Medicine and Health Sciences Commons^™

Frequent Fall Risk Assessment Reduces Fall Rates In Elderly Patients In Long-Term Care, Omokhele Rosemary Aliu

Walden Dissertations and Doctoral Studies

Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to signiï¬?cant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall …

The Lived Experiences Of School Nurses: Transitioning From Hospital To School Worksite, Irene Campbell

Walden Dissertations and Doctoral Studies

School nurses who transition from hospital or clinic-based settings to a school-based work environment often lack sufficient transitioning skills and orientation to cope with the roles and responsibilities of school-based nursing. The result is a high attrition rate among school-based nurses. School nurses may leave their positions due to experiences of marginalization, including isolation, role confusion, and barriers to practice. In this phenomenological study, the lived experiences of 12 school-based nurses who transitioned from hospital or clinical settings were explored. Bandura's self-efficacy and Spreitzer's psychological empowerment theories were used in interpreting the findings. Data were collected via face-to-face individual interviews …

Predicting Weight Management Advice Behavior Using Social Cognitive Theory Among Psychiatry Professionals, Chidi Chima

Walden Dissertations and Doctoral Studies

Obesity remains a public health concern among persons with mental illness resulting from the interaction of a combination of factors such as genetic, medication, effects of their symptoms, social, and environmental factors. Obesity complications account for increased mortality and morbidity, reduced life expectancy, and quality of life in persons with mental illness. The management of obesity is challenging and predicting the ability of mental health professionals to advise patients on weight management behavior is important to improve patients' overall well-being. The social cognitive theory constructs knowledge, expectations, situational perception, self-efficacy, and goal setting were utilized in predicting Weight Management Advice …

Dimensions Of Nurse-Physician Communication, Rachel Malek Hamdan

Walden Dissertations and Doctoral Studies

Hospital leaders set quality and safety as high priorities in their strategic goals. Improving the quality and safety of patient care requires improving internal processes that have direct implications for patient care. Hospital leaders need to improve health care providers' communication as part of improving quality and safety. The problem addressed in this study was the lack of strategies health care administrators use to guide nurse-physician communication patterns in a university medical center in the Middle East. The purpose of this qualitative case study was to explore communication strategies that health care administrators use to guide nurse-physician communication. Relational coordination …

Hospital Outcomes Based On Physician Versus Non-Physician Leadership, Collins Yazenga Mkandawire

Walden Dissertations and Doctoral Studies

Hospital performance metrics are an indicator of leadership performance. However, there is inadequate research on whether physician or nonphysician chief executive officers (CEOs) perform better in the U.S. hospitals. The purpose of this study was to examine which type of leaders is better. Leadership trait, situational leadership, and leadership behavior theories constituted the theoretical foundation. The key research question examined the relationship between a hospital's outcomes, which in this study, included hospital net income, patient experience ratings, and mortality rates, and the type of CEO in that hospital: physician or non-physician. A quantitative, causal comparative design was used to answer …

Conducting An Assessment For Hypertension In African American College Students, Frances Eugenia Montague

Walden Dissertations and Doctoral Studies

Conducting an Assessment for Hypertension

in African American College Students

by

Frances E. Montague

MS, Hampton University, 1985

BS, Hampton University, 1979

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2017

Abstract

Hypertension (HTN) in African American (AA) young adults is diagnosed, treated, and controlled at a lower rate than it is among older AA adults and Caucasians. Untreated high blood pressure (BP) can progress to pre-HTN, HTN, and cardiovascular disease (CVD), which is the leading cause of death in the United States. Guided by Pender's health promotion model, …

Ambulatory Registered Nurse Perspectives On Health Literacy Roles And Patient Communication, Gloria Medina Redden

Walden Dissertations and Doctoral Studies

Registered nurses (RNs) have a significant role in communicating health information to patients. The problem addressed in this study was RNs roles with health literacy and communicating health information using words that the patient understands. This study found that ambulatory RN perspectives on their roles in health literacy and patient communication may improve health outcomes and optimal wellness. The purpose of this qualitative study was to examine and describe ambulatory RN perspectives on their roles in health literacy and patient communication, as these are necessary components linked to better health outcomes. The conceptual framework for this study was the nurse …

Evaluating The Impact Of Integrated Care On Service Utilization In Serious Mental Illness, Heidi C. Waters

Walden Dissertations and Doctoral Studies

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between …

Development Of An Evidence-Based Practice Guideline For Prevention Of Diaper Dermatitis, Nanita Flavier Lim-Sulit

Walden Dissertations and Doctoral Studies

Diaper dermatitis, an acute inflammatory reaction of the skin, is one of the most common forms of dermatitis among neonatal and pediatric patients. The problem addressed in this quality improvement project was the absence of an evidence-based practice (EBP) guideline for perineal care which resulted in 4 unexpected cases of diaper dermatitis per 100 hospital days at a non free standing children's hospital. Framed within Rosswurm and Larrabee's model for EBP, the purpose of this project was to develop an educational initiative encompassing an EBP guideline for perineal care, an educational curriculum plan for staff members, and a Power Point …

Assessing Plant-Based Food Lifestyle To Reduce Obesity Risk, Erna Siregar

Walden Dissertations and Doctoral Studies

Despite an increasing number of healthy lifestyles throughout the country, Americans, including Native Hawaiians, keep gaining weight. Unlike several American lifestyles that have resulted in weight gain within the American population, the vegetarian lifestyle is a scientifically proven method for decreasing body weight and maintaining the weight loss for more than 1 year. This study aimed to compare the lifestyle patterns of 4 vegetarian lifestyles and 1 nonvegetarian lifestyle among Native Hawaiians aged 21 and older using their body mass index (BMI). This quantitative study utilized a correlational design, which is particularly suitable for examining the relationship of BMI to …

Factors Influencing Doctors Ordering Of Clinical Lab Tests: A Qualitative Study, Lakshmanan Suresh

Walden Dissertations and Doctoral Studies

Qualitative studies exploring the factors behind a doctor's decisions to order clinical laboratory blood testing are lacking. A better understanding of these factors can help in formulating interventions that could improve the quality of health care and limit costs. The purpose of this qualitative case series study was to identify factors that influence a doctor's decision to order routine clinical laboratory blood tests. Fifteen doctors from Western New York, working in different hospital settings, were interviewed. There were 5 doctors in each case type: major, community, and private hospitals. When analyzed by case, there was a difference between the three …

The Relationship Between Infertility, Infertility Treatment, Psychological Interventions, And Posttraumatic Stress Disorder, Antoinette Corley-Newman

Walden Dissertations and Doctoral Studies

The number of women diagnosed as infertile continues to grow every year. The psychological impact of the infertility experience has been said to create distress equivalent to that associated with life-threatening illnesses and has been linked with posttraumatic stress disorder (PTSD). Using shattered assumption and stress-buffering theory, this quantitative causal comparative study explored the potential functional relationship between infertility and PTSD. The majority of the (all-female) participants were 24- to 34-year-old college graduates. A 2 X 3 factorial between-subjects ANOVA examined and compared the cause and effect of the independent variables, fertility treatment and psychological intervention, on the dependent variable, …

Use Of Social Cognitive Theory To Understand Veterans' Postservice Physical Activity Behavior, Geoffrey Bruce Miller

Walden Dissertations and Doctoral Studies

The health of the veteran population within the United States has become a matter of ever-increasing concern, and many individuals who have attained veteran status are experiencing health issues following their discharge from the military. Despite such concerns, there are often not enough resources available to assist these individuals to the degree necessary in an expedient manner. The purpose of this case study was to use social cognitive theory to understand the physical activity of veterans following their time in service. Through the use of social cognitive theory, this study explored the thoughts, perceptions, and behaviors of 11 veterans to …

Hassles Of African Americans With Type 2 Diabetes, Sharon H. Murff

Walden Dissertations and Doctoral Studies

There has been a steady increase in the incidence of diabetes in the United States. The purpose of this study was to determine whether there was a difference in the daily hassles of African American adults with a self-reported diagnosis of type 2 diabetes compared to those of African American adults without a self-reported diagnosis of type 2 diabetes. The theoretical underpinning for this quantitative, descriptive study was the cognitive appraisal theory (CAT), but the concept of stress and the effects stress has on the body was the broad framework that connected all the variables. The CAT was used to …

Health Literacy Of Nursing Students And Their Awareness Of Patient Literacy Needs, Jennifer Potter

Walden Dissertations and Doctoral Studies

Research has suggested that providers of health services must be aware of health literacy tools as elements of communication with patients. Poor health literacy is an epidemic that affects quality of care. The purpose of this study was to examine the functional health literacy of associate-degree nursing (ADN) students and their awareness of patients' health literacy needs. This correlational study was designed to examine the relationship between the functional health literacy of ADN students and their awareness of their patients' health literacy needs using the asset model and the health literate care model. A convenience sample of 131 ADN students …

Associate Degree Nursing Graduates Perceptions Of Nclex Performance, Judy Pulito

Walden Dissertations and Doctoral Studies

There has been a shortage of registered nurses in the United States for more than a decade, and an aging population is increasing this problem. This study was prompted by the number of associate degree nursing graduates at a Midwestern community college failing the NCLEX-RN licensure exam, which is required for employment. The purpose of this study was to explore associate degree graduate nurses' views of the effectiveness of classroom and clinical training on NCLEX -RN exam performance. Guided by the conceptual framework of Bigg's students' approaches to learning, which maintains deep learning is associated with achievement of learning outcomes, …

Predictors Of Uti Antibiotic Resistance For Female Medicaid Recipients In U.S. Ambulatory Care Settings, Wendy Denise Wiesehuegel

Walden Dissertations and Doctoral Studies

Urinary tract infections are diagnosed in female populations primarily in ambulatory care settings in the United States. Yet, published evidence documents that many of the antibiotics prescribed in these settings are unnecessary, erroneous, or, inappropriately prescribed. Improper management of uncomplicated urinary tract infections in nonpregnant women has resulted in higher morbidity rates due to antibiotic resistance. The purpose of this retrospective observational cohort study was to explore a current national database for associations between nonpregnant American female patients who were exposed to poverty and at risk for urinary tract infection antibiotic resistance in an ambulatory care setting. Krieger's ecosocial theory …

Patients And Nurses Attitudes To Hysterectomy And Postoperative Pain Management, Blessing Agu

Walden Dissertations and Doctoral Studies

Over 500,000 hysterectomies are performed yearly in the United States, and they often result in a moderate to severe amount of pain. Nurses play a significant role in postoperative pain management. However, studies have shown that despite technological advances and nurses' theoretical knowledge of pain, postoperative pain management remains a challenge among healthcare providers. The purpose of this study was to examine how nurses' and patients' attitude towards abdominal hysterectomy can impact postoperative pain management and hospital length of stay after a hysterectomy. Informed by the theory of reasoned action, the study examined the differences in the nurses' and patients' …

Using Multi-Theory Model To Predict Low Salt Intake - Nigerian Adults With Hypertension, Christine Adekemi Dokun-Mowete

Walden Dissertations and Doctoral Studies

Hypertension is a chronic non-communicable disease and a major risk factor for cardiovascular diseases, renal malfunction, disability, and premature death. One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. There is need to develop and implement new evidence-based theoretical interventions to initiate and sustain behavior change in health education and promotion. Therefore, the quantitative cross-sectional method and design was used to investigate the adequacy of multi-theory model (MTM) constructs for the initiation and the sustenance of low sodium/salt intake behavior in hypertensive Nigerian adults. In addition, the impact of the MTM (initiation) …

Intimate Partner Violence During Pregnancy And Prenatal Care Attendance In Abuja, Nigeria., Dorothy Ijeoma Ezekwe-Anya

Walden Dissertations and Doctoral Studies

Intimate partner violence (IPV) among women poses a significant threat to maternal mortality during pregnancy in Nigeria with a prevalence rate of 14% in the southern region versus 43% in the northern region. Early and adequate prenatal care is essential for improving pregnancy outcomes and the reduction of the maternal mortality rate. Previous studies in several countries have demonstrated a unique barrier to healthcare access among women exposed to IPV. This study assessed the association between IPV during pregnancy and prenatal clinic attendance, using a cross-sectional quantitative study design guided by the social learning theory. The modified Conflict Tactile Scale …

Exploring Leadership Pedagogy Among Louisiana Baccalaureate Nursing Programs, Sarita James

Walden Dissertations and Doctoral Studies

Nursing accreditation bodies have recommended that nursing education programs prepare graduates who display competence in leadership. However, the reality of how nursing leadership skillsets are acquired at the undergraduate level and transferred into practice remains debatable. The purpose of this qualitative study was to understand how nursing educators teach leadership in Louisiana baccalaureate programs contrasted with ideal policy expectations. The action learning and reflective practice theories provided the foundational theoretical influences for this study. Six face-to-face virtual interviews were conducted with nursing faculty who were currently teaching or had taught leadership in a baccalaureate nursing program for at least 1 …

Strategies To Reduce Effects Of Organizational Stress In Health Care Workplaces, Kate Chinyere Mbidoaka

Walden Dissertations and Doctoral Studies

Workplace stress has become a frequent occurrence in the race for competitive business advantage. This stress leads to negative physiological consequences in the workplace, causing productivity and profitability to suffer. The purpose of this single case study was to explore the stress management strategies that some health care business leaders used to reduce the effects of work-related stress on their employees to improve productivity. The interview process included 3 managers employed at a health care institution in Houston, Texas, with records of implementing successful strategies for mitigating the effects of workplace stress. The conceptual framework was job demands-resources model, pertinent …

An Assessment Of Heart Failure Screening Tools For An Outpatient Arrhythmia Devices Clinic, Lucy Joanne Paul

Walden Dissertations and Doctoral Studies

People living with heart failure (PLHF) should be screened for symptoms at every

healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires …

Hospital Administrators' Strategies For Reducing Delayed Hospital Discharges And Improving Profitability, Sheree Boyd

Walden Dissertations and Doctoral Studies

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, …

Health Literacy, Availability, And The Need For Educational Resources On Infertility, Amber Louise Dessellier

Walden Dissertations and Doctoral Studies

There is a gap in infertility research regarding resource availability within rural communities, yet existing research declares infertility a public health concern. This qualitative study was grounded in the Heggerian phenomenological framework by way of assessing participants' perceptions of and experiences with infertility resources in a rural community. The purpose was to analyze the meaning of those experiences within their world. To accomplish this, Antonovsky's salutogenic theory was applied to investigate the strengths and weaknesses of infertility resources including the availability of resources, participant understanding of, and participants' experiences. Purposive sampling was used and in-depth interviews were conducted with 12 …

Effects Of Lifestyle Changes On The Health Of African Americans With Type 2 Diabetes, Charles Duro

Walden Dissertations and Doctoral Studies

African Americans are adversely affected by Type 2 diabetes at a greater rate than their European American counterparts; however, research on the effects of Type 2 diabetes on African Americans is limited. Lifestyle modifications that include the incorporation of physical activity and dietary changes can help patients with Type 2 diabetes better manage their disease and improve their overall quality of health. The purpose of this phenomenological study was to explore the experiences of African Americans with Type 2 diabetes who incorporated these self-management behaviors, discerning if they had improved health and quality of life. The self-efficacy framework was applied …

Parental Self-Efficacy, Feeding Practices And Styles, And Obesity In Mexican American Children, Maria Carmen Goodwin

Walden Dissertations and Doctoral Studies

Childhood obesity rates among Mexican Americans have risen along with the concerns of public health professionals. The purpose of this cross-sectional study, based on social cognitive theory, was to investigate the relationships among parental self-efficacy, parental feeding practices and styles, and childhood obesity, as measured by the parental perception of child weight, among Mexican Americans in Texas. Mothers and fathers (n=83; 33 males, 64 females), with at least 1 child between 8 and10 years, formed the sample. Relationships were assessed using the Tool to Measure Parenting Self-Efficacy questionnaire, the Parental Feeding Practices Questionnaire for Mexican American parents, the Parenting Dimensions …

Developing An Educational Module On Compassion Fatigue, Francisca Chinyere Hennes

Walden Dissertations and Doctoral Studies

Compassion fatigue is viewed as a disconcerting issue facing healthcare professionals in the clinical care milieu, and nurses are identified as the most susceptible population among healthcare professionals. The purpose of this project was to create positive social change by helping oncology nurses find ways to enhance self-care and self-awareness, thereby reducing the risk of compassion fatigue and burnout among healthcare professionals. This project investigated an educational module on compassion fatigue that focused on (a) identifying the occurrence rates of compassion fatigue among oncology nurses, (b) evaluating the demographic features that were associated with the most frequent rates of compassion …

Quantifying The Quality Of Antimalarial Drugs In Ghana, Felix Boakye-Agyeman

Walden Dissertations and Doctoral Studies

Malaria is still an epidemic in many parts of the world-about 220 million people are still infected with malaria worldwide and about 700 thousand people die from this disease per year. Most of the drugs used to treat malaria work well if they are used as required and they contain the right amounts of the active ingredient; however, it is estimated that more than 10% of drugs traded worldwide are counterfeits including 38% to 53% of antimalarial tablets produced in China and India. Due to the lack of data covering the extent of counterfeit antimalarial drugs in Ghana, the purpose …

Effectiveness Of A Medication Administration Protocol On Medication Errors And Inpatient Falls, Avril Dolly

Walden Dissertations and Doctoral Studies

Effectiveness of a Medication Administration Protocol on Medication Errors and Inpatient Falls

By

Avril Dolly

MS, University of the West Indies, 2010

BS, University of the West Indies, 2009

Project Submitted in Partial Fulfillment of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

November 2017

Adverse events such as medication errors and inpatient falls have been reported as the leading cause of safety incidences at the acute care facility in Trinidad and Tobago where this project was conducted. These mishaps aroused concerns about patient safety and led to a quality improvement (QI) initiative at the hospital. …