Medicine and Health Sciences Commons^™

The Relationship Between Hospital Leadership Activities And Clinical Quality Outcomes In Iowa, Sarah Pavelka

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services have been working with hospital networks across the United States to improve health care through education and training on clinical best practices and leadership frameworks. Some organizations have failed to reach the high-quality standards of care expected and have adverse patient care outcomes. The purpose of the study was to determine the relationship between leadership actions, funding type, and clinical care outcomes in participating Partners for Patients hospital programs in Iowa. The secondary variable data were provided from a Partnership for Patients contractor, through the Centers for Medicare and Medicaid Services Organizational Assessment …

Effect Of Genetic Background Combined With Excessive Media Screen Time On Markers Of Cardiovascular Risk In United States Youth Aged Newborn To 20 Years, Maria Moroni

Walden Dissertations and Doctoral Studies

Time with media screens (television, computers, videogames, cell phones, and tablets) is the primary activity of youth, second only to sleeping, and represents a major risk factor for cardiovascular diseases (CVD). Additionally, the populations with highest rates of screen time are also those most at risk of CVD from genetic predisposition (i.e., Blacks, Hispanics). The purpose of this descriptive, correlational study, based on cross-sectional analysis of archived data from the 2009 - 2010 NHANES for United States youth, newborn to 20 years old, was to determine whether the combination of media screen time with genetic background is a better predictor …

Risk Factors For Measles Among Hiv-Infected Children In Uganda, Miriam Nanyunja

Walden Dissertations and Doctoral Studies

Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age …

Socioecological Determinants Of Obesity Among Hispanic Parents/Child Caregivers In Aurora, Illinois, Deanna Marie Sommers

Walden Dissertations and Doctoral Studies

Obesity has increased during the past 30 years in the United States. Obese adults and children are at risk for cardiovascular disease, diabetes, hypertension, and comorbidities. Parents and child caregivers play key roles in the decisions of family health. Studies exploring sociodemographic and socioecological factors associated with obesity among U.S. Hispanic parents and child caregivers are lacking. Guided by the socioecological model, this study examined the following factors: gender; acculturation; dietary intake of fat, sugar, fruits, and vegetables; and role as food purchaser/food preparer that influenced obesity. A 3-paper-based survey, consisting of a demographic survey, the Block Fat-Sugar-Fruit-Vegetable Screener and …

Donor Coordination And Health Aid Effectiveness In The Nigerian Health Sector, Ifeoma Edna Uduji

Walden Dissertations and Doctoral Studies

Development partners and donors increasingly acknowledge the importance of coordinating their activities to achieve the outcome of the official development assistance to developing countries. Although stakeholders have recognized the importance of harmonizing donors and development partners' efforts in the Nigerian health sector, little research has addressed the influence of coordination on the health aid effectiveness. This qualitative case study determined the influence of coordination among the donors and development partners involved in the HIV/AIDS, malaria, and nutrition program on the outcome of these programs in Nigeria. Data were collected through interviews with 22 program officers participating in the health programs …

Experiences Of Chronic Disease Self-Management Program Leaders, Laketa Monique Hillman

Walden Dissertations and Doctoral Studies

Chronic conditions are public health threats. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based disease management program that addresses personal self-management of chronic conditions. The CDSMP involves peer trainers who instruct and assist with chronic disease preventive measures. Although disease management demonstrates promise to improving patient self-maintenance, previous researchers have not evaluated how the program affects program leaders. The purpose of this study was to discover how self-help leaders feel about the CDSM program. The overarching research question asked about perspectives that self-help leaders had toward the program. Through a narrative qualitative approach, the perceptions of peer leaders were …

Evaluation Of Clinical Reasoning Of Nursing Students In The Clinical Setting, Stefanie Lynn Legrande

Walden Dissertations and Doctoral Studies

The primary focus of nursing education in the 21st century is to graduate students with well-developed critical thinking and clinical reasoning skills. This descriptive case study explored the perceptions of 6 faculty and 6 unit staff nurses concerning the assessment of critical thinking and clinical reasoning skills of nursing students in the clinical setting. Benner's novice to expert theory served as the conceptual framework for the research. The guiding research questions focused on faculty and staff perceptions concerning unit staff nurses' level of preparedness to assess the critical thinking and clinical reasoning ability of nursing students, and explored how faculty …

Community And Patient-Centered Medical Home In The Care Of Chronically Ill Patients, Victor A. Carrillo

Walden Dissertations and Doctoral Studies

Large portions of the US population live in poor inner-city communities. Health needs assessment data have shown that these communities have disproportionately high rates of chronic illnesses. The patient-centered medical home (PCMH) model was developed to address the gaps that exist in the primary care system, and emphasizes a redesign of primary care that is patient centered, utilizes multiple levels of healthcare professionals, information technology, and care coordination. However, little evidence exists on the value of this model which may explain why it has not gained wide acceptance by primary care providers. Therefore, this study was designed to examine the …

Crafting A System Of Profound Knowledge Management In Long-Term Care, Charlotte Johnston

Walden Dissertations and Doctoral Studies

The paradigm shift to a knowledge economy, predicted by Drucker, is currently reflected in a knowing-to-doing gap in healthcare, potentially threatening the lives of long-term care (LTC) residents and sustainability of LTC organizations. The purpose of this grounded theory study was to seek a substantive conceptual theory to explain how LTC uses knowledge management (KM) to improve performance by probing the a priori views and lived experiences of 11 LTC knowledge creators, managers, and users. Data were collected via semi structured interviews that were transcribed and coded. The research questions guided by the conceptual concentrated on how KM is used …

Case Study Of Learning And Instruction For Members Of An Online Reflex Sympathetic Dystrophy Support Group, Heather Rae Gilmore

Walden Dissertations and Doctoral Studies

Research has shown that individual members of traditional support groups gain a sense of identity and community and feelings of respect and support. Online support groups provide individuals avenues to find medical information and thus learn more about a given condition or illness. Little has been studied about the learning and instruction that occurs in online social support groups, especially in groups about chronic pain. The purpose of this qualitative case study was to explore the perceptions and experiences of members who participated in one open social support group. Siemen's constructivism theory served as the basis for comprehending the learning …

Implementation And Evaluation Of Dietary Modification With Gestational Diabetes, Celia T. Ojeaga

Walden Dissertations and Doctoral Studies

Gestational diabetes mellitus (GDM) negatively affects the health of both mothers and babies, and is the most common pregnancy complication in the United States. Many dietary modification programs for pregnant women diagnosed with GDM rely on a one-size-fits-all approach to menu planning. The purpose of this project was to develop a diet modification program for GDM management using a patient-centered approach. The project objective was to develop the policies, procedures, and supporting documents needed to implement a successful GDM management program for pregnant women receiving antenatal care at an obstetrical clinic. The developed program incorporated strategies for clinic nursing staff …

The Perception Of African American Clergy Regarding Mental Health Services, Tamara White

Walden Dissertations and Doctoral Studies

The rise in diagnosable mental illness disorders in the United States is a major concern. However, researchers indicate that African Americans are far less likely to seek mental health treatment than Caucasian Americans. This qualitative, phenomenological study addressed a research gap regarding the beliefs, perceptions, stigmas, and practices of African American clergy regarding their promotion of mental health services. Two conceptual frameworks consisting of the sociocultural theory and the social learning theory guided the study. There were two research questions used to guide the exploration of the purposive sampling of 6 African American clergy from major African American denominations across …

History Of Pregnancy-Loss And Maternal Socioeconomic Factors As Predictors Of Under-Five Child Mortality, Henry Chukwunonso Debem

Walden Dissertations and Doctoral Studies

Nigeria is one of the countries with the highest Under-5 Mortality rates (U5M) estimated at 117 deaths/1000 live births. Despite public health control initiatives, no significant improvement in U5M has been demonstrated. The purpose of the study was to determine whether history of Adverse Pregnancy Outcomes (APO) and maternal socioeconomic factors could predict the death of children before their fifth birthday, using the life course health development and fetal programming theories. The study population was women in their reproductive age (15- 49 years). The study was a secondary data analysis of the datasets obtained from three Nigeria Demographic and Health …

Self-Care Activities And Nurse Manager Well-Being, Gretchen Eileen Johnson

Walden Dissertations and Doctoral Studies

The role of the nurse manager is important in organizations and influences outcomes such as the safety and quality of care provided on a unit, satisfaction, turnover of nursing staff, and overall health of the work environment. Stressors for managing nurses can impair physical and emotional health and lead to poor patient and staff satisfaction, safety, and outcomes. The evidence-based practice project will explore nurse managers' well-being and self-care activities. The theoretical framework of the project is the Relationship-Based Care Model as well as Kotter's change theory. The literature suggests that self-care activities can reduce stress and improve well-being. A …

Risk Factors Associated With Severe Acute Respiratory Infections Cases, Ryan Gatdula Ortiguerra

Walden Dissertations and Doctoral Studies

The close proximity of the United States to the Mexican border poses a concern for communicable diseases because of the high flow of population movement. The purpose of this retrospective, quantitative study was to identify risks associated with respiratory diseases using an analysis of archived data from the Severe Acute Respiratory Illness (SARI) surveillance program. Based on the epidemiologic triangle theory, demographic and etiologic factors were analyzed to examine any associations with SARI in this population. Between 2010 and 2012, 798 subjects enrolled in this program, with 336 (42.1%) testing positive for respiratory pathogens. Chi square analysis determined that age …

The Need For Soft Skills In A Medical Assistant Program, Micheal L. Randolph

Walden Dissertations and Doctoral Studies

There is a perceived soft skills problem within the medical assistant program (MAP) at a 2-year technical college in the Midwestern United States. Soft skills refer to relational skills such as practicing self-management, communicating with various groups, adapting to change, negotiating, and resolving conflict. The purposes of this intrinsic case study were to (a) understand the perspectives of faculty, staff, and leadership regarding students' soft skills ability within the study MAP and (b) identify important soft skills needed in the workplace. An integrative conceptual framework that drew upon vocational and organizational theories was used as a theoretical framework for the …

Development Of Assessment And Screening Tool To Assist With Prevention And Identification Of Charcot Foot In Type 2 Diabetics, Louise S. Wade

Walden Dissertations and Doctoral Studies

Abstract

Development of Assessment and Screening Tool

to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics

by

Louise Wade MSN, RN

MS, West Texas A&M University, 2010

BS, West Texas A&M University, 2010

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2016

Abstract

According to the World Health Organization, up to 50% of type 2 diabetic patients

develop neuropathy, which may cause major infections, amputation, and Charcot foot due

to impaired sensation. Early recognition and care is essential for treatment of Charcot

foot and prevention …

Promoting Annual Depression Screening In A Federally Qualified Healthcare Center, Denise Lesley Alleyne

Walden Dissertations and Doctoral Studies

According to the World Health Organization, depression affects about 350 million people worldwide. In 2014, only 50% of the adult patients were screened for depression in the community-based Federally Qualified Healthcare Center (FQHC) for which this doctorate of nursing practice (DNP) project was developed. In an effort to meet the 100% benchmark set nationally for the screening of adult patients in the primary care settings, the FQHC's quality improvement team now requires that 80% of adult patients in the clinic be screened for depression. Framed within the Iowa model of evidence-based practice, the purposes of this project were to: (a) …

Association Between Haart And Metabolic Syndrome Components Among Hiv-Positive Adults In Southeastern Nigeria, Bridget Okiemute Amechi

Walden Dissertations and Doctoral Studies

Highly active antiretroviral therapy (HAART) contributes to metabolic disorders and the growing prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV)-infected patients. Hypertension, obesity, and hyperglycemia (components of MetS) are risk factors for cardiovascular disease. Studies have shown that HIV patients on HAART have a 2-fold risk of dying from MetS. There are no such studies in Umuahia; hence the need for this study to fill this gap. Using a sample size of 192 medical records of HIV-infected patients in Federal Medical Centre, Umuahia, and applying metabolic syndrome theory, this study examined the relationships among types of HAART regimen, …

High School Teachers' Perceptions Of Mental Health And Adolescent Depression, Christine Ann Breuer

Walden Dissertations and Doctoral Studies

Adolescents have a high rate of untreated mental health issues, specifically related to depression. Current literature does not indicate the impact of teachers' attitudes toward mental health on their decisions to refer students for services. This study provides understanding specifically, how teachers' beliefs about mental health, as well as their age, gender, ethnicity, years of education, and years of teaching, were analyzed to determine the impact each these characteristics had on the decision to refer a student for services. 92 high school teachers participated in this quantitative study by completing a survey measuring their attitudes of mental health, and then …

Fall Safety Bundle, Baili Denise Campbell

Walden Dissertations and Doctoral Studies

The Centers for Medicare and Medicaid Services (CMS) report thousands of falls in hospitals each year. The CMS does not reimburse hospitals for fall related injuries, costing the hospital system organization for which this DNP project was designed millions of dollars each year. Framed within the Iowa model of evidence-based practice and using a team approach, the purpose of this project was to develop an evidence-based (EB) fall safety bundle for use by nursing staff and a curriculum to educate staff on prevention strategies. The components of the EB fall bundle kit were approved by the stakeholder committee. Evaluation of …

Integrated And Reducing Re-Entry Into The Criminal Justice System, Scott Huntington

Walden Dissertations and Doctoral Studies

Numerous studies have focused on the effectiveness of integrated treatment services for people with cooccurring disorders (CODs) within the criminal justice system (CJS). However, there has been a paucity of research on the effectiveness of community-integrated treatment services with CODs and influences on decreasing their interaction within the CJS. This study quantitatively examined the possible relationships between integrated treatment services and CODs and their effect on decreasing interactions within the CJS. The sample (N = 320) consisted of people with CODs from a community-based facility. The statistical analysis was a 2-way (2 x 2) and 3-way (2 x 2 x …

Improving Communication Between Cancer Patients And Providers During A 15-Minute Office Visit: A Systematic Review Of The Literature, Dr. Tammy Elizabeth Manganelli

Walden Dissertations and Doctoral Studies

Patients undergoing chemotherapy treatments for cancer often experience adverse side effects, including cognitive deficits. These deficits impact the patient's ability to communicate effectively with their oncology provider. Ineffective communication can adversely affect patient outcomes and decrease patient-provider satisfaction. The resulting poor communication can contribute to poor patient outcomes. This systematic literature review focused on assistive communication tools that could be used in an outpatient oncology setting to improve patient-provider communication. The literature review findings led to the development of a resource for providers that includes 15 communication tools that can be used to assess and improve communication in cancer care. …

Perception Of Cervical Cancer Screening Among Immigrant African Women Residing In Houston, Texas, Esther Ifeomadiniru Orji

Walden Dissertations and Doctoral Studies

Perception of cervical cancer screening among Immigrant African women residing in Houston, Texas

Esther I. Orji

M.Ed., University of Lagos, 2002

B. Ed, Abia State University, 1998

A.C. E. University of Benin, 1990

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Public Health

Walden University

August 2016

Disparities in cervical cancer screening participation still exist especially among immigrant and minority women compared to non immigrant populations. Research investigators through multiple studies have explored reasons for non participation in cervical cancer screening among immigrant and minority women. However, there was limited research specifically on …

Examining Nurse Practitioners' Perceptions And Beliefs Regarding Hospice Referrals For African Americans, Karen Jackson Mcclary

Walden Dissertations and Doctoral Studies

Terminally ill patients often have difficult choices at the end-of-life, and electing to receive hospice services is one of them. Hospice has been linked to improved quality of life and death and is accessible to terminally ill patients. Despite the accessibility, African American patients often make the decision to forgo hospice services. The purpose of this descriptive study was to explore perceptions and beliefs of nurse practitioners (NPs) regarding the lack of utilization of hospice for African American patients and the feasibility of NPs for initial referral for terminally ill African American patients. The research questions addressed whether an NP's …

Geographical Effects On Adult Sickle Cell Disease Treatments, Morbidity, And Mortality, Paula Busbee

Walden Dissertations and Doctoral Studies

A small percentage of patients with sickle cell disease (SCD) have experienced an increase in life span by 10 years, while others with the same disease continue to die prematurely. The purpose of the study was to evaluate whether or not regional location was a barrier to care for adults with SCD in relation to emergency department visits and health outcomes at 16 and 21 years after the approval of hydroxyurea therapy as treatment. Secondary data were sourced and a retrospective quantitative correlational design was used to examine the effect of hydroxyurea treatment approval on emergency department visits and mortality …

Perceptions Of Employed People With Narcolepsy, Chantelle L. Jones

Walden Dissertations and Doctoral Studies

Many companies have used perceptions of their employees to understand how sleep disorders affect their working environment. Sleep disorders have had an undesirable effect on employee performance and often result in employee modifications to accommodate their condition in the workplace. Though information is available concerning employees' experiences pertinent to working with sleep disorders, research focusing on how employees with narcolepsy perceive their work environment appears to be missing from the literature. The purpose of this study was to gain understanding of perceptions of employees with narcolepsy about their work environment and strategies that may influence others to promote positive health …

Bone Health Education For Osteoporosis Risk Reduction In Premenopausal Women: A Quality Improvement Project, Gloria Nichols Nichols

Walden Dissertations and Doctoral Studies

In the United States, about 8.5 million women live with osteoporosis. Osteoporosis is a debilitating systemic skeletal disorder characterized by low bone mass and reduced bone mineral density that occurs with the loss of estrogen. The mortality rate for this group is about 3 to 4 times higher than other women and as many as 1 in 3 experience a fracture. Guided by the Health Belief Model, this project evaluated how a bone health fact sheet impacts knowledge about osteoporosis and self-efficacy for preventative behavioral change in premenopausal women (age 40-58 years). The project also evaluated if an electronic medical …

Patient Safety: Improving Medication Reconciliation Accuracy For Long-Term Care Residents, Annisa Leachman Stover

Walden Dissertations and Doctoral Studies

Patient Safety: Improving Medication Reconciliation Accuracy

for Long-Term Care Residents

by

Annisa L. Stover

MSN, Southern University, 2008

BSN, Our Lady of the Lake College, 2005

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2016

During transition of care, inaccurate medication reconciliation is associated with increased risk of adverse events for patients. Older adults are the population most often affected by medication errors, and long-term care facilities struggle to accurately document medication reconciliation. Errors are more common at hospital discharge, but the critical moment for detecting and resolving them …

Electronic Learning Management System Integration Impact On Tertiary Care Hospital Learners' Educational Performance, Ahmad Tassi

Walden Dissertations and Doctoral Studies

Technological innovations have been shown to improve the quality of health information and improve safety in health care systems. The purpose of this project was to offer hospital nurses a more flexible and practical alternative to education and training than the traditional face-to-face method, supporting nurse educators in overcoming many of the obstacles in responding to nurses' needs in the clinical areas. This project used a randomized, 2-group posttest-only experimental design to measure the effect of treatment at a targeted hospital. The experimental group received a new instructional approach using an Electronic Learning Management System (ELMS) and the control group …