Medicine and Health Sciences Commons^™

Socioeconomic Status, Benzathine Penicillin Prophylaxis, And Clinical Outcomes In Patients With Rheumatic Heart Disease, Christopher Sabo Yilgwan

Walden Dissertations and Doctoral Studies

Rheumatic heart disease (RHD) is the major cause of acquired heart disease and death for children and young adults in developing countries. Poverty and social disadvantage are thought to influence the clinical outcomes in RHD patients. Guided by the health lifestyle theory, this study assessed the relationship between socioeconomic status and clinical outcomes (heart failure events and mortality) in patients with RHD. It also examined how adherence to penicillin prophylaxis mediates the effect of socioeconomic status (SES) on clinical outcomes. Using the Nigerian database of the REMEDY study, this study was conducted with 243 participants using Poisson regression and logistic …

Perceptions Of Academic Success Of English As A Second Language Nursing Students, Jean Lansang

Walden Dissertations and Doctoral Studies

Hispanic or Latino and Asian communities represent two of the rapid-growing ethnicities who seek healthcare in the United States. However, the U.S. nursing workforce does not reflect the ethnic or cultural makeup of the patient population. The purpose of this study was to examine the lived experiences of Asian and Hispanic or Latino English as a second language (ESL) nursing students and learn the barriers and facilitators they experienced in their nursing program. A qualitative phenomenological approach underpinned by the social-ecological model and the Cummins language acquisition model was used for the study. Face-to-face interviews were conducted with 7 Asian …

Access To Health Insurance And Health-Seeking Behavior In A Nigerian Suburban Community, Charles Olalekan Mensah

Walden Dissertations and Doctoral Studies

The purpose of this study was to understand the effects of access to health insurance on the healthcare-seeking behavior of the population in four suburban communities in Rivers State, Nigeria. The conceptual framework of the study is based on Anderson's behavioral model of health services use. The study looked at how access to health insurance affects the healthcare seeking behavior and the preventive care seeking behavior of the study population. Two-hundred and seventy participants were surveyed using the Health Care Access and Utilization Survey (HCAUS) questionnaire. Data were analyzed using descriptive statistics (frequencies and percentages) and bivariate logistic regression. Respondents …

Pertussis Resurgence In Europe: Incidence And Epidemiologic Cycles In Immunization Required And Non-Required Countries, Sheryl Ann Duquet

Walden Dissertations and Doctoral Studies

Although pertussis vaccines have been available for over 7 decades, countries are experiencing a pertussis resurgence. This study sought to establish a relationship between the European pertussis immunization schedule designs (with and without the inclusion of adolescent boosters) and the immunization requirement (recommended or required), which potentially influences immunity waning, and thus the incidence rate and epidemiologic cycles of pertussis. The theoretical foundation for this study was the theory of herd immunity. A quantitative research method was used, supported by a secondary data source. The statistical analysis included the use of linear regression to evaluate the relationship between the requirement …

"Evaluation Of Medication Adherence Through The Use Of Home Assisted Telemanagement", Kingsley Ezihe Ngameduru

Walden Dissertations and Doctoral Studies

Medication nonadherence can have serious consequences for patient outcomes. Home-automated telemanagement systems have supported increased levels of adherence among patients. This project explored whether the use of a home telemanagement program (HTM) would improve medication adherence in clinic patients diagnosed with hypertension (HTN). The health belief model, social learning theory, the self-regulation model and the theory of reasoned action guided this project. Providers in a primary care clinic completed the 4-question Morisky, Green, and Levine adherence scale with 50 HTN patients previously enrolled in a HTM. Survey results revealed that after 2 years in the program, patients were still forgetting …

Clinical Resource Practice Scenarios To Mitigate Bullying, Sabrina Renea Brown-Oliver

Walden Dissertations and Doctoral Studies

Workplace bullying is repeated, aggressive action towards a victim, which especially affects new graduate nurses and can inhibit growth and lead to nursing burnout and staff turnover. The purpose of this Doctor of Nursing Practice project was to develop a clinical resource educational module. The case scenarios were developed using literature on workplace bullying and lateral violence. Clegg's circuits of power theory framework demonstrate how organizational authoritative nursing power struggles that exist as a circular flow between different nursing group members, and the American Nurses Association (ANA) Practice Standards and Code of Ethics guided the assertive communication. The case scenarios …

Vitamin D Receptor Gene Polymorphisms Knowledge And Breast Cancer In Texas, Ejike Roland Egwuekwe

Walden Dissertations and Doctoral Studies

Breast cancer is a world health problem and is a leading cause of cancer-related death among women in the United States. However, breast cancer risks were reported to be reduced through exposure to Vitamin D through its Receptors identified as the p53 target gene. The purpose of this study was to assess the associations between VDR gene polymorphisms knowledge/awareness and decisions to reduce breast cancer risks and likelihood of mammogram screening among women in Texas. Data from survey were used. Roy adaptation model was the theoretical framework that guided this quasi- experimental, quantitative research. The dependent variables were decisions to …

Relationship Between Transformational Leadership And Perceived Meaning In Work, Denise Adams

Walden Dissertations and Doctoral Studies

Researchers have conducted correlational studies on transformational leadership and perceived meaning in work; however, researchers have not used an experimental design to examine the relationship between transformational leadership and perceived meaning in work. The purpose of this study was to determine whether reading information on transformational leadership, which focused on charisma and individualized consideration, influenced participants' hypothetical judgment of perceived meaning in work. The quantitative study included a 2 x 2 between-subjects design in which information on the independent variables of charisma and individualized consideration was manipulated in a description of a hypothetical leader. The dependent variable was the hypothetical …

Measuring Effects Of Childhood Adversity On Resilience Level Of Army Veterans, Stephanie Rausch

Walden Dissertations and Doctoral Studies

Veteran suicide is a public health issue that requires more research to understand the multidimensional factors, such as resilience, that lead someone to suicide. Adverse childhood events (ACEs), such as poverty and abuse, have affected how resilience is developed. This study examined the association between childhood factors of socioeconomic status, parental discipline, and being a military child, and adult resiliency level. Dienstbier's theory of mental toughness framed the study, which posits that a child who experiences mild ACEs and has time to recover between events, will be more resilient than children who experience serious ACEs, and children who experience little …

Adhesive Transparent Chlorohexidine Gluconate Tegaderm™ Gel Dressing For Central Venous Catheter, Peter Kimiti Mwangi

Walden Dissertations and Doctoral Studies

Central-line-associated bloodstream infections (CLABSIs) occur during the insertion or change of the dressing of the central venous catheter (CVC) and are reportable healthcare-associated infections at the state and the national level. The purpose of this systematic review of the literature was to evaluate and synthesize available evidence to establish the effectiveness of using an adhesive transparent chlorohexidine gluconate (CHG) Tegaderm™ gel dressing for CVC in the prevention of CLABSIs. The logic model was used as a framework to guide the review of the literature to establish how an intervention that is not currently practiced can contribute to CVC prevention of …

The Effect Of Maternity Care Practices On The Duration Of Breastfeeding, Lisette Rodriguez

Walden Dissertations and Doctoral Studies

The natural practice of breastfeeding has been strongly noted as one of the most cost-effective, health promoting, disease-prevention strategies of the 21st century. Although primary health organizations recommend exclusive breastfeeding for the first 6 months of life with added complementary foods and continued breastfeeding up to 2 years of age or longer, many mothers do not breastfeed their infants for the recommendation length of time. Applied policies and health practices, such as those described under the 10 Steps to Successful Breastfeeding and The International Code of Marketing of Breast Milk Substitutes, have been noted as contributing factors that can considerably …

Reducing Compassion Fatigue In Hospice Nurses Through Education, Gregory Daniel Friesz

Walden Dissertations and Doctoral Studies

Compassion fatigue is a secondary stress reaction that results from providing care to those undergoing traumatic life events. Frequent exposure to dying patients with complex medical concerns has been identified as a contributing factor to compassion fatigue and resultant turnover among hospice nurses. The purpose of this project was to assess whether the provision of education to hospice nurses regarding compassion fatigue resulted in a demonstrable improvement in their levels of compassion fatigue. Watson's theory of human caring and Roy's adaptation model provided the theoretical foundation for this project. The practice-focused question for this project asked whether a reduction in …

The Association Between Leapfrog's Healthcare Organizational Grades And 30-Day Mortality Rates, Steven Michael Armstrong

Walden Dissertations and Doctoral Studies

U.S. healthcare consumers have access to various provider ratings from several organizations that are meant to assist in selecting their healthcare providers. Leapfrog Hospital Safety Grades is one such rating system that professes to allow consumers the ability to select the best hospital for their care. However, since consumers ranking mortality risk as their most important concern, it is essential to determine if Leapfrog grades align with consumer expectations. Andersen's Phase-4 behavioral model of healthcare utilization was used as the foundation for understanding healthcare consumer preferences. This study was designed to determine if Leapfrog grades are predictive of CMS 30-day …

Strategies To Develop A New Nurse Residency Program, Casandra Allen

Walden Dissertations and Doctoral Studies

The ongoing shortage of registered nurses is a nationwide phenomenon. Many factors contribute to the dissatisfaction and stress of new graduate nurses during the initial transition phase of their career. The lack of peer and leadership support is among the many factors that lead to constant turnover. New nurses entering the workforce are caring for patients with more complex health problems. The Commission on Collegiate Nursing Education (CCNE) has developed standards for accreditation of entry-to-practice nurse residency programs (NRP). The purpose of this DNP project was to propose a formal evidenced-based nurse residency program to the stakeholders of an acute …

Structured Education Using Scenario-Based Training In Cerner Electronic Medical Records, Ruby Aruldass

Walden Dissertations and Doctoral Studies

Nurse practitioners are trained to use the electronic medical record (EMR) to document. Documentation in the EMR is often found to be incomplete, inaccurate, and unreliable, which affects the quality of care and patient safety outcomes. The purpose of the project was to improve the efficiency and effectiveness of nurse practitioners' documentation in the EMR. Malcolm Knowles' adult learning theory was used in this project to develop the education program. Kirkpatrick's training evaluation model was also used to analyze and evaluate the project. The study population included 5 primary care nurse practitioners in an ambulatory care setting using Cerner EMR. …

Increasing Uninsured Patients' Compliance With Return Primary Care Visits, Dorothy Clare Carleton

Walden Dissertations and Doctoral Studies

Patients who are unable to comply with their health care regimen are almost 3 times more likely to have an adverse health outcome and are more likely to suffer irreversible progression of a chronic disease process. Increasing patient return clinic visits is essential, not only to curtail rapidly rising costs of health care but also to improve patient outcomes. This project focused on an uninsured patient population of a clinic in a rural community in the southeastern United States. The purpose of the project was to conduct a systematic review of the literature and identify the barriers and motivating factors …

Implementing Guidelines To Improve Hand Hygiene Compliance, Doreen Millicent Currie

Walden Dissertations and Doctoral Studies

Hand hygiene is the term for removing microorganisms with disinfecting agents, alcohol-based rub, or soap and water. Evidence supported the low rates of hand hygiene compliance among health care workers. This project addressed this gap in practice at a large acute care facility through an educational training program. Data from the facility on hand hygiene compliance revealed a compliance rate of 63%. The problem question explored whether an educational program on hand hygiene improve compliance. The focus of the program was to provide education on the World Health Organization's My 5 Moments for Hand Hygiene and the 7-step technique for …

Improving Access To Cancer Care For The Rural Community With Telehealth, Cheryl Ann Fiscelli

Walden Dissertations and Doctoral Studies

After a diagnosis of cancer, timely access to oncology care is a priority. For patients living in a rural community, there are many challenges such as proximity to cancer care, reduced access to state-of-the art therapies, lack of coordinated care, and limited access to clinical trials. A multidisciplinary consultation (MDC) via telehealth can improve access to care for rural oncology patients. The purpose of this project was to determine the effects of telehealth MDC on the time in days from diagnosis to the first treatment with the goal of persuading the project site to implement a telehealth MDC. The data …

Enhancing Comfort Care Techniques In The Pediatric Inpatient Setting, Nicole Rae Mansky

Walden Dissertations and Doctoral Studies

The benefits of pharmacological and nonpharmacological interventions for children undergoing painful medical procedures are well documented in extant nursing literature; however, such techniques continue to be underused in practice. Improving comfort during medical procedures is necessary to enhance the patient and family experience. The purpose of this project was to provide education to nursing staff about pediatric pain theories and evidence-based practice recommendations that support the use comfort interventions for pediatric patients of all ages. The practice-focused question addressed the development of an educational program designed to enhance staff knowledge of comfort intervention options and the benefits provided to patients. …

Strategies For Reducing Medication Errors In An Outpatient Internal Medicine Clinic., Uche Gerard Obua

Walden Dissertations and Doctoral Studies

Medication errors are among the most common causes of unintended harm to patients and have led to many deaths. Some categories of medication errors include; medications administered to the wrong person; medications administered at the wrong time, through the wrong route; administration of the wrong medication and/or dose; and the omission of medications. Guided by the logic model, the just culture model, and the Knowles theory of andragogy, the purpose of the project was to determine if providing information related to evidence-based strategies to reduce medication errors would result in safer medication administration practices and improved patient outcomes A survey …

Incentive Size Alignment With Accountable Care Organization Performance, Kristie D. Racca

Walden Dissertations and Doctoral Studies

Changes to the country's health care political landscape in 2012 resulted in the development of federal programs aimed at containing costs and improving the quality of care delivered. Accountable Care Organizations (ACO) emerged linking performance to rewards. Guided by Conrad's value-based performance incentive theory as the theoretical foundation, the purpose of this quantitative study was to determine the relationship between financial incentive size and ACO performance measures. The research questions examined the predictive relationship of incentive size and acute care readmission rates, emergency department (ED) visits, and per capita spending of the ACO Medicare Shared Savings Program population. The study …

Wright's Competency Model And Quality And Safety Competencies, Staci Shanks

Walden Dissertations and Doctoral Studies

Competent nurses are instrumental in assuring that a patient receives safe patient care of the highest quality. Patient care that lacks quality places patients at risk of poor health outcomes and results in negative financial impacts for the organization. The purpose of this staff education project was to develop nurse competency education for a facility's competency program, which merged the Wright competency model with quality and safety education for nurses' competencies. The nurse competency staff education program was evaluated by the organization's stakeholders for inclusion in the competency program. The whole-part-whole model, Knowles's adult learning theory, and Lewin's change theory …

Perceptions Of Well-Being And Coping Mechanisms From Caregivers Of Individuals With Autism, Barbara Simmons

Walden Dissertations and Doctoral Studies

Caregivers of individuals with autism often report increased levels of stress and a lack of social support to help them cope with various stressors as they provide care. Without coping mechanisms or social support, as individuals with autism present various behavioral and emotional challenges, caregivers can experience a decline in well-being. Thus, the purpose of this qualitative study was to explore the processes that caregivers of individuals between the ages of 9-18 diagnosed with autism use to cope with stress and social support in Southeast Georgia. Grounded theory was used to describe the perceived thoughts caregivers have about stress and …

Leadership Strategies To Improve Nurse Retention, Floyd Jordan Colwell

Walden Dissertations and Doctoral Studies

The nursing shortage and high turnover rates are a problem in the United States. The purpose of this multiple case study was to explore leadership strategies that hospital senior nurse managers in the Rocky Mountain states use to improve nurse retention. Participants were 6 hospital senior nurse managers including 3 chief nursing officers, 1 assistant chief nursing officer, and 2 directors who had demonstrated effective leadership strategies in retention of nurses. The leadership-motivated excellence theory was the conceptual framework. Semistructured interviews with open-ended interview questions were used to collect data; organization websites and documents were used to help corroborate evidence …

Leptin Level Variance In Adults With And Without Cancer, Vilisa Chatman-Terry

Walden Dissertations and Doctoral Studies

Abstract

In 2018, health statistics revealed that, despite the many preventive measures established,

cancer was the second leading cause of death in the United States and the leading cause

of death in 22 states, exceeded only by heart disease. With obesity/leptin levels reaching

pandemic levels worldwide, and cancer having a well-known association with obesity,

both chronic diseases represent a large proportion of public health challenges. Guided by

the social ecological model, the purpose of this cross-sectional, quantitative study was to

examine if a significant difference exists in leptin levels among adults with different

types of obesity-associated and common cancers and …

Implementing Aromatherapy For Falls Reduction In The Inpatient Hospice Population, Kimberly Kay Pistek

Walden Dissertations and Doctoral Studies

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted …

Cultural Health Beliefs And Influenza Vaccination Among Caribbean-Born Students, Dona S. Walcott

Walden Dissertations and Doctoral Studies

This purpose of this quantitative study was to examine health beliefs among Caribbean-born university students regarding acceptance or rejection of influenza vaccination among populations at institutions of higher education. In addition, acculturation was addressed as a factor affecting cultural health beliefs. A survey was completed by 98 students enrolled at Florida International University during the spring 2018 semester. Linear regression was used to analyze whether cultural health beliefs and acculturation were predictive of beliefs about influenza vaccination and beliefs about perceived barriers to influenza vaccination. The study findings showed cultural health beliefs of the students were statistically significant predictors of …

Faculty And Student Perspectives Of Nursing Student Completers In A Community College, Rachael Farrell

Walden Dissertations and Doctoral Studies

Research about retention of nursing students has focused on either specific student characteristics or on nursing students at the university level. A problem experienced by a community college nursing program in Maryland is low completion rates, which can affect the institution and the nursing profession. This qualitative case study explored faculty-related factors leading to success of students in the nursing program at this school, so the low completion rate can be addressed. The conceptual foundations for this study were Tinto's theory of student retention and Jeffreys' nursing undergraduate retention and success model. The research questions addressed how faculty-related factors affected …

Effective Strategies For Recognition And Treatment Of In-Hospital Strokes, Maryika Ivanova Gibson

Walden Dissertations and Doctoral Studies

In-hospital onset strokes represent 4% to 20% of all reported strokes in the United States. The variability of treatment protocols and workflows as well as the complex etiology and multiple comorbidities of the in-hospital stroke subpopulation often result in unfavorable outcomes and higher mortality rates compared to those who experience strokes outside of the hospital setting. The purpose of this project was to conduct a systematic review to identify and summarize effective strategies and practices for prompt recognition and treatment of in-hospital strokes. The results of the literature review with leading-edge guidelines for stroke care were corelated to formulate recommendations …

Nursing Education Workflows In Ehr Training, Liezel Granada

Walden Dissertations and Doctoral Studies

A need for improvement in nursing education regarding inpatient workflows and informatics skills was identified at this project site. Upon hire, nurses were required to complete a 4-hour basic class on the electronic health record (EHR) system, but this class did not include inpatient-nursing workflows needed to provide and facilitate care for patients. This project addressed the lack of EHR education on inpatient nursing workflows. The focus of this staff education project was an education class on inpatient nursing workflow provided to a nurse residency class. Sources of evidence were obtained through a literature search and pretest/post test data analysis. …