Medicine and Health Sciences Commons^™

Strategies To Mitigate Inappropriate Test Utilization By Physicians To Improve Efficiency In A Healthcare Setting, Christine C. Wood

Walden Dissertations and Doctoral Studies

Inappropriate test utilization by physicians for clinical decision-making in patient care is a significant problem facing some healthcare leaders. Healthcare leaders are concerned about inappropriate test utilization because it can increase healthcare costs and degrade patient outcomes. Grounded in the complex adaptive system and Lean Six Sigma conceptual frameworks, the purpose of this qualitative single-case study was to identify strategies seven hospital leaders in Maryland and Washington, DC. who implemented successful test utilization strategies for physicians. Data were collected from semistructured virtual interviews and organizational reports and analyzed using Yin’s 5 step process. Five themes emerged: (a) continuing physician education, …

Help-Seeking Behavior Of African American And Non-African American Victims Of Elderly Abuse, Tesfaye Yigletu Wosene

Walden Dissertations and Doctoral Studies

Elderly abuse is a pervasive public health problem in the United States. Most abuse and neglect go unreported due to barriers including fear for safety, concerns about the consequences, culture, lack of knowledge about elder abuse, shame, and self-blame. However, there is limited research on how race and ethnicity impact help-seeking behaviors of the elderly. This cross-sectional quantitative study examined the difference in reporting and help-seeking behavior between African American and non-African American victims of elderly abuse. Applying the behavioral model of health services use, this study involved a secondary data analysis using the Nation Elderly Mistreatment Study Wave II …

Association Between Psychosocial, Obstetric, And Lifestyle Factors And Antenatal Depression, Tomnema Xiong

Walden Dissertations and Doctoral Studies

Antenatal depression, or depression during pregnancy, is a mental health concern in the United States that impacts mothers and their infants. This study examined the associations between psychosocial, obstetric, lifestyle factors, and antenatal depression. This study was guided by social cognitive theory, specifically the reciprocal determinism construct. Secondary data from the 2007–2018 National Health and Nutritional Examination Survey (NHANES) were used in this quantitative cross-sectional study. Every participant of the NHANES completed the Patient Health Questionnaire-9 depression screening form. The study sample consisted of 274 women who were pregnant at the time of participating in the NHANES, approximately 28.8% of …

Examination Of The Association Between Poverty, Income, And Education Levels On Tuberculosis Prevalence In Nigeria: Rural Niger Delta Case Study, Nwinmene George Zarakpege

Walden Dissertations and Doctoral Studies

Despite the global decline in tuberculosis (TB) cases, the prevalence of TB in rural populations in Nigeria is rising. To date, poverty and low educational levels continue to affect treatment and other prevention strategies to eradicate the disease. The purpose of this cross-sectional study was to assess the association between poverty, educational levels, household structure and vaccination status on TB prevalence in rural Niger Delta, Nigeria. The theoretical framework for this study was the socio-ecological model. Data were obtained from residents of rural Niger Delta in Nigeria attending a teaching hospital in southern Nigeria. The relationship between the stated demographic …

How Black Americans Accessed And Used Mental Health Services During The Covid-19 Pandemic, John K. Anderson

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic created barriers to accessing mental health services for the general population, but for Black Americans, it exacerbated systemic barriers that have historically influenced help-seeking behaviors. Drawing from the concept of obstructed use, this qualitative study explored those barriers and, using a narrative approach, explored how Black Americans described their experiences of accessing mental health services during the COVID-19 pandemic The participants included six men and two women who identified as U.S.-born Black American adults who sought mental health services during the COVID-19 pandemic. Narrative data were analyzed through thematic analysis, identifying themes and subthemes of the participants' …

Strategies That Reduce Nurse Turnover, Trueman Chukwuemeka Atughonu

Walden Dissertations and Doctoral Studies

Nurse turnover is a significant problem that hospital managers and administrators face in delivering high-quality patient care while ensuring organizational profitability. In the United States, the average cost of replacing a nurse ranges from $40,000 to $100,000. Hospital managers are significantly challenged to reduce nurse turnover and keep costs down. Grounded in the Herzberg’s two-factor theory, the purpose of this qualitative multiple-case study was to explore the strategies hospital managers use to reduce nurse turnover. The participants included five hospital managers at five medical centers in Arizona with successful experience in reducing nurse turnover. Data were collected from semistructured interviews …

Adverse Childhood Experiences, Internalized Homophobia, Alcohol Use, And Suicide Ideation And Attempts Among Sexual Minority Msm Of Color, Odion Clunis

Walden Dissertations and Doctoral Studies

Sexual minority men of color who engage in sexual activity with men (MSM) are twice as likely to experience a psychological episode contributing to suicide ideation or attempts when compared to White MSM. These MSM are underserved in health systems, underrepresented in research, and limited in their access to health care services and interventions. The purpose of this quantitative study was to examine relationships between adverse childhood experiences, internalized homophobia, alcohol use, and suicide ideation and attempts while controlling for age, income, education, and employment among sexual minority men of color (Asian, Black/African American, Hispanic/Latino, Middle Eastern, Native Hawaiian/Pacific islanders, …

Trauma-Informed Practices For Behavioral Health Leaders Serving Sex-Trafficking Survivors And Personnel, Evelyn Cordero Molina

Walden Dissertations and Doctoral Studies

Trauma-informed practices are essential to successful treatment outcomes and employee wellness in the context of sex trafficking clinical intervention. This single case study described the trauma-informed practices developed in a residential program for biologically-female sex trafficking survivors in the Southwest United States. The Baldrige excellence framework and the trauma-informed framework informed the study to comprehend organizational key factors and principles in the context of the residential program. Data were collected through semistructured interviews with four leaders at the senior and middle management levels, and internal documentation such as procedures, protocols, strategic plans, and yearly reports were included in the analysis. …

A Community-Based Distribution Intervention For Family Planning Among Women In Northern Nigeria, Joy Matau Garba

Walden Dissertations and Doctoral Studies

In Northern Nigeria, inadequate information on family planning contributes to high mortality and morbidity rates in women of reproductive age due to multiple childbirths yearly. This study aimed to examine the relationship between the community-based distribution (CBD) strategy, religion, and attitudes toward family planning methods. Rosenstock’s health belief model, which can be an instrumental anchor for health promotion programs, was the theoretical framework for the quantitative cross-sectional study design. The data source was survey questionnaires administered by the U.S. Agency for International Development to 809 reproductive-age Nigerian women after implementing a CBD intervention. A multinomial logistics regression analysis showed that …

Deaf And Hard Of Hearing College Students’ Experiences With Alcohol And Related Consequences, Christine Lee Gannon

Walden Dissertations and Doctoral Studies

Alcohol misuse on college campuses has been shown to be the cause of physical, socio-emotional, and academic harm. Alcohol is also an issue at Gallaudet University, the only liberal arts university for the deaf, but there is a gap in the literature describing the phenomenon in the environment and how to address it. This qualitative case study explored the perceptions and experiences of alcohol use and alcohol-related consequences for deaf and hard of hearing college students through interviews with 50 students and staff at Gallaudet University. Alcohol misuse and related harms were explored through the framework of the social ecological …

Impact Of Resilience On Quality Of Life In Spinal Cord Injured Clients, Crystal D. Glover

Walden Dissertations and Doctoral Studies

Abstract Impact of Resilience on Quality of Life in Spinal Cord Injured Clients by Crystal D. Glover

MSM, Troy University, 2006BSN, University of North Carolina at Greensboro, 1995

Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health

Walden University August 2023

Associations Between Depression, Social Support, And Sexual Risk-Taking Behaviors Among Hiv-Infected Adult Black Women In The Southeastern United States, Joy Ireri Kagendo

Walden Dissertations and Doctoral Studies

African Americans continue to carry the burden of new HIV cases and sexually transmitted infections and other comorbidity health problems more than any other social group in the United States. Except for New York; Washington, DC; and Maryland, 65% of all new HIV cases are in the Southern states. The U.S. Southern states make up 38% of the U.S. population, yet approximately 51% of annual HIV diagnoses are from the Southern U.S. states. In the Southern states, AIDS is among the leading cause of death for African American women. A gap exists in the associations of depression, social support, and …

Improving The Care Of Neonates With Hyperbilirubinemia, Kellie Busse Kainer

Walden Dissertations and Doctoral Studies

AbstractProviders at a community-based pediatric hospital in the southern region of the United States have traditionally transferred otherwise healthy neonates with hyperbilirubinemia requiring inpatient treatment to a tertiary care facility. The question addressed was whether the implementation of an evidence-based, organizational protocol increases the quality and decreases the cost of caring for neonates with hyperbilirubinemia in the community-based, pediatric acute care hospital. The main goal of the organization’s quality improvement (QI) project was to facilitate the provision of high-quality, cost-effective care to neonates with hyperbilirubinemia using an evidence-based approach as evidenced by a reduction in the number of neonates with …

Food And Income Insecurity And Academic Progress Among African American College Students During The Covid-19 Pandemic, Gloria Brown Moore

Walden Dissertations and Doctoral Studies

The impact of food insecurity on minority college students is an ongoing concern that reached new importance during the COVID-19 pandemic. Although researchers have examined food insecurity among college students during COVID-19, they had not explored the role of coping responses among African American college students during the onset of the pandemic. The purpose of this study was to investigate coping responses as mediators between situational stressors (students’ experiences of food insecurity, residential changes, and changes in employment) and academic progress among African American college students during COVID-19. The instruments used for this study were the Brief COPE Inventory, Global …

Dietary Changes In Preventing Type Ii Diabetes Mellitus Among Young Hispanic Adults, Taiwo Onipede

Walden Dissertations and Doctoral Studies

Diabetes mellitus continues to be a major chronic disease affecting the global population today with more prevalence amongst minority groups in the United States. The genetic susceptibility to obesity and higher insulin resistance seen in the Hispanic population puts them at the highest risk for development of Type II Diabetes (T2DM). The alarming increase in young adult T2DM diagnosis led to the project question: How can teaching on dietary changes affect Type II Diabetes diagnosis in predisposed young Hispanic adults? The purpose of this project is to accomplish the goal of Healthy People 2020 towards improving the quality of life …

Examining The Relationship Between Time Spent On Tasks, Job Responsibilities, And Job Satisfaction Among Nurse Practitioners, Iasia E. Owens

Walden Dissertations and Doctoral Studies

Managing patient care with the help of nurse practitioners is an expanding trend in healthcare and achieving job satisfaction is a priority for these professionals. The purpose of this quantitative study was to examine two research questions and the associated variables concerning the relationship between time spent on tasks, job responsibilities, and job satisfaction among nurse practitioners. Conway’s role theory, which is used to explore and predict behaviors of workers in certain roles, informed this study. Data were derived from the 2017 National Survey of Nurse Practitioners and 972 participants were included. Correlation and linear regression analyses were used to …

Influence Of Nurse Residency Programs On Turnover Intent For New Nurse Graduates, Ashley Raye Peters

Walden Dissertations and Doctoral Studies

Nursing turnover and nursing intent to leave is increasing due to burnout, retirement, and a competitive labor market. The purpose of this quantitative study was to determine whether there were statistical differences in turnover intent for nurses with new associate degrees and nurses with new bachelor’s degrees after participation in a nurse residency program. The theory of cognitive dissonance formed the foundation for the two research questions concerning whether there was a difference in turnover intent for nurses with associate degrees and nurses with bachelor's degrees after initial completion of a new nurse residency program and after a year of …

Impact Of Pulmonary Embolism Response Teams On Patient Quality Ratings, Sabrina Renee' Simpkins-Morris

Walden Dissertations and Doctoral Studies

AbstractLeaders of health care organizations have limited evidence of the impact of pulmonary embolism response teams (PERTs) on quality outcomes for patients with an intermediate and high-risk pulmonary embolism (PE). The purpose of this quantitative study was to determine whether there was any significant difference in patient HCAHPS linear mean scores for instructions given about medication and overall care between acute care hospitals with and without PERT teams. Donabedian’s framework for assessing health care quality was used as the theoretical foundation for this research. Survey data collected by the Centers for Medicare and Medicaid, as part of its Hospital Consumer …

Issues Encountered By Parents In Continuing School-Based Obesity Prevention Programs At Home, Prenu Skaria

Walden Dissertations and Doctoral Studies

Childhood obesity is a public health problem that can lead to various chronic health diseases such as cardiovascular disease and diabetes later in life. School-based obesity prevention programs are a public health recommendation to reduce and prevent obesity in schools through increased physical activity and better nutritional habits. This qualitative research involved exploring the reason for the discontinuation of school-based interventions at home using multi-theory model (MTM) constructs for health behavior change. A convenience sample of three focus groups of consenting parents whose children participated in the Wolf Pack Coaches Challenge (WPCC), a school-based obesity prevention program in Nevada, was …

Laboratory Practices And Antimicrobial Resistance In A Florida Hospital, Crispina Marie Sy-Trias

Walden Dissertations and Doctoral Studies

Antibiotic resistance is a health threat affecting millions of Americans. Microorganisms develop resistance to antibiotics, rendering them useless for treating infections. The purpose of this quantitative study was to assess the associations between sample processing time and antibiotic resistance and is based on the health belief model. A retrospective specimen tracking activity of data from November 2019 to November 2020 was obtained by random sampling of 246 bacterial cultures. One hundred ninety-six (80%) samples were processed on time, and 50 (20%) were delayed; 167 (68%) samples were determined to have the presence of antimicrobial resistance (AMR), and 79 (32%) with …

Examining The U.S. Disaster Management Program: A Case Study Of The U.S. Virgin Islands Hurricanes Irma And Maria Evacuation, Victoria F. Vachon

Walden Dissertations and Doctoral Studies

AbstractWhether from natural or human causes, every global community is at risk for overwhelming, destabilizing incidents. Hurricanes Irma and Maria devastated the U.S. Virgin Islands in late August and early September 2017, necessitating the urgent evacuation of hemodialysis patients over 1000 miles to the U.S. mainland. Because the damage and response to the U.S. territory were unprecedented, the public health implications of the government’s strategies on the evacuated population subset were unexplored. However, available information suggested that some evacuees sustained avoidable harm while in the protracted care and custody of the government. This qualitative case study, conceptually framed by Bronfenbrenner’s …

Overcoming Barriers To Private-Public Partnerships, Lavina Valentine

Walden Dissertations and Doctoral Studies

SA is an organization that promotes science, technology, engineering, and math (STEM) education. As a small organization, it continues to look for partnerships that allow the expansion and development of this educational coursework. The organization faces barriers to receiving private and public partnerships. In this professional administrative study, barriers were identified and addressed. Opportunities to improve the availability of collaborations and effective partnerships for this organization were also addressed, expressing the significant benefit that the community receives. The evidence drawn from scholarly resources, quantitative research, and articles highlighted the importance of STEM subjects, and their role in their community. The …

Social Worker Perspectives Of Working With Aging African Americans With Depressive Disorders, Sherian Waite

Walden Dissertations and Doctoral Studies

Although there is a greater proportion of people living with depressive disorders within the African American older adult population compared to their White counterparts, fewer African Americans are engaging in mental health treatment when compared to the Caucasian community. The purpose of this qualitative study was to explore the experiences and practices of social workers who are providing mental health care treatment to African American older adult patients (aged 65 and over) living with a depressive disorder. The study was framed using both the health belief model and critical race theory. To address the research questions, a generic qualitative design …

Nursing Knowledge And Breastfeeding Education, Mary Aguirre

Walden Dissertations and Doctoral Studies

According to the Centers for Disease Control and Prevention, the Healthy People 2020 breastfeeding goal immediately after birth of 81.9% was surpassed in 2016, with approximately 83.8% of babies breastfed shortly after delivery. However, by seven days post birth, this number decreased to 82.9%, reduced even more for infants who were exclusively breastfed to 64.7%. Local research has shown that breastfeeding decreases at one week after discharge, which may be due, in part, to the lack of nurses' knowledge related to breastfeeding. This lack of knowledge related to breastfeeding by the nurses, in turn, may negatively impact the support staff …

Self-Care And Psychosocial Factors That Predict Sickle Cell Disease-Related Outcomes Among African Americans In The Usa, Datonye Agina-Obu

Walden Dissertations and Doctoral Studies

Existing beliefs and conceptions regarding sickle cell disease (SCD) have had a significant impact on the appropriate management of the condition, including self-care and psychosocial factors, particularly among African Americans. The aim of this study was to examine the influence of self-care and psychosocial factors on SCD-related outcomes among African Americans in the United States. The study was grounded in the self-care management theory and employed a cross-sectional, quantitative design. Regression analyses were conducted to explore the associations between self-care and psychosocial factors and SCD-related outcomes sample of 180 individuals. The results indicated three factors showed significant relationships for sickle …

Hepatitis C Infection And Kidney Transplant Waiting Time Among End-Stage Renal Disease Patients, Marie J. Anglade-Mccormick

Walden Dissertations and Doctoral Studies

Kidney transplantation is identified as the ideal approach to managing end-stage renal disease (ESRD), yet access for some groups remains an ongoing concern. Research findings support the notion that hepatitis-C-infected ESRD patients benefit from kidney transplantation compared to those remaining on dialysis. Although the disparity in access to kidney transplantation has been well researched, the association between hepatitis C virus infection and kidney transplant waiting times among ESRD patients was unknown. The purpose of this quantitative retrospective study was to analyze the association between hepatitis C virus infection, blood type, and kidney transplant waiting times among ESRD patients when controlling …

Detecting Postpartum Depression In Women: Effects Of Breastfeeding, Weight Gain, And Abuse, Ifitumi Audu

Walden Dissertations and Doctoral Studies

Postpartum depression is a significant health issue that has affected over 10% of womenworldwide. However, it has not received the attention it deserves, and many women continue to suffer in silence. Certain risk factors are indicative of postpartum depression. Some include a history of depression and a lack of a support system. Others include weight gain, breastfeeding, and physical/emotional abuse. However, research on these is limited. Thus, this research aimed to investigate the effect of breastfeeding, weight gain, and abuse on postpartum depression in women between 18 and 40+. This cross-sectional study used secondary data from the Pregnancy Risk Assessment …

Association Between Educational Level, Unemployment, Race, And Chronic Kidney Disease Among African Americans, Samuel Fiifi Bediako

Walden Dissertations and Doctoral Studies

AbstractChronic kidney disease (CKD) is one of the significant health conditions that cause high morbidity and mortality in the United States. Although African Americans (AA) are only 12.9% of the population, they disproportionately suffer 25.1% of deaths due to CKD. It was not obvious how factors such as education and unemployment further complicate the condition. Thus, this quantitative study aimed to examine the association between CKD and educational level, unemployment, and race when controlling for gender and underlying health conditions such as hypertension, obesity, and diabetes, which tend to exacerbate renal insufficiency. The study was based on the socio-ecological model, …

Community Perceptions Of Syringe Service Programs In Charleston, West Virginia: A Qualitative Socioecological Perspective, Kenya M. Burton

Walden Dissertations and Doctoral Studies

In rural areas of the United States, people who inject drugs (PWID) experience an array of obstacles to accessing adequate healthcare. Locations with high rates of drug use normally offer more healthcare options, including needle exchange programs but, in some communities, there is resistance to providing this kind of care. This increases mortality, morbidity, cost, and adds to the stigma experienced by this vulnerable group. The experiences of people with substance dependency, including PWID, has been widely explored throughout studies that reflect a need for increased support. However, the perspectives of the community, especially in rural areas, though equally important, …

Promoting Healthier Treatment Outcomes In Obese Cancer Patients Taking High Dose Methotrexate, Carly Dell'ova

Walden Dissertations and Doctoral Studies

Cancer and obesity rates continue to rise, creating enormous public heath burdens to the individual and at the national and global levels, reducing quality of life, and increasing spending. Moreover, the relationships between cancer and obesity are not well understood. A commonly used chemotherapy for several types of cancer is high dose methotrexate (HDMTX). Along with chemotherapy, especially at high doses, comes toxicity to specific organs and the entire body. However, limited research has been conducted on obese cancer patients as they are often excluded from clinical studies. Practitioners need to better understand how to dose these patients to provide …