Medicine and Health Sciences Commons^™

Strategies For Compliance With Government Regulations In A Pharmaceutical Company, Charles Jagun

Walden Dissertations and Doctoral Studies

Pharmaceutical companies accrued fines of over $30 billion within 25 years because of noncompliance with regulations. Noncompliance with regulations results in fines and an adverse impact on company profitability. Some pharmaceutical company managers lack effective strategies to ensure overall company compliance with regulation. Based on complexity leadership theory, the purpose of this single case study was to explore strategies pharmaceutical company managers used to ensure compliance with regulatory requirements in Nigeria. The target population was functional managers purposely selected because they had successfully implemented strategies for compliance with the regulatory requirements in Nigeria. Data were collected through face-to-face and telephone …

Hiv Testing Service Utilization Among Men And Women In Dominica, Carol Rosetta Jno.Baptiste-Smith

Walden Dissertations and Doctoral Studies

Voluntary HIV/AIDS testing and counselling (VHTC) is one of the preventive measures used in many countries to decrease the spread of HIV/AIDS. Archived data from National HIV/AIDS Response Program's (NHARP) raw 2016 dataset were used to identify relationships and to assess significant differences between sociodemographic factors and selected sexual risk behaviours versus VHTC practices among adults 18 years and older who resided in Dominica. The health belief model was used as the framework for this cross-sectional study. The sample comprised 982 participants (40% [394] men and 60% [588] women). Logistic regression analysis was used to assess associations between sociodemographic and …

A Patient-Centered Approach To Diabetes Education In A Rural Clinic, Paul Okpuzor

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a heterogeneous metabolic disease impacting more than 8.3% of adults in the United States. Diabetes-related care accounts for more than 11% of all patient care expenditures. The purpose of this project was to identify the primary concerns of members of the T2DM patient population in an underserved clinic in rural southcentral United States and to make recommendations for a staff diabetes education program to address these concerns. Orem's theory of self care outlined the importance of educating and supporting patients in their efforts to manage their own healthcare. Knowles's assumptions of how adult's learn …

Leveraging Artificial Intelligence To Improve Provider Documentation In Patient Medical Records, Evangeline C. Ozurigbo

Walden Dissertations and Doctoral Studies

Clinical documentation is at the center of a patient's medical record; this record contains all the information applicable to the care a patient receives in the hospital. The practice problem addressed in this project was the lack of clear, consistent, accurate, and complete patient medical records in a pediatric hospital. Although the occurrence of incomplete medical records has been a known issue for the project hospital, the issue was further intensified following the implementation of the 10th revision of International Classification of Diseases (ICD-10) standard for documentation, which resulted in gaps in provider documentation that needed to be filled. Based …

Trauma And Juvenile Justice In Carson City, Nevada, Ali M

Walden Dissertations and Doctoral Studies

The Nevada State Juvenile Justice and School systems do not currently screen or treat juveniles for post-traumatic stress disorder (PTSD). Left untreated, PTSD may contribute to behaviors that can lead to engagement with the juvenile justice system and contribute to high rates of recidivism and possible future engagement with the adult justice system. Using Erickson's theory of psychological development as the foundation, the purpose of this case study was to explore whether, from the perspectives of key stakeholders whether interventions and prevention services for juvenile justice clients in Carson City met the needs of youthful offenders also diagnosed with PTSD. …

Assessment And Treatment Of Postpartum Depression Among Mothers In Imo-State, Nigeria, Allison Chinyere Nnaka

Walden Dissertations and Doctoral Studies

Postpartum depression affects many postpartum mothers. When postpartum depression is not timely assessed, identified, and treated, it can lead to problems with mother child bonding and cause family problems, negligence, and infant death. The purpose of this phenomenological study was to understand Imo State women's lived experiences and perception on sufficiency of the assessment and treatment received for their postpartum depression. The conceptual theory for this study was the empowerment theory. In-depth, face-to-face interviews were conducted to examine 10 Imo State postpartum mothers' lived experiences of assessment processes and to understand if their psychological desires were addressed. The interviews were …

Impediments Of Self-Managed Type 2 Diabetes In Mgbidi Women, Nigeria, Augustina Oha

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a complex metabolic disorder characterized by hypoglycemia or hyperglycemia that affects fat, protein, and carbohydrate metabolism. Researchers have identified that for individuals with Type 2 diabetes, staying on interventions for diabetes self-management is sometimes difficult and challenging. It is an increasing public health concern, especially in certain minority populations and in many developing and developed nations. This is especially true for the population of women 40 years and older in Mgbidi, Nigeria. In the Enugu State of Nigeria, women bear most of the burden of Type 2 diabetes when compared to the males in the state. …

Colorectal Cancer Awareness And Screening Guideline For African American Populations, Keyna Omenukor

Walden Dissertations and Doctoral Studies

Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening

provides the best prospects for preventing the morbidity and mortality associated with the

disease. Nurses have the duty to promote health and prevent diseases. However, low rates

of colorectal cancer screening continue to be reported, especially among African

Americans who continue to suffer disproportionately from the disease. There is a need for

a culturally-sensitive clinical practice guideline that nurses can use to educate patients

appropriately on colorectal cancer. The practice focused question for this project was

designed to explore whether a culturally-sensitive clinical practice guideline to increase

colorectal …

Neighborhood-Level Predictors And Obesity Among African-American Children, Uche Onyeka

Walden Dissertations and Doctoral Studies

The steady raise in childhood obesity is a major public health problem nationally and globally. Childhood obesity is primarily caused by an imbalance between caloric intake and caloric expenditure. The increase in childhood obesity rates over the past 3 decades suggested involvement of environmental and behavioral factors in the obesity epidemic. While childhood obesity is considered a public health crisis in the United States, only limited research is available about the potential impact of neighborhood-level factors such as access to healthy food, neighborhood safety, and risk-free outdoor playgrounds. The purpose of this study was to examine if any relationships existed …

The Lived Experiences Of Managing Uncertainty In Chronic Illness, Amanda Brown

Walden Dissertations and Doctoral Studies

Chronic illness is an increasing concern in the United States as the CDC reports that about 50% of adults have at least 1 chronic illness. When individuals must adjust to chronic illness they may experience uncertainty regarding the illness, prognosis, and symptoms. The purpose of this qualitative, phenomenological study was to explore the lived experiences of individuals living with uncertainty in chronic illnesses. A Merle Mishel's uncertainty in illness theory was the framework used to explore the lives of individuals diagnosed and living with chronic illness. In-depth interviews were conducted with 8 individuals who have chronic disease; data were audio-recorded …

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 …

Perceptions Of Private Medical Practitioners Towards The Nigerian National Tuberculosis Treatment Guidelines, Chijioke Pius Osakwe

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) is a major public health problem in many parts of the world. Nigeria is one of the 30 countries in the world that has the highest burden of TB. Private medical practitioners in Nigeria play an important role in health care delivery. Motivating them to adhere to TB treatment guidelines in managing persons suspected of having TB or diagnosed with the disease is one of the strategies employed by the National Tuberculosis Program to Reduce the Burden of TB. Few studies were identified which used qualitative study approaches to study the perceptions of these practitioners towards the TB …

Providers' Treatment For Overweight Navy Members And The Effect On Motivating Lifestyle Changes, Misty Scheel

Walden Dissertations and Doctoral Studies

In the military, excessive weight could put members at risk for training injuries, loss of potential career opportunities, and possible discharge from military service. This could increase cost to United States' national defense through increased injuries, decreased retention due to early discharge, cost of retraining, and lifelong chronic health conditions. The purpose of the study was to determine if there was a correlation or predictive value between active duty Navy members' perception of care provided for weight management and the active duty Navy member's motivation for weight management interventions. The social capital theory served as the theoretical framework for this …

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 …

Workplace Bullying From A Nurses Perspective, Dawn Reid White

Walden Dissertations and Doctoral Studies

Bullying has long been associated with school children. In recent years, however, more attention has been paid to the bullying that has reached beyond the playground and into the workforce. One population facing this problem is staff nurses. To date, no one has found an effective way to address workplace bullying in the healthcare field, nor have effective methods been found for retaining trained nurses affected by this problem. The focus of this dissertation was on understanding nurses' lived experiences and how nurses decided to remain in their current working position despite these problems. Taking a phenomenological approach and using …

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 …

Effects Of Social Support On Health-Seeking Behaviors Among African-American Men Who Have Sex With Men, Chan Moore

Walden Dissertations and Doctoral Studies

The rate of HIV/AIDS infections among African American men who have sex with men (MSM) is alarming. There has been a challenge in reducing HIV/AIDS among the African American MSM population due to internal and external factors that affect their decision making. The theory of social support and reasoned action were applied to gain knowledge on the lived experiences and perceptions of African American MSM as related to social support and seeking health care, which can help fight the heavy impact HIV/AIDS has placed on this population. Data was collected from 14 African American men who openly identified as MSM. …

Low Health Literacy And Hpv Vaccine Uptake Of African American And Hispanic American Women, Peter Ntiamoah

Walden Dissertations and Doctoral Studies

Cervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic American women are low. The purpose of the study was to determine if a significant relationship existed between the health literacy levels of African American and Hispanic American women, ages 18-26, and the low HPV vaccination uptake. The integrated behavioral model, which …

Effects Of Patient Protection And Affordable Care Act On Behavioral Health Access, Godwin Oshegbo

Walden Dissertations and Doctoral Studies

About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study …

Implementing A Healthy Diet In The Intellectual Disability Residential Community, Stephanie Michelle Shelton

Walden Dissertations and Doctoral Studies

The problem addressed in this study was how staff working in a residential agency for individuals with an intellectual disability (IID) make decisions about how to implement a healthy diet. The purpose of this study was to identify the influences on decisions made by staff on the meals they provided to their clients with an IID. The theory of planned was used to study the influences of attitude, subjective norms, and perceived behavior control on the meals provided for IID. The key research question explored how staff members make decisions. A qualitative case study design was used. The 12 participants …

Health Disparities Among Hispanic Americans With Type 2 Diabetes, Nelson Sitton

Walden Dissertations and Doctoral Studies

The ongoing increase in Type 2 diabetes among Hispanic Americans challenges the American public health system, particularly with health issues arising from not following appropriate health directives for the disease. This quantitative, cross-sectional, correlational study used primary data to assess the relationship between diabetes knowledge (as measured by the Diabetes Knowledge Questionnaire), health literacy level (as measured by the Short Assessment of Health Literacy-Spanish and English), education level, self-efficacy (as measured by the Diabetes Self-efficacy questionnaire), and self-reported diabetes self-care behaviors (as measured by the Summary of Diabetes Self-care Activities) among a sample of Hispanic Americans with Type 2 diabetes. …

Perceptions Of Healthcare Workers Toward Influenza Vaccination, Amos Adedokun

Walden Dissertations and Doctoral Studies

Even though influenza vaccinations were provided free to all healthcare workers in the United States, healthcare workers were not 100% compliant. The non-compliance with influenza vaccinations may expose their patients, their families, and the public at large to a high-risk source of influenza infection. This study's research questions included how registered nurses perceived influenza and influenza vaccination; registered nurses' self-reported incidents with influenza vaccination; and factors that contributed to registered nurses' non-compliance with influenza vaccination. Guided by the theory of reasoned action and the theory of planned behavior, the purpose of this qualitative study was to determine the factors that …

Systematic Review Of The Literature On Why There Is Hospice Underutilization, Maria J Garcia

Walden Dissertations and Doctoral Studies

Despite hospice and palliative care services being available for patients at the end-of-life, it remains an easily accessible health care service which has been mostly underutilized and/or misunderstood. For this project, the practice problem was underutilization of hospice and palliative care services. A systematic review of the literature which focused on under usage of end-of-life care was conducted. MEDLINE, CINAHL, and ProQuest Nursing and Allied Source databases were searched (2005 to 2017). Studies that evaluated interventions for increasing hospice and palliative care services were selected. Conceptual variables included studies that addressed the under usage of end-of-life care. Kolcoba's comfort theory, …

Using Calcaneal Heel Ultrasounds To Screen For Osteoporosis At Alaska Health Fairs, Heather Guess

Walden Dissertations and Doctoral Studies

Osteoporosis is a major health problem. The Alaska Department of Health and Social Services reports national rates of osteoporosis at 13-18% of women and 3-6% of men over age 50, but current evidence suggests that osteoporosis rates in Alaska are more equal between sexes. Known risk factors for osteoporosis that are very common among Alaskans include arthritis and low vitamin D and calcium levels. The U.S. Preventive Services Task Force (USPSTF) recommends dual-energy x-ray absorptiometry (DXA) scans of the hip and lumbar spine as the gold standard of screening for osteoporosis; however, DXA scans are expensive, not portable, and not …

A Comparison Of Social Disconnectedness And Perceived Isolation In Deaf/Hard Of Hearing Women And Hearing Women, Mellissa Perry

Walden Dissertations and Doctoral Studies

Previous research has concluded that hearing loss is related to psychological risk factors in a person that could potentially increase feelings of disconnect or isolation. However, the gap in literature and lack of knowledge regarding social disconnectedness and perceived isolation specifically for deaf/hard of hearing women makes it difficult for clinicians to develop appropriate programs to assist this population. The purpose of this study was to contribute information regarding the effects of hearing loss on social disconnectedness and perceived isolation to help clinicians create proper treatment plans to better assist the deaf/hard of hearing with negative feelings (e.g., loneliness, depression) …

The Use Of Scorecards To Improve Documentation Of Obstetrical Blood Loss, Marilyn Cejka Steinberg

Walden Dissertations and Doctoral Studies

Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality. The measurement of quantitative blood loss (QBL) at delivery prevents clinicians from failing to recognize hemorrhage in healthy obstetric patients who initially compensate for excessive blood loss. The purpose of this project was to improve the compliance of labor and delivery nurses in a community hospital with consistent QBL measurement. Key theories that formed the basis for the project were Lewin's theory of planned change and homeostasis. The project question addressed was: Is the use of weekly scorecards to provide feedback to nurses with both blinded …

Cultural And Environmental Determinants Of Dental Discoloration Among School-Aged Children In Nigeria, Ogbudu Gabriel Ada

Walden Dissertations and Doctoral Studies

Dental discoloration from fluorosis is a global public health problem. In Nigeria, 11.4% of the population is impacted by this disorder. Dental discoloration is caused by successive exposures to high fluoride concentrations during tooth development in utero and it is linked to the development of a variety of psychological and physiological problems, from dental aesthetics to a reduction in intelligence and skeletal changes. The purpose of this quantitative, cross-sectional study was to examine the cultural and environmental determinants of dental fluorosis in children in a rural community in Nigeria. A multilevel theoretical model was used to develop possible fluoride exposure …

Church-Based Intervention On Prostate Cancer Screening For African American Men, Sherly Marie Boulay

Walden Dissertations and Doctoral Studies

African American men have a significantly higher incidence of prostate cancer, they are diagnosed at a later age, have more advanced stages of cancer at diagnosis, and higher mortality rates than other ethnic group. The purpose of this project, guided by the Ottawa decision support framework and the health belief model, was to investigate whether church leaders could be trained to deliver an educational program about the value of prostate cancer screening to African American males in a church setting. The 2 participants were church leaders in a predominantly African American church. The participants were taught about prostate cancer and …

Systematic Review Of Nurse Residency Programs, Abiola Olatokunbo Ajanaku

Walden Dissertations and Doctoral Studies

The first 2 years of a new graduate nurses career can be stressful and traumatic. Many new graduates leave the profession within their first 2 years of employment. Organizations have sought to implement programs that will promote new graduate job retention. Nurse residency programs (NRPs) are programs geared toward fostering and nurturing new graduates once they begin their nursing careers. Residency programs can last anywhere from 3 months to 1year, depending on the nursing specialty. A key component in retaining new graduates is to facilitate a successful transition into nursing practice. This project served as a systematic review regarding the …

Perceptions Of Preconception Health And Prenatal Care By Young Adult Women And Men At Risk For Unintended Pregnancies, Broderick Crawford

Walden Dissertations and Doctoral Studies

Among young adults at risk for unintended pregnancies, preconception health and prenatal care programs aimed at positive birth outcomes remain unaddressed. The purpose of this phenomenological study was to explore the lived experiences of young adults in terms of their willingness to use preconception health and prenatal care as a means for increasing both positive birth outcomes and overall health. All study participants met the following criteria: (a) young adult man or woman, (b) age 18 to 25, (c) at risk for unintended pregnancies, (d) sexually active, (e) single or in cohabiting partnerships, and (f) living in the greater Los …