Medicine and Health Sciences Commons^™

Strategies For Patient Engagement In A Self-Management Program For Adults With Diabetes, Carolinee Jokotola Ogungbayi

Walden Dissertations and Doctoral Studies

Patients' lack of adherence to diabetes self-management education and support (DSMES) recommendations is a challenge for healthcare. One approach to addressing patient noncompliance with DSMES is through education of staff on current guidelines. In an outpatient facility in South Texas, staff training on current DSMES guidelines was recommended as one of the solutions to the problem of Type 2 diabetes mellitus (T2DM) complications observed among clinic patients. An educational module was created to increase staff knowledge on T2DM and to assist staff members in teaching patients to self-manage T2DM. The module was built on the self-management and health promotion models, …

Nurses' Lived Experiences Of Comfort Care Among Residents At The End Of Life, Ezekiel Olufemi Osundina

Walden Dissertations and Doctoral Studies

Nurses provide comfort care for individuals who are at the end of life and reside in the long-€term care environment. However, how nurses provide comfort care to those who are dying and nurses' perceptions about providing comfort care are not known. The purpose of this phenomenological study, guided by Kolcaba's theory of comfort, was to examine nurses' lived experiences of comfort care among residents at the end of life in long-term care facilities. The research questions were designed to elicit rich data about the lived experiences of nurses in providing comfort care to dying residents to find out factors that …

Predicting Outcomes Of American Youths' Shift Toward E-Cigarette Use, D J. Resendez

Walden Dissertations and Doctoral Studies

There has been a shift toward e-cigarette use and away from tobacco smoking among American youth. Despite effects of ongoing public health campaigns that bring attention to the harmful effects of tobacco and nicotine use generally, youths might not perceive e-cigarette use to be unhealthful in terms of psychological functioning. This study was an investigation of the impact of the method of tobacco use (cigarette or e-cigarette), past cessation attempts, cravings or needs to use tobacco, and serious cognitive difficulties, upon youths' intentions concerning future tobacco usage. The conceptual framework was based upon the self-medication hypothesis, biopsychosocial model, and social …

Integrating Health Care Systems To Maintain Quality Care And To Manage Cost, Marilynn Noble

Walden Dissertations and Doctoral Studies

The rising cost of health care in the Philippines is a concern for the Department of Defense and TRICARE beneficiaries. The purpose of this quantitative cross-sectional research study was to determine the efficacy and acceptability of a different method to deliver health care to increase access to health care and decrease out-of-pocket costs while maintaining quality of care for TOP Standard beneficiaries who receive health care under the Philippine Demonstration. Secondary data was used to determine the acceptability of an alternative reimbursement methodology to decrease cost but maintain access to quality care. The Andersen's behavioral health care model and the …

Understanding The Lived Experiences Of Counselors Who Have Been Assaulted By Clients, Cynthia S. Ellison

Walden Dissertations and Doctoral Studies

Assault of community-based mental health professionals is a worldwide phenomenon, and current extant literature examines the prevalence of client assault on counselors, social workers, and psychiatric personnel. While there is significant quantitative scholarship on the incidence of this phenomenon on social workers and psychiatric personnel, there are limited statistical data on client-perpetrated violence against community-based counselors and no qualitative studies found that examined how these professionals experience this occupation risk. Therefore, the purpose of this study was to explore how counselors who work in community-based settings make sense of these experiences. Through semi structured interviews, 6 community-based counselors living in …

Perceptions Of Fear Of Falling In Older Adults, Ken Germano

Walden Dissertations and Doctoral Studies

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence …

Telehealth And Type 2 Diabetes Management, Blessing Nneoma Ikpeama

Walden Dissertations and Doctoral Studies

The use of telehealth in healthcare has grown in recent years; however, little is known about the effectiveness of this delivery method in the management of Type 2 diabetes mellitus (T2DM). Guided by the chronic care model and telehealth in chronic disease model, the purpose of this systematic literature review was to explore evidence related to lowering hemoglobin A1c levels and managing T2DM using telehealth in the outpatient setting. The practice-focused questions explored telehealth interventions used in T2DM management and their effectiveness. The Joanna Briggs Institute (JBI) method for conducting systematic literature reviews was the process, and data were compiled …

Nurse Faculty Perceptions Of Role Stress And Faculty-To-Faculty Incivility, Anne Kraft Kleinhesselink

Walden Dissertations and Doctoral Studies

The purpose of this study was to determine the relationship between nurse faculty perceptions of role stress and faculty-to-faculty incivility using the stressor-emotion model of counterproductive work behaviors. A convenience sample of 79 nurse faculty from 39 undergraduate nursing programs in Iowa responded to an online survey. The survey consisted of two instruments: Workplace Incivility Civility Scale and Role Strain Scale. Findings revealed 76 participants perceived incivility as a problem and identified stress (n = 64) and demanding workloads (n = 54) as contributing factors. Pearson correlation results revealed a positive relationship between experienced incivility and nurse faculty perceptions of …

Predicting Educational Attainment Based On Forensic Psychiatric Patients' Age At First Hospitalization, Malinda Marie Lawson

Walden Dissertations and Doctoral Studies

Education during recovery could impact a forensic psychiatric patient's community reintegration; however, individual education goals for patients can be difficult due to the lack of available parameters. The purpose of this study was to test whether age at first hospitalization is predictive of educational attainment among forensic psychiatric patients and to determine which ages of first hospitalization best predict 8 levels of educational attainment. Cattell's intelligence theory served as the theoretical framework for this study because mental illness requiring early hospitalization may affect education and learning. This quantitative, nonexperimental study involved a predictive design with data from the Canadian Institute …

Fostering Self-Care And Nurse Resilience, Cheryl Jean Mcnamara

Walden Dissertations and Doctoral Studies

Role expectations and stressful work environments place nurses at high risk for burnout. Nurses at an urban hospital were experiencing unhealthy work environments and not engaging in self-care to promote health and wellbeing. The purpose of this project was to evaluate the effectiveness of an existing quality improvement (QI) initiative developed to encourage nurses to engage in self-care. Pender'€™s health promotion model supported the premise that despite barriers, nurses will engage in self-care. A survey elicited responses from 1,248 participating registered nurses on the extent of their engagement with self-care and perceived effect on their health, health knowledge, stress level, …

Decreasing Hospital Admission Rates In Long-Term Care, Melanie R. Meissner

Walden Dissertations and Doctoral Studies

Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best …

Experiences Of African American Mothers Raising Gifted Children, Keisha Kavon Mcgill

Walden Dissertations and Doctoral Studies

Equality in educational access has long been an area of concern for U.S. educators, policy makers, and advocates. Congress issued a mandate in 1969 to identify the needs of gifted students and to ensure that those needs were being met. However, the needs of gifted minority students were not specifically addressed. Little is known about how African American mothers are affected by the demands of raising and advocating for their gifted child. The purpose of this hermeneutic phenomenological qualitative inquiry was to explore the lived experiences of African American mothers raising gifted children. The theory of womanism was used to …

Addressing Bullying Behavior In Pediatric Patients Using A Clinical Practice Guideline, Barnitta Latricia Moses

Walden Dissertations and Doctoral Studies

Childhood bullying can lead to adverse physical and mental health outcomes for both the victim and the bully. Risk factors for bullying can be related to gender, race, sexual preference, and having any type of disability. A pediatric primary care clinic in a large, metropolitan area, the focus for this project, did not have an evidenced-based clinical practice guideline (CPG) for providers to facilitate the management of children who presented with reported bullying. The project, guided by the Tanner'€™s integrated model of clinical judgement, addressed the question whether a CPG would facilitate the early recognition and treatment of bullying in …

Developing An Educational Program For Tracheostomy Care, Joy Onuoha

Walden Dissertations and Doctoral Studies

Medical-surgical nurses at the project site demonstrated a knowledge deficit regarding the care of adult patients with a tracheostomy. Such knowledge deficits could expose patients to higher risks for infection, bedsores, prolonged hospital stays, increased costs, increased caregiver burden, and death. The purpose of this project was to develop an educational program to improve nurses'€™ knowledge and confidence in the provision of evidence-based tracheostomy care to answer the question if the content of an evidence-based educational program developed to improve nurses'€™ knowledge and confidence in managing adult patients with tracheostomy on a medical-surgical floor would meet the expectations of a …

Strategies Outpatient Health Care Executives Use To Reduce Physician Turnover, Maureen A. Onyenacho

Walden Dissertations and Doctoral Studies

Some outpatient health care executives experience high physician turnover leading to increased costs. To retain highly productive physicians, outpatient health care executives need to understand the best strategies for reducing physician turnover. Grounded in Herzberg 2-factor theory as the conceptual framework, the purpose of this multiple case study was to explore the strategies outpatient health care executives used to reduce physician turnover. Data were collected from semistructured interviews of 4 outpatient health care executives and the review of proprietary documents from 2 outpatient health care facilities in the Southern California metropolitan area. Data analysis comprised compiling and disassembling the data …

Noise Pollution/Reduction Education For Frontline Staff In The Acute Care Setting, Lopa Patel

Walden Dissertations and Doctoral Studies

Noise levels in hospital settings have risen beyond the recommended range of 35-40 decibels, resulting in poor patient healing outcomes and other health conditions ranging from sleep deprivation, anxiety, agitation, delirium, depression, and high heart rate and blood pressure. These negative patient health experiences are evidenced by poor scores for the Hospital Consumer Assessment of Healthcare Providers and Systems, which are indicators of patients' perceptions of care. This project explored whether an educational activity for 48 direct care staff, who include registered nurses and nursing assistants, in a cardiac unit on the impact of noise pollution on patient healing would …

Cultural Factors Affecting African Americans Of Caribbean Descent With Type Ii Diabetes, Ruth Runette Aguy-Paulsaint

Walden Dissertations and Doctoral Studies

Type II diabetes is a significant problem in the United States that had affected almost 10% of the American population and over 13% of African Americans. Although culturally competent diabetes education and treatment programs have been significantly more successful, little is known about the cultural factors affecting type II diabetes in African Americans of Caribbean descent (AACD). The purpose of this qualitative, phenomenological study was to explore the cultural factors relevant to the treatment and prevention of type II diabetes among AACD. The theoretical framework for the study consisted of cultural adaptation theory and the transtheoretical model. Data collection consisted …

Reducing Door-To-Provider Times By Using Nurse Practitioners In Triage, Megan Lynnell Anderson

Walden Dissertations and Doctoral Studies

Increased patient wait times it the emergency department (ED) have been linked to poor patient outcomes and adverse health care events. The purpose of this quality improvement project was to determine if placing a nurse practitioner (NP) in the triage area would reduce door-to-provider times and improve patient throughput within the ED. The primary question for this quality improvement project was whether the use of NPs in the triage area would improve patient throughput and decrease wait times in the ED. A secondary question identified was if implementing an NP in the triage area would decrease patient length of stay …

Perceptions Of Access To Healthcare In Cameroon By Women Of Childbearing Age, Wenceslaw Chap Chapnkem

Walden Dissertations and Doctoral Studies

Increased poverty and unemployment rates, minimal investment in social amenities, a shortage of healthcare professionals, poor infrastructure, inadequate social services, and poor institutional and political leadership have weakened the healthcare status of Cameroon's women who have reached the age of childbearing. The World Health Organization expressed increased urgency for healthcare providers and patients to develop new healthcare policies to eliminate health-related disparities. The aim of this phenomenological study was to examine the perceptions of women of childbearing age living in Mamfe rural community in regard to Cameroon's healthcare system and its impact on their lives. The theoretical foundation of the …

Strategies For Nursing Staff Working In A Correctional Facility., Ima James

Walden Dissertations and Doctoral Studies

As primary care providers in correctional facilities, correctional nurses are expected to balance inmates' healthcare needs with the security demands of the facility. This project explored whether an evidence-based education program could provide strategies for promoting health, a healthy work environment, and a sense of well-being to improve the knowledge, coping skills, and well-being of nurses working in a correctional occupational setting. Twenty nurses participated in an educational intervention project that was guided by the transactional theory of stress. Using a pretest/posttest design, data were collected over a 2-week period and calculated using means and percentages. The descriptive statistics using …

Dark Triad Personality Traits Prediction Of Managers' Mind-Set In Business Organizations, Robert Kabat

Walden Dissertations and Doctoral Studies

Presence of the Dark Triad traits of Machiavellianism, narcissism, and psychopathy in the workplace, especially among managers, has received increased attention due to the implications for organizations. One way to influence behavior in business organizations is through controlled interventions to change individual mind-sets. A review of the extant literature indicated that the relationship between Dark Triad traits and mind-set had not been sufficiently examined. A quantitative study was conducted to examine whether a manager's Dark Triad traits predict their mindset. To explore this relationship, a sample of 153 managers' responses was collected online. The Short Dark Triad measure was used …

Effectiveness Of Physiological Alarm Management Strategies To Prevent Alarm Fatigue, Amy Clemens

Walden Dissertations and Doctoral Studies

There is limited clinical research on the effectiveness of alarm management strategies and nursing behaviors related to alarms in clinical settings. As many as 76% of physiological monitor alarms are overlooked as clinically insignificant by nursing staff. Excessive alarms may impact patient outcomes and cause cognitive overload for nurses that can result in medical errors and missed patient resuscitations. The purpose of this systematic review was to rate alarm management studies on level of evidence for interventions, nursing responses to alarms, and impact on alarm fatigue behavior. The nursing role effectiveness model guided this project. Twenty-seven studies were reviewed to …

Building A Compassion Fatigue Toolkit, Stephanie C. Correa

Walden Dissertations and Doctoral Studies

Compassion is an important tenet of nursing care delivery. When compassion is compromised, such as with compassion fatigue (CF), not only is patient care compromised, but also caregivers can be physically and psychologically affected, resulting in stress and burnout. The purpose of this project was to create a web-based educational toolkit focused on prevention of CF, establish the content validity of the elements in this toolkit, and make recommendations regarding its implementation and sustainability. Watson's theory of human caring guided this project. Ten experts with at least 10 years of experience and CF knowledge, a bachelor's degree in nursing, and …

Guardians' Experiences With Mental Health Care For Adolescents With Pediatric Bipolar Disorder, Saudia Y. George

Walden Dissertations and Doctoral Studies

Pediatric bipolar disorder (PBD) is a growing public health problem in the United States, especially among adolescent children. Despite awareness of the diagnosis and the effects that it has on the child, little attention has been given to the effects that PBD has on the guardian. The purpose of this qualitative phenomenological study was to explore the factors influencing guardians' experiences related to PBD. Penchansky and Thomas' Theory of Access and Family Systems Theory were used in this study to explore guardians lived experiences of PBD, its effects on the entire family system, and mental health service treatment. This approach …

Reducing 30-Day Readmissions For Patients With Stroke, Faith Omomen Ighile

Walden Dissertations and Doctoral Studies

In a stroke-certified 500-bed acute care hospital, the 30-day readmission rates for patients discharged to rehabilitation centers or skilled nursing facilities were higher than the rates for patients discharged to home. A review of data by the stroke team showed 44 patients readmitted within 30 days of initial stroke discharge between October 2016 and January 2017. The rate of re-admission for those discharged home was 41% (18 patients), whereas the rate for those discharged to acute inpatient rehabilitation, long-term acute care, or skilled nursing facilities was 59% (26 patients). The practice-focused question for this project assessed whether using a re-admission …

Evidenced-Based Staff Education Program For Novice Perioperative Nurses, Marjorie Jasinski

Walden Dissertations and Doctoral Studies

Knowledge of surgical procedures, instruments, and supplies is essential to the perioperative nurse working in the operating room (OR). Nursing school curricula do not specifically educate surgical nurses; therefore, it is difficult to fill open OR positions with experienced perioperative nurses. The purpose of this doctoral project was to develop a perioperative educational program for RNs newly hired in the OR. The practice-focused question asked whether an evidence-based staff education program for the novice perioperative nurse would increase the nurse's knowledge of OR procedures and protocols for patient management. The novice-to-expert framework was used to explore how adult learners acquire …

Acuity-Based Nurse Staffing And The Impact On Patient Outcomes, Sara Kollman

Walden Dissertations and Doctoral Studies

The costs of healthcare in the United States are of national concern. The systematic review of the literature (SRL) explored the practice-focused nursing question regarding the relationship between the use of acuity-based staffing (ABS) models and positive patient outcomes. Analyzing the impact of ABS models on patient quality outcomes and the potential economic value could provide evidence essential for the healthcare executives responsible for fiscally prudent labor management and for creating an evidence-based business case for adequate, patient-centric nurse staffing. The synergy model for patient care and Covell's nursing intellectual capital theory guided the doctoral project. The Preferred Reporting Items …

Association Of Adaptive Early Phase Study Design And Late Phase Study Results In Oncology, Donna Elise Levy

Walden Dissertations and Doctoral Studies

This quantitative study assessed the association of the design methods used for early phase oncology studies (adaptive versus traditional) and the outcome of late stage clinical trials. Differences by cancer type and by drug classification were also assessed. The theoretical and conceptual frameworks used were the general systems theory and the design and evaluation of complex interventions, respectively. Units of analysis were individual oncology studies in the ClinicalTrials.gov database and Bayesian logistic modeling was applied on a random sample of 381 studies initiated after November 1999 to December 2016. When assessing study design and outcome, there were lower odds of …

The Reproductive Health Needs Of Women At Risk Of Hiv Infection In Connecticut, Emily Hoff

Yale Medicine Thesis Digital Library

Background: The number of women involved in criminal justice systems (WICJ) and women who use opioids has been dramatically increasing in the United States. An often-overlooked aspect of healthcare for women at risk of HIV infection (either WICJ or women who use drugs) is reproductive health. We aim to provide a framework, informed by a systematic review and primary data, to guide future interventions addressing the sexual and reproductive health (SRH) needs of women at risk of HIV infection.

Methods: We completed a systematic literature review of the pregnancy prevention and planning needs of US WICJ published in English from …

Csf Lymphocyte And Monocyte Activation And Trafficking In Primary Hiv Infection, Aveline Xiang Li

Yale Medicine Thesis Digital Library

Trafficking of immune cells to the central nervous system (CNS) is hypothesized to facilitate HIV entry and immune-induced neuronal injury, and is mediated by cell surface proteins such as chemokine receptors and integrins. We longitudinally assessed immune cell activation and surface marker expression in cerebrospinal fluid (CSF) and blood and their relationship with CSF HIV RNA during primary HIV infection (PHI) before and after combination antiretroviral therapy (ART). Longitudinal paired blood and CSF were obtained in initially ART-naïve PHI (infection) participants; some subjects independently initiated ART during follow up. Multiparameter flow cytometry was used to determine activation (% CD38+HLADR+) and …