Medicine and Health Sciences Commons^™

Health System Access To Maternal And Child Health Services In Sierra Leone, Alhassan Fouard Kanu

Walden Dissertations and Doctoral Studies

The robustness and responsiveness of a country's health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. This study was guided by Bryce, Victora, Boerma, Peters, and Black's framework for evaluating the scaleup to millennium development goals for maternal and child survival. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment dataset, which comprised 100% (1, 284) of the country's health facilities. …

Evidence-Based Practice Self-Study Education Program For Staff Nurses On Genomics, Nancy L. Norman-Marzella

Walden Dissertations and Doctoral Studies

Nurses routinely obtain genomic data when collecting family health histories. However, they report low confidence in their knowledge and understanding of genomics and the genetically engineered medications prescribed for their patients. The purpose of this project was the development and implementation of an evidence-based online education program about genetics and genomics to increase the nurses' understanding and ability to provide competent care for their patients receiving treatments based on the science of genomics. Knowles's principles of adult learning theory guided the development and delivery of the online education project to 12 medical-surgical registered nurses employed in a hospital in the …

Impact Of Socioeconomic Status And Health-Seeking Behavior On Malaria In Pregnancy, Ifeanyi Livinus Udenweze

Walden Dissertations and Doctoral Studies

Malaria in pregnancy remains a public health challenge in Nigeria despite the fund appropriation for malaria control. The health challenges of malaria in pregnancy vary with populations and there is limited knowledge on the impact of the socioeconomic status and health-seeking behavior on malaria in pregnancy in Nigeria. The objective of this cross-sectional quantitative survey was to examine whether socioeconomic status and health-seeking behavior predict malaria in pregnancy in Nigeria using the social cognitive theoretical model. The data from a 2015 Nigeria Malaria Indicator Survey was used in this study. Data were analyzed using chi-square, binary, and multivariate logistics regression …

Association Of Health Facility Delivery And Risk Of Infant Mortality In Nigeria, Susan Adaku Ukwu

Walden Dissertations and Doctoral Studies

Infant mortality (IM) incidence in health facility systems during or after infant delivery is

substantially high in Nigeria. In this quantitative, cross-sectional study, the effects of skill

birth attendants (SBAs), prenatal care, and providers of prenatal care on IM in health

facility delivery centers were examined. The Mosley and Chen theoretical framework

informed this study and was used to explain the relationship between SBAs, prenatal

care, and providers of prenatal care and IM. One hundred and sixty infant deaths were

examined among mothers who used an SBA versus those who did not, mothers who had

prenatal care versus those without, …

Policy Knowledge Communication In Nursing, Curtiss John Vavra

Walden Dissertations and Doctoral Studies

Evidence-based practices in nursing improve patient outcomes, decrease healthcare costs, and can be implemented with policies and procedures. However, there is limited literature describing how nurses acquire policy knowledge, the dissemination of which may require a significant investment of resources by a hospital. The purpose of this study was to learn more about how nurses obtain policy knowledge. Rogers's diffusion of innovations theory guided the examination of communication channels and how they relate to the formation of policy knowledge. The research questions were designed to gather information on the relationship of policy communication channels, demographic factors, and the frequency of …

Predictors Of Cervical Cancer Screening Among Hispanic Women In Texas, Madhu Ravindranath

Walden Dissertations and Doctoral Studies

Hispanic women in Texas show higher cervical cancer incidence rates as compared to all women in the United States. The rate of cervical cancer in the United States has reduced mostly due to regular cervical cancer screening. However, high cervical cancer among Hispanics in Texas may reflect low cervical cancer screening. The purpose of this quantitative study was to examine the insurance status (independent variable) and cervical cancer screening (dependent variable) among low-income Hispanic women, living in Texas Health Service Regions (HSRs), after controlling for age, marital status, and personal health care provider. The theoretical framework used in this study …

Predictors And Risk Factors Of Ebola Virus Disease In Sierra Leone, Kandeh Kamara

Walden Dissertations and Doctoral Studies

Sierra Leone had the highest number of cases of Ebola virus disease in history during the 2014 Ebola epidemic. The purpose of this quantitative, cross-sectional study was to examine the relationship between sociocultural and behavioral risk factors and Ebola status among women and men ages 15 to 49 years in Sierra Leone. The ecological model served as the theoretical framework. Secondary data were collected from the Sierra Leone Ebola Disease Survey. Results of chi-square tests revealed that attending a funeral (p = .001), touching a dead body at a funeral (p = .023), contact with a sick person (p = …

Self-Concealment, Perceived Discrimination, And African American Treatment Choices For Major Depression, Danita Morales Ramos

Walden Dissertations and Doctoral Studies

African Americans have a higher proclivity to depression than other ethnic groups in the United States and also have a greater propensity to avoid seeking professional mental health treatment. The available research has shown that racial and cultural barriers such as perceived discrimination and self-concealment are the primary factors that negatively affect African Americans' attitudes toward mental health itself and mental health treatment. Perceived discrimination and self-concealment may also negatively affect whether African Americans seek help for depression and from whom, but further investigation was needed. The quantitative survey study provided answers to which factors influence whether and where African …

Adherence To Art Among Hiv Infected Female Sex Workers In Nigeria, Abass Babatunde Yusuf

Walden Dissertations and Doctoral Studies

A lack of adherence to antiretroviral therapy (ART) increases the risk of onward human immunodeficiency virus (HIV) transmission and mortality. The purpose of this cross-sectional study based on Andersen's conceptual framework was to test the associations between age, marital status, job/occupational status, education, membership in a peer support group, community, and facility ARV drug refill and alcohol and substance use, and adherence to ART among female sex workers (FSWs) who are 15 years and older in Rivers and Cross Rivers states Nigeria. Data were abstracted from existing program data collected between January 2015 and December 2017 by Heartland Alliance International, …

Feeding Practices And Nutritional Status Of Infants In Northwest Nigeria, Michael Enyi Enwere

Walden Dissertations and Doctoral Studies

Infants and young children in the Northwest province of Nigeria are susceptible to malnutrition. Inappropriate and inadequate breastfeeding and complementary feeding result in stunting, underweight, and wasting. The purpose of this cross-sectional study was to examine current feeding practices of infants not older than 2 years and their nutritional status in Northwest Nigeria. The theory of planned behavior was adopted in this research. With a total sample size of 3,861, multiple linear regression was adopted as a predictive analysis to delineate the correlation between two or more independent variables and one continuous dependent variable. Also, adopted was an independent t …

Cultural Competence Of Public Health Nurses Who Care For Diverse Populations, Althea Michelle Otuata

Walden Dissertations and Doctoral Studies

Despite advances in health, science, and technology, U.S. healthcare lags in providing access to care and quality care to racial and ethnic minorities. Cultural competence has been noted as a strategy to improve access and quality. The purpose of this project was to assess public health nurses' cultural competence before and after participating in cultural competence informational modules. Two conceptual models were used in this project for theoretical guidance: Leininger's cultural care diversity and universality theory and Campinha-Bacote's process of cultural competence. To assess the nurses' cultural competence, the Cultural Competence Self-Assessment Checklist questionnaire was e-mailed to 57 public health …

Public Education/Public Health Perspectives On Collaboration-Influence On High School Completion, Claudette Virginia Campbell

Walden Dissertations and Doctoral Studies

The research problem focused on the use of collaboration by managers, supervisors, consultants, and professional staff in a department of public education and health to address disparities in on-time high school completion rates. The purpose of the study was to examine the perspectives of individuals in these public sectors on the use of collaboration as a means to improve on-time high school completion rates for African American and Hispanic students. The theoretical foundation and conceptual framework for the study were John Rawls's theory of justice and Amartya Sen's capability approach. The key research question involved how individuals in the public …

Health Care Determinants Of Cervical Cancer Screening In Harare Zimbabwe, Dominic Chifamba

Walden Dissertations and Doctoral Studies

Cervical cancer is the second leading cause of cancer deaths among women of all age groups in Zimbabwe, and mortality and incidence continue to increase. The purpose of this quantitative cross-sectional study was to assess the factors that influence the utilization of cervical cancer screening services by Zimbabwean women living in Harare, Zimbabwe. Because personal beliefs influence screening, this study was guided by the health belief model (HBM). A total of 394 women whose ages ranged from 18 to 65 years were recruited from a health care facility in Harare. A 40-item closed-ended questionnaire was used to assess participants' knowledge, …

Maintaining Confidentiality Among Hiv Infected Couples: Physicians' Patterns Of Decision In Nigeria, Francess Uju Ayaebene

Walden Dissertations and Doctoral Studies

Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided …

Novice Nurse Respiratory Educational Component's Impact On Confidence And Knowledge, Peggy Lynn Cline

Walden Dissertations and Doctoral Studies

The hospital-based novice nurse is presented daily with complex patients with multiple coexisting morbidities, which demands increasing responsibility for evidence-based clinical decision-making to prevent adverse health outcomes and associated high health costs. Knowledge and confidence of novice nurses in a medical-surgical unit in the assessment and clinic management of the respiratory system was identified as a gap during onboarding of new nurses. The purpose of this doctoral staff education project was to determine whether a respiratory educational component added to a medical-surgical novice nurse's orientation would impact the respiratory confidence and knowledge of respiratory assessment and clinical management. Benner's nursing …

The Impacts Of Race, Residence, And Prenatal Care On Infant Mortality, Mary Christine Dorley

Walden Dissertations and Doctoral Studies

Tennessee ranks high for infant mortality (IM) in the United States. Despite public health efforts, the IM rate for Blacks is twice that of Whites mimicking what is observed nationally. Several risk factors for IM have been identified; however, it was still unclear how places of residence and prenatal care (PNC) affect IM for Tennesseans. The purpose of this study was to assess the relationship between places of residence (conceptualized by rurality and racial concentration), PNC, and IM among racial groups across Tennessee and to determine if race modified these associations. This was a cross-sectional study using data from the …

Lgb Help-Seeking For Mental Health And Substance Abuse Services In Rural Northern Michigan, Jennifer Towns

Walden Dissertations and Doctoral Studies

Lesbian, gay, and bisexual (LGB) individuals are often exposed to stressors based on their nonheterosexual status; they may have unique needs related to help-seeking for mental health in a rural area where more people identify as religious or as politically conservative. To date, there have been no studies on the mental health help-seeking experiences of LGB individuals in rural Northern Michigan. This qualitative, single case study was completed to explore the help-seeking experiences of 10 LGB individuals who were recruited through criterion and snowball sampling. In-depth, semi structured interviews were conducted. Transcribed interview data were entered into Nvivo software for …

Differential Treatment Outcome Factors For Custodial And Noncustodial Mental Health Care Programs, Sheila Fay Waters

Walden Dissertations and Doctoral Studies

Researchers have suggested that jails and prisons in the United States are becoming the new mental health clinics, contributing to the phenomenon of mass incarceration and costing upwards of $15 billion per year in public revenue. The problem is no conclusive evidence exists that treatment in these custodial environments is more effective than that provided by noncustodial programs; especially for substance users. Additionally, the continuing incarceration of people with mental health problems by the hundreds of thousands poses a difficult ethical dilemma regarding why this population does not receive noncustodial or hospital treatment instead. The study addressed the research question …

Policy Addressing Family Presence During Resuscitation, Crystal Emanuel-Hayes

Walden Dissertations and Doctoral Studies

When hospitals became the primary care setting for very ill patients, visiting hours and restrictions related to family presence during resuscitation (FPDR) became common. During medical crises that occur in hospital settings, families are separated from loved ones because family members may impair resuscitation efforts or such efforts might psychologically traumatize family members. Various national health care organizations have endorsed family presence during resuscitation; however, practices preventing family presence persist. This project used evidence from the peer-reviewed literature to develop a healthcare institution policy that addresses family presence during resuscitation. Theories, concepts, and models that guided this DNP project included: …

Nursing Pain Management In An Emergency Room With Hallway Overflow, Zaida Ruiz

Walden Dissertations and Doctoral Studies

Overcrowded emergency rooms (ERs) decrease the flow of nursing care creating a delay in nurse-administered pain management leaving patients in pain. The project-focused question asked if ER nurses felt that overcrowding in the ER led to inadequate pain management and if a clinical practice guideline (CPG) could be developed to promote effective pain management in the setting. Callista Roy's theory of human adaptation was used to guide the project. To prepare for CPG development, data from a simple random selection of 10 nurses who had worked in the ER for a minimum of 6 months was obtained from the practice …

Nurses' Perception Of Their Role In Patient Safety, Janeane Walker

Walden Dissertations and Doctoral Studies

Despite efforts to ensure patient safety in the United States, patients are being harmed by preventable errors. There is a gap in the literature from the nurse's perspective as to why medical errors continue to occur despite having evidence-based safety strategies available. The purpose of this constructivist grounded theory study was to develop a theory explaining nurses' perception of their role in patient safety and why medical errors are still occurring despite implementation of evidence-based safety strategies. The systems engineering initiative for patient safety (SEIPS) model provided the conceptual framework for the study. Data collection included interviews with 11 nurses …

Amputee Social Support: A Quantitative Investigation Of Peer-To-Peer And Group Influence, Dirrick Anthony Williams

Walden Dissertations and Doctoral Studies

Previous research has indicated that vascular disease, trauma, and cancer lead to amputations and that 1.7 million Americans are living with an amputation. The social problem of this study is that amputees have limited places to obtain social support. Alderfer's Existence, Relatedness, and Growth Theory provided the foundation for this research. The current study examined the following questions. First, does type of social support impact amputee perceived social support satisfaction? Second, does type of social support impact life satisfaction? Survey methodology was used following attendance at either peer-to-peer or group support. A purposeful sample of 184 participants were assessed using …

Strategies For Healthcare Payer Information Technology Integration After Mergers And Acquisitions, Kishore Maranganti

Walden Dissertations and Doctoral Studies

Despite the high rate of failure in merger and acquisition (M&A) transactions, many organizations continue to rely on M&As as their primary growth strategy and to address market competition. The purpose of this qualitative single case study was to explore strategies managers from a large healthcare payer in the midwestern United States used to achieve operational and strategic synergies during the postacquisition information technology (IT) integration phase. Haspeslagh and Jemison's acquisition integration approaches model was the conceptual framework for the study. Methodological triangulation was established by analyzing the data from the semistructured interviews of 6 senior executives and 6 IT …

Screening And Educating Military Veterans About Post-Traumatic Stress Disorder, Jane Egbufoama

Walden Dissertations and Doctoral Studies

Veterans are at increased risk for developing mental illnesses because of separation from families, distressing experiences in the military, and previous injury to the brain. Approximately 30% of U.S. veterans returning from war suffer from post-traumatic stress disorder (PTSD). The incidence of acute PTSD is reduced when victims are aware of the condition and its associated factors. Through education and screening, the project bridged the gap between deployment of military veterans and treatment of PTSD in this population by addressing whether screening veterans and providing an educational process affected veterans' early PTSD recognition and treatment. The project study addressed the …

Creation Of An Evidence-Based Practice Guideline For A Seclusion Alternative, Patricia Green

Walden Dissertations and Doctoral Studies

Seclusion is a behavioral management intervention used at the practicum site to manage maladaptive behaviors seen in mentally ill patients. Seclusion is not a voluntary occurrence for patients. The practice-focused question asked: Can development of an evidence-based practice (EBP) guideline help guide health care providers in the development of a multisensory room as an alternative to seclusion for people living with mental health disorders (PLWMHD)? The purpose of this DNP project was to develop the EBP guideline for a multisensory room as an alternative to seclusion for the practicum site. To aid in the development of the EBP guideline, the …

Breast Cancer Disparities Among African American Women Corresponding To Health Service Barriers, Dianne Jamerson

Walden Dissertations and Doctoral Studies

African American women tend to experience higher health disparities in cancer-related illness than any other female population in the United States. The purpose of this qualitative case study was to identify and examine access-related barriers that play a significant role in the decision-making process of this population when seeking breast cancer health services. The central research question explored the effect that barriers to health care have on African American women in the Southeastern region of the United States. Secondary research questions explored the role the Patient Protection and Affordable Care Act of 2010 has on improving access to affordable, quality …

Demographic Differences, Self-Esteem And Sexual Assertiveness Among Black Women, Sharon Lewis-Keith

Walden Dissertations and Doctoral Studies

There is a high HIV prevalence rate for Black women in Virginia; however, few scholars have examined how sexual assertiveness and self-esteem against HIV vary within this group. Black women who have low levels of self-esteem may increase their risk for HIV. The purpose of this quantitative cross-sectional study was to determine if four aspects of sexual assertiveness (sexual initiation, sexual refusal, HIV/AIDS/STD communication, and contraception/STD prevention) differed across demographic categories and were associated with self-esteem in a diversified group of Black women living in Virginia. A cross-sectional survey was conducted with a community-based sample of 117 adult Black women. …

Weight Bias In Healthcare: An Investigation Of Impact On Obesity, Jennifer Scheffler, Fnp

Walden Dissertations and Doctoral Studies

More than two-thirds of Americans are obese or overweight. Obesity rates have risen to an epidemic level, contributing to health inequalities and leading to reduced health-related quality of life. When obese and overweight persons face weight bias by health care providers, fragmented care may occur. Ensuring positive relationships with healthcare providers is important in helping those who are obese or overweight. The purpose of this project was to understand the factors that contribute to negative weight bias in the provider-patient relationship and to identify the most effective interventions that would reduce stigmatizing attitudes and support self-awareness, acceptance, and resolution for …

Patient Experience And Readmissions Among Medicare Shared Savings Programs Accountable Care Organizations, Benjamin Michael Anderson

Walden Dissertations and Doctoral Studies

In 2011, Medicare patients represented the largest share of total readmissions and health costs when compared to all other patient categories. Because patient-centered care drives the use of health services, the U.S. Patient Protection and Affordable Care Act outlined improving the patient experience to reduce readmission rates; however, the relationship between patient experience and readmissions is not well understood. Grounded in systems theory, the purpose of this correlational study was to determine if the relationship between patient experience and readmission rates in Medicare Shared Savings Program accountable care organizations. Data from the Consumer Assessment of Healthcare Providers and Systems survey …

Perinatal Residents' Perceptions Of Confidence Gained Through Their Preceptors, Veritta Henderson

Walden Dissertations and Doctoral Studies

The importance of preceptorships, as a mechanism to transfer knowledge of evidence-based nursing practices and developing confidence in nurses, is well-known. However, the effectiveness of preceptorships to develop confidence in perinatal nurses who provide safe care to childbearing women is unknown. Guided by Kolb's model of experiential learning and using a narrative analysis approach, this study examined perinatal nurse residents' perceptions of experiences that enhanced learning and developed confidence during preceptorship. Twenty nurses who completed a perinatal nurse residency of 18 weeks or more in the past 12 months participated in audiotaped, structured interviews. Their answers were transcribed and data …