Medicine and Health Sciences Commons^™

Violence Against Nurses, Terri Lynne Declerck

Walden Dissertations and Doctoral Studies

Workplace violence against nurses causes stress, job dissatisfaction, injury, and financial burden. The purpose of this project was to examine training for nurses on violence, risk factors and on reporting workplace violence. The practice-focused question was designed to examine the effectiveness of educating nurses regarding violent patients and how to report episodes of violence. Benner's novice to expert theory guided the skill acquisition training of a convenience sample of 25 Midwestern medical nurses. The nurses participated by completing a survey prior to and following a violence simulation. A qualitative design was used with the 25 nurse participants who completed the …

Development Of A Quality Improvement Initiative To Screen For Postpartum Depression, Renee Traube

Walden Dissertations and Doctoral Studies

Postpartum depression (PPD) is a mood disorder affecting approximately 20% of women within 6 months of delivery. Untreated PPD diminishes a woman's functioning and may result in short and long-term consequences for her infant. Screening with evidence-based tools can identify prenatal and postpartum women at risk for PPD, ensure early treatment, and limit adverse maternal and infant effects. Using Rosswurm and Larrabee's evidence-based practice model, a multidisciplinary team of 7 key stakeholders, including directors and a nurse from the departments of OB/GYN, Pediatrics, and Primary Care, a psychiatrist specializing in women's health, and a member of nursing leadership, formed to …

Improving Fall Prevention Strategies In An Acute-Care Setting, Sylvia B. Boye-Doe

Walden Dissertations and Doctoral Studies

Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program …

Factors Related To Nursing Student Persistence In An Associate Degree Program, Patricia Ann Farley

Walden Dissertations and Doctoral Studies

The retention of nursing students remains a challenge in higher education, and the need for nurses in the United States is projected to increase. The purpose of this study was to investigate nursing student persistence in an associate degree program by examining differences in the presence of key social, environmental, and academic factors across 2 types of students: completers and non-completers of the 1st course in a registered nursing program. The study framework was based on Tinto's Student Integration Model and the Nursing Undergraduate Retention and Success Model, which identify key social, environmental, and academic factors as critical to student …

Nutrition Services, Viral Suppression, Cd4, And Retention In Ryan White Program Participants, Theresa Jumento

Walden Dissertations and Doctoral Studies

The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of …

Impacts Of Observing Live Open Heart Surgery On Young Adults' Health Behaviors, Muhammad Musa Qarizadah

Walden Dissertations and Doctoral Studies

Having a heart healthy lifestyle at a younger age is beneficial in reducing the risk of coronary heart disease (CHD) in adulthood and various health education programs for CHD prevention exist to persuade young adults to adopt a heart healthy lifestyle. Little is known, however, about the influence of watching live open heart surgery on young adults' adoption of a heart healthy lifestyle. To address that gap in knowledge, this study was conducted at a health facility in Virginia where students came to observe live open heart surgery. The purpose of the study was to understand whether watching live open …

Perceptions Of Community-Based Participatory Research From Community And Academic Members, Ivonne G. Kanko

Walden Dissertations and Doctoral Studies

Community-based participatory research (CBPR) is an increasingly popular form of public health research. However, little is known about the application of CBPR and the levels of involvement for partners in specific phases of the partnership. This phenomenological study addressed the application of CBPR from the perspectives of 7 academic researchers and 6 community members experienced in CBPR. Arnstein's ladder of citizenship participation and the community coalition action theory provided the framework for the study. Semi-structured interviews addressed participants' levels of involvement in the CBPR process, as well as challenges, concerns, successes, and recommendations for improvement. Interview transcripts were analyzed by …

Evaluation Of Automated Reminders To Reduce Sepsis Mortality Rates, Maria M. Lindo

Walden Dissertations and Doctoral Studies

Sepsis is still a leading cause of death in the United States despite extensive research and modern advancement in technology. Early recognition of sepsis and timely management strategies are important for effective reduction of sepsis-related morbidity and mortality. Guided by the logic model, the purpose of this project was to evaluate the effectiveness of electronic reminders in enhancing clinical decision-making among 30 nurses in 3 medical-surgical units. The practice-focused question addressed the effectiveness of electronic reminders for early recognition and initiation of goal-directed treatment of sepsis in hospitalized patients on medical-surgical units in an effort to reduce sepsis mortality rates. …

Identifying Communication Barriers And Trust Issues Of Black Women Seeking Preventive Health Services In Houston, Texas, Melissa E. Shelton

Walden Dissertations and Doctoral Studies

Black women mortality rates are perceived to be impacted by communication barriers, trust issues, and the lack of quality preventive health services. The purpose of this phenomenological study was to explore communication barriers and trust issues perceived by Black women when seeking preventive health services. HMB was used to identify public attitudes around receiving preventive health services and to construct each question based on perceived susceptibility and perceived severity of communication barriers and trust issues. An ecological model of the communication process was used as a framework to identify fundamental relationships between the Black female patients and health care providers. …

Women And Coronary Artery Disease, Gwendolyn Yvonne Stancell-Smith

Walden Dissertations and Doctoral Studies

Heart disease, including coronary artery disease, affects approximately 42 million women in the United States. Many of those affected are not aware they have the condition. Contributing to the problem is the fact that women are more likely than men to be misdiagnosed and undertreated for heart disease. Morbidity and mortality are high in women affected by heart disease, making the problem important to address. The purpose of this project was to understand the coronary artery or heart disease risk and the treatment for the condition provided for 31 participants at a cardiology service in the Northeast U.S. The project …

Psychological Resilience In Correctional Officers: The Role Of Demographics, Manuel Chapa Villarreal

Walden Dissertations and Doctoral Studies

Correctional officers occupy an important societal role in maintaining safety and assisting in the rehabilitation of inmates; however, both their performance and mental health are highly susceptible to fatigue because of working in a high stress environment. This study investigated the relationship between correctional officers' demographic factors (level of education, marital status, gender, and race/ethnicity) and their psychological resilience. The Connor-Davidson Resilience Scale 10 (CD-RISC-10) was used to measure correctional officers' resilience when responding and or coping with stress. This study utilized the stress-vulnerability model as a framework to investigate protective factors against and risk factors for psychopathological symptoms. Participants …

Executive Director Experiences With Consumer Operated Service Provider Governing Board Members, Merideth Mccallick Erickson

Walden Dissertations and Doctoral Studies

Consumer Operated Service Providers (COSPs) are programs that are directed and administratively controlled by mental health consumers for their peers. As such, many mental health consumers have been placed in the position of serving on a COSP and often with unclear descriptions and no training. As a result, there is often a disconnect between the will of the board and the vision of the executive director, leading to tension and the possibility of failed mission. Using servant leadership as the guide, the goal of this case study was to explore the experiences of executive directors who operate Consumer Operated Service …

Bupivacaine With Fentanyl To Treat Labor Pain: A Quality Improvement Initiative, Irvin Lee

Walden Dissertations and Doctoral Studies

Epidurals used for labor are common regional anesthesia techniques that are easily placed and controlled, while providing the most reliable method of pain relief in obstetrics for parturient women. Local anesthetics, narcotics, and/or combinations of the two are administered through epidurals to treat labor pain. Hence, the choice of medication is important, as it can highly influence outcomes of pain relief. The purpose of this DNP project was to evaluate the effectiveness of a new service line medication, bupivacaine 0.1% with fentanyl 2mcg/ml, to treat labor pain in parturient women at a rural community hospital in southern California guided by …

How Does Organizational Culture Impact Rn Engagement, Veronica Anntionette Ruffin-Ellis

Walden Dissertations and Doctoral Studies

Lack of RN engagement in the acute care setting can result in poor staffing, nursing shortages, increased stress levels for nurses and decreased morale. When nurses are not engaged in their work setting, quality of care suffers. A wide range of literature focuses on the importance of RN engagement; however, few health care organizations have taken the initiative to implement programs that foster RN engagement, demonstrating a gap in practice. This study examined the relationship between the levels of RN engagement and their perceptions of their organizational culture. Kolcaba's humanistic approach to meeting the needs of RN staff was used …

10,000 Step Challenge For Bedside Registered Nurses Working 12 Hour Shifts, Katherine Louise Schnebly

Walden Dissertations and Doctoral Studies

Obesity is a pandemic that directly affects chronic health problems and mortality. Researchers have shown that more than 54% of nurses are obese. The increasing rate of obesity among nurses and the long hours they work make healthy lifestyles, including daily physical activity, difficult. Tracking daily activity using a pedometer or fitness application has shown improved awareness and sustainability of daily physical activity. This project was an investigation of the daily steps of bedside nurses working a 12-hour shift, and their subsequent awareness of their daily physical activity. Pender's Health Promotion Model was used to consider motivating factors for improving …

A Toolkit To Support Nurse-Patient Communication Through Nurse-Expressed Empathy, Jessica Delano Holden

Walden Dissertations and Doctoral Studies

Empathy is the ability of a person to understand what another is experiencing from the receiver's perspective and the ability to communicate that understanding to the receiver. In nursing, empathy is believed to be a necessary component to the nurse-patient relationship. Evidence shows a decline in empathy specifically noted over time in nursing students who are preparing to graduate and enter the workforce. The practice focused question for this project asked whether an experiential learning toolkit for development of nursing empathy can improve sophomore nursing student empathy as measured via the Jefferson Scale of Empathy. This project was guided by …

Educating To The Collaborative Care Model, Darcy N. Duncan

Walden Dissertations and Doctoral Studies

The problem addressed in this project was the lack of experienced RNs needed in the acute care setting to deliver safe, quality patient care, while effectively managing resources and providing job satisfaction. The purpose of this project was to determine if an education module designed to educate charge and rover nurses on the Collaborative Care Model (CCM) would enhance staff nurses' abilities to provide safe, high quality care to patients, and improve staff nurse retention on one unit in an acute care setting. The theoretical frameworks utilized to guide the education module included: Lewin's theory of planned change, Benner's novice …

Workers' Perceptions Of The Effect Of Three-Tier Shift Schedules On Community Functioning, Jillian Leigh Wallace

Walden Dissertations and Doctoral Studies

Shift work is commonplace in many fields that require around-the-clock employee coverage. There is ample evidence that two-tier shift work can detrimentally affect health and functioning. The purpose of this study was to understand the impact of three-tier shift schedules on physical and mental health and community functioning, a concept which refers to activities and behaviors performed by individuals or groups within a system. This study used a qualitative phenomenological design, and community functioning and recovery theory were central to the conceptual framework. In-depth interviews were used to explore the perceptions of three-tier shift workers on their functioning, relationships, mental …

Effective Strategies Employed By Retail Store Leaders To Reduce Employee Turnover, Alexandro Beato

Walden Dissertations and Doctoral Studies

Employee turnover affects retail organizations in the form of lower productivity, decreased profitability, and reduced sustainability. In 2014, organizations lost over $11 billion in tangible and intangible assets as the result of employee turnover. High employee turnover rates have an adverse effect on productivity, which lead to unsustainable business practices. The number of retail employees who quit their jobs each month increased from 432,000 in December 2016 to 464,000 in January 2017, which indicates that some managers lack strategies to reduce employee turnover. Using the transformational leadership theory, the purpose of this single case study was to explore effective strategies …

Hourly Roudning In Th Emergency Department, Marie Chapnick

Walden Dissertations and Doctoral Studies

The Affordable Care Act of 2010 increased the number of patients seen in a northeast, urban trauma emergency department by 34%. This created a problem as it occurred simultaneously with a nursing shortage. Consequently, patient satisfaction scores fell below the national average benchmark. The rate patients left the emergency department without being seen was 2.6% higher than the national average and patient fall rates increased by 20%. A review of the literature to search for solutions led to the support of an hourly rounding project and an educational workshop promoting proactive nurse behaviors as a way to address the quality …

Work-Family Conflict: Does Romance Matter?, Christie Marie Charles

Walden Dissertations and Doctoral Studies

Research has shown that being in a romantic relationship has related negatively with work-family conflict. Using social exchange theory, the investment model, and role theory, this study examined the relationships among the dimensions of perceived partner support, romantic relationship interdependence, and work-family conflict. A sample of 192 adults in paid employment, currently involved in a romantic relationship, were recruited from SurveyMonkey Contribute. Study participants completed online a demographic survey, the revised Support in Intimate Relationships Rating Scale (SIRRS), the Investment Model Scale, and work-family conflict scales. Correlation analyses showed that work-to-family conflict and family-to-work conflict correlated negatively with commitment and …

The Soldier 360°Orgram: Strengthening Combat-Exposed, Noncommisioned U.S. Army Officers' Interpersonal Sensitivity, Anne Harper

Walden Dissertations and Doctoral Studies

Interpersonal sensitivity is a foundational component of interpersonal relationships. It encompasses an individual's self-concept and self-identity, which are formed as the individual develops. An individual's self-concept develops from the norms and mores of his or her society. Soldiers in the U.S. Army have been trained to form a repurposed self to engage in combat and work in combat-focused jobs. The consequence of this training in many cases has been diminished interpersonal sensitivity that has been detrimental to their interpersonal relationships. The Soldier 360° course is a comprehensive treatment program that takes a holistic approach to providing soldiers with self-empowering tools …

Effect Of Multiple Skin-To-Skin Experiences On Exclusive Breastfeeding Rates, Joanna Horst Horst

Walden Dissertations and Doctoral Studies

Breastmilk feeding at birth demonstrates short- and long-term medical and neurodevelopmental advantages. Infants who are exclusively breastfed demonstrate less nausea, vomiting, and diarrhea, and they experience less upper respiratory and ear infections than do infants who are not breastfed. One strategy that supports breastfeeding initiation is providing skin-to-skin contact (STS) with mothers and newborns immediately upon birth. The purpose of this project was to evaluate the impact of a second session of STS on the postpartum unit on exclusive breastfeeding rates at discharge. A retrospective comparison design using Swanson's caring model was used to guide the evaluation study that examined …

The Impact Of Adaptive Leadership Capacity On Complex Organizational Health Systems Outcomes, Laura Lentenbrink

Walden Dissertations and Doctoral Studies

Nonlinear and chaotic environmental changes characterize health services organizations as complex adaptive systems in which leaders must exercise non-traditional leadership practices to succeed. Health services leaders who have learned and implemented traditional linear management approaches are ill prepared to lead in complex environments. This study tested complexity and adaptive leadership theories of agility and resilience in complex health systems. The purpose of this quantitative cross-sectional internet-based survey study was to quantify relationships between independent variables of agility and resilience and secondary dependent variables of financial, patient satisfaction, quality and human capital outcomes. The impact of turbulence was also examined. Included …

Interprofessional Collaborative Care Educational Program For Nurses, Lynn Ann Mcewen

Walden Dissertations and Doctoral Studies

Interprofessional collaboration and collaborative patient and family-centered practice is increasingly advocated as a means of improving patient outcomes and the cost effectiveness of health care. The Canadian Interprofessional Health Collaborative and Registered Nurses Association of Ontario identified best practices and competencies required for interprofessional collaboration and collaborative practice. Despite the widespread dissemination of these competencies and best practice guidelines to health professional schools, there remains a gap in nursing practice regarding nursing knowledge about the core competencies required for interprofessional collaboration. The purpose of this project was the planning of an education program for nurses on interprofessional collaboration and collaborative …

A Phenomenological Inquiry Of Nurses' Lived Experiences Of Implementing Evidence In Practice, Monnie Abraham

Walden Dissertations and Doctoral Studies

Research-informed practice is crucial to ensure best possible decisions are made during care delivery. In reality, research-based evidence often does not reach patient care due to many elements that impede the implementation process. The purpose of this phenomenological study was to discover the lived experiences of nurses involved in implementing evidence-based practice (EBP) in clinical settings within hospitals in United Arab Emirates. The theoretical and conceptual basis for the study was derived from Promoting Action on Research Implementation in Health Services framework for knowledge translation and Benner's Novice to Expert theory. Twelve nurses who had experience implementing evidence to practice …

Educational Module Toolkit To Assist Adult Patients With Type Ii Diabetes Mellitus, Dometrives Armstrong

Walden Dissertations and Doctoral Studies

Diabetes is a challenging chronic disease for adult patients to manage effectively. Poor adherence to prescribed medications treatment is one of the main reasons for poor blood sugar control. Despite healthcare providers' efforts to emphasize the importance of taking medications, adult patients with Type II diabetes frequently present with complications related to persistent failure to adhere to prescribed medication regimen. These patients should thoroughly understand why adhering to a strict medication regimen to maintain control of their blood sugar is so important. The purpose of this project, guided by Orem's self-care deficit nursing theory, was to develop an educational module …

Characterization Of Staphylococcal Nuclease And Tudor Domain Containing Protein 1 (Snd1) As A Molecular Target In Hepatocellular Carcinoma And Non-Alcoholic Steatohepatitis, Nidhi H. Jariwala

Theses and Dissertations

CHARACTERIZATION OF STAPHYLOCOCCAL NUCLEASE AND TUDOR DOMAIN CONTAINING PROTEIN 1 (SND1) AS A MOLECULAR TARGET IN HEPATOCELLULAR CARCINOMA AND NON-ALCOHOLIC STEATOHEPATITIS

Nidhi Jariwala, PhD

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Integrative Life Sciences

Virginia Commonwealth University, 2017

Devanand Sarkar, M.B.B.S., PhD.

Associate Professor, Department of Human and Molecular Genetics

Virginia Commonwealth University

Richmond, Virginia

SND1, a subunit of the miRNA regulatory complex RISC, has been implicated as an oncogene in hepatocellular carcinoma (HCC). Oncoprotein SND1 regulates gene expression at a post-transcriptional level in multiple cancers including hepatocellular carcinoma (HCC). …

Staffing Standards And Care Outcomes In For-Profit And Not-For-Profit Religious-Based Nursing Homes, Ara Omobola Omotowa

Walden Dissertations and Doctoral Studies

Vulnerable older adults residing in nursing homes continue to experience poor care outcomes due to nurse staffing levels that are below the levels required for maintaining their well-being. Studies have shown that patient care outcomes in nursing homes are related to nurse staffing standards/levels, which are affected by profit maximization on adherence to registered nurses and licensed nurse staffing standards. The purpose of this descriptive study was to determine if there was a relationship between adherence to staffing standards and care outcomes in for-profit (FP) and not-for-profit religious-based (NFPRB) nursing homes using the profit maximization theory. Research questions focused on …

Use Of Physician Credentialing Standards By U.S. Medical Services Professionals, James Allen Reeder

Walden Dissertations and Doctoral Studies

Credentialing in hospitals is the first line of defense for improving patient safety and reducing medical errors by verifying a physician's medical knowledge and skills. There is no single set of standards for physician credentialing followed by all hospitals in the United States. Using May's normalization process theory, the purpose of this quantitative study was to survey medical services professionals (MSPs) to determine which physician credentialing standards were being used, the sources being used, and the frequency of standards used. The dependent variables in this study were the 13 ideal credentialing standards developed by the National Association of Medical Staff …