Medicine and Health Sciences Commons^™

Polypharmacy, The Electronic Medical Record, And Adverse Drug Events, Unyime Eyoh

Walden Dissertations and Doctoral Studies

Polypharmacy, a concurrent chronic use of multiple prescribed and over-the-counter medications by the same individual, is one of the clinical problems facing primary care providers. Polypharmacy creates the potential for adverse drug-related events, especially in the elderly. The advent of electronic medical records (EMR) may help identify and respond to these potential adverse events. The purpose of this project was to investigate the relationship between the total number of medication taken by elderly, 65 years and older, and the severity of drug-drug and drug-disease interactions triggered by the EMR system. The study used a retrospective chart review of the EMRs. …

An Ecological Perspective On Pertussis, Jody Ruth Goard

Walden Dissertations and Doctoral Studies

In 2012, 48,277 cases of pertussis were diagnosed in the United States. Pertussis, otherwise known as whooping cough, is a highly contagious, often debilitating, sometimes deadly, vaccine-preventable disease with an increasing incidence and death rate in the U.S, which may be due to vaccine exemptions. The purpose of this project was to determine if a relationship exists between immunization policies and immunization exemption rates, immunization exemption rates and pertussis rates, and immunization policies and pertussis rates in each state. Bronfenbrenner's bio-ecological framework was used to guide the project. Publically available data from the Centers for Disease Control and Prevention (CDC), …

Preventing Urinary Tract Infections In The Acute Care Setting, Charlotte Evette Philyaw

Walden Dissertations and Doctoral Studies

More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate …

A Needs Assessment Of African American Women's Risk For Cardiovascular Disease, Chikaodi Priscilla Eziaha Banor

Walden Dissertations and Doctoral Studies

Suboptimal cardiovascular health among African American (AA) women contributes to high costs of care related to acute illness, chronic illness, and disability. Using the health promotion model, this needs assessment project examined risk factors that predispose adult AA women between the ages of 21 to 64 years of age to higher incidence of cardiovascular disease (CVD). Seventy of the 300 charts that met the inclusion criteria (female AA patients, 21 to 64 years of age, receiving care in a community clinic in an urban city of Texas) were audited for this project. Descriptive analysis showed that 66% of the women …

Prolonged Exposure To Non-School Related Media Use And Violence Among Urban Youth, Cindy Davis

Walden Dissertations and Doctoral Studies

Youth violence is a pervasive and ongoing public health concern. Based on the paradigm of resilience, the purpose of this quantitative study was to test the relationship between prolonged (3 or more hours) of non-school related media use and youth violence. Secondary data from the Centers for Disease Control and Prevention (CDC) were utilized for this study. Logistic and multiple regression models were used to test whether exposure to prolonged non-school related media (video games and TV) use was associated with violent behavior, and whether there was a relationship between prolonged exposure to non-school related media use and electronic bullying …

A Multisite Hospital's Transition To An Interoperable Electronic Health Records System, Valerie Gerene Drill

Walden Dissertations and Doctoral Studies

The health care industry is transforming into an industry that requires health information technology, yet many health care organizations are reluctant to implement new technology. The purpose of this case study was to explore strategies that led to a successful transition from an older electronic health record (EHR) system to a compliant EHR system at a multisite hospital system (MHS). The study included face-to-face and phone interviews with 12 managers who worked on the transition of an MHS's EHR system in the Pacific Northwest region of the United States. The technology acceptance model was used to frame the study. Audio …

The Effect Of Dietary Fruits & Vegetable Consumption And Physical Activity On Obesity In African American Adolescent Females., Tanisha Brooks

Walden Dissertations and Doctoral Studies

Obesity is epidemic among Black adolescent females, and adolescent obesity often leads to adult obesity. Previous research suggests that there may be an interaction between physical activity and dietary fruit and vegetable intake on body mass index (BMI) in obese adolescent females in general, but it was unclear whether the same pattern is evident in Black adolescent females, who, on average, tend to have low levels of physical activity and fruit and vegetable intake. Bandura's social learning theory implies the possibility that adolescent females might model their behaviors on the behavior of others in their high school years, including physical …

Diminishing Stigma Sentiments In Individuals With Depression: Sociopsychological Predictors Of Deflecting And Challenging Coping Orientations, Jennifer Marie Lee

Walden Dissertations and Doctoral Studies

Individuals who suffer from depression can be stigmatized by labeling and resort to negative stigma coping orientations such as secrecy and withdrawal, resulting in internalized self-stigma. Self-stigma can have negative effects such as low self-esteem, low self-efficacy, isolation, and feeling like a failure. Guided by modified labeling theory, the purpose of this study was to fill a gap in the literature on predictors of two orientations (challenging and deflecting) of positive stigma coping. Challenging stigma involves taking action, and deflecting is a cognitive strategy; both are used to positively cope with the stigma of mental illness. Predictors included symptom severity, …

Low-Income African American Parents' Perception And Influence On Childhood Obesity, Vickie Sims-Johnson

Walden Dissertations and Doctoral Studies

Childhood obesity affects children from every socioeconomic level, but there is a higher prevalence of obesity among preschool-age children from low-income families. Some obese children are experiencing symptoms (e.g., high cholesterol and diabetes) generally experienced by adults. As a result, healthcare costs have increased. The purpose of this qualitative phenomenological study was to understand how low-income African American parents contribute to the prevalence of obesity in preschoolers. The conceptual framework and constructs from the health belief model (HBM) guided this study. Interview data were gathered from 8 participants who met the inclusion criteria of being a low-income African American parent …

The Transition-To-Practice Gap And Graduate Nurse Proficiency, Maxine Coleman

Walden Dissertations and Doctoral Studies

After nursing school, graduate nurses complete a licensure examination to demonstrate possession of the minimal knowledge necessary to practice nursing. Even with the successful completion of the examination, many new graduate nurses still lack the competencies required for safe practice. This discrepancy between demonstrated knowledge and competent practice, which is termed a transition-to-practice gap, is a safety issue especially for persons with chronic illnesses. The purpose of this study was to identify and clarify this transition gap to determine possible solutions in the local setting of a large health care system. The theoretical model framing this investigation was Benner's novice …

The Effect Of Media Literacy Training On The Self-Esteem And Body-Satisfaction Among Fifth Grade Girls, Holly Mathews

Walden Dissertations and Doctoral Studies

Repeated exposure to media images that portray women as sex objects can have negative long-term effects on self-esteem beginning in preadolescence. Negative effects include decreased feelings of competence, increased focus on appearance, increased body dissatisfaction, and limited achievement in domains not related to appearance. There is a gap in the literature examining if media literacy training can mitigate the negative effects of exposure to sexualized media content. Festinger's social comparison theory and Vygotsky's theory of cognitive development provided the framework for this study. A quasi-experimental pre-post-test design was used to examine the interaction of media literacy training and time of …

Maternal Characteristics And Childhood Immunization Series Completion Rates Among Children 2-Years-Old, Merlene Ramnon

Walden Dissertations and Doctoral Studies

Delays in childhood immunization may have adverse health implications. In the United States, childhood immunization among children who are below 3 years of age continues to be below Healthy People 2020 targets for some vaccines such as DTaP, PCV, HIB, Hep A, Rotavirus, and Hep B birth dose. The purpose of this study was to examine the association between maternal characteristics and childhood immunization series completion rates among children 2 years of age. The social learning theory and self-efficacy theory provided the theoretical foundation for the study. Data from the Florida Department of Health Immunization Surveys were used. ANOVA and …

Creating A Safe Newborn Environment Education Program For Postpartum Registered Nurses, Melanie Myers

Walden Dissertations and Doctoral Studies

In the United States, sudden infant death syndrome (SIDS) is the 3rd leading cause of death for infants; other unintentional sleep injuries are the 5th. In addition, the estimated newborn fall rate in the United States is 1.6 to 6.6 falls/10,000 live births. At the project facility, postpartum registered nurses observed parents engaging in behavior that did not contribute to a safe newborn environment such as placing the infant at risk for injury from a fall or from a sleep injury. This observation led to this current project, which examined the development of an educational program for post-partum nurses to …

Education Program For Nurses Working In An Immigration Detention Facility, Dr. Tiney Elizabeth Ray

Walden Dissertations and Doctoral Studies

Nursing response to medical emergencies has been an ongoing issue in immigration detention centers. Lack of teamwork and poor communication with medical and security staff have resulted in detainees sustaining injuries during medical emergencies. This project was developed to persuade Immigration and Customs Enforcement Health Service Corps (IHSC) leaders to consider piloting the TeamSTEPPS emergency response curriculum for nurses working in the immigration detention center. Tuckman and Jensen's model of group development will provide guidance to IHSC leaders in understanding the transformational stages of forming a successful team. TeamSTEPPS will address gaps in emergency health care competency by improving collaboration, …

Nurse Education And The Reduction Of Nosocomial Infections In Acute Care Settings, Charmaine Amoy Byrd

Walden Dissertations and Doctoral Studies

Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of …

Relationship Between Workplace Aggression And Employee Job Satisfaction, Tashua Lashun Grizzle

Walden Dissertations and Doctoral Studies

Workplace aggression incidents are increasing and, thus, becoming more difficult to address in the United States. Health care workers in particular are at an increased risk of burnout compared to individuals working in other occupations. The purpose of this quantitative correlational study was to investigate the propensity for workplace aggression among health care professionals and the association between job satisfaction and the propensity for workplace aggression. The conservation of resources theory was used to frame the study. The Work Environment Scale and the Conditional Reasoning Test of Aggression were used to collect data from 89 mental health clinicians, nurses, and …

An Evidence-Based Asthma Management Plan For The Pediatric Practice Setting, Foroogh Narmani-Mohammadi

Walden Dissertations and Doctoral Studies

Asthma is the most common chronic disease in childhood. Education directed toward asthma self-management is vital and emphasizes patient participation in symptom monitoring and control. The practice problem addressed in this quality improvement project was the lack of an asthma management plan in the pediatric setting for which the project was developed. The purpose of the project was to develop an evidence-based asthma initiative consisting of a staff education curriculum with a pretest/posttest and a patient self-management component. Using a team approach, Rosswurm and Larrabee's conceptual model served as the practice framework to guide the development of the project. Two …

Improving Colorectal Cancer Screening In Primary Care, Jenerie Reniedo Navarrete-Pak

Walden Dissertations and Doctoral Studies

Despite indications that colorectal cancer (CRC) screening strategies can decrease mortality and morbidity, screening rates among veterans remains to be low. In the Veterans Affairs (VA), the performance measure for CRC screening is lower than the national standard. This quality improvement (QI) project evaluated the effect of a team-based approach, effective electronic information structures, and the provision of education to nurses and patients in increasing CRC screening rate in primary care from 77% to 85%. CRC screening data were retrospectively collected prior to the start of the project and then compared to screening data 3 months after project implementation. The …

Strategies To Mitigate Nurse Turnover In Eastern And Northern Virginia, Fred E. Echoles

Walden Dissertations and Doctoral Studies

Registered nurses leaving the workplace are estimated to cost healthcare organizations and society between $1.4 and $2.1 billion annually. The purpose of this multiple case study was to explore what strategies leaders of healthcare organizations from the Eastern and Northern regions of Virginia can use to mitigate the effects of nurse turnover and its cost to the organization. The target population consisted of 8 RNs who experienced turnover during their nursing careers. The conceptual framework for this study was Herzberg's dual-factor theory. Face-to-face semistructured interviews were conducted and publically available documents were garnered. Thematic reduction of participants' interviews, coupled with …

Impact Of Simulation On Nurses' Satisfaction, Confidence, And Communication In Neonatal Resuscitation, Kathryn Rudd

Walden Dissertations and Doctoral Studies

Teamwork and communication in clinical practice improves with simulation using the TeamSTEPPS program. However, there is limited research about simulation efficacy for improving neonatal resuscitation through enhanced communication. Based on a needs assessment and literature review specific to quality improvement strategies for neonatal resuscitation, an enhanced neonatal resuscitation provider (NRP) course was infused with TeamSTEPPS communication strategies, and an NRP case was adopted for simulation training. Also, utilizing clinician feedback, the flow of the resuscitation documentation was revised. The purpose of this project was to evaluate the perceived level of confidence, satisfaction, and communication skills in nurses performing neonatal resuscitation …

Development Of A Church-Based Educational Program To Increase Prostate Cancer Screening For Black Men 40 And Older, Dawn Marie Silvera-Ndure

Walden Dissertations and Doctoral Studies

Prostate cancer is the most common cancer among men in the United States and is one of the leading causes of cancer death among men of all races. However, African-American men are at particularly high risk. These men are diagnosed more often with prostate cancer, are diagnosed later, and are more than twice as likely to die from prostate cancer than are Caucasian men. A strategy to address this inequity was to develop a community based program that would reach this at risk population. The goal of the project was to develop an evidence-based, theory-supported education and referral program to …

Strategies For Increasing Employee Engagement In The Service Industry, Tonia Ann Walker

Walden Dissertations and Doctoral Studies

The annual loss to U.S. organizations consequential to a lack of employee engagement was approximately $300 billion in 2013. Employee engagement is vital to the business sustainability of an organization. The purpose of this qualitative single case study was to explore successful strategies that business leaders of a service organization used to increase employee engagement. The conceptual framework guiding this study was the behavior engineering model theory developed by Gilbert. A purposeful sample of 6 engineering managers was selected based on their success in creating strategies resulting in increased employee workplace engagement in a monopoly service organization in Connecticut. Semistructured …

Case Study Of Stakeholders' Views On Retention And Self-Efficacy In Texas Nursing Programs, Durcilla Kay Williams

Walden Dissertations and Doctoral Studies

Retention of students through the completion of the nursing degree is a problem that exists at local Texas nursing programs, adding to the nursing shortage at local Texas hospitals. The purpose of this qualitative research study was to identify the best practices used by a local Texas college with graduation rates above the benchmark of 85% set by the Texas Higher Education Coordinating Board. The study framework was based on Bandura's theory of self-efficacy and Tinto's theory of student retention. The research questions for the study focused on reasons the college maintained a high retention rate, best practices currently used, …

Evaluating The Implications Of Parental Mental Illness For Children Using An Ecological Perspective, Jessica Elizabeth-Rose Carroll

Walden Dissertations and Doctoral Studies

Researchers have extensively studied the experiences and potential consequences of being a child whose parent has a mental illness (COPMI). However, there is no consensus on the best way to support these children, in general or in schools. The purpose of this quantitative study was to examine the effects of parental mental illness on children by using an ecological approach. Researchers have used ecological theory to illustrate the importance of internal characteristics, skills, and supports for children to enhance resiliency. This study looked at whether COPMI differed significantly from the children of parents of parents with no current or past …

Teen Dating Violence: Co-Occurrence With Bullying Among African American Teens In South Florida, Rosemarie Hemmings

Walden Dissertations and Doctoral Studies

Teen dating violence and bullying are major public health concerns but are preventable. Both dating violence and bullying occur within similar social context and the prevalence of teen dating violence was highest for African American teens as reported on the 2011 Youth Risk Behavior Survey (YRBS). Social learning theory provides a foundation for understanding and changing behavior related to dating violence victimization and bully victimization. The research questions focused on relationships between bully and teen dating violence victimization when controlling for race/ethnicity, gender, substance abuse, age, and age of first sexual intercourse. Additionally, the potential mediating variable of spending time …

Development Of A Bedside Shift Report Policy And Guidelines To Assist Nurses With Patient Care, Cynthia Snedecor

Walden Dissertations and Doctoral Studies

In 2013, the Hospital Consumer Assessment of Healthcare Providers System (HCAHPS), a national, independent metric of patient satisfaction, revealed room for improvement at a teaching hospital in the southeastern section of the United States. This project reports the development and validation of a Bedside Shift Report (BSR) policy, practice guidelines, and associated documentation. Several initiatives, models, and theories informed thinking about this project. The work of Kurt Lewin and the Institute for Healthcare Improvement- Robert Wood Johnson Foundation's joint initiative, Transforming Care at the Bedside, both guided the project in terms of the process of institutional change. SBAR (Situation Background …

Behavioral Modification And Relapse Rates In Opioid-Dependent Pregnant Women Managed With Subutex, Tammy Lynn Minor

Walden Dissertations and Doctoral Studies

Behavioral Modification and Relapse Rates in

Opioid-Dependent Pregnant Women Managed with Subutex

by

Tammy Minor

MSN, Walden University, 2009

BSN, Marshall University, 1986

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

March 2016

Opioid dependency affects not only the individual who is dependent on opioids but negatively impactsalso the family unit, the community, and society as a whole. Opioid use in the prenatal period can have devastating effects on both the mother and the fetus. The purpose of this paper is to perform a secondary analysis of the effectiveness of …

Improving Nurses' Knowledge Of Stroke, James Trone Mcdaniel

Walden Dissertations and Doctoral Studies

Stroke is a devastating disease. Stroke care has advanced greatly in the past 20 years with innovations in radiologic imaging, development of tissue plasminogen activator (tPA), organized systems of care, telestroke, and best practice guidelines via Get with the Guidelines Stroke (GWTGS). However, stroke remains the 5th leading cause of death in the United States. To provide current and quality care for stroke patients, nurses need ongoing stroke education. Additionally, stroke centers must provide a sustainable stoke education program to their nurses to keep their knowledge current. Guided by Rosswurm and Larrabee's model, this quality improvement project addressed whether an …

Systematic Review: Barriers That Prevent Compliance With Hydroxyurea In Sickle Cell Disease, Uchechukwu Imegi

Walden Dissertations and Doctoral Studies

Sickle cell disease (SCD) is a blood disorder that is inherited from both parents and affects millions of people globally. The symptoms of SCD may be debilitating and pose a significant challenge to nursing care. Hydroxyurea (HU), the Food and Drug Administration (FDA) approved treatment for SCD in adults is reportedly effective, but its usage is still minimal among adolescents with SCD. The purpose of this systematic review was to evaluate existing literature on the barriers to HU use in adolescents with SCD. The Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scales guided this study. An extensive electronic search of …

The Impact Of The Sentinel Initiative And Faers Surveillance System On Consumer Safety, Sonia Batra

Walden Dissertations and Doctoral Studies

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews …