Medicine and Health Sciences Commons^™

Lived Experiences Of African American Women Coping With Breast Cancer In Rural Northeastern North Carolina, Denise Germaine Belle

Walden Dissertations and Doctoral Studies

This qualitative study examined the phenomenology of breast cancer among seven African American female participants who reside in rural, medically underserved communities in Northeastern North Carolina. The aim of this descriptive study was to explore the answers to the overarching question of how African American women with breast cancer self-manage the emotional, physical, financial, and social issues associated with the diagnosis and treatment. The transactional model of stress and coping provided the theoretical framework for examining the role of social reinforcements, beliefs, attitudes, and intentions on the health behavior of African American women with breast cancer in some rural, resource-stricken …

Emergency Encounters: A Cross Sectional Study Of A Rural Emergency Room, Selynto Rodrecca Anderson

Walden Dissertations and Doctoral Studies

It is very difficult for certain populations to obtain access to healthcare within the United States, particularly in rural areas. Typically, individuals who live in rural areas are far less healthy than those who live in more urbanized areas. Although there have been some improvements made to ensure there is adequate health care for all, barriers still exist. A few examples of these barriers are socioeconomic status, education, and job status. In this study, adult patients from a rural Southeastern hospital were surveyed via those who came to the emergency room seeking care, and via those who came to the …

Understanding The Role That The Internet And Social Media Plays In Suicide Survivor Bereavement, Catherine Merle Perusse

Walden Dissertations and Doctoral Studies

Every year more than 47,000 individuals die by suicide in the United States, leaving behind numerous family and friends who become suicide survivors. While there are prodigious amounts of research on suicidal behavior, little research has focused on what the surviving family members, friends, and community members need after the loss. Many suicide survivors use social media to address their grief and pain in a very public manner. A constructionist social theory of grief and existential phenomenology provided the framework for this qualitative study to examine the use of the Internet and social media as a forum for those grieving …

Effect Of Video Recording And Self-Reflection On Skill Acquisition In Nursing Students, Lisa Aloy

Walden Dissertations and Doctoral Studies

Applications to nursing programs have grown at exponential rates causing a shortfall of clinical locations and lack of available clinical experiences. This negatively affects nursing students’ access to bedside patient care, affecting nursing students’ ability to safely learn and practice basic nursing skills. Nurse educators need to create robust learning experiences for students to learn basics nursing skills and gain confidence and competence in these skills. Video recording in nursing education is an underutilized teaching method that supports various aspects in student learning of skill acquisition. The purpose of this study was to explore Associate Degree Nursing (ADN) nursing students’ …

The Impact Of Community Churches And Barbershops On Preventive Care Utilization Among African American Men, Quiante Chappell Hager

Walden Dissertations and Doctoral Studies

Preventive health care screening plays an essential role in reducing chronic diseases and mortality rates; yet, even as health care access has increased, African American men’s utilization of preventive screenings remains low in rural areas. The purpose of this qualitative case study was to investigate why African American men are not utilizing preventive care services and ascertaining the impact that social determinants may have on their utilization of these services. The theoretical framework of this research study comprised the social-ecological modal and health belief model to investigate the barriers to preventive care utilization in the African American community. Twelve African …

Increasing Nurse Knowledge Of The Underutilization Of Hospice Services For African Americans, Vicki Schmidt

Walden Dissertations and Doctoral Studies

The focus of this doctoral project was increasing knowledge of underutilization ofhospice services for African Americans (AAs) and the need to increase cultural competence among nurses regarding this issue. The identified gap in practice was nurses’ lack of cultural competence and knowledge regarding the underutilization of hospice specific to AAs. The practice-focused question focused on whether a staff educational intervention increased nurses’ knowledge of the cultural implications regarding the introduction of hospice services for AAs. The education was guided by the Purnell model for culturally competent health care, Healthy People 2030, and the National Hospice and Palliative Care Organizations AA …

Clinical Practice Guidelines For Community-Based Resources For Substance Abuse Patients In An Emergency Department, Julie Ann Thompson

Walden Dissertations and Doctoral Studies

Substance use disorder (SUD) has plagued the United States for decades and has been an ongoing issue in a Midwest hospital emergency department where SUD patients were provided discharge information that did not include SUD specific recovery and rehabilitation resources available in the community. The purpose of this project was to develop a clinical practice guideline (CPG) for nurses to use when discharging a SUD patient with an accompanying evidence-based recovery and referral resource list including Narcan, medication-assisted treatment, crisis hotlines, needle exchange programs, and treatment options. The Johns Hopkins Nursing Evidence-Based Practice framework was used to grade the levels …

Understanding Resilience Among Individuals With Adverse Childhood Experiences (Aces), Meghan Larson

Walden Dissertations and Doctoral Studies

Adverse childhood experiences (ACEs), such as abuse, neglect, and dysfunction in a child’s home are considered a public health crisis due to their correlation to health disparities and psychosocial problems in adulthood such as substance use, relationships, education, and maintaining employment. However, some individuals are resilient and demonstrate the ability to adapt and function well despite experiencing adverse events. To better understand resilience when ACEs are present, I conducted a basic qualitative research study to explore the lived experiences of individuals in Tennessee with elevated ACE and resilience scores. A purposeful sample of 12 participants who scored high on ratings …

The Lived Experiences Of African American Nurses In South Carolina Emergency Rooms, Debra A. Dixon

Walden Dissertations and Doctoral Studies

The underrepresentation of African American (AA) nurses in South Carolina (SC) emergency rooms (ERs) may affect quality patient care for AAs and all other patients in culturally diverse populations. This qualitative interpretive (hermeneutic) phenomenological study explored the lived experiences of AA nurses in several SC ERs concerning quality patient care in culturally diverse populations. Herzberg's two-factor theory and Maslow's hierarchy of needs theory framed the study. The research question investigated the lived experiences of AA ER nurses in SC ERs concerning quality patient care in culturally diverse populations. Interpretive phenomenology was used to gain insight from a sample of 17 …

Diabetes Management And Self-Perception Of Health Among Adults In The United States, Moses Ajoku

Walden Dissertations and Doctoral Studies

The burden and complications of diabetes have been a public health concern and societal challenge for decades, and the rate of prevalence is projected to increase in the future. The study aims to examine the association between blood glucose monitoring, glycated hemoglobin test, and self-perceived health status among diabetic adults in the United States. Guided by the chronic care model, the study used data from the 2019 Behavioral Risk Factor Surveillance System to investigate diabetes management practices among diabetic adults in the United States. Quantitative and cross-sectional methods were used to assess the associations between diabetes management practices and self-perceived …

Association Between Food Insecurity And Influenza Outcome In The United States., Sabrina Fiona Pink

Walden Dissertations and Doctoral Studies

AbstractThe influenza virus is one of the most commonly occurring respiratory viral infections in the world. The outer capsule of the virus contains 18H proteins and 11N proteins, which allows the virus to reform in over 100 different strands and outperform the vaccine. Despite efforts to improve access to care and reduce vaccine inequities; the Center for Disease Control and Prevention estimates 9-45 million documented influenza-related illnesses, 140,000 to 810,000 hospitalization, and 64,000 deaths yearly. The purpose of this study is to investigate whether food insecurity, access to care and other social determinants of health such as age, race, and …

Reimbursement Of Mental Health Service For Individuals Seeking Services At Primary Care Facilities, Keith Avant

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to explore the relationship between primary care services, mental health services, patient visits, and insurance reimbursement for individuals with a mental health diagnosis who visit primary care facilities. The theoretical integrated theory of health behavior changes has been vital in identifying the contributing factors to the relationship between primary care, mental health services, and insurance reimbursement. The research questions explored whether any relationship existed between mental health diagnosis and office visits, outpatient versus inpatient, the amount paid for treatment, and reimbursement of services. This study used a quantitative approach along with a Pearson …

The Predictive Relationship Of Allostatic Load In Asthma, Mohamed Mustafa Hassan

Walden Dissertations and Doctoral Studies

Research on populations emphasizes the influence of allostatic overload, a marker of biophysical and biochemical stress, in driving adverse health outcomes. Unknown is the impact of allostatic load and its cardiovascular, metabolic, and inflammatory components as they pertain to asthma prevalence in U.S. populations. Specifically, there is a need to understand the nature of the relationship between allostatic load and asthma in light of confounders such as socioeconomic status, race, education, and gender. Using Bronfenbrenner’s bioecological model as a theoretical underpinning and binary logistic regression as a statistical modality, the predictive relationship between allostatic load and asthma was examined in …

Relationship Between Social Support And Childhood Trauma On Resilience, Carol Krieger

Walden Dissertations and Doctoral Studies

People who have not overcome childhood trauma and who have developed mental illnesses have difficulties dealing with life challenges. The purpose of this quantitative study used a correlational design to test any relationship between childhood trauma experience levels and resilience against life challenges in adulthood. The theoretical framework used for this study was Barnes’ social support theory. Data were collected from 104 participants over a 7-week period. Participants voluntarily answered the ACE questionnaire, 2-way support scale, and resilience scale. Key results indicate that people with mental illness who receive social support are positive impacted by that support. Receiving adequate levels …

Staff Education To Improve Pain Management In Skilled Nursing Patients, Keitta Evans

Walden Dissertations and Doctoral Studies

One of the key ethical principles in nursing is the promotion of health and wellness and ensuring that patients are free from unnecessary pain and suffering. It is estimated that at least 65% of patients in skilled nursing centers in the United States report the presence of pain, indicating that there are opportunities for improvement with effective pain management within this practice setting. A key factor that has been identified as an opportunity for improvement is education for clinical staff who practice within this setting. This Doctorate of Nursing Practice (DNP) project provided education to a group of clinical team …

Nursing Interventions For Reducing Falls Among Older Adults On Polypharmaceutical Agents, Kevin O. Onuekwusi

Walden Dissertations and Doctoral Studies

In the United States, the cost of treating a resident of a long-term care facility (LTC) after a fall with injury is between $10,000 and $26,000. Current nursing interventions for fall prevention among older adults aged 65 years and over at the local LTC do not address the risk of polypharmacy and are focused on environmental and intrinsic factors. The purpose of this systematic literature review was to find the nursing interventions that have been used to reduce falls in older adults aged 65 years and over in nursing homes and LTCs who are on polypharmaceutical therapy. Primary research articles …

Perspectives Of Key Court Personnel On The Prosecution Of Domestic Violence Cases, Crystal M. Schoeder

Walden Dissertations and Doctoral Studies

Domestic violence (DV) continues to be a public health and criminal justice problem. Several criminal justice system changes have been made to combat DV, such as mandatory arrest policies, no-drop prosecution policies, and specialized DV courts. Perspectives on these policies, DV, and the criminal justice system have been obtained from the victims, police officers, and victim advocates. However, perspectives from those within the criminal justice court system are missing. The purpose of this qualitative phenomenological study was to obtain the perspectives of key court personnel in small rural communities regarding the prosecution of DV cases. Narrative policy framework was used …

Caring For The Caregiver: Second Victim Recovery Following A Serious Medical Error, Beulah Patrice Vance

Walden Dissertations and Doctoral Studies

In 1999, it was estimated that 98,000 deaths were attributed to medical errors and were the fourth most common cause of death in the United States. In 2016, medical errors were estimated as the third leading cause of death, with a mean death rate of 251,454 each year. Nurse involved in errors are known as second victims. Almost one in seven staff members reported that they had experienced a patient safety event within the last year that caused personal problems such as anxiety, depression, or concerns about their ability to perform their job. This project explored whether nurses are able …

Food Insecurity In Community College Students In The Central Valley Of California, Leah Carter

Walden Dissertations and Doctoral Studies

AbstractMany college students struggle with having enough money to pay for the costs of college and basic necessities, such as adequate food, which leads to food insecurity. Food insecurity results in a more challenging time focusing on studying and less success in school. This study addressed the lack of a profile of a food-insecure California community college student at Hiker’s Community College (HCC; pseudonym) in the Central Valley of California. The purpose of this quantitative study was to determine the profile of a food-insecure student and to determine relationships between food insecurity and ethnicity, gender, being a first-generation college student, …

Comparative Analysis Of Systemic Lupus Erythematosus Support Group Type On Quality Of Life, Mary Louise Giles

Walden Dissertations and Doctoral Studies

When individuals are diagnosed with systemic lupus erythematosus (SLE), they tend to go through emotional, psychological, and physical anguish that requires support. Studies have shown that a support group can provide SLE patients with an outlet in which they can share firsthand feelings and experiences and receive emotional support but it is not known if how the individual with SLE accesses online or face to face support makes a difference. The purpose of this study, guided by the Chronic Care Model, was to determine if there were differences in quality of life (QoL) for persons with SLE participating in an …

Increasing Access To Diabetic Self-Management Education Using Telehealth In Rural Kentucky, Gina Good

Walden Dissertations and Doctoral Studies

The lack of diabetic self-management education (DSME) can affect generations of families who have suffered from diabetes. More than 80% of Appalachian Kentucky counties lack access to DSME and care due to high incidence of diabetes. The purpose of this quality improvement project was to determine whether the use of telehealth increased patient access to DSME in Southeast Kentucky. Application of Peplau’s theory of interpersonal relations to patient relationships in nursing practice provided a framework for the project. De-identified retrospective data 6 weeks before intervention and 6 weeks postintervention were collected by the project facility for secondary data analysis to …

Creating A Pain Management Clinical Practice Guideline For Hospice Patients, Tiffany Ann Bowland

Walden Dissertations and Doctoral Studies

Current evidence-based research shows that pain in hospice patients is a growing problem. A gap in practice was identified as the current clinical practice guideline (CPG) in a hospice center in South Carolina was outdated and not being employed. A literature review revealed that updated CPGs provide better outcomes in pain management for end-of-life care. The project answered the practice-focused question: In the context of hospice, what are current evidence-based strategies for managing pain. The Stettler model and Kolcaba’s comfort theory guided the development of the CPG. Three nurse case managers and two physicians participated in the creation of CPG. …

Clinical Practice Guidelines For Assessing And Reporting Workplace Violence Against Nurses, Janice Lynn Canfield

Walden Dissertations and Doctoral Studies

AbstractWorkplace violence consists of physically and psychologically damaging actions while on duty. In healthcare, under a cloak of secrecy concerning workplace violence, an underreported epidemic exists. This problem is important to address because workplace violence can affect the quality of care delivered and patient care outcomes.. The purpose of this project was to develop a nursing clinical practice guideline (CPG) to assist hospital-based nurses to identify risk factors for workplace violence, identify strategies to mitigate violence, and report workplace violence. This CPG can be an effective tool for nurses to better understand the scope and nature of violence in the …

The Impact Of Inpatient Boarding In North Carolina Emergency Departments, Miracle Howard

Walden Dissertations and Doctoral Studies

Currently, emergency department overcrowding has negatively impacted hospitals' financial, operational, and organizational performance globally. A contributing factor to emergency department overcrowding includes the delay of the throughput process for patients who have a time-sensitive diagnosis and are admitted to the emergency department. This causes adverse hospital outcomes such as longer length of stays and increase hospitalization cost. This study utilized secondary data to address a relationship between admitted patients who have time-sensitive diagnoses such as chest pain and chronic obstructive pulmonary disease within North Carolina emergency departments and length of stay, utilization of services, and overall hospital cost. The conceptual …

Nurse-Patient Ratios And Falls In The Acute Care Setting: A Staffing Educational Program, Trinia Shawell Williams

Walden Dissertations and Doctoral Studies

AbstractThe correlation between patient falls and nurse-patient ratios in acute care has been a prevalent topic for decades. The lack of nurse-patient ratio guidelines to direct nurse staffing has restricted nursing leaders’ efforts to address this issue. The purpose of this staff education project was to educate nursing leaders on nurse-patient ratios and their association to patient falls. The practice-focused question centered on whether education would increase nursing leaders’ knowledge about appropriate staffing ratios and practices to reduce falls at a long-term acute care facility. Rogers’s diffusion of innovations theory was the change model used to guide this project. There …

Exploring The Effects Of Generation And Leadership Style On Nurses’ Organizational Commitment, Kim M. Hedley

Walden Dissertations and Doctoral Studies

There is an impending shortage of nurses; therefore, healthcare leaders must use strategies that promote staff nurses’ organizational commitment (OC) to retain a clinically competent workforce. The purpose of this quantitative descriptive cross-sectional study guided by the transformational leadership theory and generational theory was to determine whether OC differs according to generational cohort (GC) and leadership style (LS) and then explore the combined effects of GC and LS on staff nurses’ OC. One-hundred sixty acute care staff nurses in the United States responded to the survey that included the Multifactor Leadership Questionnaire 5x-Short and Three-Component Model Employee Commitment Survey. A …

Effects Of Education On Rural Emergency Department Preceptors’ Self-Efficacy And Knowledge, Katherine Marie Jasper

Walden Dissertations and Doctoral Studies

The Emergency Nurses Association recommends nurse preceptorship programs for emergency departments (EDs) to give nurses the skills needed for precepting new nurses; however, many rural areas do not have nurse education for preceptorship, and no standardized training is available for preparing preceptors for their roles. Rural ED preceptors therefore lack knowledge and skills needed for precepting new nurses. The purpose of this study, guided by Benner’s skill acquisition and self-efficacy theory, was to determine if there were significant differences in 33 rural ED nurse preceptors’ knowledge and self-efficacy after they completed an online informational PowerPoint presentation. The PowerPoint education program …

Black Mothers’ Birthing Center Experiences And Exclusive Breastfeeding Practices, Natashia King-Conner

Walden Dissertations and Doctoral Studies

The persistence of racial disparities in breastfeeding is associated with a range of interconnected factors, such as historical, cultural, social, social, and psychological. The current gap in the prevalence of exclusive breastfeeding among Black mothers and White mothers has led to rising concerns in the United States. A basic qualitative approach was used to conceptualize the multidimensional constructs of the social–ecological model to investigate the individual, interpersonal, institutional, and community-level structures and existing policies in birthing centers that inadvertently harbor biases that impede care for Black mothers. Data were gathered through purposeful sampling and semistructured interviews with 10 Black mothers …

A Systematic Review Of Tobacco Cessation Strategies Tailored For Military Personnel, Ni Ketut Supiyati

Walden Dissertations and Doctoral Studies

AbstractA Systematic Review of Tobacco Cessation Strategies Tailored for Military Personnel by Ni Ketut Supiyati

MS, Walden University, 2000

Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice

Walden University August 2021

The Importance Of Staff Education About Implementing Ketogenic Diet In Prediabetic Patients, Clarissa L. Dorsey

Walden Dissertations and Doctoral Studies

Diabetes, a chronic disease that can lead to many complications, is one of the leading causes of death. Obesity tends to increase the risk of diabetes. Nutritional therapy can not only control diabetes but also prevent it in some cases by decreasing weight. The ketogenic diet is a low-carbohydrate, high-fat diet that can prevent and control diabetes. The purpose of this study was to examine the recommendations of medical providers before and after the presentation of educational content on the ketogenic diet as nutritional therapy in prediabetic and diabetic patients. The practice-focused question addressed whether educating medical staff at a …