Medicine and Health Sciences Commons^™

Chronic Pain Management In The Primary Care Setting, Rebecca Ann Day

Walden Dissertations and Doctoral Studies

Chronic pain is pain that lasts longer than 12 weeks, affects an individual physically in some mental or psychological way, influences an individual’s job performance, and may create a social complication over time. Ensuring the best possible care for the patient’s pain with the least possible complications is the responsibility of the health care provider, including nurse practitioners. Providing a clinical practice guideline (CPG) for the management of chronic pain in the primary care setting was the focus of this project. The comfort theory model was used as a framework for this project as well as the basis of nursing …

The Association Between Central Line Insertion Practices And Central Line-Associated Bloodstream Infections, Mona Elgowainy

Walden Dissertations and Doctoral Studies

Healthcare-associated infections, specifically central line-associated bloodstream infections (CLABSI), continue to remain a serious public health concern in the United States. Though CLABSI can often be prevented, healthcare professionals struggle to have a positive impact on CLABSI rates. The primary purpose of this study was to determine whether CLIP Bundle adherence has an impact on CLABSI standardized infection ratio (SIR) rates in various patient care areas in California. The research questions were focused on assessing whether there was an association between patient care areas, CLABSI rates, and CLIP Bundle adherence scores. A quantitative, cross-sectional study design utilizing secondary data was used …

Barcode Medication Administration In The Emergency Department To Mitigate Medication Errors, Holly Gauthier-Wetzel

Walden Dissertations and Doctoral Studies

Electronic health record systems (EHRs) have been adopted in healthcare facilities to unify the workflow process of healthcare professionals. Studies have demonstrated the addition of barcode medication administration (BCMA) software technology within the EHR has decreased medication errors within hospitals and long-term care facilities. However, limited research has been conducted to establish whether using BCMA in outpatient areas has had an influence on medication error rates. Literature reveals that many facilities have not adopted BCMA in outpatient areas. The purpose of this study was to investigate whether medication errors were mitigated after BCMA was implemented in the emergency department (ED). …

Severe Maternal Morbidity In Michigan: An Investigation Of Health Disparities, Laura Houdeshell-Putt

Walden Dissertations and Doctoral Studies

Severe maternal morbidity (SMM) rates in Michigan have increased over the past 20 years and continue to affect racial and ethnic women disproportionately. Women experiencing health conditions that complicate pregnancy outcomes have a greater risk of having poor obstetric outcomes that result in a SMM event. To evaluate the distribution of women experiencing health conditions that complicate pregnancy and a SMM event, geographic information systems were utilized in this study. The purpose of this study was to depict trends in the prevalence of 4 health conditions and SMM among women hospitalized for obstetric delivery in Michigan from 2016–2017. The 4 …

Increasing Awareness Of Lateral Violence In The Perioperative Setting, Laura Licea

Walden Dissertations and Doctoral Studies

Lateral violence (LV) among nurses has been widely known to occur in specialty units, such as the operating room, where disruptive behavior can breed behind closed doors. Research on LV among nurses has only identified the issue, and further research is needed to properly address the negative behavior. LV affects not only the nursing profession but also patient outcomes. The purpose of this DNP project was to shed light on the topic by improving knowledge regarding the issue in the perioperative setting. Watson’s theory of human caring provided the conceptual framework for the project. The practice question for this DNP …

Systematic Review Of Falls Among Older Individuals In The Long- Term Care Settings, Nonyelum Patience Odenigbo

Walden Dissertations and Doctoral Studies

Falls are common in the older population and can result in disability, increased dependence, or mortality. Falls have received increased attention in the literature as the most common cause of injuries among older individuals. The incidence of falls in the older population has a positive correlation with adverse health issues necessitating major lifestyle adjustments. The problem is magnified for older patients in long-term care settings where they are 3 times more susceptible to falls. The purpose of this project study was to conduct a systematic review of the literature to understand the impact and incidence of fall rates among older …

Impact Of Perceived Computed Tomography Radiation Risk And Benefit On Healthcare Decision-Making, Joseph Princewill

Walden Dissertations and Doctoral Studies

Patient-centered care is focused on healthcare consumers becoming more involved in their own health care decision-making. Research is needed to examine how those decisions are made in different settings. The purpose of this concurrent transformative design mixed method study was to evaluate how the perceived health risks and benefits of Computed Tomography (CT) influenced decision-making to accept or reject a hypothetical CT recommendation. One hundred thirty-four participants read 1 of 8 vignettes on how either “high” or “low” susceptibility to cancer risk, severity of exposure to radiation, and diagnostic benefits affected their decision-making. Using the health belief model as a …

Tuberculosis Diagnostics In Ethiopia: Assessment Of Laboratory Procedural Capabilities And Limitations, Yeshimebet Retta

Walden Dissertations and Doctoral Studies

Abstract

Tuberculosis (TB) is a curable and preventable disease; however, in 2015, 10.4 million people were diagnosed with TB, making it one of the top 10 causes of mortality. A major part of the TB disease burden is carried by low and middle-income countries. In Ethiopia, which ranks 15th among 22 countries with a high burden of TB and multidrug resistant TB (MDR-TB), important diagnostic and treatment gaps persist. This quantitative descriptive study was primarily aimed to determine levels of adherence to standardized TB laboratory procedures by calculating and reporting the number of sputum samples, and reporting valid and documented …

Help-Seeking Behaviors Among Filipino Americans: Understanding Enculturation, Depression, And Anxiety, Kristoffer John Almazan Rouse

Walden Dissertations and Doctoral Studies

Filipino Americans have some of the highest levels of psychological distress among all Asian Americans. However, underrepresentation in psychological studies and a unique set of cultural values and norms contribute to the lack of literature on the sources of this distress among Filipino Americans. The purpose of this quantitative study was to examine how aspects of cultural assimilation and norms of Filipino culture affect willingness of Filipino Americans to seek mental health services. Several factors, enculturation, anxiety, and depression, among Filipino Americans were examined to predict influence on help-seeking behaviors. A sample of 120 Filipino Americans living in the Pacific …

Sex Differences In Lyme Disease Symptomatology In The Northeast United States, Jeanine Scotti

Walden Dissertations and Doctoral Studies

Guided by the gender-analysis-matrix theoretical framework, 3 key areas of research inquiries focused on the relationship between sex and Lyme disease, symptoms of Lyme disease and sex, and severity of Lyme disease symptoms on sex. A quantitative secondary data analysis was used to address the research questions. A clinician specializing in caring for individuals with Lyme disease provided the dataset, containing responses to the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire for Lyme disease. A cross-sectional, comparative research design incorporating 2 statistical techniques for analysis—the independent samples t test and multivariable regression analyses—was used to examine symptom counts and the …

Evidence-Based Strategies For Improving Medication Adherence Among Psychiatric Patients: A Systematic Review, Omah S. Tsikada

Walden Dissertations and Doctoral Studies

Nonadherence to psychotropic medications among patients with serious and persistent psychiatric disorders, including bipolar disorder and schizophrenia, is approximately 70%. Nonadherence is a common barrier to the treatment of individuals with mental health disorders. However, there is limited awareness of evidence-based interventions and strategies to address this problem. Therefore, the question for this project asks whether a systematic review can identify strategies to improve adherence of psychotropic medications among individuals with serious and persistent mental illness. The purpose of this systematic review was to explore the evidence-based strategies that can aid in increasing medication adherence in patients with mental health …

Understanding Health Behavior In Caribbean Americans, Keva Alleyne

Walden Dissertations and Doctoral Studies

There has been a significant increase in the number of Caribbean immigrants to the United States with the population being over 4 million in 2014 and over 1 million of the immigrants residing in New York State. Among this population, there has been an increase in chronic diseases that has been linked to unhealthy eating behavior. Caribbean immigrants’ approach to their health behavior was examined in this qualitative, phenomenological study. With a focus on the different aspects of the acculturation theory as the theoretical foundation, 9 participants from across the United States were interviewed about their approach to health, cultural …

Social Determinants Of Adherence To Antiretroviral Therapy Among Hiv+ Youth, Wanza Rochelle Bacon

Walden Dissertations and Doctoral Studies

Young adults, especially African American men who have sex with men (MSM) have the lowest rates of antiretroviral therapy (ART) adherence among all age groups; however, they experience greater than 50% of all new Human Immunodeficiency Virus (HIV) infections among individuals 13 to 24 years of age. Despite the availability of ART, young MSM continue to experience suboptimal rates of adherence and are one of the most vulnerable populations for contracting HIV. Grounded in the social cognitive theory, my aim for this quantitative cross-sectional study was to investigate the relationship between diverse social determinants and ART adherence among young adult …

Living With Killing: The Lived Experiences Of Young Black Men In South Chicago, Ponda Barnes

Walden Dissertations and Doctoral Studies

Homicide is a serious public health crisis in the United States, and it has long-term health, psychological, economic, and social implications to society, including disproportionately impacting one group. Among young African American males between the ages 15–24, homicide is the leading cause of death,. Much has been written about this phenomenon, but the voices of the young men directly involved are rarely heard. The purpose of this qualitative phenomenological study was to investigate youth violence and homicide through the lens of male African Americans aged 18-24 living in one low-income community in Chicago, with the objective of understanding why Black …

Improving Nursing Knowledge Of Heart Failure Discharge Self-Care Instructions, Maria Patricia Picar Deza

Walden Dissertations and Doctoral Studies

Patients with heart failure (HF) have recurrent symptoms that lead to frequent hospital readmissions. Moreover, HF is one of the leading causes of 30-day hospital readmissions. Evidence shows that patients with a high level of HF self-care have decreased readmissions. HF self-care education is commonly delivered by the nurse at hospital discharge, and the patient’s transition to self-care is a critical point in the continuum of care. However, nurses must be knowledgeable of patient self-care in HF to effectively convey this information to the patient upon discharge. Therefore, this staff education project question asked whether nursing knowledge of HF patient …

Maternal And Infant Birth Characteristics As Predictors Of Sudden Unexpected Infant Death, Betty Jean Ezell

Walden Dissertations and Doctoral Studies

Sudden Unexpected Infant Death (SUID) is a public health issue recognized by the United States Centers for Disease Control and Prevention (CDC) as the sudden and unexpected death of a baby less than 1 year old, often during sleep, with no obvious cause. Despite known SUID risk factors for infants and mothers, there is limited research on combinations of infant birth characteristics and mother demographics that could be indicative of a higher risk of infant death. The purpose of this cross-sectional quantitative study was to examine the extent to which infant birth characteristics, delivery characteristics, month prenatal care began, and …

Association Between Mental Health Problems, Substance Use, And Social Support In Youth, Venida Gray

Walden Dissertations and Doctoral Studies

Mental health problems are a major public health concern and may be associated with substance use among youth. Youth who receive inadequate social support are at risk of experiencing mental health problems and engaging in substance use. The purpose of this study, guided by the relational regulation theory of social support and the self-medication theory, was to determine whether there was an association between mental health problems, social support, and substance abuse among middle school (MS) and high school (HS) students and whether this association varies with age, using secondary data from the Maine Integrated Youth Health Survey This study …

Work-Life Balance Best Practices, Amy Marie Higgins

Walden Dissertations and Doctoral Studies

Poor balance between workplace and family life has been shown to increase stress and impact emotional well-being. Nurses continue to report burnout and high stress levels from time spent in the workplace which contributes to an inability to balance work with life. The gap in nursing practice leadership is the lack of knowledge and tools for supporting the emotional well-being of managers and direct care nursing staff. The purpose of this systematic review was to compile a summary of rigorous evidence-based literature on programs and strategies that nursing leaders can use to provide support in achieving work-life balance for nursing …

Impact Of Food Assistance Programs On Food Insecurity, Diet Quality And Obesity, Jessica Eileen Hill

Walden Dissertations and Doctoral Studies

Obesity remains a public health issue in the United States because it contributes to chronic diseases. The Supplemental Nutrition Assistance Program (SNAP) was designed to increase food security, alleviate hunger, and increase access to a healthful diet; however, it may have the opposite effect and contribute to obesity. The purpose of this study was to examine to what extent participation in SNAP impacts food insecurity, diet quality, and obesity in U.S. adults. The social-ecological model guided the study which was conducted using a quantitative a cross-sectional research design and secondary analyses of the 2013-2014 National Health and Nutrition Examination Survey …

Systematic Literature Review On Fall Prevention In An Acute Care Hospital Setting, Sonia A. Hudson

Walden Dissertations and Doctoral Studies

Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the …

Examining Icu Nurses' Knowledge Of Ventilator-Associated Events And Ventilator-Associated Pneumonia, Dorothy J. Sanders-Thompson

Walden Dissertations and Doctoral Studies

Ventilator-associated events (VAEs) are patients' complications of respiratory conditions including ventilator-associated pneumonia (VAP). Research shows that VAP is the most common hospital-acquired infection among ventilated patients and a leading source of mortality. With greater risk for complications among ventilated- supported patients, nurses working in the ICU must keep abreast of new knowledge and update expertise to develop technical and clinical skills in daily practice. The purpose of this project was to assess whether an educational intervention would increase the ICU nurses' level of knowledge of the evidence-based intervention. Knowles' adult learning theory was chosen for this project. A paired-samples t-test …

Georgia Government Leaders' Lived Experience Creating And Implementing Health Equity Policies, Tracy M. Clopton

Walden Dissertations and Doctoral Studies

Georgia’s racial and ethnic minority communities have a continual problem of disproportionately worse health outcomes, including higher chronic disease and behavioral risk factors, compared to their nonminority counterparts. The average cost per year for chronic disease between 2016 and 2030 could be $64.6 billion in medical costs and $26.8 billion in lost employee productivity for Georgia. The purpose of this study was to explore the lived experience of Georgia legislators and health program staff to determine policy solutions to reduce chronic disease and behavioral risk factor disparities in the racial and ethnic minority population. The theoretical lens for the study …

Nitrous Oxide For Pain Management In The Emergency Department, Jagmohan Kaur Ghotra

Walden Dissertations and Doctoral Studies

The clinical practice problem addressed was pain control in emergency department (ED) patients. The purpose of this project was to establish situations when inhaled nitrous oxide (N2O) could be used to manage pain in the ED. Specifically, a systematic review provided answers to questions related to appropriate uses of N2O in acute pain management, the effectiveness of inhaled N2O in managing acute pain, and the benefits of and barriers to N2O use in the ED. The middle range nursing theory of acute pain management published by the Agency for Health Care Policy and Research served as the theoretical support for …

Evaluating The Impact Of An Early Alert Team Implementation On Sepsis Mortality Rates, Shelley Ann Hyndman

Walden Dissertations and Doctoral Studies

Sepsis is ranked as one of the leading causes of death among hospitalized patients in the United States. Early identification and treatment of sepsis according to time-sensitive evidence-based protocols is essential to improve outcomes. Existing sepsis research focused on fostering consensus on sepsis definitions and evidence-based treatment protocols; yet, the literature lacks prescriptive evidence regarding organizational structures that reduce patient mortality. The purpose of this quantitative study was to understand how a change in organizational infrastructure could influence the delivery of sepsis-focused care. Using Donabedian’s theoretical framework, the research questions for this study focused on an implementation of an Early …

Impact Of Advanced Access Scheduling On Missed Appointment Rates In Primary Care, Helen Yvonne Krippel

Walden Dissertations and Doctoral Studies

A major problem encountered within outpatient physician offices are missed appointments. Missed appointment research revealed how no-show rates remain a focus for healthcare administrators as decreasing no-show rates may reverse harmful health consequences. The purpose of this study, which also addressed the research gap, was to determine if there was an association between advanced access scheduling and no-show rates for patients scheduled with preferred primary care physicians versus nonpreferred primary care physicians. The health belief model was the conceptual framework as missing a prescheduled appointment is a health behavior. The 1st and 2nd research questions examined whether there was a …

Development Of A Staff Education Project On Managing Patients With Nonmalignant Pain, Gerald M. Mcclain

Walden Dissertations and Doctoral Studies

Opioids, once considered the cure-all for most pain ailments (acute or chronic), have developed into one of the current largest epidemics. Many contributing factors have led to the opioid crisis, but providers have played a significant role in creating this epidemic. Therefore, this project involved constructing a staff education program for providers to present evidence-based practices (EBPs) that are less addictive pharmacological and nonpharmacological methods for managing nonmalignant pain in an ambulatory clinic. The adult learning theory was used to facilitate the learning process, and logic models were used to guide the process. The topics in the education program included …

Correlations To Financial Performance In The Pharmaceutical Industry, Fred Mcclellan

Walden Dissertations and Doctoral Studies

There exist conflicting priorities for leaders when considering ethical leadership behaviors and organizational financial performance. The purpose of this quantitative study was to examine correlations between top manager ethical leadership levels and organizational financial performance, within the pharmaceutical industry. The Ethical leadership theory was used to frame the study. Relationships between top managers’ perceived ethics levels and organizational financial performance were studied, as well as, whether top managers’ practices, purposes, and virtues acted as mediators. A goal of 184 participants were recruited from 338 pharmaceutical companies. Five top managers and 17 of their direct report team members took part in …

Advanced Practice Registered Nurses And Their Knowledge Regarding The Hindrance Of Obesity, Crystal Rainey

Walden Dissertations and Doctoral Studies

Advanced Practice Registered Nurses and Their Knowledge

Regarding the Hindrance of Obesity

by

Crystal N. Rainey

MSN, Walden University, 2014

BSN, University of Arkansas in Little Rock, 2011

AASN, Southeast Arkansas College, 2009

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2020

A Systematic Review Of Structured Communication Among Interprofessional Teams, Angeleta Zipporah Robinson

Walden Dissertations and Doctoral Studies

A leading cause of errors in health care settings is failure of interprofessional teams to communicate effectively. Ineffective communication has been associated with delays in treatment, omission of care, readmissions, and adverse and sentinel events. These incidents cost billions of dollars per year and with current reimbursement processes, health care organizations are now incurring the cost of such errors. The purpose of this project was to promote effective communication between nurses and physicians to reduce errors by standardizing the interaction among team members during interdisciplinary rounds and patient handoffs to increase the nurse communication HCAHPS scores, the physician communication HCAHPs …

Human Resource Strategies Used To Retain Millennials In Hospitals, Thomas F. Turner

Walden Dissertations and Doctoral Studies

Lead hospital human resource managers (HRMs) experience new recruitment, retention, and training costs for Millennial employees to close the skill gaps and address challenges from Baby Boomer employees retiring. The median turnover rate of 3 years for Millennial workers in hospitals is more than 3 times higher than older workers at hospitals. The purpose of this qualitative multiple case study was to identify retention strategies hospital HRMs use to address the retention of millennial generational employees beyond 3 years. Transformational leadership theory was the conceptual framework for the study. The data collection process included semistructured interviews and a review of …