Medicine and Health Sciences Commons^™

Social Determinants Of Health Influence On Surgical Morbidity After Colorectal Surgery, Koianka J. Ivanova Trencheva

Walden Dissertations and Doctoral Studies

Decreasing surgical morbidity and improving surgical safety is a public health priority. With same-day or early hospital discharge after surgery, knowledge about social determinants of health (SDOH) impact on surgical morbidity is vital for surgical safety improvement. This study’s aim was to evaluate SDOH association with surgery-related morbidity after colorectal surgery in an adult population. This quantitative cross-sectional study used New York Statewide Planning and Research Cooperative System (SPARCS) secondary data from 2006 ⁠–2016 on 130,731 patients linked to SDOH. Dependent variables were anastomotic leak (AL), surgical site infection (SSI), Not SSI related, and overall complications (COMPL) within 30 days …

Reducing The Readmissions Through Multidisciplinary Rounds In Older Adults, Fatima Rajapathy Tisseverasinghe

Walden Dissertations and Doctoral Studies

Hospital readmissions are a reflection of poor quality of care. The readmission rate in an acute care for the elderly (ACE) unit was above the national benchmark in 2017. The specific problem includes lack of communication, collaboration, and coordination among the interdisciplinary team. Further, in older adults, the problem is accentuated by health illiteracy, comorbidities, cognitive impairment, polypharmacy, and unclear discharge and follow-up care instructions. Poor care transition costs Medicare 17.4 billion dollars a year. Multidisciplinary rounds (MDRs) have been adopted by many hospitals as evidence-based interventions to reduce readmissions within 30 days. This Doctor of Nursing Practice (DNP) project …

A Delphi Study On The Use Of Simulation In Undergraduate Nursing Education, Diana L. Bailey

Walden Dissertations and Doctoral Studies

AbstractThe lack of traditional clinical sites for nursing students has prompted a surge in simulation as an innovative teaching strategy in undergraduate nursing education. The International Nursing Association for Clinical Simulation and Learning (INASCL) developed the INACSL Standards of Best Practice: SimulationSM to direct schools of nursing in implementing high-quality simulations. As simulated experiences replace traditional clinical experiences, it is imperative that simulated experiences replicate real-life patient scenarios. The purpose of this Delphi study was to establish consensus on the use of the INACSL Standards of Best Practice: Simulation in undergraduate nursing education. The conceptual frameworks guiding this study were …

Insecticide Treated Nets And Malaria Control Strategy In Sierra Leone, Henry Nk Biayemi

Walden Dissertations and Doctoral Studies

AbstractMalaria is a deadly disease and endemic in Sierra Leone. It is the leading cause of morbidity and mortality amongst children younger than five years in Sierra Leone. Insecticide treated nets (ITNs) are not used widely despite free distribution, low health risks, and proven ability to reduce malaria. The purpose of this quantitative crosssectional study was to investigate the association between a set of independent variables (parental education, parents' economic status, household size, and residence) and the use of ITNs among children under five years of age in Sierra Leone. The study used a secondary dataset from the Ministry of …

Strategies To Reduce Fall Rates In A Long-Term Care Facility, Kimberly H. Brewer

Walden Dissertations and Doctoral Studies

AbstractFalls among residents of long-term care facilities (LTCFs) pose significant threats to their health and quality of life, as falls often lead to life-threatening injuries such as traumatic brain injury and hip fractures. The etiology of the falls is multifactorial and complex; thus, interventions to reduce the falls typically combine two or more evidence-based interventions. The objective of this doctorate project was to develop an evidenced-based clinical practice guideline (CPG) outlining a multifaceted, evidenced-based bundled set of interventions for a fall prevention program to reduce falls for elderly patients living in the LTCFs. Lewin’s 3-step model of change was used …

Experience Of The Obese Population With Weight Bias/Stigma, Gary Mathew Brown

Walden Dissertations and Doctoral Studies

Obesity management has been identified as an important issue in health promotion, and some researchers have also reported that people who are obese often do not seek health care. Yet, current research is lacking on the complexities of weight stigma from the perspective of people who are obese. The purpose of this qualitive descriptive study was to understand the perceptions of weight bias/stigma of obese individuals. Guided by Goffman’s Theory of Social Stigma and the Health Belief Model, purposive sampling was used to recruit 10 participants who had a body mass index greater than 30 and who lived in West …

Increasing Fall Awareness Through Nursing Staff Education, Evelyn Ahiante Dennis

Walden Dissertations and Doctoral Studies

Patient falls are a significant healthcare concern, with the highest risk being among older adults aged 65 and older. A lack of nursing knowledge can contribute to patient falls. This DNP project was conducted in the medical-surgical trauma unit of a 137-bed local rehabilitation center in Northern Georgia. The intention of the project was to understand if a nursing staff education program would increase knowledge regarding falls prevention. Kurt Lewin’s change theory provided the framework for the project. The project participants were nine medical surgical nurses. Using the analysis, design, development, implementation (ADDIE) model, a falls prevention education program was …

Strategies For Managing Work-Related Stress In The Petroleum Industry, Esang Lazarus Esitikot

Walden Dissertations and Doctoral Studies

High work-related stress negatively impacts workers’ health and productivity in the Nigerian petroleum industry. Supervisors in the Nigerian petroleum industry who lack strategies to reduce work-related stress significantly lose worker health and organizational productivity. Grounded in person-environment fit theory, the purpose of this qualitative multiple case study was to explore strategies Nigerian petroleum industry supervisors use to manage work-related stress. Participants were six supervisors who have successfully used strategies to reduce work-related stress in the Nigerian petroleum industry. Data were collected from semistructured interviews and internal company documents relevant to reducing work-related stress and analyzed using thematic analysis. Three major …

Influence Of Parenting Style On Frequency Of Alcohol Consumption By Jewish Male And Female Emerging Adults, Thomas Gross

Walden Dissertations and Doctoral Studies

Abstract

The health hazards associated with young adults’ frequency of alcohol consumption have been well documented. It has been shown that 40.1% of emerging adults have been involved in binge drinking (i.e., consumption of more than five drinks in a row). The current prevalence rates of alcohol use among young male and female adults are 19% and 26%, respectively. The purpose of the study was to examine the influence of perceived parenting style (i.e., permissive, authoritarian, or authoritative/flexible) on the self-reported frequency of alcohol consumption of 138 U.S. Jewish male and female college students ages 19 to 27 years. The …

Demographic And Socioeconomic Determinants Of Lassa Fever In Edo State, Nigeria, Faith Ogagaroghene Ireye

Walden Dissertations and Doctoral Studies

Lassa fever is a viral hemorrhagic fever caused by the Lassa virus and associated with significant morbidity and mortality. Yearly outbreaks of the disease occur in Edo State, Nigeria. The purpose of this study was to examine the demographic and socioeconomic factors that can influence transmission of the disease. The Commission on Social Determinants of Health conceptual framework was used in this research study. This framework describes the relationship between structural and intermediary factors and how they determine health outcomes. To answer the research question of how demographic and socioeconomic factors influence Lassa fever transmission in Edo State, a cross-sectional …

Social Ecological Factors Affecting Marijuana Use Among Young Adults In The United States, Temple Oritsegbubemi Jagha

Walden Dissertations and Doctoral Studies

AbstractCurrent knowledge of young adults’ marijuana use centers around individual risk factors and negative health effects (i.e., mental disorder), with less focus on contextual circumstances. In this study, I examined the association between demographic (i.e., gender, race, education, employment, income, and population density), social (i.e., risk perception and religious beliefs influence), living context (i.e., difficulty getting marijuana, poverty level, and county metro status), and marijuana use among young adults. The social-ecological model guided this study. In this quantitative cross-sectional study, data from the 2019 U.S. National Survey on Drug Use and Health that included 14,226 young adults aged 18 to …

Examining The Impact Of Mental Health Education On Bias And Stigma In Cit Trained Officers, Jennifer L. Krause

Walden Dissertations and Doctoral Studies

The purpose of this quantitative, correlational nonexperimental research was to examine the relationship between the mental health education received through Crisis Intervention Team (CIT) training and the perceptions of public mental health stigma, self-stigma, and attitudes toward seeking mental health services among law enforcement officers. The study’s theoretical framework integrated gender-role conflict theory and Goffman’s stigma theory in explaining the influence of the police culture on officers’ adoption of more traditional masculine roles. This research used three instruments: the Attitudes to Mental Illness questionnaire to measure perceptions of public stigma, the Self-Stigma of Seeking Help Scale to measure self-stigma, and …

Analysis Of Hba1c, Medication Compliance, Income Subsidies, And Comorbidity In Medicare Type 2 Diabetics, Robert E. Lazarchik

Walden Dissertations and Doctoral Studies

Diabetes is one of America’s leading chronic diseases with comorbidities contributing to lower health statuses and increased health care costs. While it is known that lowering HbA1c reduces the deleterious effects of diabetes, the capability to identify people with diabetes at risk for uncontrolled HbA1c levels or developing comorbidities based on the compliance rates for different oral antihyperglycemic medication classes (OAMCs) and financial assistance programs does not yet exist. These quantitative longitudinal retrospective studies examined the association between medication compliance, using Proportion of Days Covered (PDC), by OAMC and Medicare financial aid programs, on predicting HbA1c levels and comorbidities in …

Coping Strategies Of Dual-Role Informal Caregivers, Lorilee Maldonado

Walden Dissertations and Doctoral Studies

There are nearly 43.5 million informal caregivers (ICGs) in the United States, and this number will nearly double by 2030. Trying to fulfill the needs of an aging family member and commitments to work, home, and other relationships create a constant state of stress that may result in either leaving the workforce or placing the care recipient in a facility. Finding strategies that support both roles is economically and socially critical. This study explored the strategies that some ICGs have acquired that enable them to cope with these pressures. Work-family conflict theory, focusing on the conflict between work and family …

A Behavioral Healthcare Approach To At-Risk Youth Substance Prevention Program Development, Debra Mcintyre

Walden Dissertations and Doctoral Studies

Providing quality services that meet the needs of clients is key to organizational sustainability for behavioral health organizations. Strategic development of substance prevention programs for at-risk youth will play an important role in capacity building. The focus of this study was to identify the need for developing a targeted and effective substance abuse prevention program to support at-risk youth who have trauma experiences before they begin misusing substances to cope with their challenges. The Baldrige excellence framework was used to guide this descriptive case study of a behavioral health organization in the Northeastern region of the United States. The data …

Diabetes Education For Nursing Staff In Primary Health Care, Artemio Pontejos

Walden Dissertations and Doctoral Studies

The nature of the DNP project was a staff education program for staff nurses and other clinic personnel on diabetes self-care management in a primary health care setting. The goal of this educational program was to improve and update the knowledge on self-care management of primary health care nurses. This education program followed the Walden University DNP Project Manual for Staff Education guidelines. The purpose of this continuing education of professional nurses was to improve nurses’ patient education on self-care management. After a 3-day face-to-face 90-minute lecture, improvement of knowledge was measured with a comparison of a pretest and a …

30-Day Hospital Readmission Rates In Illinois Hospitals For Patients With Heart Failure And Pneumonia, Kristine Rucker-Morrow

Walden Dissertations and Doctoral Studies

Despite efforts from hospitals across the United States, 30-day hospital readmission rates for patients with chronic conditions are on the rise. The purpose of this quantitative study was to examine the relationships in Illinois hospitals between patients with heart failure (HF) and pneumonia (PN) and 30-day hospital readmission rates by using the Pearson’s product-moment correlation test, focusing on how often these patients were readmitted and whether the hospital-wide rate of readmission after discharge changed. Andersen-Newman’s behavioral model with health services utilization was the theoretical framework, and a pre-collected Centers for Medicaid Services dataset was used for analysis. Results found a …

A Retrospective Analysis Of Integrative Group Medical Visits For Low-Income Patients With Anxiety Disorders In Primary Care, Annamma Udaya Thomas

Walden Dissertations and Doctoral Studies

High utilization of the emergency department (ED) by patients with anxiety symptoms has brought attention to mental health access disparities among low-income racially/ethnically diverse populations. The health system in this study attempted to increase access to mental health care with integrative group medical visits (IGMVs), a nonpharmacological intervention with biomedical care consultation, health education, and peer support. The purpose of this retrospective comparative analysis, guided by integrative health equity in primary care framework, was to determine whether patients with diagnoses of anxiety who attended four or more IGMVs had reduced nonemergent ED utilization, reduced prescribed doses of benzodiazepine (BZD), and …

Effect Of Clinical Trial Participation On Patient Experience And Overall Hospital Scores, Bridget Tyrka

Walden Dissertations and Doctoral Studies

AbstractDespite groundbreaking advances in technology and medicine in the United States and intensive examination of health services quality initiatives, issues of quality and patient-reported experience measures in the hospital sector remain unimproved. Although evidence-based medicine has improved through innovation in clinical research, healthcare systems have reportedly struggled to implement advances in medicine and lack the skill sets to become learning health systems. As clinical practice and clinical trials (CTs) have rarely intersected in the past, a significant lack of quantitative research has been dedicated to correlate improved patient outcomes with participation in CTs. The analysis sought a correlation, if any, …

Expectation Setting As A Retention Strategy To Improve Military Veterans’ Transition Into Civilian Organizations, Sarah O. Bashorun

Walden Dissertations and Doctoral Studies

Military veterans entering the civilian job market have experienced challenges adapting to the civilian work place culture, which poses undesirable retention rates. This qualitative study addressed the research gap in understanding contextually the lived experiences with setting expectations and its impact on veterans withdrawing from the organization from the perspectives of veterans, HR, and hiring managers. This study was based on the met expectation theory that posits that an employee’s incoming expectation needs to match their expectation while on the job to avoid withdrawal behaviors. To confirm the theory and address the purpose two research questions were used: (a) addressed …

Clinical Practice Guidelines For Nursing Orientation At A Small Clinic, Elizabeth Bemah

Walden Dissertations and Doctoral Studies

In the United States, the registered nurse turnover rate was 17.2% in 2018, a 0.4% increase from 2017. The nursing turnover rate at a small out-patient clinic in the northeast United States was 19.1% in 2019 and has not improved to date. The administrator at the out-patient clinic further indicated that the turnover rate has been approximately two nurses per month for the last 6 months and that the facility did not have a formalized nurse orientation program. Nursing orientation is one of the strategies for increasing the confidence levels and retention of newly hired nurses. The purpose of this …

Relationship Between Nurse-To-Patient Ratios, Patient Satisfaction Scores, And Hospital Profitability, Patrick Ross Bumstead

Walden Dissertations and Doctoral Studies

In 2019, hospital profitability margins were at their lowest levels since the great recession due to a declining volume of patients. Hospital executives who fail to improve profitability are at risk of sustainability. Grounded in the service-profit chain theory, the purpose of this quantitative correlational study was to examine whether nurse-to-patient ratios and patient satisfaction scores significantly predict hospital profitability. Data were collected from 74 hospitals in Southern California from the Centers for Medicare & Medicaid Services government database and publicly available financial statements. Results from multiple regression analysis were not statistically significant. A key recommendation is for hospital executives …

An Orientation Program For Neonatal Nurse Practitioners In A Level Iii Nicu, Lu-Ann Campagnola

Walden Dissertations and Doctoral Studies

Due to a nationwide shortage of neonatal nurse practitioners (NNPs), chronic short staffing shifted priority away from hiring novice and newly graduated NNPs in favor of recruiting experienced NNPs and contracting temporary locum tenens to expeditiously fill gaps in NNP staffing. Provision of formal orientation and an infrastructure that supported successful role transition became devalued and inconsistency in clinical approach and decision-making amongst providers raised concerns for patient safety. The goal of this Doctor of Nursing Practice (DNP) project was to develop a formal orientation program for NNPs in a Level III Neonatal Intensive Care Unit. The purpose was to …

Experiences Of Spanish-Speaking Patients Using Interpreter Services With Their Physicians, Rafael Raul Caycho

Walden Dissertations and Doctoral Studies

In the United States, many patients cannot speak English well enough to communicate with their medical providers. Many of these patients use professional interpreter services offered by their medical organizations to help with communication, which can lead to miscommunication due to the translation process between patients, interpreters, and physicians, and to incorrect diagnosis and poor health outcomes for the patient. The purpose of this study was to explore the experiences of Spanish-speaking patients who used interpreter services with their physicians. The transmission model was the theoretical framework used to explore the experiences and outcomes for the participants. In this study, …

Fetal/Infant Mortality: Understanding Race And Ethnicity, Birthing Location, And Prenatal Care, Chelsea Collum

Walden Dissertations and Doctoral Studies

This study addressed whether race and ethnicity, birthing location, the month the mother begins prenatal care, and pregnancy risk level impact fetal/infant mortality. Infant mortality is a gauge by which the efficacy of the healthcare system and the overall health of the country is measured. The United States falls behind most other developed countries in terms of infant mortality rates. The ecological perspective was used as the theoretical framework. The study design was a cross-sectional cohort design using a sample of births and infant deaths from U.S. Vital Statistics data. Binomial logistic regression analyses were carried out to calculate odds …

Adult Day Care Staff Education To Improve Communication And Behavioral Management Skills, Kathy Davis

Walden Dissertations and Doctoral Studies

AbstractIneffective communication and behavioral management skills are quality and safety issues that were identified at a local adult day care facility in the Southwest United States. Administrators at the facility identified a knowledge gap in communication and behavior management techniques for patients with cognitive impairment. An educational program, with a PowerPoint presentation and verbal feedback as key components, was developed and used to address the identified gap in practice related to individuals with cognitive impairments at the facility. The adult learning theory and the plan-do-study-act model provided supportive frameworks for program development and staff education. The project question explored whether …

Predictors Of Stunting In Children Under 5 Years Of Age In Zimbabwe, Ranganai Matema

Walden Dissertations and Doctoral Studies

Stunting is the most common form of undernutrition globally and is a major public health concern. Child stunting has both short-term negative effects on children’s health and long-term negative effects on adult health and human capital. Zimbabwe has a high prevalence of stunting, 27% in 2015. Although some of the factors associated with stunting are known, there is a gap on comprehensive evidence on the significant factors associated with persistent high levels of child stunting. The UNICEF conceptual framework for malnutrition was used to guide a cross-sectional study using the 2015 Zimbabwe Demographic and Health Survey data to identify and …

Association Between Asymptomatic Malaria Infection And Pregnancy Outcome In Delta State, Nigeria, Sadiatu Sally Obi

Walden Dissertations and Doctoral Studies

Pregnant women are vulnerable due to the pregnancy-induced suppressed immunity in malaria-endemic areas. Asymptomatic malaria in pregnancy (MiP) threatens both the mother, fetus, and neonate via chronic placental malaria which impacts maternal-neonatal exchange. Some studies reported that MiP risk factors vary across locations, however, there are few studies on MiP and pregnancy outcome in Nigeria. The purpose of this study was to investigate the association between asymptomatic placental malaria infection and pregnancy outcome among parturients in Asaba, Delta State, Nigeria. This study was developed with a quantitative methodology that utilized primary and secondary healthcare data from 483 subjects aged 18–49 …

Developing A Lifestyle Modification Tool To Prevent And Manage Elevated Blood Pressure Among African Americans, Magdalene Oziwo

Walden Dissertations and Doctoral Studies

Hypertension is a national medical problem that has been predominantly seen amongst African Americans. Within this community, hypertension has been associated with obesity, a sedentary lifestyle, and poor nutrition. It is for this reason that lifestyle modifications can be used as applied tools in the field of nursing in the prevention and management of hypertension among African American patients. This doctoral project was conducted to address the gap in nursing practice that currently exists for the African American population with regards to hypertension. The project focused on a nursing staff education program with 10 participants to promote the implementation of …

The Association Between Teen Pregnancy And Academic Performance Among Schoolgirls In The Ivory Coast, Moussokoura Ouattara Epse Assoumou

Walden Dissertations and Doctoral Studies

AbstractTeen pregnancy (TP) is a social and public health problem around the world. In developed nations, approximately 16 million girls from aged 15 to 19 years become pregnant each year, presenting health problems for the mother and fetus in addition to economic and social consequences for the communities in which they live. The purpose of this quantitative causal-comparative study, based on the theory of planned behavior, was to explore the association of academic performance and self-efficacy with TP. The research questions examined the association between the TP and the academic performance and self-efficacy while controlling for two covariates (socioeconomic status …