Medicine and Health Sciences Commons^™

Medicare And Medicaid Regulations' Financial Effects On Home Health Agencies' Performance, Binzie Roy Davidson

Walden Dissertations and Doctoral Studies

Some owners of small to medium-sized managed care businesses lack strategies to address the effects of healthcare regulations on their businesses. The purpose of this multiple case study was to identify strategies that owners of small to medium-sized managed care businesses used to address the financial effects of healthcare regulations on their businesses. The conceptual framework for this study was profit maximization and adaptation in changing contexts. Data were gathered from company documents, observations, and semistructured interviews with 5 home healthcare business owners in Los Angeles County, California. Data were coded to identify themes from the narrative segments. Key themes …

Preinfection Risk Perceptions Of Human Immunodeficiency Virus Positive Homosexual And Bisexual Men, Benjamin Singer

Walden Dissertations and Doctoral Studies

In 2017, there were 4,949 persons diagnosed with human immunodeficiency virus (HIV), 116,944 persons living with HIV, and 2,044 acquired immunodeficiency syndrome (AIDS) cases in Florida. Of the 4,972 new HIV diagnoses in Florida, 60% were related to male-to-male sexual contact, 4% from intravenous drug use, 2% from male-to-male sexual contact and intravenous drug use, 33% from heterosexual sexual contact, and 1% from other sources. Guided by the health belief model (HBM), this qualitative study sought to understand the lived experiences of HIV positive adult men who have sex with men (MSM) living in Florida, regarding their preinfection perceptions of …

Successful Demand Forecasting Modeling Strategies For Increasing Small Retail Medical Supply Profitability, Arica Watkins

Walden Dissertations and Doctoral Studies

The lack of effective demand forecasting strategies can result in imprecise inventory replenishment, inventory overstock, and unused inventory. The purpose of this single case study was to explore successful demand forecasting strategies that leaders of a small, retail, medical supply business used to increase profitability. The conceptual framework for this study was Winters's forecasting demand approach. Data were collected from semistructured, face-to-face interviews with 8 business leaders of a private, small, retail, medical supply business in the southeastern United States and the review of company artifacts. Yin's 5-step qualitative data analysis process of compiling, disassembling, reassembling, interpreting, and concluding was …

Developing Staff Education Regarding Colorectal Cancer Screening Practice Guidelines, Ruth Airiohuomo Aboiralor

Walden Dissertations and Doctoral Studies

Colorectal rectal cancer (CRC) is the 3rd most common cancer in men, the 2nd most common cancer in women, and the 4th leading cause of cancer death. Lack of screening or delayed screening for CRC is the major cause of undiagnosed cancers that become malignant and eventually become fatal. Nurses at the project site are not in compliance with CRC screening guidelines due to inadequate knowledge of the screening guidelines recommended by the American Cancer Society, which creates a gap in practice. The purpose of this project was to develop staff education on CRC screening guidelines. The practice focused question …

Relationship Between Adolescent Perception Of Harm, Electronic Cigarette Use, And Texas Antitobacco Campaigns, Candace Rasheedah Campbell

Walden Dissertations and Doctoral Studies

The increase in use of e-cigarettes in adolescents is a major public health concern that must be addressed. Research studies showed some e-cigarettes contained varying amounts of nicotine and sever cancer-causing chemicals. The purpose of this quantitative, cross-sectional study was to assess the perception of harm (dependent variable) from using e-cigarettes and being exposed to state and school-based antitobacco programs (independent variable) and to determine if the association was modified by socioeconomic status or area of residence. Attitude-social influence-self-efficacy theory was the chosen theory for research and suggests that attitude, social influence, and self-efficacy variables can be persuaded via specific …

Increasing Nursing Staff Knowledge Of Palliative Care Criteria With A Decision Tree, Juliana Cotton

Walden Dissertations and Doctoral Studies

Palliative care is often not considered during care or is considered too late in the patient’s healthcare journey to provide much benefit. The underutilization of palliative care contributes to increased healthcare costs, poor patient outcomes, and decreased patient satisfaction. The practice-focused question guiding this evidence-based practice (EBP) project was whether an education program would increase nursing knowledge regarding palliative care criteria. The program was developed using Rogers’s diffusion of innovation model and a literature review to create educational tools and achieve a sustainable EBP change. An evidence-based decision tree was developed and used as a tool for teaching and learning. …

Healthy Lifestyle Practice Among Online Health Psychology Graduate Students, Judi Elster

Walden Dissertations and Doctoral Studies

Research focused on health behaviors of online graduate students is sparse. Health psychology graduate training prepares individuals to share health information with others; the information may be more credible if they present a healthy appearance. The present study tested concepts from social cognitive theory (general perceived self-efficacy) and self-determination theory (autonomy, competence, and relatedness basic needs) to determine predictive value for graduate students’ engaging in health behaviors. Participants were 121 (29 health psychology group, 92 other programs group) online graduate students who lived in the United States and attended the same online university, recruited from multiple social media sources. The …

Feeding Practices And Nutritional Status Of Infants In Northwest Nigeria, Michael Enyi Enwere

Walden Dissertations and Doctoral Studies

Infants and young children in the Northwest province of Nigeria are susceptible to malnutrition. Inappropriate and inadequate breastfeeding and complementary feeding result in stunting, underweight, and wasting. The purpose of this cross-sectional study was to examine current feeding practices of infants not older than 2 years and their nutritional status in Northwest Nigeria. The theory of planned behavior was adopted in this research. With a total sample size of 3,861, multiple linear regression was adopted as a predictive analysis to delineate the correlation between two or more independent variables and one continuous dependent variable. Also, adopted was an independent t …

Preterm Infant Incubator Humidity Levels: A Systematic Review, Laurie Glass

Walden Dissertations and Doctoral Studies

Numerous scholars have reported that inconsistent incubator humidity in the neonatal intensive care unit (NICU) requires attention. Evidence synthesis was needed to assist the identification of optimal incubator humidity levels and duration to decrease transepidermal water loss (TEWL) and the potential for infection. The purpose of this doctoral project was to appraise and synthesize the evidence of preterm outcomes related to incubator humidity. The practice-focused question addressed what patient outcomes were impacted by incubator humidity level and duration in premature infants < 32 0/7 weeks cared for in the NICU. The foundation of this project was the Joanna Briggs Institute method for systematic reviews. Mefford’s theory of health promotion for the preterm infant was used to address the wholeness of the preterm infant’s body system. Evidence was classified using the Johns Hopkins evidence-based practice levels and quality of evidence. The search was conducted in 8 databases, and citation searching was used to identify 340 articles, 12 of which met the inclusion criteria. The evidence demonstrates that the practice of incubator humidity is warranted; however, it does not come without risks. Microbial growth was increased in high levels of incubator humidity. Unnecessary TEWL was prevented by lowering high levels of incubator humidity after the 1st week, improving skin barrier formation. Incubator humidity of 60%–70% in the 1st week was effective in preventing TEWL in infants born ≥ 26 weeks; however, future research is needed for infants < 26 weeks. When optimal levels and duration of incubator humidity are achieved, positive social change will occur from the improved outcomes of the smallest neonatal patients.

Cited And Underprepared; The Call For Improved Emergency Preparedness In Ltc Facilities, Dawn M. Ide

Walden Dissertations and Doctoral Studies

This research investigated the connection between the Medicare star rating system and E-tags on emergency preparedness of nursing homes for disasters in Hampton Roads, Virginia. Emergency preparedness in nursing homes has been a topic of growing interest within the past decade. Hampton Roads, Virginia, has a history of natural disasters including hurricanes and flooding, which necessitates a proper and efficient emergency preparedness plan in nursing home facilities. The primary purpose of this research was to review the secondary Centers for Medicare and Medicaid Services (CMS) data regarding the star rating system and E-tag surveys of each of the 37 nursing …

Positive Deviance Behaviors And Definition In Nursing, Stacy L. January

Walden Dissertations and Doctoral Studies

The concept of positive deviance (PD) has not been studied in the context of nursing. Grounded in narrative inquiry and combined with vocabularies of motive and symbolic interactionism, the purpose of this study was to explore whether PD behaviors existed in nursing, and if so, to develop an operational definition of PD for nursing. The research question addressed what PD behaviors, if any, were present in nurses’ workplace stories. Using posted flyers, eight participants either self-selected or were selected by snowball method to participate. Interviews were conducted in locations decided on by each participant. Interview data were obtained, transcribed, then …

Racial Disparities, Fragmentation Of Care, And Adverse Outcomes Associated With Ectopic Pregnancy, Angela Rosa Jourdain

Walden Dissertations and Doctoral Studies

Ectopic pregnancy (EP) is a rare condition that occurs in 1% of all pregnancies. However, women of lower socioeconomic status (SES) and ethnic minority groups are at greater risk of adverse outcomes associated with EP than White women. The purpose of this study was to examine data from the 2014 National Inpatient Sample to identify predictors of complications from EP in 2,626 females ages 15-44 in the United States. The theoretical framework used to guide this study was the theory of fundamental causes to explain why the association between SES and mortality has persisted despite progressive advances in the diseases …

A Staff Training Plan On Screening African Americans For Prediabetes, Valerie Kershaw-Berry

Walden Dissertations and Doctoral Studies

African American adults have higher risks of undiagnosed Type 2 diabetes, uncontrolled Type 2 diabetes, and complications from Type 2 diabetes than members of other racial groups. Health care providers in rural Tennessee lack staff training plans for prediabetes screening of older African American adults. In addition, few rural Tennessee health care providers have programs in place to train staff in prediabetes screening, screening instrument use, and interventions for Type 2 diabetes prevention. The focus of this DNP project was on developing an evidence-based staff training program designed to improve knowledge regarding prediabetes screening in older African American adults. Concepts …

Improving Nursing Knowledge Of African American Heart Failure Self-Care Management, Sharnee Moore-Jervis

Walden Dissertations and Doctoral Studies

Heart failure is a complex chronic disease affecting 6.6 million people in the United States, with an annual cost of $39.2 billion per year. African Americans are at an especially high risk for poor outcomes and readmissions from heart failure complications, as they are 2.5 times more likely to develop heart failure than other ethnic groups. This disease requires a high level of patient self-care management, and evidence suggests that African Americans do not always receive culturally sensitive education, which can lead to suboptimal self-care practices. The practice-focused question for this educational program asked whether nurses of African American patients …

A Lifestyle Modification Toolkit To Increase Physical Activity Among Young Adults, Anthonia Ninikanwa Nwanna

Walden Dissertations and Doctoral Studies

Substantial decreases in physical activity have been observed between early to late adolescence in males and females, with decreases in levels of activity into adulthood. Physical inactivity among young adults leads to medical conditions such as Type 2 diabetes, stroke, ischemic heart disease, falls resulting in hip fractures, and depression later in life. Advanced Nurse Practitioners have a significant impact on the problem of physical inactivity among young adults through education to improve knowledge regarding physical activity participation. The focus of this project was to develop a toolkit on lifestyle modification as a resource for physical education teachers and nurses …

Staff Education: Hypertension Management For Adults In Primary Care Settings, Doris Adediwura Obaze

Walden Dissertations and Doctoral Studies

Management of hypertension and its complications requires health care providers to

understand the reason for developing the disease. Complications of hypertension (HTN)

are more prevalent when patient interventions are not consistently performed by staff. A

gap in staff knowledge regarding the management of patients with HTN was noted at an

outpatient clinic in the southwestern United States. A staff education project based on

the Eighth Joint National Committee (JNC-8) guidelines for HTN management was

developed to address the gap in knowledge. This DNP project sought to understand the

impact of an evidence-based staff education program in improving the knowledge of …

Understanding The Impact Of Choice Claims In Health Policy Among Veteran Patients, Stacie Marie Rivera

Walden Dissertations and Doctoral Studies

The patient-as-consumer has emerged as a narrative in the government health care system that cares for beneficiary veteran patients, elevating the phenomenon of choice in health care legislation and administration. The problem of the submerged state of a health policy was the issue examined within the context of access to health care and what patients experience when choice is present. The purpose of this study was to explore the motivations of beneficiary veteran patients to choose a preventive care option, a seasonal flu shot, at a private sector retail pharmacy rather than at their government health care provider, with the …

Utilizing Food Safety Knowledge In Comprehensive Patient Care Among Harlem Hospital Physicians, Sean Alexander Shivers

Walden Dissertations and Doctoral Studies

According to the World Health Organization (WHO), people throughout the world become sick every year from consuming contaminated foods, which impacts countries’ socioeconomic development, straining their healthcare system, travel and tourism, and foreign trade markets. To help alleviate the impact foodborne illness (FBI) has on society, scholars suggest physicians incorporate food safety in their standard work practice. The purpose of this study was to determine if Harlem Hospital physicians utilized food safety knowledge in comprehensive patient care with a diagnosis of FBI, in addition to how physicians passed this food safety information onto the patient. A qualitative methodology using an …

Implementation Of An Evidence-Based Diabetic Foot Care Protocol And Impact On Health Outcomes, Tina Marie Warfield

Walden Dissertations and Doctoral Studies

Diabetes is a condition that can lead to foot ulcers that often progress to amputation of a limb. Providing patients with education about foot care is crucial because it can help to prevent or minimize the incidence of foot ulcer development and amputation of a limb. Foot care education as a strategy not only empowers patients with proper foot care knowledge and skill to support and motivate self-care but can also enhance the partnership between the provider and patient. The purpose of this quality improvement project was the implementation of a sustainable evidence-based foot care program for adult patients with …

Novice Nurse Respiratory Educational Component's Impact On Confidence And Knowledge, Peggy Lynn Cline

Walden Dissertations and Doctoral Studies

The hospital-based novice nurse is presented daily with complex patients with multiple coexisting morbidities, which demands increasing responsibility for evidence-based clinical decision-making to prevent adverse health outcomes and associated high health costs. Knowledge and confidence of novice nurses in a medical-surgical unit in the assessment and clinic management of the respiratory system was identified as a gap during onboarding of new nurses. The purpose of this doctoral staff education project was to determine whether a respiratory educational component added to a medical-surgical novice nurse's orientation would impact the respiratory confidence and knowledge of respiratory assessment and clinical management. Benner's nursing …

The Impact Of Campus Health Services On The Attitudes, Perceptions, Beliefs, And Behaviors Of Historically Black College And University Students, Micah Mccray Griffin

Walden Dissertations and Doctoral Studies

African Americans suffer worse health outcomes related to chronic disease than any other racial or ethnic group. The negative effects associated with poor dietary habits and a low propensity to exercise impact young adult African Americans who attend Historically Black Colleges/Universities (HBCUs) and can lead to higher mortality rates. It is important for HBCU campus health centers to address the perceptions and beliefs of students to positively impact health behaviors associated with diet and exercise. At the time of this study, there was limited research on-campus health centers and their impact on HBCU student health beliefs and behaviors. Therefore, this …

Mothers' Parenting Discipline Style And Their Early Puberty Daughters' Engagement In High-Risk Behaviors, Yvette C. White

Walden Dissertations and Doctoral Studies

Some early puberty girls engage in high-risk externalizing behaviors such as early sexual activity, delinquent behavior, and disruptive behaviors. Harsh parenting experienced by girls who develop early has been associated with delinquent and disruptive behaviors. The purpose of this quantitative correlational study was to examine predictive relationships between the style of parental discipline by mothers of early puberty girls and the likelihood and frequency of the girls' engagement in high-risk behaviors. Parenting style theory, including the authoritarian, authoritative, and permissive style of parenting, served as the theoretical foundation for the study. Survey data were collected from 28 mothers who identified …

Predictive Relationship Between Socio-Demographics, Medication, And Treatment Completion Among Persons Experiencing Homelessness Treated For Tuberculosis, Sophia Ajoku

Walden Dissertations and Doctoral Studies

Approximately 80% of people who contract tuberculosis (TB) in the United States are first infected with untreated latent tuberculosis infection (LTBI). LTBI is an ongoing public health concern in people who experience homelessness. Because of the transient nature of this population, it is often difficult for them to adhere to and complete treatment for LTBI. In this quantitative, correlational of a cross-sectional study, secondary data was from a public health clinic in southern U.S. The theoretical framework used for the study was the social ecological framework. Multiple logistic regression was used to determine if a statistically significant predictive relationship existed …

Strategies Healthcare Managers Use To Reduce Employee Turnover, Christopher Sean Atkins

Walden Dissertations and Doctoral Studies

Healthcare managers who are unaware of the various strategies that exist for reducing turnover could adversely affect patient care, organizational morale and performance, and the achievement of organizational goals. The purpose of this qualitative multiple case study was to explore strategies healthcare supervisors used to reduce employee turnover. The participants comprised 3 senior healthcare managers located in central Texas responsible for hiring, firing, training, supervising, and successfully using strategies to reduce employee turnover. Herzberg's motivation-hygiene theory provided the conceptual framework. Data were collected from semistructured interviews and a review of company documents. Thematic analysis of the data resulted in 5 …

The Role Of Online Support For Anaplastic Thyroid Cancer Patients And Survivors, Bevin J. Nixon

Walden Dissertations and Doctoral Studies

The rate of thyroid cancer diagnosis has risen, and researchers' findings point to improved diagnostic testing and overdiagnosis as well as increases in actual incidences as the reasons behind this rise. With improved treatments and testing methods, the number of thyroid cancer survivors has also increased. Thyroid cancer presents challenges to coping and can cause significant stress in an individual's life. More specifically, anaplastic thyroid cancer (ATC) creates complicated challenges for patients and survivors. The problem is patients need support during diagnosis and treatment when adjusting to their 'new normal' and may be reaching to Internet based social support groups …

Employee Retention Strategies For Executive Operation Leaders In An Academic Nursing Environment, Polly Castro Ramos

Walden Dissertations and Doctoral Studies

Employee attrition affects organizations in the form of lower productivity, decreased profitability, and reduced sustainability. In 2014, business owners lost over $11 billion in tangible and intangible assets due to the inability to retain employees. Using the social exchange theory as the conceptual framework, the purpose of this multiple case study was to explore effective employee retention strategies used by business leaders in an academic nursing environment. The study encompassed participants from 3 of the United States: Texas, Kentucky, and Florida. Participants were purposefully selected because of their experience in implementing effective employee retention strategies. Data were collected via semistructured …

Preventing Patient On Nurse Violence Through Education, Sandra Risoldi

Walden Dissertations and Doctoral Studies

Many nurses are physically and verbally abused by the patients under their care, with those providing care to patients dealing with mental illness or addition being at particular risk. Leadership of the project site, an urban mental health treatment center, identified a need to provide additional education to improve their nursing staff's ability to work with combative patients and prevent escalation of violent behaviors. Albert Bandura's social cognitive theory and adaptation to the environment guided the development of this project to answer the question if an education program for nurses working with potentially combative patients will increase their knowledge of …

Factors That Influence Physical Activity Among African American Mothers At Recreation Centers, Nichole Leigh Glover

Walden Dissertations and Doctoral Studies

Physical activity is a critical factor in preventing obesity and other chronic illnesses. African American women experience higher rates of physical inactivity than the general population. As a key figure in the family, African American mothers should model healthy behaviors to the family, especially their children. This qualitative study explored the physical activity attitudes of African American mothers who frequently visit a recreation center in the Columbus, Ohio, area. The research questions focused on the possible barriers and motivators for physical activity engagement. The theory of planned behavior, which emphasizes behaviors, intentions, and attitudes when exploring health behaviors, guided the …

Nurse Executives' Lived Experience Of Incorporating Caring Leadership, Rachel Elizabeth Stepp

Walden Dissertations and Doctoral Studies

The link between compassion and caring at all levels of nursing practice and the enhancement of the patient experience is well-documented. However, the techniques nurse executives use to incorporate caring into their daily practice while coping with competing organizational priorities is poorly understood. The purpose of this qualitative phenomenological study, guided by Watson's theory of human caring, was to examine detailed accounts of the experiences of nurse executives incorporating compassion and caring into their daily practice, including techniques they use to build and sustain compassion and caring while balancing competing priorities. A purposive sample of 10 nurse executives participated in …

Addressing Vision Impairment In Mozambique And The Africa Region, Stephen Thompson, Kovin Naidoo, Joel Bambamba, Vanessa Moodley, Diane Van Staden, Amanda Forde, Kajal Shah, Luigi Bilotto, James Loughman

Articles

The Mozambique Eyecare Project was an international partnership to implement and research eye health education in Mozambique and the Africa region. An optometry degree was developed at Universidade Lúrio, Mozambique. In addition, existing eye health workers were upskilled with training. Researchers from various disciplines evaluated the project and its potential for impact on eye health in the region. The body of evidence generated from the research provides useful lessons for development programmes in general, as well as specific lessons for delivering eye health education and service delivery models for low income settings.