Medicine and Health Sciences Commons^™

Adult Attachment And Relationship Satisfaction Among Men Who Experienced Childhood Abuse, Selisha Nelson

Walden Dissertations and Doctoral Studies

Experiences of childhood physical and sexual abuse among men have not been sufficiently studied because many men are not forthcoming about experiences of abuse. This abuse is linked to aggressive behaviors, difficulty developing and maintaining close relationships, and various psychological disorders. Current research has not fully examined relationships between childhood abuse, adult attachment, and levels of relationship satisfaction among men. The purpose of this nonexperimental quantitative study was to evaluate the relationship between adult attachment as measured by the Relationship Scales Questionnaire and relationship satisfaction as measured by the Couples Satisfaction Index among men abused during childhood. Bowlby's theory of …

The Barriers Encountered In Telemedicine Implementation By Health Care Practitioners, Olantunji Obikunle

Walden Dissertations and Doctoral Studies

Patients in rural areas in the United States do not have adequate health care facilities for illnesses and injuries not serious enough for emergency care, but telemedicine could have a positive impact both economically and medically to control rapidly rising health care costs, which is a significant percentage of the gross national product. The purpose of this case study was to explore the barriers physicians encountered in telemedicine implementation. Participants included 4 physicians who took part in face-to-face interviews in a clinical setting in Ohio to explore strategies used in implementing telemedicine. The results of these interviews, coupled with observations …

Assessing Clinical Software User Needs For Improved Clinical Decision Support Tools, Kimberly B. Denney

Walden Dissertations and Doctoral Studies

Consolidating patient and clinical data to support better-informed clinical decisions remains a primary function of electronic health records (EHRs). In the United States, nearly 6 million patients receive care from an accountable care organization (ACO). Knowledge of clinical decision support (CDS) tool design for use by physicians participating in ACOs remains limited. The purpose of this quantitative study was to examine whether a significant correlation exists between characteristics of alert content and alert timing (the independent variables) and physician perceptions of improved ACO quality measure adherence during electronic ordering (the dependent variable). Sociotechnical theory supported the theoretical framework for this …

Analysis Of Telephonic Pharmacist Counseling, Katherine N. Swift

Walden Dissertations and Doctoral Studies

Medication complexity and nonadherence are significant risk factors for avoidable hospitalizations and health care spending for older adults in the United States. However, limited empirical research has investigated pharmacist-run telephonic medication management programs as a potential solution to the problem of reducing medication complexity while improving medication adherence. This quantitative study employed the behavioral change model to analyze archival data from a sample of 1,148 participants, examining the relationship of a pharmacist-run telephonic consulting program on medication adherence and medication complexity for one pharmacy benefit management firm's Medicare Part D recipients. The primary research questions investigated the relationship of medication …

A Proposal For The Development Of An Exercise Program To Treat Post Thrombotic Syndrome, Christy Jean Hansen

Walden Dissertations and Doctoral Studies

Healthcare costs continue to escalate and hospitals need to use programs that encourage cost effectiveness, reduce resources and staffing, and increase patient accountability for their own healthcare risk factors, comorbidities, and participation in their healthcare decisions. Post Thrombotic Syndrome (PTS) is a debilitating disease with few treatment options. Allowing patients to have shared decision making in a care plan for this disease process that involves an exercise program may be a significant factor in the success or failure of their own healthcare goals and outcomes. The development of a proposal for an exercise program for PTS should provide patients with …

The Association Between Core Science Course Timing And Completion Of An Associate Degree Nursing Program, Patricia Ann Pfeiffer

Walden Dissertations and Doctoral Studies

The aging population in the United States has led to an increased demand for registered nurses. Nursing program administrators must examine ways to increase nursing program completion, which will increase the supply registered nurses. The purpose of this study was to determine the associations among length of time between core science course completion and nursing program admission, on-time completion, and National Council Licensure Examination for Registered Nurses (NCLEX-RN) success for students at a southeastern community college. A convenience sample of 288 community students admitted to an associate degree level nursing (ADN) program between 2007 and 2012 was selected. The guiding …

School Violence And Teacher Resiliency At A Midwest Elementary/Middle School, Jounice Blackmon Wright

Walden Dissertations and Doctoral Studies

The purpose of this phenomenological study was to investigate, from the perspective of teachers, the possible effect of school violence on teacher resiliency. School violence has been studied with respect to student behavior and academic success, as well as socioeconomic influences, but not with respect to teacher resiliency, as expressed by teachers themselves. Resiliency theory was the conceptual framework. Participants were all teachers of Grades 2-8 at an elementary/middle school in the Midwest. Twelve in-depth interviews were transcribed into text data and analyzed for common themes. Using NVivo, Version 10, I was able to more easily manage the volumes of …

Reducing Emergency Department Length Of Stay By System Change, Brian Dale Haybarker

Walden Dissertations and Doctoral Studies

Emergency departments (ED) are exceeding the Centers for Medicare and Medicaid Services and The Joint Commission's recommended 4-hour door-to-admission and 2-hour door-to-discharge for patients. The purpose of this project was to look for factors that decrease door-to-admission and door-to-discharge times and offer recommendations to the Patient Flow Committee (PFC) at the health care facility that may reduce overcrowding, diversion, and patient boarding. The 7-step Iowa model of evidence-based practice (EBP) was used to concentrate on problem-focused triggers that initiate the need for change. The project focused on decreasing door-to-admission and door-to discharge times: by opening an observation unit run by …

Media Literacy Education Exposure Related To Self-Esteem, Body Esteem, And Sociocultural Ideals In College Students And Graduates, Tammy Stargardt

Walden Dissertations and Doctoral Studies

The prevalence of eating disorders (ED) in the United States has increased while the media consistently presents thinner representations of the body. Scholars have found media to negatively influence factors associated with the development of EDs. The purpose of this quantitative nonexperimental cross-sectional survey design study was to explore relationships between exposure levels to MLE and self-esteem, body esteem, and the internalization societal appearance ideals. Participants included undergraduate students or recent graduates majoring in either communications or an alternative major with comparatively less MLE curriculum. The Body Esteem Scale, Sociocultural Attitudes towards Appearance Questionnaire-3, and Rosenberg Self-Esteem Scale Surveys were …

Fukushima Nuclear Disaster Response Impact On Graduate Students, Sean Eric Kil Patrick Gay

Walden Dissertations and Doctoral Studies

The roles that universities played in the response to the Fukushima nuclear disaster were significant and varied; however, there was limited study on participating graduate students. The purpose of this study was to understand the impact of disaster response on graduate students' personal and academic development. This study examined research questions about the perceived impact on academic and personal identity development. Empowerment, cognitive content engagement, general systems theory, and utilitarianism formed the theoretical foundation. This study used a transcendental phenomenological approach to examine the subjects' experiences in the context of involvement in disaster response. The primary source of data was …

Assessing Spirituality Among Hospice Patients: A Phenomenological Study Of Hospice Nurses, Isabel Esther Kaufman

Walden Dissertations and Doctoral Studies

The shift in health care and nursing philosophy and practice from a holistic approach to a highly technological, cure-oriented approach has been attributed to effective pharmaceuticals made to prolong life. Recently medical professionals have shifted their focus to a combination of spiritual healing and medicine. Hospice care in particular have taken a key interest in integrating spirituality within their health care. The problem is that due to the complications in defining spirituality and appropriate training and education of spirituality within nursing curriculum, assessing patients' spiritual distress may be difficult for many hospice nurses which may be at a loss when …

Fall Prevention Quality Initiative: Implementation Of A Unit Safety Champion (Usc), Susan Lynn Rednak

Walden Dissertations and Doctoral Studies

The literature supports that a Unit Safety Champion (USC) may reduce falls among hospitalized patients. The purpose of this project was to determine if the implementation of a USC would assist in reducing falls on an acute unit in an urban hospital environment. The frequency of patient falls on the unit was collected from the hospital's quality department 3 months before and 3 months after the implementation of the USC. The average number of falls for 3 months before implementation was 5.0 per month (SD = 2.65) and involved a total of 15 individual patients. The average number of falls …

Evidence-Based Mentorship Program: Overview, Review Of Evidence, And Approach, Elizabeth Villanueva

Walden Dissertations and Doctoral Studies

Nurses comprise the largest segment of the healthcare workforce. Adequate numbers of

nurses help to ensure sufficient and safe nursing care in all settings. The current nursing shortage poses a barrier to optimum nursing care, and the nature of recruitment and retention of nurses has generated research interest because of its association with the labor shortage. The purpose of the project was to develop a nurse mentorship program for possible adoption by a northern state correctional facility. Goals are to aid recruitment and improve retention of nurses in the facility. This quality improvement project was informed by Jean Watson's theory …

The Correlation Among Personality Characteristics, Stress, And Coping Of Caregivers Of Individuals With Intellectual And Developmental Disabilities, Natasha O'Connor

Walden Dissertations and Doctoral Studies

There is little research on the coping strategies of direct support professional caregivers working with the intellectually disabled (ID) and developmentally disabled (DD). The study was guided by Lazarus and Folkman's (1984) theory of the transactional model of stress and coping. The purpose of this study was to assess whether there is a correlation among the independent variables of coping and personality characteristics with stress as the dependent variable. A convenience sample of 69 professional caregivers was used. Data were collected using the Ways of Coping Questionnaire, Perceived Stress Scale, NEO-FFI-3, and a demographic questionnaire. A correlational analysis was conducted …

The Influence Of On-Site Surgical Pathology Services In Rural Hospitals On Physician Satisfaction, Belinda D. Presley

Walden Dissertations and Doctoral Studies

Abstract

There is limited information regarding physician satisfaction as it relates to the presence of a surgical pathology department in rural hospitals. Physician satisfaction directly influences the quality of patient care. The theoretical frameworks that informed this study included institutional theory and population ecology. The research questions addressed differences in levels of physician satisfaction between physicians who have access to an on-site surgical pathology department and physicians who do not have such access. The research also examined differences in satisfaction between physician specialties that have or do not have access to an on-site surgical pathology department services. A quantitative, cross-sectional …

Relationships Between A Prenatal Nutrition Education Intervention And Maternal Nutrition In Ethiopia, Divya Lakshmi Selvakumar

Walden Dissertations and Doctoral Studies

In Ethiopia, 17% of pregnant women ages 18-49 are malnourished and have low awareness of prenatal nutrition, which may relate to increasingly high rates of maternal and infant mortality. The purpose of this mixed methods research study was to determine the effects of a community-based prenatal nutrition education intervention program on maternal nutrition knowledge and attitudes in the Alaje district of Ethiopia. The theoretical framework was Sen's capability theory of poverty, in which opportunities can lead to well-being and promote economic development. Research questions focused on the relationships among 8 independent variables-age, income source, degree of program implementation, marital status, …

Traumatic Facet Joint Dislocations In Western Australia, Vivek Eranki

Theses

Background: Early enlocation of dislocated cervical facets is important to minimize long term neurological deficit.

Aims: To assess impact of delay in enlocation on clinical outcome in patients with facet dislocations and propose a scheme for enlocation for rural patients who usually have longer enlocation times.

Methods: A retrospective analysis of consecutive cervical spine facet joint dislocations presenting to Royal Perth Hospital from January 2009 to November 2012 was carried out to assess factors affecting final neurological outcome (ASIA score) at discharge.

Results: A total of 51 patients were included in the study. More patients in the urban group had …

Evaluation Of Chlorhexidine Bathing Practices In Trauma/ Surgical Intensive Care Units, Kara Willett

DNP Projects

Central venous catheters (CVC) are vital in present-day medical practice, particularly in the intensive care unit (ICU). However, their use puts patients at risk for developing central line-associated bloodstream infections (CLABSIs) which are a major concern in today’s health care system. CLABSIs are a significant source of patient mortality, increased length of stay, and healthcare spending. The heightened awareness of these infections along with their escalating cost has amplified implementation of preventative protocols.This practice inquiry project includes three manuscripts, each of which discusses relevant aspects of CLABSIs prevention utilizing daily whole body chlorhexidine gluconate bathing inlcuding a review of literautre …

Treatment Outcomes For Opiate Addicted Pregnant Women, Jennifer L. Roth Parr

DNP Projects

The problem of opiate addiction is complex enough but compounded when the patient is pregnant. Substance use during pregnancy produces harmful and costly effects to both the mother and the fetus (Veilleux, Colvin, Anderson, York & Hines, 2010). The rate of opiate addiction among pregnant women in the U.S. has been increasing in epidemic numbers since the beginning of the 21st century. This paper looks at research on the origin of the problem, the demographics of the average pregnant opiate addicted patient, the effects on the woman and her unborn child, and available treatment options.

Self-Management Education In Hispanic Women With Gestational Diabetes Mellitus (Gdm), Laura B. Hieronymus

DNP Projects

The purpose of this Practice Inquiry Project was to develop, implement, and evaluate the effectiveness of a diabetes self-management education intervention in a population of Hispanic women at risk for gestational diabetes mellitus within a CenteringPregnancy(R) model of care.

Measuring Adherence To Evidence-Based Practice Guidelines For The Management Of Hypertension In Women, Cristina M. Jorgensen

DNP Projects

Approximately 1 in 3 adults In the United States (U. S.) with approximately half being women have hypertension, a significant risk factor for cardiovascular disease (CVD) and stroke (Nwankwo, Yoon, Burt, & Gu, 2013). Nearly 70% of people who had a first heart attack, 80% of those who had a first stroke, and 75% of those who had congestive heart failure (CHF) have hypertension (Mozaffarian et al., 2013). Hypertension was the underlying or contributing cause of more than 375,000 deaths in 2011. Despite multiple publications of national hypertension guidelines, only 50% of adults with hypertension have their blood pressure under …

Prenatal Anxiety And Cesarean Delivery In A Clinic Population, Carol A. Kirby

DNP Projects

Although there is an abundance of literature on the topics of prenatal anxiety, stress, depression, etc. during pregnancy, very little research has been conducted on the impact of prenatal anxiety on cesarean delivery and the studies which have been conducted have resulted in conflicting results. This study focused on prenatal anxiety in a clinical population, the characteristics of participants with reported high anxiety, and its association with cesarean deliveries. Prenatal anxiety was defined as Spielberger’s state anxiety and measured with the STAI. Data was collected over all three trimesters of pregnancy and post-delivery. The characteristics of participants who reported high …

Primary Care Providers’ Knowledge And Experience With Pediatric Acute Watery Diarrhea And Hemolytic Uremic Syndrome, Krista Marie Cassel

DNP Projects

The purpose of this capstone is to investigate the potential for hemolytic uremic syndrome (HUS) risk reduction in children through the evaluation of current evidence as well as pediatric primary care providers' knowledge and experience with children at risk for HUS. The goals of this capstone are to 1) evaluate the current literature to determine best practice for prevention of HUS, 2) assess primary care provider knowledge of HUS and experience with children with acute watery, and 3) develop a guideline for the initial management and referral of these children at risk for HUS.

Assessment Of Patient Barriers To And Facilitators Of Screening Colonoscopy: Utilizing Patient Perspectives To Formulate Recommendations To Improve Colorectal Cancer Screening Rates, Heather N. Cox

DNP Projects

A pilot study was conducted that utilized focused patient interviews to determine patient barriers to and facilitators of screening colonoscopy. The interviews were transcribed and systematically analyzed to detect recurring patterns and themes related to screening colonoscopy completion or lack thereof. Descriptive statistics were used to summarize additional sample characteristics such as gender, education level, and income level. Among those who had received a screening colonoscopy (44%, 11 of 25), provider recommendation was the most influential factor for procedure completion, followed by the combination of provider plus family member recommendation. Additional findings revealed that due to medical necessity, several patients …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Assessment Of Organizational Readiness: Parent Advisory Councils In A Children's Hospital Within A Hospital, Suzanne R. Springate

DNP Projects

Background: A children’s hospital within a hospital (CHWH) in the Midwest region of the United States established a strategic goal to become the preferred provider for children in the region. Outcomes in patient and family experience had fallen short of established organizational expectations. Recognizing that parent advisors are an essential component of patient and family centered care, the strategic plan called for integrating parents into formal, advisory roles.

Purpose: The purpose of this practice improvement project was to perform an assessment of organizational readiness to incorporate parents into formal advisory roles at this CHWH.

Methods: A cross-sectional survey design was …

Examining The Effectiveness Of An Intervention To Increase Provider Assessment Of Overweight And Obesity In The Primary Care Setting, Kristena R. Lea

DNP Projects

Obesity is an epidemic among adults in the United States, leading to a multitude of co-morbidities and billions of dollars in annual healthcare expenditures. Although primary care is the ideal setting for identification and treatment of overweight/obesity, it is often overlooked by providers. This capstone project was formed by three manuscripts, which were written to explore the lack of overweight/obesity identification and treatment in the primary care setting. Emphasis was made throughout the three manuscripts on the importance of providers using body mass index (BMI) as an objective means to discuss overweight/obesity with patients. The first manuscript is an integrative …

Implementing A Hospital-Acquired Pressure Ulcer Prevention Program, Maryann L. Lancaster

DNP Projects

Objective: To implement a Hospital-Acquired Pressure Ulcers (HAPU) prevention program utilizing an assessment tool to identify patients at risk, and intervene with a sacral Mepilex® dressing. Our aims are to determine if a change in nursing knowledge and change in nursing behavior after implementing our program.

Background: HAPUs are a significant problem in patient care and healthcare organizations must implement prevention protocols to reduce HAPU prevalence. Guidelines for implementing HAPU prevention programs suggest use of a validate risk assessment tool and initiating preventive interventions. One intervention found in the literature is the adjunctive use of prophylactic Mepilex® dressings to sacral …

Dnp Practice Inquiry Project Report: Depression Screening In Primary Care, Mary Kathleen Stafford

DNP Projects

Depression affects many people worldwide and is a leading cause of disability. National guidelines and recommendations have been created that support screening for depression in the primary care setting, however due to many barriers depression screening is often not performed or documented. This capstone project consists of three manuscripts, which evaluate the lack of depression screening in the primary care setting. The first manuscript is an integrative review of the literature to support depression screening in primary care and to address barriers to depression screening. The second manuscript is a guideline analysis of a national guideline published by the Institute …

Measuring Providers’ Adherence To The American Diabetes Association Screening Recommendation For Prevention Of Diabetic Nephropathy, Whitney R. Munroe

DNP Projects

Purpose: The purpose of this study was to evaluate provider adherence to the ADA’s recommendation for an annual screening urinary albumin excretion level to check for the presence of microalbuminuria. A secondary objective was to assess for adequate treatment (i.e. ACE inhibitor or ARB prescription) in those patients with microalbuminuria present.

Methods: A retrospective chart review was conducted on 60 randomly selected patients seen within a primary care practice in an urban university setting between January 1^st, 2014 and December 31^st, 2014. Inclusion criteria included age ≥ 18 years and an active diagnosis of type 2 …