Medicine and Health Sciences Commons^™

Genome-Wide Association Study On The Sleep Symptom Of Post Traumatic Stress Disorder, Tammy Pooler

Walden Dissertations and Doctoral Studies

Posttraumatic stress disorder (PTSD) is a psychiatric condition that presents with 3 main symptoms're-experiencing, avoidance/numbing, and hyper arousal'after an individual experiences a traumatic event. Recent evidence suggests a potential genetic basis for PTSD and a sub symptom of hyper arousal, sleep, as a potential pathway for PTSD development, but no study has identified candidate genes associated with specific symptoms such as sleep difficulty. Based on a conceptual framework in which specific genes are associated with the onset of PTSD, this study used a genome-wide association

study (GWAS) method with a case control study design to compare the genomes of individuals …

Systematic Review Of Retention Of Direct-Care Workers In Long-Term Care Facilities, Regina Evonne Goins

Walden Dissertations and Doctoral Studies

Turnover among direct-care workers in long-term care (LTC) facilities is high, and has a significant impact on residents, leaders, and owners of LTC facilities. The overall turnover costs are also substantial and constitute a significant financial burden in LTC facilities. This systematic review of the literature examined, retention strategies for direct-care workers in the LTC workforce. The information may be used to develop and provide practice recommendations that will help improve retention rates among direct-care workers in LTC facilities. The project design involved a systematic examination of English-only studies from 2001-2004, retrieved from 3 major databases: CINAHL with Medline simultaneous, …

Multiple Regression Analysis Of Factors Concerning Cardiovascular Profitability Under Health Care Reform, Gordon Brian Wesley

Walden Dissertations and Doctoral Studies

Cardiovascular (CV) patients receive one-third of the care and account for $444 billion of the health care costs in the United States. The cardiovascular service line (CVSL) in hospitals contributes to the profitability influenced by elements of resource dependence theory (RDT). The purpose of this study was to understand whether the regression model of hospital characteristics and outcomes would predict profitability in a CVSL through the cost-to-charge ratio (CCR). The use of a general linear model and multiple regression analysis to examine the 2012 National Inpatient Sample from the Healthcare Cost and Utilization Project allowed estimates from a weighted sample …

Building Resilience And Coping Effectiveness (Brace): A Program For Military Families, Linda Pauline Zarrett

Walden Dissertations and Doctoral Studies

Building Resiliency and Coping Effectiveness (BRACE): A Program for Military Families

by

Linda Zarrett

MSN, University of Cincinnati, 2012

BSN, Minnesota State University, Moorhead, 1985

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2015

Veterans returning from combat report significant family strain and Post Traumatic Stress Symptoms (PTSS) yet have limited access to care resources. Family members, including children, report very similar symptoms to those of veterans and have yet fewer health care resources. The purpose of this project was to apply principles from existing research on post-traumatic stress …

Inflammatory Markers Associated With Disease Progression Of Cardiorenal Syndrome, Srikanta Banerjee

Walden Dissertations and Doctoral Studies

An increase in cellular inflammatory biomarkers directly increases the risk of cardiovascular disease (CVD). Using the social ecological and biomedical theories, the study examined quantitatively how specific inflammatory biomarkers are associated with cardiorenal syndrome (CRS), a potential complication of hypertension and diabetes, and how sociodemographic factors modify this association in the U.S. adult population. A retrospective secondary data analysis of the data collected from National Health and Nutrition Examination Survey (NHANES) 1999-2010 was utilized to evaluate these hypotheses. High sensitivity C-reactive protein, homocysteine (hcy), and fibrinogen had a modifying effect on Type 4 (chronic reno-cardiac etiology), Type 2 CRS (chronic …

A Policy Guide To Decrease The Use Of Continuous Passive Motion Machines, Rosa M. Cooper

Walden Dissertations and Doctoral Studies

A Policy Guide to Decrease the Use of Continuous Passive Motion Machines

by

Rosa M. Cooper

MSN, Walden University, 2009

BSN, Immaculata University, 2007

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2015

This project was conducted at a post-acute rehabilitation hospital that served post-acute orthopedic, stroke, brain injury, cardiac, and skilled nursing patients. On the orthopedic unit, there were 5 practicing physicians, 3 of whom consistently used continuous passive motion (CPM) therapy on total knee arthroplasty (TKA) and 2 of whom did not. As a result of discussions …

An Interpretative Phenomenological Analysis Of Caregivers' Support For Their Preschool Children's Language And Social Skills Development, Sheri Stein Blum

Walden Dissertations and Doctoral Studies

Some children have difficulty communicating due to a lack of age-appropriate language and social skills. Researchers have explored how music and language share features that shape language processing. The purpose of this interpretive phenomenological analysis was to explore the experiences of caregivers of preschool children who participated in a music-based program and to understand their perspectives related to children's language and social skill development. Learning style and sensory integration processing theories were used as framework to provide foundations of skills in this study. Research questions addressed caregivers' choices related to this program for their children, their experiences of their children's …

Factors Motivating Employee Participation In Employer-Sponsored Health Awareness Programs, Markanthony Henry

Walden Dissertations and Doctoral Studies

Employers adopt worksite health promotions to reduce the incidence of preventable diseases, reduce healthcare costs, reduce absenteeism and presenteeism, and improve productivity. The purpose of this qualitative phenomenological study was to explore the motivational factors affecting employee participation in employer-sponsored health awareness programs. The theory of planned behavior grounded the study and formed the conceptual framework. Data collection occurred through semistructured interviews with 24 participants in the northeastern United States with lived experiences in worksite health promotion. Participants answered open-ended interview questions regarding the motivations for engaging in health promotions. Data were transcribed and coded for trends and themes. During …

Predictors Of Cervical Cancer Screening Among Hispanic Women In The United States, Benedicta Ngozi Ilouno

Walden Dissertations and Doctoral Studies

Minority women groups in the United States have the highest incidence and mortality rates of cervical cancer. Hispanic women have the highest incidence rate and the second highest mortality rate of the disease. Researchers have examined the lower rates of cervical cancer screening among Hispanic women, as compared to other groups of U.S. women, but researchers have not examined the extent to which socioeconomic status, acculturation, and sexual activity impact Hispanic women's compliance with screening. The purpose of this study was to examine the association between compliance with cervical cancer screening and acculturation, socioeconomic status, and sexual activity among U.S. …

A Mixed Method Study Of Diagnostic And Adaptive Functioning Challenges In African American Preschool-Aged Children With Autism Spectrum Disorders, Douglene Jackson

Walden Dissertations and Doctoral Studies

Children with Autism Spectrum Disorder (ASD) are known to experience performance and participation challenges, with early diagnosis being critical for improved outcomes. Children from ethnic minority backgrounds tend to receive their diagnoses later, even when symptomatology is similar. This mixed methods study explored symptom severity, functional difficulties, and age at diagnosis for ASD and to describe the functional challenges encountered by preschool-aged children with ASD of African American descent. The International Classification of Functioning, Disability, and Health along with the Model of Human Occupation were the theories used for this study to conceptualize functional challenges and other potential factors. Research …

Examining The Impact Of Accreditation On A Primary Healthcare Organization In Qatar, Alia Ghareeb

Walden Dissertations and Doctoral Studies

Although a modest body of literature exists on accreditation, little research was conducted on the impact of accreditation on primary healthcare organizations in the Middle East. This study assessed the changes resulting from the integration of Accreditation Canada International's accreditation program in a primary healthcare organization in the State of Qatar. The study also investigated how accreditation helped introduce organizational changes through promoting organizational learning as well as quality improvement initiatives. Pomey's Dimension of Change framework and questionnaire was used to measure the effect of Accreditation Canada International standards on the perceived quality performance and the progress towards organizational learning. …

Examining Biopsychosocial Factors In The Drive For Muscularity And Muscle Dysmorphia Among Personal Trainers, Beau J. Diehl

Walden Dissertations and Doctoral Studies

This cross-sectional quantitative study was conducted to assess the presence of muscle dysmorphia (MD) and a drive for muscularity (DFM) in 1,039 personal trainers using the Muscle Dysmorphia Inventory (MDI) and the Drive for Muscularity Scale (DMS). Muscle dysmorphia is considered a subtype of body dysmorphic disorder that can be exacerbated by an intense DFM, which may in turn lead to negative psychobehavioral outcomes. Because personal trainers are an unresearched population with regard to these 2 constructs, a multidisciplinary framework was used to ground the present research study. Independent variables were structured using a biopsychosocial foundation where the biological dimension …

An Educational Program For Nurses On Therapeutic Misconception In The Oncology Setting, Debra Magnanelli

Walden Dissertations and Doctoral Studies

A key component of informed consent to participate in research is the understanding that research is not the same as treatment and that scientific goals have priority over therapeutic ones. However, studies have found many research participants do not understand these important differences between research and treatment, a phenomenon termed therapeutic misconception (TM). The problem addressed in this project was research nurses' lack of education regarding the existence and concepts of TM, and their struggles to assess and address research participants' TM of clinical trials. Matutina's conceptual model of TM was used to guide this project. The purpose of this …

Relationship Between Stress Burden And Perceived Support Among Elderly Male Spousal Caregivers, Stephanie Fitzsimmons Sexton

Walden Dissertations and Doctoral Studies

As older couples age, often one partner becomes more competent and able to care for the other, in which case they are able to remain in their homes. In one township in the northeastern United States, the caregiving role had a significant effect on the lives of elderly men who care for their wives. The purpose of this quantitative project study was to determine the relationship between perceived stress burden and perceived level of social support services and between perceived stress burden and use of support services by elderly male spousal caregivers residing in active adult communities. Watson's theory of …

A Phenomenological Inquiry Into The Low Rates Of Influenza Vaccination Among Older African Americans, Delia Roxanne Howson-Santana

Walden Dissertations and Doctoral Studies

Influenza vaccination is recommended for persons with high-risk health conditions such as chronic diseases to prevent flu-related complications and death. African Americans 65 years and older have consistently been reported to have the lowest influenza vaccination rates compared to all other racial groups, despite having higher rates of chronic diseases. A review of the literature indicated that there is a dearth of qualitative studies examining the grounds for these low rates. In this study, 15 African Americans 65 years and older were interviewed to explore the factors that contribute to low rates of flu vaccination among this racial group. Research …

The Effect Of An Online Coping Skill Application On Relapsing-Remitting Multiple Sclerosis Sufferers, Jennifer H. Garrison

Walden Dissertations and Doctoral Studies

Many individuals with multiple sclerosis (MS) are classified as having relapsing-remitting MS (RRMS), a form of the illness that requires constant symptom management for suffers to achieve optimum outcomes. There are only a few community-based educational programs that exist to help RRMS sufferers cope with their illness; the effectiveness of those that have been fielded has not yet been adequately assessed. The research questions of this study were to determine if an online training development module would increase the coping skills of those affected by RRMS and if the online educational module would be more effective at improving the coping …

The Predictors Of Physician-Patient Discussions Of Sexual Health With Older Adults, Dana Marie Werner

Walden Dissertations and Doctoral Studies

The number of adults aged 65 years and over has been rising quickly, as has the rate of new onset sexually transmitted diseases within this population. Discussions of sexual health between physicians and older adults are currently lacking in frequency and effectiveness. Using the foundation of stereotype embodiment theory, the purpose of this study was to identify the factors that predict frequency of discussing sexual health with older adult patients. A comparative sample of geriatric physicians and family practitioners completed 2 researcher-developed questions and the Sexual Health Care Scale-Attitude tool that assessed their stereotype beliefs toward discussing sexual health with …

Program For Healthcare Personnel To Improve Anti-Hypertensive Medication Adherence In Black Adults, Verena D. Johnson

Walden Dissertations and Doctoral Studies

Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience …

How Spiritual Values Correlate With Hospice Use For African Americans, Latrina Dion Frazier

Walden Dissertations and Doctoral Studies

End of life hospice services have consistently been underused by African Americans. This disproportionate use of hospice has contributed to poor quality of life and a lack of cost-effective care for patients with terminal illness. Driven by the theory of reasoned action, the purpose of this quantitative study was to test associations between African Americans' perceptions of hospice, decisions to use hospice, and religiosity. A convenience sample of 154 African American adults was surveyed online. The survey instrument combined the AARP End of Life survey, Perception of Hospice survey, and the Religiousness Measure survey. The results of a multiple linear …

Improving The Quality Of Care In An Acute Care Facility Through Reeducating Nurses About Managing Central Lines, Jacqueline Raffaele

Walden Dissertations and Doctoral Studies

Central line-associated bloodstream infections continue to be some of the most deadly hospital-associated infections in the United States. Guided by Lewin's change theory which focuses on prior learning, rejection, and replacement, the purpose of this study was to improve the quality of care patients receive in an acute care facility by reducing life threatening central line infections. The research question examined whether additional education using Venous Access Nurse (VAN) customized newsletters and manager coaching of nurses in an acute care setting would improve the quality of care for patients with central lines. This was a quantitative nonexperimental descriptive retrospective study …

Automated Medication Dispensing Cabinet And Medication Errors, Marie Helen Walsh

Walden Dissertations and Doctoral Studies

The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use …

Teachers' Perceptions Of Multimodal Literacies In Middle School Health Literacy Programs, Cynthia Darlene Jackson-Howard

Walden Dissertations and Doctoral Studies

Health literacy, defined as the ability to understand and use health information to make informed decisions, is critical to maintaining health; however, not all U.S. states mandate strategies to improve adolescents' health literacy. Moreover, many middle school teachers are often unaware of how their roles could improve the health literacy of their students. Multimodal literacies help students to create meaning through viewing print-based resources and using digital technologies. The purpose of this study was to investigate teachers' perceptions of the effectiveness of multimodal literacies on adolescents' overall health literacy via the introduction of health literacy programs into the curriculum. This …

Complementary Alternative Medicine: Awareness And Perceptions Of Health Care Providers Who Provide Systemic Lupus Care, Carmen Ionie Bartley

Walden Dissertations and Doctoral Studies

The purpose of this study was to explore healthcare providers' awareness and perceptions of complementary and alternative medicine (CAM) use in providing systemic lupus erythematosus (SLE) care. This phenomenolgical study was built upon existing research indicating SLE patients' need to foster better communication about CAM use. Participants were recruited from the Long Island Rheumalogical Clinic in the State of New York. Individual in-depth semistructered interviews were conducted to explore the awareness and perceptions of a purposive sample of 10 healthcare providers who care for patients with SLE. Transcripts were analyzed, and categorical themes were developed. Guided by the use of …

Health-Related Beliefs Among Low-Income African American Women And Their Perceptions About Obesity, Cenora Kimberly Akhidenor

Walden Dissertations and Doctoral Studies

The aim of this study was to explore the health-related beliefs and perceptions of low-income African American women regarding obesity. Phenomenology served as the conceptual framework for this study. African American women, especially those in low-income brackets, have been shown to weigh more than women of other racial/ethnic groups. The consequences of these high rates are increased risks of developing chronic health disorders, such as type II diabetes and cardiovascular disease. The study sample consisted of 7 low-income obese African American women, ranging in age from 20 to 62, who resided in the Pacific Northwest. Recruitment for participation occurred via …

Predicting Post Traumatic Stress Disorder In Children With Prior Mental Health Diagnoses, Earnest E. Airhia

Walden Dissertations and Doctoral Studies

Hurricane Katrina devastated the U.S. Gulf Coast and subjected the city of New Orleans to disastrous flooding, which resulted in numerous after effects that impacted the children and adolescents of the city. The disaster contributed to high levels of stress, increased risk of psychological disorders, and was associated with an increased percentage of New Orleans children presenting symptoms of post traumatic stress disorder (PTSD). To help address these problems associated with hurricanes and other disasters, the current study investigated how age, gender, race, and pre-existing conditions increased or decreased the likelihood of a child being diagnosed with PTSD following Hurricane …

Post Hysterectomy Discharge Destination And Risk Of Hospital Readmission In Elderly Women, Ruth Ann Churley-Strom

Walden Dissertations and Doctoral Studies

In elderly women, discharge after gynecologic surgery is often associated with increased morbidity. Little information exists about elderly women's discharge destination after gynecologic surgery and the outcome of early hospital readmission. The purpose of this study, conceptualized using the quality health outcomes model, was to examine whether post hysterectomy discharge destination is an independent predictor of 30-day hospital readmission in women age 65 and older. Examination of covariates included patient age, race, medical comorbidity and complications of care, as well as surgical anatomic approach and operative technique. This study involved use of a retrospective cohort design and data from 10,598 …

Risk Factors And Food-Borne Illness: An Analysis Of Restaurant Violations In Georgia, Jovan Harris

Walden Dissertations and Doctoral Studies

Restaurant managers complete certification in food safety in order to ensure that food is handled and prepared in a manner that decreases risk factors associated with food-borne illness. However, the literature has been inconclusive concerning the connection between manager certification and the incidence of critical food-safety violations. The purpose of this quantitative study was to examine the relationship between the presence or absence of a certified food safety manager (CFSM) and the number of risk factors cited on food inspection reports and the food safety score. In addition, this study was designed to determine whether operation type (i.e., chain vs. …

Retention In Nursing Programs: Factors Contributing To The Success Of Esl Students, Patience Jegbefu Mbulu

Walden Dissertations and Doctoral Studies

The problem addressed in this project is the high attrition rate among English as Second Language (ESL) students in a local community college associate degree nursing program. If the retention problem is addressed, the increase in the number of ESL nursing student graduates could result in a more diverse nursing workforce, reflecting the diversity of the community. The purpose of this study was to examine student and faculty views regarding factors that contribute to the academic success and retention of ESL students. To that end, a qualitative case study approach was used, guided by the theoretical frameworks of Cummins's contextual …

Increasing Initiation And Exclusivity Of Breastfeeding In The Hospitalized Postpartum Dyad, Candace L. Rouse

Walden Dissertations and Doctoral Studies

The purpose of this project was to highlight an intervention to increase breastfeeding initiation and exclusive breastfeeding during the birth hospitalization in a coastal mid-Atlantic inner city hospital. Although researchers and national standards promote early initiation and exclusive breastfeeding, there continues to be a significant number of women who do not breastfeed and/or supplement with formula. The advantages of breastfeeding for mother and infant are substantial and include protecting babies from allergens to reducing maternal breast and ovarian cancer. Breastfeeding rates of initiation and exclusivity at the project hospital were below benchmarks set by international, national, and state agencies. The …

Development Of A Home Health Transitional Care Program For Elderly Heart Failure, Pamela Leshel Wright

Walden Dissertations and Doctoral Studies

Ineffective transitional care programs for ensuring the continuation of care from the hospital setting to the home setting often result in rehospitalization for elderly heart failure patients age 65 and older. The purpose of this project was to develop a home health transitional care program for elderly patients transitioning from inpatient settings to home settings using care bundles consisting of evidence-based practices to reduce preventable rehospitalizations within 30 days of discharge. The home-based chronic care model, which provides a foundation for home health's integral role in chronic disease management by ensuring patient-centered evidence-based care, guided the development of this program. …