Medicine and Health Sciences Commons^™

Population-Level Determinants Of Cholera Incidence In African Countries, Ngoy Nsenga

Walden Dissertations and Doctoral Studies

Cholera remains endemic in Africa, with limited access to safe drinking water and inadequate sanitation as 2 of the main drivers of its dissemination. Few studies have examined the impact of health system capacity, even though it plays an important role in prevention, early detection, and response to a cholera outbreak. Grounded in the ecosocial theory of infectious disease dissemination, this quantitative ecological study explored the effect of social vulnerability (as measured by access to safe drinking water and sanitation, rate of open defecation, poverty, income inequality, gender inequality, and adult literacy) and health system (as measured by health financing …

How Older Nigerians View The Impact Of Migration On Their Health, Jayne Nwankwo

Walden Dissertations and Doctoral Studies

Migration into the United States opens windows of opportunity, but also involves difficult experiences that impact the health of migrants. In this qualitative study, the meanings that Nigeria migrants (aged 65–80) placed on their migration experiences were explored in relation to their health and well-being. Literature revealed no prior migration study on this population. The social constructivist approach provided the framework for this study. Purposive sampling was used to recruit 13 participants that fell within the selection criteria. Face to face interview was used to obtain participants’ view of health; their challenges to adaptation to the United States; the impact …

Readiness Of Stakeholders To Adopt Community Paramedicine Programs In Tennessee, Roger Lloyd Ritchie

Walden Dissertations and Doctoral Studies

Abstract

Community paramedicine is an emerging model of care that promulgates EMS in a more community-based and integrated role within the broader health care system. A hallmark characteristic of community paramedicine is that programs are designed to meet the specific needs of a given community, rendering programs unique but perplexing. A need for research aimed at exploring possible barriers that may impede the adoption and implementation of community paramedicine programs has been identified by the National EMS Advisory Board, the North Central EMS Institute, and the Joint Committee on Rural Emergency Care. The purpose of this study was to explore …

Analysis Of The Impact Of Family Structure And Type 2 Diabetes Among Adolescents, Danny Lee Self

Walden Dissertations and Doctoral Studies

Type 2 diabetes (T2D) has increased among the adolescent population in the United States within the past 30 years. While the increase in T2D is linked to obesity and a lack of physical activity, it lacks contextual analysis within the structure of the non-traditional family unit. The purpose of this quantitative study was to examine family structure and prevalence of T2D among adolescents. Krieger’s ecosocial theory guided the study. The research questions were designed to investigate whether family structure directly impacts T2D prevalence or indirectly through socioeconomic status. The research design was quantitative with cross-sectional analysis of secondary data. The …

Small Business Leaders’ Strategies For Recruiting Veterans, Jamillah Deangela Stackhouse

Walden Dissertations and Doctoral Studies

Small business hiring managers who fail to implement recruitment strategies for

transitioning military veterans face hiring challenges with this population of workers.

Failed recruitment strategies are essential to small business leaders, as failure to attract

highly qualified military veterans places the organizations at a competitive disadvantage.

Grounded in recruitment theory, the purpose of this qualitative multiple case study was to

explore strategies used by leaders of small businesses to recruit, hire, and retain qualified

veterans. The participants included 3 purposefully selected hiring managers from 3 small

businesses in southeastern Virginia, who used successful strategies to recruit, hire, and

retain veterans. …

Treatment Interventions For Tobacco Cessation At An Inpatient Mental Health Facility, Stephanie Marie Stansell

Walden Dissertations and Doctoral Studies

Tobacco use is the leading cause of preventable death and disease in the United States. According to the Centers for Disease Control and Prevention, 36.5% of adults with any mental illness use tobacco compared to 25.3% of adults without a mental illness; however, there are limited data to determine the best approaches for tobacco cessation among the mentally ill. The purpose of this quantitative, quasi-experimental study was to investigate the differences among 1-on-1 counseling versus group counseling in tobacco cessation rates among psychiatric patients aged 18 years old and older who were identified as a tobacco user upon admission to …

Using Patient-Staff Ratio To Improve Patient Care Outcomes, Fadekemisola Oludayo Timothy

Walden Dissertations and Doctoral Studies

The persistence of nurse scarcity has been documented by many researchers as the leading problem in the critical care setting. A high nurse to patient ratio leads to poor healthcare outcomes associated with increased nurse burn out, medical errors, and low-quality care services. Solving the issue of nurse scarcity is still a challenge due to lack of an effective multidimensional staffing model. In this project, a multidimensional staffing model was developed based on the relationship between patient-to-staff ratio, together with and other factors in the care environment which impacts patient outcome. The project was framed on Donabedian's structure, process, and …

Sociodemographic Factors Associated With Abortion Rates Among Black Women In The United States, Lincoln Don Washington

Walden Dissertations and Doctoral Studies

Abortion has been a public health issue since the procedure became legal 47 years ago and, clinicians have performed 60,069,971 abortions from 1973 to 2017 in the United States. In 2014, a significant decline in abortion rates has been recorded in almost every state, as well as across different subpopulations when segregated by age, race/ethnicity, education, income, or geographic locations. However, abortion rates were still significantly higher among Black women relative to the U.S. average, prompting the need to examine the causes of this disparity. The main purpose of this quantitative study was to investigate and determine the sociodemographic causing …

Systematic Review Of Family Nurse Practitioner Utilization Within School Environments, Luz Elena Zapien

Walden Dissertations and Doctoral Studies

The American Academy of Pediatrics and the Institute of Medicine recommend school health screening programs to detect problems that might interfere with a student’s education and general well-being, and many U.S. states require compliance with enrollment requirements such as updated immunizations and physical exams prior to attendance. In low-income areas, however, there is often a shortage of physicians available to meet the healthcare needs of the population. Family nurse practitioners (FNPs) can be utilized in school health settings to deliver health care services that support school attendance and the well-being of school students, yet little is known about their impact. …

Nursing Home Caregivers’ Knowledge Of Decubitus Ulcer Prevention Strategies, Shola Akinfiresoye

Walden Dissertations and Doctoral Studies

Decubitus ulcers (DUs) were a constant concern among the residents of the nursing home in this project. Prolonged immobility, sensory impairment, and urinary incontinence are some of the factors found in the literature as the causes of the disease. However, the lack of useful knowledge regarding evidence-based practices (EBPs) to prevent and treat DUs also contributed to the higher incidence rates at the nursing home. The purpose of this DNP- project was to evaluate the caregivers’ knowledge of EBPs to prevent and treat DUs at the facility. The IOWA Model of Evidence-Based Practice, which healthcare practitioners use to guide clinical …

Physician Assistant Burnout And Fulfillment Related To Career Development And Physician Relationship, Kari Sue Bernard

Walden Dissertations and Doctoral Studies

Physician workforce shortages are driving increased clinical and administrative use of non-physician healthcare providers. As a result, physician assistants (PAs) may experience role expansion in a positive or negative manner. The purpose of this study was to determine if aspects of PA career development related to role expansion interacted with the quality of the collaborative physician (CP) relationship to predict PA well-being. The job demands-resources (JD-R) model was used as the theoretical foundation and the National Academy of Medicine’s conceptual model of clinician well-being was used as the conceptual framework. Research questions addressed whether PA experience level predicted well-being, and …

Health Care Providers’ Use Of Nudging With Families Of Older Patients Making Discharge Decisions, Tabatha Bowers

Walden Dissertations and Doctoral Studies

The health care system has focused on reducing costs associated with longer lengths of

stay while facilitating safe and appropriate discharges. The purpose of this educational

project was to increase awareness among health care providers regarding nudging and

how it influences discharge planning decisions by patients and families. Enhancing health

care providers’ understanding of the impact of discharge communication may address the

issue of alternate level of care (ALC). Transition theory was used to frame the project.

Practice-focused questions addressed how the use of evidence-based case studies about

nudging could improve discharge planning for patients in a large community hospital …

Relationship Between Health Risk Behaviors And Obesity Among American High School Students, Jacques Jean-Paul Cherry

Walden Dissertations and Doctoral Studies

Adolescent obesity is a serious health condition that affects more than 55% of students aged 12 to 19 years in the United States. Recent statistical data have noted that the rate of adolescent obesity has more than quadrupled during the past few decades. Genetics and factors such as tobacco use, alcohol use, and marijuana use have contributed to this critical public health issue. Although uniqueness of prevalence has often been linked to gender and race, associations related to these health risk behaviors and increased body mass index remain relatively unexplored among today’s U.S. youth. Adolescence has been described as a …

A Staff Educational Model For Prevention Of Type 2 Diabetes In The Primary Care Setting, Mieshia Staples Clark

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic, debilitating disease affecting millions of Americans. Though preventable, it is the most common form of diabetes in the United States, costing the U.S. health care system billions of dollars annually. Lifestyle modifications taught, encouraged, and supported in established, evidence-based diabetes prevention programs (DPP) are proven to be more effective than medications alone in preventing Type 2 diabetes. While DPPs are cost-effective and can reduce or delay the incidence of Type 2 diabetes, they are greatly underutilized due to primary care providers’lack of knowledge about the benefits and availability of these programs and also due …

Exploring Young Opioid Users’ Motivation To Seek Treatment For Substance Use Disorder, Patricia Gianotti-Avella

Walden Dissertations and Doctoral Studies

In the past 15 years, the nonmedical use of opioids in the United States has reached epidemic proportions, resulting in a 21% increase in overdose fatalities. This surge in opioid use and dependence represents a shift in the demographic from inner-city populations over the age of 40 to young adults between the ages of 20 and 34 who dwell in primarily white suburban neighborhoods. Research has identified physicians’ liberal prescribing practices as one cause of this epidemic and has documented the ineffectiveness of current interventions with young addicts. The purpose of this narrative study was to gain insight into what …

Experiences Of Resiliency And Family Support In Older Women With Mental Illness, Dawn Harbin

Walden Dissertations and Doctoral Studies

Lack of a support system for older females with mental illness may cause reduced resiliency skills and an increase in mental illness symptoms while they attempt to manage independent living. The purpose of this qualitative study was to explore the individual stories of older women living independently who suffer from a mental illness and have a support system. Social learning theory and self-efficacy theory provided the framework for the study. Data were collected from face-to-face interviews with 8 women ages 65-80 years who are in treatment at a mental health center in South Carolina. Findings from coding analysis showed that …

Experiences And Challenges Of Social Workers Working With Transitioning And Postmilitary Service Members Who Have Mental Health Issues, Joyce M. Hewitt

Walden Dissertations and Doctoral Studies

Active duty service members, veterans, and their family members are faced with a myriad of problems including mental health issues, substance abuse issues, traumatic brain injury, suicide, family integration issues, and family distress. Understanding the organizational, environmental, and person-centered factors that affect the delivery of mental health care treatment to active duty service members, veterans, and their families is urgent to this unique population for social work practitioners (licensed master, advanced, & clinical). This project explored the experiences and challenges that social work practitioners (licensed master, advanced, & clinical) have in providing effective services for mental health care treatment to …

Nurse Educator Perceptions Of Using Simulation For Evaluation Of Nursing Competencies, Angela Elizabeth Horton

Walden Dissertations and Doctoral Studies

Over the past 10 years, simulation technology has been increasingly used in clinical settings to evaluate nursing competencies and ensure safe patient care. However, not all simulation laboratories are used consistently by hospital nursing education departments to support learning. The purpose of this qualitative case study, framed by constructivist theory, was to identify nurse educators’ perceptions of the value of using simulation to evaluate nurse competence. Research questions addressed how nurse educators decided what teaching methods to use when evaluating nursing competencies. The participant sample included 8 nurse educators responsible for the education of new and practicing nurses in the …

Evaluation Of Inappropriate Use Of Antibiotics In The Long-Term Care Community, Charlene A. Hughes

Walden Dissertations and Doctoral Studies

The number of antibiotics prescribed in the 65 and older population significantly increased related to the diagnosis of urinary tract infections (UTIs). Although empiric treatment is necessary at times, it can lead to antibiotic resistance; therefore, clinical symptomology with an active infection verified by diagnostic testing is the requirement for the treatment of a UTI. This project addressed the practice-focused question of how the implementation of an evidenced-based antibiotic stewardship program (ASP) in a nursing home on the East Coast may impact the overuse of antibiotics in that clinical setting. The project, guided by the theory of planned behavior, was …

The Relationship Between Sense Of Coherence And Coping With Stress Among Emergency Room Physicians, Melina Masihi

Walden Dissertations and Doctoral Studies

Physicians face different stressful situations daily when caring for patients in the emergency room (ER). The individual ER physician’s ability to cope with stressful situations varies considerably and affects patient care. Developing a sense of coherence (SOC) is thought to be one of the significant strategies for self-regulation in stressful conditions like those in the ER. The purpose of this research was to examine the relationship between SOC and coping abilities among emergency physicians in the United States. The study used a quantitative, cross-sectional design to assess physicians’ SOC and coping skills using an SOC scale and a coping scale, …

Improving Care Of Patients With Asthma Through Staff Education, Nicholas Moscatelli

Walden Dissertations and Doctoral Studies

Chronic asthma is a health epidemic and an increasing problem in the pediatric population. The purpose of this project was to raise nursing staff awareness of symptom recognition, treatment protocols, preventive measures, and detrimental effects of asthma for children. Adult learning theory provided the framework to support the staff education program on asthma. The project site stakeholders and the DNP student identified educational opportunities to assist staff in meeting caregiver needs, improving symptom recognition, and improving asthma outcomes. Prior to presentation of the educational program to the clinic nursing staff, it was reviewed by an expert panel including the clinic …

Patient Risks And Clinical Care Disruptions In Rural Hospital Mergers, Gabriel Muzanenhamo

Walden Dissertations and Doctoral Studies

Over 440,000 U.S. citizens are dying annually from avoidable, hospital-associated adverse events, with rural inhabitants experiencing more significant health threats than any other group in the United States. The trend of large health systems acquiring and consolidating rural hospitals (RHs) to improve the coordination of clinical care is backfiring, and accumulating patient safety risks. Although arguments for supporting hospital mergers in the past have focused on efficiency and presented a chance for struggling RHs with a financial survival mode, limited research has explicitly examined the impact of rural hospital mergers (RHMs). This study was constructed to explore the relationship between …

Public Health Leadership In The Philippines: Effective Approaches In Malaria Surveillance, Gethro Nullan

Walden Dissertations and Doctoral Studies

Leadership traits that affect and shape cost-effective practices ensure the long-term

growth and success for any organization. The purpose of this single case study was to explore leadership traits that may contribute to cost-effective approaches in a malaria surveillance program in the Philippines. The National Health Service Leadership Framework provided the conceptual framework for this study. The participants included 12 public health leaders/managers who have worked or been involved in malaria surveillance programs with budgetary oversight. Data were collected through in-depth interviews and document analysis. Values coding was used for data analysis, in which participants’ perspectives were coded using the …

Fall-Related Patient Education: An Essential Feature Of A Fall Prevention Program, Immaculata Okonkwo

Walden Dissertations and Doctoral Studies

This project documented the evaluation of a voluntary patient falls prevention education

program (VPFPEP) of a rehabilitative facility in a Mid-Atlantic US state and ascertained

its sustainability. The project was designed using the customized Moore et al. evaluation

model and Lippitt’s planned theory of change to encourage patient engagement in

physical activity (PA) through fall prevention education to allay patients’ fear of falling.

The sample included patients who opted into the facility’s VPFPEP. Evaluation was

performed using run charts to visually and quantitatively monitor trends and patterns of

fall incidents over time. Run charts also facilitated comparison of injuries sustained …

Program Evaluation Of A Black Barbershop Health Outreach Campaign, Berkina Denise Porter

Walden Dissertations and Doctoral Studies

Black-owned barbershops in the Black community lack barber administered interventions to provide education and health screenings to Black men. Increasing knowledge of health assessments in a black barbershop setting increases the number of health screenings and preventative care among Black men. Grounded in general systems theory, the purpose of this qualitative summative program evaluation was to explore the extent to which a nonprofit Black barbershop health program aligns with the Health Research (HR) program objectives. The evaluation was performed for a nonprofit organization located in Maryland, 6 years after the organization implemented the HR Program Network of barbers and salon …

Predictors Of Condom Use Among High School Students In North Carolina, Danielle Cierra Robinson

Walden Dissertations and Doctoral Studies

The spread of sexually transmitted diseases is a major ongoing public health issue in North Carolina. Adolescents between the ages of 13 and 19 years have consistently contributed to this trend. Researchers have found that condom use among high school students has decreased. High school students continue to engage in sex with multiple partners, with lack of knowledge about sexually transmitted diseases, even though sex education and prevention programs have been recommended. The purpose of this quantitative study was to evaluate the predictors of condom use among adolescents. The socioecological model theoretical framework was applied to guide this research involving …

Socioeconomic And Sociocultural Factors Associated With Parenting Choice And Fertility Experience Among Lesbian And Nonlesbian Women, Annette Silvia

Walden Dissertations and Doctoral Studies

Minorities including lesbians may face disparities that contribute to minority stress, which leads to adverse health outcomes. The purpose of this social epidemiology study was to examine the association between insured status, perceived stress, and parental status among lesbians and nonlesbians. The theoretical foundation was minority stress, and the design was quantitative with a convenience sample of women aged 18 years and older. Data on demographics, perceived stress, fertility quality of life, and lesbian identity disclosure were collected via online survey. Among the 314 respondents, 102 self-selected as lesbian (49% parents), and 212 self-selected as nonlesbian (73.1% parents). More than …

Primary Payer Status And 30-Day Readmission Rates Among U.S. Diabetes Patients, Christina Marie Swilling

Walden Dissertations and Doctoral Studies

Diabetes is a leading cause of hospitalization and readmission in the United States. The 30-day readmission rate for diabetic patients represents substantial costs to the nation’s health care system. The purpose of this quantitative study was to examine the relationship between primary payer status and hospital readmission rates among individuals whose primary or secondary reason for admission was Type 2 diabetes mellitus (T2DM). Secondary data from the Healthcare Cost Utilization Program Nationwide Database of the 2015 National Readmission Database was analyzed. Participants in the data set included 41,068 diabetes patients, 53.8% of whom were female. The average age was 67.26, …

The Impact Of Faculty Bullying On Associate Degree Nursing Students, Angela M. Vitale

Walden Dissertations and Doctoral Studies

Bullying is prevalent in the profession of nursing, impacting the quality of health care and health care costs. The foundation of bullying, in the profession of nursing, may be attributed to bullying behaviors in nursing academia among nursing faculty and nursing students. Using Bandura’s social learning theory, the purpose of this study was to determine the relationship between bullying behaviors of nursing faculty and bullying behaviors of nursing students in associate degree nursing programs. Seventy-one randomly selected registered nurses who graduated from associate degree nursing programs in the past 5 years completed an online Incivility in Nursing Education-Revised survey. Spearman’s …

Faculty Members’ Perceptions Of Organizational Culture And Implementation Of Interprofessional Education, Cynthia Voyce

Walden Dissertations and Doctoral Studies

A disparity exists between what is known about the benefits of interprofessional education (IPE) and implementation of IPE at the university under study. The World Health Organization called on institutes of higher education to provide IPE in the education of health professionals to improve the healthcare workforce’s capacity to provide quality care. The purpose of this qualitative study was to understand the perceptions of health professions faculty members (HPFMs) about IPE and how those perceptions might be influenced by the organizational culture at the site. Informed by Hofstede’s dimensions of culture theory, the research questions addressed HPFMs’ understanding of and …