Medicine and Health Sciences Commons^™

Leadership, Quality Improvement, Team Functionality, And Hiv Viral Load Suppression In Uganda, Esther Karungi Karamagi Nkolo

Walden Dissertations and Doctoral Studies

Low viral load suppression rate is a significant public health issue in Uganda and similar countries. A nationwide quality improvement (QI) initiative was implemented from January 2019 to improve viral load suppression. Although QI team characteristics have been shown to influence the success of such QI initiatives, no studies have been found to understand how they influence the success of QI efforts to improve HIV viral load suppression in Uganda. The purpose of this cross-sectional, quantitative study was to determine whether there is a significant association between HIV clinic leader involvement in QI teams, QI team functionality, QI team diversity, …

Examining The Factors That Lead To Latinas Stopping Breastfeeding Across The United States, Dulce Ruelas

Walden Dissertations and Doctoral Studies

Breastfeeding is the optimal nutrition for an infant, yet only 25.4% of women in the United States decide to breastfeed. A Latina's choice for infant feeding must be made with accurate information as breastfeeding may reduce infant mortality and decrease chronic conditions such as obesity, depression, and diabetes. The study's purpose was to examine if Latinas are influenced by suggestions to not breastfeed by family members and health care providers or by events that may have happened at the hospital. Grounded in the theory of planned behavior, this study reviewed if social influences, marital status, and maternal education link to …

Relationship Between Nurse Job Satisfaction Variables And Voluntary Turnover Intention, Mmayen Monday Nnah

Walden Dissertations and Doctoral Studies

Increased turnover among hospital nurses has adverse business outcomes. Hospital nurse managers are concerned with minimizing turnover to reduce hospital costs, lower risk to patients, and positively impact hospital performance. Grounded in motivation-hygiene theory, the purpose of this quantitative correlational study was to examine the relationship among nurses' views of the quality of work environments, level of management support, opportunities for promotion, and nurses' voluntary turnover intentions. Data were collected from nurses with registered nurse status or a bachelor of science in nursing degrees working in hospital settings in the United States (N = 82), who completed the Job Satisfaction …

Type 2 Diabetes Prevention And Management Educational Toolkit, Theresa O. Orjiakor

Walden Dissertations and Doctoral Studies

AbstractDiabetes is one of the chronic diseases that are challenging to prevent and manage. Approximately 8.3% of the United States' population has type 2 diabetes. One of the primary challenges in managing the disease entails reducing the associated financial and human costs by preventing new cases and enacting social change. Prevention and management education programs using enhanced toolkit may have positive effects on type 2 diabetes patients, who start enjoying a good quality of life, as well as positive social change in their communities and families. The purpose of this project was to develop and evaluate a type 2 diabetes …

Nursing Clinical Practice Guideline Development For The Care Of Sexual Assault Survivors, Elssy J. Bingham

Walden Dissertations and Doctoral Studies

Sexual assault, a form of sexual violence, is an egregious crime that continues to be a serious and significant public health problem which affects millions of people each year in the United States and globally. Sexual assault may have lasting and devastating negative physical and emotional consequences. Knowledgeable nurses can have a positive impact on a survivor’s safety and recovery. The purpose of this project was to develop a Clinical Practice Guideline (CPG) for nurses who provide the initial care when patients present in the emergency room following sexual assault. The conceptual framework used for this project included Knowle’s Theory …

Program Evaluation Of A Home-Based Primary Care Practice And Patients With Heart Failure, Anne Rose Walsh

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects over 5.5 million adults in the United States with a prevalence of 10%'€“20% in older adults and accounts for 3% of all hospital admissions with a readmission rate as high as 25% within 1 month of discharge. Patients with HF account for approximately 42% of the doctor of nursing practice project site's patient population, and the health system has a 30-day readmission rate of 35% for patients with HF in 2 large hospitals. Thus, the health system loses almost $13 million per year in Medicare penalties. This retrospective quality improvement project reviewed the effectiveness of care …

Pressure Injury Prevention In An Urban Surgical Intensive Care Unit, Kayma P. Ricks

Walden Dissertations and Doctoral Studies

Hospital-acquired pressure injuries (HAPIs) affect approximately 2.5 million patients in the

United States, annually. Prevention requires surgical intensive care unit (SICU) nursing staff to

effectively use evidence-based risk assessment measures to appropriately identify patients at risk

for developing HAPIs and to prevent poor patient outcomes. The Braden Scale risk assessment

tool has demonstrated reliability and validity in the prediction and assessment of patients at risk

for the development of HAPIs. The purpose of this Doctor of Nursing Practice (DNP) project

was to improve nurses’ knowledge of the appropriate use of the Braden Scale risk assessment

tool in the SICU of …

Strategies To Retain Mental Health Workers In Community Mental Health Clinics, Debbie L. Young

Walden Dissertations and Doctoral Studies

In 2017, the United States employee turnover rate for mental health workers with 2 or more years of experience was more than 50%. High turnover rates among these mental health workers are associated with inadequate quality of care for patients with mental health issues in community mental health clinics. Grounded in Herzberg’s two-factor theory, the purpose of this qualitative multiple case study was to explore retention strategies used by health care administrators to retain their mental health workers with more than 2 years of experience. The participants consisted of 6 health care administrators who successfully implemented strategies to minimize high …

Managing Disruptive Patient Behaviors In A Mental Health Clinic: A Staff Education Program, Mary Odusanya

Walden Dissertations and Doctoral Studies

Disruptive patient behavior is a significant issue in healthcare. Staff education programs are beneficial in managing disruptive patient behaviors. There has been an increase in the occurrence of disruptive patient behaviors at the clinical site, which is an outpatient mental health clinic, and staff members are not well equipped to deal with these situations. The purpose of this project was to develop, implement, and evaluate a staff education program on how to manage disruptive patient behaviors in an outpatient mental health clinic. Using a pre- and posttest design, the project aimed to answer the question of whether a staff education …

Rural Practical Nursing Students' And Faculty Members' Perceptions Of Supports And Barriers To Success, Amy J. Randall-Mcsorley

Walden Dissertations and Doctoral Studies

Practical nursing program students at a rural vocational school (RCC) in the midwestern United States were graduating at a low rate that was putting the school at risk to not meet accreditation standards set by the Council on Occupational Education. The purpose of this study was to explore the perceptions of practical nursing program students and faculty at RCC about institutional, situational, and dispositional supports and barriers students faced toward graduation. The conceptual framework, Cross’s model of barriers to adult learning, was used to identify institutional, situational, and dispositional supports and barriers. A bounded case study design was employed to …

Addressing Cardiovascular Disease Among Populations Disproportionately Impacted In The United States, Michael Leron Sells

Walden Dissertations and Doctoral Studies

Cardiovascular disease (CVD) causes the most deaths in the United States and is disproportionately impacting certain groups more than others. A gap in the research exists when focusing on national data for those who bear the highest burden of CVD amongst people with hypertension when cardiovascular morbidity and mortality are examined. There is also a need to investigate the relationships between key indicators for CVD health disparities in people with hypertension. The purpose of this quantitative study is to investigate the cumulative effect of key health disparities indicators such as race, age, gender, education, and income using national-level surveillance data …

Effectiveness Of Education On Modified Early Warning System For Nurses, Shanmugavalli Janakaraj

Walden Dissertations and Doctoral Studies

The research problem at the practicum site was a delay in recognizing patient’s deterioration due to lack of nurses’ knowledge with early warning signs. It is important to address the problem as the Quality Department noted the delay in identification of patient decline and treatment from mortality case reviews, rapid response team and Code Blue debriefing analysis and missed sepsis identification. A further gap analysis revealed an inadequacy of staff knowledge with warning signs. The purpose of this project was to educate nurses on the Modified Early Warning System (MEWS), a patient assessment scoring system based on six physiological parameters. …

An Interpretive Qualitative Study Of Idaho Head Start Families Facing Food Insecurity, Sherry Deiter

Walden Dissertations and Doctoral Studies

The purpose of this basic interpretive qualitative study was to examine food insecurity among Idaho Head Start enrolled families, focusing on barriers and deterrents to accessing available nutrition assistance programs. The social-ecological model (SEM) was used as the theoretical foundation for this study. Based on this model, the research questions were designed to explore experiences of participants related to individual, interpersonal, community, organizational, policy, and educational factors that influenced food insecurity. Parents who had children enrolled in Idaho Head Start programs that met purposeful sampling criteria were recruited for the study. A total of 11 parents, all who had experiences …

Perceptions Of Health Care Professionals Providing Smoking Cessation In Health Care Settings, Dr. Tenishia Tamika Edwards

Walden Dissertations and Doctoral Studies

Tobacco use affects many individuals in the United States and around the world, particularly those who have existing health disparities. Smoking cessation therapy is a process used by health care professionals (HCPs) to help aid in the reduction or elimination of tobacco use. HCPs providing this service in health care settings can reach patients directly while helping to decrease the mortality rate in those who use tobacco. The purpose of this phenomenological qualitative study was to identify HCPs’ perceptions of patient barriers to adherence to smoking cessation services and what can be done to improve smoking cessation in health care …

Accelerated Baccalaureate Nursing Student And Faculty Perceptions Of Blended Learning, Emily Elliott

Walden Dissertations and Doctoral Studies

In response to the demand for baccalaureate-educated nurses, nursing schools offer an accelerated baccalaureate of science in nursing (BSN). The problem is nursing programs have used blended learning approaches, but it is unclear whether and in what ways accelerated BSN students benefit from this learning design. The purpose of this qualitative case study was to explore how faculty and students perceived the benefits and challenges of an accelerated BSN program utilizing a blended learning format. Knowles’s adult learning theory served as the conceptual framework through which interview data were analyzed. Participants included 6 faculty and 7 students from 1 school …

The Effectiveness Of The Biopatch Disc In Decreasing Mrsa In Peripherally Inserted Intravenous Catheters, Ketha Franklin

Walden Dissertations and Doctoral Studies

Methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant bacterial infection, is a pressing global health care issue that decreases patients’ quality of life and places a high burden on health care delivery systems. The purpose of this quality improvement evaluation project was to evaluate an infection prevention management program derived from evidence-based research to decrease the incidence of MRSA in peripherally inserted intravenous catheters (PIVs) in acute care settings through the utilization of the Biopatch disc. The practice-focused question addressed whether the use the Biopatch disc over a 6-month period in acute care would coincide with a reduction of the incidence of MRSA …

Evaluating Integrated Treatment On Recidivism For Female Offenders In Criminal Justice System, Oyin T. Popoola

Walden Dissertations and Doctoral Studies

The burden of co-occurring disorders (CODs) among offenders in the criminal justice system (CJS) in the United States, particularly among the female population, is threatening the communities. About 80% of women in the CJS were diagnosed and treated for CODs, and 63% tend to be rearrested. The study examined the possible influence of CODs, integrated treatment of CODs, and gender, on recidivism while controlling for other demographic factors. The study was based on the conceptual framework of integrated dual disorder treatment (IDDT) and feminist criminology theory. Cross-sectional quantitative study design was applied on a secondary dataset from the 2017 Treatment …

Utilization And Impact Of Peer-Support Programs On Police Officers’ Mental Health, Beth A. Milliard

Walden Dissertations and Doctoral Studies

Police officer suicides rates hit an all-time high in the province of Ontario, Canada, in 2018. Sadly, this statistic is somewhat unsurprising, as research has shown that police officers suffer from higher rates of mental health disorder diagnoses compared the general public. One key reason for the elevated levels of suicide and other mental health issues among police officers is the stigma associated with seeking help. In an attempt to address these serious issues, Ontario’s police services have begun to create internal peer-support programs as a way of supporting their members. The present research explores the experiences of police officers …

Congestive Heart Failure And Strategies To Improve Quality Of Life, Esther Akunna Okorie

Walden Dissertations and Doctoral Studies

Congestive heart failure is a global, chronic, progressive, and debilitating disease affecting mostly older adults. The multiple complications associated with the health issue led to readmissions and markedly reduced ability of heart failure (HF) patients to perform the self-care management of the problem. Nurses are responsible for providing a standardized quality education for patients; however, nurses at the project site lacked adequate skills and knowledge to bridge the gap in HF self-care management education. The project was guided by health belief model and self-care deficit with the goal of boosting the staff knowledge and confidence with providing patient HF self-care …

Strategies To Reduce Costs Associated With Hospital Readmissions, Almunzer Zakaria

Walden Dissertations and Doctoral Studies

Hospital administrators struggle to reduce hospital readmissions to improve hospital performance. Reducing costs of readmissions is important to hospital administrators because it may lead to an inability to meet budget requirements. Grounded by complex adaptive systems and business process quality management principles, the purpose of this qualitative single case study was to explore strategies nonprofit hospital administrators use to reduce costs associated with hospital readmissions. Participants included 4 successful hospital administrators at 1 hospital in Doha, Qatar, who have responsibility for overseeing readmissions. Data were collected using semistructured face-to-face interviews and organizational documents. Traditional text analysis was used to identify …

Sexual Orientation, Body Mass Index, And Methamphetamine Use Among Chicago Youth, Nileshkumar Panchal

Walden Dissertations and Doctoral Studies

Drug use and obesity are two of the most challenging health-related issues that young people face. Obesity, substance abuse, and drug addiction lead to brain dysfunction, which can decrease the quality of life and academic performance as well as increase the vulnerability of developing chronic diseases. To date, there has been little research to determine whether sexual orientation influences the relationship between body mass index (BMI) and methamphetamine use. Focusing on youth, the relationship between BMI, methamphetamine use, and sexual orientation were examined in this study through secondary data analysis of the Youth Risk Behavioral Surveillance System in Chicago. Guided …

Factors Associated With Incarceration Of Adolescents With Learning Disabilities, Sabine Silien Charles

Walden Dissertations and Doctoral Studies

Incarceration of adolescents in the United States has grown substantially during the last 3 decades with nearly 53,000 adolescents held every day in correctional facilities. Many researchers have raised concerns about the greater percentage of adolescents with learning disabilities (LDs) in the juvenile system. In the state of Washington, one study in residential placements showed approximately 20% of youth incarcerated had a diagnosed LD. The purpose of this quantitative cross-sectional study was to use the therapeutic change, length of stay, and recidivism in incarcerated juvenile offenders in Washington state, 2008–2015 data set to examine possible factors associated with incarceration of …

African American Maternal Mortality In The United States: A Quantitative Analysis Of Chronic Disease And Maternal Deaths, Glory Inyang

Walden Dissertations and Doctoral Studies

African American women have higher rates of chronic disease including diabetes and cardiovascular related disease compared to White women and are 3 to 4 times more likely to die during childbirth, more than any other ethnic group in the United States. . When African American women become pregnant these conditions may influence their maternal health outcomes. This study aimed to determine difference in pregnancy related death associated with chronic conditions between African American women and White women. Based on secondary/archival data from the Center for Disease Control and Preventions' 2017 National Center for Health Statistics Mortality Multiple Cause Files a …

New Graduate Residency Programs, Shareen Estelle Taylor

Walden Dissertations and Doctoral Studies

Nurses are the largest group of healthcare providers in most acute care hospitals, and the demand for registered nurses is expected to grow by 15% by 2026. The new graduate registered nurse (NGRN) is the supply that will fill the shortage; however, NGRNs are reportedly lacking in the ability to connect the lessons learned in the classroom with real patient care, unprepared for necessary skills, emotionally stressed, and have a high first-year turnover rate. Strategies such as nurse residency programs are needed to support NGRNs as these new nurses’ transition from academics to clinical practice. The purpose of this project, …

Impact Of Nurse Education Program On 30-Day Readmissions Among Ischemic Stroke Patients, Mariana Tsucuneli

Walden Dissertations and Doctoral Studies

Unplanned 30-day readmissions among patients diagnosed with ischemic stroke (IS) is a significant public health problem in the United States. The Affordable Healthcare Act introduced financial penalties and incentives for facilities to encourage the adoption of care plans aimed at reducing 30-day readmissions rates for stroke and 5 other illnesses. Therefore, facilities with high rates of 30-day readmissions for IS patients are penalized by the Centers for Medicare and Medicaid services in addition to receiving poor scores on the quality of care they provide. This project was a staff education program aimed to improve postacute stroke transitional care and reduce …

Assisting Psychiatric Nurses In Managing Work Stress And Decreasing Callouts And Absenteeism, Prisca Njume

Walden Dissertations and Doctoral Studies

Management and reduction of work stress is important in promoting nurses' well'€being. Understanding how to decrease stress levels may allow nurses to provide better care, improve patient outcomes, and experience increased job satisfaction. The focus of this project was to empower psychiatric nurses to manage work-related stress and decrease callouts and absenteeism. Person-environment fit theory, job demand-control (support) theory, the job demands-resources model, and the effort-reward imbalance model were used to inform the project. Pretest and posttest data were collected from 61 nurses using the Perceived Stress Scale. Deidentified retrospective and prospective data of the number of callouts were also …

Practice Improvement: Intimate Partner Violence Screening Implementation, Enitan Salawu

Walden Dissertations and Doctoral Studies

Intimate partner violence (IPV) is a significant public health problem in the United States and worldwide. A recent U.S. crime report indicated that close to half of all homicides involve women victims of current or former intimate partners. The purpose of this doctoral project was to develop a training program to educate clinicians in the primary care setting on IPV screening. Participants received education on the Hurt, Insult, Threaten, Scream (HITS) screening tool to identify IPV survivors with available referral resources. The practice-focused question involved clinicians' level of knowledge regarding using the HITS tool kit to screen for IPV in …

Telehealth Efforts To Reduce Hospital Readmissions Of Congestive Heart Failure Patients, Sirfornia L. Deasfernandes

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is a chronic condition that affects millions of individuals in the United States. There is no cure for CHF, but medical interventions can help treat the symptoms and improve health outcomes. The purpose of this quantitative study was to determine if telehealth services help to reduce the readmission status of patients diagnosed with CHF. The theoretical framework used in this study was the individual and family self-management theory to help focus on self-management behaviors that contribute to improving the patients' health outcomes. The research questions were focused on addressing CHF patients receiving telehealth services and whether …

Educating Nurses About Poststroke Depression And Using The Phq-2/9, Mary Mcmullen

Walden Dissertations and Doctoral Studies

Stroke has affected more than 7 million people and up to 33% of those patients reporting depression. The lack of screening for depression for patients post stroke can delay treatment for depression and hinder or lengthen recovery. The purpose of this project was to develop a nursing staff education program on using the Patient Health Questionnaire (PHQ) tools (PHQ-2 and PHQ-9) at the bedside to detect signs and symptoms of depression and identify nurse-driven interventions. Using the Johns Hopkins nursing evidence-based practice model and Orem's self-care model for guidance, an interdisciplinary team was assembled to collaborate on the development. A …

Examining Icu Nurses' Knowledge Of Ventilator-Associated Events And Ventilator-Associated Pneumonia, Dorothy J. Sanders-Thompson

Walden Dissertations and Doctoral Studies

Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test …