Medicine and Health Sciences Commons^™

Effects Of Patient Protection And Affordable Care Act On Behavioral Health Access, Godwin Oshegbo

Walden Dissertations and Doctoral Studies

About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study …

Perceptions Of Healthcare Workers Toward Influenza Vaccination, Amos Adedokun

Walden Dissertations and Doctoral Studies

Even though influenza vaccinations were provided free to all healthcare workers in the United States, healthcare workers were not 100% compliant. The non-compliance with influenza vaccinations may expose their patients, their families, and the public at large to a high-risk source of influenza infection. This study's research questions included how registered nurses perceived influenza and influenza vaccination; registered nurses' self-reported incidents with influenza vaccination; and factors that contributed to registered nurses' non-compliance with influenza vaccination. Guided by the theory of reasoned action and the theory of planned behavior, the purpose of this qualitative study was to determine the factors that …

Variables That Impact Incidence Of Diarrhea Amongst Under-Five In Uganda, Anne Ngonde Muli

Walden Dissertations and Doctoral Studies

Diarrhea in children remains a major public health problem in Uganda and other countries in the region and acts as one of the leading contributors to child mortality. Most of the risk factors for diarrhea in children are preventable. This study, guided by the socioecological model, was conducted to investigate the association between the occurrence of diarrhea in children and length of breastfeeding, coinfection with acute respiratory infection (ARI), and vaccination status of the child. These variables were identified in the literature as risk factors for diarrhea that had not been investigated in Uganda. The source of the data for …

Hardiness, Adult Attachment Style, And Burnout In Nurses, Kristy A. Negri

Walden Dissertations and Doctoral Studies

The current nursing shortage is a pressing crisis that is expected to worsen over time. A key reason nurses leave nursing is burnout. The purpose of this study was to investigate personality hardiness and adult attachment style in relation to the development of burnout in licensed professional nurses. Hardiness theory and attachment theory indicated that each provided protection against burnout, but no research has been conducted to examine both factors in relation to burnout in nurses. Research Question 1 asked if there was a relationship between attachment style and total hardiness score; Research Question 2 asked if there was a …

Patient-Centered Medical Homes And Parental Attention-Deficit Hyperactivity Disorder Medication Beliefs And Adherence, Sydney L. Watkins

Walden Dissertations and Doctoral Studies

As many as 87% of children discontinue ADHD medication, which can lead to clinically significant academic, cognitive, and social impairment. ADHD costs billions of dollars to the healthcare and educational systems, and previous attempts to stem these costs and increase ADHD medication adherence have been unsuccessful. The purpose of this study was to determine if patient-centered medical homes (PCMH), which have been shown to improve patient health outcomes, impact parental beliefs (benefits vs. risks) about ADHD medication and adherence to ADHD medication. The theory of planned behavior was the theoretical framework for this study. There were 294 parents of children …

Waste Management Minimization Strategies In Hospitals, Andrea L. Clark

Walden Dissertations and Doctoral Studies

During the delivery of healthcare services, hospital employees use enormous amounts of water, energy, and nonbiodegradable carcinogenic plastics. In the U.S., hospital staff generate an average of over 7,000 tons of waste per day at an average cost of $0.28 per pound for the disposal of regulated medical trash, which if efficiently managed or reduced, could result in substantial cost savings. Using the organizational learning and the transaction cost economics theories as the conceptual frameworks, the purpose of this qualitative case study was to explore strategies healthcare leaders used to minimize their waste management operational costs. Data were collected using …

Geographic Variations In Antenatal Care Services In Sierra Leone, Eunice Nyambura Chege

Walden Dissertations and Doctoral Studies

Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the …

Transitional Care For The Cardiac Surgery Population: Development Of A Clinical Practice Guideline, Sheila Davies

Walden Dissertations and Doctoral Studies

Recovering from a cardiac surgery procedure and the transition to home can be an overwhelming experience for patients and caregivers. A tertiary care hospital's cardiothoracic surgery department suspended a nurse-practitioner-coordinated transitional care program in the 1st quarter of 2016. Following this decision, the readmission rate increased from its previous rate of 15.6% in quarter 1 to 20% in quarter 3. The purpose of this scholarly project was to develop a clinical practice guideline (CPG) that can bridge the gap in the transitional care process. The transitional care model informed the design of the project. A draft guideline was distributed to …

Access To Primary Care In Pennsylvanian Rural Townships, Ann Eneh

Walden Dissertations and Doctoral Studies

Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using …

Development Of A Scholarly Educational Intervention To Improve Inpatient Diabetes Care, Sharon.Hasfal Hasfal

Walden Dissertations and Doctoral Studies

Advanced practice providers (APPs), consisting of nurse practitioners and physician assistants, face many challenges in the provision of evidence-based practice in their management of hospitalized adult patients with diabetes. Some of the barriers faced by APPs at a Northeast acute care facility are poor communication between disciplines, lack of confidence in initiating insulin, limited understanding of the management of insulin and the insulin pump, and insufficient treatment of the hospitalized patient with diabetes that aligns with current clinical guidelines for the management of inpatient hyperglycemia. This quality improvement project focused on the development of an evidence-based theory supported educational intervention …

A Diabetic Child's Impact On An African American Family, Silvanus Okeke

Walden Dissertations and Doctoral Studies

Diabetes, a chronic disease with devastating but preventable consequences, is common in the United States, especially within African American communities. Earlier research has indicated that 21.7% of African American parents have children diagnosed with Type 1 diabetes in the Mississippi Delta Region. Researchers have examined coping, stress, and behaviors of African American parents of children diagnosed with Type 1 diabetes; however, there is a gap in literature regarding how African American parents can cope with stress and how changes in health behavior due to Type 1 diabetes impact African American families. The purpose of this qualitative phenomenological study was to …

Perceptions Of Stress: Employee Participation In A Yoga Class, Rosemarie Lee

Walden Dissertations and Doctoral Studies

Abstract

Employees experience workplace stress that can affect their health resulting in chronic diseases such as diabetes, stress, hypertension, and cardiovascular diseases. Stress also contributes to staff presentism, absenteeism, and high turnover rate. The employee wellness program (EWP) yoga class at a metropolitan teaching hospital has not been evaluated for its effectiveness in employee stress reduction and improvement in employee health. The practice focus question for this project explored employees' perception of the impact of a metropolitan teaching hospital's EWP yoga class on their stress reduction and health promotion activities. The theoretical framework for this project is Lazarus' transactional model …

Facilitating Collaboration Among School And Community Providers In Children's Mental Health, Holly J. Curran

Walden Dissertations and Doctoral Studies

Interprofessional collaboration among school-based and community-based mental health providers in children's mental has been studied in relation to specific providers and as part of program evaluation; however, limited information exists as to how to overcome barriers to collaborative relationships. This study describes the experiences of school and community mental health service providers and those who supervise them. Using phenomenological methodology, three focus-group interview transcripts were analyzed by identifying recurrent themes relevant to the experience of collaboration from school and community providers' perspectives. Although participants viewed aspects of collaboration positively, barriers frequently interfered with collaborative relationships. Support for collaboration from state, …

Education Models For Teaching Adults About Modifying Dietary Carbohydrate And Controlling Weight, Vincient Cleamons

Walden Dissertations and Doctoral Studies

The prevalence of diabetes and other pathophysiological conditions has been correlated with the incidence of obesity. A large portion of an adult community in the northwestern United States suffers from excessive weight that has been linked to premature mortality rates and certain forms of diabetes. Excess calories from carbohydrate have been shown to increase weight. Therefore, diets that are modified in carbohydrate and calories may help mitigate weight and obesity comorbidities. This qualitative, single case study's purpose was to explore the methods health care professionals use for teaching adults about controlling weight. Altheide and Johnson's analytic realism theory, in which …

Relationship Between The U.S. Air Force Physical Fitness Assessment And Healthcare Utilization, Elena Arushanyan

Walden Dissertations and Doctoral Studies

Escalating health care costs in the military health system are not sustainable long term. Regular physical activity has been shown to improve health and reduce health care costs. Military members serving in the United States Air Force (USAF) are encouraged to maintain physical fitness year-round and undergo mandatory physical fitness assessments (PFAs) annually. The purpose of this quantitative correlational study was to determine the nature of the relationship between the timing of the PFA and health care utilization (HU) by active duty service members assigned to the United Kingdom's USAF military treatment facility. Donabedian's framework and the logic process model …

Improvement In The Retention Of Graduate Nurses In A Long-Term Acute Care Hospital, Angie Lim Torres

Walden Dissertations and Doctoral Studies

The high turnover rate of graduate nurses is a challenge in the United States' hospitals because of high job dissatisfaction rates. The premature disaffiliation of the graduate nurses is costly for organizations and can significantly affect the quality and safety of patient care due to the inadequate supply of adequately prepared staff nurses, particularly in the long-term acute care hospitals. The purpose of the project was to decrease the turnover rate of graduate nurses in a long-term acute care setting from 40% to 20% through modification of the nurse residency program by applying an intervention based on Bauer and Erdogan's …

Improving Care Transitions In Patients With Heart Failure: An Integrative Literature Review, Heather Mae Mclain

Walden Dissertations and Doctoral Studies

Heart failure (HF) hospital readmission reductions are linked to nursing interventions that include scheduling a hospital follow-up appointment with the patient's health care provider within a week of discharge. Yet, patients often leave the hospital without an appointment scheduled. The focus of this integrative literature review was on analyzing data that associated follow-up within 7 days with reduced 30-day readmissions. A search of articles using CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, and ProQuest databases resulted in 4,813 articles retrieved using the following search terms: heart failure, readmissions, follow-up appointments, and heart failure guidelines. Scholarly articles selected for inclusion were …

Effects Of Simulated Clinical Experiences On Empathy, Self-Confidence, And Satisfaction In Nursing Students, Dawn Riess

Walden Dissertations and Doctoral Studies

Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students' empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students' empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb's experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing …

Discharge Calls And Avoiding Hospital Readmissions, Wanda Lee Cassavettes

Walden Dissertations and Doctoral Studies

Hospital readmissions are disruptive and costly for patients and hospitals. As hospital discharge instructions are a key nursing responsibility, this project implemented a nurse follow-up phone call intervention within 12-48 hours of patient discharge from an indigent care facility in the Great Lakes region of the United States. The project was designed to understand whether follow-up phone calls from nurses that clarified discharge instructions, symptom management, and medications would be associated with decreased readmission rates within 30 days post-discharge among chronic care patients. The theoretical framework was the health belief model, which proposes that the patient's knowledge of illness severity, …

How Fine Particulate Matter Modifies Preterm Birth Risks In Korea, Hyun Jin Choi

Walden Dissertations and Doctoral Studies

Despite the increasing interest in preterm birth risk associated with maternal exposure to the current level of fine particulate matter (PM2.5) in Korea, there is little information on differences in PM2.5 exposure and its impact on preterm birth. This study was designed to examine the effects of Korea's air quality on preterm birth, including the possibility of moderation and mediation. This work was also designed to investigate manipulable factors for PM2.5 exposure. The theoretical framework of this quantitative and observational study included the social ecological theory and systems theory. The conceptual framework of this partially ecologic and retrospective cohort study …

Antibiotic Prescribing Habits Of Urgent Care Providers, Mellisa Thompson

Walden Dissertations and Doctoral Studies

Antibiotics are commonly prescribed and requested for viral illnesses despite evidence-based research studies and societal guidelines that advise against this practice. Literature has indicated that antibiotic decision-making comes from a provider's experience or exposure to illness, uncertainty of illness, or from being pressured by the patient. Nurses and advanced practice nurses are important participants in the antibiotic stewardship initiative. The purpose of this project was to examine potential knowledge deficits responsible for inappropriate antibiotic prescribing at a rural urgent care clinic in the southeastern United States, which when addressed could promote an educational in-service to decrease the number of antibiotics …

Toward Excellence: Exploring Leader Strategies In Chronic Wound Care Centers, Geraldine Rosol

Walden Dissertations and Doctoral Studies

The number of chronic wounds is rising in the United States, and health leaders face the economic and health burdens these wounds pose to the U.S. health care system. Many investigators have documented the importance of leadership in promoting excellence and reducing health care costs in chronic disease. Yet, the literature lacks information regarding leader strategies used to promote wound treatment cultures of excellence directed toward improved quality and reduced health costs. This study examined leader strategies used to promote excellence in chronic wound treatment to address the problem of the economic and health burdens associated with chronic wounds. The …

Efficacy Of Methods Available To Remove Environmental Tobacco Smoke In Vehicles, Brian Albert Nielson

Walden Dissertations and Doctoral Studies

Environmental tobacco smoke (ETS) is a serious public health threat. Residual ETS in vehicles unknowingly exposes future occupants to environmental tobacco smoke. Reducing or removing exposure to ETS has been proven to reduce long-term health complications. This quasi-experimental study investigated 5 cleaning methods and their effect on air particulate matter2.5 (PM2.5) along with the correlation between air nicotine levels and PM2.5 levels. Study variables included cleaning methods as the independent variable, and changes in air nicotine and PM2.5 levels as the dependent variables. This study is framed within primary prevention and risk reduction based on the harm reduction theory. The …

Nursing Self-Efficacy In The Acute Care Setting With The Neighborhood Staffing Model, Laurie Swaney Berghoff

Walden Dissertations and Doctoral Studies

Due to changes in health care, along with increasing technological demands, nurse's experiences increased stress. Nurses who are asked to staff another area other than their own have increased stress that can lead to increased nurse turnover, absences, and nursing dissatisfaction scores. The purpose of this quality improvement project was to assess whether limiting what units a nurse works on can reduce nurse stress, improve self-efficacy, and improve nurse job satisfaction. The design of this pilot placed like nursing units within a neighborhood staffing model for floating. The plan-do-check-act model was used as a framework to implement a change in …

Improving The Care Of Patients With Urinary Catheters Through A Quality Improvement, Ashley Nicole Holmstrom

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infections (CAUTI) significantly increases patient morbidity and mortality, length of stay, and organizational cost. In the 2 years prior to project implementation, the incidence of CAUTI increased by 15% in the local acute care, inpatient facility that served as the project site. Nursing leaders at the project site linked the increase in CAUTIs to a nursing knowledge deficit related to CAUTI prevention principles. The clinical question focused on the impact of CAUTI prevention staff training on the incidence of CAUTI, length of stay, and cost to the local acute care organization. After a review and critical appraisal …

Validating A Home Health Care Staff Educational Module For Wound Treatment And Documentation, Kimberly Sanders Hebert

Walden Dissertations and Doctoral Studies

Although guidelines and minimal standards for the care and documentation of wounds in home health care settings in the United States are available, there is a lack of compliance among many home health care agencies (HHAs) with regard to the accuracy of wound documentation and care of wounds. Failure to follow guidelines for wound care according to Centers for Medicare and Medicaid Services and Home Health Outcome and Assessment Information System standards could result in loss of revenue for HHAs, improper treatment of wounds, and legal ramifications. The purpose of this doctoral project was to develop and validate a staff …

Women Of Intimate Partner Abuse: Traumatic Bonding Phenomenon, Meghan Koch

Walden Dissertations and Doctoral Studies

Researchers indicate women succumb to relational abuse as seen with maladaptive attachment, identity enmeshment, and implicit maltreatment. Implicit violence and nonviolence, bonding victims to victimizers remains unstudied, although the domestic abuse phenomenon continues. Intimate partner abuse was examined through qualitative inquiry. There is much to learn about female victim perspectives describing attachment bonds, identity conflicts, and implicit maltreatment experiences. Traumatic bonding theory served as the lens through which female participant responses were examined in this study. Research questions were developed to focus on female attachment bond perceptions, views concerning self-esteem, self-identity, or self-reference, and implicit aggression, coercive control, or manipulation …

Exploring Sports Participation And Sexual Risk Behaviors In High School Males, Jessica L. Dupree

Walden Dissertations and Doctoral Studies

Casual sex culture, also known as hook-up culture, is an experience adversely affecting teens in America. The intent of this study was to test the association between sports participation and sexual risk behaviors among high school males. For the purpose of this study, sports participation, the independent variable, was defined by having played on a sports team in the last 12 months. The sexual risk behaviors, dependent variables, were defined by sexual engagement with multiple partners, drug and alcohol use before intercourse, and sex without condoms. The ecological model provided the theoretical foundation for the study. Secondary analysis of the …

Empowering Cultural Competency In Healthcare Providers, Betty Antoinette Dement

Walden Dissertations and Doctoral Studies

Racial and ethnic health disparities are highest in communities of color; providing culturally competent care could address these disparities. Culturally competent communication between the healthcare provider and the patient is an essential behavior that may improve health in racially and ethnically diverse women. A quality improvement project was completed with guidance from the 5 constructs of the Campinha-Bacote model as the conceptual framework, and the method used was the Consumer Assessment of Healthcare Providers and Systems survey. The perspective of 20 Mexican American and 20 African American women in El Paso, Texas between ages 45 and 72 with menopausal symptoms …

The Relationship Between Nurse Staffing And Quality Outcomes In Georgia Nursing Homes, Tamara Kathleen Stephens

Walden Dissertations and Doctoral Studies

The quality of care in United States' nursing homes has been of concern to consumers, government agencies, and researchers for several decades. Nurse staffing has been identified as a key factor influencing the quality of care in nursing homes. The purpose of this quantitative, correlational research was to determine if relationships existed between nurse staffing levels and three quality care outcomes in the state of Georgia. Donabedian's quality conceptual framework guided the study. The framework encompasses three interrelated dimensions of quality including structure, process, and outcomes. Nurse staffing levels and facility bed size represented the structure of nursing homes and …