in urban areas through drug treatment centers and needle exchange programs. However, limited research is available on the efficacy and feasibility of these programs in rural locations and other nontraditional settings. Guided by harm reduction theory, the purpose of this qualitative phenomenological study was to address this gap by exploring the feasibility of implementing a take home naloxone program in rural jails. Semistructured interviews were conducted with 6 jail administrators in rural …

The Role That Autism Parent-Led Support Groups Play In Facilitating Advocacy, Carlos Javier Carmona

Walden Dissertations and Doctoral Studies

In this study, autism parent-led support groups and the contribution these groups had in creating parental advocacy were studied. The primary purpose of the study was to determine if autism parent-led support groups promoted advocacy skills of parents of children with autism. The secondary purpose of the study was to evaluate the level and extent of support provided by parent-led support groups. The qualitative data collection was done through individual interviews of parents of children with autism whose children were of any age. Through data analysis 6 major themes were identified: advocacy, emotional support, difficulty with funding, informational support, instrumental …

Breast Cancer, Mana'olana/Hope, And The Experience Of Native Hawaiian Women, Karla Marie Calumet

Walden Dissertations and Doctoral Studies

Breast cancer is one of the leading causes of morbidity and mortality among women. A diagnosis of cancer is a stressful event that requires an individual to adapt to new stressors. The purpose of this qualitative study was to better understand the perceptions of mana'olana/hope and living with breast cancer among Native Hawaiian women. The conceptual framework of this phenomenological study was positive psychology. Data collection included in-depth interviews with 5 Native Hawaiian women who had been diagnosed with breast cancer. Data coding and analysis resulted in identification of 8 themes.

The themes included: (a) mana'olana /hope is the essence …