Medicine and Health Sciences Commons^™

Boost Tool Implementation And Sepsis Readmissions, Length Of Stay, And Patient Satisfaction, Jane Venus-Nocentelli

Walden Dissertations and Doctoral Studies

Sepsis is a global concern because it contributes to high mortality rates, increased healthcare costs, and poor patient outcomes. Health care organizations have used risk stratification tools such as the Better Outcomes by Optimizing Safe Transitions (BOOST) tool to reduce unnecessary readmissions, decrease length of hospital stays, and improve patient health outcomes. But there is limited data on the use of the BOOST tool in the sepsis population and the impact on readmissions and length of stay. The purpose of this quantitative study was to investigate the relationship between BOOST tool implementation, readmissions, and length of stay in patients with …

Staff Education Program On Postpartum Depression Screening, Pamela Barstow

Walden Dissertations and Doctoral Studies

AbstractPostpartum depression (PPD) in the US is a serious health concern that negatively impacts an average of 11.5% of women, with 13.36% of women in Virginia in 2018 reporting PPD symptoms. Mothers experiencing PPD may have trouble bonding with their infants, which may negatively impact childhood growth and development. However, fewer than one-half of pediatricians screen mothers of infants for PPD. Literature supports staff education on PPD to promote the wellbeing of postpartum mothers and their infants. Using the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this Doctor of Nursing Practice project was to …

Annual Financial Performance, Efficiency, And Quality Of Care In Accountable Care Organizations In Florida And Texas, Tony Lavance White

Walden Dissertations and Doctoral Studies

The association between efficiency and quality of care among accountable care organizations is not fully understood. Therefore, the purpose of this quantitative study was to examine the relationships between ACO efficiency, ACO financial performance, and ACO quality scores in the states of Florida and Texas. Guided by structural contingency theory, the research questions explored whether there was a statistically significant relationship between ACO efficiency and financial performance, as well as ACO efficiency and the quality of care among ACOs in the states of Texas and Florida in 2018 using all ACOs located in those states. The results of the study …

Perceptions Of Contraceptive Practice Among Arab American Victims Of Intimate Partner Violence, Linda Humaidan-Zayed

Walden Dissertations and Doctoral Studies

There has been limited research on Arab Americans as they are an unidentified minority population. The specific research problem addressed through this study is that there is little research pertaining to the role of intimate partner violence (IPV) in poor contraceptive practice among Arab Americans, contributing to the larger problem of unwanted pregnancies, reproductive coercion, and other aspects of reproductive health. The problem with a high prevalence rate of IPV among Arab American women is that they are more susceptible to becoming pregnant and not accessing the reproductive health services that they may need. Thus, the purpose of this qualitative …

Huddle Implementation In The Perioperative Setting, Tina Thomas

DNP Projects

Background: Communication is essential for safe and effective patient care. In the perioperative setting, information sharing is critical to care coordination. Lack of communication between caregivers can lead to medical errors. Evidence shows that huddles lead to increased communication, satisfaction, and engagement between team members resulting in better patient outcomes. Huddles are short, less than 10-minute gatherings that focus on the daily schedule, identify potential obstacles, explain unique needs, and discuss preceding day issues.

Objectives: This project aimed to evaluate the effectiveness of huddles on employee satisfaction, engagement, and communication of healthcare workers while also determining if huddles were …

Evaluating The Use Of A Diet Screening Tool For Diabetes And Weight Management In Primary Care, Christie Mcbride

DNP Projects

Background: Type 2 diabetes mellitus is a prominent disease and leading cause of death in the nation. Many complications can develop when glucose levels are poorly controlled. When patients receive education and support in diabetes self-management, including individualized dietary interventions, it leads to improved glycemic control.

Purpose: The purpose of this quality improvement (QI) project was to evaluate the incorporation of a diet recall tool, Starting the Conversation (STC), in the standard care for diabetic patients with abnormal body mass index (BMI). The study aimed to examine: (1) patient opinion of the intervention and (2) healthcare provider satisfaction with use …

Examining The Impact Of A Protein Intervention To Improve Outcomes In Frail Perioperative Candidates: A Feasibility Study, Anna M. Rose

DNP Projects

Background: Frailty is a syndrome or grouping of clinical characteristics that collectively increases one’s vulnerability to acute and external health stressors. Higher rates of frailty are present in oncology surgical patients and is a predictor of postoperative complications, as well as increased morbidity and mortality. Long- and short-term survival of surgical oncology patients is worse in frail patients than robust patients. Prehabilitation interventions during the planning phase of surgical intervention may serve to mitigate already known health concerns prior to inflicting the stressor that is surgical intervention.

Purpose: To measure the feasibility of an educational prehabilitative nutritional intervention aimed at …

Implementing A Health-Related Quality Of Life Assessment Tool In An Outpatient Hematology/Oncology Clinic: A Pilot Quality Improvement Project, Jennifer Holl

DNP Scholarly Projects

BACKGROUND: Although overall and disease-free survival remain the goals of cancer care, health-related quality of life (HRQOL) during and after treatment is increasingly acknowledged as vital to the patient’s outcomes. The purpose of this project was to identify and implement a valid, reliable HRQOL assessment tool into daily clinical practice in an outpatient hematology/oncology clinic at a 25-bed critical access hospital in rural New Hampshire.

METHODS: This project used a methodological design. Descriptive and inferential statistics, plus qualitative analysis were used to determine results. Three nurses and seven patients participated in this quality improvement project.

INTERVENTIONS: The interventions …

Covid-19 Vaccine Policies, & Vaccine Hesitancy: Improving Vaccine Uptake Together With One Respectful Voice, Emmanuela Nwaonumah, Emilee Larson, Danielle Soler Lopes, Bettye Apenteng

Eagles Talking About the Public’s Health

No abstract provided.

Strategies For Improving Customer Retention For Medical Imaging Devices, Guillermo Sander

Walden Dissertations and Doctoral Studies

Some sales managers of medical imaging devices lack strategies to improve long-term customer retention. Increasing retention can save these sales managers up to 50% of their customer acquisition costs. Grounded in the service profit chain theory, the purpose of this qualitative multiple case study was to explore strategies sales managers of medical imaging devices use to improve long-term customer retention. The participants comprised seven sales managers of medical imaging devices from three companies who successfully achieved long-term customer retention. Data were collected using semistructured interviews and public documents. Thematic analysis was used to analyze the data. Three themes emerged: value-added …

Nursing Staff Education Project To Improve Diabetic Patients' Glycemic Control, Valerie R. Gaston

Walden Dissertations and Doctoral Studies

Diabetes is a chronic disease affecting more than 34.2 million people in the United States. The International Diabetes Federation predicted by the year 2045 an estimated 700 million people will have diabetes. In the clinic project site, the practice problem involved the increasing clinician’s knowledge about Type 2 diabetes mellitus (T2DM) with improved glycemic control through self-care management. The purpose of this project was to develop an educational training and intervention for staff to increase their knowledge of self-care management to improve glycemic control and have it validated by a panel of experts before dispersing it to the intended audience. …

Relationship Between Rurality, Home Telehealth, And Bed Days Of Care For Military Veterans Readmitted For Heart Failure, Storm Li Morgan

Walden Dissertations and Doctoral Studies

Heart failure (HF), the leading hospital admission diagnosis for military veteran patients discharged from a Department of Veterans Affairs (VA) hospital, is more common in patients residing in rural than urban areas. Primary care managers prioritize reducing readmissions for HF as up to 80% of health care costs for HF, projected to increase to $69.7 billion annually by 2030, incur during hospitalizations. Underpinned in Andersen’s behavioral model of health services use, the purpose of this quantitative ex post facto correlational study was to examine the relationship between residence rurality, home telehealth enrollment, and bed days of care for military veteran …

Reducing Sepsis Rates Through Nursing Staff Education, Joshua J. Wilkinson

Walden Dissertations and Doctoral Studies

Many hospitals fail to comply with sepsis treatment core measures. The purpose of this project was to educate nursing staff in a small rural emergency department in the Midwest United States about core measures that included 1-hour bundles for sepsis treatment. The project attempted to answer the practice-focused question: Does educating emergency department nursing staff in a small rural emergency department on the 1-hour sepsis bundle increase knowledge? Lewin’s Change Theory and Kirkpatrick’s Four-Level Training Evaluation Model served as the framework for the project. A 1-hour in-person education was developed using the Analyze, Design, Develop, Implement, and Evaluate model with …

Predictors Of Very Late Onset Infection In Kidney Transplant Recipients At Least Ten Years Post Transplant, Harry Cheung

Yale Medicine Thesis Digital Library

Although there have been improved outcomes for kidney transplant recipients, infection is still a leading cause of morbidity and mortality for long-term kidney transplant survivors (LTKS). This thesis and study aims to investigate the epidemiology of very late onset infections (>10 years post-transplant), or VLOI and clinical markers that can predict these infections.

A single-center, retrospective study of a cohort of patients (≥18 years old) who underwent kidney transplantation between 2003-2009 and survived for at least 10 years post transplantation was conducted. The primary outcome studied was the occurrence of VLOI. The data collected included transplant data, patient co-morbidities, …

Pre-Operative Urinary Tract Infection And 30-Day Outcomes In Neurosurgery, James Yoon

Yale Medicine Thesis Digital Library

Urinary tract infections (UTIs) are the most common bacterial infection in the United States, placing significant demands on our healthcare system already constrained by rising costs and limited resources. While patient complications occur in all areas of surgery, the issue around neurosurgical patients deserves special attention as treatment of surgical site infections in neurosurgery is the most expensive among all surgical specialties. Complication rates are also disproportionately higher in patients over 65 years old, which are noteworthy in caring for our aging patient population.

While the adverse effects of a post-operative UTI have been well described in the surgical literature, …

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon, Ali Elreichouni

Yale Medicine Thesis Digital Library

Objective: Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury.

Methods: This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, …

Nurse Management Education To Improve Job Satisfaction And Nurse Retention, Motunrayo Omoloye Adegorusi

Walden Dissertations and Doctoral Studies

Abstract Nurses play a critical role as primary care providers in correctional facilities, as well as custodians of security. However, there is a significant disparity in the supply of nurses in correctional settings relative to other practice settings, which is a major gap in practice. The current problem arises from the inability to retain nurses in the correctional settings. Prisons have a harsh work environment characterized by a difficult patient population and stringent policies that govern operations. Additionally, a high level of bureaucracy impedes system reforms and transformations. The purpose of the DNP project was to find out if the …

The Correlation Between Laura’S Law And The Incarceration Of The Mentally Ill In A Southwestern State, Aaron Alarcon-Bowen

Walden Dissertations and Doctoral Studies

Assisted outpatient treatment and involuntary outpatient treatment laws refer to the power of the court system to order community-based treatment without hospitalization to individuals with a mental illness diagnosis. Studies have linked these laws to a decrease in the use of incarceration among this population. The effectiveness of the assisted outpatient treatment law in a Southwestern state, known as Laura’s Law, has not been studied. With a theoretical foundation based on the social contract and multiple streams analysis theories, a quantitative, casual, comparative study using an independent t test was centered on determining whether the mean numbers of incarcerated individuals …

Relationship Of Mindfulness To Worldview Defense When Mortality Is Salient, Blake Ausmus

Walden Dissertations and Doctoral Studies

Humans value self-preservation, and therefore that which is perceived to threaten survival should cause stress. However, humans have also developed the understanding of their own mortality, meaning that they cognitively understand that death is inevitable. The conflict arising from these opposing constructs holds the potential to cause anxiety. Interestingly, this anxiety is not easily observed in most. Terror management theory posits that there are buffer systems in place that help to keep death anxiety at bay so that humans are able to continue to function in their daily lives. These buffers include becoming more stringent to one’s worldviews and less …

Improving Nurses' Knowledge On The Assessment And Documentation Practices In The Pediatric Settings Of A Jamaican Hospital, Binol Rajesh Balachandar

Walden Dissertations and Doctoral Studies

AbstractThere have been anecdotal reports from the on-site Quality Assurance team, administrators, and educators that a theory-practice gap exists in pediatric nursing practice settings relating to the specific assessment and documentation. A deidentified chart review confirmed the reported practice gaps in 80% of the patient records. Therefore, in collaboration with the in-service unit, this staff education project and the educational interventions were implemented, and the knowledge improvement was appraised using a pre and posteducation survey. Mozirow’s reflective learning theory formed the basis for staff education, utilizing adult learning principles. Twenty-five consenting nurses completed the preeducation survey (N = 25); however, …

Influence Of Cyberbullying On Suicidal Behaviors, David Dellerman

Walden Dissertations and Doctoral Studies

Secondary data was used to examine the prevalence of suicidal behaviors and the association between cyberbullying by high school-aged students (Grades 9–12) both heterosexual and sexual minority youth (SMY) and suicidal behaviors experienced by high school-aged students (Grades 9–12) in the United States using data from the 2017 CDC’s Youth Risk Behavior Surveillance System (YRBSS). The YRBSS used in this research was the newest and most comprehensive data. The YRBSS is a national school-based survey, that is used to monitor health-related behaviors including violence, sexual behaviors (heterosexual and SMY students), intentional and unintentional injuries that contribute to suicide behaviors. Results …

American Urologists’ Concerns With Nonclinical Activities Moderating Burnout, Nichele Lynn Greer

Walden Dissertations and Doctoral Studies

As burnout continues to increase in the healthcare field and specifically in the specialty of urology, gaining knowledge of certain risk factors associated with burnout can potentially help prevent further increases. Intervention programs may also be developed as a result of understanding these relationships. The purpose of this quantitative correlational analysis was to determine whether hours worked on nonclinical activities moderated the relationship between age and burnout as well as gender and burnout in American urologists. The theoretical foundations utilized in this research were the jobs demands resources model, which suggested that burnout occurs as a result of job demands …

Website Accessibility Strategies, Gary W. Hrezo

Walden Dissertations and Doctoral Studies

Most websites cannot be readily used by people with disabilities, despite the internet being an essential component for people to be part of a community. Applying web accessibility strategies means that people with disabilities can better interact with the web. Grounded in Davis’s technology acceptance model, the purpose of this qualitative multiple case study was to examine strategies used by web designers to make websites accessible for people with disabilities. The participants were experienced web developers from organizations in Florida with websites that have a Web Content Accessibility Guidelines Level 2 of three levels, i.e., AA- rating. The data collection …

An Educational Program For Standardization Of Care For The Acute Opioid Withdrawal, Jessica Ann Larson

Walden Dissertations and Doctoral Studies

Opioid addiction is a widespread chronic disease affecting millions of Americans each year, resulting in medical, social, financial, and societal detriments. Patients experiencing opioid withdrawal benefit from a standardized and evidence-based approach to care. The purpose of this doctoral nursing project was to provide inpatient nursing education for a standardized clinical practice approach to optimize patient outcomes. The research question examined the impact of an educational program for nurses presenting a new standardized opioid withdrawal clinical practice guideline inclusive of assessment, nursing interventions, a symptom triggered order set, and follow up plan of care in terms of knowledge gained and …

Prediabetes, Implementation Of Ada Practice Guidelines And Provider Perspective, Kimberlee May Manguiat-Lang

Walden Dissertations and Doctoral Studies

AbstractPrediabetes occurs before the development of diabetes in some people. Practitioners who educate people about prediabetes are not consistently using the latest evidence-based practice guidelines. The purpose of this mixed-method study was to fill a gap in the literature by providing evidence of the provider practices, attitudes and barriers when implementing American Diabetes Association (ADA) practice guidelines for the prediabetic patient. The Theory of Planned Behavior applies to evidence-based practice and the implementation of evidence-based practice guidelines. Research questions for this study focused on determining rate of compliance with ADA clinical practice guidelines from health care professionals to include providers …

Exploring Moral Distress, Ethical Climate, And Psychological Empowerment Among New Registered Nurses, Luz Bruel Mauro

Walden Dissertations and Doctoral Studies

Moral distress in nursing has been an issue for decades and has consequences on nurses’ physical, emotional, and psychological well-being. Nurses in different settings experience a high intensity and frequency of moral distress particularly in intensive care units (ICU), but few studies have examined the moral distress of non-ICU nurses. The purpose of this 3-manuscript dissertation was to assess the frequency and level of moral distress, ethical climate, and psychological empowerment among new registered nurses (NRNs) who work in non-ICU settings. The conceptual framework of Jameson's moral distress guided this study. Twenty-three NRNs with fewer than 3 years of experience …

Exploring Implementation Strategies Of Iot Technology In Organizations: Technology, Organization, And Environment, Khanhhung Hoang Pham

Walden Dissertations and Doctoral Studies

AbstractAfter organizations successfully adopt the internet of things (IoT) technology, many corporate information technology (IT) leaders face challenges during the implementation phase. Corporate IT leaders' potential failures in implementing IoT devices may impede organizations from integrating IoT solutions and promoting business benefits. Grounded in technology-organization-environment (TOE) theory, the purpose of this qualitative, pragmatic inquiry study was to explore strategies that corporate IT leaders use to implement IoT technology in their organizations. The participants were six corporate healthcare IT leaders who successfully used implementation strategies for implementing IoT solutions for their organizations. Data were collected using semistructured interviews and industry security …

The Correlation Between Acl Injury & Concussion, Brandon Michael Phillips

Theses and Dissertations--Kinesiology and Health Promotion

Concussion (also known as mild traumatic brain injury) is a neurological injury that occurs after a blow to the head or neck area and can have affects to movement based on the severity of the injury. Mild traumatic brain injury has possible linkage to an increased risk of anterior cruciate ligament (ACL) injury. The purpose of this thesis was to assess the impact of prior concussion on lower extremity mechanics that are associated with risk of ACL injury. A total of 11 individuals with prior history of concussion and 11 healthy individuals without prior history of concussion (56.5 months since …

Etiology Of Firefighter Injuries: A Health Care Practitioner Perspective, Alyssa Quinn Eastman

Theses and Dissertations--Kinesiology and Health Promotion

BACKGROUND: Structural firefighting involves the performance of rigorous occupational tasks in unpredictable, dynamic, and hot environments which increases firefighters’ risk of injury. Specifically, the National Fire Protection Association reported that musculoskeletal injuries account for 56% of non-fireground and 41% of fireground injuries. Furthermore, physical training is the most common cause of injury, accounting for one-third of all injuries and resulting in 41% of post-injury absences from work. There is limited research identifying occupational and exercise injury risk factors among firefighters. However, experienced health care practitioners working with fire departments may provide critical insight into potential mechanisms of these common injuries. …

Estrogen Regulation Of Daily Metabolic Rhythms In Female Mice, Oluwabukola Omotola

Theses and Dissertations--Biology

Circadian rhythms are approximately 24-hour cycles of behavior, physiology, and gene expression. In mammals, these circadian rhythms are generated by clocks located in nearly every tissue in the body. The function of circadian clocks is to synchronize physiology and behavior with environmental cycles such as the light-dark cycle. After menopause, when circulating levels of estrogens are very low, women are more susceptible to obesity comorbidities such as metabolic syndrome and cardiovascular disease, suggesting that estrogens regulate these processes. Estrogens could protect females from metabolic dysfunction by regulating circadian rhythms. Consumption of diets that are high in fat contribute to obesity. …