Medicine and Health Sciences Commons^™

Predictors Of Mastectomy In Male Breast Cancer, Esther Opara

Walden Dissertations and Doctoral Studies

Male breast cancer (MBC) is rare, and research on the predictors of MBC has been limited because of inadequate funding in and outside of the United States. One goal of this study was to eradicate the stereotyping of breast cancer as a female disease. The emergence of medical technology and education to benefit the public will help to ensure greater health awareness at the individual, community, and global levels. The purpose of this study was to understand the influence of the predictors of age; race (Black, White, and Other); and grade of cancer (I, II, or III) on the outcome …

An Integrated Approach To Malaria Prevention And Control In Rural Cameroon, Naomi Chuiwo Azunie

Walden Dissertations and Doctoral Studies

Malaria is a life-threatening parasitic disease spread to humans through bites of an infected mosquito. In rural Cameroon, malaria is one of the major causes of morbidity and mortality. Several studies have examined the use of various malaria preventive tools; however, there is insufficient literature available on use of an integrated approach to prevent and control malaria in rural Cameroon. The aim of this study was to provide information necessary for bridging the gap in understanding the proper use of insecticide treated nets (ITNs) and antimalarial drugs and the roles of education and socioeconomic status in malaria prevention and control …

Nursing Informatics Competency Program, Kristina Ann Dunn

Walden Dissertations and Doctoral Studies

Currently, C Hospital lacks a standardized nursing informatics competency program to validate nurses' skills and knowledge in using electronic medical records (EMRs). At the study locale, the organization is about to embark on the implementation of a new, more comprehensive EMR system. All departments will be required to use the new EMR, unlike the current policy that allows some areas to still document on paper. The Institute of Medicine, National League of Nursing, and American Association of Colleges of Nursing support and recommend that information technology be an essential core competency for nurses. Evidence of the need for nursing informatic …

Exercise Adherence Among Active Working Women, Roxane Evonne Hearn

Walden Dissertations and Doctoral Studies

Low levels of exercise adherence has contributed to the increased prevalence of heart disease, cancer, and diabetes in American women. These low levels, coupled with high exercise program dropout rates, point to a need for strategies to increase exercise frequency in women who exercise, but not enough to improve their health and reduce risks. Real-time interventions, such as text messaging, could be useful in improving the cognitions that regulate adherence. Using a snowball sampling strategy, a cross-sectional sample of working women (N =130), ages 18-64, in the volitional stage of exercise behavior, completed a 60-item survey on exercise behavior. Social …

An Evidence-Based Mentorship Program For Experienced Nurses, Roma Allen

Walden Dissertations and Doctoral Studies

Turnover of experienced nurses is a component of the nursing shortage, which has created a lack of expert nurses administering bedside care. The project site is a Chicago suburban hospital with an average first year turnover of experienced nurses at 35%. This rate is above the 27% first year turnover reported by the Metropolitan Chicago Healthcare Council. This project focused on development and evaluation of an evidence-based mentorship program supported by theory that can contribute to an increase in experienced nurse retention. A detailed literature review references causative factors of turnover, such as an increasing workload, a multigenerational and aging …

Culturally Competent Nutrition Counseling And Health Outcomes Of Patients On Emergency Dialysis, Edlyn Geraldine Bustamante

Walden Dissertations and Doctoral Studies

Undocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on …

Development Of An Evidence-Based Protocol For The Management Of Acute Vertebral Fragility Fractures, Shannon De Ann Carey

Walden Dissertations and Doctoral Studies

Vertebral fragility fractures are common, affecting approximately 50% of all postmenopausal women and 33% of men over the age of 50, and are the most common type of fracture seen in osteoporosis. The management of vertebral fragility fractures in the acute care setting is lacking in standardization, in the use of evidence-based practice, and in addressing the underlying cause of osteoporosis. The purpose of this project was to develop an evidence-based protocol to standardize the care of the vertebral fragility fracture in the acute care setting. This protocol included patient education, fall risk assessment, screening for osteoporosis, and follow up …

Nurse Practitioner Navigator Policy And Procedure Protocols In Private Practice, Wendy Grose

Walden Dissertations and Doctoral Studies

In 2010, the Patient Protection and Affordable Healthcare Act (PPACA) implemented changes to reduce healthcare spending that incorporated Centers for Medicare and Medicaid (CMS) incentive programs to reduce 30-day readmission rates in seniors with heart failure. This project includes a policy and procedure for private practice using a nurse practitioner navigator (NPN) led multidisciplinary team (MDT) for the patient-centered medical home (PCMH) to improve communication between hospitals and PCMH to decrease readmission rates in seniors with heart failure (HF). This practice change will provide an implementation and evaluation plan along with plans for future expansion. Meetings were held twice weekly …

Studying The Prevalence Of Depression Among Diabetic Patients In Primary Care, Lanita Rochelle Hood

Walden Dissertations and Doctoral Studies

Abstract

The prevalence of diabetes in the United States in 2015 was 30.3 million people; which is the equivalent of 9.4% of the population. It is a major contributor to morbidity and mortality. Depression is often underdiagnosed in these patients, which contributes to poor self-management and poor health outcomes. In a large primary-care practice on the East Coast, there is no guideline for depression screening in the diabetic population. Focusing on this specific primary care setting, the research question addressed the underdiagnoses of depression in diabetic patients. The project evaluated the prevalence of depression among patients diagnosed with diabetes by …

Defining The Scope Of Practice For Nurse Practitioners In Miam, Samantha Lucero

Walden Dissertations and Doctoral Studies

Minimally invasive aesthetic medicine (MIAM) is a relatively new field, which lacks a clearly defined scope of practice. The purpose of this project was to clarify the scope of practice for nurse practitioners in MIAM in California. Without a clearly defined scope of practice, nurse practitioners are unable to practice to the full extent of their license which causes them to be underutilized and face liability issues. This project sought to answer the question: What is the scope of practice of the nurse practitioner in MIAM in the state of California? The model of professional nursing practice regulation was the …

Servant Leadership And Its Effect On Employee Job Satisfaction And Turnover Intent, Dennis M. Mitterer

Walden Dissertations and Doctoral Studies

Experts expect a shortage of more than 900,000 nurses by 2022, according to the United States Bureau of Labor Statistics Employment Projections. Turnover in nursing contributes significantly to the shortage and often results from poor leadership of nurse managers. The purpose of this quantitative study was to investigate how servant leadership behaviors affected the psychological state and behavioral response of staff nurses as reflected by job satisfaction and turnover intention. Specifically, the research question addressed whether servant leadership positively contributes to the psychological states and the behaviors of staff nurses leading to greater job satisfaction. The study design was correlational, …

Senior Students' Experiences, Perspectives, And Attitudes Of Technological Competencies In Nursing Education, Patricia C. Bennett

Walden Dissertations and Doctoral Studies

Technological standards appear to be needed in undergraduate nursing education, as existing research has yet to establish technological standards for undergraduate nursing students. The purpose of this qualitative study was to examine the lived experiences of senior nursing students with respect to their perceptions regarding exposure to and abilities gained in the areas of information management, information literacy, and computer literacy. The framework of the study was based on Bandura's theory of self-efficacy and the Dreyfus model of skills acquisition. Using a phenomenological approach, in-depth face-to-face interviews were used with a purposive sample to collect data about the technological competencies …

Violence Against Nurses, Terri Lynne Declerck

Walden Dissertations and Doctoral Studies

Workplace violence against nurses causes stress, job dissatisfaction, injury, and financial burden. The purpose of this project was to examine training for nurses on violence, risk factors and on reporting workplace violence. The practice-focused question was designed to examine the effectiveness of educating nurses regarding violent patients and how to report episodes of violence. Benner's novice to expert theory guided the skill acquisition training of a convenience sample of 25 Midwestern medical nurses. The nurses participated by completing a survey prior to and following a violence simulation. A qualitative design was used with the 25 nurse participants who completed the …

Development Of A Quality Improvement Initiative To Screen For Postpartum Depression, Renee Traube

Walden Dissertations and Doctoral Studies

Postpartum depression (PPD) is a mood disorder affecting approximately 20% of women within 6 months of delivery. Untreated PPD diminishes a woman's functioning and may result in short and long-term consequences for her infant. Screening with evidence-based tools can identify prenatal and postpartum women at risk for PPD, ensure early treatment, and limit adverse maternal and infant effects. Using Rosswurm and Larrabee's evidence-based practice model, a multidisciplinary team of 7 key stakeholders, including directors and a nurse from the departments of OB/GYN, Pediatrics, and Primary Care, a psychiatrist specializing in women's health, and a member of nursing leadership, formed to …

Improving Fall Prevention Strategies In An Acute-Care Setting, Sylvia B. Boye-Doe

Walden Dissertations and Doctoral Studies

Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program …

Factors Related To Nursing Student Persistence In An Associate Degree Program, Patricia Ann Farley

Walden Dissertations and Doctoral Studies

The retention of nursing students remains a challenge in higher education, and the need for nurses in the United States is projected to increase. The purpose of this study was to investigate nursing student persistence in an associate degree program by examining differences in the presence of key social, environmental, and academic factors across 2 types of students: completers and non-completers of the 1st course in a registered nursing program. The study framework was based on Tinto's Student Integration Model and the Nursing Undergraduate Retention and Success Model, which identify key social, environmental, and academic factors as critical to student …

Impacts Of Observing Live Open Heart Surgery On Young Adults' Health Behaviors, Muhammad Musa Qarizadah

Walden Dissertations and Doctoral Studies

Having a heart healthy lifestyle at a younger age is beneficial in reducing the risk of coronary heart disease (CHD) in adulthood and various health education programs for CHD prevention exist to persuade young adults to adopt a heart healthy lifestyle. Little is known, however, about the influence of watching live open heart surgery on young adults' adoption of a heart healthy lifestyle. To address that gap in knowledge, this study was conducted at a health facility in Virginia where students came to observe live open heart surgery. The purpose of the study was to understand whether watching live open …

Evaluation Of Automated Reminders To Reduce Sepsis Mortality Rates, Maria M. Lindo

Walden Dissertations and Doctoral Studies

Sepsis is still a leading cause of death in the United States despite extensive research and modern advancement in technology. Early recognition of sepsis and timely management strategies are important for effective reduction of sepsis-related morbidity and mortality. Guided by the logic model, the purpose of this project was to evaluate the effectiveness of electronic reminders in enhancing clinical decision-making among 30 nurses in 3 medical-surgical units. The practice-focused question addressed the effectiveness of electronic reminders for early recognition and initiation of goal-directed treatment of sepsis in hospitalized patients on medical-surgical units in an effort to reduce sepsis mortality rates. …

Identifying Communication Barriers And Trust Issues Of Black Women Seeking Preventive Health Services In Houston, Texas, Melissa E. Shelton

Walden Dissertations and Doctoral Studies

Black women mortality rates are perceived to be impacted by communication barriers, trust issues, and the lack of quality preventive health services. The purpose of this phenomenological study was to explore communication barriers and trust issues perceived by Black women when seeking preventive health services. HMB was used to identify public attitudes around receiving preventive health services and to construct each question based on perceived susceptibility and perceived severity of communication barriers and trust issues. An ecological model of the communication process was used as a framework to identify fundamental relationships between the Black female patients and health care providers. …

Psychological Resilience In Correctional Officers: The Role Of Demographics, Manuel Chapa Villarreal

Walden Dissertations and Doctoral Studies

Correctional officers occupy an important societal role in maintaining safety and assisting in the rehabilitation of inmates; however, both their performance and mental health are highly susceptible to fatigue because of working in a high stress environment. This study investigated the relationship between correctional officers' demographic factors (level of education, marital status, gender, and race/ethnicity) and their psychological resilience. The Connor-Davidson Resilience Scale 10 (CD-RISC-10) was used to measure correctional officers' resilience when responding and or coping with stress. This study utilized the stress-vulnerability model as a framework to investigate protective factors against and risk factors for psychopathological symptoms. Participants …

Executive Director Experiences With Consumer Operated Service Provider Governing Board Members, Merideth Mccallick Erickson

Walden Dissertations and Doctoral Studies

Consumer Operated Service Providers (COSPs) are programs that are directed and administratively controlled by mental health consumers for their peers. As such, many mental health consumers have been placed in the position of serving on a COSP and often with unclear descriptions and no training. As a result, there is often a disconnect between the will of the board and the vision of the executive director, leading to tension and the possibility of failed mission. Using servant leadership as the guide, the goal of this case study was to explore the experiences of executive directors who operate Consumer Operated Service …

How Does Organizational Culture Impact Rn Engagement, Veronica Anntionette Ruffin-Ellis

Walden Dissertations and Doctoral Studies

Lack of RN engagement in the acute care setting can result in poor staffing, nursing shortages, increased stress levels for nurses and decreased morale. When nurses are not engaged in their work setting, quality of care suffers. A wide range of literature focuses on the importance of RN engagement; however, few health care organizations have taken the initiative to implement programs that foster RN engagement, demonstrating a gap in practice. This study examined the relationship between the levels of RN engagement and their perceptions of their organizational culture. Kolcaba's humanistic approach to meeting the needs of RN staff was used …

A Toolkit To Support Nurse-Patient Communication Through Nurse-Expressed Empathy, Jessica Delano Holden

Walden Dissertations and Doctoral Studies

Empathy is the ability of a person to understand what another is experiencing from the receiver's perspective and the ability to communicate that understanding to the receiver. In nursing, empathy is believed to be a necessary component to the nurse-patient relationship. Evidence shows a decline in empathy specifically noted over time in nursing students who are preparing to graduate and enter the workforce. The practice focused question for this project asked whether an experiential learning toolkit for development of nursing empathy can improve sophomore nursing student empathy as measured via the Jefferson Scale of Empathy. This project was guided by …

Educating To The Collaborative Care Model, Darcy N. Duncan

Walden Dissertations and Doctoral Studies

The problem addressed in this project was the lack of experienced RNs needed in the acute care setting to deliver safe, quality patient care, while effectively managing resources and providing job satisfaction. The purpose of this project was to determine if an education module designed to educate charge and rover nurses on the Collaborative Care Model (CCM) would enhance staff nurses' abilities to provide safe, high quality care to patients, and improve staff nurse retention on one unit in an acute care setting. The theoretical frameworks utilized to guide the education module included: Lewin's theory of planned change, Benner's novice …

Workers' Perceptions Of The Effect Of Three-Tier Shift Schedules On Community Functioning, Jillian Leigh Wallace

Walden Dissertations and Doctoral Studies

Shift work is commonplace in many fields that require around-the-clock employee coverage. There is ample evidence that two-tier shift work can detrimentally affect health and functioning. The purpose of this study was to understand the impact of three-tier shift schedules on physical and mental health and community functioning, a concept which refers to activities and behaviors performed by individuals or groups within a system. This study used a qualitative phenomenological design, and community functioning and recovery theory were central to the conceptual framework. In-depth interviews were used to explore the perceptions of three-tier shift workers on their functioning, relationships, mental …

Effective Strategies Employed By Retail Store Leaders To Reduce Employee Turnover, Alexandro Beato

Walden Dissertations and Doctoral Studies

Employee turnover affects retail organizations in the form of lower productivity, decreased profitability, and reduced sustainability. In 2014, organizations lost over $11 billion in tangible and intangible assets as the result of employee turnover. High employee turnover rates have an adverse effect on productivity, which lead to unsustainable business practices. The number of retail employees who quit their jobs each month increased from 432,000 in December 2016 to 464,000 in January 2017, which indicates that some managers lack strategies to reduce employee turnover. Using the transformational leadership theory, the purpose of this single case study was to explore effective strategies …

Hourly Roudning In Th Emergency Department, Marie Chapnick

Walden Dissertations and Doctoral Studies

The Affordable Care Act of 2010 increased the number of patients seen in a northeast, urban trauma emergency department by 34%. This created a problem as it occurred simultaneously with a nursing shortage. Consequently, patient satisfaction scores fell below the national average benchmark. The rate patients left the emergency department without being seen was 2.6% higher than the national average and patient fall rates increased by 20%. A review of the literature to search for solutions led to the support of an hourly rounding project and an educational workshop promoting proactive nurse behaviors as a way to address the quality …

Work-Family Conflict: Does Romance Matter?, Christie Marie Charles

Walden Dissertations and Doctoral Studies

Research has shown that being in a romantic relationship has related negatively with work-family conflict. Using social exchange theory, the investment model, and role theory, this study examined the relationships among the dimensions of perceived partner support, romantic relationship interdependence, and work-family conflict. A sample of 192 adults in paid employment, currently involved in a romantic relationship, were recruited from SurveyMonkey Contribute. Study participants completed online a demographic survey, the revised Support in Intimate Relationships Rating Scale (SIRRS), the Investment Model Scale, and work-family conflict scales. Correlation analyses showed that work-to-family conflict and family-to-work conflict correlated negatively with commitment and …

Effect Of Multiple Skin-To-Skin Experiences On Exclusive Breastfeeding Rates, Joanna Horst Horst

Walden Dissertations and Doctoral Studies

Breastmilk feeding at birth demonstrates short- and long-term medical and neurodevelopmental advantages. Infants who are exclusively breastfed demonstrate less nausea, vomiting, and diarrhea, and they experience less upper respiratory and ear infections than do infants who are not breastfed. One strategy that supports breastfeeding initiation is providing skin-to-skin contact (STS) with mothers and newborns immediately upon birth. The purpose of this project was to evaluate the impact of a second session of STS on the postpartum unit on exclusive breastfeeding rates at discharge. A retrospective comparison design using Swanson's caring model was used to guide the evaluation study that examined …

The Impact Of Adaptive Leadership Capacity On Complex Organizational Health Systems Outcomes, Laura Lentenbrink

Walden Dissertations and Doctoral Studies

Nonlinear and chaotic environmental changes characterize health services organizations as complex adaptive systems in which leaders must exercise non-traditional leadership practices to succeed. Health services leaders who have learned and implemented traditional linear management approaches are ill prepared to lead in complex environments. This study tested complexity and adaptive leadership theories of agility and resilience in complex health systems. The purpose of this quantitative cross-sectional internet-based survey study was to quantify relationships between independent variables of agility and resilience and secondary dependent variables of financial, patient satisfaction, quality and human capital outcomes. The impact of turbulence was also examined. Included …