Medicine and Health Sciences Commons^™

Frontline And Middle-Level Nursing Leader Transition Within The Military Health System, Rudolph George Newman

Walden Dissertations and Doctoral Studies

Healthcare delivery within the military requires a multifaceted approach to achieve the desired outcomes of safe, effective, patient-centered, timely, efficient, and equitable health care. The prospect of maintaining a cycle of continuous process improvements within military clinical settings hinge on frontline leaders and middle-level managers who must be prepared to execute the mission and motivate, supervise, coach and mentor the staff. This project showcases a review of current literature translated into the development of an evidence-based Transformational Leadership Induction Program (TLIP) module that consisted of 4 subsections: the environment of care, clinical decision support systems, human resources management, and change …

What Are The Perspectives Of Osteoporosis Screening Among Black Women?, Angela Alsberry Wilkins

Walden Dissertations and Doctoral Studies

Osteoporosis is a serious disease which often brings pain, disability, hospitalization, and even death. An increasing number of studies have been conducted on the prevention and treatment of osteoporosis in White women, yet a paucity of research exists to explain disparities in screening and treatment of osteoporosis in Black women. This narrative study describes the perspectives of Black women regarding individual barriers to osteoporosis screening. The purpose of this study was to better understand the perspectives of Black women regarding prevention of and screening for osteoporosis. Selections included purposive, criterion sampling of 10 Black women who were 50 years and …

Childhood Attention Deficit Hyperactivity Disorder: A Stress Factor For African Immigrant Mothers, Helen Agatha Awatefe

Walden Dissertations and Doctoral Studies

Children between the ages of 6-17 years suffering from childhood attention deficit hyperactivity disorder (ADHD) need constant attention as they are more likely to be accident proned, hospitalized, disruptive, and educationally challenged. The constant attention required for children with ADHD may impose stress on mothers and primary caregivers, yet this stress has not been sufficiently studied. The objective of this study was to fill a gap in literature by studying the stress experienced by African immigrant mothers living in the United States who are living with and caring for a child with ADHD, and then comparing the level of stress …

Hospital Profiling Of The Cesarean Delivery Procedure For The State Of Georgia, 2012, Denise Frances Giles

Walden Dissertations and Doctoral Studies

Approximately 35.1% of live births for the state of Georgia were delivered by the cesarean delivery procedure with significant variation among hospitals. The purpose of this research was to develop a population-based hospital profiling methodology for study of the cesarean delivery procedure. This was a retrospective, observational design, using a 2012 linked dataset that included maternity deliveries from all nonfederal hospitals. The research was guided by Robson 10 Group Classification System, propensity score methodologies, and ethical precepts, for the development of hospital profiles and the study of variations in the cesarean delivery procedure. Key research questions aimed to determine whether …

Predictors Of Excessive Alcohol Consumption Among U.S. Business Travelers, Jennifer Clore Barrickman

Walden Dissertations and Doctoral Studies

Excessive alcohol consumption (EAC) is an important public health problem. Several researchers have examined work-related influences on EAC, but few have investigated the predictors of EAC related to business travel. This study measured the association between EAC and frequency of business travel, duration of business travel, and job industry among U.S. business travelers. Research was conducted within the social-ecological theoretical framework. Snowball sampling was used to gather data from 187 business travelers. Data were evaluated using bivariate analysis to assess the association between measures of EAC and each independent variable. Multiple logistic regression was used to adjust for covariates. Respondents …

The Association Of Cancer Development In Patients With Systemic Lupus Erythematosus, Rose Michelle Coley

Walden Dissertations and Doctoral Studies

The Association of Cancer Development in Patients with Systemic Lupus Erythematosus by

Rose Michelle Coley

MPH, Walden University, 2011

BS, University of Mount Olive, 2008

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Public Health

Walden University

March 2016

Both cancer and autoimmune diseases have been associated with numerous factors that may independently lead to the development of either disease. When these factors overlap the difficulty in assessing association is compounded. The numerous factors that are thought to cause systemic lupus erythematosus (SLE), which leads to the development of cancer, makes the study …

A Phenomenological Exploration Of Children's Experiences During The Therapeutic Process, Katherine Destefano

Walden Dissertations and Doctoral Studies

Billions of mental health care dollars for millions of children and adolescents in need has garnered significant attention within the behavioral health industry to reduce costs while improving treatment efficacy through the identification and implementation of evidence based practices with youth populations requiring therapeutic services. This hermeneutic phenomenological qualitative research approach in the field of psychology is a consumer driven one in the world of business. Line by line context and discourse analyses, which included both a prior and inductive coding, of the verbiage and phraseology of 10 boys and 10 girls, aged 8-12, actively engaged in outpatient psychotherapy, formed …

Analysis Of How Newly-Hired Nurses Are Educated To Provide Customer Service, Patricia Mcafee

Walden Dissertations and Doctoral Studies

As part of healthcare reform through the Affordable Care Act of 2010,

hospitals across the United States are being held accountable for

providing a positive patient experience and will lose up to 2% of

their reimbursement by 2017 if they fail to reach targeted scores.

The purpose of this quality improvement project was to review the

process used by a Georgia hospital to educate newly-hired nurses

about customer service expectations and to provide recommendations

for process improvement. Theoretical foundations supporting

customer service included the caring philosophy of Mayeroff; the

caring theories of Watson, Leininger, Boykin, and Nyberg; and

Roy's adaptation …

Behaviors Related To Hiv Infections In Rural Versus Urban Regions Of Nigeria, Michael Ifeanyi Okeke

Walden Dissertations and Doctoral Studies

Efforts by the Federal Republic of Nigeria and international nongovernmental agencies to reduce the impact of HIV in Nigeria have not yielded the anticipated results. This study focused on the association between attitude, religious beliefs, knowledge of HIV, sexual risk behavior, and HIV epidemiology in rural and urban Nigeria. This quantitative study used social-cognitive theory and problem theory. The study was based on the Nigerian Demographic and Health Survey (NDHS) 2013 data including a sample of 33,006 participants. Specific covariates including gender, sexual partners over the past years, age at first sexual encounter, socioeconomic status, and literacy level were obtained …

Development Of A Guide To Successful Onboarding Of New Nurse Graduates, Jacquelyn Estelle Young

Walden Dissertations and Doctoral Studies

The literature indicates that serving as a preceptor for new nurse graduates can be challenging and stressful without proper training in this role. Many organizations appoint preceptors without providing training and support for the role, which negatively impacts both the new nurse and the preceptor. Evidence shows that a preceptor workshop can cultivate the knowledge and skills needed to train and precept new nurse graduates. Further, there is evidence that preceptorship programs ease new graduates' transition to practice, increase employee satisfaction, and improve the quality of care provided to clients. The purpose of this developmental project was to develop a …

Standardized Assessments, Care Planning, And Improved Quality Of Life For Residents Of Adult Family Homes, John A. Rogers

Walden Dissertations and Doctoral Studies

Quality of life for adults living in adult family homes requires further attention as the elderly population continues to grow and moves from minority to majority. There is a lack of data on residents in adult family home settings and their quality of life. The purpose of this project was to identify if individualized nursing care plans had an impact on the residents' quality of life in the adult family home. In this study, a registered nurse assessed the residents to create an individualized nursing care plan that would be implemented to improve quality of life. These care plans were …

Barriers To Exclusive Breastfeeding Among Mothers During The First Four Weeks Postpartum, Jessy V. Thomas

Walden Dissertations and Doctoral Studies

According to the World Health Organization, breastfeeding is natural and the most effective way of nourishment to feed infants and young children to ensure child health and survival. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding during the first 6 months of life. Although exclusive breastfeeding has been shown to reduce the occurrence of adverse health outcomes to the infant and mother, the duration of exclusive breastfeeding remains relatively low in the United States. The theory of planned behavior was used as a theoretical framework for this study. The purpose of …

Bedside Nurse Recognition Of Delirium In The Medical-Surgical Setting, Bridget Ann Denzik

Walden Dissertations and Doctoral Studies

Delirium in adults aged 65 and older is a common occurrence in the acute care setting and is often unrecognized by bedside nurses. Delirium can trigger a negative cascade of events resulting in an increase in morbidity and mortality, functional decline, longer length of stay, and high rates of post hospital institutionalization and has a significant socioeconomic impact. The purpose of this quality improvement project was to establish a solid foundation using scholarly literature to support the development of a delirium prevention, recognition, and treatment program in the medical-surgical acute care setting applying the program logic framework. The goal was …

Adoption Of Electronic Health Record Systems Within Primary Care Practices, Marvin Leon Reid, Jr.

Walden Dissertations and Doctoral Studies

Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. …

Development Of A Policy And Procedure To Decrease Alarm Fatigue, Samantha Deck

Walden Dissertations and Doctoral Studies

According to The Joint Commission (TJC), 98 unexpected and unacceptable events related to alarm fatigue were reported in United States hospitals between January 2009 and June 2012. There were 80 deaths, 13 permanent loss of function, and 5 extended care stays that occurred during this time period. The problem identified in this quality improvement (QI) initiative was the TJC report that nursing staff in the US was experiencing alarm fatigue due to the overstimulation of senses from continuous beeping from alarms on the unit. Framed within the Iowa model of evidence-based practice to promote quality care, the purpose of the …

Improving The Charge Nurse's Leadership Role: A Collaborative Learning Forum, Felicia Katherine Pryby

Walden Dissertations and Doctoral Studies

Staff nurses are frequently placed in charge nurse positions without the necessary formal training. The long-term goal of this project was to develop a curriculum for a formal institutional leadership workshop for the charge nurses at the practicum site. The Johns Hopkins Nursing Evidence-Based Practice model and Lewin's change theory were used to guide the development and implementation of the workshop. Data were collected using a focus group approach with 4 novice and 5 expert medical-surgical charge nurses. The short-term goal of the project was to understand the charge nurses' perceptions of leadership and the challenges as a front-line leader. …

Female Circumcision: A Phenomenological Study Of Somalian Immigrant To The United States, Emmanuel Fai Tatah

Walden Dissertations and Doctoral Studies

Female circumcision (FC) is the partial or total removal of the female genitalia for nonmedical reasons. This study was designed to examine the lived experiences of Somali women who underwent FC before coming to the United States. FC is widely carried out in Somalia with a prevalence of 98%, making Somalia the country with the highest percentage of circumcised women. There are short- and long-term consequences associated with FC such as bleeding, infection, and death. Therefore, it is important to understand how Somali women who underwent FC think and feel about circumcision, why they would continue the practice, and whether …

Transformational Leadership As A Means Of Improving Patient Care And Nursing Retention, Carla D. Thomas

Walden Dissertations and Doctoral Studies

The Joint Commission (TJC) sets standards to assist healthcare organizations in improving performance. The hospital for which this project was developed did not meet national TJC benchmarks for patient satisfaction and nurse retention. Based on direct observation, discussion with staff, and results of the Multifactorial Leadership Questionnaire given to 39 staff nurses before this project was chosen, evidence suggested that the leadership style of the charge nurses was transactional, which is less effective than transformational leadership (TFL). Framed within the Plan, Do, Study, Act model, the purpose of this quality improvement project was to design an educational curriculum including didactic …

Effect Of Genetic Background Combined With Excessive Media Screen Time On Markers Of Cardiovascular Risk In United States Youth Aged Newborn To 20 Years, Maria Moroni

Walden Dissertations and Doctoral Studies

Time with media screens (television, computers, videogames, cell phones, and tablets) is the primary activity of youth, second only to sleeping, and represents a major risk factor for cardiovascular diseases (CVD). Additionally, the populations with highest rates of screen time are also those most at risk of CVD from genetic predisposition (i.e., Blacks, Hispanics). The purpose of this descriptive, correlational study, based on cross-sectional analysis of archived data from the 2009 - 2010 NHANES for United States youth, newborn to 20 years old, was to determine whether the combination of media screen time with genetic background is a better predictor …

Risk Factors For Measles Among Hiv-Infected Children In Uganda, Miriam Nanyunja

Walden Dissertations and Doctoral Studies

Measles remains a major global public health problem. Attainment of high population immunity to measles through vaccination is necessary to control this disease. Children infected with HIV infection often experience secondary measles vaccine failure by 2 years of age, making them susceptible to measles. It is not clear whether HIV-infected children on Highly Active Antiretroviral Treatment (HAART), older than 2 years, have a higher risk of measles than HIV-uninfected children. This retrospective cohort study, guided by the proximate determinants framework, was conducted to compare the risk of measles between HIV-infected children on HAART (exposed) and HIV-uninfected peers (unexposed). The age …

Socioecological Determinants Of Obesity Among Hispanic Parents/Child Caregivers In Aurora, Illinois, Deanna Marie Sommers

Walden Dissertations and Doctoral Studies

Obesity has increased during the past 30 years in the United States. Obese adults and children are at risk for cardiovascular disease, diabetes, hypertension, and comorbidities. Parents and child caregivers play key roles in the decisions of family health. Studies exploring sociodemographic and socioecological factors associated with obesity among U.S. Hispanic parents and child caregivers are lacking. Guided by the socioecological model, this study examined the following factors: gender; acculturation; dietary intake of fat, sugar, fruits, and vegetables; and role as food purchaser/food preparer that influenced obesity. A 3-paper-based survey, consisting of a demographic survey, the Block Fat-Sugar-Fruit-Vegetable Screener and …

Perceptions About Sexually Transmitted Diseases In Akwa Ibom State Of Nigeria: A Qualitative Study Of Young Adults Age 18-24, Mfon Archibong Archibong

Walden Dissertations and Doctoral Studies

Despite the ongoing investments in programs to increase sexual health awareness among young adults globally, many youths remain vulnerable to sexually transmitted diseases (STDs). Two-thirds of all STDs occur among youths engaging in high-risk sexual behaviors, which put young adults at higher risk of STDs and can result in serious consequences including infertility. Additionally, the social consequences of STD affect families and communities. While a need exists for increased public awareness of STDs among young adults, extant intervention and prevention activities should be informed by a cultural perspective, including the integration of community and government roles. The purpose of this …

Predictors Of Influenza Vaccination Compliance Among Union And Nonunion Workers In A Pennsylvania Health Care System, Ericka Lynne Kalp

Walden Dissertations and Doctoral Studies

To improve U.S. residents' health, advocates are focusing their efforts on workplace health. Researchers have found that unionization is a positive influence on workers' participation in health promotion programs relating to smoking and obesity prevention. However, the effect of union membership on other health promotion initiatives, such as influenza vaccination compliance among health care workers, has not been examined. The purpose of this quantitative study was to address this knowledge gap between a union and a nonunion health care facility in the U.S. state of Pennsylvania. The health belief model was used to determine if different domains of influenza vaccination …

Moving Evidence Into Practice: Early Sepsis Identification And Timely Intervention In The Emergency Department (Project Code Sepsis), Jonjon Macalintal

Walden Dissertations and Doctoral Studies

Sepsis is the leading cause of death among hospitalized patients in the United States, is responsible for more than 200,000 deaths annually, and has as high as a 50% mortality rate. Sepsis requires prompt identification so that early goal-directed therapy can be instituted to lead to better outcomes. The purpose of this quality improvement project was to determine if implementing an evidence-based identification and intervention program, Project Code Sepsis, in the emergency department can increase the number of patients who receive antibiotics within the first hour of triage and decrease the length of hospital stay. Specifically, the primary project goals …

Experience With Social Support Systems Among Women Exposed To Intimate Partner Violence In Cameroon, Ahone Esther-Alice Ngujede

Walden Dissertations and Doctoral Studies

The southwest and northwest regions of Cameroon have experienced high rates of intimate partner violence (IPV). Limited information is available about IPV victims' experiences with social support systems. This phenomenological study was aimed at investigating IPV victims' lived experiences with social support systems in Cameroon. Some of these systems are the judicial system, police officers, hospitals and clinics, and domestic violence agencies. The Health Belief Model (HBM) and the Transtheoretical Model of Change (TTM) were used to understand how 8 self-identified victims of IPV were able to discuss their lived experiences with social support systems. The research questions addressed women's …

The Impact Of Free Healthcare On Hospital Deliveries In Sierra Leone, Salifu Salito Samura

Walden Dissertations and Doctoral Studies

Improving maternal health has been a challenge for developing nations with very high rates of maternal mortality. Sub-Saharan Africa, particularly Sierra Leone, has some of the highest maternal mortality rates in the world. In an attempt to improve on this, the Sierra Leonean government enacted free maternal healthcare services in 2010. The Sierra Leone Free Healthcare Initiative (SLFHCI) provides free healthcare for pregnant women, lactating mothers, and children under 5 years old. This research explored the impact of the free healthcare on hospital deliveries. The determinant of health model was used to evaluate the effectiveness of the SLFHCI program, and …

Providing Optimal Nutrition In Critical Care, Jo Anne Foley

Walden Dissertations and Doctoral Studies

Malnutrition among hospitalized patients is prevalent and associated with adverse outcomes. At the health care facility for which this quality improvement (QI) initiative was developed, patients were not consistently fed within the nationally recommended 48 hours. The purpose of this project was to facilitate the early initiation of enteral feedings to prevent malnutrition in a vulnerable patient group by development of an evidence-based enteral feeding policy, algorithm, and nursing education module. The find, organize, clarify, understand, select, plan, do, check, and act model provided a systematic approach for development of the project. Validation of the QI initiative was through the …

Effect Of Healthy Food Demonstration On Minority Women's Dietary Habits In San Antonio, Texas, Staria Hudson Black

Walden Dissertations and Doctoral Studies

Obesity has become a global epidemic. Healthcare cost continues to increase due to co-morbidities such as diabetes, hypertension, and coronary artery disease associated with obesity. The purpose of this project was to examine whether teaching nutritious food choices to obese African American and Hispanic females in healthy cooking demonstrations would have an effect on their dietary behavior. The holistic self-care model was used to develop healthy strategies for weight loss. The model guided the development of nutritional support, exercise, and spiritual strategies for weight reduction. African American and Hispanic females between the ages of 25 to 64 were solicited from …

Prevalence And Predictors Of Complementary And Alternative Medicine Use Among Lebanese College Students, Lama Jizi

Walden Dissertations and Doctoral Studies

In Lebanon, estimates of Complementary and Alternative Medicine (CAM) use among college students are not available. CAM practices are not well regulated and some products contain unsafe substances. The purpose of this study was to estimate the prevalence and predictors of CAM use among Lebanese college students using the health belief model. A quantitative cross sectional research design was used. An online survey was administered to 126 Lebanese college students with the aim of determining the most important predictors of CAM use. A majority (89%) of surveyed students reported the use of CAM in the last 12 months. Based on …

Nurses' Occupational Trauma Exposure, Resilience, And Coping Education, Sherry Lynn Jones

Walden Dissertations and Doctoral Studies

Nursing education courses and professional development (PD) do not include coping and resilience training for registered nurses (RNs) who work in emergency departments (EDs). Exposure to traumatic events, death, and dying may lead to health issues, substance abuse, stress symptoms, nursing staff turnover, and compassion fatigue among ED RNs. Without training, the pattern of adverse outcomes may continue. The purpose of this study was to explore ED RNs' experiences with occupational traumatic stress (OTS), and their recommendations for change to nursing PD programs, using a qualitative bounded intrinsic case study. The conceptual framework for this study included social learning and …