Medicine and Health Sciences Commons^™

Addressing Bullying And Incivility Among Nurses, Caroline Holland Combs

Walden Dissertations and Doctoral Studies

For decades, nurses have experienced some form of bullying and incivility throughout their careers. Incivility contributes to behaviors that constrain the sense of empowerment among nurses and directly encroach upon Provision 6 of the American Nurses Association code of ethics, which addresses sustaining a moral environment and the need to create a contagious culture of respect that is free from uncivil behavior. The nature of this staff education project was to bring awareness to the bullying behaviors and incivility that exist within an organization’s culture by assessing for the incidence of bullying and by providing an educational program for the …

Pulmonary Rehabilitation: A Quality Improvement Evaluation, Michelle Groth

Walden Dissertations and Doctoral Studies

COPD is a progressive, multifaceted, chronic disease with steadily increasing worldwide rates of prevalence, morbidity and mortality, making improved COPD care a global health priority. Current practice guidelines are in place, but the literature continues to demonstrate inadequacies in practice, for example the inconsistent use of pulmonary rehabilitation (PR). The purpose of the project was to conduct a quality improvement initiative evaluation of the PR program at a hospital in south-central Idaho. The practice-focused question was: What impact has implementation of a PR program had on COPD care in the area? Donabedian’s framework for healthcare quality evaluation was the theoretical …

Evidence-Based Pediatric Diabetic Ketoacidosis Education, Sonya Sandhu

Walden Dissertations and Doctoral Studies

Pediatric patients with diabetic ketoacidosis (DKA) are a unique subset of patients who arrive to the emergency department (ED) for care, and differ from adults regarding symptomology, treatment, and adverse effects. Nurses who will encounter this patient population must have adequate knowledge and confidence to care for them, yet research continues to show a gap in practice. The purpose of this doctoral project was to determine if a staff education project would increase ED nurse knowledge and confidence in caring for pediatric emergency patients with DKA. Utilizing Kirkpatrick’s evaluation model, an evidence-based staff education program was formulated, reviewed by an …

Systematic Review Of Loss-Frame Messaging And Change In Health Behavior, Eddie Jean Simmons

Walden Dissertations and Doctoral Studies

Recent analysis estimates Type II diabetes affects 23.4 million people in the US. Approximately 30% of these patients are not in optimal control of their diabetes, raising risks for blindness, amputation, and cardiac disease. A gap in diabetes education practice is that traditional positive-framed messaging has not persuaded many patients to modify their self-management behaviors. There is a need for alternative ways to communicate the risks of not managing the disease to patients who may have different health beliefs. The purpose of this systematic review was to examine the best available evidence regarding the efficacy of loss-frame messaging when used …

Examining The Relationship Between Rural African-American Adolescents’ Self-Perception And Their Academic Performance, Vincent Dewayne Tompkins

Walden Dissertations and Doctoral Studies

Poverty, crime, and the need for public assistance are associated with dropping out of high school in the United States. African American adolescents have a higher dropout rate than their White peers, especially in the rural south. Moreover, racial discrimination toward African American adolescents is more prevalent in the rural south compared with the urban areas of United States. Academic self-perception and experienced racial discrimination are probable factors that influence African American adolescents to leave school before they graduate. This study was conducted to determine a relationship between the combination of rural African American adolescent’s academic self-perception as measured by …

Nurse Leaders’ Perspectives On Animal-Assisted Interventions, Samantha Vita Abate

Walden Dissertations and Doctoral Studies

Knowledge deficits and unfavorable attitudes are commonly cited barriers that prevent adoption of animal-assisted interventions (AAIs). Nurse leaders’ (NLs’) knowledge of and attitudes toward AAIs have not been well documented in the literature. The purpose of this study was to identify NLs’ perspective on AAI, including their usage, knowledge, and attitudes. This information may be helpful in overcoming common barriers to AAI usage. The theory of transformational leadership guided this 3-manuscript dissertation study, which included 3 studies on NLs’ use of AAIs, the relationship between NLs’ knowledge of AAIs and NLs attitudes toward AAIs, and the potential impact of AAI …

Strategies For Teaching New Mothers The Importance Of Vaccination, Halimat Akojie

Walden Dissertations and Doctoral Studies

Vaccinations provide protection against a number of severe childhood communicable diseases, such as polio, measles, and pertussis. However, not all parents follow the recommended immunization schedules for their young children, a decision which could lead to increased disease incidence and prevalence. The purpose of this DNP project was to address the gap-in-practice related to ineffective strategies to reduce vaccination refusal among parents. This systematic review sought to understand strategies effective at teaching new mothers the importance of vaccinating their children. The theoretical foundation for addressing this question is Rogers’ protection motivation theory, which explains that sources of information, mediating cognitive …

Improving Suicide Prevention In The Emergency Department, Crystal Hartis Andrews

Walden Dissertations and Doctoral Studies

Suicide is a leading cause of death and a significant public health problem in the United States, especially among the youth population. The wide variability of screening practices and limited educational programs for nurses in terms of identification and management of individuals at risk for suicide exists. The purpose of this project was to conduct a systematic review to identify evidence available in support of adequately preparing nurses to conduct suicide screening and inform suicide prevention efforts for youth in emergency departments. Results from the literature review were correlated to formulate recommendations for improving suicide screening practices through the provision …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Pain Assessment Strategies For People With Cognitive Impairment In Nursing Home Settings, Meskelo Tsegaye Bobo

Walden Dissertations and Doctoral Studies

Assessment of pain in patients with a diagnosis of dementia or cognitive impairment continues to be underdiagnosed as there are no objective ways of assessing their pain. Available evidence also indicates that these patients are not receiving satisfactory pain management. Due to a lack of self-reporting of pain, accurate assessments of pain are challenging. This systemic review aimed to find a pain assessment strategy effective in identifying pain in patients with a diagnosis of dementia. Kolcaba's theory of comfort was used as the theoretical framework for the study. The databases of Medline, Cochrane Database of Systematic Reviews, Embase, and Cumulative …

Experiences Of College Freshmen Women Who Eat In A Social Environment, Kylie Cowens Blodgett

Walden Dissertations and Doctoral Studies

The social cognitive theory suggests that social surroundings influence health behaviors, and social modeling literature supports that eating behaviors are influenced by social norms. Eating decisions are especially vulnerable to social influence during the transition to college, although current interventions do not address social influence in the context of the eating environment itself or consider how men and women may experience this environment differently. This generic qualitative study explored how freshmen women perceived their experiences eating in a cafeteria setting. The research questions investigated freshmen women’s perceptions about social influence on self-efficacy, self-regulation, outcome expectations, and modeling of normative information …

Hiv/Sti Screening, Testing, And Prophylaxis Among Sexual Assault Survivors In U. S. Emergency Departments, Elizabeth A. Cita

Walden Dissertations and Doctoral Studies

Use of HIV screening/testing and prophylaxis has been found to be low in the general emergency department (ED) population. Less is known about the use of HIV/sexually transmitted infection (STI) screening, testing, and prophylaxis among sexual assault survivors who present to EDs. The main research questions asked whether there was a relationship between race, socioeconomic status (SES), geographic region, or age, HIV/STI, treatment, and prophylaxis among sexual assault survivors that present to U.S. EDs. This study was a secondary analysis of data collected in the NHAMCS years 2010 to 2016 and included 112 geographic primary sampling units, about 480 hospitals. …

Educating Registered Nurses On Decreasing Missed Care Events, Marie St. Clair Dixon-Brown

Walden Dissertations and Doctoral Studies

Abstract

Missed care or partially completed nursing care is a prevalent problem in healthcare with negative consequences for patients, nurses, and healthcare organizations. This project was developed to address a gap in practice by providing staff education regarding the current evidence about missed care along with practical evidence-based strategies to decrease missed care events. Kalisch’s missed nursing care model framed the project. The staff education program used a PowerPoint presentation with interactive discussion and role-play opportunities for nurse participants to engage in and employ strategies to prevent missed care events. A 10-item multiple-choice post-education quiz and 4-point Likert-type program evaluation …

A Guide For Effective Home Health Education, Dianne M. Nissen

Walden Dissertations and Doctoral Studies

Older adults afflicted with chronic conditions present a unique set of challenges for home health nurses. In addition to caring for many of the patient’s physical problems, patient education is needed to enable patients to manage themselves. Patient education focuses on complicated medication and treatment adherence, safety, and preventing complications. The purpose of this oral presentation and supplemental guide was to increase the knowledge and skills of home health nurses by formally preparing them for the responsibility of patient educator. The practice-focused question was whether the provision of education and a supportive guide for individualizing patient education would improve the …

Impact Of Social Economic Factors On U. S. Veterans’ Access To Care, William Kwaku Adjei Ofori

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD), the leading cause of death worldwide, affects about 8.45 million United States veterans, individuals honorably discharged from the active military, naval services, and air services. The purpose of this study was to determine whether veterans’ access to care is associated with income level determinants, such as job status, education level, and location. Using the social cognitive theory as the framework, the study examined the extent to which income level and the other social determinants, impacted access to care for veterans with CHD. The 2016 Behavioral Risk Factor Surveillance System, the nation’s leading data system was the …

Use Of The Smoking Cessation Power Plan In An Observation Unit, Joycelyn Kennedy Land

Walden Dissertations and Doctoral Studies

Of 34.2 million adults who use tobacco, nearly 50% of the population living in the United States, or 16.5 million people, have a smoking-related disease. The purpose of this DNP project, conducted on an observational unit located in an acute care hospital, was to address the evidenced-based practice gap of the limited use of assessing tobacco use and the initiation of a readily available smoking cessation power plan (SCPP) intervention by nurses and healthcare providers. The practice-focused questions were whether an educational intervention for nursing staff would increase use of the 3As assessment (Ask and record smoking status; Advise patient …

Perceptions And Beliefs Of African American Men And Women 30 Years And Older About The Health Care System In The United States, Jacqueline Chadwick Mcnair

Walden Dissertations and Doctoral Studies

This qualitative study described perceptions and beliefs of African American men and women ages 30 and over regarding their experiences with the health care system in the United States. The health belief model was the theory that drove this research, and it was grounded in the concept of cultural competency. The study used grounded theory methodology as well as phenomenology to describe the lived experiences of the participants and ethnography to describe the cultural characteristics of African American men and women ages 30 and over as related to their perceptions and beliefs about health care in the United States. The …

Improving Sedation Management In Mechanically Ventilated Patients, Jannette Lord

Walden Dissertations and Doctoral Studies

Abstract

In the intensive care unit (ICU), sedation management of the critically ill, mechanically

ventilated patient is a source of concern. Optimal sedation management is integral to

critical care practice, yet optimal levels of sedation are not consistently applied.

Suboptimal sedation carries significant risks for patients, as inadequate sedation or

oversedation may lead to prolonged ventilator days, ventilator-associated pneumonia

(VAP), extended length of ICU stay, and costs. The purpose of this quality improvement

(QI) project was to improve sedation management of mechanically ventilated patients by

improving staff nurses’ knowledge of and attitudes toward sedation management,

ultimately achieving a zero-ventilated associated …

Social Support And Hiv Among Young Transwomen Of Color, Cynthia Joycelle Tucker

Walden Dissertations and Doctoral Studies

HIV is an emerging epidemic among young transgender women of color (YTWC). Researchers have documented the challenges and issues that YTWC encounter, including discrimination, isolation, and violence. However, little is known about whether social support can impact these challenges as an avenue to improve HIV preventive behaviors and HIV status. Using secondary data from the Life Skills HIV study, this research assessed how social support affects HIV preventive behaviors among 298 YTWC residing in Chicago. The study was grounded in the modified social-ecological model and Spearman’s rank correlation and logistic regression analyses was used to determine whether there was an …

Lifestyle Factors And Social Determinants As Predictors Of Weight/Body Mass Index, Uthman Alhaji Baba

Walden Dissertations and Doctoral Studies

Obesity is a major public health concern that includes the risk of developing cardiovascular disease and premature death in adults. Previous studies have established the relationship between gender, educational level, household income and respondents’ weight but additional research is needed to factor the nature of education in relation to gender differences, diet, and other important behavioral mediators such as social determinants. The purpose of this quantitative cross-sectional study is to determine the extent to which frequency of physical activity, household income, social determinants of health (money for balanced meals, finances at the end of month, and poor mental health), respondent …

Effects Of Short-Term Intensive Insulin Therapy In Type 2 Diabetes Mellitus Management, Ernest Mwathi

Walden Dissertations and Doctoral Studies

Diabetes is a chronic illness affecting millions of individuals in the United States and is the seventh leading cause of death. Most of the Type 2 Diabetes Mellitus (T2DM) patients manage their illness with non-insulin therapies resulting in inadequate glycemic control but there are times when they experience inadequate glycemic control and require short-term intensive insulin therapy (SIIT). Despite proven effectiveness of SIIT, there is a lack of research focusing on the effectiveness of clinical practice where providers revert their clients to non-insulin therapy after SIIT. The focus of this quality improvement (QI) project was to evaluate pre/post data and …

Professional Development For Nurse Educators, Samdaye Ramdial

Walden Dissertations and Doctoral Studies

At a large university on the outskirts of Toronto, Canada, there was an influx of students entering the nursing program. Therefore, the need arose for an updated, restructured, and professional development training guideline with current knowledge for nurse educators to achieve high quality learning and critical thinking. The purpose of this study was to explore professional development leaders’ perceptions of quality training guidelines for nurse educators. The conceptual framework of this study was Knowles’s adult learning theory. The research questions were centered on what professional leaders perceive to be quality professional development. A qualitative case study design was used in …

Association Between Certificate-Of-Need Laws And The Health Outcomes Of Home Health Patients, Peter A. Atemnkeng

Walden Dissertations and Doctoral Studies

The Certificate of Need (CON) law on home health limits start-ups and expansions by providers. Seventeen states and the District of Columbia maintained CON restrictions in 2015. The regulation was intended to control health care cost and expenditure, and to promote quality public health outcomes, as postulated in the public interest theory. The purpose of the study was to assess the association between the CON laws by the states and the health outcomes of the Medicare patients that used home health services in 2015. The provider ratings data from Home Health Compare were analyzed using multiple linear regression models and …

Staff Education On Depression Screening In An Outpatient Psychiatric Setting, Naiga Dohnji

Walden Dissertations and Doctoral Studies

Depression is among the common mental illnesses in the United States affecting 1 in 10 Americans. The U.S. Preventive Services Task Force recommended screening for depression irrespective of the risk factors. Yet, providers struggle to implement depression screening. Inadequate use of Patient Health Questionnaire-9 (PHQ-9) screening tool to identify and manage depression can lead to poor patient outcomes. PHQ-9 is valid and reliable tool used to diagnose depression and monitor treatment response. The purpose of this project was to develop, deliver, and evaluate an educational program for providers on the use of the PHQ-9 screening tool for the identification of …

Medication Nonadherence Among African American Male Psychiatric Patients: Healthcare Providers’ Perspectives, Felix O. Agoye

Walden Dissertations and Doctoral Studies

African American men show less adherence toward maintenance pharmacotherapy for psychiatric disorders than Caucasian men. However, studies that specifically investigated the sociodemographic determinants of medication nonadherence in African American psychiatric patients based on healthcare providers’ perspectives are limited. Therefore, this study explored the viewpoints of healthcare workers in a Chicago-area hospital network about medication nonadherence among psychiatric African American male patients. This qualitative case-study is guided by the health-communication model and theory of planned behavior. Interview sessions were conducted with providers who met the inclusion criteria and NVivo 11 was used to store and organize the data in order to …

Assessing Pain-Related Factors As Predictors Of Distress During Transitional Musculoskeletal Pain Experience, Gary Robert Ahlstrom

Walden Dissertations and Doctoral Studies

During people’s pain experience, certain difficulties may emerge within individuals’ psychological and social domains that can confound and exacerbate the frequency of their pain-related distress episodes. Previous research has consistently found psychosocial factors evident during the first months of unresolved pain are reliable predictors of pain chronicity and disability at 12 months. This exploratory descriptive quantitative multivariate study included 2 nationwide online surveys that examined the frequency of moderate-to-severe symptoms of distress within the anxiety-depression spectrum, and the extent that 8 pain-related factors influenced and predicted episodes of anxiety and depressed mood, which included 2 demographic risk factors (age range …

An Educational Activity For Primary Care Providers Treating Older Veterans With Sexually Transmitted Infections, Beatrice Fannie Grant

Walden Dissertations and Doctoral Studies

AbstractComprehensive sex education is an effective method of promoting sexual health. Because primary care providers conduct the initial health need assessment of veterans, it is important that providers understand how to approach the subject of sexual health and the prevention of sexually transmitted infections. The purpose of this evidence-based project was to implement and evaluate an educational activity for primary care providers. The health belief model was used as theoretical framework. This project was introduced to a federal primary care clinic in the Mid-Atlantic United States. Twenty-five participants completed a pretest prior to the start of the educational activity that …

Increasing Compliance With Sequential Compression Devices To Reduce Venous Thromboembolism, Randy Mcclain

Walden Dissertations and Doctoral Studies

Venous Thromboembolism (VTE) is a life-threatening complication. Approximately 900,000 people in the United States are affected by VTE with a mortality of 300,000 cases per year. Although potentially preventable, VTE remains the leading cause of hospital deaths in the U.S. The practice problem addressed in the Doctor of Nursing Practice (DNP) project was evidence of an increased incident of VTE events on a trauma surgical unit. The practice-focused question evaluated the extent to which a nurse-driven protocol for VTE prophylaxis could improve adherence to mechanical prophylaxis with sequential compression devices and compliance with nursing documentation. The purpose for the doctoral …

Relationship Between Parent Asthma Knowledge, Parental Control Of Child's Asthma, And Parent Qol, Glori Sommerer

Walden Dissertations and Doctoral Studies

The long-term responsibility of caring for a child with asthma can result in parents

experiencing a lower quality of life (QoL), especially if the child's asthma is not well

controlled. Asthma knowledge can enhance asthma control practices among parents.

However, research has not explored these variables together to determine whether

parental control of child's asthma mediates the relationship between parent asthma

knowledge and parent QoL. This quantitative research study explored whether parental

control of child's asthma mediated the relationship between parent asthma knowledge

and parent QoL. The theoretical foundation was asthma self-regulation theory, focused

on the importance of asthma knowledge …

Verbal Abuse Toward Early Career Nurses And The Effect To Workforce Operations, Steven G. Purdon

Walden Dissertations and Doctoral Studies

AbstractSeveral studies report that healthcare workers face verbal abuse from patients, patients’ family members, and other healthcare personnel at increasingly higher rates, and trends depict early-career registered nurses (ECRNs) are affected disproportionally. This negative trend can affect the future registered nurse (RN) workforce and create a potential shortfall of qualified nurses. It has become increasingly important for hospital administrators to mitigate verbal abuse among ECRNs to manage their future RN workforce. This purpose of this quantitative study was to empirically evaluate the effects of verbal abuse towards ECRNs. This study used the social exchange theory to provide a framework that …