Medicine and Health Sciences Commons^™

Obesity Among Women In Rural Kenya: Knowledge, Beliefs, And Perceptions., Ann Mugo

Walden Dissertations and Doctoral Studies

Obesity or being overweight is a prevalent health concern around the world. Despite the growing problem in developing countries such as Kenya, there is scant literature available on obesity or being overweight among women in rural Kenya. This research study provides information necessary for bridging the gap in understanding the perceptions, beliefs, and knowledge of obesity among women in rural Kenya. This study used the social cognitive theory (SCT) framework to assist in understanding the impact of obesity or being overweight among women living in rural Kenya. Participants were women aged 20 to 45 recruited from a local church in …

Factors Associated With Primary And Secondary Sexual Transmission Of Hiv In Concurrent Relationships In Kenya, Daphne Parker

Walden Dissertations and Doctoral Studies

This phenomenological study was designed to understand the lived experiences of a purposive sample of 9 participants from local villages in Nairobi, Kenya, who had sexual behaviors that contributed to higher HIV risk exposure. Past studies have provided information about the increased rates of HIV infection; however, little has been done to identify the solutions for minimizing the negative impact of HIV among concurrent partnerships. The study investigated the role of high risk cultural practices among participants in married and cohabitating unions. The conceptual framework of the study was gender and power theory, which addresses the complex sexual relationships between …

Complexity Of Prostate Cancer Diagnosis In African American Men In The United States, Adam B. Sumlin

Walden Dissertations and Doctoral Studies

Researchers have identified higher incidence rates and mortality rates among African American men (AAM) diagnosed with prostate cancer than they have among urban African American men. This quantitative descriptive study was conducted to measure the association between advanced stage and grade of prostate cancer, demographic location, and prostate specific antigen (PSA) levels over a 5-year period in AAM and European American men (EAM) in rural versus urban communities. This study addressed 4 research questions concerning cancer grade, cancer stage, age, geographic location, PSA level, and the impact that each of these variables had on prostate cancer diagnosis in AAM in …

Improving Health Literacy With Clear Communication, Carol Barbara Wilson

Walden Dissertations and Doctoral Studies

Health literacy is demonstrated when individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions. Veteran health literacy is believed to be lower than the general population due to the aging and culturally diverse population. Veterans require adequate health literacy to manage their diverse high acuity physical injuries, psychological conditions, and chronic diseases. Clear communication between the clinician and veteran patient is essential to provide high quality health services. The objective of this quality-improvement project was to evaluate the ability of nurses in the ambulatory environment to identify low health literacy patients and …

Evaluating Key Predictors Of Employee Response To Change In The Pharmaceutical Industry, Otis S. Johnson

Walden Dissertations and Doctoral Studies

This study addressed the factors that predict employee response to large-scale change in the United States pharmaceutical industry. When poorly executed, major organizational changes such as mergers and acquisitions are often disruptive and costly to organizations and demoralizing to employees. Although employee responses to change have been studied in several industries, employee responses during change execution in the pharmaceutical industry have not been subject to study. The purpose of this correlational study was to reduce the knowledge gap related to organizational change in the pharmaceutical industry by evaluating key predictors of employee response to large-scale change. The theoretical framework consisted …

The Association Between Demographic Factors And Use Of California's Health Insurance, Chiquita Theresa Tuttle

Walden Dissertations and Doctoral Studies

The Patient Protection and Affordability Act of 2010 (PPACA) addressed the access to healthcare in the United States. One of the problems of this healthcare access was rooted in disproportionally lower access among minority populations. The purpose of this quantitative study, guided by the consumer behavior theory, was to examine the association between race/ethnicity and enrollment within the Covered California-?¢ (CoveredCA) Insurance Exchange. A cross-sectional study design was used to investigate the association between race/ethnicity and the use of Covered CA health benefit exchange. Logistic regression analysis was used to examine the relationship between enrollment and race/ethnicity, having adjusted for …

Total Quality System Breakdowns In Outsourced Clinical Trials, Hemali Barrios

Walden Dissertations and Doctoral Studies

Numerous deaths, tragedies, and underreported drug side effects occur in outsourced clinical trials. Total quality system breakdowns occur even though quality agreement contracts and quality management systems are used by pharmaceutical organizations. The purpose of this single case study was to explore strategies clinical quality assurance managers use to avoid breakdowns in quality with outsourced clinical trials in Asia-Pacific countries. The study included a purposeful sample of 15 clinical quality assurance managers from 1 pharmaceutical organization located in the Northeast region of the United States. The conceptual framework was von Bertalanffy's general systems theory. Face-to-face semistructured interviews or e-mail questionnaires …

The Move From Recorded To Bedside Shift Report: Evaluating Barriers To Full Implementation, Elizabeth Jackson Cipra

Walden Dissertations and Doctoral Studies

Many sentinel events in acute care centers can be attributed to miscommunication of patient information at shift change. A growing body of evidence supports the implementation of bedside shift report as the standardized approach to ensure effective communication by staff. The purpose of this study was to identify the barriers that impede nurses from fully participating in bedside shift report in order to create an educational initiative to develop the nursing staff's proficiency in performing bedside report. Lewin's change theory served as the framework for the project. Data for the staff development project were collected using a focus group approach …

Chiropractic Student Infection Control Practices And Methicillin-Resistant Staphylococcus Aureus Skin Infections, Jonathon Todd Egan

Walden Dissertations and Doctoral Studies

Chiropractic training involves many hours of skin contact, and chiropractors have manual contact with millions of patients annually, but chiropractic has only had professional clinical hygiene guidance since 2010. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of cultured skin and soft tissue infection (SSTI) in the United States. Using the epidemiologic triad of person, place, and time as a framework, this quantitative, cross-sectional study obtained the first assessment of MRSA SSTI incidence among chiropractic students and its association with infection control behaviors (hand and table hygiene, sharing gowns, and sharing lotion) and initiation of patient care. The study …

Culturally-Based Diabetes Self-Management Education And Diabetes Knowledge In The Hispanic Population, Leslie Weldon Grunden

Walden Dissertations and Doctoral Studies

The Hispanic population has an elevated prevalence of diabetes, resulting in large part from a lack of self-management skills required to obtain glycemic control. The purpose of this project was to determine whether diabetes self-management knowledge was improved through the use of a culturally-based diabetes self-management program for Hispanic adults with diabetes using elements of the Hispanic culture. The research question asked whether a researcher-developed diabetes self-management education program that incorporated elements of the Hispanic culture improved diabetes knowledge in the Hispanic population when compared to a non-culturally based diabetes self-management program. The project was conducted using a quasi-experimental control …

Acculturation, Inflammation, And Depression Among Hispanic Adults In The United States, Kristin Marie Marano

Walden Dissertations and Doctoral Studies

Disparities exist in the recognition and treatment of depression among Hispanics in the United States, creating a social, ethical, economic, and public health burden. This study was designed to generate an improved understanding of the causes of and/or contributors to depression within this population. It was specifically designed to 1) assess the prevalence and severity of depression among Hispanic adults in the United States relative to adults of other race/ethnicities in the United States; 2) clarify the inconsistent results in the literature concerning the relationship between acculturation and depression among Hispanic adults in the United States; and 3) fill a …

Associations Between Healthcare Facility Types And Healthcare-Associated Infections, Aretha D. Miller

Walden Dissertations and Doctoral Studies

Healthcare-Associated Infections (HAIs) continue to be an epidemiological issue burdening patients and public health systems worldwide. The purpose of this study was to determine if specific healthcare facility types (Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities) were associated with particular categories of HAIs: Ventilator-Associated Pneumonias (VAPs), Central Line-Associated Bloodstream Infections (CLABSIs), and Catheter-Associated Urinary Tract Infections (CAUTIs). The theoretical framework for this study was the environmental determinants of infectious disease framework. A single research question focused on whether an association existed among the specified health care facility types and HAIs. Three independent categorical variables were …

Asthma Determinants, Health Care Utilization, And Control Among Women In Puerto Rico, Maria Calixta Ortiz-Rivera

Walden Dissertations and Doctoral Studies

Active asthma and asthma-related health care utilization are higher among adult females than they are among adult males in Puerto Rico. The purpose of this study was to examine the determinants of the risk of active asthma and associated health care utilization and asthma control among women in Puerto Rico. Guided by the Andersen behavioral model, the study included data from the Asthma Call-Back Survey (ACBS) during 2011 and 2012 in Puerto Rico. The associations between active asthma and behavioral, demographic, and environmental factors were assessed using logistic regression. The relationship between asthma-related health care utilization and predisposing, enabling, and …

The Relationship Of General Science Grades To Program Completion In An Associate Degree Nursing Program, Catherine Edlebeck

Walden Dissertations and Doctoral Studies

High attrition of nursing students in the United States may contribute to a shortage of registered nurses and inefficient use of scarce resources. The purpose of this study was to explore the relationship between nursing student grades in 3 science prerequisites and length of time to program completion on each of the study college's 4 campuses. Ausubel's theory of subsumption, wherein a learner's ability to meaningfully learn new data depends on the existing cognitive structure within which the new material is assimilated, was used as a theoretical framework. Prerequisite science course grades for 575 nursing students attending a Midwestern technical …

Using The Power Of 3 With Total Joint Surgery Patients, Lynda M. Sanchez

Walden Dissertations and Doctoral Studies

The purpose of patient education is to provide patients and their families with the tools needed to care for themselves after discharge from the hospital, but shortened hospital stays, limited health literacy, language, and age can impede the patient's comprehension of the information provided. Researchers have found that the lack of effective patient education is related to 30-day hospital readmissions. The Power of 3 educational tool, designed by Sanchez and Cooknell, addressed the factors that impeded effective patient teaching by using the adult learning theory and low health literacy concepts. The Power of 3 was implemented as a quality improvement …

Use Of Maternal Health Services And Pregnancy Outcomes In Nigeria, Abubakar Sadiq Umar

Walden Dissertations and Doctoral Studies

Maternal health services (MHS) provide primary, secondary, and tertiary levels of prevention to achieve better pregnancy outcomes. However, use of prenatal and natal services among Nigerian women has been ranked among the lowest in the world and, consequently, the country is among the 10 countries with the highest maternal mortality ratio. Moreover, nationwide community-based studies on the use of maternal health services in Nigeria are limited. To address this gap, this quantitative, cross-sectional study analyzed the 2008 Nigerian Demographic and Health Survey (NDHS) data to identify whether Nigerian women's biological, cultural, and socioeconomic characteristics are associated with their use of …

Oral Nutritional Supplement Use In Relation To Length Of Stay In Heart Failure Patients At A Regional Medical Center, Ellen Burkhardt Babb

Walden Dissertations and Doctoral Studies

Improving the nutritional status of hospitalized patients has been shown to reduce length of stay (LOS), hospital costs, readmission rates, complication rates, and mortality. Provision of nutrient-rich, liquid, oral nutrition supplements (ONS) is one approach to improving nutritional status. ONS use has been associated with improved outcomes among patients with diagnoses of orthopedic injuries and pressure ulcers, mainly using prospective designs among elderly and/or malnourished patients. Less information is available for other diagnoses, and no analysis of the effects of ONS could be found that considered the epidemiological triad of person, place, and time. This study used a quantitative, retrospective …

Analyzing Interrelationships Between Food Safety Practices And Inspections Among Food Staff In Manitoba, Kirandeep Kaur Brar

Walden Dissertations and Doctoral Studies

The incidence and prevalence of food safety practices among food staff working in food establishments in Manitoba is underrepresented and has not been adequately reviewed and researched. Uncertified food staff are at higher risk of not following food safety practices that can cause contamination of food and result in foodborne illness. The purpose of this quantitative study was to determine the prevalence of food safety practices among food staff in Manitoba and to determine the relationship between food safety certification and routine health inspections. Pender's health promotion model and Bandura's social cognitive theory were used to explain the relationships and …

Development Of Evidence-Based Scenario With High Fidelity Simulation To Improve Nursing Care Of Chest Pain Patients, Ma Zolaica Paragas

Walden Dissertations and Doctoral Studies

Cardiovascular disease remains the leading cause of mortality in the United States, and a primary educational objective is to develop professional competency among nurses to ensure the provision of safe and effective care to the cardiac patient. Benner's theory of novice-to-expert led to the development of an evidence-based scenario for the care of the patient with chest pain using risk-free high-fidelity simulation environments that focused on assessment, history taking, and communication, while evaluating improvements in the competency of nurses providing care to chest pain patients. Thirty-six nurses volunteered in the study. Feedback from nurse educators, which led to modifications to …

Frontline And Middle-Level Nursing Leader Transition Within The Military Health System, Rudolph George Newman

Walden Dissertations and Doctoral Studies

Healthcare delivery within the military requires a multifaceted approach to achieve the desired outcomes of safe, effective, patient-centered, timely, efficient, and equitable health care. The prospect of maintaining a cycle of continuous process improvements within military clinical settings hinge on frontline leaders and middle-level managers who must be prepared to execute the mission and motivate, supervise, coach and mentor the staff. This project showcases a review of current literature translated into the development of an evidence-based Transformational Leadership Induction Program (TLIP) module that consisted of 4 subsections: the environment of care, clinical decision support systems, human resources management, and change …

What Are The Perspectives Of Osteoporosis Screening Among Black Women?, Angela Alsberry Wilkins

Walden Dissertations and Doctoral Studies

Osteoporosis is a serious disease which often brings pain, disability, hospitalization, and even death. An increasing number of studies have been conducted on the prevention and treatment of osteoporosis in White women, yet a paucity of research exists to explain disparities in screening and treatment of osteoporosis in Black women. This narrative study describes the perspectives of Black women regarding individual barriers to osteoporosis screening. The purpose of this study was to better understand the perspectives of Black women regarding prevention of and screening for osteoporosis. Selections included purposive, criterion sampling of 10 Black women who were 50 years and …

Childhood Attention Deficit Hyperactivity Disorder: A Stress Factor For African Immigrant Mothers, Helen Agatha Awatefe

Walden Dissertations and Doctoral Studies

Children between the ages of 6-17 years suffering from childhood attention deficit hyperactivity disorder (ADHD) need constant attention as they are more likely to be accident proned, hospitalized, disruptive, and educationally challenged. The constant attention required for children with ADHD may impose stress on mothers and primary caregivers, yet this stress has not been sufficiently studied. The objective of this study was to fill a gap in literature by studying the stress experienced by African immigrant mothers living in the United States who are living with and caring for a child with ADHD, and then comparing the level of stress …

Hospital Profiling Of The Cesarean Delivery Procedure For The State Of Georgia, 2012, Denise Frances Giles

Walden Dissertations and Doctoral Studies

Approximately 35.1% of live births for the state of Georgia were delivered by the cesarean delivery procedure with significant variation among hospitals. The purpose of this research was to develop a population-based hospital profiling methodology for study of the cesarean delivery procedure. This was a retrospective, observational design, using a 2012 linked dataset that included maternity deliveries from all nonfederal hospitals. The research was guided by Robson 10 Group Classification System, propensity score methodologies, and ethical precepts, for the development of hospital profiles and the study of variations in the cesarean delivery procedure. Key research questions aimed to determine whether …

Predictors Of Excessive Alcohol Consumption Among U.S. Business Travelers, Jennifer Clore Barrickman

Walden Dissertations and Doctoral Studies

Excessive alcohol consumption (EAC) is an important public health problem. Several researchers have examined work-related influences on EAC, but few have investigated the predictors of EAC related to business travel. This study measured the association between EAC and frequency of business travel, duration of business travel, and job industry among U.S. business travelers. Research was conducted within the social-ecological theoretical framework. Snowball sampling was used to gather data from 187 business travelers. Data were evaluated using bivariate analysis to assess the association between measures of EAC and each independent variable. Multiple logistic regression was used to adjust for covariates. Respondents …

The Association Of Cancer Development In Patients With Systemic Lupus Erythematosus, Rose Michelle Coley

Walden Dissertations and Doctoral Studies

The Association of Cancer Development in Patients with Systemic Lupus Erythematosus by

Rose Michelle Coley

MPH, Walden University, 2011

BS, University of Mount Olive, 2008

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Public Health

Walden University

March 2016

Both cancer and autoimmune diseases have been associated with numerous factors that may independently lead to the development of either disease. When these factors overlap the difficulty in assessing association is compounded. The numerous factors that are thought to cause systemic lupus erythematosus (SLE), which leads to the development of cancer, makes the study …

A Phenomenological Exploration Of Children's Experiences During The Therapeutic Process, Katherine Destefano

Walden Dissertations and Doctoral Studies

Billions of mental health care dollars for millions of children and adolescents in need has garnered significant attention within the behavioral health industry to reduce costs while improving treatment efficacy through the identification and implementation of evidence based practices with youth populations requiring therapeutic services. This hermeneutic phenomenological qualitative research approach in the field of psychology is a consumer driven one in the world of business. Line by line context and discourse analyses, which included both a prior and inductive coding, of the verbiage and phraseology of 10 boys and 10 girls, aged 8-12, actively engaged in outpatient psychotherapy, formed …

Analysis Of How Newly-Hired Nurses Are Educated To Provide Customer Service, Patricia Mcafee

Walden Dissertations and Doctoral Studies

As part of healthcare reform through the Affordable Care Act of 2010,

hospitals across the United States are being held accountable for

providing a positive patient experience and will lose up to 2% of

their reimbursement by 2017 if they fail to reach targeted scores.

The purpose of this quality improvement project was to review the

process used by a Georgia hospital to educate newly-hired nurses

about customer service expectations and to provide recommendations

for process improvement. Theoretical foundations supporting

customer service included the caring philosophy of Mayeroff; the

caring theories of Watson, Leininger, Boykin, and Nyberg; and

Roy's adaptation …

Behaviors Related To Hiv Infections In Rural Versus Urban Regions Of Nigeria, Michael Ifeanyi Okeke

Walden Dissertations and Doctoral Studies

Efforts by the Federal Republic of Nigeria and international nongovernmental agencies to reduce the impact of HIV in Nigeria have not yielded the anticipated results. This study focused on the association between attitude, religious beliefs, knowledge of HIV, sexual risk behavior, and HIV epidemiology in rural and urban Nigeria. This quantitative study used social-cognitive theory and problem theory. The study was based on the Nigerian Demographic and Health Survey (NDHS) 2013 data including a sample of 33,006 participants. Specific covariates including gender, sexual partners over the past years, age at first sexual encounter, socioeconomic status, and literacy level were obtained …

Development Of A Guide To Successful Onboarding Of New Nurse Graduates, Jacquelyn Estelle Young

Walden Dissertations and Doctoral Studies

The literature indicates that serving as a preceptor for new nurse graduates can be challenging and stressful without proper training in this role. Many organizations appoint preceptors without providing training and support for the role, which negatively impacts both the new nurse and the preceptor. Evidence shows that a preceptor workshop can cultivate the knowledge and skills needed to train and precept new nurse graduates. Further, there is evidence that preceptorship programs ease new graduates' transition to practice, increase employee satisfaction, and improve the quality of care provided to clients. The purpose of this developmental project was to develop a …

Standardized Assessments, Care Planning, And Improved Quality Of Life For Residents Of Adult Family Homes, John A. Rogers

Walden Dissertations and Doctoral Studies

Quality of life for adults living in adult family homes requires further attention as the elderly population continues to grow and moves from minority to majority. There is a lack of data on residents in adult family home settings and their quality of life. The purpose of this project was to identify if individualized nursing care plans had an impact on the residents' quality of life in the adult family home. In this study, a registered nurse assessed the residents to create an individualized nursing care plan that would be implemented to improve quality of life. These care plans were …