Medicine and Health Sciences Commons^™

Association Between Pm2.5 And The Coexistence Of Chronic Obstructive Pulmonary Disease And Coronary Heart Disease, Shan Gao

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To identify PM2.5 as a risk factor for chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) respectively, and to explore the magnitude of the association of PM2.5 with the coexistence of CHD and COPD, by using the combined dataset of 1999-2014 EPA Air Data and 2017 BRFSS SMART data (age 18 and older).

Methods: Cross-sectional study was designed to identify the association between PM2.5 exposure and COPD and CHD. The PM2.5 exposure values were adapted from the county-level EPAAir Data, the yearly mean values of PM2.5 were used to determine the association. Characteristics of sex, age, race, …

Retrospective Policy Analysis Of Kentucky House Bill 1, Sarah E. B. Covey

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: In 2011, the Centers for Disease Control (CDC) coined the phrase, “opioid epidemic” in response to the staggering increase in opioid use and opioid- related deaths. Kentucky House Bill 1 (HB1) passed in 2012, attempted to stifle the impact of the opioid epidemic on the citizens of the Commonwealth by imposing supply-side restrictions on the prescription and dispensing of opioid pills. Objective: The primary objective of this analysis is to evaluate the effectiveness of HB1 on the reduction of opioid-related deaths, opioid prescription rates, and intravenous opioid drug use rates. Methods: This analysis employed Eugene Bardach’s framework for policy …

A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Access to clean water and sanitation is known to decrease childhood mortality, improve health outcomes, and decrease risk of water-borne diseases. However, access to clean water is often restricted in impoverished or indigenous communities. This cross-sectional study evaluated the primary source of drinking water for forty homes, the Est. Cheche river, a local spring, and a local school in the TsáChila indigenous community of El Bua, Santo Domingo, Ecuador. This analysis focused on the presence of coliforms and E. coli in the water source (well or city/piped), the physical parameters of the water and the type of sanitation …

Disparities In The Risk Of Subsequent Primary Cancer Diagnosis And Recurrence Among Women With Breast Cancer (First Primary) In Kentucky, Pierre Fwelo

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and objectives

Breast cancer is one of the most common malignancies among women in the United States. Women residing in the state of Kentucky have breast cancer incidence and mortality rates greater than the national average. Recent studies suggest an association between breast cancer subtypes/hormone receptor (HR) status and the risk of recurrence and the onset of subsequent primary cancer, however, limited research has focused on Kentucky or its Appalachian region.

Investigating these associations may potentially save lives by providing information that can be used in breast cancer education in Kentucky, assessing the population at greater risk of recurrence …

Mentoring Nursing Leaders To Foster Frontline Accountability And Engagement In Continuous Performance/Process Improvement Through The Utilization Of Team Huddles And A Huddle Board, Brandon L. Buckingham

DNP Scholarly Projects

BACKGROUND: Establishing a connection for staff between the work being done and the associated implications and outcomes on patient safety and quality care delivery is not often a simple task for any nursing leader. Team huddles and huddle boards aim to establish and foster frontline accountability and engagement for continuous process and performance improvement. The setting of the project was a 17-bed acute care inpatient unit specializing in neurosciences within an academic medical center. Participants included nursing leaders and staff of the unit.

METHODS: Consultation and mentorship in conjunction with standard work were utilized for this project. The intervention was …

Utilizing Telecommunication To Provide Patient Centered Care For Adults Newly Diagnosed With Gi Cancer: A Quality Improvement Project, Laurie Miller

DNP Scholarly Projects

INTRODUCTION: A confirmed diagnosis of GI Cancer causes anxiety and stress as patients become overwhelmed with questions, worries and fears. At diagnosis, patients are not yet formally connected to the support services available to those actively receiving chemotherapy, creating a “gap period”. To help reduce anxiety, as well as, foster therapeutic relationships and improve overall patient experiences, a structured telephone communication by the gastrointestinal cancer oncology nurse practitioner (GI NP) was proposed.

AVAILABLE KNOWLEDGE: Reduction of anxiety has been shown to enhance the quality of life, increase compliance with a prescribed treatment plan and foster the ability to sign informed …

Quality Improvement On The Long-Term Care Ventilator Unit: Interventions To Increase Patient Safety And Prevent Patient Harm, Billie Anderson, Joanne Samuels

DNP Scholarly Projects

BACKGROUND: Tracheostomy patients are susceptible to life-threatening emergencies when their airways are compromised. Epidemiologic data suggests that 3.2% to 30% of tracheostomy patents have a complication. The long-term care ventilator unit (LTCVU) is a 25-bed unit in a nursing home. It has noted that 40% of patients have a complication. A group of hospitals demonstrated a 90% reduction in complications through five interventions.

METHODS: The Johns Hopkins Nursing Evidence-Based Practice model was utilized to take the Global Tracheostomy Collaborative interventions and apply them to the LTCVU with the aim of reducing the number of airway complications on the unit by …

Implementation Of Safe Patient Toileting To Decrease Patient Falls On Medical-Surgical Unit, Kimberly A. Goldsborough

DNP Scholarly Projects

BACKGROUND: Patient falls are a serious safety concern in the hospital setting throughout the country. Falls are one of the most challenging patient safety events to prevent, as there are many contributing factors with toileting activities producing the highest incidence. Fall prevention bundles are used to minimize and reduce these such events although multifaceted. The project was conducted with an academic medical center on an acute inpatient medical-surgical unit primarily housing burn wound patients. Nursing leaders and front-line nursing staff participated.

METHODS: Literature review to determine the gap in knowledge of interventions to prevent acute inpatient falls was completed. Concepts …

A Brain-Computer Interface For Closed-Loop Sensory Stimulation During Motor Training In Patients With Tetraplegia, Sarah Helen Thomas

Theses and Dissertations--Biomedical Engineering

Normal movement execution requires proper coupling of motor and sensory activation. An increasing body of literature supports the idea that incorporation of sensory stimulation into motor rehabilitation practices increases its effectiveness. Paired associative stimulation (PAS) studies, in which afferent and efferent pathways are activated in tandem, have brought attention to the importance of well-timed stimulation rather than non-associative (i.e., open-loop) activation. In patients with tetraplegia resulting from spinal cord injury (SCI), varying degrees of upper limb function may remain and could be harnessed for rehabilitation. Incorporating associative sensory stimulation coupled with self-paced motor training would be a means for supplementing …

Evaluation Of Shared Governance Implementation At A Community Hospital, Teresa Nardontonia

Walden Dissertations and Doctoral Studies

Shared governance is a model in which staff collaborate through a decentralized decision-making structure, sharing ownership and accountability and partnering to make decisions about clinical practice, professional development, patient experience, quality improvement, and research. The hospital shared governance project team aligned its shared governance model with the American Nurses Credentialing Center Pathway to Excellence standards. The purposes of this project were to do a process evaluation of shared governance implementation at one 64-bed community hospital in central Florida and make recommendations for continuous quality improvement. The project followed the plan-do-study-act methodology developed by Deming. Through the collection of meeting minutes …

Improving Compassion Fatigue And Vicarious Trauma Knowledge For Psychiatric Nurses, Natalie P. Rebelo

Walden Dissertations and Doctoral Studies

Nurses are exposed to traumatic patients and high stress regularly; this repeated exposure can increase rates of compassion fatigue and vicarious trauma. When nurses are not properly educated about compassion fatigue and vicarious trauma, it can impact their ability to provide effective patient care and result in harmful effects including insecurity, altered cognitive functioning, loss of empathy and diminished self-esteem. This project focused on educating psychiatric nurses regarding compassion fatigue and vicarious trauma. The theory guiding the project was the Neuman's system model. Fifty-six psychiatric nurses were administered a pretest consisting of 10 multiple choice test questions. They were educated …

Quality Improvement Initiative To Improve Patient Attendance In Diabetes Self-Management Education Classes, Charon Denise Randel

Walden Dissertations and Doctoral Studies

Diabetes self-management education (DSME) is a key resource in the battle against diabetes and its secondary effects. This quality improvement project was conducted to address the decreased attendance rates of DSME classes in a community health center in the southern United States. The practice question for this project explored process-related strategies to increase patient attendance in DSME classes. Based on review of patient reports of reasons for nonattendance and an evaluation of peer reviewed literature on improving attendance in DSME, the following strategies were implemented: (a) alternative solutions such as providing patients with the dates for a year of initial …

A Thematic Analysis On How Forensic Psychologists Conduct Personal Injury Evaluations, Denise M. Autret

Walden Dissertations and Doctoral Studies

Psychological evaluations administered by forensic psychologist in personal injury cases are surrounded by complex issues. Although empirically-based research has legitimized that psychological damages do exist in personal injury cases there is a missing link in the way forensic psychologists are conducting these evaluations. Prior researchers suggested that some personal injury evaluations had been dismissed or overlooked due to a lack of a standard of care. Addressing the current literature, this study examined how a diverse group of 14 licensed forensic psychologists, operating in different judicial jurisdictions (Daubert, Frye, and Independent) were conducting personal injury evaluations and their perspectives on the …

Cardiovascular Exercise Participation And Obstructive Sleep Apnea Among Adults Over Normal Weight In The United States, Marytherese Agwara

Walden Dissertations and Doctoral Studies

Obstructive sleep apnea (OSA) is a type of sleep apnea that is common, complicated, and a major contributor to cardiovascular diseases, neurocognitive impairment, and mortality. This disease has additional negative impacts on patients' lives by contributing to daytime sleepiness and low productivity at work as well as absenteeism and work-related injuries. Several studies have been conducted to assess the relationship between cardiovascular exercises and OSA; however, a definite conclusion is lacking. The purpose of this quantitative cross-sectional study was to assess the relationship between cardiovascular exercise participation and OSA by examining the relationship between total cardiovascular exercise participation per week …

An Education Program For Improving Knowledge Of Experienced And Aspiring Mentors, Joy-Marie Quiambao Calunsag

Walden Dissertations and Doctoral Studies

Using a staff development approach, this doctor of nursing practice project addressed the preparation of nurses who serve in the role of mentors. Developed and carried out in an American Nurses Credentialing Center Magnet-designated hospital, the primary aim of the project was to develop and implement a staff education program for mentors focusing on best-practice strategies for mentoring new nurses. The secondary purpose was to conduct a literature review on evidence-based practice strategies for mentoring new nurses. This project was guided by Knowles' adult learning theory and Benner's novice to expert model. A 2-hour education program was attended by 16 …

Characteristics Of Young People Seen In The Emergency Department For Assault-Related Injuries, Robyn Coons

Walden Dissertations and Doctoral Studies

Violence is among the most serious threats to the health and safety of young people between the ages of 10 and 24 in the United States. The purpose of this cross-sectional quantitative study using secondary data from the CDC's 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) data set was to examine the characteristics (age, sex, race and ethnicity, insurance or payer source, and housing status) of young people between the ages of 10 and 24 who seek medical care for assault-related injuries through the emergency department (ED). The social ecological model was used to examine the complex interplay between …

Development Of A Standardized Oral Care Staff Education Program, Katrina Detoye

Walden Dissertations and Doctoral Studies

Hospital-acquired infections such as nonventilated hospital-acquired pneumonia (NV-HAP) are significant patient safety concerns. The lack of oral care in the nonventilated acute care patient population is a major contributor to NV-HAP. Nursing staff are on the frontline in the provision of oral care to hospitalized patients, but a lack of knowledge regarding the relationship between oral care and NV-HAP was identified as a gap in practice at the project site. The purpose of the project was to develop a staff education program on oral care of the nonventilated patient population. The practice-focused question addressed whether an evidence-based education for nurses …

A Comparison Of Motivational Differences Among Older Marathon Runners And Their Injury Status, Marsha Renee Kaufman

Walden Dissertations and Doctoral Studies

Despite the high occurrence of running-related injuries, master level runners, those aged 40 years and older, account for 50% of all marathon finishers. What is not known is the common motive sustaining participation, especially among this age demographic. The self-determination theory was the theoretical framework to support how behavior is regulated by the individual. The purpose of this quantitative research was to identify a difference in the motives (psychological, physical, social, and achievement) and their subcategorical motives (health orientation, weight concern, affiliation, recognition, psychological coping, life meaning, self-esteem, competition, and personal goals) via the Motivations of Marathoners Scales by master …

Evaluation By Geospatial And Spatiotemporal Distribution Of Tularemia Cases In Arkansas, Toni Kathleen Beavers

Walden Dissertations and Doctoral Studies

Tularemia is a vector-borne disease of global concern with diverse regional foci. Arkansas is an endemic state with differences in case distribution and land suitability supporting host and vector sustainment. The aim of this study was to conduct a geospatial and spatiotemporal assessment of factors associated with case distribution and timeliness and completeness of public reporting. Guided with direction from spatial epidemiology and nidality, referring to the association of ecology, climate, and proximity of disease, analysis included secondary data collected from the Arkansas Department of Health between 1995 and 2018. Using Poisson-based software, 2 clusters were found: a high-risk cluster …

Factors Contributing To High Readmissions For Congestive Heart Failure Among African Americans, Shavonda Caprice Devereaux

Walden Dissertations and Doctoral Studies

Abstract

African Americans are disproportionately affected by heart failure, with prevention and treatment of heart failure being a public health concern in the United States. The purpose of this retrospective quantitative study was to examine the primary variable race, specifically African Americans, and how this variable relates to 30-day readmission post discharge when controlled with geographic location (urban vs. rural), gender, and insurance status. The expanded chronic care model was used as a framework to shape health promotion, prevention efforts, and social determinants of health and to enhance community involvement related to chronic disease issues. The research questions were focused …

Nurse Practitioner Attitudes, Perceptions And Knowledge About Antimicrobial Stewardship, Evelyn C. Fabian

Walden Dissertations and Doctoral Studies

Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The purpose of this project was to assess nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship and knowledge in the management of anaerobic infections as well as resistant gram-negative bacteremia. Data were collected using a web-based survey in a hospital facility. The practice question explored whether nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship significantly increased after an education program on antimicrobial stewardship. The project was framed by Knowles's adult learning theory. A 16-item survey was administered before and after …

Psychiatric Nurses' Knowledge Of Suicide Prevention, Wanda F. France

Walden Dissertations and Doctoral Studies

Suicide is a major health concern worldwide. Nurse practitioners must possess suicide assessment skills and treatment knowledge to ensure appropriate identification of persons with suicidal ideation. The purpose of this project was to assess psychiatric nurse practitioners' knowledge of suicide prevention in rural Kentucky. The conceptual framework was Orlando's nursing process theory, which emphasizes the importance of nurse-patient interaction. A 13-item survey of suicide-related knowledge and skills was administered to 10 psychiatric nurse practitioners in rural Kentucky. Only 3 participants responded correctly to a question related to suicidality in persons with borderline personality disorder. Regarding competency and support for assessing …

Staff Education Program On Diabetes Using Self-Care Behaviors, Ruth Adhiambo Ogot

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus affects patients' health across the globe and is costly to manage. The chronic high blood sugar of diabetes is linked to cardiovascular and kidney damage, impaired functional status, and multiple organ failure. To lessen the complications associated with diabetes and promote self-care in those with the disease, health care professionals must be vigilant in offering diabetes education to patients with each clinic or primary care visit. Lack of diabetic educators in the clinic that provided the setting for this study indicated a need to increase clinical staff competency in teaching self-care and diabetes management to patients. …

The Relationship Between Limited Partner Availability, Masculine Ideologies, And Condom Use, Diakima Y. Thomas

Walden Dissertations and Doctoral Studies

One in every 4 people living with the Human Immunodeficiency Virus (HIV) are women. The leading cause of infection is heterosexual contact. The purpose of this quantitative, correlational study was to examine the relationship between gender ratio perception and masculine ideology and a woman's decision to use condoms during her sexual activity. The theory of gender and power and the theory of planned behavior served as the theoretical frameworks for this study. The perceptions of gender ratios, as measured by the Gender Ratio Imbalance Beliefs and Behaviors Scale (GRIBBS) subscale, GRIBeliefs, and masculine ideologies, as measured by the Gender Role …

Reducing Patient Falls And Decreasing Patient Safety Attendant Utilization With Careview Communication Technology, Maura Marisela Stanford

Walden Dissertations and Doctoral Studies

Attention to quality outcomes, cost reduction, value-based purchasing, and improved initiatives for hospital-acquired conditions (HACs), as well as labor utilization savings, provide a foundation for hospitals to achieve safety and quality outcomes. Falls resulting in fractures, joint dislocation, or other physical injuries are considered HACs and can produce unexpected consequences such as an increase in costs related to an increased length of stay. The CareView Communications system, a fall prevention management program that uses video surveillance technology, offers a strategy to prevent patient falls by customizing patient rounding, conducting fall risk assessments, and generating reports. Guided by Donabedian's framework, this …

Factors Affecting Breastfeeding In Preterm Infants, Evangeline Starks Glover

Walden Dissertations and Doctoral Studies

Even though initiation of breastfeeding among term and preterm infants has increased, the incidence and duration among preterm infants continues to lag because of the unique challenges of breastfeeding preterm infants. African American mothers have the lowest rates of breastfeeding initiation and duration, and their preterm infants are less likely to receive breast milk while in the neonatal intensive care unit. The objective of this cross-€sectional quantitative study was to evaluate the relationship between breastfeeding and maternal sociodemographic factors as well as medical and obstetrical conditions for infants born between 32-€37 weeks gestational age in South Carolina from 2009 to …

Implementation Of A Trauma-€Informed Care Program For The Reduction Of Crisis Interventions, Renae Denise Hale

Walden Dissertations and Doctoral Studies

Childhood trauma is the primary reason children and adolescents display behavioral issues that require hospitalization. Implementation of a trauma-€informed care (TIC) program was the intervention chosen at a child and adolescent behavioral health hospital to decrease physical holds and seclusion rates for patients aged 3 to 17 and to reduce the risk of retraumatization of children needing psychiatric care. Six core strategies from the National Association of Mental Health Program Directors was the framework for this project. The number of crisis interventions before and after implementation were 440 and 259, respectively. The number of seclusions before implementation was 215, and …

Opioid Abuse In Rural Communities Among Adolescents With Bipolar Disorder, Sherlina Daishernai Holland

Walden Dissertations and Doctoral Studies

Abstract

Low population density in rural areas makes it difficult to deliver services to people with mental health problems and nonmedical prescription opioid abuse remains a problem in the United States. The purpose of this cross-sectional study was to determine whether a parent's socioeconomic status affected care opportunities for children 12 to 17 years of age and whether bipolar disorder increased the likelihood of substance abuse in those children. The theory of reasoned action/planned behavior provided the framework for the study. Secondary data from the Interuniversity Consortium for Political and Social Research 36361 data system, specifically the National Survey on …

Psychosocial Consequences Of Parental Wrongful Conviction On Children, St.Jean Jeudy

Walden Dissertations and Doctoral Studies

This qualitative multiple-case study sought to provide an in-depth understanding of how children living in broken families-due to the wrongful conviction of parent(s)-developed psychosocial issues. The theoretical frameworks applied to this study were the social learning theory, the social control theory, the role-modeling theory, and the general theory of crime. A purposeful sample of 13 adults who were children at the time of their parents’ wrongful incarceration were drawn for phone and in-person interviews. The data were transcribed and analyzed to code, sort, and organize; to analyze connections in the information, and to compare and contrast cases. The multiple-case study …

An Investigation Of The Help-Seeking Attitudes Of African American Christian Churchgoers, Kristi Madison

Walden Dissertations and Doctoral Studies

The Black Church has been a powerful support system for African Americans, providing economic, and psychological support in addition to meeting spiritual and religious needs. African American church leaders continue to provide a multitude of services to the community; however, research has shown that African American Protestant Christian churchgoers'€™ preference for informal supports may exacerbate some symptoms of mental illness as people may postpone seeking formal help. Utilizing a nonexperimental, cross-€sectional design, this study examined the relationship between these churchgoers'€™ attitudes toward religious help-€seeking and attitudes toward professional help-€seeking. One hundred four African American Protestant Christian churchgoers in the mid-Atlantic …