Medicine and Health Sciences Commons^™

Impact Of Simulation On Nurses' Satisfaction, Confidence, And Communication In Neonatal Resuscitation, Kathryn Rudd

Walden Dissertations and Doctoral Studies

Teamwork and communication in clinical practice improves with simulation using the TeamSTEPPS program. However, there is limited research about simulation efficacy for improving neonatal resuscitation through enhanced communication. Based on a needs assessment and literature review specific to quality improvement strategies for neonatal resuscitation, an enhanced neonatal resuscitation provider (NRP) course was infused with TeamSTEPPS communication strategies, and an NRP case was adopted for simulation training. Also, utilizing clinician feedback, the flow of the resuscitation documentation was revised. The purpose of this project was to evaluate the perceived level of confidence, satisfaction, and communication skills in nurses performing neonatal resuscitation …

Strategies For Increasing Employee Engagement In The Service Industry, Tonia Ann Walker

Walden Dissertations and Doctoral Studies

The annual loss to U.S. organizations consequential to a lack of employee engagement was approximately $300 billion in 2013. Employee engagement is vital to the business sustainability of an organization. The purpose of this qualitative single case study was to explore successful strategies that business leaders of a service organization used to increase employee engagement. The conceptual framework guiding this study was the behavior engineering model theory developed by Gilbert. A purposeful sample of 6 engineering managers was selected based on their success in creating strategies resulting in increased employee workplace engagement in a monopoly service organization in Connecticut. Semistructured …

Evaluating The Implications Of Parental Mental Illness For Children Using An Ecological Perspective, Jessica Elizabeth-Rose Carroll

Walden Dissertations and Doctoral Studies

Researchers have extensively studied the experiences and potential consequences of being a child whose parent has a mental illness (COPMI). However, there is no consensus on the best way to support these children, in general or in schools. The purpose of this quantitative study was to examine the effects of parental mental illness on children by using an ecological approach. Researchers have used ecological theory to illustrate the importance of internal characteristics, skills, and supports for children to enhance resiliency. This study looked at whether COPMI differed significantly from the children of parents of parents with no current or past …

Type 2 Diabetes In Offspring Of Diabetic African American Women, Toby Valentino Yak

Walden Dissertations and Doctoral Studies

The prevalence of Type 2 diabetes is greater among African American women and their offspring than it is among Caucasian women and their offspring. In Iowa, there has been a gap in public health knowledge regarding risk factors associated with Type 2 diabetes in African American women and their offspring. The behavioral change wheel model was used to guide this study. This research study was a quantitative, retrospective cohort using primary data to investigate the association between a sample of diabetic African American and the occurrence of diabetes in their offspring. The sample included 105 diabetic African American women between …

Development Of A Bedside Shift Report Policy And Guidelines To Assist Nurses With Patient Care, Cynthia Snedecor

Walden Dissertations and Doctoral Studies

In 2013, the Hospital Consumer Assessment of Healthcare Providers System (HCAHPS), a national, independent metric of patient satisfaction, revealed room for improvement at a teaching hospital in the southeastern section of the United States. This project reports the development and validation of a Bedside Shift Report (BSR) policy, practice guidelines, and associated documentation. Several initiatives, models, and theories informed thinking about this project. The work of Kurt Lewin and the Institute for Healthcare Improvement- Robert Wood Johnson Foundation's joint initiative, Transforming Care at the Bedside, both guided the project in terms of the process of institutional change. SBAR (Situation Background …

Behavioral Modification And Relapse Rates In Opioid-Dependent Pregnant Women Managed With Subutex, Tammy Lynn Minor

Walden Dissertations and Doctoral Studies

Behavioral Modification and Relapse Rates in

Opioid-Dependent Pregnant Women Managed with Subutex

by

Tammy Minor

MSN, Walden University, 2009

BSN, Marshall University, 1986

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

March 2016

Opioid dependency affects not only the individual who is dependent on opioids but negatively impactsalso the family unit, the community, and society as a whole. Opioid use in the prenatal period can have devastating effects on both the mother and the fetus. The purpose of this paper is to perform a secondary analysis of the effectiveness of …

Improving Nurses' Knowledge Of Stroke, James Trone Mcdaniel

Walden Dissertations and Doctoral Studies

Stroke is a devastating disease. Stroke care has advanced greatly in the past 20 years with innovations in radiologic imaging, development of tissue plasminogen activator (tPA), organized systems of care, telestroke, and best practice guidelines via Get with the Guidelines Stroke (GWTGS). However, stroke remains the 5th leading cause of death in the United States. To provide current and quality care for stroke patients, nurses need ongoing stroke education. Additionally, stroke centers must provide a sustainable stoke education program to their nurses to keep their knowledge current. Guided by Rosswurm and Larrabee's model, this quality improvement project addressed whether an …

Systematic Review: Barriers That Prevent Compliance With Hydroxyurea In Sickle Cell Disease, Uchechukwu Imegi

Walden Dissertations and Doctoral Studies

Sickle cell disease (SCD) is a blood disorder that is inherited from both parents and affects millions of people globally. The symptoms of SCD may be debilitating and pose a significant challenge to nursing care. Hydroxyurea (HU), the Food and Drug Administration (FDA) approved treatment for SCD in adults is reportedly effective, but its usage is still minimal among adolescents with SCD. The purpose of this systematic review was to evaluate existing literature on the barriers to HU use in adolescents with SCD. The Johns Hopkins Nursing Evidence-based Practice (JHNEBP) Rating Scales guided this study. An extensive electronic search of …

Reducing Length Of Hospital Stay For Intellectually Disabled Psychiatric Patients With Chronic Medical Problems, Joseph Wigwe

Walden Dissertations and Doctoral Studies

Length of hospital stay (LOS) is a major indicator for measuring efficient care. Intellectually disabled psychiatric patients (IDPP) with chronic medical problems have longer LOS due to challenges faced by providers in jointly managing both psychiatric and medical problems. The purposes of this study were to understand the significance of LOS for IDPP, create an intervention toolkit to reduce LOS, establish the content validity of the toolkit, and recommend its implementation. The items of the toolkit are pharmacology, somatic, rehabilitation, psychosocial, and monitoring patients' psychiatric and medical symptoms across care domains. The toolkit was created from the constructs of the …

Facilitating Person-Centered Care For People With Intellectual And Developmental Disabilities, Laure Bertille Ndeutchoua

Walden Dissertations and Doctoral Studies

The patient centered care (PCC) model is recommended by the Institute of Medicine for individuals with intellectual and developmental disabilities. The problem identified in this quality improvement (QI) project was that PCC practices had not been included in the training curriculum within the organization. Framed within the plan-do-study-act model of QI, the purpose of this project was to develop an educational initiative on PCC that included a curriculum plan, a pretest/posttest, a protocol, a revision of the training policy, and an implementation and evaluation plan. Drawing upon the evidence-based literature and using a team approach, a curriculum plan on PCC …

Assessment Of Her2-Neu In Breast Cancer Lines Upon Differential Exposures To Xenoestrogens, Abha Aggarwal

Walden Dissertations and Doctoral Studies

Synthetic xenoestrogens have differential estrogenic properties. Research has shown that exposures to xenoestrogens could promote breast cancer by disrupting normal function of the human epidermal growth factor receptor 2 (Her2) gene. Although animal models demonstrated a connection between xenoestrogen exposure and Her2 activity, no study using human cells has systematically examined their carcinogenic potential influencing the Her2 gene expression. Furthermore, breast cancer cells are phenotypically disparate (ER+, Her2+), with some phenotypes (Her2+), leading to more aggressive disease. This study aimed to dosimetrically assess the carcinogenic potential of commonly used xenoestrogens influencing Her2 gene expression, and delineate cellular phenotypes at greater …

Preceptor Progam For New Graduate Nurses, Althea Louise Webster

Walden Dissertations and Doctoral Studies

The transition from student to new graduate nurse is a difficult conversion. The challenges of the new graduate are the demanding workload, lack of clinical skills, and incivility from staff nurses and unfamiliar institutional cultures. More than 40% of new graduate nurses report making medication errors and feel unprepared to recognize and intervene in life-threatening complications that keep the patient safe from harm. Preceptorship is a clinical instructive model in which a professional relationship provides new graduate nurses with access to a clinical expert and role model within a preset time frame. The goal of the program was to evaluate …

An Obesity Needs Assessment With African American Adults In Central Virginia, Nicole Michelle Brown

Walden Dissertations and Doctoral Studies

The risk for obesity is especially prevalent among African American adults in Central Virginia, who have one of the highest rates of obesity in the nation. Efforts to address obesity in African American adults through diet, weight reduction, and increased physical activity in settings such as schools, worksites, healthcare organizations, churches, and communities, are among the initiatives of Healthy People 2020. The objective of this project, conducted with 91 African American adults (33 females and 58 males) in central Virginia, was to complete a community needs assessment that related to obesity among members of an African American church. The needs …

An Exploration Of A State Mandated Health Education Program, Patricia Lyons

Walden Dissertations and Doctoral Studies

Shaken baby syndrome (SBS) is one of the most violent forms of physical child abuse. In 2007, the State of Ohio enacted a health education mandate known as Claire's law. Claire's law requires all birthing hospitals to provide SBS education to mothers prior to their discharge. This law is the result of public demand and advocacy initiatives; however, it was not clear how the mandate was developed or whether or not the mandate and subsequent educational programs have had an impact on efforts to prevent SBS. The purpose of this qualitative case study was to explore the state of Ohio's …

Nurse Practitioners' Attitudes Toward Nonpharmacological Interventions For Individuals Diagnosed With Clinical Depression, Joseph Ocran

Walden Dissertations and Doctoral Studies

Depression negatively impacts the American economy, and there is a shortage of physicians to provide treatment. Nurse practitioners are viable alternatives to provide high-quality treatment of depression. The project's purpose was to describe nurse practitioners' attitudes toward nonpharmacological interventions to treat clinical depression. Attitude theory provided the theoretical framework. The American Psychiatric Association's guidelines for treating major depression provided the conceptual framework. The project used a quantitative nonexperimental descriptive survey research design. A purposeful sample of 63 nurse practitioners was obtained from members of the American Association of Nurse Practitioners. Data were collected through an online survey that included questions …

Behavioral Health Medical Interpreters: Cluster Analysis Of Vicarious Traumatization And Posttraumatic Growth, Pauline N. Stahlbrodt

Walden Dissertations and Doctoral Studies

Medical interpreter services will be essential for developing and implementing culturally relevant interventions and treatment for limited English proficiency (LEP) populations. This study sought to identify the possible risks or protective factors that may be associated with vicarious traumatization (VT) or vicarious posttraumatic growth among medical interpreters in behavioral health settings. A 2-step cluster analysis was conducted yielding 2 distinct groupings of medical interpreters (Subtype 1, n = 73; Subtype 2, n = 101). The most important predictor determining the 2 subtypes was whether the participant had a personal history of trauma. In addition, there were significant differences between the …

Federal Health Care Fraud Statute Sentencing In Georgia And Florida, 2011-2012, Lisa Walker Johnson

Walden Dissertations and Doctoral Studies

The financial costs of U.S. federal health care fraud continue to increase, and as health care payments due to fraudulent claims increase, the portion of The Medicare Trust Fund available to pay for legitimate health care expenses decreases. Prosecution is one of several fraud management life cycle components that contributes to and can alter the course of increasing health care fraud; however, despite this recognition, there is a gap in the literature regarding the consistency of prosecution for federal health care fraud across different judicial districts. The purpose of this qualitative, exploratory multiple case study was to explore the federal …

Implementation Of A Nurse Practitioner Residency Program In Critical Access Hospitals, Anna Ngwisah Bolima

Walden Dissertations and Doctoral Studies

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in practice expectations and significant role transition stress and turnover. The purpose of this project was to construct from the scholarly literature a transition-to-practice residency program to support NP's in providing emergency department care in the CAH. The limbo to legitimacy theory guided the …

Diabetes Mellitus Type 2: A Quality Improvement And Patient Safety Initiative, Remeliza Navarrete Tukay

Walden Dissertations and Doctoral Studies

The purpose of the quality improvement (QI) project was to examine the relationship between amended nursing education concerning diabetes mellitus (DM) Type 2 self-care management incorporating Tune in, Explore, Assist, Communicate, and Honor (TEACH) and Motivational Interviewing (MI) strategies and techniques and the Glycosylated hemoglobin (HgbA1C) of veteran patients with uncontrolled diabetes. The target sample included the 2 licensed practical nurses and 2 registered nurses assigned to 2 primary care teams, and the 10 purposively sampled patients with uncontrolled DM Type 2 from each team. The nurses' competencies were measured through descriptive comparison before and after nursing education implementation using …

Improving Quality Of Care For Mechanically Ventilated Patients In Long Term Care Through Full Compliance With The Ventilator Bundle Protocol, Tedgardo Pacal Mercene

Walden Dissertations and Doctoral Studies

One of the most common methods used by healthcare professionals in the ventilator unit to reduce morbidity and mortality due to ventilator-associated pneumonia (VAP) is a group of best practices known as the ventilator bundle. However, evidence from the literature shows that all its components must be in compliance if the bundle is to be effective. The purpose of this quality improvement project was to investigate the level of compliance with the different components of the ventilator bundle protocol at the study site's nursing home and rehabilitation center, as well as to improve compliance with the bundle protocol at the …

Influence Of Teacher Participation On Student Fitness And Student Participation In Physical Education, Whitney Morris

Walden Dissertations and Doctoral Studies

Physical activity plays a key role in the health of children. Childhood obesity is increasing in the United States, and children are spending less time being physically active. Active participation by a physical education (PE) teacher in physical activities has been suggested as a means of promoting student fitness. The purpose of this quasi-experimental quantitative study was to determine whether modeling of physical activity by a PE teacher would increase student participation and physical fitness. Bandura's social learning theory provided the theoretical framework for the study. Participants included 311 4th and 5th grade elementary students enrolled in physical education classes. …

Developing A Guideline For Care Of Students With Diabetes, Rita Ozioma Onwenna-Aninyei

Walden Dissertations and Doctoral Studies

Diabetes mellitus (DM) is one of the most common chronic diseases affecting children under the age of 20, and it often leads to serious complications. In recent decades, there has been an increase in incidence of both types of DM among U.S. children. Having this chronic condition not only negatively impacts the health of these children but also their academic achievements. School health nurses struggle to manage these children appropriately and safely. The purpose of this project was to develop an evidence- based guideline for a standardized process in which school nurses coordinate the school and student health care teams …

Meeting Meaningful-Use Requirements With Electronic Medical Records In A Community Health Clinic, Tony Andrew Richardson

Walden Dissertations and Doctoral Studies

Small nonprofit medical practices lack the technical expertise to implement electronic medical records (EMRs) that are consistent with federal meaningful-use requirements. Failure to comply with meaningful-use EMR requirements affects nonprofit community health care leaders' ability to receive reimbursement for care. Complexity theory was the conceptual framework used in this exploratory single case study. The purpose of the study was to explore the strategies nonprofit community health care leaders in Washington, DC used to implement EMRs in order to comply with the meaningful-use requirements. Data were collected via in-depth interviews with 7 purposively-selected health care leaders in a nonprofit clinic and …

Developmental Evaluation Of A Centralized Denials Management Program, Lisa Schiener

Walden Dissertations and Doctoral Studies

Health care reimbursement is changing, and hospitals are finding it difficult to receive payment due to insurers' denial of services already rendered to patients. A denial can be considered an underpayment by the insurer to the hospital. Using a Six Sigma approach, a large hospital system in the southeast United States found that individual hospitals were not focused strictly on denials, but other tasks as well. Hospital administrators conducted a literature review and found that centralizing denials management team has improved reimbursement outcomes elsewhere. Therefore, the hospital system implemented a centralized denials unit to focus on overturning insurer denials while …

An Exploration Of Bullied Nurses, Witnesses, And A Hospital's Bottom Lline, Brenda Kay Williams

Walden Dissertations and Doctoral Studies

Nurses experiencing bullying or witnessing other nurses bullied may choose to vacate their hospital positions. Nurse attrition negatively impacts a hospital's bottom line, which can lead to insolvency and a lack of access to healthcare by patients. The purpose of this phenomenological study was to understand the choices nurses made regarding their careers after experiencing or witnessing bullying and to calculate a hospital's cost of loss. Freire's oppressed group theory provided the conceptual framework for the study. The basis of the research questions was to understand how the nurse felt when bullied or observing a coworker bullied, the actions taken, …

Promoting Diabetes Self-Managment Eduaction And Training In Out-Patient Clinics, Inemesit Godwin Udo

Walden Dissertations and Doctoral Studies

Abstract

Type 2 diabetes mellitus (T2DM) is a long term metabolic disorder characterized by high blood sugar, insulin resistance, and relative lack of insulin. T2DM is a leading cause of cardiovascular disease, blindness, kidney failure, lower-limb amputation, and other complications that are costly to patients and the U.S. health care system. Lack of knowledge and underdeveloped skills for self-management of diabetes continues to be the biggest problem for patients with T2DM. Using a team approach and Rosswurm and Larrabee's (1999) conceptual model as a framework, the purpose of this doctorate of nursing practice quality improvement project was to develop an …

Impact Of Medicare And Medicaid Beneficiaries With Selected Conditions On Emergency Department Utilization, John K. Amoh

Walden Dissertations and Doctoral Studies

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 …

Effect Of Reduced-Fee Dental Hygiene Treatment And Oral Health Perceptions Among Socioeconomically Deprived Persons, Janeime Necole Asbury

Walden Dissertations and Doctoral Studies

Access to oral health care remains problematic for millions of Americans. Factors such as socioeconomic status, age, race, and lack of dental insurance benefits inhibit the ability of many to obtain preventative oral health care. The aim of this study was to explore the effect of preventive oral health treatment and education at reduced-fee dental hygiene facilities on the oral health behaviors and perceptions of socioeconomically deprived persons within the state of Georgia. This study was based on the health belief model constructs. A convenience sample of 102 participants was recruited from the individuals who visited two dental hygiene colleges …

Gestational Age, Birth Weight, And Incidence Of Adult Type 2 Diabetes Among Southeast Alaska Natives, Renee Elaine Crawford

Walden Dissertations and Doctoral Studies

American Indian and Alaska Native adults are 2.6 times more likely to have adult onset diabetes resulting from higher weight at birth. Pregnant women, providers, and Indian Health Service administrators may benefit from timely information during pregnancy to intervene and prevent Type 2 diabetes. The purpose of this study was to examine the role of birth weight in the development of Type 2 diabetes among Southeast Alaska (SEA) Natives. Guided by the socioecological model, this study examined the extent to which birth weight and gestational age predict the incidence of Type 2 diabetes. The study used a quantitative research design …

Influences Of Nutritional Food Label Understanding In African-American Women With Obesity, Cynthia Jean Hickman

Walden Dissertations and Doctoral Studies

Nutritional food label understanding (NFLU) in African American Women (AAW) is a philosophy that addresses obesity. Public health efforts have implemented nutritional and caloric information to packaged and restaurant foods to improve nutrient and calorie literacy. Research suggest NFLU might have a minimal effect on reducing obesity. However, it is not known how obese AAW born during the baby-boom era (51 to 64 years of age) perceive NFLU in relation to their dietary behaviors. The purpose of this phenomenological study was to understand the lived experience of obese AAW regarding NFLU from a cognitive and behavioral perspective. Twelve, AAW answered …