Medicine and Health Sciences Commons^™

Preventing Acute Myocardial Infarction Readmission Rates, Sherin Abraham

Walden Dissertations and Doctoral Studies

Unplanned readmissions to the hospital are a problem faced by most health care organizations in the United States; hospitals are penalized for such readmissions. The project site identified high readmission rates for patients who were discharged after acute myocardial infarction (AMI), making careful transition home a necessity for post-AMI patients. The focus of this quality improvement (QI) project was implementation of an early follow-up appointment of AMI patients following discharge. The purpose of this project was to evaluate the effectiveness of changing follow-up appointments for patients with an AMI from 14-30 days to 7-14 days post discharge to reduce unplanned …

Associations Between Healthcare Utilization Factors And Diabetic Retinopathy Among Adult African Americans, Olusina Adesanya

Walden Dissertations and Doctoral Studies

African Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations …

Impact Of A Healthcare Workplace Violence Prevention Module On Staff Knowledge, Michelle Leigh Arroyo

Walden Dissertations and Doctoral Studies

The healthcare sector experiences violence 4 times as much as any other civilian domain, including law enforcement and corrections facilities. The clinical practice problem addressed in this project was the lack of adequate healthcare workplace violence (HWV) prevention in a not-for-profit community hospital. The purpose of this project increase awareness of HWV prevention through the use of an education module. Rogers’ diffusion of innovation model served as the foundation for analysis of scores from pre- and posteducation tests. The practice-focused question asked if a module on HWV prevention based on current clinical practice guidelines and peer-reviewed literature would improve staff …

Caregiver Review Of Nonpharmacological Interventions For Behavioral Symptoms Associated With Dementia, Karla Chaney Ballew

Walden Dissertations and Doctoral Studies

Alzheimer’s disease (AD) is the most common form of dementia and affects an individual’s overall cognitive function, including orientation, memory, and executive function. Most AD patients in the United States reside in residential care facilities or private homes under the care of individuals with little education on the challenges of the AD patient. Among the challenges faced by caregivers are behavioral and psychological symptoms related to dementia (BPSD). Education has been shown to improve caregivers’ treatment of BPSD in AD patients and to improve caregiver retention. The purpose of this project was to develop an evidence-based education module guided by …

Effects Of Pregnancy-Related Depression On Low Birth Weight Infants, Kimberly J. Bauer-Schaub

Walden Dissertations and Doctoral Studies

Maternal depression during pregnancy can have a negative impact on the developing child. Numerous studies have focused on postpartum depression and the influences on infant outcomes; however, there are limited data on pregnancy-related depression. The problem addressed in this study was the inadequacy and insufficiency of depression screening during the pregnancy period and access to quality-related health services for women. The purpose of this quantitative retrospective study was to test social cognitive theory on low birth weight and prenatal care adherence to pregnancy-related depression in women residing in Colorado. This research measured an association between pregnancy-related depression and both low …

Impact Of Queueing Theory On Capacity Management In The Emergency Department, Nina Bush

Walden Dissertations and Doctoral Studies

Hospital systems in the United States are facing a dilemma regarding capacity management in the emergency department (ED) and the inpatient care setting. The average wait time in EDs across the United States exceeds 98 minutes, which is also the point at which patients begin to abandon healthcare treatment. The purpose of this quantitative study was to examine the use of queueing theory in capacity management on length-of-stay (LOS) rates, left-without-being-seen (LWBS) rates, and boarding rates in the ED and inpatient setting. The boarding rates represent the rate in which patients were roomed in the ED but required inpatient care. …

Multidisciplinary Simulation Training To Improve Nursing Knowledge Of Intraoperative Malignant Hyperthermia, Heather Burrell

Walden Dissertations and Doctoral Studies

Malignant hyperthermia (MH) is a rare but severe reaction that can occur in the operating room. Due to the low volume of these reactions, nurses are often unprepared to handle the event; however, not recognizing the event and intervening can lead to the death of the patient. This is a practice problem that can be addressed through a nursing staff education simulation training program. The purpose for this doctoral project was to develop a multidisciplinary MH simulation program that could improve nursing knowledge when caring for patients experiencing an MH crisis in the operating room. The practice-focused question for this …

Yoga As A Women’S Population Health Intervention, Lisa Ann Clow

Walden Dissertations and Doctoral Studies

Women’s mortality rate in the United States has increased in almost every age group in the past several years. However, more women in the United States are choosing yoga as a complementary health approach to improve general well-being. Thus, research on yoga and other factors that affect women’s health in the United States may inform public health initiatives to address the health disparities in women’s mortality rates. Grounded in the health belief model, the purpose of this study was to explore whether the factors of practicing the components of yoga, doctor’s recommendation for increased physical activity, body mass index (BMI) …

Screening For Depression During The Early Perinatal Period, Loretta Ann Donnelly-Moreno

Walden Dissertations and Doctoral Studies

The clinical practice guideline (CPG) is the implementation of a depression screening tool to be used in the early perinatal period. The practice change occurred in a rural Obstetrical and Gynecological (OBGYN) practice in the southern United States. The CPG change has been guided by recommendations from both the American Congress of Obstetrics and Gynecology and the American College of Nurse Midwives. Implementation of this CPG change addresses the gap in practice of not doing depression screening during the perinatal period, and only screening during the postpartum period, which was being done at the OBGYN office. Theorist Lewin’s ‘change theory’ …

Mental Health Disparities Among Minority Populations, Arrey Irenee Eyongherok

Walden Dissertations and Doctoral Studies

Despite the existence of effective treatments, mental health care disparities exist in the availability, accessibility, and quality of services for racial and ethnic minority groups. People living with serious mental complaints often resist engaging in treatments and experience high rates of dropout; poor engagement can lead to worse clinical outcomes. Addressing the complex mental health care needs of racial and ethnic minorities warrants considering evidence-based strategies to help reduce disparities. This systematic review sought to provide an analysis of published literature about the barriers and effective strategies in identifying and treating minority patients with mental health disorders. The practice-focused question …

Development Of Nursing Staff Education For Central Line Maintenance, Doreen Lynn Farley

Walden Dissertations and Doctoral Studies

Patients with cancer who receive bone marrow transplants (BMT) are at increased risk for central line-associated blood stream infections (CLABSI), a serious complication leading to increased costs, length of stay, and even death. Recognition of an increased CLABSI rate at one BMT unit in the southwestern United States prompted development of an evidence-based staff development education program to improve nurses’ knowledge of central line maintenance and CLABSI prevention practices. Guided by Lewin change theory, the program was developed based on a nurse-led analysis and synthesis of the evidence, and a formative evaluation of the educational program conducted by a 3-member …

The Association Between Behavior Disorders And Return Visit To The Emergency Department, Destiney Fraguada

Walden Dissertations and Doctoral Studies

Presently, extensive research supporting the overcrowding of emergency departments (EDs) and behavior disorder patients presenting to EDs are prevalent. There exists a knowledge gap between specific behavior disorders diagnoses associated to repeated visits to the ED. The purpose of this quantitative study was to address whether a relationship exists between patients with psychotic and/or substance abuse disorders and the repeated ED visits within 72 hours. The Andersen Behavioral framework model and the secondary data were used in the study. The cross-sectional archival data from the 2016 National Ambulatory Medical Care Survey was analyzed by using cross-tabulation with the 2 test …

Effects Of Increasing Education For Clinicians On Stress While Treating Pressure Injuries, Roscelyn Garner

Walden Dissertations and Doctoral Studies

Previous healthcare professionals researched the effects of treating and healing pressure

injuries within long-term care facilities. This study was conducted to explore the stress clinicians face when treating pressure injuries in the long-term care setting. This qualitative study provides information for the need to educate nurses about treating and healing pressure injury. It was derived from a phenomenological study that incorporated real life perspectives of individuals responsible for treating and healing pressure injury. This study was guided by Castles and Ferguson’s conceptual framework related to employee perceptions on pressure injuries, employee level of education and knowledge about improving quality initiatives …

Improving Disaster Preparedness And Planning For Chronic Disease Populations, Gladys N. Gichomo

Walden Dissertations and Doctoral Studies

The significant rise of both chronic diseases and disasters in the last 20 years and the healthcare outcomes of individuals with chronic diseases during and in the aftermath of disasters have raised concerns among public health practitioners, healthcare providers, the U.S government, and the general public. Researchers have indicated that during disasters, the health outcomes of individuals with chronic diseases are significantly unfavorable compared to the general public. However, there is inadequate information on the management of chronic diseases, quality of care, and resource identification and allocation by disaster responders. This qualitative, grounded theory study, explored how the study participants …

A Urinary Catheter Insertion And Care Program For Reducing Catheter-Related Infections, Rodney R. Hauch

Walden Dissertations and Doctoral Studies

Many inpatients in U.S. hospitals acquire an hospital-acquired infection (HAI), the majority of which can be attributed to an indwelling urinary catheter. The use of urinary catheters is a common practice within the acute care setting although the placement comes with risk. Improper catheter placement or a lack of care and maintenance can increase patient morbidity and mortality, as well as increase financial strain for the hospital. The purpose of this quality improvement (QI) evaluation was to determine if using a safety checklist and a 2-person urinary indwelling catheter-insertion team would reduce the rate of catheter-associated urinary tract infections (CAUTIs). …

Effects Of Maternal Obesity On Preterm Birth And Birthweight, La Tosha Headley

Walden Dissertations and Doctoral Studies

Obesity is one of the major risk factors for neonate low birthweight among reproductive women. The purpose of this quantitative study was to examine the association between 3 categories of obese status (moderate, severe, and very severe) and low neonate birthweight and preterm birth among women ages 18 to 39 years at all socioeconomic levels. Secondary data were obtained from 141,859 women ages 18-39 years living in the United States who had participated in the 2012-2015 Pregnancy Risk Assessment Monitoring System. Social-ecological theory was used to guide the study, and binary logistic regression was used for the analyses adjusting for …

Reducing Falls In The Vulnerable Elderly: Implementing An Inpatient Fall Prevention Program, Bibi Farida Khan

Walden Dissertations and Doctoral Studies

Inpatient falls are a leading cause of fatal and serious injuries among hospitalized elderly patients, often with devastating consequences. This quality improvement project was conducted on a geriatric unit in a large southeastern U. S. hospital, following recognition of an increase in the number of falls with several sustained injuries. After an analysis of the previous fall prevention strategies, a panel of stakeholders who formed a falls prevention committee determined that implementing an evidence-based fall risk assessment tool to help identify risk factors, as well as implementing interventions to address those risk factors, would make fall prevention more patient specific …

Perceptions Of Lifestyle As Mental Health Protective Factors Among Midwestern Amish, Gregory Lantz

Walden Dissertations and Doctoral Studies

The Amish are commonly known for horse-and-buggies, simple clothing, and refusal to use electricity. Less commonly known is their rate of mental illness, which is significantly lower than the non-Amish population. The literature that points to lower depression and anxiety among the Amish does not adequately explain what elements of their lifestyle contribute to this phenomenon. Depression and anxiety are a widespread problem in the United States, increasing the importance of understanding a lifestyle that can reduce these issues. The purpose of this study was to explore the Amish way of life through the words of its members. The three …

Effects Of Teach-Back On Children’S Treatment In Parents With Low Health Literacy, Marion Ines Kopulos

Walden Dissertations and Doctoral Studies

Health literacy (HL) skills are necessary to understand the context of medical information provided to patients in all settings including the emergency room. People with low health literacy (LHL) have difficulty comprehending and implementing basic tasks such as understanding medication administration. The purpose of this quasi-experimental study guided by Orem’s self-care theory was to determine the effect of using the teach-back method for discharge instructions compared to standard written instructions based on parents’ learning style and HL skills assessed during their visit to the emergency room. The Newest Vital Sign (NVS) tool was reworded to assess the parents’ HL. A …

Relationship Between Post-Resuscitation Debriefings And Perceptions Of Teamwork In Emergency Department Nurses, Kerri Lyman

Walden Dissertations and Doctoral Studies

Emergency department nurses are faced with traumatic patient events while functioning as members of multidisciplinary teams. Critical incident debriefing has been shown to benefit health care professionals and patient clinical outcomes. The purpose of this quantitative correlational study was to examine the relationship between the use of formal post-resuscitation debriefings and perceptions of teamwork in emergency department nurses. The study also addressed the type and timing of debriefing to determine whether these factors impacted perceptions of teamwork. The nurse as wounded healer theory served as the theoretical framework. Data from the Nursing Teamwork Survey were collected from 68 emergency department …

Development Of A Tele-Healthcare Clinical Practice Guideline For Diabetic Patients, Kathy J. Montgomery

Walden Dissertations and Doctoral Studies

Lack of access to healthcare in rural communities has resulted in increased morbidity and mortality rates among diabetic patients. The problem identified in this project was the lack of access to healthcare among diabetic patients living in rural southeast Ohio. Tele-healthcare is a strategy that provides healthcare remotely and has been introduced into the rural setting and offers an appropriate healthcare delivery mode for the rural community. The purpose of the project was to develop a tele-healthcare clinical practice guideline, including smart phone applications, for the management of diabetic patients. An expert panel consisting of 2 advanced practice nurses in …

Patient Awareness And Knowledge Of Medically Induced Radiation Exposure, Travis L. Mann

Walden Dissertations and Doctoral Studies

The level of knowledge and awareness among patients about the concepts and implications of medical radiation is unknown. The purpose of this qualitative, case study was to explore patients' awareness and knowledge of information regarding this topic from their perspectives. The health belief model provided the framework for the study. A total of 20 individuals were recruited using purposive sampling. All participants were above the age of 18 in central North Carolina and had undergone or are currently undergoing medical radiation exams. Data were collected using semistructured interviews and analyzed using Yin's 5-phased cycle, which involved compiling, disassembling, reassembling, interpreting, …

Director Of Nursing Role Conflict And Ambiguity, Commitment, And Intent To Stay, Amy Elizabeth Thiesse

Walden Dissertations and Doctoral Studies

High rates of turnover and the limited tenure of directors of nursing (DONs) in long-term care creates instability in the nursing workforce and the quality of care provided. Organizations, industry, and stakeholders have made little progress to change this turnover crisis. The purpose of this quantitative study, guided by organizational role and social exchange theories, was to determine if there was a difference in levels of affective organizational commitment and intent to stay mediated by leader-member exchange in long-term care DONs with different levels of role conflict and role ambiguity. The key variables were measured with the Role Questionnaire, Leader-Member …

Reducing Cost Of Healthcare Facilities By Decreasing Nursing Turnover, Valour Akia Richardson

Walden Dissertations and Doctoral Studies

Registered Nurse (RN) turnover is costly for hospitals and healthcare facilities. The problem that healthcare administrators face today is their inability to retain nurses for long periods of time and the detrimental effects that come from the lack of retention. The purpose of this quantitative secondary data analysis is to explore the relationship between the retention of RNs and the geographic regions in which they work. The theoretical framework for this study was Barney's concept of viewing people as resources. Deidentified secondary data of RNs was utilized from the Healthforce Center at the University of California San Francisco to probe …

A Conflictive Triuvirate Consruct Of Epidemiologic Systems Failure, Ngozi Lois Ulinwa

Walden Dissertations and Doctoral Studies

Epidemiologic systems failure (ESF) is a major hurdle in minimizing the spread of infectious diseases during outbreaks. The reasons for ESF include the technical limitation of personnel handling epidemic crises, strictly defined health policies that limit the actions of epidemiologists, and personal perspective's reservations towards the intentions of health agencies. The purpose of this triumvirate mixed-methods case study was to examine factors of infectious disease control mechanisms useful for determining ESF. Three juxtaposed pre-emptive factors (technical [T], organizational [O], and personal [P] perspectives were used to determine how the multiple perspectives inquiring systems and fuzzy logic revealed factors causing ESF …

Health Awareness On High Blood Pressure, High Cholesterol, And Risk For Cardiovascular Disease, Innocent Bibi

Walden Dissertations and Doctoral Studies

Cardiovascular disease (CVD) is responsible for 25% of the annual deaths in the United States and represents a major public health burden, as patients often require screening and lifestyle changes related to multiple risk factors such as high blood pressure and high cholesterol. The purpose of this quantitative correlational study was to determine if there was a statistically significant association between high blood pressure and high cholesterol awareness (prevention and management) and cardiovascular health outcomes (angina pectoris, coronary heart disease, and heart attack). The theoretical framework that guided this study was the health belief model. Data from adults over the …

Successful Strategies For Increased Dental Practice Competitiveness, William Eyster

Walden Dissertations and Doctoral Studies

The rapid expansion of dental service organizations (DSOs) continues to disrupt the traditional dental practice model and there was a 12.2% increase in DSOs between 2015 and 2016. Some solo and small group dental practice owners lack strategies to adapt their businesses to be successful in newly competitive markets including DSOs. Grounded in systems theory, the purpose of this qualitative multicase study was to explore strategies dental practice owners use to adapt their businesses to be successful in newly competitive markets. The participants included 3 solo and 2 small group dental practice owners in central Kentucky who demonstrated success in …

Embracing Ujima: A Grounded Theory Of African Americans Choosing The Counseling Profession, Rashida Karriem Fisher

Walden Dissertations and Doctoral Studies

Racial and ethnic diverse populations experience discrimination in educational and career attainment and remain underrepresented in the counseling profession. The current literature provides limited guidance for the counseling profession and academic institutions for successfully recruiting racial and ethnic minority students in a master's level counselor training program. Social Constructivist theory and Adlerian/ Individual Psychology are the theoretical foundations of the study. This constructivist grounded theory study sought to understand the career decision-making process of African Americans choosing to enter in the counseling profession and the influence of racial and ethnic identity on this decision-making process. Utilizing semistructured interviews via video-conferencing; …

Destination Arrival And Discharge Unit To Improve Patient Flow, Shelia Celeste Jeter

Walden Dissertations and Doctoral Studies

The increase in patients presenting to the emergency department (ED) for primary care poses a serious safety issue in the care that can be provided. In a care area that is overcrowded, physicians, nurses, ancillary department staff, and other care team members may have a difficult time delivering care. Poorly managed flow in the ED leads to overcrowding, and patients with life-threatening illnesses are less likely to be transitioned to designated specialized areas in a safe and efficient manner. The practice-focused question was whether processes to improve the flow of patients entering the ED decreased the number of patients leaving …

A Practice Guideline For Triaging Mental Health Patients In The Emergency Setting, Florence Nguh

Walden Dissertations and Doctoral Studies

Today's emergency departments (EDs) are challenged with increasing numbers of patients with behavioral health (BH) issues and associated management problems. Patients presenting in the ED are increasingly in need of BH services due to a lack of available services in the community. The implication is that ED staff are faced with conducting a comprehensive review of their systems and processes for BH care delivery to ensure that the needs of this population are safely met. Specifically, this DNP project addressed the lack of evidence-based screening tools for the ED triage area for patients with BH issues. The purpose was to …