Medicine and Health Sciences Commons^™

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 …

Targeted Education For The Prevention Of Vaccine Refusal, Catina Lashawn Davis

Walden Dissertations and Doctoral Studies

Vaccinations are important factors in the eradication of most communicable diseases. Tetanus, diphtheria, and pertussis (Tdap) vaccine has been found to decrease the incidence and further spread of pertussis, and even nullify its existence, yet many postpartum mothers opt not to receive the vaccination even if eligible to do so. It was unknown whether clinical nursing staff at the project site had sufficient knowledge about Tdap vaccine to educate postpartum mothers to accept the vaccine. The practice-focused question explored whether an educational program and a toolkit implemented for nursing staff members on the postpartum nursing unit would improve Tdap vaccination …

Social Workers' Experiences With Deaf And Hard Of Hearing People With Mental Illness, Makoto Ikegami

Walden Dissertations and Doctoral Studies

The social work practice problem for this study was a lack of knowledge about social workers' experiences of working with deaf and hard of hearing people with mental illness. This study was needed to fill a practice gap by increasing an understanding of the experiences of social workers to inform best practices and address the needs of deaf and hard of hearing population through culturally and linguistically competent mental health services. The research questions focused on the experiences and challenges of social workers working with deaf and hard of hearing people and best practices identified by these social workers. Ecological …

Community Health Worker's Perceptions Of Integration Into The Behavioral Health Care System, Juliette Swanston Jenkins

Walden Dissertations and Doctoral Studies

Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence …

The Benefit Of Leadership Using First Choice For New Graduate Nurse Retention, Jodie Marie Lyons

Walden Dissertations and Doctoral Studies

The United States has a nursing shortage that is projected to grow to over 500,000 by the year 2030. This is an issue for leaders because the nursing shortage affects health care organizations sustainability. The purpose of this qualitative descriptive phenomenological study was to identify and report the lived experiences of new graduate nurses (NGNs) in oncology and whether unit of first choice (UFC) effected their intention to remain after 2 years of practice. The research question considered the lived experiences of NGNs in oncology units who either had oncology as their UFC or were placed on an oncology unit …

Addresing Challenges In Caring For Morbidly Obese By Learning About Bariatric Care, John Abayomi Makanjuola

Walden Dissertations and Doctoral Studies

Obesity is a public health issue linked to high morbidity and mortality among critically ill patients. There are approximately 15.5 million morbidly obese adults in the United States. The purpose of the project was to develop and implement an educational program using evidence-based protocols for bariatric care to educate nurses and caregivers regarding best practices when attending to obese patients. The practice-focused question examined whether learning about evidence-based bariatric care would improve the knowledge of nurses and caregivers caring for morbidly obese patients in an acute care setting. The theoretical foundation was Bandura'€™s self-efficacy theory. A questionnaire using a Likert …

A Quality Improvement Evaluation Of Patient Experience Through The Enhanced Recovery Program, Sarah Orozco

Walden Dissertations and Doctoral Studies

The purpose of this project was to evaluate the effectiveness of adopting clinical care bundles for the enhanced recovery program (ERP) at the project site. The practice-focused questions explored whether care bundles from the enhanced recovery program (ERP) would achieve positive postoperative patient care experiences when compared to the traditional surgical care pathways. The concepts, models, method, and theories used for this project include the Iowa model, the plan-do-study-act model, lean methodology, Donabedian's framework, and Watson's theory of caring. The sources of evidence included the facility site analysis report to evaluate surgical inpatient complications, morbidity, and mortality rates. Over 100 …

Evaluating The Discharge Process Improvement Initiative In Reducing The Length Of Stay, Maria Reina Ventura Siazon

Walden Dissertations and Doctoral Studies

Extended hospital length of stay (LOS) causes increased health care costs and incidence of never events, such as hospital-acquired infections, pressure ulcers, and falls, which are not reimbursed by Medicare. This study examined if there would be a statistically significant decrease in the LOS of patients after the implementation of a discharge process improvement initiative (DPII), The model for improvement and small tests of change concept were used to guide the DPII at a hospital in northern California. Sources of data included archival data obtained from the hospital's quality improvement department that showed LOS prior to and after the implementation …

Experiences And Attitudes Of Older Homeless Women Toward Healthcare Access, Mary Ann Mueller

Walden Dissertations and Doctoral Studies

Homelessness among older women is a growing problem in many metropolitan areas of the United States. Researchers have indicated that health issues and problems accessing basic care are connected. Older homeless women face increased health issues, multiple challenges related to accessing basic care, and low incomes which put them at higher risk of becoming homeless, staying homeless, and delaying medical treatment. The homeless who lack fulfillment of social support and timely medical care are considered repetitive users of the emergency department and hospital stays. The purpose of this phenomenological study was to explore the experiences and beliefs of older homeless …

The Lived Experiences And Perceptions Of African American Women In Federal Senior Leadership, Latonya Michelle Mitchell

Walden Dissertations and Doctoral Studies

In the United States, African American women remain underrepresented in senior leadership positions in many workforce sectors, including the federal sector. Despite this challenge, a few African American women have successfully attained senior leadership responsibilities in a public health service agency. Using intersectionality and social cognitive career theory as the theoretical frameworks, the purpose of this study was to explore the lived experiences of African American women leaders in their career advancement to senior leadership positions in a health service agency of the Department of Health and Human Services in the United States. The research questions explored the experiences and …

Noncompliance With Follow-Up Visits In Primary Care, Amanda Michelle Northern

Walden Dissertations and Doctoral Studies

No-show appointments, also referred to as missed appointments, occur 23% to 34% annually in general practice care settings. Missed appointments can lead to reduction in appointment availability, decrease in provider/staff productivity, patient/provider discordance, disruption in continuity of care, and reduced quality of care. There is a gap in the nursing literature regarding effective interventions to reduce missed appointments. The purpose of this quality improvement, secondary analysis project was to determine whether implementation of an evidence-based no-show, nurse-led intervention would reduce missed appointment rates in a family medicine practice. The health belief model and the plan, do, study, act model guided …

African American Masculinity And Its Influence On Hypertension-Related Behaviors, Tangee Denise Thomas

Walden Dissertations and Doctoral Studies

High blood pressure (hypertension) is known to be one of the leading factors that directly contributes to heart disease and stroke, which are the first and third leading causes of disabilities and death in the general U.S. population. The prevalence of high blood pressure among African American men in the United States ranks as one of the highest in the world. Research indicates the roots of this phenomenon are found in physiological, psychosocial, cultural, and socioeconomic factors differentially affecting the African American population. The purpose of this study was to examine the interaction between African American males' masculine perspective and …

Relationship Between Elevated Blood Pressure/Hypertension In Military Personnel And The Stress Of Combat Deployment, Stephen James Pinkerton

Walden Dissertations and Doctoral Studies

Few studies about elevated blood pressure in the U.S. military exist in which researchers examined exposure to combat and its association with elevated blood pressure. The purpose of this quantitative research was to describe the extent of association between those who were exposed to combat deployment, were 40 or older, and were overweight or obese and had elevated blood pressure for U.S. military personnel who deployed to an area of declared combat between 2012 and 2017. The conceptual basis of this research was best represented by the determinants of health model. Chi-square correlation revealed that being older (equal to or …

Managing Post-Traumatic Stress Disorder In Emergency Personnel: A Qualitative Case Study, Jason Lee Brooks

Walden Dissertations and Doctoral Studies

The material in current emergency medical services (EMS) curricula is insufficient to prepare prehospital emergency medical care personnel recognize the signs and symptoms of post-traumatic stress disorder (PTSD) within their workforce. Prehospital emergency textbooks focus on treating patients affected with PTSD, but there is very little included about how EMS professionals may also be affected. Moreover, supervisors and managers of EMS agencies receive very little education on workforce PTSD in their personnel. The purpose of this study was to understand the educational preparation of EMS supervisors in order to develop a PTSD-awareness course. The research question investigated the educational preparation …

Knowledge, Attitudes, And Beliefs About Food Additives And Obesity, Lorna Theresa Ingram

Walden Dissertations and Doctoral Studies

Knowledge, Attitudes, and Beliefs about Food Additives and Obesity

by

Lorna Theresa Ingram

MS, Long Island University, 2007

BA, Florida International University, 1999

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Walden University

November 2019

Obesity is a chronic health problem that affects the health and well being of its population. The purpose of this cross-sectional, descriptive study was to examine whether there is a relationship between individuals’ knowledge, attitudes, and beliefs regarding food additives and obesity. The research questions concerned knowledge, attitudes, and beliefs participants had regarding food additives and obesity. The …

Development Of A Nurse Residency Program In Perinatal Nursing, Elizabeth W. Roberts

Walden Dissertations and Doctoral Studies

Staffing turnover created a challenge for the women’s services department of a hospital in the southern United States, potentially compromising care for women and infants during childbirth. The gap in practice was the lack of a structured nurse orientation/residency program for nurses new to perinatal nursing, which requires specific competencies not learned at the prelicensure level of education. The guiding practice-focused question was whether a multidisciplinary team could develop a formal evidence-based perinatal nurse residency program that would meet the needs of on-boarding and support for the new nursing hires at this facility. A team of experienced nurses, which included …

Sleep Deprivation In The Intensive Care Unit: Lowering Elective Intervention Times, La Von Michelle Ross Purdie

Walden Dissertations and Doctoral Studies

Sleep deprivation is a multifactorial phenomenon, occurring frequently in the intensive care unit (ICU) and linked to adverse patient healthcare outcomes. The key practice question of this project focused on determining if retiming of routine laboratory and imaging testing outside of the designated “quiet time” can improve sleep quality among adult patients in the ICU. The purpose was to evaluate the effectiveness of implementing an evidence-based intervention to improve sleep quality in the ICU setting. The theoretical framework was the plan-do-study-act model, which offered a process for implementing a practice change and reevaluation of the intervention’s sustainability within the organization. …

Relationship Between Senior Leadership Style And Patient Satisfaction In The Inpatient Rehabilitation Facility, Amy Elder

Walden Dissertations and Doctoral Studies

Patient satisfaction has a significant role in the healthcare industry, as high patient satisfaction can improve quality outcomes. Hospital leadership is responsible for the culture, outcomes, and patient experience, which can involve different leadership styles. The purpose of this quantitative study was to examine the relationship between leadership style of senior leaders and patient satisfaction in inpatient rehabilitation facilities (IRFs). Through the theoretical framework of transformational and transactional leadership theories, the research questions were designed to determine whether a statistically significant relationship existed between leadership style (transformational, transactional, and laissez-faire leadership) and patient satisfaction. The Multifactor Leadership Questionnaire was administered …

Preventing Catheter-Associated Urinary Tract Infections With Education On Using The Catheter Bundle, Diana Elizabeth Carlson

Walden Dissertations and Doctoral Studies

The Centers for Disease Control and Prevention, the Joint Commission, and the Agency for Healthcare Research and Quality recognized the importance of reducing health-care-associated infections (HAIs) and catheter-associated urinary tract infections (CAUTIs) for the safety of all patients. The U.S Department of Health and Human Services has focused on approving a plan to address HAIs in the health care setting with an emphasis on CAUTIs. The purpose of this project was to decrease CAUTI rates on a long-term care and rehab unit by educating staff about using the CAUTI bundle and CAUTI maintenance tool kit. The theoretical framework that guided …

Experience Of Resilience Among African American Women Who Left Abusive Relationships, Audrey L. French

Walden Dissertations and Doctoral Studies

The rate of DV for AA women is higher than other groups and often more severe; however, some AA women are successful in leaving the violence for good. Researchers continue to examine how victims move beyond their former life and into an abuse free environment by directing more attention on positive dynamics of victims of DV. One area is the study of resilience; however, little is known about the lived experience of resilience. The purpose of this phenomenological study was to explore the lived experiences of resilience in AA women who successfully abandoned an abusive relationship. The interview questions were …

A Word From The Writing Team (January 2019), Jennifer Wilson, Ms, Els, Pam Walter, Mfa

A Word From the Writing Team (Newsletter)

This issue includes:

• Grammarly Tips
• Expanded NVivo Access
• Upcoming Workshops

Empowering Representations Of Impairing Mental Illnesses In The Media: Investigating Mental Health Narratives Through Song, Ray Johnson

Honors College Theses

No abstract provided.

The Neurological Development Of Sagittal Craniosynostosis Patients Treated With Whole Vault Cranioplasty, Raysa Cabrejo

Yale Medicine Thesis Digital Library

Objective: In this study we seek to clarify the neurological changes before and after whole vault cranioplasty (WVC) in patients born with sagittal craniosynostosis.

Methods: A case control study design was performed that included forty fMRI scans, from thirty-five individual patients. Functional MRI (fMRI) and diffusion tension imaging (DTI) data were analyzed with BioImageSuite (Yale University, USA). All nine functional brain networks were analyzed with appropriate regions of interest.

Results: Comparing functional MRI the infants after WVC vs. infants before WVC group, the after WVC group demonstrated an increased connectivity in the left frontoparietal (LFPN), secondary (V2) and third (V3) …

Outcomes Among Patients With Chronic Critical Limb Ischemia With No Revascularization Option And Deep Vein Arterialization As A Novel Revascularization Approach: A Systematic Review And Meta-Analysis, Mohammed Imran Riaz Ghare

Yale Medicine Thesis Digital Library

Objective: To quantify the 6- and 12-month amputation-free survival (AFS) in patients with “no-option” Rutherford category 5/6 critical limb ischemia (CLI) in current clinical practice and to characterize outcomes and methods for deep vein arterialization as a possible means for revascularization in patients who are not candidates for conventional surgical or endovascular revascularization. We also sought to determine if there was any trend in amputation-free survival before and after 2003 which was the year of publication for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).

Background:

The natural …

Assessing Clinical Reasoning Skills Using Script Concordance Test (Sct) And Extended Matching Questions (Emqs): A Pilot For Urology Trainees, Syed Muhammad Nazim, Jamsheer Jehangir Talati, Sheila Pinjani, Syed Raziuddin Biyabani, Muhammad Hammad Ather, John J. Norcini

Section of Urology

Introduction: Clinical reasoning skill is the core of medical competence. Commonly used assessment methods for medical competence have limited ability to evaluate critical thinking and reasoning skills. Script Concordance Test (SCT) and Extended Matching Questions(EMQs) are the evolving tests which are considered to be valid and reliable tools for assessing clinical reasoning and judgment. We performed this pilot study to determine whether SCT and EMQs can differentiate clinical reasoning ability among urology residents, interns and medical students.
Methods: This was a cross-sectional study in which an examination with 48 SCT-based items on eleven clinical scenarios and four themed EMQs with …