Medicine and Health Sciences Commons^™

Awareness Of Clinical Laboratory Sciences And Shortage Of Clinical Laboratory Scientists In The 21st Century, Cynthia Funnye Doby

Walden Dissertations and Doctoral Studies

Retiring baby boomers and the lack of interest and awareness among college students to enroll in an accredited Clinical Laboratory Science (CLS) program have created a shortage of CLS professionals in the 21st century. The U.S. Bureau of Labor Statistics predicts 18,000 CLS vacancies by 2018. However, only about 5,000 students graduate from accredited CLS programs each year. The purpose of this study was to explore students' perceptions of allied health professions and factors that influenced students and CLS professionals to select CLS as a profession. Bandura's social cognitive career theory served as the theoretical framework for this phenomenological study. …

Education And Mentoring Of Staff Nurses In Evidence Based Practice, Sherri L. Smith-Keys

Walden Dissertations and Doctoral Studies

Current gaps in nursing practice can decrease by the translation, implementation, and dissemination of evidence-based practice (EBP). The purpose of this project was to provide staff nurses with EBP education and mentoring in identifying and addressing nursing practice issues using EBP to manage patient care. The Advancing Research & Clinical Practice through Close Collaboration (ARCC) and the social cognitive theory were used as a framework to guide this project development, which addressed if medical surgical nurses receiving education in EBP practice led to improved use, implementation, and improved best practice outcomes. Seven randomly selected medical surgical nurses from a local …

Impact Of Simulation Training On Novice Nurses, Sheila Marjean Moore

Walden Dissertations and Doctoral Studies

In 1999, the Institute of Medicine released its report on building a safer health system. Since then, safety in patient care has become a paramount interest. Given the growing support for increasing patient safety, simulation training has become a common part of novice nurses' orientation program. This simulation training is designed to mimic situations in the acute care setting where novice nurses can practice in a patient safe environment. In this DNP project, a stroke simulation scenario and supporting patient chart was developed as an addition to a novice nurses' orientation program. The National League for Nursing simulation template was …

Psychological Stress In Critical Care Nurses, Oladele Augustine Odunayo Akinwolere

Walden Dissertations and Doctoral Studies

Increased levels of stress in the workplace have led the American Psychological Association to predict a looming public health crisis. Critical care nurses (CCNs) are highly exposed to stressors in the workplace, more than other nurses. Tens of billion dollars were reported lost in productive work time yearly due to ill health from depression alone. An important gap remains in understanding the relationships of stressors with the amount of stress. Supported by the biopsychosocial stress theory, the purpose of this study was to determine the relationship between frequencies of perceived stressors (IVs) as a source of perceived levels of stress …

Exploring Leadership Strategy Influence On Nursing Personnel Retention Within Safety-Net Hospitals, Carl Brown

Walden Dissertations and Doctoral Studies

Frequent turnover among a hospital's nursing staff can profoundly impact organizational operating costs. With a national turnover rate of 17% in 2015, understanding the impact of management approaches on nurse attrition is vital to business success. Guided by Homan's social exchange theory, the purpose of this single case study was to explore leadership strategies used by safety-net hospital leaders to increase nursing personnel retention. Data collection consisted of semistructured interviews from a purposive snowball sampling of 8 senior directors working at a safety-net hospital in southern Maryland. Additional information collected involved documents and artifacts related to human resources management policies …

Emergency Room Utilization Of Participants With Mental Health Conditions Enrolled In Health Home Services, Amanda Duff

Walden Dissertations and Doctoral Studies

Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeated-measures t-test and …

Transcriptome Analysis Of Vaccine Responses To Francisella Tularensis Or Venezuelan Equine Encephalitis Virus, Rebecca Ann Erwin-Cohen

Walden Dissertations and Doctoral Studies

The lack of vaccines for emerging and re-emerging diseases highlights technical gaps and indicates a need for innovative approaches to produce new vaccines. Vaccines may be improved by knowledge of host responses to vaccination, disease pathogenesis, and the effect of age and genetics on vaccine outcome. This study's purpose was to quantitatively assess the molecular epidemiology of Francisella tularensis (Ft) and Venezuelan Equine Encephalitis Virus (VEEV). Study results support the Epidemiology Nexus model which holds that association of changes in gene expression to vaccination facilitate understanding the mechanisms of immune development and link public health and disease epidemiology. My research …

Impact Of Distance, Diagnosis, And Demographics On Attendance For Rural Outpatient Treatment, Trey Howard Jensen

Walden Dissertations and Doctoral Studies

Missed psychotherapy appointments inhibit mental health treatment, limit the availability of treatment to those waiting for care, and reduce clinician revenue. Previous research has revealed that the factors that predict missed appointments vary depending on the geographic location in which that research is conducted. There is not a complete understanding of the characteristics of people who miss appointments in a rural context. This study used information from 281 client records to examine the predictive relationships among missed appointments and the distance traveled to the clinic, mental health diagnosis, age, and gender at a rural outpatient mental health clinic. The purpose …

The Development And Content Validation Of An Adult Obesity Educational Program, Abel Okuma

Walden Dissertations and Doctoral Studies

Overweight and obesity in patients with intellectual and developmental disabilities (IDD) are at epidemic levels in the United States. The problem identified for this DNP project is the incidence of overweight and obesity in IDD. The framework used involved the quality model for improvement. For this DNP project a new program called the Daily-Enhanced Physical Activities Program (DEPA) was developed to promote weight loss, reduce sedentary activities, and optimal body mass index (BMI) for IDD patients. Local experts consisting of two registered nurses, two physical therapists, and one direct support personnel working with IDD patients were recruited. Each expert reviewed …

Characterization And Economic Burden Associated With Pediatric Opioid Exposures And Poisonings, Anisha M. Patel

Theses and Dissertations

Introduction

The main objectives of this study were: 1) to examine the prevalence and characteristics of opioid exposures, 2) to estimate the economic costs associated with opioid poisonings, and 3) to examine the characteristics associated with opioid poisoning-related health care resource use (HCRU) and costs in children.

Methods

Data from the National Poison Data System from January 1, 2010 to December 31, 2014 were utilized to examine the prevalence and characteristics of opioid exposures and poisonings in children <18 years. Economic costs were estimated using the 2012 Nationwide Emergency Department Sample, Kids’ Inpatient Database, Multiple Cause-of-Death file and other published sources, applying a societal perspective. Direct costs included costs associated with ED visits, hospitalizations and ambulance transports. Indirect cost included productivity costs due to caregivers’ absenteeism and premature mortality among children.

Results

There were a total of 83,418 pediatric opioid exposures and nearly half of them resulted in poisoning. The epidemiology of opioid …

Prevalence, Incremental Cost And Resource Utilization Associated With Opioid Overdoses, Batul Electricwala

Theses and Dissertations

Background –

An increase in opioid prescribing has led to an increase in opioid overdoses.^1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”.

Objectives –

The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated …

Emerging Pathogens In Cystic Fibrosis Patients At Virginia Commonwealth University Medical Center (Vcumc), Emily M. Hill

Theses and Dissertations

Cystic fibrosis (CF) is an autosomal recessive disorder affecting 70,000 individuals worldwide. This disease is characterized by the buildup of mucus in the airways leading to chronic lung infections resulting in pulmonary failure and death in 95% of CF patients. Routine surveillance of CF pathogens using traditional microbiology culture guides management and treatment of CF patients. Molecular profiling studies have revealed emerging pathogens that may play a role in CF lung disease by either directly causing infection or upregulating the virulence factors of classic CF pathogens, such as P. aeruginosa; however, routine CF culture protocols have not been modified …

An Examination Of African American Women With Hiv And Health Care Barriers, Robert Salvatore Petralia

Walden Dissertations and Doctoral Studies

For over 40 years, HIV has been seen as an epidemic and problem on health care that disproportionately affects the African American women (AAW) and population. This epidemic represents 12% of the total U.S. population, yet accounts for 37% of the commutative HIV cases, and 45% of the new HIV cases reported since 1998. Research in this case was needed for increased understanding to this health care problem, between AAW and HIV. A review in the literature indicated the problem and found new alternatives that helped support aspects on today's health care. The purpose of the study was to help …

Parental Perceptions Of Childhood Overweight And Obesity In Four-Year-Olds In Northeastern North Carolina, Crystal Keyes Terry

Walden Dissertations and Doctoral Studies

Childhood obesity has increased due to factors such as more television time, less outside play, parents' lack of education about nutritious meals, and eating more fast food versus home cooked meals. Research has been performed on many school-aged children; however, there is a gap in research as it pertains to preschool children. Preschool age learning is when children are most receptive to habit-forming activities. The purpose of this transcendental phenomenological study was to assess the parental perceptions of 11 preschool parents in rural Northeastern North Carolina of 4-year-old children who have been told by a health care professional that their …

Effect Of Home Telehealth On Vterans With Chronic Heart Failure, Yolanda Major

Walden Dissertations and Doctoral Studies

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as …

Determinants Of Obesity Among Deaf And Hard Of Hearing Adults, Lindsay Buchko

Walden Dissertations and Doctoral Studies

Trends of obesity increased over the last 3 decades with the obesity rate doubling from 1980 to 2010. People with disability are more likely to experience health disparities including obesity compared to the general population. Yet research on the determinants of obesity such as self-efficacy, hearing levels, and deaf acculturation styles among those who are deaf or hard of hearing (HoH) is limited. This cross-sectional study, using the social cognitive theory framework, examined BMI and self-efficacy differences between deaf/HoH adults and hearing adults, aged 20 years and older. This study also examined the associations between BMI or self-efficacy and factors …

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 …

Strategies Technology Development Marketing Leaders Used To Commercialize A New Product Innovation, Roxie Mooney

Walden Dissertations and Doctoral Studies

Strategies for commercialization of a new product innovation are critical for gaining a sustainable level of customer acceptance and financial performance. The purpose of this single case study was to explore the commercialization strategies used by 5 technology development marketing leaders from a healthcare company in Washington state. The conceptual framework for this study was commercialization of innovation theory (CoI). The data were collected through semistructured interviews and company documentation, and analyzed using Yin's 5-step data analysis process for case studies to identify and code themes. Analysis of data generated 3 major themes: strategies implemented during the prelaunch phase, strategies …

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 …

Drinking Water And Autism: Using Spatial Cluster Detection To Explore Patterns Of Autism Cases In Lane County, Oregon, Sherry Sandreth

Walden Dissertations and Doctoral Studies

Autism Spectrum Disorders (ASD) are a complex array of neurological disorders with a diverse presentation, multiple etiologies, and long-term ramifications. Prevalence of ASD in the United States is about 1 in 50 children as of 2013, making it a significant public health problem. The etiology is not understood, and it is widely accepted that it is multicausal, with genetic and environmental influences. Prior research suggests an association between water source and ASD. Contaminants such as lead, arsenic, mercury, pharmaceuticals and pesticides found in water are associated with developmental disorders suggesting that a systematic review focused on water source was warranted. …

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 …

Nurses' Experiences Transitioning From Staff Nurse To Management In A Community Hospital, Jennifer Sylvia Buffenbarger

Walden Dissertations and Doctoral Studies

This project study addressed the problem of frequent turnover of nurse managers at a Northeastern community hospital. The lack of retention of nurse managers has led to attenuated support for the nursing staff who continued to hold the front line in patient care. The purpose of this qualitative bounded case study was to explore nurse managers' experiences with turnover in order to identify strategies for enhancing retention. Work empowerment and servant leadership theories served as the frameworks for the study. Research questions focused on nurse managers' perceptions of empowerment and servant leadership characteristics that were important in decisions to assume …

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 Use Of The Illness Perception Questionnaire: Enhancing Clinical Staff Understanding, Typhanie Beasley

Walden Dissertations and Doctoral Studies

Women with Type II diabetes face unique challenges coping with the physiologic complications of the disease, which can be enhanced or hindered by their perception of their ability to effectively manage their diabetes. The Illness Perception Questionnaire (IPQ-R) is a tool that evaluates factors influencing patient-provider communication and assesses patient's perception of their health. Guided by the common sense model of self-regulation, this quality improvement project focused on familiarizing health care providers with the IPQ-R and evaluating their receptiveness to implement it with women with Type II diabetes. Seven Primary Care providers participated in an educational in-service that included information …

Interrelationships Of Colorism, Violence, And Sexual Behaviors Among Southern African American Women., Phaedra Christensen

Walden Dissertations and Doctoral Studies

Two significant public health concerns that threaten both the physical and mental health of African-American women are Intimate Partner Violence (IPV) and Human Immunodeficiency Virus (HIV). African-American women (AAW) in the south carry the greatest burden of HIV and disproportionately represent the region with an incidence of 71% for new HIV infections, and elevated rates of morbidity and mortality. In 2013, the murder rate among AAW was 2.5 times higher than it was among Caucasian women. Most of the published studies that explored the association between IPV and HIV had mixed populations, did not explore topics unique to AAs, or …