Medicine and Health Sciences Commons^™

Perceptions Of Clinical Adjunct Instructor Preparedness In Nurse Education, Melissa Ann Harvey

Walden Dissertations and Doctoral Studies

This project study addressed the perceptions of novice adjunct clinical instructors as they transition from clinician to novice educator within an associate degree nursing program in Ohio. Lack of formal training in educational preparation has caused the disorientation of effective supervisory practices in the clinical setting and prevents the optimal transfer of knowledge from educators to nursing students. Mezirow’s transformative adult learning theory and Schoening’s nurse educator transition model were the two conceptual frameworks that guided this study. A qualitative exploratory research design was used to study the role transition process and perceptions of supervision, challenges, and strategies or support. …

Public Health Care Policies And Their Impact On Patient Satisfaction, Bryan John Henderson, Ph.D.

Walden Dissertations and Doctoral Studies

Health care is a trillion-dollar industry, but without public policies in place to support a sustainable health care system, life would decline. For instance, health care providers now receive decreased payments from federal agencies if their health facility scores do not meet national benchmarks. The purpose of this retrospective, quantitative, comparative study was to examine the extent to which patient satisfaction was impacted by national public health policies in the United States and Canada. The research questions related to how health care reimbursement policies and patients’ financial responsibility of both the eastern United States and eastern Canada would predict country-specific …

Clinical Practice Patient Education Guideline For Elective Induction Of Labor, Allison Keleske

Walden Dissertations and Doctoral Studies

In 2018, the state of Florida had a cesarean section birth rate of 38.3% which was the 3rd highest in the nation with the national average being 31.9%. Elective induction of labor (EIOL) involves the initiation of labor for convenience and not because of medical necessity. EIOL carries risks for the mother and fetus, including an unplanned cesarean section. The problem identified in this project was the lack of informed decision-making by pregnant women related to risks, benefits, and management of EIOL. Using the Informed Decision-Making through Engagement Model, the purpose of the project was to develop an evidence-based clinical …

Veterans' Perceptions Of Behavioral Health Services For Posttraumatic Stress, Larence Kirby

Walden Dissertations and Doctoral Studies

Behavioral health services exist for Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans diagnosed with posttraumatic stress disorder (PTSD); yet, untreated diagnoses may lead to the risk of compromised behavioral health. The purpose of this hermeneutic phenomenological study was to understand the lived experiences of OEF/OIF veterans regarding their decision to seek and retain behavioral health services for addressing PTSD. The research focus and questions were employed through the theoretical concepts of Heidegger’s hermeneutic phenomenological theory, Heider’s attribution theory, and Beck’s cognitive behavioral theory. In-person interviews were conducted to collect data from 8 OEF/OIF veterans who had encounters with behavioral …

African American College Students’ Attitudes Toward Help Seeking For Mental Health Illness, Sylvia Krow

Walden Dissertations and Doctoral Studies

Past research has shown that African Americans are less likely to seek treatment for mental health illness compared to individuals in other ethnic groups. Research has also revealed that African American college students’ attitudes, perceptions, and stigmas against mental illness impacts their willingness to seek treatment for mental illness. The purpose of this quantitative, nonexperimental, correlational study was to investigate the predictive relationships between ethnic identity, perceptions of mental illness, stigma and attitudes toward seeking professional help for mental illness among African American college students attending Historically Black colleges and universities. The research question addressed the predictive relationships between ethnic …

Mortality Disparities Among Puerto Rican Infants In 2015, Maria Del Carmen Medina

Walden Dissertations and Doctoral Studies

There is a well-established disparity between infant mortality rates among women residing in rural areas in Puerto Rico in comparison with woman residing in urban areas of Puerto Rico. There is a significant amount of research that connects infant mortality to low birth weight, congenital malformations, and premature births. The purpose of this study was to determine infant mortality and its relationship with the geographical location of Puerto Rican mothers. The study also examined whether there is a relationship between infant mortality and the area of residence (rural/urban) of the mother, marital status, race, and education level of the mother. …

Association Of Landfall Atlantic Tropical Storms And Human Cases Of Locally Acquired West Nile Virus Infection In Florida, Jackson G. Mosley

Walden Dissertations and Doctoral Studies

West Nile virus (WNv) is the most widely distributed flavivirus and considered a vector-borne pathogen of global significance. During the study period from 2002 to 2018, WNv had the highest incidence of locally acquired human cases when compared to any other mosquito borne illness in Florida with 373 cases documented during the study period. The purpose of the study is to determine if there is an association between Florida landfall tropical storms (LTS) and the incidence of locally acquired human WNv cases from 2002 through 2018. The study used a retrospective ecological study design guided by the epidemiological triad model …

Evidence-Based Colorectal Cancer Screening Staff Education, Chantal Navalah

Walden Dissertations and Doctoral Studies

Colorectal Cancer (CRC) is the leading cause of cancer-related death, although it is considered preventable with adequate routine screening. Despite the decline in prevalence and mortality of CRC in the United States, the African American population persist in having the highest rates of death and shortest survival for CRC. This doctoral project focused on the gastrointestinal (G.I.) staff knowledge gap about the importance of CRC screening to achieve better patient outcomes. The purpose of this project was to address the knowledge gap among the G.I staff as it relates to CRC screening. The health belief model served as a guide …

Population-Level Determinants Of Cholera Incidence In African Countries, Ngoy Nsenga

Walden Dissertations and Doctoral Studies

Cholera remains endemic in Africa, with limited access to safe drinking water and inadequate sanitation as 2 of the main drivers of its dissemination. Few studies have examined the impact of health system capacity, even though it plays an important role in prevention, early detection, and response to a cholera outbreak. Grounded in the ecosocial theory of infectious disease dissemination, this quantitative ecological study explored the effect of social vulnerability (as measured by access to safe drinking water and sanitation, rate of open defecation, poverty, income inequality, gender inequality, and adult literacy) and health system (as measured by health financing …

How Older Nigerians View The Impact Of Migration On Their Health, Jayne Nwankwo

Walden Dissertations and Doctoral Studies

Migration into the United States opens windows of opportunity, but also involves difficult experiences that impact the health of migrants. In this qualitative study, the meanings that Nigeria migrants (aged 65–80) placed on their migration experiences were explored in relation to their health and well-being. Literature revealed no prior migration study on this population. The social constructivist approach provided the framework for this study. Purposive sampling was used to recruit 13 participants that fell within the selection criteria. Face to face interview was used to obtain participants’ view of health; their challenges to adaptation to the United States; the impact …

Hiv Knowledge And Behaviors Among Young People In Kenya And Lesotho, Beatrice Ochieng

Walden Dissertations and Doctoral Studies

Sub-Saharan Africa (SSA) has a great burden of human immunodeficiency virus (HIV) and high new HIV infection rates among youths age 15-24 years. Suboptimal practice of HIV risk-reducing sexual behaviors among youths threatens to reverse the gains made in preventing the spread of HIV in SSA. The purpose of this quantitative cross-sectional study was to investigate the effects of comprehensive knowledge of HIV transmission and prevention, on individuals’ attitude toward people living with HIV, and ability to obtain condoms (if needed) on practice of HIV risk-reducing sexual behaviors, in adolescents age 15-19 years and young adults age 20-24 years in …

Demographic Factors Associated With Childhood Obesity Among Women, Infants, Children (Wic) Participants In 2014, Olukayode Wisdom Oduwole

Walden Dissertations and Doctoral Studies

In the past few years, there has been an alarming increase in childhood obesity in the United States and worldwide, however there is little consensus around how to respond to the problem. What has now become an epidemic, was uncommon decades ago. This study assessed the demographic factors associated with childhood obesity among WIC participants in 2014. The study utilized demographic data from 3,011,119 participants in 2014 nationally representative National Health and Nutrition Examination Survey, and social cognitive theory (SCT) to understand the demographical factors associated with childhood obesity. Adjusted odds of obesity were calculated to assess association between males …

Readiness Of Stakeholders To Adopt Community Paramedicine Programs In Tennessee, Roger Lloyd Ritchie

Walden Dissertations and Doctoral Studies

Abstract

Community paramedicine is an emerging model of care that promulgates EMS in a more community-based and integrated role within the broader health care system. A hallmark characteristic of community paramedicine is that programs are designed to meet the specific needs of a given community, rendering programs unique but perplexing. A need for research aimed at exploring possible barriers that may impede the adoption and implementation of community paramedicine programs has been identified by the National EMS Advisory Board, the North Central EMS Institute, and the Joint Committee on Rural Emergency Care. The purpose of this study was to explore …

Analysis Of The Impact Of Family Structure And Type 2 Diabetes Among Adolescents, Danny Lee Self

Walden Dissertations and Doctoral Studies

Type 2 diabetes (T2D) has increased among the adolescent population in the United States within the past 30 years. While the increase in T2D is linked to obesity and a lack of physical activity, it lacks contextual analysis within the structure of the non-traditional family unit. The purpose of this quantitative study was to examine family structure and prevalence of T2D among adolescents. Krieger’s ecosocial theory guided the study. The research questions were designed to investigate whether family structure directly impacts T2D prevalence or indirectly through socioeconomic status. The research design was quantitative with cross-sectional analysis of secondary data. The …

Small Business Leaders’ Strategies For Recruiting Veterans, Jamillah Deangela Stackhouse

Walden Dissertations and Doctoral Studies

Small business hiring managers who fail to implement recruitment strategies for

transitioning military veterans face hiring challenges with this population of workers.

Failed recruitment strategies are essential to small business leaders, as failure to attract

highly qualified military veterans places the organizations at a competitive disadvantage.

Grounded in recruitment theory, the purpose of this qualitative multiple case study was to

explore strategies used by leaders of small businesses to recruit, hire, and retain qualified

veterans. The participants included 3 purposefully selected hiring managers from 3 small

businesses in southeastern Virginia, who used successful strategies to recruit, hire, and

retain veterans. …

Treatment Interventions For Tobacco Cessation At An Inpatient Mental Health Facility, Stephanie Marie Stansell

Walden Dissertations and Doctoral Studies

Tobacco use is the leading cause of preventable death and disease in the United States. According to the Centers for Disease Control and Prevention, 36.5% of adults with any mental illness use tobacco compared to 25.3% of adults without a mental illness; however, there are limited data to determine the best approaches for tobacco cessation among the mentally ill. The purpose of this quantitative, quasi-experimental study was to investigate the differences among 1-on-1 counseling versus group counseling in tobacco cessation rates among psychiatric patients aged 18 years old and older who were identified as a tobacco user upon admission to …

Using Patient-Staff Ratio To Improve Patient Care Outcomes, Fadekemisola Oludayo Timothy

Walden Dissertations and Doctoral Studies

The persistence of nurse scarcity has been documented by many researchers as the leading problem in the critical care setting. A high nurse to patient ratio leads to poor healthcare outcomes associated with increased nurse burn out, medical errors, and low-quality care services. Solving the issue of nurse scarcity is still a challenge due to lack of an effective multidimensional staffing model. In this project, a multidimensional staffing model was developed based on the relationship between patient-to-staff ratio, together with and other factors in the care environment which impacts patient outcome. The project was framed on Donabedian's structure, process, and …

Factors Affecting Adherence To Diabetes Management Recommendations Among Afro-Caribbean Farm Workers, Aretha Meritian Townsend

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a global epidemic, impacting the economy and quality of life of affected individuals. The treatment and management of the disease often rely heavily on self-efficacy and provider guidance. Adherence to provider treatment regimens can help to prevent T2DM-related complications. However, non-adherence to T2DM regimens is a growing concern among minority populations, where T2DM is highly prevalent. Limited research is available for the Afro-Caribbean migrant farmworker (ACMF) with high rates of diabetes and an alarmingly high rate of non-adherence to treatment recommendations which is further complicated by low literacy, common cultural practices, and poor diets. …

Sociodemographic Factors Associated With Abortion Rates Among Black Women In The United States, Lincoln Don Washington

Walden Dissertations and Doctoral Studies

Abortion has been a public health issue since the procedure became legal 47 years ago and, clinicians have performed 60,069,971 abortions from 1973 to 2017 in the United States. In 2014, a significant decline in abortion rates has been recorded in almost every state, as well as across different subpopulations when segregated by age, race/ethnicity, education, income, or geographic locations. However, abortion rates were still significantly higher among Black women relative to the U.S. average, prompting the need to examine the causes of this disparity. The main purpose of this quantitative study was to investigate and determine the sociodemographic causing …

Systematic Review Of Family Nurse Practitioner Utilization Within School Environments, Luz Elena Zapien

Walden Dissertations and Doctoral Studies

The American Academy of Pediatrics and the Institute of Medicine recommend school health screening programs to detect problems that might interfere with a student’s education and general well-being, and many U.S. states require compliance with enrollment requirements such as updated immunizations and physical exams prior to attendance. In low-income areas, however, there is often a shortage of physicians available to meet the healthcare needs of the population. Family nurse practitioners (FNPs) can be utilized in school health settings to deliver health care services that support school attendance and the well-being of school students, yet little is known about their impact. …

Nursing Home Caregivers’ Knowledge Of Decubitus Ulcer Prevention Strategies, Shola Akinfiresoye

Walden Dissertations and Doctoral Studies

Decubitus ulcers (DUs) were a constant concern among the residents of the nursing home in this project. Prolonged immobility, sensory impairment, and urinary incontinence are some of the factors found in the literature as the causes of the disease. However, the lack of useful knowledge regarding evidence-based practices (EBPs) to prevent and treat DUs also contributed to the higher incidence rates at the nursing home. The purpose of this DNP- project was to evaluate the caregivers’ knowledge of EBPs to prevent and treat DUs at the facility. The IOWA Model of Evidence-Based Practice, which healthcare practitioners use to guide clinical …

Staff Education On Fall Reduction Strategies For Residents Of A Long-Term Care Facility, Olivia C. Anaele-Nwogu

Walden Dissertations and Doctoral Studies

Fall-reduction programs are frequently ineffective in reducing falls among geriatric patients in long-term care (LTC) facilities. Multicomponent strategies have proved to be effective in reducing these falls. However, these strategies require staff education to ensure their success. The purpose of this project was to support the integration of multicomponent fall prevention strategies into practice by providing staff education focusing on the appropriateness use of hourly rounding and the 4Ps (pain, position, prompted voiding and placement) in addition to bed alarms to prevent falls among geriatric patients in the local LTC facility. The Johns Hopkins Nursing Evidence-based model was the conceptual …

Physician Assistant Burnout And Fulfillment Related To Career Development And Physician Relationship, Kari Sue Bernard

Walden Dissertations and Doctoral Studies

Physician workforce shortages are driving increased clinical and administrative use of non-physician healthcare providers. As a result, physician assistants (PAs) may experience role expansion in a positive or negative manner. The purpose of this study was to determine if aspects of PA career development related to role expansion interacted with the quality of the collaborative physician (CP) relationship to predict PA well-being. The job demands-resources (JD-R) model was used as the theoretical foundation and the National Academy of Medicine’s conceptual model of clinician well-being was used as the conceptual framework. Research questions addressed whether PA experience level predicted well-being, and …

Health Care Providers’ Use Of Nudging With Families Of Older Patients Making Discharge Decisions, Tabatha Bowers

Walden Dissertations and Doctoral Studies

The health care system has focused on reducing costs associated with longer lengths of

stay while facilitating safe and appropriate discharges. The purpose of this educational

project was to increase awareness among health care providers regarding nudging and

how it influences discharge planning decisions by patients and families. Enhancing health

care providers’ understanding of the impact of discharge communication may address the

issue of alternate level of care (ALC). Transition theory was used to frame the project.

Practice-focused questions addressed how the use of evidence-based case studies about

nudging could improve discharge planning for patients in a large community hospital …

Relationship Between Health Risk Behaviors And Obesity Among American High School Students, Jacques Jean-Paul Cherry

Walden Dissertations and Doctoral Studies

Adolescent obesity is a serious health condition that affects more than 55% of students aged 12 to 19 years in the United States. Recent statistical data have noted that the rate of adolescent obesity has more than quadrupled during the past few decades. Genetics and factors such as tobacco use, alcohol use, and marijuana use have contributed to this critical public health issue. Although uniqueness of prevalence has often been linked to gender and race, associations related to these health risk behaviors and increased body mass index remain relatively unexplored among today’s U.S. youth. Adolescence has been described as a …

A Staff Educational Model For Prevention Of Type 2 Diabetes In The Primary Care Setting, Mieshia Staples Clark

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic, debilitating disease affecting millions of Americans. Though preventable, it is the most common form of diabetes in the United States, costing the U.S. health care system billions of dollars annually. Lifestyle modifications taught, encouraged, and supported in established, evidence-based diabetes prevention programs (DPP) are proven to be more effective than medications alone in preventing Type 2 diabetes. While DPPs are cost-effective and can reduce or delay the incidence of Type 2 diabetes, they are greatly underutilized due to primary care providers’lack of knowledge about the benefits and availability of these programs and also due …

Exploring Young Opioid Users’ Motivation To Seek Treatment For Substance Use Disorder, Patricia Gianotti-Avella

Walden Dissertations and Doctoral Studies

In the past 15 years, the nonmedical use of opioids in the United States has reached epidemic proportions, resulting in a 21% increase in overdose fatalities. This surge in opioid use and dependence represents a shift in the demographic from inner-city populations over the age of 40 to young adults between the ages of 20 and 34 who dwell in primarily white suburban neighborhoods. Research has identified physicians’ liberal prescribing practices as one cause of this epidemic and has documented the ineffectiveness of current interventions with young addicts. The purpose of this narrative study was to gain insight into what …

Experiences Of Resiliency And Family Support In Older Women With Mental Illness, Dawn Harbin

Walden Dissertations and Doctoral Studies

Lack of a support system for older females with mental illness may cause reduced resiliency skills and an increase in mental illness symptoms while they attempt to manage independent living. The purpose of this qualitative study was to explore the individual stories of older women living independently who suffer from a mental illness and have a support system. Social learning theory and self-efficacy theory provided the framework for the study. Data were collected from face-to-face interviews with 8 women ages 65-80 years who are in treatment at a mental health center in South Carolina. Findings from coding analysis showed that …

Experiences And Challenges Of Social Workers Working With Transitioning And Postmilitary Service Members Who Have Mental Health Issues, Joyce M. Hewitt

Walden Dissertations and Doctoral Studies

Active duty service members, veterans, and their family members are faced with a myriad of problems including mental health issues, substance abuse issues, traumatic brain injury, suicide, family integration issues, and family distress. Understanding the organizational, environmental, and person-centered factors that affect the delivery of mental health care treatment to active duty service members, veterans, and their families is urgent to this unique population for social work practitioners (licensed master, advanced, & clinical). This project explored the experiences and challenges that social work practitioners (licensed master, advanced, & clinical) have in providing effective services for mental health care treatment to …

Nurse Educator Perceptions Of Using Simulation For Evaluation Of Nursing Competencies, Angela Elizabeth Horton

Walden Dissertations and Doctoral Studies

Over the past 10 years, simulation technology has been increasingly used in clinical settings to evaluate nursing competencies and ensure safe patient care. However, not all simulation laboratories are used consistently by hospital nursing education departments to support learning. The purpose of this qualitative case study, framed by constructivist theory, was to identify nurse educators’ perceptions of the value of using simulation to evaluate nurse competence. Research questions addressed how nurse educators decided what teaching methods to use when evaluating nursing competencies. The participant sample included 8 nurse educators responsible for the education of new and practicing nurses in the …