Medicine and Health Sciences Commons^™

Development Of A Clinical Practice Guideline For The Care Of Transgender Patients, Wayne Zeh Wellington

Walden Dissertations and Doctoral Studies

AbstractTransgender persons face stigma and discrimination while receiving health care services. The gap in nursing practice at a clinic serving transgender patients in the Southeastern United States was a lack of understanding by providers of evidence-based practices for the provision to patient-centered care. The purpose of this project was to develop a clinical practice guideline (CPG) for the care of transgender patients. The project question asked, based on current evidence, what CPG for patient-centered care should be recommended to providers in the clinic. The patient-centered care model developed around the Donabedian model of quality improvement was used to guide the …

Qualitative Evaluation Of A Hospital-Based Preceptor-Guided Clinical Orientation Program, Brian Eigelbach Martin

Walden Dissertations and Doctoral Studies

Effective preceptor-guided clinical orientation programs (PGCOP) help new graduate nurses (NGNs) across the theory-practice gap to provide safe, effective, and efficient patient care. This constructivist-designed qualitative program evaluation study explored NGNs’ and preceptors’ perceptions of a local hospital’s PGCOP as an effective transition vehicle. The conceptual framework combined Knowles’ andragogical process model for learning with the new world Kirkpatrick model evaluation model. The sample included 7 NGNs who graduated in the past year and had no prior orientation experience and 5 preceptors employed by the study site for at least 1 year. A goal-free approach guided data collection with face-to-face …

Use Of Simulations To Improve Clinical Judgment In New Graduate Nurses, Aaliyah Sabreen Franks

Walden Dissertations and Doctoral Studies

The goal of healthcare organizations across the world is to provide safe, efficient healthcare for patients and their families. The practice problem for this DNP Project, a staff education project, addressed simulation as a strategy to improve clinical judgment in new graduate nurses. Recent studies have shown that 23% of new nurses do not demonstrate entry-level competency and are not as effective as more experienced nurses when making clinical judgment decisions. This lack of efficacy poses a threat to patient safety. This was based on nurse’s progression through Benner’s five levels of competency and was designed to enhance new graduate …

Clinical Practice Guideline: Early Screening For Dementia In Diabetes Mellitus, Angelyn Levell-Smith

Walden Dissertations and Doctoral Studies

AbstractDiabetes mellitus (DM) is a recognized cognitive impairment risk factor. Even with hyperglycemia being a modifiable risk factor in dementia, primary care is without an evidence-based screening tool to screen patients with diabetes for cognitive abilities. Current literature supports developing an evidence-based standardized guideline for early screening for cognitive impairment in elderly patients with DM. The purpose of this doctor of nursing practice (DNP) clinical practice guideline (CPG) project was to develop an evidence-based CPG for early screening of dementia in patients with DM, providing a means for early recognition of cognitive decline in these patients, making early intervention more …

Staff Education On American Diabetes Association Standards Of Medical Care For Diabetes, Christine Nsubuga

Walden Dissertations and Doctoral Studies

Diabetes is a commonly encountered chronic illness that leads to other lifelong comorbidities if left uncontrolled. Ranked as the seventh leading cause of death in the United States, diabetes affects over 29 million Americans. Although 90%-95% of all diabetes cases are preventable with proper planning and management, clinicians continue to be challenged as they strive to achieve the desired patient care goals. This Doctor of Nursing Practice (DNP) staff education project addressed the lack of standard evidence-based care for diabetic patients in the federally qualified health center look-alike practice for which this project was developed. Guided by the practice-focused questions …

Guiding Nurses To A Healthier Lifestyle, Margaret Yvonne Garcia

Walden Dissertations and Doctoral Studies

AbstractNurses provide continuous patient care around the clock. Nurses who work outside of the 9:00 a.m. to 5:00 p.m. hours are susceptible to fatigue and sleep deprivation that impair their attention to detail, ability to remain focused, information processing, and problem solving. This is especially prevalent among those who work the night shift. Nurses also find that their memory, reaction time, motivation, communication, mood, and empathy are affected with fewer hours of sleep. This project explored the sleepiness that night shift nurses experience and provides nurses with strategies to improve these symptoms. Nurses were provided with a PowerPoint presentation to …

Non-Pharmacological Interventions For Residents With Dementia, Jared Bielanski

Walden Dissertations and Doctoral Studies

The use of antipsychotic medications in persons with dementia has been shown to increase mortality in long-term care (LTC) patients. National guidelines recommend the use of nonpharmacological interventions when possible for LTC residents with dementia. Nurses who work in a local LTC facility are not regularly trained in effective nonpharmacological interventions and lack the knowledge to provide care for patients with dementia. To provide safe and effective alternative interventions to antipsychotic medication use, nurses and direct care staff must have current, evidence-based education available to them about alternative practices. The purpose of this staff education project, guided by Calista Roy’s …

Decreasing Thirty-Day Readmissions For Heart Failure Patients, Willybroad Che

Walden Dissertations and Doctoral Studies

Heart failure (HF) patients have a 20-25% hospital readmission rate within the first month of discharge. Patients experiencing HF often have a decline in health resulting in frequent hospitalizations and encumbering symptoms including dyspnea, fluid retention, and orthopnea. HF is a common condition in nursing homes and accounts for a significant proportion of resident transfers to emergency departments. HF is considered one of the costliest diagnoses in the United States, estimated to cost the healthcare system billions of dollars annually. The purpose of this systematic review was to provide a synthesis of evidence-based literature on the current recommendations and strategies …

Barriers To Reporting Workplace Violence In Emergency Departments: A Systematic Review, Kari Gaston

Walden Dissertations and Doctoral Studies

Underreporting of workplace violence by emergency department (ED) nurses is a global practice concern. When workplace violence is not reported, the breadth of the issue is not reflected in the data, which is necessary to support legislative action, regulatory requirements, and organizational changes to prevent violence. The purpose of this systematic review of literature was to appraise and synthesize evidence regarding ED nurses’ barriers to reporting workplace violence. The practice-focused question addressed the barriers to reporting workplace violence according to emergency nurses. The theory of planned behavior was the theoretical framework for this project. Melnyk and Fineout-Overholt’s critical appraisal of …

Perceptions Of Physician Influence On Healthcare Accessibility, Samuel N. Jacobs-Abbey

Walden Dissertations and Doctoral Studies

A significant portion of the U.S. population across the country has limited access to quality healthcare; however, this situation is more pronounced in rural areas. One potential solution is for healthcare practitioners to move their services to underserved rural areas to improve healthcare coverage. No previous studies have explored the perceptions of practitioners regarding their influence on healthcare access, particularly the potential impact of moving healthcare services to underserved areas. Thus, the purpose of this research was to address this gap. A qualitative phenomenological approach was adopted. A sample of 24 participants was selected using purposive sampling, from the target …

Increasing Culturally Competent Care Of Lgbtq Patients By Providing Staff Education, Victoria Jacoby

Walden Dissertations and Doctoral Studies

The majority of health care professionals do not feel confident or competent to adequately care for a lesbian, gay, bisexual, transgender, and queer (LGBTQ) patient. Research has identified a link between poor preparedness of the provider/staff and poor patient outcomes. The purpose of this study was to evaluate the effectiveness of an in-person staff education module about providing culturally competent care to LGBTQ patients. The study focused on providers’ attitudes, preparedness, and confidence in caring for a LGBTQ patient. The Iowa and Kirkpatrick models were utilized to ground and evaluate the study. This study was a one-group pre- and posttest …

The Association Between Provider Cultural Competence And Type 2 Diabetes Health Behaviors, Bernadette Joyce Mejia-Tran

Walden Dissertations and Doctoral Studies

Provider cultural competence is poorly understood in relation to the outcome of Type 2 diabetes patient health behaviors. The purpose of this study was to examine the association between provider cultural competence and diabetes patient health behaviors. The chronic care model provided the conceptual framework for this study. The research questions were designed to determine whether 5 measures of provider cultural competence play a role in diabetes patient health behavior change. The research design of the study was a quantitative cross-sectional survey using the 2017 National Health Interview Survey. The 2,342 participants included in the study represent a national sample …

Prevention Practices And West Nile Virus Infection Among Ethnic Minorities, Texas, Bayabel Debebe Mengistu

Walden Dissertations and Doctoral Studies

Abstract

West Nile virus (WNV) is a major public health problem and the cause of nearly 25% of the world's economic burden of disease. While the risk factors for developing West Nile fever and West Nile disease from WNV infection have been identified, it is not known how knowledge, attitude, behavior (KAB), access to health care (AHC), and comorbidities are associated with prevention practices of WNV infection among ethnic minorities. The aim of this study was to examine the association between KAB, AHC, comorbidities, and prevention practices of WNV infection among ethnic minorities in Texas. KAB, AHC. Comorbidities were used …

Development Of Practice Guidelines Based On Need-Driven Dementia-Compromised Behavior Model, Amy Marie Nolan

Walden Dissertations and Doctoral Studies

People with dementia, who experience cognitive decline, memory loss, and reasoning difficulties, often exhibit compromised behaviors such as agitation or aggressive behavior that impact negatively upon the person’s quality of life and increase safety risks. The purpose of this project was to develop an evidence-based clinical practice guideline (CPG) to improve the use of effective evidence-based interventions by staff in a skilled long-term care nursing facility to manage the compromised behavior of residents with dementia. The Need-Driven Behavioral Model, which suggests that compromised behaviors occur when patient attempts to accomplish a goal or express a need, provided the framework CPG …

Reducing Readmissions For Patients Hospitalized With Congestive Heart Failure, Morgan B. Morgan

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is the leading cause for readmission in hospitals and has a

high mortality and morbidity rate, with implications for hospitals and third-party payers.

Readmissions of patients with CHF are related to inadequate patient knowledge at

discharge, inadequate follow-up with a health care provider, and treatment regimen

nonadherence. Patients report feeling ill prepared to provide appropriate self-care during

the transition from inpatient hospital stay to the home setting. One strategy to assess the

patient's understanding following discharge education is through a process known as

teach-back. The purpose of this quality improvement initiative guided by Knowles's

theory was …

Nursing Faculties’ Perceptions Of Teaching Students Who Speak English As Second Language, Natalia S. Ruiz Muniz

Walden Dissertations and Doctoral Studies

Nursing students who speak English as a second language (ESL) often struggle due to language barriers, the complexity of the medical vocabulary, and the knowledge base that they must develop in a short time. These struggles may be due in part to the preparation of nursing educators to meet the specific needs of the ESL student population. The purpose of this qualitative research study was to develop a greater understanding of nurse educators' perceptions when teaching ESL nursing students. The conceptual framework used was Cummins' framework for the development of language proficiency. Four research questions guided this basic qualitative research …

Relationship Between Burnout And Academic Teaching Level Among Nursing Faculty, Erica Lynn Sciarra

Walden Dissertations and Doctoral Studies

Nursing faculty function as healthcare providers, educators, mentors, advisors, and researchers, which contributes to the development of emotional exhaustion or burnout due to role overload. Symptoms of burnout may vary among nursing faculty depending on academic teaching level, tenure status, and educational preparation and may influence the physical and psychological health of nursing faculty, potentially affecting work productivity, career longevity, and the number of future nurses educated. The purposes of this study, guided by Maslach’s multidimensional burnout theory and the job demands resources model, were to determine (a) if there was a difference in level of burnout between graduate and …

Associate Degree Nursing Graduates’ Experiences Of The Transition From Student To Nurse, Katherine Margaret Slusser

Walden Dissertations and Doctoral Studies

Attrition among newly graduated nurses remains a top concern among nursing leaders in the United States. Many published studies about new graduate nurses focus on bachelors-prepared nurses or on mixed populations of nurses that include both associate and baccalaureate degree graduates. No published studies were located that focused specifically on the Associate Degree Nursing (ADN) graduate. The purpose of this qualitative, interpretive phenomenological study was to understand the experiences of transition after graduation and into professional nursing of newly employed nurses who graduated from an ADN program. The theoretical basis for this study was Meleis’s transition theory. The research question …

Burden And Coping Strategies Of Caregivers Of Persons With Alzheimer's Disease, Annette Laverne Tucker Osborne

Walden Dissertations and Doctoral Studies

Alzheimer’s disease (AD) currently presents a huge burden to individuals and families, a burden that is increasing in incidence with the aging of the baby boomer generation. Caring for a spouse diagnosed with AD holds potentially severe negative consequences for the caregiver’s physical and psychological well-being. The current study used secondary data from the 2017 New York State Department of Health/Behavior Risk Factor Surveillance System to identify a relationship, if any, between the time and activities a caregiver spends with the AD person and the caregiver’s self-reported level of general and mental health. A logistic regression was used for RQ1 …

Provider Perspectives Of Equine Assisted Psychotherapy For Social Skills, Rachel Young

Walden Dissertations and Doctoral Studies

Animal assisted therapy has been used for years and has been researched primarily for autism but researchers have not focused specifically on the experiences of children with Attention Deficit Hyperactivity Disorder (ADHD) and their social skills after involvement in animal assisted therapy. Children with ADHD frequently struggle expressing their emotions and communicating effectively, primarily in social settings, which can have an extensive impact on their functioning that can extend into adulthood. The theoretical attachment framework from Ainsworth and Bowlby, when applied through the retrospective multiple case study model allowed for a greater understanding of the experiences of children involved in …

Newly Licensed Registered Nurse Generation Cohorts And Retention In First Registered Nurse Positions, Elizabeth S. Gizenski

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to evaluate the association between newly licensed registered nurses (NLRN) generational cohorts and NLRN who plan to leave or have left their first nursing position. The research problem focused on the generational cohorts of NLRN and retention. The research questions addressed different generations of NLRN, their intent to stay in their first job, and whether poor orientation was a factor for those who already left their first nursing position. The theoretical foundation was Strauss–Howe’s generational theory explaining how each generation views the world based on what they experienced in their lifetime. Data retrieved …

Relationship Of Complementary Modes Of Agency In The Self-Management Of Diabetes, Andrew Romo

Walden Dissertations and Doctoral Studies

Effective control of type-2 diabetes mellitus (DM2) is essential for minimizing the likelihood of developing comorbidities that result from poor glycemic control. Extensive self-management considerations are required of people with DM because they must actively participate in their own care and engage with other socially-based sources of self-management support. The purposes of this quantitative study were to determine if there is an association between (a) the extent that the individual mode of human agency is employed and quality of diabetes control among adults who have been diagnosed with DM2 for at least one year and (b) the extent that the …

Inpatient Stays Involving Mental Illness And Substance Use Disorders, Latonya Smith

Walden Dissertations and Doctoral Studies

Nearly one-third of Americans suffer from a mental illness. Twenty-three million people are affected by substance use or a dependency issue and the length of stay for patients enrolled in treatment services is rising. Mental health issues and substance use are rising within the United States and are associated with increased healthcare costs and the need for healthcare services. The purpose of this quantitative study was to determine the association between inpatient services, residential, outpatient, age, and payer source on substance use and mental health services using the 2017 Substance Abuse and National Mental Health Services Administration survey. The Donadebian …

Amyotrophic Lateral Sclerosis Patients' Sociological Resilience, Self-Determination, And Decision-Making For Life-Sustaining Treatments, Jeremy Jon Van Tress

Walden Dissertations and Doctoral Studies

People with amyotrophic lateral sclerosis (ALS) suffer from a rare, progressive, untreatable, and fatal neuromuscular disease. Their decision-making for life-sustaining treatments may not be fully self-deterministic. While researchers have examined resilience and self-determination in people with mental health problems and chronic illness, none have researched these variables in ALS patients from a socioecological framework. The purpose of this study was to explore the relationships between people with ALS socioecological resilience, self-determination, and decision-making for life-sustaining treatments. A cross-sectional concurrent mixed-methods design was used, with online surveys completed by 197 people with ALS who were solicited through the National ALS Registry. …

Area-Level Factors Linked To Obesity In African American And Caucasian Women In Michigan, Marjorie Arrey

Walden Dissertations and Doctoral Studies

Obesity is a major public health crisis, affecting every segment of the U.S. population. African American women have higher prevalence of obesity than all other subpopulations and are disproportionately burdened by the disease and its comorbidities. Despite this disparity, African American women are often underrepresented in obesity research. This research examined obesity-related risk factors specific to African American women compared to those for Caucasian women. The design was based on the socioecological model and social cognitive theory, both emphasizing the impact of social factors on health outcomes. The data set included only adult Michigan women from the NHANES study. Multiple …

Methamphetamine Screening And Brief Intervention In A Hospital Heart Failure Program, Tamra Chavez

Walden Dissertations and Doctoral Studies

AbstractThe efficacy of screening, brief, intervention, referral to treatment (SBIRT) in reducing or eliminating methamphetamine use has not been investigated and addressed among patients with heart failure. According to urine toxicology screens at admission at a county hospital, approximately 50% of patients in a heart failure program were positive for illicit substance use, and the majority of these tests (>60%) were for methamphetamine use, one of the most cardiotoxic drugs available. This quantitative study used an existing dataset to test the theory of intentional behavior by examining whether SBIRT intervention increases the patient’s ability to make a behavioral change …

Successful Retention Strategies By Perfusion Managers To Reduce Perfusionist Attrition, Krysta Lynne Gleeson

Walden Dissertations and Doctoral Studies

Perfusion managers who lack strategies to mitigate perfusionist attrition place a strain on their remaining employees and incur replacement costs for their organization. Grounded in Vroom’s expectancy model, the purpose of this multiple case study was to explore strategies perfusion managers use to mitigate perfusionists attrition within open-heart centers in a northeast U.S. city. Data were collected through digital semistructured interviews with 5 licensed perfusionists who demonstrated successful staff retention. Perfusionist job listings were used as a secondary data source. Data were analyzed using Yin’s 5 step process. Four significant themes emerged: job satisfaction, work-life balance, surveys, and compensation. Perfusion …

Predicting Behavior To Engage In Fall Prevention Practices: The Role Of Interests And Basic Psychological Needs, Jan Fay Kress

Walden Dissertations and Doctoral Studies

AbstractA fall is associated with adverse outcomes that include occupational, physical, cognitive, and psychological decline together with economic and caregiving burden. Despite the continued increase in prevalence of falls globally, most studies address the well-known risk factors of falls but exclude the behavioral risk factors associated with human actions, emotions, and everyday choices. Following the theory of self-determination and person object of interest framework, this quantitative, nonexperimental study was conducted using face-to-face and web surveys to examine the relationship between motivational, relational, and sociodemographic/medical conditions to predict engagement in fall prevention practices in a sample of 75 community dwellers, 65 …

Examining The Mortality Risk Of A Population With Mental Illness, Glorimar Ortiz

Walden Dissertations and Doctoral Studies

Individuals with mental illness experience increased mortality and premature death. In a sample composed of 88% decedents with mental illness who were Black, the findings from three research studies provided insight about excess and premature mortality, odds of dying by cause of death, and risk factors associated with premature mortality. The purpose of this quantitative study was to examine the mortality of a population group with mental illness that was served in a public mental health system (PMHS). The ecoepidemiological life course framework for health, disease, and mortality was used to link mechanisms that may influence health and longevity in …

Exploring The Lived Experiences Of The Prelicensure Hispanic Nursing Student, Mary Valerie Santos

Walden Dissertations and Doctoral Studies

AbstractNursing constitutes the largest group of healthcare professionals in the United States. Despite decades of discussion about the need to diversify the nursing profession, there continues to be a significant lack of diversity, particularly in the number of Hispanic nurses. The purpose of this qualitative study was to explore the lived experiences of Hispanic nursing students who have enrolled in a pre-licensure nursing program using Leininger’s culture care theory as the theoretical framework for this phenomenological study. This study sought to explore the lived experiences of the prelicensure Hispanic nursing student attempting to complete nursing school successfully and what factors …