Medicine and Health Sciences Commons^™

Urgent Care Centers And Workers’ Compensation Medical Cost Containment, Drema M. Thompson

Walden Dissertations and Doctoral Studies

In response to healthcare payment policy reforms, billions of dollars in healthcare provider charges are challenged annually. Following the implementation of the Virginia workers’ compensation medical fee legislation, healthcare organizations experienced declining worker compensation medical fee schedule reimbursements and lack of profitability. Grounded in the adaptive cycle model, the purpose of this qualitative single case study was to explore strategies 2 urgent care center (UCC) leaders in Virginia used to increase profits after implementing the Virginia workers’ compensation medical fee legislation. Data were collected via in-depth interviews and a review of company documents. Thematic analysis was used to analyze data. …

Diversity Gap In Healthcare Leadership, Percival Vera

Walden Dissertations and Doctoral Studies

The rapid change of the U.S. population has prompted many organizations in both the private and public sectors to adjust their C-Suite leadership to reflect the population that they serve. Unfortunately, healthcare seems to be the exception to this. Several studies have been done to explore the issue of diversity in general; however, limited research has been done to address the diversity gap in the U.S. Healthcare System C-Suite. The purpose of this qualitative case study is to explore the reasons behind the lack of diversity in the U.S. Healthcare C-Suite. The C-Suite is defined as the group of executives …

The Relationship Between Emotional Intelligence And Assessment Technology Institute Nclex- Rn Predictor Score, Debra Ann Wallace

Walden Dissertations and Doctoral Studies

The ability to pass a rigorous nursing curriculum and subsequently pass the National Council Licensing Examination for Registered Nurses (NCLEX-RN) exam is a requirement for nursing students to enter the nursing profession. Test anxiety may lead students to perform poorly on exams but emotional intelligence (EI) may buffer stress, improve communication, decrease anxiety, and improve nursing performance. The purpose of this descriptive, correlational study, guided by the EI theory, was to determine if there was a relationship among EI, the ATI -RN Comprehensive Predictor score, and first time pass rates on the NCLEX-RN among registered nurses who had graduated from …

Perspectives Of African Americans Diagnosed With End Stage Renal Disease And Their Perceptions Regarding Accessibility Of Care, Toya Williams

Walden Dissertations and Doctoral Studies

End stage renal disease (ESRD) is the final phase of kidney disease. African Americans make up 35% of all ESRD cases, which is rising. They lead all other racial groups and are 3 times more likely to be diagnosed with ESRD. Researchers have reported quantitative results involving this population, but none have focused on their experiences. The researcher sought to capture the experiences of these patients and their perceptions regarding access to healthcare to determine the role that access to care played in their condition. Interviews were conducted to gain an understanding of their experiences related to their use of …

Nurse Practitioner Approach To Care For Peripheral Vascular Disease, Jessica R. Wozniak

Walden Dissertations and Doctoral Studies

The Amputation Coalition indicates that there were approximately 2 million people with limb loss in the United States primarily caused by peripheral vascular disease in 2019. Those with amputation related to vascular disease have a 5-year mortality rate. The gap in clinical practice at the facility used for this project is that there were no comprehensive program guidelines for nurse practitioners and other health care professionals working with people who are at risk for vascular intervention or limb loss. The practice-focused question was answered that an interprofessional team did develop a prototype for a comprehensive peripheral vascular program that serves …

Association Between Obesity, Socioeconomics, Mental Illness, And Education In Native American Communities, Darrell D. Wright

Walden Dissertations and Doctoral Studies

Obesity is a profound health epidemic that adversely affects the health of all ethnicities. This growing health crisis has been found to be linked to several chronic diseases such as stroke, diabetes, and several forms of cancer. As in Native American populations, increased morbidity and mortality rates associated with obesity prevalence in minority populations has been linked to variables such as income, education, mental illness, and age. The purpose of this research was to examine the association of obesity with socioeconomic status, education, mental illness, and age in Native American populations. The theoretical framework used in this study was based …

Changes In Operating Performance In Rural Hospitals From 2012 To 2019, Oluwaseyi Tami Young-Harry

Walden Dissertations and Doctoral Studies

Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American …

Strategies For Reducing Adverse Medical Events From Implanted Medical Devices, Gary John Zack

Walden Dissertations and Doctoral Studies

Managing medical device monitoring processes is challenging and lacks a realtime, life cycle tracking strategy to reduce adverse medical events and revision costs for hospital administrators, physicians, and patients. Understanding the malfunctions of medical devices for cardiac and orthopedic patients could save lives and reduce hospital liability. Grounded in the business process reengineering conceptual framework, the purpose of this single qualitative case study was to explore strategies hospital managers used to redesign the implant recall surveillance process at one hospital in Pennsylvania. The 5 participants selected successfully implemented a medical device surveillance process that reduced adverse medical events and revision …

Registered Nurse Engagement And Patient Falls In The Acute Care Setting, Jenna Zaliauskas

Walden Dissertations and Doctoral Studies

Falls are a critical problem for inpatient medical-surgical adult patients. Past research has indicated a link between nurse disengagement and unsafe care. The purpose of this study was to improve the understanding of the relationship between nurse engagement and patient falls with injury on medical surgical units in health care facilities in the United States using the National Database of Nursing Quality Indicators. Retrospective data were reviewed from 13 U.S. hospitals in the Midwest covering Q1 (2018) and Q2 (2018) on medical-surgical units related to nurse engagement and patient falls. A correlational and MANOVA design was used to determine the …

Impact Of Medicare Utilization On Mortality And Readmission Rates Of Heart Failure Patients 65 Years And Over, Joanna Alexander

Walden Dissertations and Doctoral Studies

Roughly 25% of individuals 65 years and over hospitalized with heart failure are readmitted within 30 days after discharge. Elderly individuals identified with heart failure possess a 5-year mortality approaching 50%. The purpose of this study was to determine if there is a relationship between Medicare-covered services for care, mortality rates, and readmission rates for beneficiaries 65 years and over with heart failure. To address this topic, the chosen approach was retrospective and quantitative. The theoretical foundation was the Chronic Care Model. The research questions sought to determine if there is a relationship between the Medicare-covered services for care and …

Retail Pharmacy Clinic Antibiotic Stewardship Program And Guidelines, Abdulrahman Sudi Amiri

Walden Dissertations and Doctoral Studies

Overuse of antibiotics poses serious consequences for patient's well-being, including the risk for antibiotic resistance and adverse effects from inadequate and timely treatment. The emergence and frequency of multi-drug resistant bacteria are alarming global public health care experts, as these strains are resisting effective management of life-threatening infections. The gap in practice was that a retail pharmacy clinic did not have a practice guideline for the implementation of a wait-and-see prescription program as part of an antimicrobial stewardship program. The purpose of this project was to coordinate an interprofessional team to develop guidelines for this primary care setting. The practice-focused …

Recovering Illicit Substance Users' Perspective About Mandatory Drug Testing In Schools, Julie Bowser

Walden Dissertations and Doctoral Studies

The purpose of this exploratory qualitative study was to examine recovering substance

abusers' perceptions about the usefulness of mandatory drug testing in schools for adolescent substance abuse. Illegal substance abuse has reached epidemic proportions as more than half of U.S. adolescents, aged 12 to 17 years, have engaged in illicit drug use. Substance abuse information has been a part of school health education programs since the United States Drug Free Schools and Communities Act of 1986. Despite substance abuse education and school programs about the effects of drug use, many high school students abuse illicit drugs. Face-to-face interviews were conducted …

The Impact Of Dietary Intake On Mortality Risk In Colorectal Cancer Survivors, Ellen Chow

Walden Dissertations and Doctoral Studies

The colorectal cancer (CRC) survivor population is increasing in the United States. The lack of effective dietary recommendations in recurrence prevention undermines the health-related quality of life of survivors. Grounded in the socioecological model, dietary behavior is a personal-level risk factor that individuals may control. This study investigated the CRC-specific mortality risk as predicted by diet quality, dietary fiber intake, and dietary fat intake in hope of contributing to future dietary recommendations. A secondary analysis using data from 1,166 CRC survivors in the Multiethnic Cohort Study was analyzed via Cox proportional hazard regression models to estimate mortality risk. Results from …

Experiences Of Postpartum Women With Nurse-Delivered Education And Postpartum, Krystal Evans

Walden Dissertations and Doctoral Studies

Postpartum depression affects many women globally, yet largely remains underdiagnosed. It is thus important for nurses to have all available tools when delivering education and care to the postpartum patient. Yet, there is a lack of information on the experiences of postpartum women related to postpartum education and postpartum depression. The purposes of this quantitative study, for which Beck's postpartum theory was the framework, were to explore postpartum women's perceptions of education experiences and to determine if a correlation exists between the satisfaction with education and scores on the Edinburgh Postnatal Depression Scale. Sixty study participants who were 6-8 weeks …

Voluntary Male Circumcision And Risk For Human Immunodeficiency Virus In Homa Bay, Kenya, George Obhai Gabriel

Walden Dissertations and Doctoral Studies

The role played by the belief about voluntary medical male circumcision (VMMC) in predicting HIV status has not been examined. The purpose of this study was to investigate whether there were any differences between belief about VMMC, unprotected sex, age, number of sexual partners, relationship status, and HIV status among circumcised males aged between 18-49 years in Homa Bay County, Kenya. Drawing from the health belief model and case-control study design, 936 men were recruited based on their HIV status (468 HIV cases and 468 controls). A bivariate logistic regression was applied, and the results indicated that unprotected sex, age, …

Prostate Cancer Screening Intention Among African American Males Ages 40 To 65 Years, Paul L. Johnson

Walden Dissertations and Doctoral Studies

African American men are at a higher risk of developing and dying from prostate cancer (PCa) compared with any other race or ethnic group. Despite prostate cancer screening (PCS) recommendations, African American men are less likely to be screened for PCa compared with any other race or ethnic group. The purpose of this study was to identify factors that influence the intentions of African American men to obtain a PCS. A nonexperimental cross-sectional research design was used to identify factors associated with the intention to obtain PCS. The theoretical framework for the study was the social-ecological model which posits that …

Work-Life Balance Of Rotational Workers In The Nigerian Energy Sector, Israel Olalekan Jolaolu

Walden Dissertations and Doctoral Studies

Rotational workers in the Nigerian oil and gas industry otherwise referred to as the energy sector, are confronted with challenges and stresses of work-life balance (WLB). Using boundary theory, 15 oil and gas workers with more than 5 years of rotational work experience were recruited to examine the strategies they employed to deal with the stresses and work-life balance required for the social well-being of the workers, which translates to improved job performance in the oil and gas sector in Nigeria. The research question was designed to explore the lived experiences of rotational workers with more than 5 years in …

Impact Of Chlorpyrifos Exposure On Colorectal Cancer In Agricultural Communities In Ohio, Vicky Knisley-Henry

Walden Dissertations and Doctoral Studies

Colorectal cancer (CRC) is the third leading cancer diagnosis in the United States, and second in Ohio, for both men and women. In 2019, there were an estimated 145,000 cases of new CRC diagnoses and will lead to more than 50,000 deaths. Results from a systematic review indicate that chlorpyrifos use in agriculture is linked to the incidence of breast and lung cancers and has a possible association with CRC. Grounded in the social-ecological model, this study investigated the association between exposure to chlorpyrifos and CRC rates in agricultural communities in Ohio. The quantitative cohort design method utilized secondary data …

Understanding Behavioral Health Stigma Within The Healthcare Workforce, Jason Robert Martin

Walden Dissertations and Doctoral Studies

Individuals who seek mental health treatment in the United States face significant barriers. One such barrier is the belief that those seeking mental health treatment are subpar people with some moral failure. One area where this phenomenon exists is the behavioral healthcare workforce. This study was conducted to understand the phenomenon of stigma that behavioral healthcare leaders exhibit toward behavioral healthcare patients using the Baldrige framework as its conceptual framework. Using a qualitative approach and case study design, interviews were conducted with 6 leaders within a large healthcare system in the suburbs of a major metropolitan area to evaluate their …

Influence Of Supervisor Support And Resilience On Productivity And Turnover Intentions In Pediatric Health Care, Adrienne Y. Martin

Walden Dissertations and Doctoral Studies

Workplace violence has become a critical safety issue in the health care setting, often leading to increased stress levels and employees that feel unsupported and inadequately prepared; which leads to increased turnover, and subsequently, diminished overall organizational productivity and poorer patient outcomes. The purpose of this study was to examine whether supervisor support and resilience affect productivity and turnover intent related to professional role and work experience following workplace violence in the pediatric health care setting. Organizational support theory and the framework of the resilience model provided the theoretical structure for this study. Data were collected through anonymous surveys with …

Introducing Exercise And Home Safety Check To Decrease Falls In Older Adults, Alie Theresa Massicot-Gray

Walden Dissertations and Doctoral Studies

The lack of education related to causes of, complications from, and interventions for falls is associated with the high rate of falls and fall-related injuries in older adults (OAs) beginning at age 65. The purpose of this project was to develop a fall prevention program that included components of the Stopping Elderly Accidents Deaths & Injuries Algorithm to increase fall prevention awareness and reduce falls in OAs at one community senior center. The project practice question asked whether introducing a fall prevention program that focused on exercise and home safety checks to educate OAs could decrease the rate of falls. …

Nurse-Driven Protocols In The Pediatric Emergency Department: A Systematic Review, Roberta Miller

Walden Dissertations and Doctoral Studies

Long wait times in emergency departments across the United States contribute to overcrowding, and adverse patient outcomes. Adult emergency departments use nurse-driven protocols to decrease time to treatment and wait times. However, nurse-driven protocols are not commonly used in the pediatric emergency department (ED). The purpose of this project was to evaluate and appraise current evidence to determine if nurse-driven protocols can be safely implemented to improve ED wait times, time to disposition, patient/family satisfaction, and patient outcomes in the pediatric emergency setting. The Iowa model of evidence-based practice (EBP) was used to guide the mixed methods systematic review. A …

Obesity, Snoring, Sleep Apnea, And Coronary Heart Disease, Maryam Khalilah Muhammad

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD) is a significant public health issue that affects communities across all socioeconomic and demographic groups. Risk factors for CHD include sleep apnea and snoring. Obesity with short sleep duration also places individuals at higher risk for CHD. Although limited research has been conducted on CHD and its relationship to obesity, sleep apnea, and snoring as individual risk factors for CHD, a gap exists as these factors had not been studied as paired in this study. The purpose of this quantitative, cross sectional study was to determine if a significant relationship existed between obesity, snoring, sleep apnea, …

Factors Associated With Hepatitis B Vaccination Among Asian Adults (≥ 18 Years) In The United States., Naana Abena Ohemeng-Tinyase

Walden Dissertations and Doctoral Studies

In the United States, hepatitis B disproportionately affects Asian and Pacific Islanders (AAPIs). Hepatitis B related liver cancer is the leading cause of cancer deaths among Asian Americans. Despite the proven significant economic, health, and social effect of hepatitis B virus, immunization rates remain low. The purpose of this study is to examine the association between sociodemographic factors (age, marital status, gender, work experiences), health status factors (chronic disease, nonchronic disease), health behavior factors (smoking, alcohol intake, tobacco use, physical activity), and hepatitis B vaccination among Asian adults (≥ 18 years) in the United States. The main theory that frames …

Education To Improve Health For Rural Africa American Women With Diabetes, Monique Deidre Pendleton

Walden Dissertations and Doctoral Studies

Diabetes (DM) is the 7th leading cause of death in the United States. Minorities like Hispanics and African Americans (AA) are at greater risk of developing DM. The prevalence and outcomes affecting diabetes are attributed to socioeconomic status, sex differences, ethnic, cultural, and religious status. Diabetes-related mortality is a major health problem in AA in rural America. The focus for this project was to identify the best evidence regarding educational counseling on lifestyle modifications that positively impact adult AA women with diabetes living in Rural America. The social-ecological theory and health belief model informed this project because these models incorporate …

Clinical Practice Guideline: Maintaining Skin Integrity In The Surgical Patient, Erin Renne Price

Walden Dissertations and Doctoral Studies

The purpose of this project was to develop clinical practice guidelines for intraoperative positioning that will help prevent deep tissue injury and skin breakdown. Maintaining skin integrity in the surgical patient by preventing deep tissue injuries and skin breakdown is an identified gap in practice for surgical patients in the Operating Room environment that a clinical practice guideline could positively impact. To assist in achieving the development of a clinical practice guideline to maintain skin integrity, Benner's novice to expert theory addressing the educational needs for novice operating room nurses was applied. The clinical practice guideline, based on evidence, should …

Parental Characteristics And Lead Knowledge In The Minimization Of Environmental Lead Exposure, Trina Yvette Redford

Walden Dissertations and Doctoral Studies

A method for guiding lead intervention and minimizing lead exposures in Philadelphia, Pennsylvania (PA) is through understanding the relationship between lead knowledge and parental characteristics such as gender, age, income, marital status, and education attainment. Parental characteristic may play a significant role in the identification of population groups where knowledge pertaining to lead exposure is inadequate. Through awareness and intervention, preventive measures can be implemented to minimize and eliminate lead exposure. The theoretical concept used in this quantitative study was Krieger ecosocial theory. The ecosocial theory provides guidance and analyzes differences in existing health relationships, especially those with biological and …

Relationship Between Clostridium Difficile Testing Method, Antibiotic Treatment, And Clinical Symptoms, Jennifer L. Sanguinet

Walden Dissertations and Doctoral Studies

Clostridium difficile (C. difficile) infection is a leading cause of morbidity and mortality in the United States, making the infection a top public health priority. Early and accurate identification of disease is a critical factor in successful management, including clinical symptomology. The testing methods for C. difficile have improved in efficiency and sensitivity, which potentially causes over- or underprescribing behavior. Guided by the symbolic theory, the purpose of this study was to examine the association between C. difficile testing method by case year (2015 and 2018) and antibiotic treatment with the potential moderation of clinical symptoms. The secondary correlational analysis …

Compassion Satisfaction, Burnout, And Intent To Stay Among Nurse Leaders, Lisa Denile Surby

Walden Dissertations and Doctoral Studies

Nurses in leadership roles have a substantial influence on the quality of the work environment and on safety, quality, and patient outcomes. However, compassion satisfaction (CS) and burnout (BO) have historically been understudied, and evidence is lacking regarding the existence of a relationship between CS, BO, and intent to stay among nurse leaders. The purpose of this cross-sectional descriptive study, guided by Stamm's theory of CS and compassion fatigue (CF), was to determine if there was a relationship between CS and BO and intent to stay among nurse leaders. An anonymous online survey was conducted using the Professional Quality of …

Evaluation Of Telehealth Applications For Patients Seeking Hospice Care, Victoria Emma Surujlall

Walden Dissertations and Doctoral Studies

Telehealth (TH) is one of the newest avenues for improving accessibility and healthcare accommodations for patients with chronic health issues and terminal illness. The purpose of a quality improvement (QI) initiative at the project site was to align current evidence-based practice to address the disparities in the admissions process experienced by patients seeking hospice care from remote locations. The health belief model and Roger's diffusion of innovation theory were used to inform this doctor of nursing QI evaluation project to determine whether using a standardized evidence-based intake assessment process delivered by TH would increase accessibility for patients seeking hospice services. …