Medicine and Health Sciences Commons^™

Strategies To Reduce Hospital-Acquired Conditions, Steven G. Littleson

Walden Dissertations and Doctoral Studies

Hospital-acquired conditions cause harm to patients and increase mortality. In addition to lowering the quality of patient care, hospital-acquired conditions also negatively affect financial performance, which makes them a business problem for hospital administrators. The purpose of this single case study, which was grounded in the theory of high reliability, was to explore strategies used to reduce the number of hospital-acquired conditions. The sample consisted of 13 senior leaders of a large academic medical center in the southeastern United States, who shared successful strategies used to reduce hospital-acquired conditions. Data collection took place through semistructured interviews and a review of …

Los Angeles Community-Based Associate Social Workers' Understanding Of Culture And Therapy, Christine Cearfoss

Walden Dissertations and Doctoral Studies

Social workers have no clear professional guidelines about the application of culturally competent mental health service delivery. Without culturally competent mental health service delivery, clients from diverse cultures do not access needed mental health services and they experience less effective therapy treatment outcomes and overall disparity of service delivery throughout the therapeutic process. The purpose of this descriptive case study was to better understand how community-based social workers are delivering culturally competent services to clients. The theoretical framework for the study was multiculturalism and the primary research questions addressed how associate clinical social workers who provide in-home mental health services …

Preventing Obesity And Type 2 Diabetes In Immigrant Populations, Maxwell K. Chikuta

Walden Dissertations and Doctoral Studies

Obesity-related diseases have been increasing in African immigrants throughout the United States. Although research has been done to identify risk factors associated with many ethnic groups in the United States, only a few studies exist that explore obesity and type 2 diabetes diseases among Central African immigrants. The conceptual framework for this qualitative case study was social constructivism and the health belief model. The primary research question addressed the potential underlying causes for an increase in obesity and type 2 diabetes among Central African Immigrants. The secondary research questions explored how culture, illiteracy, and religion contribute to the problem of …

Strategies Used By Healthcare Supervisors For Employee Retention, Serrita Chaney

Walden Dissertations and Doctoral Studies

Healthcare supervisors who lack effective employee retention strategies could negatively affect patient well-being, employee performance, and organizational functions. The purpose of this single case study was to explore strategies that healthcare supervisors used to improve employee retention in 1 health care organization in southeast Georgia. Vroom expectancy theory was the conceptual framework for the study. Data were collected from semistructured interviews with 5 healthcare supervisors in a medium-sized healthcare organization who had hiring responsibilities and a history of implementing successful strategies to improve employee retention. Data were analyzed using coding and word frequency to discern patterns. Three significant themes emerged …

Comparison Of Army Veterans' And Nonveterans' Individual Work Performance, Petrina Veola Stack

Walden Dissertations and Doctoral Studies

Business managers lack knowledge and understanding of the transferability of Army veterans' individual work performance (IWP) in the private sector, which results in organizations' failure to hire Army veterans who possess strong IWPs. The purpose of this nonexperimental, cross-sectional study was to compare Army veterans' and nonveterans' transferable IWP as defined by task performance (TP), contextual performance (CP), and counter-productive work behavior (CWB). The IWP framework provided the theoretical foundation for this study. The research question examined how veterans' IWPs compared to those of nonveterans. The sample frame included U.S. Army civilian veterans and nonveterans at a large military installation …

Predictors Of Admission For Stroke Or Transient Ischemic Attack Patients, Jessica Janice Tucker

Walden Dissertations and Doctoral Studies

Approximately 11% of patients diagnosed with a stroke or a transient ischemic attack are readmitted to the hospital, creating a cost burden of nearly $2 billion per year for Medicare beneficiaries. Because researchers and policy makers consider hospital readmission for patients with strokes or transient ischemic attack to be an indicator for the delivery of quality care, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare reimbursement in 1 year for excessive readmissions, potentially impacting the financial sustainability of various healthcare organizations. The ecological systems theory allows for the understanding …

Family Predictive Factors Of Rural Malaria Prevalence In Nsukka, Eastern Nigeria, Gabriel Ugwuja Ugwu

Walden Dissertations and Doctoral Studies

Children in early childhood are still suffering from burdens of malaria-related morbidity and mortality. There have been insufficient studies on how family-level factors may predict the prevalence of malaria (PoM), and negatively impact the control of malaria in rural areas, especially among children. In this study, potential family factors were explored to address the challenges associated with the increase in PoM among the children in rural areas of Nsukka. Socioecological framework guided this study at the interpersonal level. The quantitative cross-sectional study used secondary data from Demographic and Health Surveys (DHS) of 2015 in Nsukka rural communities. Data were analyzed …

Globalization Of Clinical Research And Assessment Of Global Access To Treatments Approved Between 2006-2015, Rafael Duncan Escandon

Walden Dissertations and Doctoral Studies

Globalization in clinical research and development has increased since the 1990s. Products approved in the United States (U.S.) and European Union (EU) include increasing numbers of research participants from low- and middle-income countries. The purposes of this quantitative correlational study were to investigate the lag time, or drug lag, between U.S. approval and the approval of selected drugs in all countries that hosted their pivotal clinical trials. The study population was limited to products approved first in the U.S. between 2006 and 2015. The health capability model and research for health justice framework were the theoretical frameworks for the study. …

Connecticut Primary Care Physicians And Chronic Lyme Disease, Yvette P. Ghannam

Walden Dissertations and Doctoral Studies

The prevalence of chronic Lyme disease (CLD) remains relatively unknown in Connecticut because there is not an agreement on what CLD is and how it should be diagnosed in addition to which pathological agent causes CLD. The aim of this quantitative study was to assess whether there were significant differences between two groups of primary care physicians (PCP) working in Connecticut from two different points in time regarding their knowledge in the diagnosis, treatment, and management of CLD. A knowledge, attitude, and practice model was used as the underlying theoretical framework for this study. A random cross-sectional survey was mailed …

Parental Perception Of Physician Cultural Sensitivity And Adherence To Asthma Treatment, Narue Jaynelle Wright-Jegede

Walden Dissertations and Doctoral Studies

In the United States, asthma remains a major cause of frequent urgent care visits, hospitalizations, and preventable deaths among children. Nationwide, the chronic disease continues to fall disproportionately on minorities, mostly residing in urban localities. When a child is diagnosed with asthma, the parents are typically tasked with managing the child's condition. Establishing a collaborative partnership between parents and their child's primary physician is significant for improving asthma self-management among youth. Using the theory of reasoned action as a theoretical framework, this mixed-methods study examined whether a relationship exists between parental perceptions of physician cultural sensitivity and parental care in …

Evaluation Of Shared Governance Implementation At A Community Hospital, Teresa Nardontonia

Walden Dissertations and Doctoral Studies

Shared governance is a model in which staff collaborate through a decentralized decision-making structure, sharing ownership and accountability and partnering to make decisions about clinical practice, professional development, patient experience, quality improvement, and research. The hospital shared governance project team aligned its shared governance model with the American Nurses Credentialing Center Pathway to Excellence standards. The purposes of this project were to do a process evaluation of shared governance implementation at one 64-bed community hospital in central Florida and make recommendations for continuous quality improvement. The project followed the plan-do-study-act methodology developed by Deming. Through the collection of meeting minutes …

Improving Compassion Fatigue And Vicarious Trauma Knowledge For Psychiatric Nurses, Natalie P. Rebelo

Walden Dissertations and Doctoral Studies

Nurses are exposed to traumatic patients and high stress regularly; this repeated exposure can increase rates of compassion fatigue and vicarious trauma. When nurses are not properly educated about compassion fatigue and vicarious trauma, it can impact their ability to provide effective patient care and result in harmful effects including insecurity, altered cognitive functioning, loss of empathy and diminished self-esteem. This project focused on educating psychiatric nurses regarding compassion fatigue and vicarious trauma. The theory guiding the project was the Neuman's system model. Fifty-six psychiatric nurses were administered a pretest consisting of 10 multiple choice test questions. They were educated …

Quality Improvement Initiative To Improve Patient Attendance In Diabetes Self-Management Education Classes, Charon Denise Randel

Walden Dissertations and Doctoral Studies

Diabetes self-management education (DSME) is a key resource in the battle against diabetes and its secondary effects. This quality improvement project was conducted to address the decreased attendance rates of DSME classes in a community health center in the southern United States. The practice question for this project explored process-related strategies to increase patient attendance in DSME classes. Based on review of patient reports of reasons for nonattendance and an evaluation of peer reviewed literature on improving attendance in DSME, the following strategies were implemented: (a) alternative solutions such as providing patients with the dates for a year of initial …

A Thematic Analysis On How Forensic Psychologists Conduct Personal Injury Evaluations, Denise M. Autret

Walden Dissertations and Doctoral Studies

Psychological evaluations administered by forensic psychologist in personal injury cases are surrounded by complex issues. Although empirically-based research has legitimized that psychological damages do exist in personal injury cases there is a missing link in the way forensic psychologists are conducting these evaluations. Prior researchers suggested that some personal injury evaluations had been dismissed or overlooked due to a lack of a standard of care. Addressing the current literature, this study examined how a diverse group of 14 licensed forensic psychologists, operating in different judicial jurisdictions (Daubert, Frye, and Independent) were conducting personal injury evaluations and their perspectives on the …

Cardiovascular Exercise Participation And Obstructive Sleep Apnea Among Adults Over Normal Weight In The United States, Marytherese Agwara

Walden Dissertations and Doctoral Studies

Obstructive sleep apnea (OSA) is a type of sleep apnea that is common, complicated, and a major contributor to cardiovascular diseases, neurocognitive impairment, and mortality. This disease has additional negative impacts on patients' lives by contributing to daytime sleepiness and low productivity at work as well as absenteeism and work-related injuries. Several studies have been conducted to assess the relationship between cardiovascular exercises and OSA; however, a definite conclusion is lacking. The purpose of this quantitative cross-sectional study was to assess the relationship between cardiovascular exercise participation and OSA by examining the relationship between total cardiovascular exercise participation per week …

An Education Program For Improving Knowledge Of Experienced And Aspiring Mentors, Joy-Marie Quiambao Calunsag

Walden Dissertations and Doctoral Studies

Using a staff development approach, this doctor of nursing practice project addressed the preparation of nurses who serve in the role of mentors. Developed and carried out in an American Nurses Credentialing Center Magnet-designated hospital, the primary aim of the project was to develop and implement a staff education program for mentors focusing on best-practice strategies for mentoring new nurses. The secondary purpose was to conduct a literature review on evidence-based practice strategies for mentoring new nurses. This project was guided by Knowles' adult learning theory and Benner's novice to expert model. A 2-hour education program was attended by 16 …

Characteristics Of Young People Seen In The Emergency Department For Assault-Related Injuries, Robyn Coons

Walden Dissertations and Doctoral Studies

Violence is among the most serious threats to the health and safety of young people between the ages of 10 and 24 in the United States. The purpose of this cross-sectional quantitative study using secondary data from the CDC's 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) data set was to examine the characteristics (age, sex, race and ethnicity, insurance or payer source, and housing status) of young people between the ages of 10 and 24 who seek medical care for assault-related injuries through the emergency department (ED). The social ecological model was used to examine the complex interplay between …

Development Of A Standardized Oral Care Staff Education Program, Katrina Detoye

Walden Dissertations and Doctoral Studies

Hospital-acquired infections such as nonventilated hospital-acquired pneumonia (NV-HAP) are significant patient safety concerns. The lack of oral care in the nonventilated acute care patient population is a major contributor to NV-HAP. Nursing staff are on the frontline in the provision of oral care to hospitalized patients, but a lack of knowledge regarding the relationship between oral care and NV-HAP was identified as a gap in practice at the project site. The purpose of the project was to develop a staff education program on oral care of the nonventilated patient population. The practice-focused question addressed whether an evidence-based education for nurses …

A Comparison Of Motivational Differences Among Older Marathon Runners And Their Injury Status, Marsha Renee Kaufman

Walden Dissertations and Doctoral Studies

Despite the high occurrence of running-related injuries, master level runners, those aged 40 years and older, account for 50% of all marathon finishers. What is not known is the common motive sustaining participation, especially among this age demographic. The self-determination theory was the theoretical framework to support how behavior is regulated by the individual. The purpose of this quantitative research was to identify a difference in the motives (psychological, physical, social, and achievement) and their subcategorical motives (health orientation, weight concern, affiliation, recognition, psychological coping, life meaning, self-esteem, competition, and personal goals) via the Motivations of Marathoners Scales by master …

Evaluation By Geospatial And Spatiotemporal Distribution Of Tularemia Cases In Arkansas, Toni Kathleen Beavers

Walden Dissertations and Doctoral Studies

Tularemia is a vector-borne disease of global concern with diverse regional foci. Arkansas is an endemic state with differences in case distribution and land suitability supporting host and vector sustainment. The aim of this study was to conduct a geospatial and spatiotemporal assessment of factors associated with case distribution and timeliness and completeness of public reporting. Guided with direction from spatial epidemiology and nidality, referring to the association of ecology, climate, and proximity of disease, analysis included secondary data collected from the Arkansas Department of Health between 1995 and 2018. Using Poisson-based software, 2 clusters were found: a high-risk cluster …

Factors Contributing To High Readmissions For Congestive Heart Failure Among African Americans, Shavonda Caprice Devereaux

Walden Dissertations and Doctoral Studies

Abstract

African Americans are disproportionately affected by heart failure, with prevention and treatment of heart failure being a public health concern in the United States. The purpose of this retrospective quantitative study was to examine the primary variable race, specifically African Americans, and how this variable relates to 30-day readmission post discharge when controlled with geographic location (urban vs. rural), gender, and insurance status. The expanded chronic care model was used as a framework to shape health promotion, prevention efforts, and social determinants of health and to enhance community involvement related to chronic disease issues. The research questions were focused …

Nurse Practitioner Attitudes, Perceptions And Knowledge About Antimicrobial Stewardship, Evelyn C. Fabian

Walden Dissertations and Doctoral Studies

Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The purpose of this project was to assess nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship and knowledge in the management of anaerobic infections as well as resistant gram-negative bacteremia. Data were collected using a web-based survey in a hospital facility. The practice question explored whether nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship significantly increased after an education program on antimicrobial stewardship. The project was framed by Knowles's adult learning theory. A 16-item survey was administered before and after …

Psychiatric Nurses' Knowledge Of Suicide Prevention, Wanda F. France

Walden Dissertations and Doctoral Studies

Suicide is a major health concern worldwide. Nurse practitioners must possess suicide assessment skills and treatment knowledge to ensure appropriate identification of persons with suicidal ideation. The purpose of this project was to assess psychiatric nurse practitioners' knowledge of suicide prevention in rural Kentucky. The conceptual framework was Orlando's nursing process theory, which emphasizes the importance of nurse-patient interaction. A 13-item survey of suicide-related knowledge and skills was administered to 10 psychiatric nurse practitioners in rural Kentucky. Only 3 participants responded correctly to a question related to suicidality in persons with borderline personality disorder. Regarding competency and support for assessing …

Staff Education Program On Diabetes Using Self-Care Behaviors, Ruth Adhiambo Ogot

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus affects patients' health across the globe and is costly to manage. The chronic high blood sugar of diabetes is linked to cardiovascular and kidney damage, impaired functional status, and multiple organ failure. To lessen the complications associated with diabetes and promote self-care in those with the disease, health care professionals must be vigilant in offering diabetes education to patients with each clinic or primary care visit. Lack of diabetic educators in the clinic that provided the setting for this study indicated a need to increase clinical staff competency in teaching self-care and diabetes management to patients. …

The Relationship Between Limited Partner Availability, Masculine Ideologies, And Condom Use, Diakima Y. Thomas

Walden Dissertations and Doctoral Studies

One in every 4 people living with the Human Immunodeficiency Virus (HIV) are women. The leading cause of infection is heterosexual contact. The purpose of this quantitative, correlational study was to examine the relationship between gender ratio perception and masculine ideology and a woman's decision to use condoms during her sexual activity. The theory of gender and power and the theory of planned behavior served as the theoretical frameworks for this study. The perceptions of gender ratios, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBeliefs, and masculine ideologies, as measured by the Gender Role …

Reducing Patient Falls And Decreasing Patient Safety Attendant Utilization With Careview Communication Technology, Maura Marisela Stanford

Walden Dissertations and Doctoral Studies

Attention to quality outcomes, cost reduction, value-based purchasing, and improved initiatives for hospital-acquired conditions (HACs), as well as labor utilization savings, provide a foundation for hospitals to achieve safety and quality outcomes. Falls resulting in fractures, joint dislocation, or other physical injuries are considered HACs and can produce unexpected consequences such as an increase in costs related to an increased length of stay. The CareView Communications system, a fall prevention management program that uses video surveillance technology, offers a strategy to prevent patient falls by customizing patient rounding, conducting fall risk assessments, and generating reports. Guided by Donabedian's framework, this …

Factors Affecting Breastfeeding In Preterm Infants, Evangeline Starks Glover

Walden Dissertations and Doctoral Studies

Even though initiation of breastfeeding among term and preterm infants has increased, the incidence and duration among preterm infants continues to lag because of the unique challenges of breastfeeding preterm infants. African American mothers have the lowest rates of breastfeeding initiation and duration, and their preterm infants are less likely to receive breast milk while in the neonatal intensive care unit. The objective of this cross-€sectional quantitative study was to evaluate the relationship between breastfeeding and maternal sociodemographic factors as well as medical and obstetrical conditions for infants born between 32-€37 weeks gestational age in South Carolina from 2009 to …

Implementation Of A Trauma-€Informed Care Program For The Reduction Of Crisis Interventions, Renae Denise Hale

Walden Dissertations and Doctoral Studies

Childhood trauma is the primary reason children and adolescents display behavioral issues that require hospitalization. Implementation of a trauma-€informed care (TIC) program was the intervention chosen at a child and adolescent behavioral health hospital to decrease physical holds and seclusion rates for patients aged 3 to 17 and to reduce the risk of retraumatization of children needing psychiatric care. Six core strategies from the National Association of Mental Health Program Directors was the framework for this project. The number of crisis interventions before and after implementation were 440 and 259, respectively. The number of seclusions before implementation was 215, and …

Opioid Abuse In Rural Communities Among Adolescents With Bipolar Disorder, Sherlina Daishernai Holland

Walden Dissertations and Doctoral Studies

Abstract

Low population density in rural areas makes it difficult to deliver services to people with mental health problems and nonmedical prescription opioid abuse remains a problem in the United States. The purpose of this cross-sectional study was to determine whether a parent's socioeconomic status affected care opportunities for children 12 to 17 years of age and whether bipolar disorder increased the likelihood of substance abuse in those children. The theory of reasoned action/planned behavior provided the framework for the study. Secondary data from the Interuniversity Consortium for Political and Social Research 36361 data system, specifically the National Survey on …

Psychosocial Consequences Of Parental Wrongful Conviction On Children, St.Jean Jeudy

Walden Dissertations and Doctoral Studies

This qualitative multiple-case study sought to provide an in-depth understanding of how children living in broken families-due to the wrongful conviction of parent(s)-developed psychosocial issues. The theoretical frameworks applied to this study were the social learning theory, the social control theory, the role-modeling theory, and the general theory of crime. A purposeful sample of 13 adults who were children at the time of their parents’ wrongful incarceration were drawn for phone and in-person interviews. The data were transcribed and analyzed to code, sort, and organize; to analyze connections in the information, and to compare and contrast cases. The multiple-case study …