Medicine and Health Sciences Commons^™

Mental Health Therapists' Attitudes On Adoption Of Evidence-Based Practices And Organizational Culture, Jennifer Guerguis

Walden Dissertations and Doctoral Studies

Evidence-based practice (EBP) in mental health was initiated in the United States due to state legislation. The EBP implementation process is complex due to multiple factors related to organizational culture. Mental health agencies implementing EBP processes can expect significant personnel changes due to higher turnover rates, which may have a negative effect on the quality of services. The purpose of this study was to investigate the relationship between providers' attitudes toward the adoption of EBPs and organizational culture. The theoretical framework for this study was organizational culture theory and the Denison organizational culture model. This correlational and predictive study examined …

Examining Barriers With Implementing Augmentative And Alternative Communication In A Midwest School, Ashley Renee Fields

Walden Dissertations and Doctoral Studies

Many speech-language pathologists (SLPs) in a Midwest urban public school system have experienced barriers that prohibit the effective use of augmentative and alternative communication (AAC). The result has left some students with speech language impairments (SLI) without the communication skills for meaningful relationships and success in and out of school. The purpose of this exploratory case study was to determine the perceived barriers of 8 local school SLPs regarding the successful implementation of AAC and their suggestions for addressing the problem. Data were collected from semi-structured interviews with the SLPs. Data collection and analysis were grounded by Ely's conditions of …

Practice Guidelines For Self-Management Of Osteoarthritis Pain In The Home-Based Settings, Oyesola Omowunmi Akintan

Walden Dissertations and Doctoral Studies

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI …

Facilitating Weight Tolerance Among Health And Fitness Majors Toward Obese Persons, Stephanie Boss

Walden Dissertations and Doctoral Studies

Weight bias exists in some health-related degree programs. Overweight and obese persons who experience weight bias in health-related services often delay or avoid medical attention altogether. Guided by the attribution theory, the purpose of this sequential explanatory study was to examine weight bias among health majors at a southwest regional university to illuminate how attitudes can affect the level of care provided to overweight persons. The Attitudes toward Obese Persons (ATOP) scores from a convenience sample of 184 health majors revealed that participants' scores were found to be significantly lower than the midpoint (60) of the ATOP scale, M = …

Nitrate In Private Wells:Knowledge, Oppinions,And Perceptions Of Stakeholders, Augustus D. Jaja

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to examine data describing nitrate concentration and cases of congenital cardiac defects. Residents with private wells and other stakeholders need data to make informed environmental decisions about the adverse health implications of nitrate contamination of private well water. Researchers have examined the exposure of nitrate in contaminated groundwater, but they have not examined nitrate levels in unregulated water systems. This gap in the literature highlighted the need to provide nitrate data for future research and private well users. Guided by the social ecological model, a quantitative, cross-sectional, nonexperimental design was used to survey …

Psycho-Social Resilience And Risky Hiv Behaviors Among Black Males Who Have Sex With Males, Wilson Osaro Iyokho

Walden Dissertations and Doctoral Studies

The incidence rate of HIV among Black males having sex with Black males (BMSM) is high compared to that of other racial groups. Researchers have established the association between inappropriate sexual practices, age, income, and environmental determinants and HIV positive status among BMSM. Guided by resilience theory, the purpose of this study was to examine the relationship between HIV risk behavior and resiliency with the goal of identifying a new intervention to mitigate the HIV infection rate in the BMSM community. The theoretical framework used for this study was the resilience theory. This theory is concern with the phenomenon of …

Spiritual Transcendence And Burnout Rate Among Psychologists And Social Workers Working With Severely Mentally Ill Patients, Cynthia Fuhrer Cameron

Walden Dissertations and Doctoral Studies

Burnout is a psychological syndrome caused by occupational stress, which often manifests in mental health professionals who experience demanding and emotionally charged relationships with clients. Guided by the equity theory, this study examined the relationship between spiritual transcendence and burnout in psychologists and social workers who work with severely mentally ill patients after accounting for specific personality traits. Constructs were measured via the Spiritual Transcendence scale (STS), Maslach Burnout inventory (MBI), and the NEO-Five Factor Inventory (NEO-FFI). Sixty eight psychologists and social workers were selected from psychiatric hospitals, community centers, and private practice in Nevada to participate in the study. …

Correlations Between Childhood Obesity And Obesogenic Environmental Variables Within Durham County, North Carolina, Eureka Capri Daye

Walden Dissertations and Doctoral Studies

The application of geographic information systems was used to map obesogenic conditions by zip code tabulation areas in Durham County, North Carolina and evaluated associations between those conditions and the understudied area of early childhood obesity. Of the thirty one percent of the children in Durham County, North Carolina who were considered obese in 2010, four hundred and thirty three (1:5) 2 - 4 year old children who received supplemental nutrition services for women, infants and children were obese with BMI levels greater or equal to the 95th percentile and were used as the criterion variable in the study (N=433). …

Steps To Reducing Heart Failure Hospital Readmissions Through Improvement In Outpatient Care, Paticia Laubach Dunn

Walden Dissertations and Doctoral Studies

The outpatient care of the heart failure (HF) patient is fragmented due to the lack of evidence-based practice guidelines use. The primary goal of this project was to improve the care of the HF patient in the outpatient arena through use of clinical pathways using the logic model as the project framework. The intervention was carried out over a 4-week period on a convenience, random sample of patients (n = 80) attending a cardiology practice. The patients were recruited from 2 physicians' patient populations and were selected based on an adult diagnosis of HF, reduced ejection fraction of <40% at some point in time, and the New York Heart Association (NYHA) functional class II-V. Comparisons were made in the documentation of care between patients on or off the pathway. The intervention included documentation of patient education, care follow-up, medications, NYHA functional class, and symptom exacerbation, documented in the electronic medical record. The quality of care data were evaluated based on 3 of the Joint Commission core measures for outpatient care of the HF patient. Additional data were collected regarding use of the clinical pathway based on provider and week of implementation. Data were analyzed via a Chi-square test of independence comparing pathway use by provider and use of pathway as study progressed. The comparative results show statistically significant differences in use of the pathway by provider and a statistically significant increase in use during the project . The quality of care results varied in statistical significance. The pathway utilization increased over time and provided a method for standardizing documentation of care for the HF patient in this outpatient clinic, a benefit for HF patients and providers in this cardiology practice and beyond.

Prehospital Staffing And Road Traffic Accidents: Physician Versus Trained Nonphysician Responders, Timothy A. Grant

Walden Dissertations and Doctoral Studies

Road traffic deaths, which affect people in their productive years, are projected to be the third leading cause of death by the year 2030. While most studies have focused on road infrastructure and vehicle safety, this study examined something new: the impact of prehospital response to road traffic accidents on the rate of death. Some countries send physicians to the scene of an accident; some send paramedics or registered nurses. The question this research sought to answer was whether the use of physician responders resulted in a lower rate of death compared to the use of nonphysician responders. The literature …

The Relationship Between Compassion Fatigue And Self-Transcendence Among Inpatient Hospice Nurses, Donna Marie Johnson

Walden Dissertations and Doctoral Studies

Health care complexities have limited the understanding of nursing care and have jeopardized the "soft skills" or foundation of caring as the art of nursing. Hospice nurses provide a deeper, more spiritual and complex type of care for critically ill and end-of-life (EOL) patients, which place them at a high risk for compassion fatigue. Using Reed's middle range theory of self-transcendence, the purpose of this project was to examine the relationship between compassion fatigue and self-transcendence among inpatient hospice nurses. A descriptive, correlational research methodology guided this inquiry surveying a convenience sample of 42 inpatient hospice nurses at 4 hospice …

The Effects Of Barriers Toward Fighting Childhood Obesity Within Head Start, Vanessa Chaney

Walden Dissertations and Doctoral Studies

Childhood obesity is associated with significant morbidity and mortality and poses a health care burden. Child care facilities serve at the forefront in fighting childhood obesity among preschoolers. Since 2009, a significant shift has occurred in studying child care settings among children aged 3-5 in North Carolina and South Carolina in response to the rising rates of obesity in this population. Some of the hypothesized determinants of childhood obesity among preschoolers in North Carolina and South Carolina are outdoor activity, staff behavior, center's size and location. The purpose of this study was to investigate if significant relationships exist between childhood …

Incorporating Ada Best Practice Guidelines In Electronic Medical Records To Improve Glycemic Management In Hospitals, Jennifer Claudette Benjamin

Walden Dissertations and Doctoral Studies

Aggressive management of diabetes using American Diabetes Association (ADA) best practice guidelines in hospitalized patients reduces morbidity and mortality. Inpatient electronic medical records systems improve care in chronic diseases by identifying care needs and improving the data available for decision making and disease management. The purpose of this quality improvement project was to evaluate the impact of ADA best practice guidelines of glycemic management once they have been entered into the electronic medical record (EMR) of hospitalized diabetics. Kotter's organizational change process guided the project. The project question investigated whether nurses' use of ADA Best Practice Guidelines incorporated into the …

Communication Skills Of Novice Psychiatric Nurses With Aggressive Psychiatric Patients, Rose Moss

Walden Dissertations and Doctoral Studies

Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients

by

Rose L. Moss

MS, University of Hartford, 1996

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

March 2015

The transition from novice nurse to a competent psychiatric staff nurse is often associated with major communication challenges, primarily when caring for aggressive patients. Guided by Peplau's theory, this quantitative study assessed the communication skills of novice psychiatric nurses (N = 25) who worked 24 months or less in the state psychiatric hospital with aggressive psychiatric patients. Additionally, certain demographic data …

Meaningful Use Of Electronic Medical Recording To Improve Diabetic Treatment Compliance Of American Diabetic Association Treatment Standards, Tamara Ann Parrish

Walden Dissertations and Doctoral Studies

Diabetes affects approximately 10% of the American population with an annual expenditure of approximately $174 billion dollars. The utilization of electronic medical records (EMR) combined with the meaningful use (MU) initiative may ensure that diabetic patients receive the recommended preventative care. Dorthea Orem's self-care deficit theory and the transtheoretical model of behavior change was utilized to design this quality improvement project. Medical professionals at a small private practice received education on American Diabetic Association (ADA) treatment standards and how to use the EMR system to track patients receiving the recommended diabetes care. The project question examined the effectiveness of provider …

A Comparison Of Regional Health Care Structures For Emergency Preparedness, Leslie Porth

Walden Dissertations and Doctoral Studies

Since 2001, increased policy attention and federal funding mechanisms have required more effective disaster response by government actors and private sector organizations, including the health care system. However, there is limited scholarly evidence documenting which structural elements have been associated with efficacious regional coalitions. This study addressed the gap by examining whether the number of different participating disciplines (a proxy for coalition roles), community setting, and prior weather-related disaster declaration influenced the number of activities (a proxy for coalition responsibilities) conducted by the health care coalition. Social network theory was the theoretical lens with which the study results were used …

Glioblastoma Multiforme: Geographic Variations In Tumor Size, Treatment Options, And Survival Rate, Susan Rebecca Nohelty

Walden Dissertations and Doctoral Studies

Glioblastoma multiforme (GBM) is a destructive brain cancer that results in death 12 to 15 months after diagnosis. The purpose of this retrospective study was to determine if variations in tumor size at diagnosis, treatment options, and survival rate occur in GBM patients living in urban and rural areas of the United States. Using the behavior model of health services as the theoretical framework, this study used secondary data sets of GBM cases reported from 1988 to 2011 from the Surveillance, Epidemiology, and End Results program. Tumor size was measured in millimeters; treatment was evaluated by ascertaining the number of …

Perceived Factors Contributing To Coronary Heart Disease In African American Women, Funmilola O. Sholanke

Walden Dissertations and Doctoral Studies

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to …

Interpersonal Safety Of Active Duty Women In The Deployed Environment Of Bagram Afghanistan, Cynthia Tara Ferguson

Walden Dissertations and Doctoral Studies

In the United States Armed Forces, 30% of women in the military suffer physical assault each year; in 2009, there were 22 reported cases of sexual assault in the U.S. Central Command. Aggravated assault, gang violence, sexual assault, homicide, and suicide can damage the morale of military personnel at a deployed site and collectively cost millions of dollars over time. Interpersonal violence in the United States military is destructive to the military system and directly diminishes mission readiness. This study was designed to illuminate the environmental, cultural, and political influences that affect interpersonal safety among military women in the deployed …

The Creation Of A Pacemaker Clinic At A Federally-Funded Patient-Centered Medical Home: A Quality Improvement Project, Tony Anno

Walden Dissertations and Doctoral Studies

It is common for clinicians to implant medical devices, such as permanent pacemakers and implantable defibrillators, for cardiac diseases. These medical devices require follow-up care at regular intervals to ensure proper device function and optimal outcomes. Currently, many individuals without insurance or financial resources lack access to recommended follow-up care after implantation of a cardiac device. The purpose of this project was to determine the number of individuals who have had a medical device implanted without insurance coverage over a 3-year period, and then to establish a clinic that provides this service. The standard of care and operating procedure for …

Predictors Of Recidivism For Offenders With Mental Illness And Substance Use Disorders, Linda Buckmon

Walden Dissertations and Doctoral Studies

Mental illness and substance use disorders have been determined to be leading predictors for recidivism among criminal offenders in the United States who are released to community supervision. Women make up an increasing in percentage of this criminal justice population; however, few studies have explored the role that gender plays in determining men and women's recidivism. Offender's education, employment, and peer association have also been reported to be predictors increasing the likelihood of recidivism among criminal offenders. This study was designed to determine if gender, mental illness, substance use disorder, employment, education, and peer association predicted recidivism. Differential association theory …

Factors Contributing To Loss Of Nursing Intellectual Capital, Vera Ligia Grover

Walden Dissertations and Doctoral Studies

In a Level II trauma center, experienced nurses are retiring from nursing positions, which is causing an unstable workforce. According to the literature, there are not enough experienced nurses to mentor the new nurses. Evidence suggests that experienced nurses are associated with improved patient outcomes and that experienced nurse mentors can improve the work environment for less experienced nurses. Focusing on Watson's theoretical framework of caring and Covell's theoretical framework of intellectual capital, this phenomenological study explored the lived experiences of a small group of nurses. Five nurses with 15 years of experience and who had served as mentors were …

Development Of An Evidence-Based Nursing Orientation Program For A Community Health System, Janet Brooke Cuddy

Walden Dissertations and Doctoral Studies

Through discussion with the community health system's administration, it was identified that their current nursing orientation program was not well structured or comprehensive. The nursing staff also reported dissatisfaction with the current program. Therefore, a Doctor of Nursing Practice project commenced to develop an evidence-based nursing orientation program for Registered Nurses (RN) and Licensed Practical Nurses (LPN) at a community health system in Virginia. The Competency Outcomes Performance Assessment model guided development of the project through a comprehensive literature review to identify evidence-based data for competencies, learning strategies, and performance evaluations. This review highlighted the importance and benefits of nursing …

School Administrator And Staff Member Perceptions Of A Teenage Pregnancy Prevention Program, Sharon Lacretia Mcconnell-Smith

Walden Dissertations and Doctoral Studies

Mississippi is among the states with the highest teenage pregnancy rates, and the study site is among the high schools with the highest teenage pregnancy rates in the state. The purpose of this qualitative case study was to identify successful practices and areas for improvement in the implementation of a teenage pregnancy prevention program (TPPP) at the study site based on the perspectives of school administrators and staff members. Bandura's social cognitive theory provided a conceptual framework for considering behaviors and the social contexts in which they occur. Twelve participants were interviewed, including 3 administrators and 9 staff members. Data …

Nurses Knowledge, Skills, And Attitude Toward Electronic Health Records (Ehr), Sharon L. Adams

Walden Dissertations and Doctoral Studies

Information technology (IT) has been rapidly integrated into the healthcare industry, including nursing, and has the ability to reduce errors, cut cost, and enhance patient care. However, approximately 45% of the current nurse workforce lacks adequate training in computer skills, which may hinder the adoption of health-related IT in the workplace. Characteristics of Rogers's diffusion of innovation (relative advantage, compatibility, complexity, trialability, and observability) guided this project. This project was conducted to address the problem of IT adoption on a local level and was designed to assess whether simulation training on a generic electronic health record (EHR) system would improve …

The Relationship Between Social Intelligence And Hearing Loss, Deborah Finken

Walden Dissertations and Doctoral Studies

This study was an exploration of adults with long-term hearing loss (LTHL) and how it may relate to social intelligence (SI) proficiency. The outcome of this study was intended to illuminate a gap in the literature, namely, the manner in which those with long-term LTHL were able to understand social situations and communicate with others when auditory comprehension was limited. A quantitative nonexperimental method was used that provided the Tromso Social Intelligence Scale (TSIS) to a group of 66 adults with LTHL who were diagnosed with hearing loss as children, as well as a group of 70 adults with no …

Quality Improvement To Increase Nurse Knowledge On Nursing Informatics Project Management Standards, Elizabeth J. Fleischer

Walden Dissertations and Doctoral Studies

When an inexperienced nurse project manager is assigned to serve as a project manager for health information technology (HIT) tools, there is increased risk the project will not be completed on time, within budget, and in scope. An identified business need at a large military treatment facility was an educational tool to bridge the gap between nursing informatics and project management. The scholarly project was a Nursing Informatics Project Management Guidebook, which served as an educational tool to increase nurses' knowledge to serve in the HIT project manager role. With a quality improvement methodology, the outcome and impact sequence logic …

Predictors Of Community Supervision Failures Among Female Offenders, Fayola Wolfe

Walden Dissertations and Doctoral Studies

This study explored the predictors of community supervision failures amongst female offenders in the United States criminal justice system. Female offenders have, in comparison with male offenders, particular challenges for community reintegration. This study used the relational theory and Maslow's hierarchy of needs theory to investigate the effects of childhood trauma on adult female offenders' behaviors, including substance use disorder and mental health issues. Secondary archival data were obtained from the Court Services and Offender Supervision Agency's AUTO Screener and Supervision and Management Automated Record Tracking System; this data pool included information on 1,085 female offenders who had served at …

Improving Attitudes And Perceptions About Teamwork Among Health Care Professionals With A Teamstepps Approach, Tetsuya Umebayashi

Walden Dissertations and Doctoral Studies

Effective communication among health care professionals is essential for the provision of quality patient-centered care; however, effective communication practices are not guided by evidence-based models in many health care organizations. The Joint Commission has estimated that most sentinel events are induced by miscommunication among health care professionals. The problem addressed in this project was poor and ineffective teamwork skills and general communication among health care professionals and a lack of formal models to guide effective communication among the healthcare team. The purpose of the project was to adapt TeamSTEPPS to an institutional context in order to improve health care team …

A Couple’S Marital Disharmony And Its Psychological Effects On Their Children During The Hiv Disclosure Process In Kenya, Grace Gachanja

Walden Faculty and Staff Publications

Limited published data exists on how HIV-positive parents perform disclosure to all their children. A couple’s HIV disclosure experience to all their children is presented. They participated in a larger study conducted to understand the lived experiences of HIV-positive parents and their children during the disclosure process. Each underwent individualized in-depth semi-structured interviews. Interviews were transcribed and transferred into NVivo 8 for analysis using the Van Kaam method. Three themes emerged including HIV testing, full disclosure delivery accompanied by marital disharmony, and postdisclosure psychological effects on the family. Marital disharmony and non-involvement of the father caused the mother to fully …