Medicine and Health Sciences Commons^™

Review Of A Remediation Program In An Associate Degree Nursing Program, Christopher Thomas Young

Walden Dissertations and Doctoral Studies

New nurse graduates must pass the National Council Licensure Examination (NCLEX) in order to achieve nursing licensure. In Northern New Mexico associate degree nursing program with a large disadvantaged student population, the average pass rate for the licensure exam often falls below the state board of nursing mandated 80% pass rate. This study's purpose was to evaluate the effect of an NCLEX remediation program on students' ability to pass the NCLEX, using Knowles adult learning theory to guide this work. The research questions investigated the relation between the remedial instruction and the 2 dependent variables KAPLAN predictor scores and NCLEX …

Challenges In Quality Care Delivery In Tertiary Health Facilities In North-Central Nigeria, Thomas Terlumun Torkula

Walden Dissertations and Doctoral Studies

The increasing mortality rates in tertiary healthcare hospitals in developing countries, such as Nigeria, have given growing concerns about the quality of healthcare services delivered in these hospitals. The purpose of this study was to examine the challenges of quality healthcare delivery in tertiary healthcare hospitals in North Central Nigeria, using a quantitative method. A total of 255 respondents, comprising medical, paramedical staff, and patients, from 3 tertiary hospitals were included in the study. The Healthcare Quality Assessment Questionnaire was used to collect data. Chi-square and analysis of variance were used to test the hypotheses. Results of the study showed …

Mothers' Knowledge, Clinic Staff, Community Support, And Breastfeeding Practices, Ubong Usua

Walden Dissertations and Doctoral Studies

Among low-income mothers enrolled in the Women Infant and Child (WIC) program and Medicaid, the rate of initiating breastfeeding immediately after delivery is low (57%) compared to high-income mothers (74%). Among the many factors contributing to this are low-income mothers' poor knowledge of the benefits of breast-feeding and lack of support and encouragement from clinical staff, family, and community. However, few studies have singled out the role of community and family support in improving maternal knowledge and breastfeeding practices. Using the Theory of Planned Behavior framework, this quantitative study used WIC data from the Texas Department of Health and Human …

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 …

Review Of A Remediation Program In An Associate Degree Nursing Program, Christopher Thomas Young

Walden Dissertations and Doctoral Studies

New nurse graduates must pass the National Council Licensure Examination (NCLEX) in order to achieve nursing licensure. In Northern New Mexico associate degree nursing program with a large disadvantaged student population, the average pass rate for the licensure exam often falls below the state board of nursing mandated 80% pass rate. This study's purpose was to evaluate the effect of an NCLEX remediation program on students' ability to pass the NCLEX, using Knowles adult learning theory to guide this work. The research questions investigated the relation between the remedial instruction and the 2 dependent variables KAPLAN predictor scores and NCLEX …

Nurse Practitioner-Led Education Program For Heart Failure Patients, Shay Felecia Clarke

Walden Dissertations and Doctoral Studies

Heart failure (HF) affects 5.7 million Americans and continues to be a leading cause of hospitalizations and deaths in the United States, posing an enormous burden on patients, families, and the health care system. Readmission rates for HF within 30 days post hospital discharge at small rural acute care facility in the southeast are consistently higher than the national average. The gap in nursing practice was the lack of up to date patient education postdischarge guidelines on HF for the socioeconomically disadvantaged, culturally diverse patient population located in this small rural town. The purpose of this project was to use …

Reducing Morbidity: Establishing A Relationship Between Perioperative Normothermia And Colon Surgical Site Infections, Nychie Dotson

Walden Dissertations and Doctoral Studies

Healthcare-associated infections (HAIs) are an emerging public health threat. Every day in the United States, HAIs impact 1 in 31 hospitalized patients. Surgical site infections (SSIs) account for over 40% of all reported HAIs and have an increased risk for morbidity and mortality. Surgery associated with colon procedures present an increased risk for infection, morbidity, and mortality. There has been vast work to prevent colon SSIs; however, there remain areas for improvement and exploration. The main research question evaluated the relationship between maintaining perioperative normothermia and colon SSIs. Secondary research questions explored additional risk factors to include age, gender, obesity, …

Fertility Treatments Of Women In Nigeria: Using Long Versus Short Protocols, Michael Egwu

Walden Dissertations and Doctoral Studies

A global estimate indicates that over 70 million heterosexual married couples live with the burden of infertility, and Nigeria accounts for about 30%. Although protocols exist, it appears there are no standardized treatment guidelines for practicing fertility experts in Nigeria. This study, therefore, aimed to determine which protocol provides a better outcome across a given population of infertile women in Nigeria as a method to move towards developing standardized treatment guidelines. The study was grounded using the Patient-Centered Care Treatment Model, and the method of inquiry was a retrospective, cross-sectional, quantitative, and nonexperimental technique, and the influence of the patient’s …

A Provider Education Program Addressing Barriers To Diabetic Patients’ Self-Care, Henrietta O. Emokidi

Walden Dissertations and Doctoral Studies

Diabetes is the leading cause of death among American Indian/Alaskan Natives and the 7th leading cause of death in the United States. Type 2 diabetes (T2DM) affects 9% of the U.S. population and costs the United States an estimated $245 billion annually. The purpose of this project was to identify patients’ concerns related to their disease and to develop an education program for providers to address these concerns. The project was framed using Orem’s theory of self-care and the middle-range theory of self-care of chronic illness. Five providers in an underserved clinic in Alaska conducted assessments during a primary care …

Atheoretical Versus Theory-Based Approaches In Promoting Safer Adhd-Medication Prescribing For Adults, Kathleen A. Fairman

Walden Dissertations and Doctoral Studies

Gaps between treatment guidelines and medical decisions persist despite interventions with physicians, which are mostly atheoretical. The purpose of this retrospective cross-sectional study was to compare atheoretical and theory-based logistic regression models of a binary outcome: potentially unsafe prescribing of attention-deficit hyperactivity disorder (ADHD) medications to adults. Social cognitive theory and self-determination theory provided the framework for the study. Predictors were framed as social cognitive theoretical constructs: knowledge (e.g., physician specialty) and environmental influence (e.g., interventions). Atheoretical hypotheses were based on legislation mandating meaningful use of electronic health records and computerized decision support (CDS). Theory-based hypotheses were derived from literature …

Evaluating The Effects Of A Total Joint Education Class On Patient Outcomes, Kevin Marshall

Walden Dissertations and Doctoral Studies

As the population ages and as people live longer, there is a growing demand for total hip and total knee procedures. Possible outcomes for these procedures is a postoperative joint infection (PJI) that can cause long postoperative lengths of stay (LOS) in the hospital. The PJIs can also negatively impact the quality of life for the patient. Using the roadmap of the continuous quality improvement theory, the purpose of this quantitative study was to examine the relationship between the independent variables (joint education class participation, body mass index [BMI], A1c, and smoking) and dependent variables (PJI and LOS). To evaluate …

Mental Health Care Practitioners, Self-Care, And Men Who Are Postincarcerated, Aduke Mccoy

Walden Dissertations and Doctoral Studies

Mental health practitioners often suffer physical exhaustion, burnout, and increased stress from providing care to postincarcerated men with elevated mental illness. When working in these high environments, helping professionals, may neglect self-care when caring for clients under stressful conditions. Neglected self-care can have adverse implications for both the patient and the mental health professional. The research question aligned with the purpose of this study was to understand what grounded theory that explains how mental health practitioners manage self-care while providing services to postincarcerated men with elevated mental illness. Self-care theory was used as a conceptual framework for this qualitative grounded …

Microcystins And Liver Disease Mortality, Insights From An Ecological Study, Rajesh Tirpaul Melaram

Walden Dissertations and Doctoral Studies

Microcystins (MCs) are toxic secondary metabolites produced by freshwater cyanobacteria. Algal bloom subsidence can stimulate MC release, which can impair liver function if orally exposed to in large doses. The purpose of this retrospective, U.S. ecological study was to determine if MC exposure represented an environmental risk factor for liver disease mortality using a socioecological approach. A longitudinal ecological substudy investigated the association between average total MCs in Lake Washington and Lake Manatee and age-adjusted chronic liver disease (CLD)/cirrhosis death rates in Brevard County and Manatee County, Florida (FL). A prediction model of total MCs was deduced by quantifying levels …

Decreasing Hiv Stigmatization For Care Of Young Men Of Color Who Have Sex With Men, Alethea Arnett Miller

Walden Dissertations and Doctoral Studies

HIV-related stigma from healthcare provider attitudes, beliefs, perceptions, or misconceptions has been a barrier to healthcare delivery. This project was conducted to examine whether an HIV-related stigma education provided to healthcare clinic staff with a focus on advance practice registered nurses can improve knowledge and empathy toward young men of color who have sex with men (MSM), which can lead to improved overall quality of healthcare through increased health behaviors and retention in care. An educational intervention was conducted utilizing a blended-learning environment focused on social cognitive theory to influence social behavior change among healthcare professionals, increasing their exposure, knowledge, …

Effect Of Bundled Interventions By Patient Type To Reduce Falls, Celia Nurse

Walden Dissertations and Doctoral Studies

Despite consistent efforts in the healthcare field, 700,000 to 1 million patients fall in hospitals each year. There is a gap in the literature regarding identification of optimal bundles of fall prevention interventions (FPIs) for patients by type, and though patients of all ages fall in hospitals, older adults fall more, which may mean that the influence of FPIs may differ for patients by age. The purpose of this descriptive, retrospective, quantitative secondary data analysis study, guided by Virginia Henderson’s need theory, was to examine the differences in the influence of bundled FPIs in reducing the number of falls (NOF) …

The Correlation Between Unemployment Rate, Gdp Per Capita, And Adult Obesity Prevalence In Developed Economies. Evidence From Oecd Member Countries., Uche Noel O'Martins

Walden Dissertations and Doctoral Studies

Adult obesity continues to be endemic in developed countries; at least 1 in every 5 people in developed economies is obese. In line with the theory of social suffering, socioeconomic factors may be correlated with the increasing prevalence of adult obesity. The purpose of this study was to investigate the correlation between socioeconomic factors and adult obesity prevalence rate in developed countries using Organization for Economic Co-operation and Development (OECD) member countries as a case study. In this study, the correlation between 2 independent variables - unemployment rate and Gross Domestic Product (GDP) per capita - and the dependent variable …

Childhood Blood Lead Levels And Adolescent Crime Rates In The United States, Jude Juiye Soweh

Walden Dissertations and Doctoral Studies

Juvenile violent crime rates in the United States have been on a continuous decline since 1996. Despite this decrease, youth violence as well as racial differences in crime rates continues to be a public health issue in the United States. Researchers have linked externalization behavior in children to factors including genetics, parental upbringing, abuse, school environment, and media exposure but have not fully considered the relationship between early childhood lead contamination and youth violence. This was an ecologic study of the relationship between early childhood blood lead levels (BLLs; ≥ 10µg/dL before 2012 or ≥ 5µg/dL after 2012) and crime …

Increasing Staff Knowledge On Obesity In Pediatric Patients With Asthma, Oluwakemi Taiwo

Walden Dissertations and Doctoral Studies

Asthma is a chronic life-long lung disease that contributes to morbidity and mortality around the world. The increased prevalence of asthma, particularly in children who are obese, inadequate assessment of obesity in pediatric patients, and a gap in staff knowledge regarding the Centers for Disease Control and Prevention (CDC) body mass index (BMI) percentiles resulted in a need for strategies to minimize this health concern. The purpose of this staff education project was to increase staff’s knowledge about identifying asthma patients who are clinically obese using the CDC BMI percentiles. The framework for the project was based on Knowles’s adult …

The Role Of Self-Mutilation Behaviors Among Adolescents Who Are Depressed, Patricia Wilkins

Walden Dissertations and Doctoral Studies

Adolescents who are depressed may self-injure themselves. Common methods for non-suicidal self-injury are cutting and burning the skin of one’s own body. Multiple confounding factors of age, gender, race and socio-economic status could lead one to engage in intentional or unintentional self-mutilation acts. The current body of literature on adolescent mental health demonstrates limited understanding of how racial and ethnic identity factors contributes to depression, self-injurious behavior, and suicide. This quantitative study determined if there was a relationship between depression and prevalence of adolescent self-mutilation. The social ecological theory was used to study the intersection of social determinants of depression …

Effectiveness Of A Standardized Fall Assessment Tool In Reducing Falls Among Elder Home Health Clients, Terica M. Woods

Walden Dissertations and Doctoral Studies

Because of the physiological changes that occur with the normal aging process, falls tend to have more serious consequences in individuals age 65 and older. The purpose of this systematic review of literature was to analyze studies that addressed the impact of a multifactorial fall risk assessment tool on decreasing falls in the elderly home health patient population following hospitalization. The conceptual model for this project was Roper, Logan, and Tierney’s activity of daily living model. A narrative analysis was used to analyze 16 selected articles from the CINAHL, ProQuest and MEDLINE databases. Results indicated that implementing fall assessment tools …

Registered Nurses’ Assessment Of Clinical Leadership Knowledge And Competence, Valerie D. Wright

Walden Dissertations and Doctoral Studies

As a prevalent component of the health care workforce, clinical nurse leaders play a vital role in reducing costs and promoting quality patient outcomes. The purpose of his project was to assess clinical leadership skill of nurses at a 160-bed rehabilitation hospital in a metropolitan city in the southeast United States. Guided by the Academy of Medical-Surgical Nurses model (AMSN), the practice-focused question explored the extent to which nurses perceived that they held clinical leadership knowledge and leadership competencies which impact positively on the nurse workforce and patient care. Thirty clinical registered nurses (RN) participated. According to the clinical leadership …

Antibiotic Stewardship And The Quality Of Life For Residents Over 65 Years, Reshma Beharry-Guest

Walden Dissertations and Doctoral Studies

Antibiotics were often over-prescribed in long term care facilities (LTCFs) and antibiotic stewardship guidelines, established by the CDC were not followed. The nursing home administrator was responsible for the quality of care for the residents and ensured that the facility met and/or exceeded the CMS antibiotic stewardship standard of care. The purpose of this quantitative study was to analyze operational secondary data collected from a Texas LTCF regarding antibiotic utilization for male and female residents over 65 years. The theoretical framework of the social cognitive theory was applicable for quality improvement in the LTCF setting. The data analysis showed that …

Comparison Of Diagnosis And Hospital Referral Rates Between Physician And Non-Physician Practitioners, Joshua Alan Fisher

Walden Dissertations and Doctoral Studies

Physician extenders as support in healthcare facilities has been increasing in the United States and has the potential to help in currently under served communities. This study evaluated the quality of care provided by physician extenders through the examination of average diagnosis and referral rates that may inform healthcare leaders and policymakers in future decisions. The literature review pointed to a gap in the research related to the quality of care based on patient diagnosis and referral rates by physicians and physician extenders. The conclusions were based on a quantitative analysis of secondary data from the National Ambulatory Medical Care …

Health Literacy And Diabetes Among Refugee Women Residing In Arizona, Aline Nina Indatwa

Walden Dissertations and Doctoral Studies

There is limited research available linking health literacy and diabetes knowledge to poor health outcomes among refugees. The aim of this study was to determine the levels of health literacy and diabetes knowledge and examine whether different factors (age, education, employment status, number of years lived with diabetes and length of stay since resettlement) are associated with health literacy and diabetes knowledge. A cross-sectional study was performed among 82 refugee women with a known diagnosis of diabetes and residing in Maricopa County, Arizona. A modified two part questionnaire (self-reported health literacy extracted from the European Health Literacy Questionnaire [HLS-EU-Q16] and …

Lived Experiences Of Medical Coders Who Work Remotely In A Sedentary Environment, Theresa Deans Jones

Walden Dissertations and Doctoral Studies

Abstract

Sedentary behavior is a public health issue which may increase the risk of mortality. The work environment is critical to the success of reducing sedentary behavior due to the amount of time spent in the workplace. Excessive sitting during work hours may perpetuate sedentary behavior of medical record coders that may result in adverse health outcomes. There is a lack of understanding of the lived experiences of coders who work in sedentary home environments toward their perspectives of the effect that sitting may have on their health. The purpose of this descriptive phenomenological study was to understand the lived …

Physicians’ Perceptions Of Facilitators And Barriers In Electronic Health Record Education, Alice Keene Martin

Walden Dissertations and Doctoral Studies

A significant focus in health care is quality documentation to lower patient safety risks. The local problem at a healthcare organization in the northeastern United States is that some physicians are falling short with quality documentation of patient care in athenaNet, a cloud-based electronic health record (EHR). This qualitative case study was conducted to explore physicians' perceptions of the facilitators and barriers that impact the educational process for quality documentation in EHRs. Attention also focused on identifying physicians' recommendations for enhancing the educational process for quality documentation. Knowles’ adult learning theory served as the conceptual framework. Purposeful sampling was used …

Respiratory Therapists' Roles In Reducing 30-Day Readmission Rates For Patients With Copd, Soumaya M. Osen

Walden Dissertations and Doctoral Studies

Since 2014, hospital administrators initiated several measures to reduce the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD). The research problem was that the respiratory therapists (RTs) were excluded from the discharge planning teams in many hospitals while 20% of patients with COPD continue to be readmitted within 30-day post discharge. The purpose of this qualitative study was to seek understanding of the care managers’ perceptions regarding the potential role of the respiratory therapists in the discharge planning for patients with COPD. The theoretical framework for this study was the systems theory in management. The research questions …

Evaluation Of Nurse-To-Nurse Handoff With The Use Of A Tablet, Maria Bessie Ziegenfuss

Walden Dissertations and Doctoral Studies

According to recent studies, many medical errors are caused by ineffective hand-off communication, which leads to patient harm and poor outcomes. Researchers have demonstrated that accurate and timely communication improves patient outcomes. The purpose of this quality improvement project was to evaluate the necessity, planning, implementation, outcomes, and transferability of the site quality improvement project, “Improving Nurse-to-Nurse Handoff With the Use of a Tablet.” The context/input/process/product model was used to provide a systematic approach to the evaluation of the site quality improvement project. A paired t test was used to analyze the pre- and post-survey results and demonstrated improvement in …

Familial Caregivers’ Perceptions Of Alcohol Use Among Mature Adults Residing In Assisted Living Communities, Lemeshia Meshana Agee Chambers

Walden Dissertations and Doctoral Studies

Research suggests that alcohol abuse is among the 8 primary causes of death for mature adults, which includes individuals age 65 and older. Alcohol use is a growing, unaddressed, public health concern among this referent population. Additionally, as mature adults enter the retirement phase of their lives, many of them transition to residing in assisted living communities. The purpose of this study was to explore mature adults’ alcohol use in assisted living communities and how such use, as perceived by the familial caregivers, affected the mature adults’ ability to age successfully. The population under study consisted of 8 familial caregivers, …

Staff Instruction On Patient Health Questionnaire And Collaborative Care Model In Primary Care, Jennifer Carton

Walden Dissertations and Doctoral Studies

The DNP project examined the effectiveness of the Patient Health Questionnaire-9 (PHQ-9) and the Collaborative Care Model (CCM) as a practice protocol for patients suffering from depression in primary care to address the problem of a shortage in mental health specialists. Research reveals an increase in Americans suffering from depression. Many primary care clinics do not have a practice protocol in place to screen and manage depression. The project's purpose was to develop a lesson plan to instruct staff on the PHQ-9 and CCM to implement into their practice. The project questions were if the lesson plan developed by the …