Medicine and Health Sciences Commons^™

Completion Of Preventive Health Care Actions By Older Women With Hiv/Aids, Patricia Kay Correll

Walden Dissertations and Doctoral Studies

The widespread use of highly active antiretroviral therapy (HAART) has resulted in longer lifespans for HIV seropositive women in the United States, during which preventive health care is recommended. Failing to complete recommended cancer screening tests can result in cancer being diagnosed at a later stage with a poorer prognosis. The purpose of the study, based on the ecosocial theory, was to describe the sociodemographic and clinical variables of HIV seropositive women who failed to complete recommended screening tests for breast, cervical, and colorectal cancers, and determine if the presence of hypertension, obesity, diabetes, depression, or tobacco use impacted the …

Nursing Care Of Terminal Patients In Intensive Care Units, Pervell Velethia Dunbar

Walden Dissertations and Doctoral Studies

Nursing Care for Terminal Patients in Intensive Care Units

by

Pervell Dunbar

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2015

Although the goal of the ICU has always been to save lives, ICU now additionally provides end-of life (EOL) care. The objective of this project was to provide ICU nurses with a comprehensive awareness of physical, emotional, and spiritual EOL care issues of patients and their families in order to be better equipped to handle EOL care. The framework used was Jean Watson's Caring model (10 Caritas). A …

Role Ambiguity, Role Strain, Job Dissatisfaction, And Difficulty Transitioning Into Academia Among Nursing Faculty, Paula Stallard Whitehead

Walden Dissertations and Doctoral Studies

Registered nurses with experience in the clinical area entering academia go through a transition that may lead to difficulties such as role ambiguity and role strain when beginning a new job. The purpose of this study was to understand the experiences leading to role ambiguity, role strain, difficulty with role transition, and job dissatisfaction among the faculty at colleges of nursing in the mountain region of Western North Carolina. Guided by Kahn's organizational role theory and Schlossberg's transition theory, research questions investigated the nursing faculty experience of role ambiguity, role strain, difficulty transitioning into academia, and job dissatisfaction. A qualitative …

Factors Relating To Underrepresentation Of Black American Women In Health Care Administration, Alquietta Lavayle Brown

Walden Dissertations and Doctoral Studies

There is a low representation of Black American women (BAW) in health care senior leadership. With the high level of health problems found among the Black community, diversifying the executive leadership with BAW may be instrumental in increasing provider trust and reducing discriminatory action. Using critical race theory as the conceptual framework, this study examined the experiences, perceptions, and influential or deterrent factors inhibiting advancement of BAW in the health care field. Inquiry centered on factors related to lack of advancement, experiences at different stages of career progression, and strategies impacting career advancement. A qualitative research design using a transcendental …

Vitamin D Deficiency And Immune Function In African American, Hiv-Infected Men, Rana H. Ismail

Walden Dissertations and Doctoral Studies

Vitamin D deficiency is common in individuals diagnosed with HIV and is known for its detrimental health effects. Its recognition as a potent immune-modulator with possible immune health implications in HIV disease progression was the main impetus for this study. The association between Vitamin D and CD4 count falls short of being consistent and is too weak to allow conclusions. Similarly, the literature is inconsistent with regard to the impact of Vitamin D supplementation on CD4. This observational, retrospective chart review study aimed to explore the relationship between Vitamin D deficiency and CD4 count/percent, and to evaluate whether changes in …

Challenges Of A Novice Nurse Educator's Transition From Practice To Classroom, Tori Brown

Walden Dissertations and Doctoral Studies

This project study addressed the lack of formal preparation encountered by novice nurse educators within a nursing program located in the southeastern region of North Carolina. This problem is significant at both the local and national levels because expert clinicians are needed to fill nurse educator vacancies that have led to qualified students being denied admission to nursing programs. A qualitative case study research design was employed to explore the perceptions of novice nurse educators in one nursing program transitioning from clinical nursing practice to the nurse educator role. The theoretical framework to guide this study was Benner's novice to …

Food Policy: Urban Farming As A Supplemental Food Source, Bessie Didomenica

Walden Dissertations and Doctoral Studies

The distance between farms and cities and the limited access that some residents have to fresh foods can be detrimental to a city's capacity to feed people over time. This study addressed the under-studied topic of urban farming as a secondary food source, specifically by exploring the opportunities and limitations of urban farming in a large Northeastern city. Brundtland's food policy was the pivotal theory supporting food production to end global starvation, and was the link between environmental conservation and human survival. The research question for this study examined the potential food policy opportunities and limitations that assist urban farms …

Regression Analysis Of Cloud Computing Adoption For U.S. Hospitals, Terence H. Lee

Walden Dissertations and Doctoral Studies

Industrial experts agree that cloud computing can significantly improve business and public access to low cost computing power and storage. Despite the benefits of cloud computing, recent research surveys indicated that its adoption in U.S. hospitals is slower than expected. The purpose of this study was to understand what factors influence cloud adoption in U.S. hospitals. The theoretical foundation of the research was the diffusion of innovations and technology-organization-environment framework. The research question was to examine the predictability of cloud computing adoption for U.S. hospitals as a function of 6 influential factors: relative advantage, compatibility, complexity, organizational size, structure, and …

The Association Of Gender And Socioeconomic Position With Cardiorespiratory Fitness In Adolescents, Quentin Oliphant

Walden Dissertations and Doctoral Studies

This meta-analysis investigated the association of gender and socioeconomic position with cardiorespiratory fitness in adolescents. Public health professionals know the importance of physical activity level as a modifiable behavior; however, the literature has revealed that more research is needed on the association of sociodemographic variables like gender and socioeconomic position with cardiorespiratory fitness in adolescents. Using the physical fitness and health outcomes conceptual model as a guide, the overall effect sizes across studies were assessed as well as the moderators of study design, sample size, age, and country. A systematic review of literature identified a total of 18 peer-reviewed studies …

Impact Of Whole Grain Consumption Compliance On Gluten Sensitivity And Bowel Health, Sarah Anne Roberts

Walden Dissertations and Doctoral Studies

While many health benefits have been associated with increased whole grain consumption, current researchers have not considered if the consumption of whole grains in currently recommended or higher amounts actually leads to health problems, specifically to a correlated increase in gluten sensitivity. The purpose of this study was to determine if diets high in whole grains or those that met the recommended daily intake of whole grains help minimize or increase gluten sensitivity, and when whole grains are consumed as recommended if they cause more harm than good. The theoretical basis for this quantitative, cross sectional design was the precaution …

Nurse Educators' Perspectives Of Supplemental Computer-Assisted Formative Assessment In An Associate Degree Nursing Program, Jennifer Buehler Sugg

Walden Dissertations and Doctoral Studies

Despite the implementation of various strategies to improve outcomes, the pass rates for the National Council Licensure Exam for Registered Nurses (NCLEX-RN) for an associate degree nursing (ADN) program continue to decrease. This study examined the use of a supplemental computer-assisted formative assessment (SCAFA) as a strategy for NCLEX-RN success. A qualitative case study with a theoretical framework based on constructivism was designed to investigate nurse educators' perspectives of this particular strategy for successful outcomes. To explore these perspectives, data were collected from face-to-face interviews with nurse educators and from program documents from 1 ADN program in the southeastern United …

Cultural Competence Education For Care Coordinators, Wendy Janet Renault

Walden Dissertations and Doctoral Studies

Aboriginal people bear a burden of health disparities when compared to non-Aboriginal people in Canada. To date, traditional health-related programs to address these disparities have not been effective. Compounding this problem, the Aboriginal people have also reported dissatisfaction with the healthcare system and the relationships they experience with healthcare providers. However, the literature supports that when providers employ cultural competence in their practice, there is a possibility for improved relationships with patients. Using critical social theory as a framework, the purpose of this project was to conduct a 1-hour class on cultural competence for care coordinators and nurses in a …

Support Of Maternity Care Practices To Increase Breastfeeding Among First-Time Mothers, Jessica Strauch

Walden Dissertations and Doctoral Studies

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding …

The Impact Of Immigration Variables On Tuberculosis Rates In South Carolina, Lisa J. Dimitriadis

Walden Dissertations and Doctoral Studies

After HIV/AIDS, tuberculosis (TB) is the deadliest single infectious agent worldwide; globally in 2013, 1.5 million people died of the disease. Although TB infection rates in the United States are low compared to that of other countries, TB still remains a threat to public health in the U.S., especially among immigrant populations. The main purpose of this study was to investigate the correlations between the independent variables of immigration status, years of residence, and race/ethnicity and the dependent variable of TB infection within South Carolina between 2006 and 2012. To examine these possible relationships, this quantitative study employed the ecological …

Outcome Evaluation Of A School-Based Program For Pregnant And Parenting Girls, Angela Lynn Glynn

Walden Dissertations and Doctoral Studies

Research has indicated that effective parenting programs for pregnant and parenting teens greatly improve educational and career opportunities for teen parents. Such research underscores the need for schools to use these programs in their efforts to increase high school graduation rates for this population. The aim of this case study was to assess if a school-based parenting program was successful and, if so, how elements of this program might be useful to educators who are planning similar programs. The study included an examination of archived program data, which included end-of-year reports related to the program and participants, and interviews with …

Predictors Of Knowledge Of Stroke And Intent To Call 911 Among African Americans, Hyacinth Idu Hyacinth

Walden Dissertations and Doctoral Studies

Stroke is associated with significant health disparity and predominantly affects the elderly. Stroke outcome is significantly improved if an individual is able to get "clot-bursting" medication. A significant predictor of an on-time arrival to the emergency room for treatment in the event of a stroke is the ability to accurately recognize stroke signs and symptoms. The purpose of this study was to determine the factors (demographic, socioeconomic, and educational) that predict the knowledge of stroke signs/symptoms and intent to call 911 in the event of a stroke. The study was grounded in the social ecological theoretical model and analyzed archived …

Health Care Reform And The Transition From Volume To Quality Payment Models: A Primary Care Focus, Kevin Lee Jackson

Walden Dissertations and Doctoral Studies

The 2010 Patient Protection and Affordable Care Act (PPACA) resulted in providers and health care organizations conforming to new payment models that connect reimbursement to patient outcomes. Primary care providers (PCPs) are tasked to provide new quality provisions as chronic disease management is a key focus to improve outcomes. The purpose of this study was to understand the transition to new payment models and determine whether care is improved. The conceptual framework is grounded in health care access models geared towards the improvement of quality outcomes including the chronic care model (CCM). The research questions were designed to understand providers' …

Diffusion Of Electronic Health Records In Rural Primary Care Clinics, Patricia Lynn Mason

Walden Dissertations and Doctoral Studies

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 …

Coalitions Members' Perceived Methods To Prevent Adolescent Marijuana Usage After Legalization, Lanise A. Hutchins

Walden Dissertations and Doctoral Studies

Community coalitions have had successful reductions in adolescent substance abuse, and the legalization of marijuana presents an opportunity for these coalitions to re-evaluate their current methods and messages for preventing adolescent marijuana usage. Using the theory of planned behavior, the purpose of this qualitative study was to determine how legalization of marijuana for recreational purposes affects the methods and messages of coalitions and how the coalition members perceive their efforts to reduce adolescent marijuana usage post-legalization in Colorado. Participants were obtained by recommendations from the executive director in each of four coalitions. A purposive sample of 12 coalition members was …

A Proposal For The Development And Validation Of A Diabetic Self-Management Education (Dsme) Program, Melissa Sue Garrison

Walden Dissertations and Doctoral Studies

The World Health Organization has estimated that by 2030, approximately 350 million people will be diagnosed with Type 2 diabetes mellitus (T2DM). Currently, 18.8 million people are diagnosed with T2DM. An additional 7 million people have high blood sugar but have yet to have an official diagnosis of diabetes. The literature supports early identification and prevention are key to reducing the severity of T2DM its complications. The Health Belief Model, the Chronic Care Model and Orem's Theory of Self-Care guided the current proposal, whose purpose was to develop and validate a new T2DM DSME module. A validation of the DSME …

Exploring Yoga As A Holistic Lifestyle For Sustainable Human And Environmental Health, Julia A. Leischner

Walden Dissertations and Doctoral Studies

Improved health indicators, mental and physical health outcomes, and sustainable lifestyle practices have been found among yoga practitioners. The purpose of this study was to examine the impact of mixed styles of yoga practice on the health and behaviors of yoga practitioners. The relationship between yoga and body mass index (BMI), self-reported disease diagnosis, participation in other types of physical activity, adoption of healthy and sustainable lifestyle and dietary behaviors, perceived improvements in medical conditions that yoga was used to treat, quality of life resulting from yoga practice, and the reasons for beginning and continuing yoga were observed and tested …

Correctional Nurses' Knowledge And Perceptions Of Methicillin-Resistant Staphylococcus Aureus, Deborah Winbush

Walden Dissertations and Doctoral Studies

Since 1999, Methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have occurred in many correctional facilities. Even after the Federal Bureau of Prisons developed clinical practice guidelines on the management of MRSA within correctional facilities, the prevalence of MRSA decreased only insignificantly. Other researchers suggested infection control compliance was equally as important as developing clinical practice guidelines in reducing the incidence of MRSA. Several studies identified the healthcare professionals' nonadherence and inconsistencies to clinical practice guidelines as contributors to MRSA transmission. Accordingly, this project was designed to develop evidence-based recommendations for improving nurse professionals' adherence to MRSA practice guidelines in correctional settings. Using …

Mri As An Adjunct To Conventional Mammography Screening For Cancer In Dense Breast Tissue, Rachel Sunmattie Connett

Walden Dissertations and Doctoral Studies

Diagnostic methods to effectively image dense breast tissue (DBT) can pose challenges for breast cancer screening. While conventional mammography is the gold standard for breast cancer screening, this technique has a low sensitivity to DBT and can miss about 78% of cancers in DBT, but magnetic resonance imaging (MRI) has a high sensitivity for imaging DBT, and produces a smaller number of false positives. The purpose of this study was to determine the extent to which conventional mammograms can miss breast cancer in women with DBT and to determine if an adjunct method of imaging DBT might detect breast cancers …

The Association Of Maternal Health Literacy Levels And Preterm Birth, Aimee Moynihan

Walden Dissertations and Doctoral Studies

According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this …

Predictors Of Physician Use Of The New Nia Alzheimer's Assessment Protocols, Richard Norman Schultz

Walden Dissertations and Doctoral Studies

Consensus is lacking on early diagnostic criteria and the exact symptoms of Alzheimer's disease (AD). A new, in-office test may help physicians detect the early symptoms of AD, based upon new National Institute of Aging (NIA) criteria. However, a gap exists in knowledge regarding physicians' current use or intent to use the new protocols. Choreographing the descriptive AD terminology in the Diagnostic and Statistical Manual of Mental Disorders IV-TR and the International Classification of Diseases (ICD-10) is recommended. Thus, the purpose of this study was to understand possible contributing factors to physician's use or intent to use of the new …

Oral Care Practice Guidelines For The Care-Dependent Hospitalized Adult Outside Of The Intensive Care Unit Setting, Cynthia Susan Drapal

Walden Dissertations and Doctoral Studies

Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations …

A Transition-To-Practice Residency That Supports The Nurse Practitioner In A Critical Access Hospital, Nancy Jean Stock

Walden Dissertations and Doctoral Studies

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to …

Technology As A Health Intervention And The Self-Efficacy Of Men, Karen Denise Maxwell

Walden Dissertations and Doctoral Studies

Mortality rates in the United States are higher for men than they are for women as a result of chronic diseases such as heart disease, cancer, and diabetes. Despite these disproportionate rates, few health interventions are targeted to men, and limited knowledge exists regarding the specific components needed to design technology health tools to appeal to men. The purpose of this quantitative study was to examine the relationship between the use of technology health tools and the role of self-efficacy in men and the influence on participation in healthy lifestyle behaviors. A quasi-experimental design was used to analyze data collected …

The Design And Implementation Of A Relationship-Based Care Delivery Model On A Medical- Surgical Unit, Paula Ann Rodney

Walden Dissertations and Doctoral Studies

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit

by

Paula A. Rodney

MSN, California University of Pennsylvania, 2011

BSN, University of Virginia, 1979

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

April 2015

Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were …

Faculty Perceptions Regarding Best Practices In Clinical Dental Hygiene Assessment, Brenda Kaye Walstead

Walden Dissertations and Doctoral Studies

This qualitative case study explored faculty perceptions regarding best practices and uses of assessment in a dental hygiene program at a small northwestern college. It was discovered that faculty in the program were assessing students in their clinical courses using widely varied methods, designs, and scoring tools. Faculty neither calibrated processes nor communicated about this problem. In addition, a review of the assessments in this local setting indicated a significant gap in the current guidelines for best practices in clinical assessment procedures. Knowles' adult learning theory served as the foundation for this study. Research questions were designed to obtain clinical …