Medicine and Health Sciences Commons^™

Improving Nurses' Knowledge To Reduce Catheter-Related Bloodstream Infection In Hemodialysis Unit, Mohammed Jawad Kadium

Walden Dissertations and Doctoral Studies

Central venous catheters (CVCs) are commonly used as vascular access for patients who require hemodialysis. Infectious complications are a serious clinical problem, and they are associated with high rates of morbidity and mortality, prolonged hospital stay, and increased medical treatment costs. The purpose of theproject was to evaluate the effectiveness of educating registered dialysis nurses regarding CVC maintenance care to reduce catheter-related bloodstream infection (CRBSI) in a hemodialysis unit. The project question focused on the educational program derived from the evidence-based guidelines recommended by the Centers for Disease Control and Prevention (CDC) to improve registered dialysis nurses' knowledge regarding CVC …

Moving From Productivity To Professional Value Model Of The Hospital-Based Registered Nurse, Crystal Maree Billings

Walden Dissertations and Doctoral Studies

There is a gap between organizational commitment to professional value of the nurse and the achievement of quality outcomes. This study explored the relationship between the productivity model and the professional value (PVS) model of the hospital-based registered nurse (RN). It was essential to understand how to measure nursing's contribution to patient care as a means to promote patient care outcomes. The current professional nursing dynamic provides an unprecedented opportunity for nurses to achieve their highest professional potential through increased demonstration of advocacy and accountability for the central tenets of nursing. The intent of this project was to explore the …

Development Of An Evidence-Based New Graduate Nursing Orientation Program For The Emergency Department, Mary Ellen Zaleski

Walden Dissertations and Doctoral Studies

The traditional new graduate nurse (NGN) orientation process places NGN with an experienced preceptor for 24 weeks and requires clinical skills checklists to be completed by the preceptor, a practice which is not an evidence-based practice for orienting NGNs. The purpose of this quality improvement project was to develop an evidence-based orientation to decrease time requirements and standardize the processes and evaluation of the NGN in the emergency department. The project was informed by Benner's novice to expert theory and focused on acquisition of clinical skills. The project team included 6 stakeholders: the Doctor of Nursing Practice student-leader, the unit …

Graduate Nurse Pediatric Emergency Nursing Orientation Program, Mindi Lynne Johnson

Walden Dissertations and Doctoral Studies

Research has found that the turnover rate of graduate nurses within their first year is significantly high. Specialties such as pediatric and emergency nursing have even a higher turnover rate. It has been suggested that significant amounts of stress and lack of skills are responsible for the turnovers. This quality improvement project, which is theoretically based on Benner's novice to expert theory, will examine if a lack of a specialized pediatric emergency graduate nurse orientation program is a contributing factor. The purpose of the project is to improve retention of graduate nurses by implementing a specialized orientation program that focuses …

Relationships Between The Coordinated School Health Program And Childhood Obesity In Tennessee, Tekeela Shonta Green

Walden Dissertations and Doctoral Studies

Childhood obesity rates have increased nationwide, but rates of childhood obesity are higher in Tennessee (TN). The Coordinated School Health (CSH) Program is a multicomponent approach designed to improve academics and health in children in Tennessee; however, researchers have not evaluated the 8 components of the plan and the impact it has on weight in children. The purpose of the study was to determine if a relationship existed between the Coordinated School Health Program and obesity in children. The conceptual framework for this study was Bandura's social cognitive theory. One hundred forty CSH coordinators in TN were surveyed and the …

Association Between Psychological Trauma From Assault In Childhood And Metabolic Syndrome, W Sumner Davis

Walden Dissertations and Doctoral Studies

Metabolic syndrome and its component conditions of hypertension, obesity, and insulin resistance are on the increase in United States. Metabolic syndrome substantially increases the risk of cardiovascular disease and type 2 diabetes (T2D). To date, no published study has examined the relationship between psychological traumas from physical and/or sexual assault in childhood and metabolic syndrome or its components. This study, using the psychoneuroimmunology (PNI) model, investigated associations between psychological trauma (physical/sexual abuse) in childhood and metabolic syndrome in adulthood using data from the Midlife in the United States II (MIDUS-II) study. This research was undertaken to investigate whether a history …

An Examination Of Physician Resistance Related To Electronic Medical Records Adoption, Terrence Duncan

Walden Dissertations and Doctoral Studies

The 2009 American Recovery and Reinvestment Act, signed under the Obama administration, mandated physicians to complete certification for electronic medical records (EMRs). Despite these mandates and the increased access to information technology, slow adoption rates persist on the use of EMRs. Guided by the theory of planned behavior and the technology acceptance model, the purpose of this quantitative study was to examine the relationship between the independent variables perceived ease of use, perceived usefulness, perceived behavioral control, perceived social influence, attitudes toward EMR, and the dependent variable user acceptance. This study identified physicians in the United States as end-users of …

Weight Management Of Women Of Childbearing Age, Marcia Hagen

Walden Dissertations and Doctoral Studies

Black River Memorial Hospital identified obesity as a priority health concern in its rural service area; this concern was in line with the county's needs assessment. It was identified that women of childbearing age affect the lifestyle and health choices of their families and that they are at higher risk for the additional health risks associated with obesity affecting pregnancy and birth. Despite the identification of these risk factors, the factors that affect healthy weight management have not been well understood. Using the life course theory, a qualitative inquiry in the form of a structured interview was developed with local …

The Association Between Asthma Management And Routine Posture Exercise, Anne-Marie Lydie Coleman

Walden Dissertations and Doctoral Studies

Asthma cannot be cured, but it can be managed. Asthma management is a public health issue that is complex. Medication, asthma triggers, age, and the environment are all factors that impact asthma management. There is a gap in research in terms of what lifestyle characteristics need to be in place in order for adults to manage asthma. Shaw found that posture care is a lifestyle variable that should be explored as it relates to asthma management in older adults. The Life University Clinic (Marietta, GA) sees asthmatic patients daily and teaches them about a posture care routine through a program …

Development Of An Electronic Health Record Educational Project For Staff Nurses, Nanah Sheriff Sesay

Walden Dissertations and Doctoral Studies

Abstract

The use for electronic health records (EHRs) by 2015 is being mandated through incentive payments for health care providers. Evidence-based literature has shown that almost half of the hospitals in the Unites States have not adopted EHRs, and many nurses have not been educated to effectively use them. In order to enhance and sustain EHR adoption by hospitals, nurses need to be educated on EHRs' usability. The purpose of this project was to develop an evidence-based EHR educational project for nurses on how to enter nursing assessments, document patients' medical data, and communicate effectively with patients and health care …

A Case Study Of Respect Among Young Urban African American Men, Morgan Zenobia London

Walden Dissertations and Doctoral Studies

Many young adult African American men living in urban areas adopt a style of self-presentation known as the gangsta image in an attempt to earn and maintain what they may perceive to be respect, self-esteem, and social status. While these young men succeed in earning the respect of their peers, they also may jeopardize their chances of succeeding in mainstream society by engaging in an alienating lifestyle related to their alternative form of status. The purpose of this case study was to explore the concepts of respect and self-esteem as defined by a culture-sharing group of young African American men …

Planning A Smoking Cessation Program In A Mental Health Hospital, Victoria Omuson

Walden Dissertations and Doctoral Studies

The incidence of smoking among mentally ill people is very high. Smokers have a 50%, rate of mental illness diagnosis compared with 23% rate for general population. To address this problem, the purpose of this project was to plan a smoking cessation program for patients in a mental health facility. The theoretical foundation for this project was based on the theory of planned behavior, which identifies the predictive nature of smoking and the benefits that can be derived from implementing a systematic approach for change. The project question examined the effectiveness of smoking cessation program using educational support, pharmacological strategies, …

Women And Thyroid Disease: Treatment Experiences And The Doctor-Patient Relationship, Laura J. Mccormick

Walden Dissertations and Doctoral Studies

Thyroid disease, a chronic illness, affects nearly 200 million people worldwide and is more common among women than in men. Numerous factors make diagnosing and treating thyroid disease in women challenging. The standard blood test for diagnosing thyroid disease and determining treatment effectiveness is inconsistent in its accuracy. Many women with thyroid disease are misdiagnosed or struggle with symptoms even once receiving treatment. Although thyroid disease is highly prevalent among women and the doctor-patient relationship is known to influence treatment outcomes, there is a gap in the literature regarding the treatment experiences of women with thyroid disease and the doctor-patient …

Evaluation Of Post-Deployment Ptsd Screening Of Marines Returning From A Combat Deployment, Erika L. Hall

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to examine whether the post-deployment screening instrument currently utilized to assess active-duty Marines for symptoms of PTSD upon their return from a combat deployment can be solely relied upon to accurately assess for PTSD. Additionally, this study sought to compare the number of Marines who have sought trauma-related mental health treatment based on their answers on the Post-Deployment Health Assessment (PDHA) to the number who have sought trauma-related mental health treatment based on their answers on their PTSD Checklist - Military Version (PCL-M). The participants in this study were comprised of a sample …

A Guide For Delivering Evidence - Based Discharge Intructions For Emergency Department Patients, Andre Walker

Walden Dissertations and Doctoral Studies

Discharge instructions provided to patients discharged from the emergency department (ED) are often provided in a way that is neither clear nor concise. Patients are often discharged home without a clear understanding of their diagnosis, medications, reasons to return to the ED, follow-up instructions, or how to manage their care at home during their illness. Therefore, a guideline needed to be developed in order to help the ED staff provide clear and concise discharge instructions to patients discharged from the ED. The Ace Star Model of Knowledge Transformation was the foundation for the development of the evidence-based guideline. A formative …

African American Eighth Grade Students' Attitudes Toward Hiv/Aids In The District Of Columbia, Enock Kolawole Adewuyi

Walden Dissertations and Doctoral Studies

The group most affected by HIV/AIDS, according to the Centers for Disease Control and Prevention (CDC), is African Americans. The purpose of this study was to explore the knowledge of HIV/AIDS held by African American children as a first step towards developing prevention strategies for these youths. In order to bridge the knowledge-behavior gap, this study sought to investigate the attitude towards HIV/AIDS of African American 8th grade students. The study involved secondary data from the 2012 District of Columbia (DC) Middle School Youth Risk Behavior Survey, obtained from the District of Columbia Office of Superintendent of Education (OSSE). Guided …

Barriers To Receiving The Influenza Vaccine In Adults 65 Years And Older, Melissa Madalone

Walden Dissertations and Doctoral Studies

Vaccination is regarded by many as the most effective means of reducing influenza infection and disease; however, many people in the United States are hospitalized from flu-related illness each year. Adults 65 years and older account for more than half of these hospitalizations and almost all flu-related deaths. This project aimed to identify barriers to receiving the influenza vaccine among the adult population (> 65 years of age) in a community setting. The goal was to develop a teaching tool that would assist practitioners towards improving influenza vaccination rates among this population. The Health Belief Model was the theoretical framework …

Peer Support Education For Uncontrolled Hypertension Among African Americans Adults, Melvina Juliana Semper

Walden Dissertations and Doctoral Studies

Hypertension is a major chronic health problem that can lead to heart attack, stroke, and kidney failure. African Americans disproportionately suffer from the morbidity and mortality of hypertension-related illnesses. The purpose of this comparative project was to determine the impact of peer support educational workshops as an avenue for lifestyle modification, using changes in blood pressure (BP) before and after participation. The target population consisted of 64 African Americans with hypertension in Brooklyn NY, aged 20 to 65 years old. BP measurements were taken within 1 month before and after participating in a weekly peer support educational workshop facilitated by …

Preventative Strategies To Improve Birth Outcomes Among African American Women In Rhode Island, Yvonne Michele Heredia

Walden Dissertations and Doctoral Studies

Despite increased access to prenatal care, birth outcomes continue to be a major source of disparity among women in the United States. The focus on lifestyle choices and negative behaviors prior to a pregnancy to reduce adverse birth outcomes has become a well-documented strategy. The purpose of this study was to determine if preparing for a pregnancy in advance improves birth outcomes for African American women of childbearing age between the ages of 12 and 45 years in the State of Rhode Island (RI). The theoretical foundation for this study was based on Prochaska's model of change, which is also …

Client-Centered Care Approach To Group Home Care, Peniel Mugo Wambugu

Walden Dissertations and Doctoral Studies

Scholars since the 19th century have focused on the provision of care in group homes and have demonstrated that structure (that is, the staff, facilities, and equipment), is critical in the delivery of care. The researchers, however, advocate doing for, rather than doing with the clients the activities that address the clients' welfare. The purpose of this study is to investigate how a client-centered approach would affect the quality of care delivered to the mentally challenged individuals (MCIs) in a group home. The study employed the quality-care framework in which the emphasis is on structure (skills), process (efficiency), and outcome …

Preceptor Training And Nurse Retention, Laurie Lynn Squillaci

Walden Dissertations and Doctoral Studies

Nurse turnover is a significant problem that has led to a nursing shortage in hospitals, particularly in rural hospitals. The nursing shortage will continue to grow if changes are not implemented to retain qualified nurses. Nurse turnover puts patients at risk for substandard care and increases healthcare-related costs, as organizations try to recoup costs to train and orient new nurses. Retention, turnover, and quality of care are important organizational drivers. One strategy that targets each of these drivers is to have newly hired nurses partake in a preceptorship, where a preceptor facilitates the assimilation and amalgamation of newly hired nurses …

Health Behaviors, Hardiness, And Burnout In Mental Health Workers, Jeremiah Brian Schimp

Walden Dissertations and Doctoral Studies

Burnout has emerged as a significant and costly issue in the modern workforce. Researchers have not fully explored the role of individual health behaviors and personality in burnout among mental health workers. The knowledge gap addressed in this study was the connection between health behaviors, what mental health workers do to take care of themselves, and hardiness, the characteristic way they perceive and interpret environmental challenges. The purpose of this study was to examine the influence of health behaviors and hardiness among mental health workers on the 3 dimensions of burnout as measured by the MBI-HSS: emotional exhaustion, depersonalization, and …

Centering Pregnancy Implementation And Its Effect On Preterm Birth And Low Birthweight, Carole Ann Moleti

Walden Dissertations and Doctoral Studies

Preterm birth (PTB) and low birthweight (LBW) babies are the source of a large burden of infant, neonatal, and childhood morbidity. The purpose of this project was to expand the use of the CenteringPregnancy^TM Group Prenatal Care Model as an evidence-based intervention for management of both medical and psychosocial risk in low-income, ethnic and racial minorities in New York City. The standardized model developed by Schindler Rising decreases the incidence of preterm birth and low birthweight and increases the rate of breastfeeding. A CenteringPregnancy^TM program implementation plan, customized to meet the needs of a multisite urban hospital system, …

Attitudes And Behaviors Of South African Women And Psychosocial Determinants Of Gonorrhea, Takiyah White Ndwanya

Walden Dissertations and Doctoral Studies

The incidence of gonorrhea had declined since the HIV epidemic in the late 1980s, but is now increasing globally due to the emergence of antibiotic-resistant forms of this disease. In South Africa, the incidence of gonorrhea is highest among Black women due to their high co-infection rates with HIV and other sexually transmitted infections (STIs). This study examined the psychosocial determinants of gonorrhea among Black women aged 18 - 35 in the Langa township in Cape Town, South Africa. All participants had reported at least one sexual experience and at least one positive test for gonorrhea in the past two …

Climate Change Implications For Health-Care Waste Incineration Trends During Emergency Situations, Emilia Mmbando Raila

Walden Dissertations and Doctoral Studies

Healthcare waste (HCW) incineration practices in the global South countries are among the major sources of black carbon (BC) emissions or smoke. This study analyzes HCW incineration trends during emergency situations and smoke from HCW incineration processes in Haiti. The study was prompted by the current arguments about the climate change and the growing health effects associated with BC emissions. The conceptual framework was based on both adverse health effects from BC emissions exposure and climate change potential of BC emissions. Therefore, the goal was to determine whether cardboard HCW sharps containers emit lower BC emissions to the atmosphere during …

Type 2 Diabetes Prevention Program In The Medical Office Clinic, Jovita Chibuzo Ezirim

Walden Dissertations and Doctoral Studies

The challenge of diabetes prevention is to reduce the financial and human costs of diabetes by preventing new cases and enacting social change. African Americans and Hispanics Americans have a high incidence of Type 2 diabetes because of factors that place them at risk for prediabetes. The purpose of this project was to plan the implementation and evaluation of a Type 2 diabetes prevention program in a medical office clinical setting. The clinic of interest was located in the downtown area of the city and provided care mostly to African American population. The Iowa model of evidence-based practice formed the …

Exploring Strategies For Implementing Barcode Medication Administration Systems, Julie A. Frederick

Walden Dissertations and Doctoral Studies

The number of medication errors associated with preventable deaths in healthcare facilities remains at a high rate for healthcare leaders. Practices of medication delivery remain similar to those 10 years ago. Hospitals that have implemented barcoding medication administration systems have reported a decrease in medication errors ranging from 60% to as high as 93%. Despite this utility of barcoding, only 50% of U.S. hospitals have implemented barcode medication administration. This comparative case study explored the strategies hospital leaders used to implement barcode medication administration systems, utilizing the sociotechnical theory for a conceptual framework. Face-to-face, semistructured interviews were used to identify …

The Distribution Of Type 1 Diabetes Onset In The United States By Demographic Factors, Margaret Beckstrand

Walden Dissertations and Doctoral Studies

Type 1 diabetes (T1D) is a chronic and lifelong condition, often diagnosed in childhood. Patients with T1D are at elevated risks of associated health complications, comorbidities, and mortality. Occurrence, clinical presentation, and complications related to T1D differ by age of onset, ethnicity, and gender. The last reported population-based estimates regarding the burden of T1D in children using the National Health and Nutrition Examination Survey (NHANES) were published in 2008, and these estimates were not well stratified by age of onset, ethnicity, and gender. The purpose of this study was to examine these demographics within the conceptual framework of the hygiene …

Health Literacy And The Level Of Hypertension In Urban Latinos, Marlene Rosetta Glashen

Walden Dissertations and Doctoral Studies

Health literacy (HL) plays a significant role in health care communication and patient compliance. Low health literacy leads to noncompliance with health instructions, poor health choices, failure to participate in recommended health screenings, frequent hospitalizations, and higher health care costs. Using the health belief model (HBM) as the conceptual framework, this quantitative, cross-sectional study addresses a gap in the literature related to the research questions of this study. The research questions are: (a) Is there a relationship between HL and the level of hypertension (HTN) in hypertensive urban Latinos?, and (b) Will HL predict the level of control of HTN …

Medical Academia Conflict Of Interest Policy And Potential Impact On Research Funding, Michael Keith Maahs

Walden Dissertations and Doctoral Studies

The partnership between medical academia and the pharmaceutical industry has been scrutinized for issues associated with research bias. As a result of this scrutiny, the Institute of Medicine (IOM) issued policy recommendations in 2009 directing academia to adopt comprehensive conflict of interest (COI) policies. During the same time, a slowdown of funded research into academia occurred, and it is not clear whether the IOM recommendations contributed to this problem. The purpose of this case study was to determine the extent to which compliance with the IOM policy resulted in a reduction in funded research. The Advocacy Coalition Framework (ACF) was …