Medicine and Health Sciences Commons^™

Clostridium Difficile Infection (Cdi): Use Of Preventive Bundle To Decrease Cdi Incidences, Lisa Feliciano

Walden Dissertations and Doctoral Studies

The challenge of combating Clostridium difficile infections (CDI) is a major problem within many health care organizations as CDI adds to the cost of care and is an uncomfortable and sometimes fatal complication of hospitalization for the patient. The practice-focused question for this doctoral project was targeted at patients in hospital settings on a medical surgical floor and asked if clostridium difficile preventive bundles reduce the incidence of CDI compared with nonstandardized preventative methods. Using the plan-do-study-act framework, the purpose of this DNP project was to use a clostridium difficile bundle approach to study the effects of clostridium difficile incidence …

Determining Perceived Barriers Affecting Physicians' Readiness To Disclose Major Medical Errors, Jean-Pierre K. Folligah

Walden Dissertations and Doctoral Studies

Medical errors have been detrimental in the field of medicine. They have impacted both patients and doctors. While physicians recognized that error disclosure was an ethical and professional obligation, most remained silent when mistakes happened for different reasons. Guided by the theory of planned behavior and Kant's deontological theory, the purpose of this quantitative study was to investigate the perceived barriers affecting physicians' willingness to report major medical errors. An association was tested between the independent variables physician fear of disclosure of errors, organizational culture toward patient safety, physician apology, professional ethics and transparency, physician education, and the dependent variable …

Leisure Time Physical Activities Of Older Adults In Senior Housing, Tamiera S. Harris

Walden Dissertations and Doctoral Studies

Increasing physical activity levels of older adults is a public health priority given the associated risks with sedentary lifestyles. Exercise such as walking may positively affect older adults as they age decreasing the risk of heart disease, stroke, or death. The purpose of this study was to examine physical activities of older adults in senior housing and to determine if age correlates with the amount of physical activity. Physical activity studies on older adults are limited due to time and resources. The health belief model and transtheoretical model frames this study theorizing that older adults will take positive steps towards …

Assessment Of Evidence-Based Practice Readiness And Plan For Implementation Of Clinical Practice Guidelines In A Tertiary Hospital, Linda Keller

Walden Dissertations and Doctoral Studies

Using evidence-based practice (EBP) to deliver patient care in a hospital setting improves patients' care and their outcomes. The use of clinical practice guidelines (CPG) enables nurses and other healthcare professionals to translate current evidence into bedside care. However, there continue to be barriers for hospitals in adopting and implementing evidence-based care using CPGs, including a lack of understanding about EBP by nursing staff. The purpose of this project was to explore readiness of registered nurses in a tertiary hospital to use EBP and provide recommendations for a plan to implement CPGs successfully. Melnyk's research identified EBP as an approach …

Effects Of Cancer Staging On Maternal Coping And Mother-Child Communication Patterns Among Breast Cancer Survivors, Kevin Michael Lycke

Walden Dissertations and Doctoral Studies

Few researchers have examined the relationship between earlier stages of breast cancer and its effect on staging of the disease process and the co-occurring coping and communication patterns between mothers and their children. The purposes of this qualitative study with a multiple case study design were to examine (a) coping mechanisms that mothers used to manage the uncertainty of their breast cancer status and (b) the impact of early-stage breast cancer on communication patterns between mothers and their children. The Lazarus and Folkman theory of psychological coping and the McMaster family systems communication theory informed the conceptual framework for the …

Evaluating 30 Day Rehospitalization After Sbar Implementation In Rounding, Michell Mulberry

Walden Dissertations and Doctoral Studies

Transferring from an acute care setting to a sub-acute rehabilitation (SAR) setting can be challenging for both patients and providers because communication errors may occur. The purpose of this project was to evaluate the effectiveness of a 2017 quality improvement (QI) initiative that was implemented to reduce 30-day rehospitalization in a SAR setting serving older patients. The project involved an evaluation of the implementation of the Situation, Background, Assessment, and Recommendation (SBAR) tool for patient rounding to decrease the incidence of 30-day re-hospitalizations. Aristotle's linear model of communication, which emphasizes the impact of message delivery on audience response, provided the …

A Staff Education Project And Screening Tool To Identify Calciphylaxis, Janice Pennington

Walden Dissertations and Doctoral Studies

Calciphylaxis is a deadly disease seen primarily in patients with end stage renal disease. Literature indicated that improved patient outcomes are seen with routine screenings. Many dialysis providers lack fundamental knowledge that would enable early identification of calciphylaxis in patients with renal disease. The purpose of this project was to design a screening instrument and develop a staff education program that would transform calciphylaxis management by promoting early identification and treatment of the disease. Knowles's theory of andragogy was used as the theoretic framework for the project. Dialysis center staff (n = 26) participated in the education. The number of …

Effectiveness Of Continuous Subcutaneous Insulin Infusion Therapy Education In A Clinic Setting, Kimberly Rizzo

Walden Dissertations and Doctoral Studies

Diabetes affects an estimated 29.1 million Americans, with approximately another 1/3 of Americans not yet diagnosed. Complications associated with diabetes include heart disease, stroke, hypertension, blindness, kidney disease, neuropathy and death. All of these complications can be prevented with optimal control of blood glucose levels. Advances in technology provide people living with diabetes (PLWD) a multitude of treatment options such as continuous subcutaneous insulin infusion (CSII) therapy. Unfortunately, sustained improvement in glycated hemoglobin A1c (HgA1c) is not always achieved even with this advanced therapy. The purpose of this doctoral project was to educate nurses on CSII therapy and promote improved …

Family Relational Experiences During Major Transitions With A Chronic Illness, Juanita Sibayan

Walden Dissertations and Doctoral Studies

Although health care transitions have received some attention in the literature, few researchers have emphasized family relational experiences and communication during major changes while living with a chronic illness. The purpose of this phenomenological study was to understand the lived experience of parents and their adult children while transitioning from pediatric to adult care of a chronic illness. The bio-psychosocial theory, family systems theory, and attachment theory established the context for this study. A criterion-based sampling technique and snowball sampling were used to recruit 7 parents and 6 of their adult children aged 18 to 30 years who were diagnosed …

The Impact Of Diabetes And Obesity In The African American Population, Andrea Lynette Swails

Walden Dissertations and Doctoral Studies

Within the 21st century, Type II diabetes has emerged as a public health crisis. African Americans and Hispanic Americans have the highest rates of Type II diabetes and obesity compared to European Americans. The purpose of this DNP project was to teach medical assistants (MA) to provide self-management of diabetes and obesity for the African American population in the local clinical setting. An educational tool kit for health providers was developed to guide the educational project. The chronic care model was used to guide the development of the educational toolkit. A pretest posttest design was incorporated into the educational program. …

Factors Influencing Use Of Pre-Exposure Prophylaxis Among Men Who Have Sex With Men, Justin B. Terry-Smith

Walden Dissertations and Doctoral Studies

Prevention is key to keeping men who have sex with men (MSM) protected from Human Immunodeficiency Virus (HIV). Despite new and innovative HIV prevention resources such as pre-exposure prophylaxis (PrEP), factors such as education level, employment status, number of sexual partners, and access to health resources may inhibit certain populations from using PrEP. The purpose of this cross-sectional study was to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM. The fundamental cause theory was used to examine how socioeconomic barriers are associated with the …

The Effects Of Hourly Rounding On Patient Safety And Satisfaction, Renee Allatzas

Walden Dissertations and Doctoral Studies

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting …

Single Men's Experiences Of Coping With Financial Stress, Heath Downes

Walden Dissertations and Doctoral Studies

Experiencing financial hardship is stressful and can lead to the development of psychological symptoms, including depression and anxiety. Although researchers have examined the broad categories of coping strategies that people employ when faced with financial hardship, little is known about the experiences of single men who were able to navigate stressful times without developing anxiety or anxiety-like symptoms. The purpose of this phenomenological study was to explore the successful coping experiences of single men with financial hardship (e.g., loss of job, home, finances). Bonanno's theory of resilience provided the framework for the study. Data were collected from interviews with 12 …

Wic Participant Fruit And Vegetable Intake In California, Lindsay Estrada

Walden Dissertations and Doctoral Studies

Low-income populations in the United States consume less healthful diets than higher-income populations, specifically relating to fruit and vegetable consumption. The supplemental nutrition program Women, Infants, and Children (WIC) is intended to bridge this gap by providing nutrition education and vouchers for nutritious foods. The purpose of this study was to determine if the 2009 WIC food package revisions impacted fruit and green vegetable consumption in 18 to 24-year-old females in California. Using the social ecological model as a guide, a population of WIC (N = 115) and non-WIC (N = 276) participants from the California Behavioral Risk Factor Surveillance …

Nurse's Role Within The Informed Consent Process: A Systematic Review Of The Literature, Maria Faison

Walden Dissertations and Doctoral Studies

Each year, over 50 million surgical and nonsurgical inpatient procedures are performed and yet, shared decision making between patients and health care providers is not achieved. Obtaining patients' informed consent is part of a nurse's daily routine during admissions and before a procedure. The purpose of this project was to evaluate evidence to answer the practice-focused question regarding support for a policy change to implement a nurse-driven informed consent protocol. The systematic literature review was conducted using the adapted literature review by Souz, Silva, and Carvalho, which consisted of 6 levels for evaluating evidence. A total of 15 articles were …

Public Health Strategies For Strengthening Prehospital Injury Responses In St. Lucia, Delwin Oliver Ferguson

Walden Dissertations and Doctoral Studies

Traumatic injuries have steadily increased during the last two decades, affecting over 5.8 million persons annually and have become a global public health issue. Since 2008, 80% of all deaths from noncommunicable diseases and trauma, approximately 29 million occurred in developing countries. Sixteen thousand young adults worldwide have died due to traumatic injuries. Additionally, injuries account for over 15% of the global burden of diseases, with approximately 90% of these injuries occurring in developing countries like St. Lucia. The purpose of this qualitative descriptive study was to examine policy gaps in prehospital traumatic injury responses and explore implementing Essential Public …

Predictors Of Binge Drinking In High School Youths In Montgomery County, Maryland, Lum M. Fube

Walden Dissertations and Doctoral Studies

Underage drinking is a major problem in the United States, leading to increased morbidity and mortality. About 43,000 deaths a year result from binge drinking in youths at a cost of $24 billion in 2010 to the U.S. economy. The purpose of this quantitative dissertation was to examine the predictors of binge drinking in high school youths in a highly racial diverse community of Montgomery County, Maryland. The social ecological model was the theoretical framework used for this study due to the presence of both personal and contextual factors that influence behavior. Using binary logistic regression to analyze data from …

Use Of Hpv Vaccination For Cervical Cancer Prevention In African American Women, Diamond Diane Hanson

Walden Dissertations and Doctoral Studies

Despite the availability of the human papillomavirus (HPV) vaccine, African American women are still at risk for contracting HPV. This is significant because HPV is one of the main risk factors for cervical cancer. The purpose of this quantitative study was to explore the relationship between the use of HPV vaccination for cervical cancer prevention and personal history of HPV, reduced access to healthcare, and risky sexual behaviors in African American women. The theoretical framework used for this study was the health belief model (HBM). Two hundred twenty-nine (n=229) African American women living in the United States, ages 18-49, who …

Nonprofessional Healthcare Staff Perceptions Regarding Inmate Self-Injury In Georgia, Alisa Adele Harmer

Walden Dissertations and Doctoral Studies

Self-injury in correctional facilities is an increasing problem. Healthcare staff are tasked with responding to and treating self-injurious inmates. Research concerning the perceptions of prison self-injury depended on the experiences of professional healthcare staff and showed that specialized training reduced anxiety and altered perceptions. The perceptions of nonprofessional healthcare staff regarding inmate self-injury have not been studied. The purpose of this research was to understand the perceptions of inmate self-injury maintained by untrained healthcare staff through evaluation of their expressed experiences with self-injuring inmates. The research was based on the humanistic nursing theory. A phenomenological approach guided interviews of 8 …

Strategies For Compliance With Government Regulations In A Pharmaceutical Company, Charles Jagun

Walden Dissertations and Doctoral Studies

Pharmaceutical companies accrued fines of over $30 billion within 25 years because of noncompliance with regulations. Noncompliance with regulations results in fines and an adverse impact on company profitability. Some pharmaceutical company managers lack effective strategies to ensure overall company compliance with regulation. Based on complexity leadership theory, the purpose of this single case study was to explore strategies pharmaceutical company managers used to ensure compliance with regulatory requirements in Nigeria. The target population was functional managers purposely selected because they had successfully implemented strategies for compliance with the regulatory requirements in Nigeria. Data were collected through face-to-face and telephone …

The Effects Of Cultural Dissimilarity On Employee Job Attitudes And Productivity, Sherrice Olithia Lyons

Walden Dissertations and Doctoral Studies

Organizations in Jamaica have been impacted by globalization and the opportunities and challenges of cultural incompatibilities. Most previous studies on cultural incompatibilities have focused on the impact on expatriates leaving a gap in the literature with respect to the implications for host country nationals, and specifically Jamaicans. This quantitative study focused on employees of 2 companies in Jamaica, an energy company and a hospitality company. It examined cultural dissimilarity with respect to host country nationals and expatriates, and its effect on the productivity, job satisfaction, affective commitment, and normative commitment of these employees (N = 110). In addition to the …

Long-Term Health Impacts Of Cell Phone-Driven Radiofrequency Radiation Exposure In Humans, Ndukaku Omelu

Walden Dissertations and Doctoral Studies

Uncertainties still exist about the safety of cell phone use and the level of cell phone-driven radiation. The purpose of the current inquiry was to determine the long-term health impacts of cell phone-driven radiation via the use of cell phones. In this cross-sectional study, which was based on socio-ecological theory, secondary data from the 2012 National Health Interview Survey were analyzed to assess the difference in the prevalence of thyroid cancer, mouth/tongue/lip cancer, and heart disease between exposed and non-exposed/less exposed cell phone-driven radiation groups in the United States. Logistic regression was used to address three research questions. Findings initially …

Evaluating The Impact Of An Evidence- Based Weight Reduction Program Among The Obese At A Medical Facility In North Central United States, Petronilla Eke

Walden Dissertations and Doctoral Studies

In September 2016, the Centers for Disease Control and Prevention (CDC) determined that more than one-third (36.5%) of U.S. adults have an obesity problem. According to the CDC, this issue results in other medical conditions such as type 11 diabetes, hypertension, cancer, heart disease, and stroke. This project was designed to evaluate the effectiveness of an evidence-based weight reduction program for obese individuals at a medical facility in the North Central United States. The methodology used consisted of a retrospective chart review of pre- and post-data for 45 people who participated in the medical facility's weight-reduction program over a 6 …

The Relationship Between Technology Threat Avoidance And Innovation In Health Care Organizations, Melvin R. Fenner Jr

Walden Dissertations and Doctoral Studies

Most leaders of healthcare delivery organizations have increased their rate of technological innovation, but some still struggle to keep pace with other industries. The problem addressed in this study was that senior leaders in some rural ambulatory healthcare facilities failed to innovate, even with recent healthcare technological innovations, which could lead to increased medical errors and a loss of efficiency. The purpose of the study was to examine if a relationship exists between the avoidance of technology threats by senior leaders in ambulatory healthcare organizations and the innovation propensity of the organization. Technology threat avoidance theory served as the theoretical …

Perceptions Of Women Receiving Services From Domestic Violence Advocacy And Counseling Programs, Lisa Yvette Proby

Walden Dissertations and Doctoral Studies

Abstract

The purpose of this qualitative study was to examine domestic violence victims' perceptions of advocacy and counseling programs that provide women with safe refuge, prevention education, mental health treatment, and other services. Many women in the United States are victims of intimate partner violence. Review of existing literature found that little is known about the extent to which the needs of these victims are met from available advocacy and counseling services. The health belief model was used to theorize victims' perceptions of services and risk factors for re-abuse. A phenomenological design was used to answer research questions, and in-depth …

Possible Risk Factors For Multidrug-Resistant Tuberculosis Infection In The Philippines, Molovon Jr Pasagui Azores

Walden Dissertations and Doctoral Studies

Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) is a leading cause of morbidity and mortality in the Philippines. The purpose of this study was to gain knowledge about the relationship between potential risk factors and MDR-TB. Risk factors (the independent variables) for MDR-TB (the dependent variable) include previous TB treatment, infection with HIV, exposure to patients with drug-susceptible TB/MDR-TB, delays in diagnosis and treatment, employment status, smoking, imprisonment, alcohol abuse, and poor compliance with TB treatment regimens. The study was based on the epidemiological approach to causal inference work. A case-control study design was used wherein a quantitative method was applied in data …

An Rn Sepsis Training Program That Supports Registered Nurses In The Emergency Room Setting, Daphne Marjorie Davis-Patrick

Walden Dissertations and Doctoral Studies

Sepsis is a severe blood stream infection that claim the lives of almost 220,000 Americans annually. Delayed patient treatment results in multi-organ failure, morbidity, mortality, and increased hospital length of stay. Timely sepsis management enables hospitals to have decreased expenses, increased patient survival, and judicious interventions. The problem addressed in this project was the lack of sepsis- training for registered nurses (RNs) working in the emergency department (ED) of a 628-bed hospital in the southeastern United States. Under the direction of the director of the ED, 269 patient charts were reviewed during 2014 to February 2015 for data related to …

Faculty Perspectives On Effective Integration Of Simulation Into A Baccalaureate Nursing Curriculum, Linda Jane Howell

Walden Dissertations and Doctoral Studies

Research shows that use of high fidelity simulation (HFS) as a teaching strategy requires extensive amounts of faculty time and financial resources for faculty development and equipment. This project study addressed the challenges encountered in the integration of HFS into a Midwestern metropolitan baccalaureate nursing program. The purpose of this qualitative case study was to explore perceptions of nursing faculty about best practice elements for successful integration of HFS into undergraduate nursing programs. Guiding questions were developed using Donabedian's structure-process-outcome model and focused on faculty perceptions related to successful implementation of simulation in their programs. Purposeful sampling was used to …

Design And Development Of An Educational Intervention On Nurse Perceptions Of Caring, John S. Norris Iii

Walden Dissertations and Doctoral Studies

Caring is central to the nursing profession and important to patients and family members who expect nurses to display caring attributes. The acute care hospital in this study did not have an education program on caring practices for nursing staff although the organization acknowledged the importance of and need for a culture of caring practices in the organization. The purpose of this project was to design an educational program based on Watsons' theory of caring for registered nurses at the acute care hospital where the project took place. Rosswurm and Larrabee's model for change and Watson's theory of caring were …

Adherence Barriers To Healthcare For African Americans With Hiv/Aids On Antiretroviral Medications, Angela Bumphus Corbin

Walden Dissertations and Doctoral Studies

The purpose of this mixed methods research study was to examine the role of adherence barriers to healthcare and the impact that such barriers have on highly active antiretroviral therapy (HAART) compliance for African Americans living with HIV/AIDS. HAART helps reduce HIV/AIDS morbidity and mortality. Of the 49% of study participants who had been out of medical care for more than 12 months, financial concerns were listed as the most common barrier (22.8%). Not having the support from family and friends (17.5%), being tired of going to doctor appointments (15.8%), health challenges (12.3%), lack of transportation (12.3%), and incarceration (12.3%) …