Medicine and Health Sciences Commons^™

Creation Of An Evidence-Based Practice Guideline For A Seclusion Alternative, Patricia Green

Walden Dissertations and Doctoral Studies

Seclusion is a behavioral management intervention used at the practicum site to manage maladaptive behaviors seen in mentally ill patients. Seclusion is not a voluntary occurrence for patients. The practice-focused question asked: Can development of an evidence-based practice (EBP) guideline help guide health care providers in the development of a multisensory room as an alternative to seclusion for people living with mental health disorders (PLWMHD)? The purpose of this DNP project was to develop the EBP guideline for a multisensory room as an alternative to seclusion for the practicum site. To aid in the development of the EBP guideline, the …

Breast Cancer Disparities Among African American Women Corresponding To Health Service Barriers, Dianne Jamerson

Walden Dissertations and Doctoral Studies

African American women tend to experience higher health disparities in cancer-related illness than any other female population in the United States. The purpose of this qualitative case study was to identify and examine access-related barriers that play a significant role in the decision-making process of this population when seeking breast cancer health services. The central research question explored the effect that barriers to health care have on African American women in the Southeastern region of the United States. Secondary research questions explored the role the Patient Protection and Affordable Care Act of 2010 has on improving access to affordable, quality …

Demographic Differences, Self-Esteem And Sexual Assertiveness Among Black Women, Sharon Lewis-Keith

Walden Dissertations and Doctoral Studies

There is a high HIV prevalence rate for Black women in Virginia; however, few scholars have examined how sexual assertiveness and self-esteem against HIV vary within this group. Black women who have low levels of self-esteem may increase their risk for HIV. The purpose of this quantitative cross-sectional study was to determine if four aspects of sexual assertiveness (sexual initiation, sexual refusal, HIV/AIDS/STD communication, and contraception/STD prevention) differed across demographic categories and were associated with self-esteem in a diversified group of Black women living in Virginia. A cross-sectional survey was conducted with a community-based sample of 117 adult Black women. …

Weight Bias In Healthcare: An Investigation Of Impact On Obesity, Jennifer Scheffler, Fnp

Walden Dissertations and Doctoral Studies

More than two-thirds of Americans are obese or overweight. Obesity rates have risen to an epidemic level, contributing to health inequalities and leading to reduced health-related quality of life. When obese and overweight persons face weight bias by health care providers, fragmented care may occur. Ensuring positive relationships with healthcare providers is important in helping those who are obese or overweight. The purpose of this project was to understand the factors that contribute to negative weight bias in the provider-patient relationship and to identify the most effective interventions that would reduce stigmatizing attitudes and support self-awareness, acceptance, and resolution for …

Patient Experience And Readmissions Among Medicare Shared Savings Programs Accountable Care Organizations, Benjamin Michael Anderson

Walden Dissertations and Doctoral Studies

In 2011, Medicare patients represented the largest share of total readmissions and health costs when compared to all other patient categories. Because patient-centered care drives the use of health services, the U.S. Patient Protection and Affordable Care Act outlined improving the patient experience to reduce readmission rates; however, the relationship between patient experience and readmissions is not well understood. Grounded in systems theory, the purpose of this correlational study was to determine if the relationship between patient experience and readmission rates in Medicare Shared Savings Program accountable care organizations. Data from the Consumer Assessment of Healthcare Providers and Systems survey …

Perinatal Residents' Perceptions Of Confidence Gained Through Their Preceptors, Veritta Henderson

Walden Dissertations and Doctoral Studies

The importance of preceptorships, as a mechanism to transfer knowledge of evidence-based nursing practices and developing confidence in nurses, is well-known. However, the effectiveness of preceptorships to develop confidence in perinatal nurses who provide safe care to childbearing women is unknown. Guided by Kolb's model of experiential learning and using a narrative analysis approach, this study examined perinatal nurse residents' perceptions of experiences that enhanced learning and developed confidence during preceptorship. Twenty nurses who completed a perinatal nurse residency of 18 weeks or more in the past 12 months participated in audiotaped, structured interviews. Their answers were transcribed and data …

Strategies Small Construction Business Managers Use To Reduce Safety Incidents In Their Organization, Peggy Ann Mcknight

Walden Dissertations and Doctoral Studies

Globally the construction industry struggles to prevent injurious and fatal safety incidents. The purpose of this single case study was to explore strategies used by construction business managers that had significantly reduced the occurance of safety incidents in a Northwest Ohio construction company. Data were collected from organizational records and interviews with 6 construction managers. The conceptual framework for this research was the concept of safety management systems. Data were compiled and organized, disassembled into fragments, grouped, and then interpreted for meaning. Methodological triangulation and member checking were used to enhance reliability and validity. Four themes emerged from the data: …

Perceptions And Interpretations Of Posttraumatic Stress Disorder Among Cambodian Immigrant Community, Raksmey Arun Roeum Castleman

Walden Dissertations and Doctoral Studies

Posttraumatic stress disorder (PTSD) affects more than 60% of Cambodian immigrants in the United States. However, researchers do not yet know why less than 5% of Cambodian immigrants are accessing mental health services. This qualitative study involved investigation of participants' perceptions of how PTSD is manifested in the Cambodian immigrant community to understand barriers to mental health services access. The social ecological theory provided a frame for understanding how traditions, values, culture, and beliefs affect Cambodian immigrants' perceptions of PTSD and the mental health system. Data was collected from semi structured interviews of 13 participants, 18 to 70 years of …

Nurse Practitioners' Experiences With Role Transition: Supporting The Learning Curve Through Preceptorship, Viktoriya Y. Pleshkan

Walden Dissertations and Doctoral Studies

The nurse practitioner (NP) role transition is difficult and ill-supported before and after graduation. Although preceptorships are essential in supporting a NP's role transition, there is a paucity of data on student and novice NPs' experiences with their role transition and how it is supported through preceptorships. The purpose of this hermeneutic phenomenological study was to understand and describe the meaning of NPs' role transition experiences while in a preceptorship before and after graduation. Schlossberg's transition theory and the cognitive apprenticeship models were used to guide the exploration of concepts of role transition and preceptorship. One face-to-face, 3 Skype, and …

Minimizing Home Health Care-Acquired Pressure Injuries Through Effective Nursing Teamwork, Juliana Baah

Walden Dissertations and Doctoral Studies

Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients' skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain …

Meeting The Nutritional Needs Of Very Low Income Diabetic Patients, Mary Hossley

Walden Dissertations and Doctoral Studies

Adult Type II diabetes is an increasing public health problem, particularly among very low-income minority populations. The purpose of this study was to create a nutritional guide for a diabetic specific meal plan with an accompanying food pantry nutrition packet for very low-income Type II diabetic patients at a rural Mississippi Free Clinic. The practice-focused question is: Will a nurse-prepared nutritional guide with supplemental food packets improve the glucose control in low income diabetic patients? The gap in practice is that there has been no structured nutrition education guide and no food pantry support plan for Type II adult diabetics. …

Health Literacy Best Practices In Policy Development, Stacie Lee Trueheart

Walden Dissertations and Doctoral Studies

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and …

African American Women Caring For Loved Ones With Alzheimer's Disease And Dementia, Lisa M. Forbes

Walden Dissertations and Doctoral Studies

Abstract

In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the …

Evaluating A Discharge Bundle For Chronic Obstructive Pulmonary Disease, Sharon Scardina Jones

Walden Dissertations and Doctoral Studies

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the leading causes of hospital readmissions within 30 days. Frequent readmissions negatively affect hospital reimbursements and patient outcomes. Creative strategies, such as COPD care bundles, have been shown to reduce readmission rates according to existing studies. A COPD discharge bundle was developed and implemented at 1 community hospital in response to an identified problem with COPD readmissions. Evaluation of this quality improvement initiative was the purpose of this project study. The practice-focused question was: Have 30-day readmission rates changed following the implementation of a COPD discharge bundle prior to …

Challenges Of Aging With The Hiv Virus And Comorbidities, Rommie Navylia Abele

Walden Dissertations and Doctoral Studies

Since the introduction of antiretroviral therapy, the survival rate of infected HIV patients has been on the rise with a predicted increase by 2030. The longer a person lives with the virus, the more prone to HIV-associated chronic diseases he or she becomes, but it is not clear whether these diseases are solely from aging with the virus or from long-term use of antiretroviral therapy. Scientists demonstrated that the introduction of antiretroviral therapy led to an increased life expectancy yet early onset of comorbidities; however, they failed to address the challenges that people 50 years old or older face, as …

Perceived Usefulness And Perceived Ease Of Use Impact On Patient Portal Use, Dasantila Sherifi

Walden Dissertations and Doctoral Studies

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, …

Self-Disclosure Of Human Immunodeficiency Virus Status In Personal Relationships: Perceptions Of South Africans Living With Human Immunodeficiency Virus, Delile Gertrude Langeni

Walden Dissertations and Doctoral Studies

Despite enormous research on the experience of living with HIV, many questions remain regarding self-disclosure of HIV status to sexual partners by people living with HIV (PLWHIV), which is essential to reducing further infection. In this study, a phenomenological approach captured the experience of self-disclosure among South Africans living with HIV in Louwsburg, South Africa. The health belief model served as a theoretical framework, and in-depth interviews were conducted with 12 PLWHIV (8 women, 4 men) who self-disclosed their HIV status to their sexual partners. Their experiences were explored, discovering their illness, motives for self-disclosure, feelings regarding disclosing, responses of …

Streamlining Hospital Administrative Procedures To Reduce Costs, Dr. Claret Onukogu

Walden Dissertations and Doctoral Studies

Americans spent nearly $2.6 trillion, or $8,000 per person for medical and administrative costs in 2010. By 2015, healthcare spending in the United States increased to 5.8% reaching $3.2 trillion or $9,990 per individual. By tackling healthcare administrative costs, it is estimated that healthcare providers could reduce these costs by $20 billion yearly. This case study explored strategies for streamlining hospital administrative procedures to reduce costs. The business process reengineering model formed the conceptual framework for this study. Data were gathered through semistructured face-to-face interviews guided by open-ended questions with a purposeful sample of 4 hospital managers in Atlanta, Georgia. …

Complementary Infant Feeding Practices In Afghanistan, Hasibullah Na Niayesh

Walden Dissertations and Doctoral Studies

Children are at greater risk of malnutrition in Afghanistan than they are in many other countries. Malnutrition impairs the mental and physical growth of more than 50% of children in Afghanistan. It also exacerbates the risks of mortality by 45% in infants and children in Afghanistan. The purpose of this study was to determine the association between mothers' knowledge, attitudes, and practices regarding complementary feeding and malnutrition in children in Afghanistan. The precaution adoption process model served as a theoretical framework in this quantitative cross-sectional research study. Data analyzed were collected from 306 mothers and children at 6 randomly selected …

Management Of Chronic Kidney Disease By Advanced Practice Nurses, Anthony C. Amagwu

Walden Dissertations and Doctoral Studies

Despite best available care, uncontrolled chronic kidney disease (CKD) - a complex disease that impacts millions in the United States, will eventually progress to end stage renal disease which is associated with high morbidity and mortality. New evidence suggests management of earlier stages of CKD is effective in delaying disease progression. This project evaluated the impact of a CKD class, led by a nephrology nurse practitioner, on preventing disease progression in advanced CKD patients with diabetes and hypertension. The purpose of the class was to validate the need for the advanced practice nurse (APN) in the care continuum of CKD. …

Increasing Knowledge About Food Allergy Management In The Preschool Setting, Katherine Mizell Crow

Walden Dissertations and Doctoral Studies

The prevalence of food allergies is a growing concern in the United States. Approximately 8% of the pediatric population has some form of food allergy. Many of these children are either in the preschool and primary school setting, which is where the majority of allergic reactions occur. If the symptoms of a food allergy reaction are not treated within minutes of exposure, the results can be damaging or fatal. Evidence continues to demonstrate that preschool and school personnel do not feel trained or prepared should a severe reaction arise. The purpose of this evidence-based project was to determine if the …

Provider Recommendation: Influence On Colorectal Cancer Screening, Trudy Istre

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Colorectal cancer is the third leading cause of cancer related death yet is one of the most preventable. The goal of the National Colorectal Cancer Roundtable and the United States Preventive Services Task Force is that 80% of eligible patients will be screened by the year 2018. Provider recommendation has a positive impact on colorectal cancer screening rates. Methods: Completion of colorectal cancer screening rates after use of a provider standard scripted recommendation versus usual care was compared. Post intervention retrospective chart review was conducted to evaluate the percentage of patients who completed colorectal cancer screenings. Design: A pre- and …

Association Between Altitude And Bronchopulmonary Cancer, Hung Ching

Walden Dissertations and Doctoral Studies

As a validation study, this study addressed an under-researched area of bronchopulmonary cancer mortality and incidence. The association between altitude and bronchopulmonary cancer mortality and incidence was investigated using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The theoretical framework for my study was Bronfenbrenner's ecological model. This model emphasizes the relevance of social and physical environments that influence patterns of disease and injury and shape responses to these patterns of disease and injury. The age-adjusted bronchopulmonary cancer mortality and incidence rates per 100,000 people in the highest elevation and lowest elevation states …

Socioeconomic Status And Cancer Risks In Employer-Insured Cancer Survivors, Christine Clinton

Walden Dissertations and Doctoral Studies

Chronic illnesses such as cancer continue to be among the costliest for employers who provide health insurance to their employees. Despite efforts to incorporate health improvement programs in the workplace, there are concerns about the effectiveness of these programs that do not always deliver a positive return on investment. Little is known about the specific socioeconomic status of employees for whom these workplace health improvement programs are designed for. Guided by the social-ecological model, this study sought to understand the relationship between cancer health risks about socioeconomic factors among cancer survivors in the employer-insured population. Data were extracted from the …

Nursing Leadership And Employee Satisfaction Perception In A Virtual Work Environment, Angelique Duffy

Walden Dissertations and Doctoral Studies

Virtual team leaders in health care must have the right resources available to help them effectively perform their jobs. Better performance from the leader may lead to greater employee satisfaction. The problem addressed by this study was the impact of leadership style on employee satisfaction of virtual nurses. The purpose of this quantitative correlational study was to investigate the relationship between the leadership styles of virtual nursing environment leaders as perceived by virtual employee nurses and the nurses' satisfaction as measured by the Multifactor Leadership Questionnaire-short form. Building on the theoretical foundation of Bass's 1990 work, this study examined the …

Creation Of A Diabetic Health Literacy Program For Staff Of A Rural Federally Qualified Healthcare Center, Cathy Jones

Walden Dissertations and Doctoral Studies

Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase …

Length Of Pretrial Detainment For Inmates With Mental Illness, Maria Pereira-Sosa

Walden Dissertations and Doctoral Studies

There has been an increase in the number of individuals with mental illness being housed in correctional facilities over the last 50 years. In this study, the length of pretrial detention was compared for inmates who have a mental illness and are compliant with psychiatric medications, inmates who have a mental illness and are noncompliant or not prescribed psychiatric medication, and inmates with no mental illness. I also examined if inmates who have a mental illness have less severe charges and if there was a difference in the classification of mental health diagnoses for inmates who are and are not …

Breastfeeding Perceptions, Rates Of Initiation, And Duration Among Urban And Rural Women, Shaunta N. Rutherford

Walden Dissertations and Doctoral Studies

Breastfeeding is the optimal feeding method for infants up to the age of 2. Breast milk is suited to fulfill the nutritional needs of infants while providing immunological and neurological benefits. Breastfeeding rates of initiation and duration are low in the United States, especially in the state of Georgia. The purpose of this cross-sectional study was to investigate how breastfeeding initiation and duration, self-efficacy, perceptions, and community breastfeeding resources differ based on geographical location. The social ecological model was used as the theoretical framework for this study. An online and in-person survey that combined the Iowa Feeding Attitude Scale, Breastfeeding …

Cultural Perspectives On African American Adolescent Sexual Risk Behavior In Central Mississippi, Debra Suzette Smith

Walden Dissertations and Doctoral Studies

In 2015, Mississippi had the 3rd highest adolescent birth rate in the United States, high rates of sexually transmitted diseases, and enduring racial disparities between African American and White teenagers. Few researchers have described the immediate cultural environment to determine how it may influence the sexual behaviors and attitudes of African American teens. The purpose of this qualitative ethnographic study was to describe the sociocultural environment of African American adolescents in Mississippi that influences their sexual behavior by exploring the knowledge, feelings, experiences and beliefs of African American adults. The social cognitive theory was used as a theoretical framework to …

Clinical Practice Guideline For Differentiating Risk Factors For Avoidable And Unavoidable Pressure Ulcers., Vivian Suarez-Irizarry

Walden Dissertations and Doctoral Studies

Pressure ulcers (PUs) present intrinsic risk factors that are not consistently identified by clinical assessments. The objective of this project was to develop a clinical practice guideline (CPG) to provide nurses with guidance in identifying and differentiating how intrinsic and extrinsic risk factors are associated with populations at risk for developing avoidable and unavoidable PUs. CPG development followed a systematic method to search the literature, organize findings, and assess the strength of the resulting evidence and its applicability to the CPG. Quality of the CPG was assessed by a panel of 8 health care professionals using the Appraisal of Guidelines …