Medicine and Health Sciences Commons^™

Leadership Strategies To Influence Employee Engagement In Health Care, John David Vizzuso

Walden Dissertations and Doctoral Studies

Hospitals are in a precarious financial position with declining reimbursement, eroding profit margins, and low patient satisfaction. The Patient Protection and Affordable Care Act of 2010 reform may decrease hospital reimbursement by $500 billion from 2010 to 2020, while low patient satisfaction may decrease profitability for hospitals by 27%. Employee disengagement may decrease patient satisfaction and consumer loyalty. The purpose of this phenomenological study was to explore the lived experiences of health care leaders as they worked to engage employees and provide better patient care. Improving patient care provides opportunities to capture new market shares, which increases sustainability of health …

Self Esteem, Locus Of Control, And The Relationship With Registered Nurses' Experience With Workplace Incivility, Elizabeth Anne Berry

Walden Dissertations and Doctoral Studies

The study's purpose is evaluating the relationship between locus of control and selfesteem

in relation to the registered nurse's experience and perception with lateral and

vertical incivility. There is a lack of research concerning nurse-to-nurse incivility within

the nursing profession. The hypothesis examined whether dynamics of locus of control

and self-esteem could provide insight into the personality dynamics influencing incivility

in the workplace. This non-experimental quantitative study used 2 self-evaluation tools

and 1 demographic survey tool to collect data via Survey Monkey, a commercial data

collection company. Participants were 65 randomly selected faculty (n = 36) and

graduate students (n …

Student Perceptions Of Effective Learning Strategies For National Council Licensure Examination Preparation, Lori Jean Johnson

Walden Dissertations and Doctoral Studies

The purpose of this study was to examine efficacious instructional strategies that the New England Community College (NECC) nursing program could implement in the curricula to improve National Council Licensure Examination Registered Nurse (NCLEX-RN) first-time pass rates. Effective strategies from students and nursing program faculty had used were investigated. Such strategies support student nurses in their efforts to succeed on the first administration of the exit examination. The rationale for this study and resulting project was that they could improve NCLEX-RN first-time pass rates and positively impact the local hiring of qualified nurses. Guided by Knowles's adult learning theory, key …

Toward A Therapeutic Use Of Spirituality Among Individuals With Mild To Moderate Intellectual Disabilities, Tony Terrell Lee

Walden Dissertations and Doctoral Studies

Toward a Therapeutic Use of Spirituality among Individuals with Mild to Moderate Intellectual Disabilities

by

Tony Terrell Lee

MS, William Carey University, 2005

BS, University of Southern Mississippi, 1992

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Clinical Psychology

Walden University

May 2015

Research has shown that community employment, different levels of independent living, and advocacy groups are factors that influence self-esteem in individuals with mild to moderate intellectual and developmental disabilities (ID). One gap in the literature is whether there is a correlation between spirituality and self-esteem in individuals with mild to …

Decision Making And Pediatric Bipolar Disorder Assessment/Diagnosis: A Phenomenographic Study, Kristen Davies

Walden Dissertations and Doctoral Studies

Prior to the 1990s, bipolar disorder, a behavioral disorder characterized by severe mood fluctuations, was not considered an suitable diagnosis for children. However, in recent decades, an increase in pediatric bipolar disorder (PBD) diagnosis has occurred in the U.S. The purpose of this study was to explore the perceptions and lived experiences of licensed mental health clinicians regarding their decision-making processes used during assessment and diagnosis of PBD. This phenomenographic study utilized individual, semi-structured interviews to explore the perceptions and lived experiences of 14 licensed clinicians in the Commonwealth of Massachusetts who assess and diagnose PBD. Data were collected with …

Nurse-Physician Communication Tools To Enhance Use Of Nursing Evidence-Based Protocols, Tochi Onyenwe Ubani

Walden Dissertations and Doctoral Studies

Nurse-Physician Communication Tools to Enhance use of Nursing Evidence-Based Protocols

by

Tochi Onyenwe Ubani

MSN, Walden University, 2011

BSN, Chamberlain College of Nursing, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2015

In the current health care environment, consumers are demanding collaboration among clinicians even when traditional attitudes minimize nurses' input on the direction of clinical care. Compounding this problem is that nursing practices have not always been derived from randomized clinical trials, but instead from personal experiences. The purpose of this study was to explore the perceptions …

Implementing Bedside Shift Report: An Evaluation Of Change In Practice, Jessica Palumbo

Walden Dissertations and Doctoral Studies

Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey results from 2013 revealed a need for improvement in nurse-patient communication at the unit level. In response, nursing administrators at an acute-care hospital asked bedside nurses to develop a protocol for bedside shift report according to best practices. The protocol was implemented in May 2014. Three months later, a postimplementation survey was distributed. Work from Lewin and Kotter theoretical concepts were used to evaluate this organizational change. The purpose of this study was to determine whether re-educating staff nurses on the bedside shift report protocol increased compliance with evidence-based practice …

The Use Of Mock Code Training In Improving Resuscitation Response, Maureen Anne O'Brien

Walden Dissertations and Doctoral Studies

The American Heart Association's Get With the Guidelines (GWTG) has established measures for how quickly a resuscitation team is to respond in a cardiac arrest with performance of cardiopulmonary resuscitation (CPR) and defibrillation. Two of the core measures for GWTG require initiation of CPR within 1 minute of cardiac arrest and defibrillation within 2 minutes in at least 85% of cases. The problem of interest in this Doctor of Nursing Practice (DNP) project was that the facility had not been able to reach 85% on these 2 measures. The purpose of this project was to achieve nursing response times for …

Effects Of Telemedicine In The Intensive Care Unit On Quality Of Care, Amanda Wallace

Walden Dissertations and Doctoral Studies

The growing concern over the nursing shortage has affected the intensive care unit (ICU) and how these units provide quality care, adhere to best practices, and maintain high satisfaction scores. Implementing telemedicine technology allows the ICU to have additional staff available, via cameras at an offsite location, to assist with patient care. The purpose of this project was to evaluate the potential benefits of telemedicine application used within an ICU on quality of care, adherence to best practices, and satisfaction, as evidenced by data from the hospital's telemedicine dashboard. The goals of this project were to reduce length of stay, …

Identifying Risk Factors For High Incidence Of Peripheral Intravenous Catheters Complications: Reducing Infiltration Rate Within The Hospital, Janise Marrisette Banks

Walden Dissertations and Doctoral Studies

This study addressed an increasing number of peripheral intravenous catheter infiltrations within hospitals, leading to problems such as phlebitis and cellulitis, which may result in a longer length of hospital stay. The purpose of this project was to determine how to reduce infiltrations in order to increase the longevity of the catheter. A quantitative, description design was used, guided by Abdellah's classification framework for identifying nursing problems. The target population was 50 patients experiencing incidents of peripheral intravenous catheter infiltration, identified in a patient safety event log used across a 252-bed hospital. Each incident was assessed for several risk factors, …

A Comparative Study Of Compliance Among Patients Attending An Opiate Outpatient Treatment Center In Rural Appalachia, Jerry Russell Morris

Walden Dissertations and Doctoral Studies

Adults with an opiate addiction have a higher rate of noncompliance with treatment, which limits its effectiveness and increases the burden of care for society. Effective treatment decreases emergency room visits, and overdoses. The tristate area of Kentucky, West Virginia, and Ohio has experienced increased opiate-related arrests and deaths. This study sought to measure the extent to which treatment type (medical treatment (MS) or faith-based component of service (FBS)) predicts compliance when measured by number of clean urine drug screens (UDSs) and number of kept pill count, over and above dual diagnosis, college education, and income. The on-site records of …

Educational Intervention: Effects On Heart Disease Risk Factor Knowledge Among African Americans, Linda M. Smith

Walden Dissertations and Doctoral Studies

Abstract

Fatal coronary heart disease among African Americans is associated with a

disproportionate burden of cardiovascular disease (CVD) risk factors. Research has indicated that CVD risk factor knowledge and the prevalence of ideal CVH both persist at suboptimal levels. However, few researchers have investigated the relationship between culturally-tailored community-based heart health sessions, short-term knowledge acquisition of CVD risk factors, and the awareness of the American Heart Association's (AHA's) CVH construct. The purpose of this cross-sectional, secondary analysis study was to examine the interplay between these variables in an urban African American sample. Guided by social cognitive theory, the study analyzed …

Provider-Initiated Condom Education, Hiv, And Stds Among Older African American Women, Natasha Hall

Walden Dissertations and Doctoral Studies

Older African American (AA) women are at increased risk for HIV and STDs. The purpose of this quantitative study was to examine the influence of provider-initiated condom use education on condom use among unmarried, heterosexually active AA women aged 50 and over using the constructs of self-efficacy and attitudes of the health belief theoretical model. The relationships between provider education on condom use, condom use self-efficacy, condom use attitudes, and actual condom use were tested individually, and provider education on actual condom use was tested after controlling for condom use self-efficacy and attitudes among 95 study participants recruited primarily from …

Social Ecological Influences Of Wic Programming Behavior Change Of Former Wic Participants, Joyce L. Terrell

Walden Dissertations and Doctoral Studies

The Special Supplemental Women, Infants, and Children (WIC) Program is one of many United States Department of Agriculture's (USDA) food subsidy programs that serves 8.6 million participants, deemed nutritionally at risk. WIC is designed to influence nutritional and health behaviors to a population least capable of functioning. The purpose of this study was to identify if participation in WIC's nutrition education activities and restricted use of food subsidy benefits had a post-factorial effect on their nutritional behaviors. This study provides data on Bronfenbrenner's social ecological influences and how it impacts on long-term behavioral change. A quantitative causal-comparative design utilizing a …

The Effect Of A Drama On Young Adults' Attitudes About Domestic Violence, Regina Watson

Walden Dissertations and Doctoral Studies

Intimate partner abuse has been and remains a pervasive problem that has been documented in every race, religion, class, and level of education. This study presented the rationale for achieving positive social change by examining the problem through prevention rather than reaction and intervention. Although many theories of causation have been presented at various times, none has been proven or offers a complete explanation. Social ecological theory examines the interaction of individual, community, relational, and societal influences on the development of attitudes and behavior acceptance. This pre and post-survey group, quasi-experimental study examined the effects of an intervention on attitudes …

A Community Health Program To Reduce Cardiovascular Risk In Women, Xander Bacchus

Walden Dissertations and Doctoral Studies

Cardiovascular disease (CVD) is the leading cause of death among United States women. Regular aerobic exercise can significantly reduce CVD risk. This dissertation reflects one of the first studies of the efficacy of Community Health Programs (CHP) in promoting exercise among American women aged 25 to 65. Primary data used from a study involved a sample of 42 women aged 25 to 65 who attended a CVD and exercise-related CHP, while a 42-member control group merely received the CHP information in a printed form. A pretest was administered at the outset of the study, and a posttest was administered at …

Visual Arts And Chronic Pain: Thematic Analysis To The Artistic Statements Of Visual Artists, Susan Beth Janicke

Walden Dissertations and Doctoral Studies

The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. …

Parental Confidence In U.S. Government And Medical Authorities, Measles (Rubeloa) Knowledge, And Mmr Vaccine Compliance, Wendy Leonard

Walden Dissertations and Doctoral Studies

Parents' refusal to immunize their children with the measles, mumps, and rubella (MMR) vaccine has resulted in a surge of measles outbreaks in the United States. The purpose of this correlational study was to examine the relationships between parental knowledge and trust of the MMR vaccine, and their trust in government and medical authorities. The theoretical foundation for this study was the health belief model (HBM). This study determined if there was any relationship between general trust in doctors/governments (i.e., the predictor variable) and attitudes toward MMR vaccine (i.e., the sole dependent variable), and whether gender, age group, or level …

Correlation Analysis Of Climatic Variables, Migration And Dengue Cases In Southeast Florida, Brunilda Lugo

Walden Dissertations and Doctoral Studies

Dengue fever is a debilitating, viral, mosquito-borne disease occurring in tropical and subtropical areas in the world. The majority of dengue cases in the United States were acquired in endemic areas by travelers or immigrants. However, in recent years, autochthonous (locally acquired) dengue cases have been diagnosed in Florida. The purpose of this study was to find an association between potential risk factors and the expansion of dengue fever in the United States. Guided by the eco-bio-social framework, which offers a broad assessment of risk factors for the illness, a retrospective design was used with archival data to correlate changes …

Physicians' Perceptions And Practice Regarding The Prevention Of Catheter-Associated Urinary Tract Infections In The Icu, Marilyn Keng-Nasang Mbi Feh

Walden Dissertations and Doctoral Studies

Catheter associated urinary tract infection (CAUTI) incidence continue to rise despite all prevention efforts. The state of Georgia incidence of CAUTI between 2012 and 2013 showed an increase by 350 cases. The challenge is translating CAUTI prevention knowledge into practice by all physicians. The purpose of this correlational study was to improve the epidemiological understanding of CAUTI. Looking at physicians’ perception and practice of CAUTI preventions was necessary. A total of 336 physicians from the state of Georgia completed a 26-item survey. Additionally, a pilot study was conducted on a small sample of participants. The result of the Cronbach alpha …

Survival Analysis Of Total Therapy 3 In Newly Diagnosed Multiple Myeloma, Scott Edward Bowman Miller

Walden Dissertations and Doctoral Studies

Multiple Myeloma (MM) is a hematologic malignancy that accounts for approximately 1% of all adult cancers. This study investigated the impact of patient distance traveled to MM care sites, which was not considered in previous research on any disease-specific staging or prognostic schema despite evidence suggesting that distance impacts patient outcome. This study investigated the impact of patient distance from the site of care on survival outcomes using a group of 480 clinical trial participants. Andersen's behavioral model of health services use functioned as the theoretical model for this study. The independent variable was patient travel distance, controlling for established …

The Impact Of Self-Imposed Barriers On African Americans Successes, Pennie L. Murray

Walden Dissertations and Doctoral Studies

Researchers and economists have argued that the economic and social stagnation of African Americans is the result of their lack of self-confidence, initiative, and commitment toward their own advancement. This qualitative study examined whether historical conditioning and personal experiences have created a hypersensitivity in this population to events triggering behaviors that mirror the success fearing personality when seeking social, economic, and political advancement. It used Zuckerman and Allison's fear of success scale to identify the range of success fearing in 30 African American men and women aged 35 years or more; this group was also interviewed regarding their lived experiences …

Effect Of Placard Grading On Food Safety In Retail Food Facilities, Christopher Ogbonna Ogbu

Walden Dissertations and Doctoral Studies

Most people have had an episode of foodborne illness at one time or another; however, the majority of those stricken with foodborne illness fails to associate ill health with something consumed within the past 72 hours. The World Health Organization (WHO) estimates that foodborne diseases affect 30% of the population in developed countries, and that in developing countries, about 2 million people die yearly due to foodborne illness. Previous researchers have indicated that food handlers with poor personal hygiene are potential sources of infection. Although public health agencies in many countries already regularly inspect food facilities to control potential foodborne …

Health Education To Decrease Obesity In Adolescents With Asthma, Mitzie Eumarie Thomas

Walden Dissertations and Doctoral Studies

Obesity increases asthma severity and is costing the health care industry a significant amount of money. Decreasing adolescents' obesity will decrease the risk for chronic health problems, which can have a significant impact in adulthood. Implementing a school-based health education program can decrease the prevalence of obesity amongst adolescents. This program will be implemented by school nurses in the after-school program at Public School 59 (P.S) in New York City. The purpose of this project is to develop adolescents' school-based obesity prevention policies and documentation which will focus on increasing their nutrition education, increasing physical activities, and providing skills to …

U.S. Army Enlisted Soldiers' Adherence To Prescribed Malaria Chemoprophylaxis In Afghanistan, Michael Paul Brisson

Walden Dissertations and Doctoral Studies

Over the past 13 years, the United States Army has been engaged in armed conflict within Afghanistan. Unfortunately, the United States Army has been forced to evacuate soldiers from the battlefield because of malaria, a parasitic disease that is endemic in Afghanistan. Even though the U.S. Army has adopted an effective chemoprophylaxis protocol, soldiers' adherence to their prescribed medication has been historically low. This research addressed a gap in literature regarding the adherence rates of U.S. Army enlisted soldiers to their prescribed oral malaria chemoprophylaxis. In addition, this research investigated self-reported reasons for soldiers' nonadherence to this medication. The study …

Massage Therapy Effects On Pain And Distress/Anxiety In Breast Cancer Patients, Tanya Brigitte Buchrieser

Walden Dissertations and Doctoral Studies

Pain and distress/anxiety are likely to result from breast cancer and/or the medical treatment associated with this illness. Breast cancer researchers have focused on massage therapy and its influence on pain and distress in breast cancer patients; however, these research efforts were limited by small sample sizes, homogeneous populations, and small to medium effect sizes. This study explores the effectiveness of massage therapy for decreasing pain and distress in a larger, heterogeneous population of breast cancer patients and across all durations and frequencies of treatment by pooling the findings of former studies. The gate control theory which relates to the …

Chlamydia Trachomatis And Neisseria Gonorrhoeae: Impact Of Health Literacy On Prevalence, Patricia Alice Abshier

Walden Dissertations and Doctoral Studies

Millions of dollars are spent each year on preventing sexually transmitted diseases (STDs), yet the rates of chlamydia trachomatis (chlamydia) and neisseria gonorrhoeae (gonorrhea) infection continue to be high. Health literacy and its impact have been recognized in diabetes maintenance, control of hypertension, medical adherence, and reproductive health outcomes, yet no research has been conducted regarding the relationship between health literacy and chlamydia and gonorrhea prevalence. This study examined the relationship between health literacy scores and chlamydia and gonorrhea prevalence health literacy scores and reproductive health/STD knowledge, and reproductive health/STD knowledge and chlamydia and gonorrhea prevalence. Participants included 114 women …

Reasons For Living And Self-Reported Suicidal Behavior Among A Sample Of U.S. Army Personnel, Deborah Elaine Willis

Walden Dissertations and Doctoral Studies

Suicidal Behavior in the U.S. Army is a problem that persists despite significant efforts to promote help-seeking behaviors and the investment of millions of dollars to develop resilience-building interventions. Evidence-based literature supports the use of reasons for living as a protective factor against suicidal behavior in clinical and nonclinical samples, yet it has rarely been studied in an active duty (AD) Army population. This study examined the relationship between self-reported reasons for living and self-reported suicidal behavior, to determine if high levels of reasons for living correlated with low risk of suicidal behavior, over and above demographics, depression, stressful life …

Chronic Care Model Staff Education And Adherence With End-Stage Renal Disease Patients, Emilia K. Addo

Walden Dissertations and Doctoral Studies

The management and treatment of chronic diseases, such as end-stage renal disease, is often unproductive because of patients' poor adherence to treatment. The chronic care model toolkit is an Agency for Healthcare Research and Quality supported framework, associated with improved outcomes in patients living with chronic disease. The purpose of this project was to develop and plan an educational program using the chronic care model toolkit for the interdisciplinary clinical staff of a renal hemodialysis center. The goal of this project was to adapt team building between patients and their clinicians through the use of the chronic care model in …

Adult Attachment And Relationship Satisfaction Among Men Who Experienced Childhood Abuse, Selisha Nelson

Walden Dissertations and Doctoral Studies

Experiences of childhood physical and sexual abuse among men have not been sufficiently studied because many men are not forthcoming about experiences of abuse. This abuse is linked to aggressive behaviors, difficulty developing and maintaining close relationships, and various psychological disorders. Current research has not fully examined relationships between childhood abuse, adult attachment, and levels of relationship satisfaction among men. The purpose of this nonexperimental quantitative study was to evaluate the relationship between adult attachment as measured by the Relationship Scales Questionnaire and relationship satisfaction as measured by the Couples Satisfaction Index among men abused during childhood. Bowlby's theory of …