Medicine and Health Sciences Commons^™

Methamphetamine Screening And Brief Intervention In A Hospital Heart Failure Program, Tamra Chavez

Walden Dissertations and Doctoral Studies

AbstractThe efficacy of screening, brief, intervention, referral to treatment (SBIRT) in reducing or eliminating methamphetamine use has not been investigated and addressed among patients with heart failure. According to urine toxicology screens at admission at a county hospital, approximately 50% of patients in a heart failure program were positive for illicit substance use, and the majority of these tests (>60%) were for methamphetamine use, one of the most cardiotoxic drugs available. This quantitative study used an existing dataset to test the theory of intentional behavior by examining whether SBIRT intervention increases the patient’s ability to make a behavioral change …

Successful Retention Strategies By Perfusion Managers To Reduce Perfusionist Attrition, Krysta Lynne Gleeson

Walden Dissertations and Doctoral Studies

Perfusion managers who lack strategies to mitigate perfusionist attrition place a strain on their remaining employees and incur replacement costs for their organization. Grounded in Vroom’s expectancy model, the purpose of this multiple case study was to explore strategies perfusion managers use to mitigate perfusionists attrition within open-heart centers in a northeast U.S. city. Data were collected through digital semistructured interviews with 5 licensed perfusionists who demonstrated successful staff retention. Perfusionist job listings were used as a secondary data source. Data were analyzed using Yin’s 5 step process. Four significant themes emerged: job satisfaction, work-life balance, surveys, and compensation. Perfusion …

Predicting Behavior To Engage In Fall Prevention Practices: The Role Of Interests And Basic Psychological Needs, Jan Fay Kress

Walden Dissertations and Doctoral Studies

AbstractA fall is associated with adverse outcomes that include occupational, physical, cognitive, and psychological decline together with economic and caregiving burden. Despite the continued increase in prevalence of falls globally, most studies address the well-known risk factors of falls but exclude the behavioral risk factors associated with human actions, emotions, and everyday choices. Following the theory of self-determination and person object of interest framework, this quantitative, nonexperimental study was conducted using face-to-face and web surveys to examine the relationship between motivational, relational, and sociodemographic/medical conditions to predict engagement in fall prevention practices in a sample of 75 community dwellers, 65 …

Examining The Mortality Risk Of A Population With Mental Illness, Glorimar Ortiz

Walden Dissertations and Doctoral Studies

Individuals with mental illness experience increased mortality and premature death. In a sample composed of 88% decedents with mental illness who were Black, the findings from three research studies provided insight about excess and premature mortality, odds of dying by cause of death, and risk factors associated with premature mortality. The purpose of this quantitative study was to examine the mortality of a population group with mental illness that was served in a public mental health system (PMHS). The ecoepidemiological life course framework for health, disease, and mortality was used to link mechanisms that may influence health and longevity in …

Hiv Prevention: Pre-Exposure Prophylaxis, Sexual Decision Making, Risk Taking, And Condoms, Jonathan D. Spencer

Walden Dissertations and Doctoral Studies

HIV is an infectious disease that continues to have new cases each year within high-risk populations, such as men who have sex with men (MSM). To help in the fight against new HIV infections within the MSM population, new medications such as pre-exposure prophylaxis (PrEP) are being used. The purpose of this cross-sectional online survey study was to address whether PrEP use had any relationship with (a) sexual decision-making, (b) risk-taking, and (c) condom use in the MSM population 18-64 years of age, after controlling for socioeconomic status, race, and age while using the behavioral disinhibition and risk compensation models. …

Improving The Patient Experience With Communication, Pauline Adora Salmon

Walden Dissertations and Doctoral Studies

A quality patient experience is one of the highest priorities for hospitals as patients and families are looking to healthcare providers to meet their demands for quality service. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures the extent to which providers effectively communicate pertinent information such as communication about medications. On a 20-bed intermediate care unit, the HCAHPS item scores relating to nurse communication and communication about medicine were inconsistent and, on most occasions, were below the comparison benchmark of the 50th percentile when compared to other like hospitals. The purpose of this quality improvement project …

Quality Initiative To Reduce Falls In An Acute Care Setting, Janet Maxine Belcher

Walden Dissertations and Doctoral Studies

Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the …

Treatment Plans For Diabetes Management During Hurricane Maria In Puerto Rico, Joel De La Cruz Oller

Walden Dissertations and Doctoral Studies

The purpose of this study was to evaluate the health outcomes of diabetic patients in Puerto Rico, before, during, and after Hurricane Maria, in 2017. The Department of Health in Puerto Rico provided the secondary data for the variables low-density lipoproteins (LDL) cholesterol, hemoglobin A1C (HbA1c), mortality, and consumer price index (CPI). The inclusion criteria were participants for whom electronic data were available before, during, and after Hurricane Maria; the sample size was 450. The theoretical framework for this investigation was the health outcomes and impact assessment. The data were analyzed by univariate and analysis of variance (ANOVA) to compare …

Adolescent Substance Abuse Screening, Wesley W. Lynch

Walden Dissertations and Doctoral Studies

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse …

Evidence-Based Diagnosis Of Posttraumatic Stress Disorder Using Quantitative Electroencephalography, Roger Yoder

Walden Dissertations and Doctoral Studies

Diagnosing post-traumatic stress disorder (PTSD) is challenging and is currently, diagnosis through self-administered checklists. Because a diagnosis of PTSD can open up significant benefits to compensation, education, and medical care, people can tailor their responses to the checklist to help ensure a diagnosis of PTSD. The purpose of the study was to examine the utility of the quantitative electroencephalograph for diagnosing PTSD. Frequency and presence of biomarkers and alpha brain wave symmetry in the frontal and parietal lobes were examined. Research questions involved examining the presence of alpha wave imbalance across the frontal lobe and between the right and left …

Systematic Literature Review On Fall Prevention In An Acute Care Hospital Setting, Sonia A. Hudson

Walden Dissertations and Doctoral Studies

Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the …

The Caregiver Advise Record And Enable (Care) Act And Compassion Fatigue In The United States, Karen Marie Johnson

Walden Dissertations and Doctoral Studies

The transition from hospital to home can be complicated, leaving family caregivers in stressful situations that they may not know how to handle. The burden that is placed on these individuals has led researchers to focus on the public health implications of caregiving in hopes of identifying at-risk caregivers. This quantitative analysis identified what relationships exist between caregiver compassion fatigue among family caregivers and training or education received per the Caregiver Advise Record and Enable (CARE) Act and if education influences readmission rates. A purposive sample of 385 family caregivers participated in this study. The Care Transitions Measure (CTM-15), the …

Stress And Job Satisfaction As Predictors Of Teacher Turnover Intentions, Alrick Thompson

Walden Dissertations and Doctoral Studies

High teacher turnover is problematic because of the costs associated with recruiting and training new hires. However, some of the factors originating outside of the working environment that may influence teacher turnover intentions are not fully understood. The purpose of this quantitative correlational design study was to examine the extent to which job satisfaction, commuting stress, and financial stress are predictors of teacher turnover intentions. The study involved a purposive sampling of 227 teachers within a school district in the South Eastern part of the United States. Hobfoll’s conservation of resources theory provided the theoretical framework for the study. Validated …

Impact Of Nursing Education On Dysphagia Screening Knowledge, Jeanette Doreen Brumm

Walden Dissertations and Doctoral Studies

Dysphagia is a common, life-threatening complication potentially experienced by patients with acute stroke. Complications related to dysphagia can lead to aspiration pneumonia, morbidity, and mortality. Thus, early identification of dysphagia is necessary for improving patient outcomes and avoiding adverse health consequences. Nurses have the unique opportunity to impact patient care by increasing knowledge of evidenced-based treatment of dysphagia in acute ischemic stroke patients. Therefore, the project question asked whether Registered Nurse (RN) dysphagia education could improve nursing knowledge of dysphagia screening. The purpose of this project was to increase RN knowledge regarding dysphagia screening using the Yale Swallow Protocol (YSP). …

Improving Nursing Knowledge Of Heart Failure Discharge Self-Care Instructions, Maria Patricia Picar Deza

Walden Dissertations and Doctoral Studies

Patients with heart failure (HF) have recurrent symptoms that lead to frequent hospital readmissions. Moreover, HF is one of the leading causes of 30-day hospital readmissions. Evidence shows that patients with a high level of HF self-care have decreased readmissions. HF self-care education is commonly delivered by the nurse at hospital discharge, and the patient’s transition to self-care is a critical point in the continuum of care. However, nurses must be knowledgeable of patient self-care in HF to effectively convey this information to the patient upon discharge. Therefore, this staff education project question asked whether nursing knowledge of HF patient …

Tetanus Immunity Among Adults In The Democratic Republic Of The Congo, Sue K. Gerber

Walden Dissertations and Doctoral Studies

Although tetanus is not a contagious disease, it can be deadly for people who are exposed and do

not have protective immunity against tetanus, which can be acquired only through vaccination.

Most studies on adult tetanus protective immunity are from high-income countries; limited

studies occur in Africa, and none has been reported from the Democratic Republic of the Congo

(DRC). This study sought to determine protective immunity against tetanus among adults in

DRC in relation to their age, sex, place of residence, and for women, antenatal care. The primary

purpose of this observational cross-sectional study using a nested serosurvey within …

The Effects Of A Clinical Coaching Education On Clinical Faculty’S Coaching Behaviors, Kara L. Kaldawi

Walden Dissertations and Doctoral Studies

New graduates’ readiness to provide safe nursing care is a goal of nursing programs and employers. However, new graduate nurses do not always have the skills to make decisions in the clinical setting during a patient situation, which can result in poor patient outcomes. But clinical coaching is a faculty teaching framework that promotes the development of clinical reasoning through the deliberate practice of questioning and feedback after a patient situation. Thus, the purpose of this study was to determine whether participation in a clinical coaching education program improved the coaching behaviors of clinical nurse educators. Knowles’ theory of adult …

The Impact Of Mental Health First Aid Training On Law Enforcement Officer Mental Health Literacy, Cindy J. Blankenship

Walden Dissertations and Doctoral Studies

An increasing number of juvenile offenders with untreated mental health issues are entering the justice system. Lack of adequate training of criminal justice personnel enhances the possibility of this population being arrested which is creating an overwhelming problem for stakeholders. This study sought to determine if the implementation of Mental Health First Aid (MHFA) Training impacted law enforcement officers’ (LEOs’) mental health literacy. This mixed-methods study used a quasi-experimental, one-group, pretest-posttest design, with a qualitative survey. Participants consisted of a sample of 28 LEOs from a rural Southeastern United States law enforcement agency. Study findings indicated that MHFA training increased …

Reduce Postpartum Complications By Improving Postpartum Care Appointment Attendance, Shayla Tennille Buckler

Walden Dissertations and Doctoral Studies

This evidence-based project (EBP) was developed to increase postpartum appointment attendance to improve maternal outcomes for postpartum women. The practice problem was that the postpartum women who received prenatal care failed to return for postpartum care at a community clinic in north east Texas. The practice-focused question explored whether an educational intervention with the nursing staff would increase postpartum appointment attendance. The framework used was Pender’s Health Promotion Model. The preintervention data were retrieved from an electronic medical record (EMR) generated report that provided the number of postpartum appointments attended 30 days before the intervention. The nursing staff received a …

Meat Intake And Prostate Cancer In African American Men, Uchenna Njoku

Walden Dissertations and Doctoral Studies

African American men have more prostate cancer and are more than twice as likely to die of the disease as Caucasian men, and the reasons for this racial disparity have not been clarified. Identifying lifestyle and dietary risk factors of prostate cancer is an important public health issue. Studies on the association between meat intake and prostate cancer risk have produced inconsistent results. The purpose of this cross-sectional quantitative study was to determine whether there is an association between total meat intake and total prostate cancer risk among African American men when controlling for age, income, educational level, physical activity, …

Behavioral, Demographic, And Clinical Determinants Of Hiv Serostatus In Zambian Women, Debebe Masresha Gebreyohannes

Walden Dissertations and Doctoral Studies

The rate of human immunodeficiency virus (HIV) infection shows a diminishing trend at the global level while it shows increasing in intensity of mortality, morbidity, and burden in Sub-Saharan Africa. The intertwined behavioral, demographic, and clinical determinants fueled the incidence of infections in Zambian women. The purpose of this study was to determine the association between demographic, behavioral, and clinical determinants with HIV serostatus in Zambian women. With the conceptual framework of the World Health Organization’s Commission for Social Determinants of Health (CSDH) and quantitative method of MANOVA, this study examined Zambian Demographic Health Survey data for Zambian women of …

Impact Of Education On Hiv Testing Among African American Women In The United States, Florence Matimbah Mbangowah

Walden Dissertations and Doctoral Studies

Improved and increased human immunodeficiency virus (HIV) testing among African American women in the United States could facilitate early detection of the virus. The purpose of this cross-sectional quantitative study was to determine if there was a significant association between HIV testing participation and education level (i.e., high school, college, post-college level) based on access to healthcare after accounting for insurance, income, employment, marital status, English language proficiency, and vision quality. The integrated theory of health behavior change, the theoretical framework used for this research, proposes that changes in health behavior can be improved by various factors such as fostering …

Care Management And Readmission Among Elderly African American Patients With Chronic Illnesses, Vivien Lyn Salmon

Walden Dissertations and Doctoral Studies

More than 70 million Americans aged 50 years and older suffer from at least 1 or more chronic condition and use the emergency department frequently. By 2025, chronic illness will affect an estimated 164 million Americans or nearly 49% of the population. The rapid rise in chronic illness is due to a combination of an aging population, longer life expectancies, and poor lifestyle choices. This quantitative study provided a statistical analysis on the impact of care management on readmissions among African Americans between the ages of 65 and 80, with diabetes, hypertension, asthma, or multiple chronic conditions. Logistic regression was …

Methods To Increase The Rate Of Childhood Vaccinating, Mary Beth Tillman

Walden Dissertations and Doctoral Studies

Vaccinations such as polio, diphtheria, varicella, and meningitis help to protect a child from life-threatening illnesses which have previously been contained by routine vaccinations. However, misinformation, negative press, and other contributing factors, have influenced caregivers to refuse to vaccinate their children placing the children at risk for contracting the disease. The Centers for Disease Control and Prevention recommends regular vaccinations for children beginning as newborns, yet the vaccination rate remains below acceptable levels. This project was developed to provide an educational program guided by Orem’s self-care theory and intended to increase nurses’ knowledge of vaccination and ultimately vaccination rates. A …

Reducing Congestive Heart Failure Hospital Readmission Through A Practice Guideline, Michelle Hamric

Walden Dissertations and Doctoral Studies

Patients with congestive heart failure (CHF) are at increased risk for hospital readmission within 30 days of discharge. The gap in practice involves the coordination of care for patients with CHF in the transition from hospital to home. Patients with CHF are at increased risk for hospital readmission due to barriers involving self-care, communication, and coordination of care. The purpose of this project was to implement a clinical practice guideline (CPG) that used a predictive tool and clinical pathway for coordination of care for CHF patients at increased risk for hospital readmission within 30 days. The DNP project involved using …

Sociopolitical Determinants Of Parental Acceptance Of Childhood Vaccination In Abuja, Nigeria, Lawrence Madu Ohammah

Walden Dissertations and Doctoral Studies

Despite the efficacy of vaccines, some parents still reject vaccination of their children, resulting in low vaccination coverage, a greater burden of vaccine-preventable diseases, and high infant mortality. The purpose of this study was to investigate the sociopolitical determinants of vaccination status among children, aged 0-24 months, and identify the factors that drive vaccine hesitancy. The social ecological model served as the theoretical framework. The study research design was a quantitative cross-sectional survey. An interviewer-administered questionnaire was used to collect primary data from parents and caregivers in 384 randomly selected households from 48 settlements in the Abuja Municipal Area Council. …

Hiv Positive African American Women’S Lived Experiences And Clinical Outcomes, Christie Olejemeh

Walden Dissertations and Doctoral Studies

African American (AA) women are disproportionately affected by HIV/AIDS. The infection rate for AA women continues to increase, and literature lacks information specifically on education for AA women regarding viral suppression at diagnosis. The purpose of the study was to understand the lived experiences of AA women living with HIV in the District of Columbia, particularly how they acquired knowledge of viral suppression. To understand their experiences with antiretroviral medications, viral suppression, discrimination, and stigma, this qualitative study applied a hermeneutic phenomenological approach. The theories of resilience and empowerment were applied. Ten HIV positive AA women living in the District …

Preparing Clinical Faculty To Teach And Reinforce Hourly Rounding, Lisa Bailey

Walden Dissertations and Doctoral Studies

A gap exists in the knowledge of clinical faculty teaching prelicensure students about hourly rounding. The purpose of this project was to develop an educational program to prepare clinical faculty teaching student nurses to conduct hourly rounding. Hourly rounding trained faculty ensure safe practice by students and adherence to hospital policies. Hourly rounding includes the 4 Ps, which entails the assessment of “potty”, pain, position, and possession/periphery. Models and theories used to inform the project included the American Academy of Pediatrics’ 10-step process for developing training courses, Knowles’ theory of adult learning, Kirkpatrick's evaluation model, and the Accreditation Commission for …

Guidelines For Chronic Back Pain: An Education Module For Health Providers, Ron Pascual

Walden Dissertations and Doctoral Studies

Effective chronic back pain management and patient self-care guidelines are necessary for healthcare providers treating patients with complaints of low back pain (LBP). The purpose of this doctoral project was to provide an evidence-based educational program aimed at improving the knowledge and skills of healthcare professionals regarding the Center for Disease Control (CDC) and American Chronic Pain Association (ACPA) guidelines, emphasizing alternative pain management treatments. The staff education project was supported by the biomedical pain model and chronic care model. A panel of 3 experts including the clinic’s board-certified anesthesiologist and pain management specialist, clinical manager, and leading medical director …

Exploring Health Literacy In The Acute Care Setting In A Rural Border Region, Shiloh Williams

Walden Dissertations and Doctoral Studies

Health literacy is important to ensuring patients have the necessary knowledge and skills needed to actively participate as a member of their own healthcare team. Patients with low health literacy are at increased risk for poor outcomes and limited participation in decisions affecting their health or treatment plan. Using the Social Ecological Model (SEM) as a framework, the purpose of this study was to determine the relationship between medical-surgical registered nurses, medical-surgical patients and the registered nurse’s (RN) assessment of their patient’s health literacy of those who live in a rural-border region. The study’s sample consisted of 84 pairs of …