Medicine and Health Sciences Commons^™

Waste Management Minimization Strategies In Hospitals, Andrea L. Clark

Walden Dissertations and Doctoral Studies

During the delivery of healthcare services, hospital employees use enormous amounts of water, energy, and nonbiodegradable carcinogenic plastics. In the U.S., hospital staff generate an average of over 7,000 tons of waste per day at an average cost of $0.28 per pound for the disposal of regulated medical trash, which if efficiently managed or reduced, could result in substantial cost savings. Using the organizational learning and the transaction cost economics theories as the conceptual frameworks, the purpose of this qualitative case study was to explore strategies healthcare leaders used to minimize their waste management operational costs. Data were collected using …

Family Relational Experiences During Major Transitions With A Chronic Illness, Juanita Sibayan

Walden Dissertations and Doctoral Studies

Although health care transitions have received some attention in the literature, few researchers have emphasized family relational experiences and communication during major changes while living with a chronic illness. The purpose of this phenomenological study was to understand the lived experience of parents and their adult children while transitioning from pediatric to adult care of a chronic illness. The bio-psychosocial theory, family systems theory, and attachment theory established the context for this study. A criterion-based sampling technique and snowball sampling were used to recruit 7 parents and 6 of their adult children aged 18 to 30 years who were diagnosed …

Accountable Care Organization Success Strategies: The Importance Of System Changes, Shelly Pierce

Walden Dissertations and Doctoral Studies

Accountable care organizations (ACOs) are a new health care reform initiative that has been highlighted as one of the most important organizational structures that could lead to quality improvements and cost savings in the United States through shared savings. The inability of health care managers to successfully implement ACOs could result in financial losses, reduced patient access to health care, and poor patient outcomes. Grounded by von Bertanlaffy's general systems theory, the purpose of this multiple case study was to explore the system change strategies health care managers used to implement an ACO to meet ACO quality and cost standards. …

Exploring Management Practices Of The Health Care System For Contractors, Gary L. Williams

Walden Dissertations and Doctoral Studies

Researchers have found that military members serving in war experienced changes in physical and mental health. Military members' healthcare is managed by the Department of Defense. The problem was that management practices of the system for providing long-term healthcare for employees of a contracting company working in foreign combat zones is either minimal or nonexistent. The purpose of this case study was to explore ways that contractor managers and government managers can work together to provide healthcare for those contract employees who will be deployed with the U.S. military. The primary research question was to determine what managers of contractors …

Relationship Between The U.S. Air Force Physical Fitness Assessment And Healthcare Utilization, Elena Arushanyan

Walden Dissertations and Doctoral Studies

Escalating health care costs in the military health system are not sustainable long term. Regular physical activity has been shown to improve health and reduce health care costs. Military members serving in the United States Air Force (USAF) are encouraged to maintain physical fitness year-round and undergo mandatory physical fitness assessments (PFAs) annually. The purpose of this quantitative correlational study was to determine the nature of the relationship between the timing of the PFA and health care utilization (HU) by active duty service members assigned to the United Kingdom's USAF military treatment facility. Donabedian's framework and the logic process model …

Job Satisfaction And The Effects And Influences On Nurse Retention, Burke N. Kline

Walden Dissertations and Doctoral Studies

Researchers have predicted that by 2020 the United States will experience a severe shortage of registered nurses. The purpose of this correlation study, using the National Sample Survey of Registered Nurses 2008, was to investigate the relationship between nurse job satisfaction and its effect on nurse retention nationwide. Secondary data sets from the 2008 National Sample Survey of Registered Nurses and examining relationships between the variable of nurse retention and job satisfaction. Bivariate (correlation coefficient, chi squares, and simple linear regression) and multivariate (logistic regression) analyses identified and connected associations and examined measurement levels between the dependent and independent variables, …

Chronic Care Management Services At A Clinical Medical Group, Sharon Guccione

Walden Dissertations and Doctoral Studies

The purpose of this project was to design a chronic care plan using the chronic care management (CCM) framework to improve health services at lower healthcare costs. The practice-focused question explored whether the operationalization of the CCM model would impact progress toward the management of chronic illness for the target population of Medicare beneficiaries with 2 or more chronic illnesses in an urban acute care agency located in the western United States. The middle-range theory, logic rational plan model, Lewin’s change theory, and the CCM’s coordination care and collaborative care concepts were used to guide the project. Data were collected …

Association Between Type Of Diabetes Education And Health Status, Limitations, And Healthcare, Starr Michelle Seip

Walden Dissertations and Doctoral Studies

Diabetes is an epidemic that has started to capture political attention in the United States because of the devastating health care costs associated with the disease. Researchers in other studies have concluded that additional education face-to-face (FTF) and FTF with alternative forms of diabetes communication (FTF plus) have been beneficial. However, there is very little information on the comparison of the two groups as mentioned above when comparing chronic limitations, self-perception, health status, and healthcare satisfaction as circumscribed by specific demographic population. This study was an investigation of the above variables and explored how specific demographic characteristics (age, gender, educational …

Educational Training Of Staff Nurses For Evidence-Based Practice, Tina June Theriaque

Walden Dissertations and Doctoral Studies

Translating research into practice takes 10 to 20 years or more. Evidence-based practice (EBP) integration remains at 10% to 20%, despite recommendations requiring EBP-guided decisions. Up to 30% decreases in health care system spending, improved quality outcomes, and increased staff satisfaction result from EBP integration. Nurse leaders, who rate quality and safety as the highest priority but EBP as the lowest, are accountable for EBP enculturation; a desire to support bedside registered nurses in EBP exists, yet this EBP use knowledge gap supersedes this goal. The purpose of this project was to provide an EBP education program introducing the use …

Pain Management, Gender, And Quality Of Life In Cancer Patients, John Robert Buhmeyer

Walden Dissertations and Doctoral Studies

The type of cancer pain management used may have an effect on the quality of life (QOL) of cancer patients. Researchers have determined that cancer patients are inadequately treated for pain and pain management is an essential determinant of patient survivability and QOL. Numerous clinical studies have been accomplished concerning opioid administration and noncancer and cancer pain management exist. Previous studies have examined the relationship between cannabinoid products, noncancer pain, cancer pain, and related QOL for patients but have not focused on the QOL of cancer patients while also moderating for gender. These relationships were investigated using the health belief …

Implementation Of A Diabetic Resource Toolkit In A Veterans Administration Emergency Department, Caroline Hairston

Walden Dissertations and Doctoral Studies

Diabetes is the 7th leading cause of death in the United States. Uncontrolled diabetes and lack of self-care knowledge leads to increased emergency department (ED) visits, utilizing limited health care resources. The practice-focused question asked whether a patient-focused diabetic self-care toolkit could decrease the number of diabetes-related ED visits. The purpose of this project was to reduce the number of diabetes-related ED visits and was supported by the social cognitive theory. The sources of evidence included the facility's ED Information System (EDIS) data and a patient survey developed by the project lead. There were 149 participants (135 males and 14 …

Public Health Providers' Perceptions Of Electronic Health Records In A Disaster, Sherhonda Yvette Harper

Walden Dissertations and Doctoral Studies

The introduction of federal initiatives and incentives regarding health information technology fostered a movement towards the adoption of electronic health records (EHR). Implementation of EHRs sparked discussions among healthcare providers, patients, and others about the benefits or challenges of the move from the traditional paper method to the electronic version in healthcare settings. A knowledge gap in research involving the usefulness of EHRs and their impact to the delivery of care in other settings exists. The purpose of this qualitative study was to explore public health providers' perceptions of the meaningful use of EHRs in a disaster setting. Study participants …

Advanced Cancer Patients' Medical Decision-Making While Experiencing Financial Toxicity, Heather L. Morel

Walden Dissertations and Doctoral Studies

Financial toxicity (FT) is the impact that out of pocket (OOP) costs of cancer care have on patients' well-being, leading to lower quality of life, less compliance with prescribed therapy, and poorer outcomes, including increased mortality. The purpose of this study was to understand the impact of FT on advanced cancer patients' lives and their health care decision-making. Fuzzy trace theory provided the framework for examining how patients use gist and verbatim when making health care decisions while experiencing FT. Gist refers to main ideas that are often infused with emotional overlays that people use to make risky decisions, while …

Advocating Ideal Type Policy For Police Officer Wellness Based On Body Mass Index As A Predictor Of Self-Reported Occupational Stress, Louis Chiappetta

Walden Dissertations and Doctoral Studies

Scholars have validated both the damaging presence of police officer stress and separately, their increasing obese condition in the United States. Previous studies of police officers focus on stress or body weight, but not these variables conjointly. The purpose of this study was to inform policy creation by examining the problem of officer stress in relation to the calculated body mass index (BMI) values and to gain insight into stress outcomes. Lazarus and Folkman's stress-coping theory served as the research lens to examine if BMI would significantly contribute to the percent change of R2 variance accounted for in the predictive …

Strategies For Increasing Volunteer Engagement In Nonprofit Healthcare Organizations, Sanja Katina Hudson

Walden Dissertations and Doctoral Studies

Implementing effective strategies to address the challenges of volunteer engagement is critical for helping ensure the sustainability of nonprofit healthcare organizations. Nonprofit healthcare leaders seek strategies to increase the volunteer workforce and enhance volunteer engagement. Through the conceptual lens of Deci and Ryan's self-determination theory, the strategies nonprofit healthcare leaders used to reduce volunteer turnover were explored in this single-case study. Data were collected using semistructured interviews with 5 nonprofit healthcare leaders from a single organization in the southwestern United States. Analysis of internal and external organizational documents and publicly available data were manually coded and thematically organized. The use …

Advanced Practice Nurse Intervention And Heart Failure Readmissions, Tanesha Kemble

Walden Dissertations and Doctoral Studies

Heart failure (HF) is one of the main reasons for hospitalizations and readmissions. A local hospital collaborated with a skilled nursing facility (SNF) in 2012 with the goal of reducing systolic HF readmissions. This collaboration consisted of having an Advanced Practice Nurse (APN) who specializes in cardiac care follow up with all patients discharged from the hospital to the SNF with a diagnosis of systolic HF. The practice-focused question for this project addressed whether early follow-up and continuity of care by a cardiac APN would decrease hospital readmission within 30 days in patients with systolic HF who are discharged to …

Reducing Clabsi Rate Among Icu Patients, Rita L. Walker

Walden Dissertations and Doctoral Studies

Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a …

Improving Glycemic Control In Adult With Type 2 Diabetes, Basirat Romoke Triplett

Walden Dissertations and Doctoral Studies

Ninety percent of people with diabetes have Type 2 diabetes mellitus (T2DM). T2DM is a complex disease that affects every organ in the body, which makes effective management of the disease imperative. The American Association of Clinical Endocrinologist (AACE) and American College of Endocrinology (ACE) strongly recommended early treatment initiation among the target population to delay disease progression and complications. The purpose of this evidence-based project was to examine the impact of using the T2DM management algorithm for effective management of adults with T2DM over a 3-month period. The shared experience decision-making model and the chronic care model were used …

Leadership Communications Strategies For Enhancing Virtual Team Performance, Rachel Oludolapo Agbi

Walden Dissertations and Doctoral Studies

The fast-growing trend of using virtual teams comes with challenges including the lack of knowledge by some virtual team leaders for managing virtual teams. The purpose of this single case study was to explore the communication strategies that leaders use to manage virtual teams in real time to enhance team performance. The sample was composed of 4 successful virtual team leaders of a multinational accounting firm whose headquarters is in the northeastern region of the United States of America. The conceptual framework that guided this study was Tuckman's small group developmental model. Data consisted of semistructured interviews and the review …

Hospital Executive Succession Planning Strategies, Janet Tingling

Walden Dissertations and Doctoral Studies

Approximately 50% of New York City hospitals lack succession planning as baby boomers transition out of the workforce into retirement. The potential loss of knowledge capital could affect leadership development and corporate stability. Guided by the transformational leadership theory, the purpose of this single site case study was to explore successful strategies executive-level leaders used to facilitate succession planning within their hospital. Three hospital executive-level leaders from a single site location participated in a semistructured face-to-face interview and provided data that assisted the analysis. Four themes emerged from the data analysis through a word cloud format that showed the most …

Successful Strategies For Financial Sustainability In Nursing Homes, Renee Walthour

Walden Dissertations and Doctoral Studies

From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of …

Management Of Inappropriate Behaviors By Healthcare Risk Managers, Sahar Ebrahim Zadeh

Walden Dissertations and Doctoral Studies

Medical errors are the 3rd leading cause of death in the U.S.. The problem is timely recognition and management of inappropriate healthcare worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of fair …

Predictive Relationships Between Electronic Health Records Attributes And Meaningful Use Objectives, Solomon Nii Koppoe

Walden Dissertations and Doctoral Studies

The use of electronic health records (EHR) has the potential to improve relationships between physicians and patients and significantly improve care delivery. The purpose of this study was to analyze the relationships between hospital attributes and EHR implementation. The research design for this study was the cross-sectional approach. Secondary data from the Health Information and Management Systems Society (HIMSS) Analytics Database was utilized (n = 169) in a correlational crosssectional research design. Normalization Process Theory (NPT) and implementation theory were the theoretical underpinnings used in this study. Multiple linear regressions results showed statistically significant relationships between the 4 independent variables …

Strategies For Healthcare Payer Information Technology Integration After Mergers And Acquisitions, Kishore Maranganti

Walden Dissertations and Doctoral Studies

Despite the high rate of failure in merger and acquisition (M&A) transactions, many organizations continue to rely on M&As as their primary growth strategy and to address market competition. The purpose of this qualitative single case study was to explore strategies managers from a large healthcare payer in the midwestern United States used to achieve operational and strategic synergies during the postacquisition information technology (IT) integration phase. Haspeslagh and Jemison's acquisition integration approaches model was the conceptual framework for the study. Methodological triangulation was established by analyzing the data from the semistructured interviews of 6 senior executives and 6 IT …

Strategies For Sustaining Small Businesses In The U.S. Health Care Sector, James Utobunwa Nwachukwu

Walden Dissertations and Doctoral Studies

In the United States, many small businesses fail within the first 5 years due to poor implementation of sustainability strategies. Researchers and business practitioners have indicated that small business owners face challenges on how to maintain their businesses beyond 5 years due to lack of sustainability strategies. The purpose of this qualitative multiple case study was to explore the strategies that health care small business owners and managers in New York State use to maintain their businesses beyond 5 years. Sustainability development theory was used for the study's conceptual framework. Semistructured face-to-face interviews were conducted with 6 purposively-selected participants who …

A Diabetic Child's Impact On An African American Family, Silvanus Okeke

Walden Dissertations and Doctoral Studies

Diabetes, a chronic disease with devastating but preventable consequences, is common in the United States, especially within African American communities. Earlier research has indicated that 21.7% of African American parents have children diagnosed with Type 1 diabetes in the Mississippi Delta Region. Researchers have examined coping, stress, and behaviors of African American parents of children diagnosed with Type 1 diabetes; however, there is a gap in literature regarding how African American parents can cope with stress and how changes in health behavior due to Type 1 diabetes impact African American families. The purpose of this qualitative phenomenological study was to …

Chaplaincy Inclusion In Hospital Interdisciplinary Teams And Its Impact On Chaplains' Well-Being, Chike Nzegwu

Walden Dissertations and Doctoral Studies

Healthcare providers may impede the delivery of spiritual and emotional support to

patients and their families by healthcare professional chaplains if they misunderstand how to effectively use chaplains, who often prefer to be engaged sooner than they are. This issue prevents highly trained, board-certified professional chaplains from providing services, thereby impacting the quality of patient care. The purpose of this phenomenological study was to examine, through the lived experiences of professional chaplains, the extent to which chaplains feel that others perceive them as valued members of an interdisciplinary team (IDT), as well as to determine how team inclusion may impact …

Strategies To Mitigate Information Technology Discrepancies In Health Care Organizations, Oluwatosin Tolulope Oluokun

Walden Dissertations and Doctoral Studies

Medication errors increased 64.4% from 2015 to 2018 in the United States due to the use of computerized physician order entry (CPOE) systems and the inability to exchange information among health care facilities. Healthcare information exchange (HIE) and subsequent discrepancies resulted in significant medical errors due to the lack of exchangeable health care information using technology software. The purpose of this qualitative multiple case study was to explore the strategies health care business managers used to manage computerized physician order entry systems within health care facilities to reduce medication errors and increase profitability. The population of the study was 8 …

Leadership Strategies For Implementing Quality Improvement Initiatives In Primary Care Facilities, Jose A. Poncevega

Walden Dissertations and Doctoral Studies

Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. …

Strategies Department Store Managers Use To Increase Employee Engagement, Samara Desir

Walden Dissertations and Doctoral Studies

Business leaders are challenged with sustaining an engaged workforce to achieve economic prosperity in their organizations. The implementation of effective strategies to increase employee engagement can mitigate the challenges of employee disengagement. The purpose of this qualitative, single case study was to explore the strategies that department store managers used to increase employee engagement. The conceptual frameworks selected for the research were Vroom's expectancy theory of motivation and Kahn's engagement theory. The research participants consisted of 5 department store managers, from the northeastern United States, who successfully used strategies to increase employee engagement. Data were collected from the participants in …