Medicine and Health Sciences Commons^™

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 …

Managing Acute Pain In Postoperative Surgical Patients, Sabrina Gregory

Walden Dissertations and Doctoral Studies

Every year, millions of Americans suffer from either chronic or acute pain that results in tremendous healthcare cost, rehabilitation, and loss of work productivity. Pain is an unpleasant sensation associated with sensory and emotional experiences that can cause potential or actual tissue damage. One plausible solution to managing pain is the use of nonpharmacological modalities such as guided imagery. The purpose of this project was to determine if there was a difference in pain scores following pharmacological interventions and the use of guided imagery among postoperative same day surgical patients. Guided imagery is a nonpharmacological modality that uses pictures, music, …

Environmental Factors Associated With Body Mass Index Among Long Haul Truck Drivers, Charlotte Hughes Huntley

Walden Dissertations and Doctoral Studies

In 2009–2010, the prevalence of obesity among U.S. adults was 40%, and the prevalence was 69% among long haul truck drivers. Researchers have not established a clear relationship between working environment and weight among truck drivers. This quantitative cross-sectional study, using an ecological framework, evaluated the relationship between the working environment (sleep performance, food choices, driving environment, and activity level) and weight severity (e.g., body mass index [BMI]) among long haul truck drivers. One hundred and twenty six adults (46 + 10, years of age), including both genders (male = 97 and females = 29) completed an online questionnaire evaluating …

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 …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Autotaxin In Central Nervous System Development And Disease, Natalie A. Wheeler

Theses and Dissertations

During development, oligodendrocytes (OLGs), the myelinating cells of the central nervous system (CNS), undergo a stepwise progression during which OLG progenitors, specified from neural stem/progenitor cells, differentiate into fully mature myelinating OLGs. This progression along the OLG lineage is characterized by well-synchronized changes in morphology and gene expression patterns. The studies presented in this dissertation identified the extracellular factor Autotaxin (ATX) as a novel upstream signal modulating HDAC1/2 activity and gene expression in cells of the OLG lineage. Using the zebrafish as an in vivo model system, as well as rodent primary OLG cultures, this functional property of ATX was …

Nest - Caring For The Caregiver, Ashley Whitehead

Theses and Dissertations

Today, more than ever, there exists an overlap between hospitality and healthcare industries; with the impact being felt in the way hospital interiors are designed. This influence impacts the patient’s experience but focuses very little on the experience of the caregiver. Caring for a sick child takes an emotional, mental, and physical toll on a family. It is especially challenging to care for a sick family member when away from the comfort and security of the family’s private home. This project explores that challenge through the interior design of a space that, for both patient and family, is restorative, healing, …

Perceptions Of Infertility Among Arab Women In The U.S, Zena Hamdan

Walden Dissertations and Doctoral Studies

Infertility is a serious public health issue. Infertile couples may perceive infertility differently based on their own cultural background. There is a paucity of literature about how infertility is perceived among Arab women living in the United States. The purpose of this study was to be able to understand how Arab women who live in Dearborn, Michigan feel about infertility and to understand their concerns and worries about their health status. The primary research questions asked Arab women how they perceive infertility and how infertility may impact their future. This qualitative case study was guided by the social support theory …

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

Walden Dissertations and Doctoral Studies

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

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 …

An Exploration Of Male Batterers' Perceptions Of A Standardized Batterers' Treatment Program, Dionne Lynn Spooner

Walden Dissertations and Doctoral Studies

The focus of this hermeneutic phenomenological, qualitative study was to gather an in-depth understanding of the lived experiences of male batterers participating in a standardized Duluth-model batterers' treatment group. The study had three main goals: (a) to understand the experience of male batterers participating in a standardized male batterers' treatment program, (b) to improve the treatment being provided to male batterers, and (c) to improve services to those impacted by domestic violence. Results from previous studies indicated that treatment for male batterers is ineffective and inconsistent and that the treatment provided, regardless of framework or modality, has little or no …

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 …

Healthy Work Environment: Essentials For Outcome Improvement, Lisa Cuff

Walden Dissertations and Doctoral Studies

The purpose of this project was to identify the standards for the American Association of Critical Care Nurses (AACN). The employees of a 39-bed medical surgical unit within a 697-bed metropolitan medical center were selected through collaboration with the practicum site. Out of 68 allocated positions for this unit, only permanent employees were selected to participate. An employee presented the purpose of the project, the survey process, and inferred consent represented by online login to complete the survey. Following the online assessment, the employee explained the AACN healthy work environment standards in a subsequent presentation. The online healthy work environment …

Health Science Adminstrators' Perception Of Remediation With Students In The Professional Track Programs, Yvonne Jackson Jackson

Walden Dissertations and Doctoral Studies

Remediation to improve student retention is rapidly becoming an important part of health science programs in higher education. A career college located in the midwestern United States implemented remediation for students to address declining enrollment health science professional-track programs. The purpose of this qualitative case study was to explore how remediation was carried out by college instructors and their perceptions of instructional best practices for students in health science programs in the context of current research. The conceptual framework that guided this study was based on constructivism and adult learning theory. Research questions focused on how instructors were carrying out …

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 …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

Development And Evaluation Of A Peer-To-Peer Intervention To Increase Self-Management Among Adult In-Center Hemodialysis Patients, Jennifer J. St Clair Russell

Theses and Dissertations

Background: Peer-to-peer (P2P) support programs have the potential to assist ESRD patients in managing their disease and improve outcomes. Yet, there is little research examining P2P programs’ impact on psychosocial outcomes and disease management behaviors.

Methods: A 4-month P2P mentoring intervention was designed and piloted in a facility serving 249 in-center hemodialysis patients in Lynchburg, Virginia. Preceded by a social marketing effort, which included a program naming contest and participant recruitment, the intervention included: (1) mentor training, (2) pairing of mentees and mentors, (3) kick-off social mixers, (4) ongoing meetings between mentees and mentors, (5) mentor training booster, and (6) …

The Scoop, Vol. 2 Issue 10, January 2016, Health Sciences Library

Volume 2

Latest news and events from the Health Sciences Library in our monthly newsletter for January 2016.

Motivating Parents Of Kids With Asthma To Quit Smoking: The Effect Of The Teachable Moment And Increasing Intervention Intensity Using A Longitudinal Randomized Trial Design, Belinda Borrelli, Erin M. Tooley

Arts & Sciences Faculty Publications

Aims—We tested two aims: 1) The Teachable Moment (TM): whether second hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma vs. parents of healthy children (HC) and 2) whether greater intervention intensity (Enhanced-PAM) produces greater cessation than a previously tested intervention (Precaution Adoption Model; PAM).

Design and interventions—Aim 1: Two home visits (asthma education or child wellness), and cessation induction using Motivational Interviewing and SHSe feedback. Aim 2: Post home-visits, parents with asthmatic children were randomized to PAM (n=171; 6 asthma education calls) or Enhanced-PAM (n=170; 6 asthma education/smoking cessation calls + repeat SHSe …

Prevalence, Reasons For Use, And Risk Perception Of Electronic Cigarettes Among Post-Acute Coronary Syndrome Smokers, Andrew M. Busch, Erin M. Tooley

Arts & Sciences Faculty Publications

Purpose—The use of electronic cigarettes (e-cigarettes) has risen dramatically in recent years. However, there is currently no published data on use of e-cigarettes among cardiac patients. The current study reports on the prevalence, reasons for use, and perceived risks of e-cigarettes among post-Acute Coronary Syndrome (ACS) patients. The relationship between e-cigarette use and post- ACS tobacco smoking cessation is also explored.

Methods—Participants were drawn from a randomized trial of smoking cessation treatments following hospitalization for ACS. The current study focuses on 49 participants that completed e- cigarette questions at 24 weeks post-ACS.

Results—51.0% of participants reported ever …

Comparison Of Secondhand Smoke Exposure In Minority And Non-Minority Children With Asthma, David A. Fedele, Erin M. Tooley

Arts & Sciences Faculty Publications

Objective—Determine if secondhand smoke exposure (SHSE) is related to asthma-related functional morbidity by examining racial/ethnic differences in Non-Latino White (NLW), African American, and Latino families and whether racial/ethnic SHSE differences across families persist when accounting for smoking factors.

Methods—Participants were 305 caregiver smokers of children with asthma. Two passive dosimeters measured SHS: one in the home and one worn by the child.

Results—Higher SHSE was related to greater asthma-related functional morbidity. African Americans had higher levels of home SHSE than Latinos (p = .003) or NLWs (p = .021). SHSE as assessed by the child …

Ethics Pertaining To The Legalities Of Male Routine Infant Circumcision And Surrogate Consent To Non-Therapeutic Surgery, Jason A. Domashevskiy, Artem V. Domashevskiy

Publications and Research

Circumcision is the most contentious surgery performed in the world today. Approximately 38% of the world male population has been circumcised, mostly during the neonatal and prepubescent periods. Circumcision in regularly practiced ubiquitously throughout the Islamic countries, Israel, and the United States; the US is only country who regularly circumcises its boys for a non-religious reason. No world health body advocates circumcision prior to adulthood. Routine Infant Circumcision (RIC) violates the United Nations Policy on Genital Integrity, the Hippocratic Oath taken by doctors, and the rules for surrogate consent to surgery. Studies have shown no benefits to circumcision during the …

Cancer Health Literacy And Hospitalization In The First Five Years Following A Cancer Diagnosis, Laura A. Cartwright

Theses and Dissertations

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the …

Burnout In Firefighters: A Word On Methodology, Irvin Sam Schonfeld, Renzo Bianchi

Publications and Research

At least three methodological problems affect the study by Katsavouni et al. (2016). First, there are currently no diagnostic criteria for burnout, neither in the DSM-5, nor in the ICD-10. Second, one extremely important variable was omitted from this study of firefighters, namely, depression. Third, the authors did not control for relevant nonoccupational factors such as stressors occurring outside of work.

In Adult Patients With Unilateral Stroke, Is Distributed Constraint-Induced Therapy Or Bilateral Arm Training More Effective In Improving Upper Extremity Motor And Functional Outcomes Compared With A Routine Approach?, Courtney Beyer, Christine Kim, Janice Li, Angelica Soltis, Kitsum Li

Occupational Therapy | Critically Appraised Papers Series

Stroke survivors may experience deficits and impairments of upper extremity (UE) function that limit their engagement in meaningful everyday occupations. It is important for occupational therapists to identify and test the effectiveness of interventions targeted to decrease UE learned nonuse, improve functional performance, and increase participation in one’s daily occupations.

This study compared the efficacy of distributed constraint-induced therapy (dCIT) and bilateral arm training (BAT) in improving movement strategies and functional abilities of the UE in stroke survivors. Each intervention group participated in the intervention 2 hr/day, five times per week for 3 consecutive weeks. Participants in the dCIT group …

For Stroke Patients, In What Ways Does Robot-Assisted Therapy Improve Upper Extremity Performance In The Areas Of Motor Impairment, Muscle Power, And Strength?, Maria Mandrussow, Ani Keshishyan, Kitsum Li

Occupational Therapy | Critically Appraised Papers Series

Stroke is the leading cause of long-term disability among adults. Adequate rehabilitation of the upper extremity in stroke patients can improve performance in activities of daily living. Robot-assisted therapy can offer intense, repetitive, and task-specific training to the impaired limb after stroke. Prior studies have shown that robot-assisted therapy may improve strength and motor deficits of the impaired limbs, but there is a lack of research comparing the effects of unilateral robot-assisted training protocol (URTP) versus bilateral robot-assisted training protocol (BRTP) with a robotic device. Comparison of the effectiveness of these two protocols is beneficial to determine the appropriate treatment …