Medicine and Health Sciences Commons^™

Participant Experiences In Christian-Based Recovery, Joshua Mjolsness

Walden Dissertations and Doctoral Studies

Health care leaders are challenged with addressing addiction and the treatment of addiction. Many studies have been conducted around addiction treatment; however, no studies have been conducted on Christian-based recovery programs that use the same approach regardless of the addiction. The purpose of this phenomenological study was to explore the experiences of participants in a Christian-based recovery program that uses the same approach for all addictions. The social learning theory provided the framework for this study. Data were collected by interviewing participants of the Christian-based recovery program Free Grace Recovery (FGR). Eight participants selected had a variety of reasons for …

Reducing Child Maltreatment Through Prevention, Chantel Marie Eckert

Walden Dissertations and Doctoral Studies

Child maltreatment is a public health problem directly linked to poor outcomes across the lifespan, including chronic health conditions and even death. The local population served by the agency in which the project took place experienced an increase in reports of child maltreatment. Agency leadership identified deficiencies in parental knowledge about positive parenting practices as a contributing factor to the problem. To address the problem, the agency implemented a quality improvement evidence-based home visiting pilot initiative. The evaluation of that initiative was the purpose of this project. Bandura's social cognitive learning theory provided the theoretical framework for the project, and …

Logistical Resource Capability During A Mass Casualty Event In Washington State, Todd Devin Brauckmiller

Walden Dissertations and Doctoral Studies

The need for increasing efficiencies for medical resource delivery during a mass casualty incident/event is a paramount logistical planning factor that could mean life or death to the citizens affected by a disaster. As such, Washington State has prioritized emergency management and preparedness. Using the just-in-time system by way of Baghbanian' s complex adaptive decision-making theory as the foundation, gave purpose to this qualitative study. This was accomplished by analysis of emergency management professional responses, and to what degree, improvements can be made to the medical resource delivery system during a mass casualty incident/event. Data were collected through semi structured …

The Impact Of Exercise During Radiation Therapy For Breast Cancer Patients, Diane Yu

Walden Dissertations and Doctoral Studies

Breast cancer is one of the leading causes of death among women. In 2017, breast, lung and bronchus, prostate, and colorectal cancers accounted for almost 50% of all new cancer cases in the United States. Breast conservation therapy with lumpectomy (i.e., surgery) and adjuvant radiation therapy is commonly used as treatment for early stage breast cancer. However, side effects such as pain and poor sleep quality can affect quality of life for breast cancer patients undergoing radiation treatment. The main purpose of this quantitative study, using the health belief model (HBM) theoretical framework, was to investigate the correlations between the …

Education Of Clinic Providers To Promote Improved Diabetes Management, Olubunmi Roseline Awe

Walden Dissertations and Doctoral Studies

Diabetes is one of the most common major illnesses in the United States population and can lead to severe complications if not properly managed. Research has shown that over the past 2 decades there has been an increase in the prevalence of prediabetes, Type 2 diabetes, and associated complications and chronic diseases. Diabetes management is an ongoing challenge faced by providers nationally and it is the focus of this staff education development project at the outpatient clinic site. The purpose of this project was to ensure that clinic staff used an evidence-based approach to identify patients with diabetes, manage patients …

Survey Of U.S. Undergraduate Self-Reported Opioid Diversion And Heroin Use, Motives, Sources, And Collective Efficacy As Mediating Factors, Mark Francis Plaushin

Walden Dissertations and Doctoral Studies

Epic morbidity and mortality, and intractability make prescription opioid diversion a wicked problem. Meanwhile, college undergraduates are vulnerable to opioid misuse and its consequences. The purpose of this quantitative study was to assess U.S. undergraduate students' opioid misuse and the relationship between mediating factors. The study's theoretical framework rested on Wakeland's et al. opioid system model and Shaw and McKay's social disorganization theory. This study bridged the gap, measuring collective efficacy and testing its relationship to undergraduate decisions to regulate misuse. Thus, research questions focused on gauging the problem's scope and assessing relationships between factors that drive or potentially regulate …

Impact Of Smoking Cessation Education On Workplace Wellness, Monica Coles

Walden Dissertations and Doctoral Studies

Guidelines and laws prohibit smoking in public places, and evidence supports the safety and effectiveness of workplace wellness programs in promoting healthy environments. A long-term care (LTC) facility selected as the focus for this project does not offer wellness programs and does not restrict on-site smoking by employees. The purpose of this project was to construct an evidence-based smoking cessation education program for delivery to employees at the LTC facility. The practice-focused question addressed whether a workplace wellness smoking cessation education program would increase employees' knowledge of the harmful effects of smoking and promote engagement in smoking cessation strategies. A …

Examining Fear Of Recurrence In Cancer Survivors, Christina L. Dixon

Walden Dissertations and Doctoral Studies

Improvements in the medical field have given many cancer patients and survivors better odds of long-term survival. As more patients become survivors, the demand for psychological treatment becomes greater. The most prevalent concern of survivors is getting help with a psychosocial condition known as fear of recurrence (FOR). Prior to this study, few researchers had explored how having a more aggressive cancer influences the development of FOR. The purpose of this quantitative study was to determine whether cancer stage and type (a measurement of severity) are predictive of FOR development in the high-risk cancer groups lung and bronchus and female …

Social Support And Glycohemoglobin Level Among Older Adults, Emma O. Fakiya

Walden Dissertations and Doctoral Studies

Diabetes is a public health concern among older adults in the United States due to the increasing prevalence of diabetes among this age group and the associated long-term and financial impacts. Self-management is a key strategy in the control of diabetes. The purpose of this quantitative study was to examine the association between social support and glycohemoglobin level. The social cognitive theory was the conceptual framework for this study. The research questions were designed to determine whether social support played a role in diabetes management. Data were collected using a cross-sectional survey of secondary data from the 2007-2008 National Health …

Strategies To Improve Employee Ethical Conduct In Health Care Organizations, Shannon La'vone Hill

Walden Dissertations and Doctoral Studies

Organizational leaders face challenges related to implementing ethical standards, which influence performance, organization sustainability, and culture. The purpose of this single case study was to explore ethics strategies that health care business leaders used to improve employees' ethical conduct. Data were collected through face-to-face, semistructured interviews with a purposive sample of 7 business leaders of a health care organization located in central Georgia and a review of organization documents. The conceptual framework was Brady's Janus-headed model of ethical theory. Using a priori coding during the data analysis process provided 3 thematic categories: policy strategies for the improvement of employee ethical …

Blood Lead Testing Guideline Development For A Public Health Department, Becky Sue Johnson Himes

Walden Dissertations and Doctoral Studies

A lack of consistent, evidence-based practices for blood lead testing of children existed in a local public health department (LHD). No known blood lead level is safe, and toxicity can result in behavioral and cognitive impairments. The purpose of this project was to develop and analyze a clinical practice guideline to establish blood lead testing procedures in the LHD to improve testing procedures and enhance future testing within the jurisdiction. The RE-AIM framework was used to address the reach, effectiveness, adoption, implementation, and maintenance of the clinical practice guideline. Five experts evaluated the guideline using the Appraisal of Guidelines for …

Hydraulic Fracturing And Cause-Specific Mortality: A Multicity Comparative Epidemiological Study, Uzoma C. Nduka

Walden Dissertations and Doctoral Studies

Cause-specific mortality (CSM), among other global health estimates, has garnered prominence in the contemporary public health field. CSM has been associated with several factors, however, research comparing CSM for prefracking versus postfracking periods is sparse. Hydraulic fracturing or fracking is a technique of extracting oil and gas from deep underground. The purpose of this study was to evaluate the difference among mean CSM scores from 1975 through 2015 in the available cities and counties of residence in Colorado and to determine the impact of gender, marital status, county of residence, and city of residence on CSM scores (prefracking period 1975-1977 …

The Equality Toolkit: Practical Skills For Lgbtq And Dsd-Affected Patient Care, Laura Weingartner, Emily Noonan, Amy Holthouser, Jennifer Potter, Stacie Steinbock, Suzanne Kingery, Susan Sawning

Undergraduate Medical Education

The eQuality Toolkit is a training manual that helps healthcare providers build a foundation of inclusive clinical skills to competently care for lesbian, gay, bisexual, transgender, and queer-identified (LGBTQ) patients and individuals born with differences of sex development (DSD). Although this toolkit was designed for medical students, any healthcare provider who wants to learn inclusive clinical skills can benefit from this accessible, brief primer through its actionable steps to improve clinical care.

Beta-Lactam Plus Macrolide Vs Fluoroquinolone For Empiric Therapy Of Hospitalized Patients With Cap: Results From The University Of Louisville Pneumonia Study, Vidyulata Salunkhe, Stephen P. Furmanek, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

Background

Current guidelines recommend a β-lactam plus a macrolide or fluoroquinolone monotherapy as initial empiric antibiotic therapy for treatment of patients hospitalized with community-acquired pneumonia (CAP). Multiple studies have shown different results comparing the two regimens for the treatment of CAP. Our objective, in a city-wide prospective study, was to compare outcomes among hospitalized patients with CAP who received empiric treatment either with a β-lactam plus a macrolide or fluoroquinolone monotherapy.

Methods

This was a propensity score matched case-control study of the University of Louisville Pneumonia Study. It was a prospective population-based cohort study of all hospitalized adults with CAP. …

Peer Support For Addiction In The Inpatient Setting, Rebecca Sweeney

DNP Scholarly Projects

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered …

Bill To Restrict Indoor Tanning For Minors In The State Of Maine, Jamie M. Lowery

DNP Scholarly Projects

Background: Melanoma is the deadliest and the most common type of cancer in individuals age 15 to 29. Evidence has shown that ultraviolet radiation overexposure at younger ages significantly increases the risk of developing non-melanoma and melanoma skin cancer in later years. Despite these concerns, approximately 1.6 million minors under the age of 18 participate in the use of indoor tanning devices annually. The high prevalence of skin cancer in the United States continues to be a public health issue that warrants continued preventative and regulatory action. In spite of the health risks associated with indoor tanning, the state of …

Compassion Fatigue In Emergency Department Nurses, Michelle Candice Lawrence

Walden Dissertations and Doctoral Studies

Compassion fatigue (CF) is defined as a sudden onset of the inability to experience feelings or compassion for others that is triggered by a nurse's inability to separate his/her feelings of stress and anxiety associated with caring for patients who have suffered from a traumatic event. The practice problem addressed in this doctoral project was the lack of knowledge of emergency department nurses (EDNs) related to CF in the work setting, resulting in a negative impact on a nurse's ability to provide quality care to patients. The purpose of the project was to present an educational program on how to …

Preventing Falls In Long-Term Care Facilities, Kay Keise

Walden Dissertations and Doctoral Studies

Falls and related injuries have affected residents in long-term care facilities for many years. It has been well-established that patient fall prevention includes staff education and hourly rounding in addition to adequate risk assessment. These steps, taken together, have the potential to decrease a 52.7% fall rate on the long-term care pilot unit. The purpose of this quality improvement project was to: (a) educate staff on the process of properly performing hourly rounding and (b) and achieve a decreased incidence of falls from the current fall rate. Thus, the practice-focused question for the project addressed whether rounding hourly on patients …

Relationship Between Hospital Size, Staff Communication, Physician Communication, And Patient Experience Scores, Cheryl Marie Layton

Walden Dissertations and Doctoral Studies

Healthcare leaders who struggle to understand the importance of interactions between patients, staff, and physicians can result in poor patient experience. Healthcare care leaders who understand the importance of patient experience can develop customer service training modules and tutorials to improve organizational outcomes. The purpose of this correlational study was to examine the relationship between staff communication, physician communication, size of the hospital, and patient experience. House's path-goal theory was used to frame the study. Secondary data were collected from hospitals in Northeastern Ohio, that reported patient experience scores through the Centers for Medicare and Medicaid's Hospital Consumer Assessment of …

Ambidexterity And Innovation In Chief Nursing Officers In The Healthcare Setting, Jennifer Wasilewski

Walden Dissertations and Doctoral Studies

Leaders in the healthcare setting are challenged with competing responsibilities as they seek to provide high-quality services, ensure the implementation of safety measures, and engage in workforce maintenance. Many researchers have described innovation as a strategic approach to organizational concerns and have noted a failure to implement innovative measures in healthcare. This study was an investigation of the impact of ambidexterity in healthcare leaders on innovation. The purpose of this quantitative study, guided by the ambidexterity theory of leadership for innovation, was to analyze the extent to which ambidextrous leadership characteristics of healthcare executives and chief nursing officers (CNOs) influence …

Staff Education For Providers In An Outpatient Hemodialysis Center, Ibijoke Owolabi

Walden Dissertations and Doctoral Studies

The impact of end-stage renal disease (ESRD) on healthcare costs is significant. In 2013, the cost of providing care for the ESRD patient population was 7.1% of total Medicare expenses. ESRD patients' non-adherence with the medical plan is a reason for the high cost of care and poor patient outcomes. Staff education can have a positive impact on patient adherence in terms of the management of chronic illnesses, such as ESRD. This DNP project was an education program for hemodialysis (HD) staff regarding empowering patients to learn about self-care strategies aimed at improving ESRD patients' adherence to fluid restriction and …

A Narrative Study Focusing On Survivors Of Forced Labor Trafficking, Taras Nk Raggio

Walden Dissertations and Doctoral Studies

Throughout history, the media's rendering of slavery depicts vulnerable groups caught in a network of trafficking looking for a better life. Scholars of trafficking cite challenges in understanding the health care needs of domestic forced labor trafficking survivors in the United States. Seminal trafficking findings have shown that variations of trafficking affect the survivors' health after surviving trafficking. Therefore, in this qualitative, narrative inquiry I sought to understand how 8 survivors of forced labor trafficking, ages 25 years and older, described their health following trafficking beyond 5 years. The theory of social constructionism constituted the theoretical foundation, and the salutogenic …

Toxic Air Discharge And Infant Mortality: Effects Of Community Size And Socioeconomics, Khabira Salter

Walden Dissertations and Doctoral Studies

Living in counties where manufacturers release environmental toxins, such as those tracked by the Environmental Protection Agency's (EPA) toxic release inventory (TRI), may elevate infants' health risks. Because infant mortality (IM) is a strong indicator of a population's health status, it is an important topic in public health research. The purpose of this research was to examine the potential relationships between IM, community size, and factors related to mothers' SES in counties where more than 25,000 pounds of annual toxic air releases occur. The dependent variable was IM per 1,000 live births in a given community for each of the …

Impact Of Community Factors On The Donor Quality Score In Liver Transplantation, Giovanna Saracino

Walden Dissertations and Doctoral Studies

An increasing prevalence of metabolic syndrome and obesity has been linked to the rise in transplant indication for cryptogenic cirrhosis and nonalcoholic fatty liver disease (NAFLD), creating a growing challenge to public health. NAFLD liver transplant (LT) candidates are listed with low priority, and their waiting mortality is high. The impact of community/geographic factors on donor risk models is unknown. The purpose of this study was to develop a parsimonious donor risk-adjusted model tailored to NAFLD recipients by assessing the impact of donor, recipient, transplant, and external factors on graft survival. The theoretical framework was the social ecological model. Secondary …

Risk-Taking Behaviors Of First-Generation Sub-Saharan African-Born U.S. Resident Men, Henry K.J. Sinyangwe

Walden Dissertations and Doctoral Studies

African-born residents of the United States have a higher incidence of HIV than African Americans. Factors such as lifestyle, habits, behavior practices, and activities may predispose African-born residents to behave sexually in ways that place them at risk of becoming infected with HIV. This study used a qualitative narrative approach to understand the lived experiences first generation Sub-Saharan African-born men who are U.S. residents to analyze the behaviors that expose them to HIV. To analyze data, the study used the health-belief model as the conceptual framework and NVivo for data analysis to assist in identifying, categorizing, and analyzing common themes …

Root Cause Of Medication Errors In A Pediatric Intensive Care Unit, Louis Gilbert Tingling

Walden Dissertations and Doctoral Studies

Five to 27% of all pediatric medication orders lead to errors and play a significant role in the morbidity and mortality of the pediatric patients admitted to hospitals. The practice problem explored the high rate of medication errors in the pediatric intensive care unit (PICU) of the project site, where the population is particularly vulnerable due to their acute illnesses. The purpose of this project was to analyze the root causes of all cases of medication error in this hospital's PICU during the last 2 years. The literature review was used to categorize secondary data extracted from the hospital's quality …

Nursing Program Progression Requirements And Student Success At A U.S. Community College, Deborah Joleen Cipale

Walden Dissertations and Doctoral Studies

Although licensed registered nurses (RNs) comprise a significant percentage of the U.S. health care workforce, there is a lack of qualified nurses to meet patient needs. This shortage is expected to intensify as practicing nurses leave the profession. The problem that prompted this study was that an attrition-reduction program implemented in the nursing program at a U.S. midwestern community college did not show a reduction in the average attrition rate. The academic integration construct of Tinto's theory of student departure was used to examine archival academic performance records of 145 students enrolled in the local program from 2010 to 2012. …

Hospital Admission From The Emergency Department For Patients Diagnosed With Heart Failure, Tammy Young

Walden Dissertations and Doctoral Studies

Approximately 25% of those hospitalized with congestive heart failure are readmitted within 30 days after discharge. Because researchers and policy makers consider hospital readmission within 30 days for patients with heart failure to be a quality of care issue, the Centers for Medicare and Medicaid Services has imposed financial penalties of up to 3% of a hospital's Medicare revenue for 1 year for excessive readmissions, potentially impacting the financial sustainability of some organizations. The purpose of the study was to address the research gap regarding the outcome quality measure of hospital admissions from the emergency department (ED) and 2 each …

Social Workers And Early Intervention With Diabetic Clients, Rievu Agiri

Walden Dissertations and Doctoral Studies

Social workers are uniquely positioned to facilitate early intervention services that minimize the impact and burden of Type 2 diabetes. There is little evidence on the specific role that social workers play in addressing the psychosocial factors that exacerbate the condition or impact treatment outcomes. The purpose of the study was to examine the role of social workers in facilitating early interventions for clients with Type 2 diabetes. The theories of role and organizational systems provided the conceptual framework. Data was collected from interviews with eight participants with Master'€™s degrees in Social Work in a large Southwestern state in the …

Prevention And Management Of Aggression And Violence In Mental Health Settings, Margaret Arotimi

Walden Dissertations and Doctoral Studies

Aggression and violence in healthcare settings can lead to severe psychological, physical, and economic consequences for the victims, institutions, and society in general. Empirical evidence indicated that patient-initiated physical and verbal aggression is a longstanding problem affecting nurses working in psychiatric hospital settings. At the project site, approximately 88% of the staff members reported having been assaulted by mental health patients in the admission units at some point in the provision of care between 2015 and 2017. The purpose of this project was to develop an educational program for nurses at the site to use as preventive strategies in managing …