Medicine and Health Sciences Commons^™

Assessment Of Detroit Hospital Preparedness For Response To An Improvised Nuclear Attack, Sharri Suesette Andersen

Walden Dissertations and Doctoral Studies

An improvised nuclear device (IND) is considered by the DHS to be the most catastrophic terrorist incident that could befall the United States, causing severe economic damage, extensive property damage, and enormous loss of life. Effective response to an IND is best accomplished with preparation including emergency operations plans (EOP) specific to an IND and training for staff on how to respond. The literature documents several areas of weakness in U.S. health services' preparation that affects entire communities and puts lives at risk. The purpose of this study was to assess the strengths, weaknesses, and gaps in Detroit, Michigan hospitals' …

Time To Diagnosis Of Second Primary Cancers Among Patients With Breast Cancer, Edward Okezie Irobi

Walden Dissertations and Doctoral Studies

Many breast cancer diagnoses and second cancers are associated with BRCA gene mutations. Early detection of cancer is necessary to improve health outcomes, particularly with second cancers. Little is known about the influence of risk factors on time to diagnosis of second primary cancers after diagnosis with BRCA-related breast cancer. The purpose of this cohort study was to examine the risk of diagnosis of second primary cancers among women diagnosed with breast cancer after adjusting for BRCA status, age, and ethnicity. The study was guided by the empirical evidence supporting the mechanism of action in the mutation of BRCA leading …

Generic Drugs : Physician Prescribing Practices For Brand Name And Generic Medications, Tamuno Raymond George

Walden Dissertations and Doctoral Studies

Brand-name drug costs continue to create a burden for many US seniors who receive care from healthcare institutions. Generic medication is as therapeutic as is brand-name drugs and, in most cases, costs far less. Despite this cost difference, physicians continue to prescribe brand-name drugs. The purpose of this cross-sectional study was to explore physicians' patterns of prescribing brand-name drugs over generic drugs. This study was guided by the medical home model, which was developed in 1967 by the American Academy of Pediatrics. The study incorporated a purposeful sampling approach with a sample size of 151 physicians. Multiple linear regression was …

Clergy Characteristics As Predictors Of Mental Health Literacy, Jodi Vermaas Vermaas

Walden Dissertations and Doctoral Studies

The mental health literacy (MHL) rates of Christian clergy in the United States remains underinvestigated in the current literature. This gap of knowledge is problematic for the large numbers of individuals with mental illness who seek assistance from clergy and may receive inadequate care for their concerns. As theoretically designated by the behavioral models of health care and MHL research, denomination-type, educational variables, and demographic characteristics were investigated as potential predictors of MHL. A sample of 238 Christian clergy from throughout the United States completed the web-based Mental Health Literacy Scale and demographic questionnaire. Results of analysis of variance (ANOVA) …

Perceived Barriers To Oral Health Care Access For Massachusetts' Underserved Parents, Doudelyne Cenafils-Brutus

Walden Dissertations and Doctoral Studies

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data …

Promoting Shared Decision Making Through Patient Education Of Labor Inductions, Lenora W.Y. Low

Walden Dissertations and Doctoral Studies

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and …

Knowledge, Attitudes, And Beliefs About Preconception Care Among American Adolescent Females, Lynette Collins Collins

Walden Dissertations and Doctoral Studies

Despite an initiative to provide preconception care (PCC) and reproductive life planning (RLP) for all women of childbearing age, many women, especially those with low incomes, are not receiving it. As a result, there continues to be a high rate of infant morbidity and mortality in this population. Furthermore, low income adolescent females have not been adequately studied regarding this phenomenon. The purpose of this phenomenological study was to explore low income adolescent females' knowledge, attitudes, and beliefs about PCC and RLP in order to serve them more effectively. Five low income adolescent females, aged 18 to 21, were recruited …

Delaying First Pregnancies: Canadian Women's Knowledge And Perception Of The Consequences, Deborah Haynes

Walden Dissertations and Doctoral Studies

Many women aged 20-30 are postponing their first pregnancies until their mid 30s and beyond, which has resulted in compressed childbearing years and/or infertility. Little is known about the knowledge and understanding that Canadian women of advanced age (age 35-45) possess of their reproductive capacity. This phenomenological study sought to explore these women's knowledge and perception of their reproductive capacity in relation to the timing of first pregnancy. Research questions using the constructs of Ajzen's theory of planned behavior were developed to explore how the behavioral, normative, and control beliefs of women's childbearing behaviors were based on their perceptions of …

Disparities In Arkansas Mandated Immunization Coverage Among Natural Home And Foster-Care Adolescents, Jerome Essono Ngundue

Walden Dissertations and Doctoral Studies

Anecdotal evidence indicated vaccine coverage disparities among foster-care (FCA) and natural-home adolescents (NHA). Arkansas laws require 5 vaccines for school entry (FVSE) to prevent 9 common childhood diseases. The study problem was that Pulaski County, Arkansas adolescent birth cohort (PCABC) immunization rates were low compared to U.S. adolescents for these FVSE. This study examined the extent to which (1) PCABC immunization rates were significantly different from those estimated for U.S. adolescents in 2006–2008, (2) NHA and FCA immunization rates were different in 2003– 2008; (3) sociodemographic variables mediate associations between home of residence (HOR), NHA or FCA, and up to …

The Effect Of Federal Reporting Regulations On Hospital Investment In Community Building, Dorothy Magasis Escobar

Walden Dissertations and Doctoral Studies

The role of hospitals as partners in community health improvement is changing, especially for nonprofit hospitals receiving tax exemptions in exchange for providing benefits to the community. There are examples of reported health improvement activities funded through hospitals' charitable donations, but there's a gap in the literature on the effect of policy and legislation on hospitals' investments in community building activities that address the social determinants of health. Grounded in eco-social theory, this quantitative, correlational study compared secondary data from CA's nonprofit hospitals' annual 2009 and 2012 reports to determine what, if any, changes have occurred in the hospitals' investments …

Improving The Completion Rate Of Advance Directives In Home Health Agencies, Ndidiamaka Ezinne Mbakpuo

Walden Dissertations and Doctoral Studies

The number of individuals aged more than 65 years in the United States and their life expectancy has been increasing in the past decades. In spite of the presence of federal and accreditation policies recommending completion of advance directive documents by patients admitted to health care settings, advance directive completion rates are low in most health care organizations. The purpose of this study was to determine the level of advance directive completion among home health patients. The health belief model provided the theoretical framework that guided this study. A retrospective chart review was carried out in a home health agency …

Risk Factors For Hypertension Among African-Born Immigrants In The United States, John Ojih

Walden Dissertations and Doctoral Studies

Essential hypertension (HTN) has been and continues to be a serious public health problem across the globe, particularly among Black races, with an estimated morbidity rate of over 1 billion people and an estimated mortality rate of 9.4 million people worldwide. Essential HTN can lead to a host of chronic diseases including cardiovascular disease (CVD), stroke, myocardial infarction, brain damage, kidney failure, and retinopathy. The main purpose of this quantitative, descriptive, nonexperimental study was to investigate the association of physical inactivity, length of stay in the United States, immigrants' health status, and food security as risk indicators in the development …

Alignment Of Standards, Assessment, And Compliance For A Residential Support Provider Organization, Monique Day

Walden Dissertations and Doctoral Studies

Although Code of Maryland policy mandates multidisciplinary, integrated teams for residential service provider organizations (RPOs) for an intellectual/developmental disabilities (IDD) population, alignment criteria to identify and evaluate the functional characteristics of such teams do not exist. This ambiguity has resulted in potential conflict in the goals of service delivery, as well as misaligned quality assessment and policy development criteria. The intent of this general qualitative study was to use complex adaptive systems theory and Vitkiene's work on corporate ethos to determine whether the services provided by a single RPO were consistent and aligned with the regulatory mandate set by the …

Perceived Effects Of The Affordable Care Act On Emergency Preparedness, Tanya Marie Scherr

Walden Dissertations and Doctoral Studies

National healthcare as executed through the Patient Protection and Affordable Care Act (ACA) was introduced in 2010, but was discussed for several decades prior to its enactment. Section 5210 of the ACA established funding for a Regular and Ready Reserve Corps (RRRC) to provide support to local healthcare entities with emergency preparedness. It is unknown what impact Section 5210 of the ACA has had on local emergency preparedness, as well as what obstacles are encountered with implementing this piece of legislation at the local level. The purpose of this case study was to understand the obstacles encountered at a local …

Rural Obese African American Women And Depression, Food Culture, And Binge Eating, Tracee Tamiko Smith

Walden Dissertations and Doctoral Studies

The rural African American population has a high incidence of severe psychosocial problems and a skewed perception of obesity, despite obesity's extremely high prevalence rate in this population. Despite the acknowledgements of these problems, there is a gap in literature relative to the effective treatments for obese African Americans diagnosed with depression. This study measured correlations between obesity and depression, binge eating, and food culture amongst African American women residing in Jefferson County, MS. The health belief model was used to guide an assessment of beliefs, perceptions, susceptibility, cues to action, and self-efficacy. A cross-sectional design was used based on …

Strategies To Retain Employees In Clinical Laboratories, Amber Rose Phipps

Walden Dissertations and Doctoral Studies

With 30 million citizens gaining access to U.S. healthcare through the Affordable Care Act by 2016, healthcare managers need preanalytic employees to ensure quality healthcare services can be provided. The purpose of this qualitative single case study explored strategies used to retain preanalytic employees. The target population consisted of 10 clinical laboratory managers in a single community-based clinical laboratory in the mid-southern United States, selected because of prior success in improved employee retention strategies. The conceptual framework grounding this study was the theory of work adjustment. Data triangulation occurred from using semistructured interviews and company documents. All interpretations from the …

Exploring Obesity Risk Factors In Five Regions Of Virginia, Karen Toth Carpenter

Walden Dissertations and Doctoral Studies

Obesity continues to weaken our nation physiologically, psychologically and financially with an overall prevalence rate of 34.9% or 78.6 million Americans affected. Variance in obesity prevalence rates, in the state of Virginia, account for over a 15% difference from one health district to the next. The purpose of this research was to better explore the regional obesogenic factors that may exist among five health districts in the state of Virginia. The socio ecological theory provides the conceptual framework of the study to understand the variance in regional obesity rates, as a function of the contributing risk factors that a region …

Development Of A Mentorship Program To Help Support And Retain New Nurses, Sherrie Marie Jones

Walden Dissertations and Doctoral Studies

Many newly graduated registered nurses (NGRNs) leave the nursing profession within the first 2 years of employment in a rural hospital located in the Southwestern region of Oklahoma. A strategy to address this problem was to introduce a mentorship process that would help support the NGRNs as they transition into independent practice in the clinical setting. The goal of this project was to develop a mentorship program for future implementation. The Partners In Nursing (PIN) program sponsored by the Robert Wood Johnson Foundation, and developed by the American Association of Colleges of Nursing and the American Nurses Association, was selected …

A Nurse's Perception Of Hand-Off Communication Before And After Utilization Of The I-5 Verification Of Information Tool, Maryann Bowersox

Walden Dissertations and Doctoral Studies

Abstract

Miscommunication or omission of critical patient information contributes to preventable

medical errors that result in 98,000 patient deaths each year. The hand-off

communication process creates a critical time for the patient as necessary information for

the continuity of care must be communicated. The purpose of this practice project was to

evaluate the nurses' perception of the current hand-off communication process before and

after an educational intervention and implementation of the I-5 Verification of

Information Tool. Registered nurses were asked to complete a pre survey of their

perception of the current hand-off communication process, followed by an educational

power point …

Videotaped Role-Play Simulation In Teaching Transcultural Self-Efficacy To Interprofessional Healthcare Students, Holldrid Aner Odreman

Walden Dissertations and Doctoral Studies

Increased demand for culturally sensitive healthcare services suggests that interprofessional beginning healthcare students need to gain the necessary cultural competency skills to be successful in delivering positive health outcomes for diverse patients. Bandura's theory of observational learning, Mezirow's theory of transformative learning, and Purnell's and Paulanka's model of cultural competence informed the framework for this research. The purpose of this quasi-experimental quantitative study was to determine the relationship between mode of instruction (observing role models in videotaped role-play simulation) and increased transcultural self-efficacy in cultural competence instruction. A convenience sample of 196 students enrolled in an interprofessional education (IPE) course …

Supervisory Working Alliance And Job Satisfaction In Community Mental Health Settings, Jennifer Weigelt

Walden Dissertations and Doctoral Studies

Researchers have written extensively on many facets of supervision in the counseling profession, including the supervisee benefits associated with a strong supervisory working alliance. While the majority of studies have focused on the working alliance in academic settings with student trainees, there has been a lack of research exploring the role of the supervisory working alliance in workplace settings, where supervision can be different from supervision offered in a university clinic or counseling center. Employee job dissatisfaction has been a problem identified within the mental health workforce. Researchers have identified effective supervision as a mediating factor. The purpose of this …

Adult Learning-Focused Professional Development For Dental Hygiene Clinical Instructors, Meghan Ann Mcguinness

Walden Dissertations and Doctoral Studies

At a dental hygiene program within a community college in New York State, clinical instructors are hired based on their expertise as practitioners. Most clinical instructors lack a background in adult learning theory and practice, which is an issue because their students are adult learners whose average age is 26. The instructors' lack of knowledge in this area challenges their effectiveness. The purpose of this qualitative case study was to explore dental hygiene instructors' views about what kind of professional development offerings related to adult learning might help improve their teaching effectiveness. The conceptual framework for this project study was …

Facilitators And Barriers To Physical Activity Among People With Spinal Cord Injury, Laura Nicole Richardson-Smith

Walden Dissertations and Doctoral Studies

Research has shown that people with physical disabilities are at risk for developing secondary health conditions. Many of these secondary health conditions may be reduced by engaging in physical activity, yet people with physical disabilities are less likely to participate in physical activity. Information gaps remain regarding facilitators and barriers to physical activity. The purpose of this phenomenological study was to understand the experiences with physical activity among adults with a spinal cord injury (SCI). Research questions asked were about exercise experiences, barriers and facilitators, and the role of the natural and social environment. The theoretical framework used was the …

Self-Efficacy And Select Characteristics In Nurses Who Respond To A Pediatric Emergency, Nancy Mcneill

Walden Dissertations and Doctoral Studies

Self-Efficacy and Select Characteristics in Nurses Who Respond to a Pediatric Emergency

by

Nancy McNeill

MA, New York University, 1996

BS, New York University, 1987

Doctoral Project Study Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Education

Walden University

June 2016

Nurses at a suburban northeastern U.S. community hospital reported that they felt unprepared to effectively respond to a pediatric emergency. Empirical data were not available to identify if this local problem was due to a lack of the nurses' self-confidence or if other factors were involved. The purpose of this study was to determine …

Evaluating The Role Of Nurses In Educating Women During The Preconception Period, Oluwatoyin Ottun

Walden Dissertations and Doctoral Studies

Nurses play a crucial role in promoting educational programs aimed at informing women about their reproductive health. However, the role of nurses in providing the health related information is not well defined. Guided by the continuum model, this project evaluated nurses' perceived role in promoting the reproductive health of women during the preconception period. Twenty nurses from 2 outpatient offices wrote responses to an open-ended questionnaire. A summary of the responses indicated that 70% of the participants refer women to community-based programs to enhance awareness for preconception care. Twenty percent of the nurses indicated that they have an educational program …

Transition To The Professional Role For Graduate Nurses In A Hospital Orientation Program, Shirley Denise Richardson

Walden Dissertations and Doctoral Studies

This study focused on the transitioning of graduate nurses (GNs) employed by a teaching hospital in the eastern United States to the professional role of registered nurse after a 6-week orientation was the focus of this study. Benner's novice-to-expert theory served as the framework for this qualitative case study. Twelve participants were chosen from 3 specific populations: GNs, nursing preceptors, and nurse managers. Three research questions asked about the perceptions of newly licensed nurses after completion of the orientation process related to their ability to make critical decisions in the professional role of RN, how the preceptor educational training program …

Equine Facilitated Psychotherapy For Veteran Survivors With Full Or Partial Ptsd, Mark Aaron Mayfield

Walden Dissertations and Doctoral Studies

Symptom severity among veteran survivors with partial or full posttraumatic stress disorder (PTSD) continues to increase, with approximately 40% of U.S. veterans reporting significant symptomology 10 years after initial onset of the condition. Veteran survivors often struggle to find therapeutic interventions that meet their specific needs and have a difficult time maintaining a therapy that is both equitable and evidenced based. Grounded in the Rogerian, client-centered theory, the purpose of this qualitative collective exploratory case study was to explore the effects of equine-facilitated psychotherapy with 3 veteran survivors with partial or full PTSD. A 4-stage process was used to collect …

Development Of A Patient And Family Educational Document Following Cancer Treatment, Debbie Slipkovich

Walden Dissertations and Doctoral Studies

New pharmacological interventions for oncology patients have resulted in longer lifespans after treatment completion and a large population of cancer survivors in communities. When patients complete treatment regimens for cancer, they leave the oncology practice with minimal knowledge of community resources that may assist them during this time of transition. These patients may not interact with care providers again until they return for a surveillance appointment in the future. Guided by Bandura's social cognitive theory, this project's aim was to develop a community-specific brochure that described the variety of services available to oncology patients and their families. The practice-focused question …

Increasing Seasonal Influenza Vaccine Rates In A Black Inner City Population, Barbara E. Beckford

Walden Dissertations and Doctoral Studies

The seasonal influenza (flu) vaccine has been shown to prevent flu outbreaks that can cause debilitating effects on the body and even death. Underserved members of Black communities are more likely to refuse the flu vaccine than are persons of other ethnicities. The purpose of the project was to determine from a needs assessment the reasons for flu vaccine refusal in the Black population of an inner city clinic in order to develop tailored communication and nursing actions that promote awareness of the flu vaccine's importance and safety. The health belief model constructs (perceived susceptibility, perceived severity, perceived benefits, and …

Using Nutrition And Fitness Awareness To Reduce Overweight And Obesity In Adolescents, Allissa.Johnson Johnson

Walden Dissertations and Doctoral Studies

In the United States, adolescent obesity rates continue to increase unabated, yet there is a paucity of programs to address these conditions for this population. The current study evaluated an after-school program in California high schools that uses a mentoring model with youth to promote regular exercise and healthy food choices. It is grounded in Social Cognitive Theory which focuses on both the impact of the environment on shaping behaviors and the ability of an individual to construct his or her own suitable environment. A quantitative single-group pretest-posttest design using archived participant responses was utilized in order to determine whether …