Medicine and Health Sciences Commons^™

Poverty, Demographics, And Hepatitis C Infection In The National Health And Nutrition Examination Survey, Wilson J. Washington Jr

Walden Dissertations and Doctoral Studies

Hepatitis (HCV) is a communicable disease that impacts many Americans. The scholarly literature lacked the knowledge pertaining to the relationships between poverty and HCV diagnosis and prescription for HCV medication. The purpose of the study was to measure the magnitude and statistical significance of these relationships, as modeled by the health belief model and public health surveillance and action framework. Specifically, the study was designed to determine whether there is a statistically significant relationship between living below the poverty line and being diagnosed with HCV, as well as living being below the poverty line and being prescribed HCV medication. A …

Improving Early Mobilization In Acute Stroke Patients Through Best Practice Education, Angela Christine Middleton

Walden Dissertations and Doctoral Studies

Nonadherence to best practice guidelines in early mobilization in acute stroke increases the time from admission to mobilization and may increase residual long-term stroke effects. Early mobilization following an acute stroke is known to decrease long-term and secondary disability. The purpose of this project was to decrease the time from admission to mobilization in the acute stroke patient population by improving knowledge of best-practice guidelines in early mobility using an educational intervention for advanced practice nurse practitioners, physicians, and registered nurses. The practice-focused question for this project asked whether a staff educational program based on best-practice guidelines would decrease the …

The Effect Of Self-Esteem, Bullying, And Harassment On Nurse Turnover Intention, Joyce Richelle Arand

Walden Dissertations and Doctoral Studies

Currently there is a high rate of registered nurse (RN) turnover due in part to bullying and harassment among peers; which fosters lower quality nursing care, jeopardizes patient safety, and increases healthcare costs. The purpose of this quantitative nonexperimental study was to examine the relationship between inpatient nurses' individual self-esteem and reported bullying and harassment with their intent to leave their job. Two theories were used to provide structure to this work: cognitive experimental self theory and oppressed group theory. Data were collected using the Negative Acts Questionnaire, the Rosenberg Self-Esteem Scale, and the Turnover Intentions Measure. All RNs in …

Adolescent Obesity Intervention In An Outpatient Primary Care Setting, Chinyere Susanna Awamba-Agu

Walden Dissertations and Doctoral Studies

Lack of education in the outpatient setting related to causes, complications, and prevention of obesity is associated with high rates of obesity in adolescents 12 to 19 years of age. The gap in the adolescents' and family members' knowledge of obesity contributes to the adolescents' high calorie consumption and the development of obesity. The purpose of this project was to develop a staff education guideline for use by clinicians to educate adolescents and their families on how to develop nutritious food plans and decrease obesity. The project practice question asked whether educating the primary care providers in the primary care …

Tobacco Treatment Education Module For Nurses Working In The Inpatient Psychiatric Setting, Marchell Rene Spielmann

Walden Dissertations and Doctoral Studies

Tobacco use among people with mental illness remain a significant problem in the western United States. At the project site, there is widespread tobacco use among patients with mental illness and lack of training for nurses to address the issue. The purpose of this project was to educate nurses working in the acute psychiatric setting about evidence-based tobacco treatment interventions. The practice-focused question addressed whether a tobacco education program would increase nurses' knowledge, confidence, and skills to provide tobacco treatment interventions to patients with a mental illness. Self-determination theory and the transtheoretical model of change provided the theoretical framework for …

Increasing Daily Exercise Adherence In Women By Examining Motivational Factors, Victoria Wozniak

Walden Dissertations and Doctoral Studies

Women ages 20–39 years old have seen the most dramatic increase in obesity levels in the United States over the last 2 decades. Researchers have indicated the need for studies to increase motivation in women to promote daily exercise. There is a gap in the literature about what motivational factors are most effective with increasing exercise in daily life. Using the transtheoretical model of change (TM) as the grounding theory, this study measured daily exercise adherence. A selective sampling of women ages 20–39 years old in the United States were recruited to complete an online survey. The online survey included …

Impact Of Emergency Department Prescriber Type On The Rate Of U.S. Opioid Prescriptions, Edward Worlanyo Agbevey

Walden Dissertations and Doctoral Studies

Many drug overdoses in the United States are from prescription drugs, most of which are classified as opioid pain relievers (OPRs) and commonly prescribed in emergency departments (EDs) to treat pain. OPR abuse and addiction is a major public health issue. Researchers have identified the role of various patient characteristics (race, gender, demographics, etc.) in the variation in OPR prescription rates, but the contribution of provider-type differences to that variation has not been exposed. The purpose of this study was to evaluate the strength of the association between provider type and the likelihood of an opioid prescription by ED providers …

Parents' Knowledge Of Child-Passenger Safety And Child-Passenger Restraint Usage, Amanda Cadore

Walden Dissertations and Doctoral Studies

Although occupant protection laws exist, limited research has been conducted on how current child passenger safety (CPS) issues and CPS marketing strategies relate to child passenger safety seat (CPSS) usage. The purpose of this cross-sectional study was to analyze the relationship between parents' perception and knowledge of CPS issues and CPSS usage rates. The diffusion of innovation and the social marketing theories provided the frameworks for this study. The overall research question for the study examined the correlation between parents' knowledge of CPS issues and CPSS usage. Data (participants' surveys, car seat check-up information, and observational statistics) were collected from …

Medicare And Medicaid Regulations' Financial Effects On Home Health Agencies' Performance, Binzie Roy Davidson

Walden Dissertations and Doctoral Studies

Some owners of small to medium-sized managed care businesses lack strategies to address the effects of healthcare regulations on their businesses. The purpose of this multiple case study was to identify strategies that owners of small to medium-sized managed care businesses used to address the financial effects of healthcare regulations on their businesses. The conceptual framework for this study was profit maximization and adaptation in changing contexts. Data were gathered from company documents, observations, and semistructured interviews with 5 home healthcare business owners in Los Angeles County, California. Data were coded to identify themes from the narrative segments. Key themes …

Preinfection Risk Perceptions Of Human Immunodeficiency Virus Positive Homosexual And Bisexual Men, Benjamin Singer

Walden Dissertations and Doctoral Studies

In 2017, there were 4,949 persons diagnosed with human immunodeficiency virus (HIV), 116,944 persons living with HIV, and 2,044 acquired immunodeficiency syndrome (AIDS) cases in Florida. Of the 4,972 new HIV diagnoses in Florida, 60% were related to male-to-male sexual contact, 4% from intravenous drug use, 2% from male-to-male sexual contact and intravenous drug use, 33% from heterosexual sexual contact, and 1% from other sources. Guided by the health belief model (HBM), this qualitative study sought to understand the lived experiences of HIV positive adult men who have sex with men (MSM) living in Florida, regarding their preinfection perceptions of …

Successful Demand Forecasting Modeling Strategies For Increasing Small Retail Medical Supply Profitability, Arica Watkins

Walden Dissertations and Doctoral Studies

The lack of effective demand forecasting strategies can result in imprecise inventory replenishment, inventory overstock, and unused inventory. The purpose of this single case study was to explore successful demand forecasting strategies that leaders of a small, retail, medical supply business used to increase profitability. The conceptual framework for this study was Winters's forecasting demand approach. Data were collected from semistructured, face-to-face interviews with 8 business leaders of a private, small, retail, medical supply business in the southeastern United States and the review of company artifacts. Yin's 5-step qualitative data analysis process of compiling, disassembling, reassembling, interpreting, and concluding was …

Developing Staff Education Regarding Colorectal Cancer Screening Practice Guidelines, Ruth Airiohuomo Aboiralor

Walden Dissertations and Doctoral Studies

Colorectal rectal cancer (CRC) is the 3rd most common cancer in men, the 2nd most common cancer in women, and the 4th leading cause of cancer death. Lack of screening or delayed screening for CRC is the major cause of undiagnosed cancers that become malignant and eventually become fatal. Nurses at the project site are not in compliance with CRC screening guidelines due to inadequate knowledge of the screening guidelines recommended by the American Cancer Society, which creates a gap in practice. The purpose of this project was to develop staff education on CRC screening guidelines. The practice focused question …

Relationship Between Adolescent Perception Of Harm, Electronic Cigarette Use, And Texas Antitobacco Campaigns, Candace Rasheedah Campbell

Walden Dissertations and Doctoral Studies

The increase in use of e-cigarettes in adolescents is a major public health concern that must be addressed. Research studies showed some e-cigarettes contained varying amounts of nicotine and sever cancer-causing chemicals. The purpose of this quantitative, cross-sectional study was to assess the perception of harm (dependent variable) from using e-cigarettes and being exposed to state and school-based antitobacco programs (independent variable) and to determine if the association was modified by socioeconomic status or area of residence. Attitude-social influence-self-efficacy theory was the chosen theory for research and suggests that attitude, social influence, and self-efficacy variables can be persuaded via specific …

Increasing Nursing Staff Knowledge Of Palliative Care Criteria With A Decision Tree, Juliana Cotton

Walden Dissertations and Doctoral Studies

Palliative care is often not considered during care or is considered too late in the patient’s healthcare journey to provide much benefit. The underutilization of palliative care contributes to increased healthcare costs, poor patient outcomes, and decreased patient satisfaction. The practice-focused question guiding this evidence-based practice (EBP) project was whether an education program would increase nursing knowledge regarding palliative care criteria. The program was developed using Rogers’s diffusion of innovation model and a literature review to create educational tools and achieve a sustainable EBP change. An evidence-based decision tree was developed and used as a tool for teaching and learning. …

Healthy Lifestyle Practice Among Online Health Psychology Graduate Students, Judi Elster

Walden Dissertations and Doctoral Studies

Research focused on health behaviors of online graduate students is sparse. Health psychology graduate training prepares individuals to share health information with others; the information may be more credible if they present a healthy appearance. The present study tested concepts from social cognitive theory (general perceived self-efficacy) and self-determination theory (autonomy, competence, and relatedness basic needs) to determine predictive value for graduate students’ engaging in health behaviors. Participants were 121 (29 health psychology group, 92 other programs group) online graduate students who lived in the United States and attended the same online university, recruited from multiple social media sources. The …

Preterm Infant Incubator Humidity Levels: A Systematic Review, Laurie Glass

Walden Dissertations and Doctoral Studies

Numerous scholars have reported that inconsistent incubator humidity in the neonatal intensive care unit (NICU) requires attention. Evidence synthesis was needed to assist the identification of optimal incubator humidity levels and duration to decrease transepidermal water loss (TEWL) and the potential for infection. The purpose of this doctoral project was to appraise and synthesize the evidence of preterm outcomes related to incubator humidity. The practice-focused question addressed what patient outcomes were impacted by incubator humidity level and duration in premature infants < 32 0/7 weeks cared for in the NICU. The foundation of this project was the Joanna Briggs Institute method for systematic reviews. Mefford’s theory of health promotion for the preterm infant was used to address the wholeness of the preterm infant’s body system. Evidence was classified using the Johns Hopkins evidence-based practice levels and quality of evidence. The search was conducted in 8 databases, and citation searching was used to identify 340 articles, 12 of which met the inclusion criteria. The evidence demonstrates that the practice of incubator humidity is warranted; however, it does not come without risks. Microbial growth was increased in high levels of incubator humidity. Unnecessary TEWL was prevented by lowering high levels of incubator humidity after the 1st week, improving skin barrier formation. Incubator humidity of 60%–70% in the 1st week was effective in preventing TEWL in infants born ≥ 26 weeks; however, future research is needed for infants < 26 weeks. When optimal levels and duration of incubator humidity are achieved, positive social change will occur from the improved outcomes of the smallest neonatal patients.

Cited And Underprepared; The Call For Improved Emergency Preparedness In Ltc Facilities, Dawn M. Ide

Walden Dissertations and Doctoral Studies

This research investigated the connection between the Medicare star rating system and E-tags on emergency preparedness of nursing homes for disasters in Hampton Roads, Virginia. Emergency preparedness in nursing homes has been a topic of growing interest within the past decade. Hampton Roads, Virginia, has a history of natural disasters including hurricanes and flooding, which necessitates a proper and efficient emergency preparedness plan in nursing home facilities. The primary purpose of this research was to review the secondary Centers for Medicare and Medicaid Services (CMS) data regarding the star rating system and E-tag surveys of each of the 37 nursing …

Positive Deviance Behaviors And Definition In Nursing, Stacy L. January

Walden Dissertations and Doctoral Studies

The concept of positive deviance (PD) has not been studied in the context of nursing. Grounded in narrative inquiry and combined with vocabularies of motive and symbolic interactionism, the purpose of this study was to explore whether PD behaviors existed in nursing, and if so, to develop an operational definition of PD for nursing. The research question addressed what PD behaviors, if any, were present in nurses’ workplace stories. Using posted flyers, eight participants either self-selected or were selected by snowball method to participate. Interviews were conducted in locations decided on by each participant. Interview data were obtained, transcribed, then …

Racial Disparities, Fragmentation Of Care, And Adverse Outcomes Associated With Ectopic Pregnancy, Angela Rosa Jourdain

Walden Dissertations and Doctoral Studies

Ectopic pregnancy (EP) is a rare condition that occurs in 1% of all pregnancies. However, women of lower socioeconomic status (SES) and ethnic minority groups are at greater risk of adverse outcomes associated with EP than White women. The purpose of this study was to examine data from the 2014 National Inpatient Sample to identify predictors of complications from EP in 2,626 females ages 15-44 in the United States. The theoretical framework used to guide this study was the theory of fundamental causes to explain why the association between SES and mortality has persisted despite progressive advances in the diseases …

A Staff Training Plan On Screening African Americans For Prediabetes, Valerie Kershaw-Berry

Walden Dissertations and Doctoral Studies

African American adults have higher risks of undiagnosed Type 2 diabetes, uncontrolled Type 2 diabetes, and complications from Type 2 diabetes than members of other racial groups. Health care providers in rural Tennessee lack staff training plans for prediabetes screening of older African American adults. In addition, few rural Tennessee health care providers have programs in place to train staff in prediabetes screening, screening instrument use, and interventions for Type 2 diabetes prevention. The focus of this DNP project was on developing an evidence-based staff training program designed to improve knowledge regarding prediabetes screening in older African American adults. Concepts …

Improving Nursing Knowledge Of African American Heart Failure Self-Care Management, Sharnee Moore-Jervis

Walden Dissertations and Doctoral Studies

Heart failure is a complex chronic disease affecting 6.6 million people in the United States, with an annual cost of $39.2 billion per year. African Americans are at an especially high risk for poor outcomes and readmissions from heart failure complications, as they are 2.5 times more likely to develop heart failure than other ethnic groups. This disease requires a high level of patient self-care management, and evidence suggests that African Americans do not always receive culturally sensitive education, which can lead to suboptimal self-care practices. The practice-focused question for this educational program asked whether nurses of African American patients …

A Lifestyle Modification Toolkit To Increase Physical Activity Among Young Adults, Anthonia Ninikanwa Nwanna

Walden Dissertations and Doctoral Studies

Substantial decreases in physical activity have been observed between early to late adolescence in males and females, with decreases in levels of activity into adulthood. Physical inactivity among young adults leads to medical conditions such as Type 2 diabetes, stroke, ischemic heart disease, falls resulting in hip fractures, and depression later in life. Advanced Nurse Practitioners have a significant impact on the problem of physical inactivity among young adults through education to improve knowledge regarding physical activity participation. The focus of this project was to develop a toolkit on lifestyle modification as a resource for physical education teachers and nurses …

Staff Education: Hypertension Management For Adults In Primary Care Settings, Doris Adediwura Obaze

Walden Dissertations and Doctoral Studies

Management of hypertension and its complications requires health care providers to

understand the reason for developing the disease. Complications of hypertension (HTN)

are more prevalent when patient interventions are not consistently performed by staff. A

gap in staff knowledge regarding the management of patients with HTN was noted at an

outpatient clinic in the southwestern United States. A staff education project based on

the Eighth Joint National Committee (JNC-8) guidelines for HTN management was

developed to address the gap in knowledge. This DNP project sought to understand the

impact of an evidence-based staff education program in improving the knowledge of …

Understanding The Impact Of Choice Claims In Health Policy Among Veteran Patients, Stacie Marie Rivera

Walden Dissertations and Doctoral Studies

The patient-as-consumer has emerged as a narrative in the government health care system that cares for beneficiary veteran patients, elevating the phenomenon of choice in health care legislation and administration. The problem of the submerged state of a health policy was the issue examined within the context of access to health care and what patients experience when choice is present. The purpose of this study was to explore the motivations of beneficiary veteran patients to choose a preventive care option, a seasonal flu shot, at a private sector retail pharmacy rather than at their government health care provider, with the …

Utilizing Food Safety Knowledge In Comprehensive Patient Care Among Harlem Hospital Physicians, Sean Alexander Shivers

Walden Dissertations and Doctoral Studies

According to the World Health Organization (WHO), people throughout the world become sick every year from consuming contaminated foods, which impacts countries’ socioeconomic development, straining their healthcare system, travel and tourism, and foreign trade markets. To help alleviate the impact foodborne illness (FBI) has on society, scholars suggest physicians incorporate food safety in their standard work practice. The purpose of this study was to determine if Harlem Hospital physicians utilized food safety knowledge in comprehensive patient care with a diagnosis of FBI, in addition to how physicians passed this food safety information onto the patient. A qualitative methodology using an …

Implementation Of An Evidence-Based Diabetic Foot Care Protocol And Impact On Health Outcomes, Tina Marie Warfield

Walden Dissertations and Doctoral Studies

Diabetes is a condition that can lead to foot ulcers that often progress to amputation of a limb. Providing patients with education about foot care is crucial because it can help to prevent or minimize the incidence of foot ulcer development and amputation of a limb. Foot care education as a strategy not only empowers patients with proper foot care knowledge and skill to support and motivate self-care but can also enhance the partnership between the provider and patient. The purpose of this quality improvement project was the implementation of a sustainable evidence-based foot care program for adult patients with …

The Impact Of Campus Health Services On The Attitudes, Perceptions, Beliefs, And Behaviors Of Historically Black College And University Students, Micah Mccray Griffin

Walden Dissertations and Doctoral Studies

African Americans suffer worse health outcomes related to chronic disease than any other racial or ethnic group. The negative effects associated with poor dietary habits and a low propensity to exercise impact young adult African Americans who attend Historically Black Colleges/Universities (HBCUs) and can lead to higher mortality rates. It is important for HBCU campus health centers to address the perceptions and beliefs of students to positively impact health behaviors associated with diet and exercise. At the time of this study, there was limited research on-campus health centers and their impact on HBCU student health beliefs and behaviors. Therefore, this …

Mothers' Parenting Discipline Style And Their Early Puberty Daughters' Engagement In High-Risk Behaviors, Yvette C. White

Walden Dissertations and Doctoral Studies

Some early puberty girls engage in high-risk externalizing behaviors such as early sexual activity, delinquent behavior, and disruptive behaviors. Harsh parenting experienced by girls who develop early has been associated with delinquent and disruptive behaviors. The purpose of this quantitative correlational study was to examine predictive relationships between the style of parental discipline by mothers of early puberty girls and the likelihood and frequency of the girls' engagement in high-risk behaviors. Parenting style theory, including the authoritarian, authoritative, and permissive style of parenting, served as the theoretical foundation for the study. Survey data were collected from 28 mothers who identified …

Predictive Relationship Between Socio-Demographics, Medication, And Treatment Completion Among Persons Experiencing Homelessness Treated For Tuberculosis, Sophia Ajoku

Walden Dissertations and Doctoral Studies

Approximately 80% of people who contract tuberculosis (TB) in the United States are first infected with untreated latent tuberculosis infection (LTBI). LTBI is an ongoing public health concern in people who experience homelessness. Because of the transient nature of this population, it is often difficult for them to adhere to and complete treatment for LTBI. In this quantitative, correlational of a cross-sectional study, secondary data was from a public health clinic in southern U.S. The theoretical framework used for the study was the social ecological framework. Multiple logistic regression was used to determine if a statistically significant predictive relationship existed …

Strategies Healthcare Managers Use To Reduce Employee Turnover, Christopher Sean Atkins

Walden Dissertations and Doctoral Studies

Healthcare managers who are unaware of the various strategies that exist for reducing turnover could adversely affect patient care, organizational morale and performance, and the achievement of organizational goals. The purpose of this qualitative multiple case study was to explore strategies healthcare supervisors used to reduce employee turnover. The participants comprised 3 senior healthcare managers located in central Texas responsible for hiring, firing, training, supervising, and successfully using strategies to reduce employee turnover. Herzberg's motivation-hygiene theory provided the conceptual framework. Data were collected from semistructured interviews and a review of company documents. Thematic analysis of the data resulted in 5 …