Medicine and Health Sciences Commons^™

Exploring Recruiting Challenges Of The Insurance Industry, Hema Chaurasia

Walden Dissertations and Doctoral Studies

Insurance companies provide financial protection to the general population, but their workforce challenges may destabilize the companies to the point of financial distress. Senior insurance company leaders lack effective strategies to recruit skilled professionals. With contingency theory and resource-based view theory as the framework, the focus in this multicase study was the exploration of the recruiting strategies of human resources (HR) managers in New York City area insurance companies. Four insurance company HR managers were recruited via a purposeful and snowball sampling method for semistructured interviews. These interviews were analyzed through a reflective interpretation process, which was guided by the …

Diabetes Self-Management Education Program, Lesa Faye Williams

Walden Dissertations and Doctoral Studies

Diabetes is a devastating disease in American. The disease can cause chronic health comorbidities, and untreated diabetes has negative consequences for individuals and on our nation's economy. Newly diagnosed diabetics often have a lack of knowledge about the disease process. The purpose of this project was to design and implement a diabetes educational program to enhance participants' knowledge about diabetes management and self-care using the Health Belief Model. Diabetes Self-Management Education (DSME) is critical in improving patient outcomes and the prevention of diabetes related complications. Participation in a standardized diabetic educational intervention will improve patient knowledge, as measured by a …

Using Appreciative Inquiry To Improve Rn Retention In A Clinical Float Pool, Janet Buck

Walden Dissertations and Doctoral Studies

In an Idaho-based hospital, the registered nurse (RN) turnover rate in the float pool was excessively high. The purpose of this project was to examine the effect of Appreciative Inquiry (AI) on a RN's sense of community (SOC) in a float pool and an RN's intent to stay employed after attending an AI event. Although much had been written about nursing retention, AI, and SOC separately, there was nothing on how AI could be used to increase a RN's SOC or intent to stay employed. AI is a change management framework that has been used to engage employees in a …

Diabetes Education Tailored Towards English Speaking Caribbean Immigrants, Joanna A. Dunk

Walden Dissertations and Doctoral Studies

The prevalence of diabetes is increasing among persons of Caribbean ancestry in the United States, yet there is little research on the differences in the health and nutrition patterns of diabetics from this population. This study created a culturally-sensitive diabetes education program for the staff of an internal medicine practice that treated patients from the English-speaking Caribbean. The project was guided by the health belief model, as well as Leininger's theory of transcultural nursing. Methodology of project had a quality improvement focus. The comprehensive curriculum included diabetes medications, physical activity, culturally-tailored medical nutrition therapy, complications, self-care behavior, problem solving, and …

The Role Of Religious Vaccination Exemptions In The Ocean County, New Jersey Pertussis Outbreak, Siobhan Bridget Pappas

Walden Dissertations and Doctoral Studies

Pertussis, also known as whooping cough, is a vaccine-preventable disease that is on the rise in the United States, a trend which has been attributed to vaccination exemption. Indeed, the pertussis outbreak that occurred in February, 2012 in Ocean County, New Jersey was associated with vaccine exemption. Considering that pertussis is deadly to young children, it is important to understand why this disease rate is on the rise. The research questions were focused on whether a relationship existed between pertussis status (no, yes) and exemption status (no, yes), sex (male, female), and county type (Middlesex, Ocean, or Other), using a …

Faculty Perspectives On Factors Impacting Work As Nurse Educators, Sharon Shockness

Walden Dissertations and Doctoral Studies

Job dissatisfaction among nursing faculty could have a significant impact on nursing faculty retention and student enrollment in nursing programs. The purpose of this qualitative instrumental case study was to gain insight into the perspectives of faculty members who teach nursing education in a university program. This study used Herzberg, Mausner, and Snyderman's motivation-hygiene theory to explore employee satisfaction and dissatisfaction in the workplace. The research question focused on the perspectives of nursing educators and challenges they face. Data were collected through individualized interviews with 15 nurse educators, using open-ended questions and reviewing relevant documents. The data were analyzed by …

Use Of Traditional 3-Hour Lectures In Preparing Students For The Childbearing Clinical Setting, Teresa Pohle

Walden Dissertations and Doctoral Studies

Following completion of a 4-year nursing program, some graduates have difficulty applying theories learned in the classroom to the clinical environment. This difficulty results in healthcare employers providing additional in-house training to ensure graduates' ability to safely care for their patients. The purpose of this research was to explore how traditional lecture methods have prepared students for the clinical environment. Based on a constructivist theoretical framework, a case study design was used to examine students' learning of theories delivered by traditional lecture methods. The research questions focused on student activities in the classroom and clinical setting, teaching strategies, critical thinking …

Depression And Hiv Risk Among African American Men Who Have Sex With Men, Sonya Anyaka

Walden Dissertations and Doctoral Studies

African American men who have sex with men (AAMSM) are at a greater risk of contracting HIV than any other ethnic group, subpopulation, or race. Personal, environmental, and social variables can affect risk behavior. Driven by Beck's cognitive theory of depression, this quantitative study examined the relationship between depression and HIV risk behaviors in a sample of AAMSM (n = 108). Data was gathered via the Beck Depression Inventory and the HIV Risk Behavior Questionnaire. Simple and multiple linear regression analysis were conducted to analyze the data to determine the correlation between HIV risk behavior and depression. According to study …

Planning For A Community Supported Farmers Market In A Rural Usda Food Desert, Carrie Lynn Engelbright

Walden Dissertations and Doctoral Studies

A community initiative to develop and sustain a farmer's market can address insufficient access to fresh and affordable fruits and vegetables for individuals working and residing in a United States Department of Agriculture (USDA) designated food desert. This project addressed a particular USDA food desert in South Wood County, Wisconsin. The purpose of this project was to develop and plan for implementation and evaluation of a community-supported farmers market in South Wood County, with the goal to increase access to fruits and vegetables. Project objectives included development of a sustainable community infrastructure to support the market, development of policies and …

Silence Improves Anxiety Levels And Test Scores Among Children With Disabilities, Hanna Matatyaho

Walden Dissertations and Doctoral Studies

Students with disabilities may experience more anxiety when taking a test than do students without a disability. The purpose of this study was to assess whether a technique called 1-minute of silence reduces anxiety and improves test scores among students with disabilities. The theoretical framework for this study was the theory of planned behavior/reasoned action and the health belief model. Two research questions were used, one to determine the difference in anxiety levels in students with special needs and the other to determine the difference in New York State (NYS) Math posttest scores in children with special needs (no silence, …

Witnessing Parental Domestic Violence And Young Girls' Dating Relationships, Brinda Kay Mckinney

Walden Dissertations and Doctoral Studies

Domestic violence afflicts people regardless of ethnicity, socio-economically status, age, or gender. Too often, girls enter and remain in abusive relationships, despite the trauma and risks of doing so. Using Roy's theory of adaptation, this study explored the effect of witnessing inter-parental violence on girls' experiences of physical violence or sexual abuse in their dating relationships. Original data collection occurred at a Midwestern U.S. university via e-mail using questions adapted from the CDC's Youth Risk Behavior Survey Surveillance System. The study used 526 responses from female participants who self-disclosed if they had or had not witnessed inter-parental violence for categorical …

Health Care Administration Faculty Perceptions On Competency Education, Graduate Preparedness, And Employer Competency Expectations, Wittney A. Jones

Walden Dissertations and Doctoral Studies

Health care administration programs have transitioned to using the competency approach to better prepare graduates for workplace success. The responsibility of preparing graduates lies with the program faculty, yet little is known about faculty perceptions of the competency approach. The purpose of this cross-sectional study was to assess the perceptions of graduate-level health care administration faculty about the competency approach, the approach's effect on graduate preparedness, and employer expectations. Adult learning theory and the theory of self-efficacy were used as the theoretical foundations for the study. Faculty demographics related to personal information, workplace/teaching experience, and program information served as the …

Psychosocial Determinants Of Elective Cesarean Section Deliveries In Selected Obstetric Facilities In Nairobi, Kenya, Tom Joseph Oguta

Walden Dissertations and Doctoral Studies

Cesarean section (CS) rates have generally increased across the world in the past decade. Reducing elective cesarean section (ECS) rates is imperative as many countries aim to maintain threshold CS rates at or below 15%, the level recommended by the United States' National Institutes of Health. Women are believed to consider ECS for various interconnected psychosocial reasons, but few quantitative studies have investigated these factors. This prospective cohort study was based on the social ecological model (SEM) and the theory of planned behavior (TPB) models, and identified the psychosocial predictors of ECS among 1,268 expectant women in 2 hospitals in …

Herpes Virus Infections, Inflammatory Markers And Risk Of Developing T2dm And Cvd: An Analysis Of Nhanes With Adults, Aged 20-49, 1999-2010, Margarita Irizarry-De La Cruz

Walden Dissertations and Doctoral Studies

Herpes simplex viruses (HSVs), are among the most virulent and widespread pathogens; they affect 60-90% of the population worldwide. Substantial evidence indicates a possible association between pathogens and chronic disease. HSVs, among other viruses, have been associated with increased risk for inflammatory diseases. However, prior findings have been inconsistent on the role of infection in triggering autoimmune response and chronic disease. This study builds on the premise that pathogens can induce an inflammatory response and increase the risk for disease development. A representative U.S. sample from NHANES, a national population-based cross-sectional survey, was used to examine the relationship between HSVs …

Caregiver Status And Self-Reported Health Status Among African American, Phanta Soko Sackor

Walden Dissertations and Doctoral Studies

African American women (AAW) are at a high risk for type 2 diabetes, a debilitating and potentially fatal disease for which there is no cure. The purpose of this study was to extend the research of Mosca et al. (2012) by examining the relationship between caregiver status and self-reported health status for AAW 18 years or older diagnosed with type 2 diabetes. The chronic care model (CCM) provided the theoretical framework for this study. The CCM promoted routine care for patients with chronic illnesses to migrate from acute care to proactive, planned, and risk-based protocols. A binomial logistic regression investigated …

Disparities In Monoclonal Antibody Treatment Of Elderly Metastatic Colorectal Cancer Patients, Krista Marie Schroeder

Walden Dissertations and Doctoral Studies

Multiple research studies have demonstrated racial, socioeconomic status (SES), and neighborhood disparities in first-line treatment of colorectal cancer patients, including those with metastatic colorectal cancer. However, disparities in adjunct monoclonal antibody treatment disparities have not been explored. The purpose of this study was to assess racial, SES, and neighborhood disparities in adjunct monoclonal antibody treatment of elderly metastatic colorectal cancer patients. The research was rooted in 3 theories: the fundamental cause theory, the diffusion of innovations theory, and theory of health disparities and medical technology. Data from the SEER-Medicare database and logistic regression were used to assess the relationship between …

Evaluation Of A Mobile Health Intervention To Improve Anti-Retroviral Treatment Retention In South Africa, Ambereen Jaffer

Walden Dissertations and Doctoral Studies

South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates …

The Association Between Online Risk Behaviors And Real Life Sexual Behaviors Among African American Female Adolescents, Nicole Rankine

Walden Dissertations and Doctoral Studies

An increased exposure to the sexual content of traditional mass media (i.e., television, magazines, movies, music) affects real life sexual behaviors among adolescents. Engaging in online risk behaviors such as sharing/posting sexual content using social networking sites, cellphones, smartphones, IPads, or other new media devices has become common among adolescents. The purpose of this quantitative, correlation study, based upon the theory of reasoned action and three pre-existing national surveys, was to determine whether significant associations exist between attitudes, intentions, and behaviors related to online risk behaviors and real life sexual behaviors among African American female adolescents in Metro Atlanta. Data …

Emotional Labor And Employee Engagement Within A Pediatric Hospital, Michele Louise Mitchell

Walden Dissertations and Doctoral Studies

High levels of emotional work, staffing shortages, high turnover rates, low workforce engagement levels, and complex healthcare reforms are common problems in healthcare settings. Healthcare leaders are increasingly aware of the vital impact an engaged workforce can have on patient outcomes and an organization's ability to survive despite current challenges in the healthcare setting. It is important for leaders to understand what factors may influence the ability to engage with their organization, such as emotional labor. The purpose of this correlational quantitative study was to test whether emotional labor is related to employee engagement within a large Midwestern pediatric hospital. …

An Outcome Evaluation Of An Evidenced-Based Leadership Framework On Nursing Retention In A Tertiary Medical Center, Robbie Gail Robbie

Walden Dissertations and Doctoral Studies

An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 …

Effect Of Burnout And Organizational Commitment On The Turnover Intention Of Clinical Laboratory Employees In Florida, Tasia Lawnetta Hilton

Walden Dissertations and Doctoral Studies

The field of clinical laboratory science is experiencing a critical shortage of qualified professionals. Because health care practitioners depend on the results of laboratory tests to help diagnosis and treat patients, it is important to address the current and future shortage in the laboratory workforce. There is limited research on factors affecting the turnover intentions of clinical laboratory employees. Accordingly, the research questions for this study examined the effect of burnout (BO) and organizational commitment (OC) on the turnover intention of laboratory employees in Florida. A cross-sectional survey design was used to examine the relationship between BO and OC on …

Germline Mutations In Chek1 And Chek2 In Women With Ovarian, Peritoneal, Or Fallopian Tube Cancer, Maria Isabel Harrell

Walden Dissertations and Doctoral Studies

Ovarian cancer is the deadliest gynecological malignancy affecting women. Diagnosis often occurs late due to non-specific symptoms, but if detected early, there is excellent chance for survival. One of the most important risk factors is family history. Up to 24% of cases are due to inherited loss-of-function mutations in genes involved in the DNA damage response. The theory underlying hereditary cancers is Knudson's two-hit theory of cancer causation, where two hits are necessary for cancer to occur in an individual: one in the germline and one in the tissue. The genes, CHEK1 and CHEK2, are modulators of the DNA damage …

Development Of An Evidence-Based Influenza Vaccination Program For Nurses, Marlene Reid

Walden Dissertations and Doctoral Studies

The purpose of this educational influenza vaccination project was to increase nurses' influenza vaccination rates. Nationally, 41% of nurses were vaccinated, which is far below the Healthy People 2020 goal of an influenza vaccination rate of 90%. Literature suggests that the low nurses' vaccination rate is responsible for inpatient healthcare associated influenza, mortality, and influenza-like illness. Healthcare facilities will not be reimbursed for treatment of healthcare associated infection. Despite recommendations from the Centers for Disease Control and Prevention for nurses to become vaccinated, only 20% of the 800 nurses at a healthcare facility in Baltimore were vaccinated for the past …

Needs Assessment For A Nurse Practitioner-Led Transitional Care Program, Maria Victoria Trinidad Salcedo

Walden Dissertations and Doctoral Studies

The rising cost of health care and changes in healthcare delivery have prompted a need to improve continuity from the hospital to home. This scholarly project was initiated to assess the impact on patient outcomes related to initiation of a nurse practitioner-led transitional care program (TCP). Using the Diffusion of Innovations and Health Belief Models, the purpose of this study was to identify the impact of a TCP on improving the health of patients with congestive heart failure (CHF), diabetes mellitus Type II (DM II), and chronic obstructive pulmonary disorder (COPD). The impact of the TCP was evaluated by a …

The Effects Of Stress And Burden On Caregivers Of Individuals With A Chronic Illness, Betty Wilborn-Lee

Walden Dissertations and Doctoral Studies

Informal caregivers have played a significant social and economic role in the care and treatment of individuals diagnosed with chronic illness. However, caregiving can have harmful effects on a caregiver's physical, psychological, and emotional well-being. Using caregiver stress theory as the theoretical framework, the purpose of this archival research was to determine the predictive relationship of stress in relation to caregiver quality of life for 309 selected cases. Correlational and hierarchical multiple linear regression analyses were used to examine the relationship between the independent variables and the dependent variable. The independent variables examined were environment and context, stressors related to …

Completion Of Preventive Health Care Actions By Older Women With Hiv/Aids, Patricia Kay Correll

Walden Dissertations and Doctoral Studies

The widespread use of highly active antiretroviral therapy (HAART) has resulted in longer lifespans for HIV seropositive women in the United States, during which preventive health care is recommended. Failing to complete recommended cancer screening tests can result in cancer being diagnosed at a later stage with a poorer prognosis. The purpose of the study, based on the ecosocial theory, was to describe the sociodemographic and clinical variables of HIV seropositive women who failed to complete recommended screening tests for breast, cervical, and colorectal cancers, and determine if the presence of hypertension, obesity, diabetes, depression, or tobacco use impacted the …

Nursing Care Of Terminal Patients In Intensive Care Units, Pervell Velethia Dunbar

Walden Dissertations and Doctoral Studies

Nursing Care for Terminal Patients in Intensive Care Units

by

Pervell Dunbar

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

August 2015

Although the goal of the ICU has always been to save lives, ICU now additionally provides end-of life (EOL) care. The objective of this project was to provide ICU nurses with a comprehensive awareness of physical, emotional, and spiritual EOL care issues of patients and their families in order to be better equipped to handle EOL care. The framework used was Jean Watson's Caring model (10 Caritas). A …

Role Ambiguity, Role Strain, Job Dissatisfaction, And Difficulty Transitioning Into Academia Among Nursing Faculty, Paula Stallard Whitehead

Walden Dissertations and Doctoral Studies

Registered nurses with experience in the clinical area entering academia go through a transition that may lead to difficulties such as role ambiguity and role strain when beginning a new job. The purpose of this study was to understand the experiences leading to role ambiguity, role strain, difficulty with role transition, and job dissatisfaction among the faculty at colleges of nursing in the mountain region of Western North Carolina. Guided by Kahn's organizational role theory and Schlossberg's transition theory, research questions investigated the nursing faculty experience of role ambiguity, role strain, difficulty transitioning into academia, and job dissatisfaction. A qualitative …

Factors Relating To Underrepresentation Of Black American Women In Health Care Administration, Alquietta Lavayle Brown

Walden Dissertations and Doctoral Studies

There is a low representation of Black American women (BAW) in health care senior leadership. With the high level of health problems found among the Black community, diversifying the executive leadership with BAW may be instrumental in increasing provider trust and reducing discriminatory action. Using critical race theory as the conceptual framework, this study examined the experiences, perceptions, and influential or deterrent factors inhibiting advancement of BAW in the health care field. Inquiry centered on factors related to lack of advancement, experiences at different stages of career progression, and strategies impacting career advancement. A qualitative research design using a transcendental …

Vitamin D Deficiency And Immune Function In African American, Hiv-Infected Men, Rana H. Ismail

Walden Dissertations and Doctoral Studies

Vitamin D deficiency is common in individuals diagnosed with HIV and is known for its detrimental health effects. Its recognition as a potent immune-modulator with possible immune health implications in HIV disease progression was the main impetus for this study. The association between Vitamin D and CD4 count falls short of being consistent and is too weak to allow conclusions. Similarly, the literature is inconsistent with regard to the impact of Vitamin D supplementation on CD4. This observational, retrospective chart review study aimed to explore the relationship between Vitamin D deficiency and CD4 count/percent, and to evaluate whether changes in …