Medicine and Health Sciences Commons^™

Clinical Practice Guideline Development To Diagnose And Treat Adolescents With Obesity, Barbara Hunter Hudgens

Walden Dissertations and Doctoral Studies

Adolescent obesity is a worldwide multifaceted epidemic. This disease affects the medical, physical, psychosocial, and family aspects of adolescent life. Identification, diagnosis, and referrals to providers that can initiate early interventions that improve weight status have been recommended as critical steps in curtailing childhood obesity. This evidence-based clinical practice guideline (CPG) was developed for the healthcare providers at a rural clinic in Southwest Arkansas to provide consistency in the identification, diagnosis, and referral of adolescents. The health belief model (HBM) and the trans-theoretical model (TTM) were used to consider adolescents’ individual characteristics and beliefs as well as their readiness to …

Acknowledging And Addressing Adolescent Depression, Johnsie Burke Hughes

Walden Dissertations and Doctoral Studies

A family practice was found to inconsistently screen adolescents for depression even with the necessary Patient Health Questionnaire (PHQ) screening tools being readily available in their electronic medical record. The development of a practice guideline that offers a systematic approach to screening using the PHQ2 and the PHQ9 will potentially result in an increased guidance and provider willingness to screen for adolescent depression in the family practice setting. The purpose of this DNP project was to determine if an algorithmic practice guideline would increase provider willingness to assess for adolescent depression and identify any barriers to the use of the …

Relationship Between Pm2.5 Levels And Cancer Incidences In Interior Alaska, Sandra G. Lewis

Walden Dissertations and Doctoral Studies

Exposure to high levels of ambient air particulates < 2.5 microns in diameter (PM2.5) in the Fairbanks North Star Borough (FNSB) and the resulting impact on cancer incidence is the focus of this study. Climate, geography, and culture influence PM2.5 levels, particularly during the long cold season. While this study considers lung cancer incidences from PM2.5 exposure, the primary focus of the study is the incidences of all other types of cancers from exposure to PM2.5, because of the limited research done on this topic. This quantitative, retrospective, cohort study considered the incidences of new cancer diagnoses in the population during a 10-year period (January 1, 2008-December 31, 2017). The 2 FNSB Zip Codes, designated “hot spots,” frequently see spikes in PM2.5 during the long cold season. These areas are densely populated and contain the EPA-regulated air quality monitors. Cancer diagnoses in the hot spot Zip Codes were compared to cancer diagnoses in outlying Zip Codes (non-hot spots) that experience less PM2.5 and are more consistently within the EPA air quality guidelines. EPA monitors are not yet located in the non-hot spots. Cancer patient data were obtained from the Fairbanks Memorial Hospital Cancer Center. The results demonstrated that a strong association was found between PM2.5 exposure and non-lung cancers (OR = 1.37; RR = 1.36; p < 0.001); and between PM2.5 exposure and lung cancer (OR = 1.87; RR = 1.88; p < 0.001). These findings may be used to promote an increased awareness among FNSB residents of the potential impact on cancer diagnoses from inhaling high levels of PM2.5, so residents may change their behavior in favor of alternatives to biomass burning to improve air quality.

Job Satisfaction And Turnover Among Millennial Nurses In Public Hospitals, Gwen Mancuso

Walden Dissertations and Doctoral Studies

This study addressed turnover of millennial generation behavioral health nurses (MGBHNs). Because retention strategies mitigate the consequences of turnover, the purpose of this quantitative, correlational study was to examine job satisfaction (JS) and anticipated turnover (AT) intention among MGBHNs employed in U.S. public hospitals. Research questions were focused on determining what, if any, correlation exists between AT and JS. The theoretical frameworks were Herzberg’s theory and person in environment theory. A multiple linear regression and 5 Spearman’s rho correlation analyses were used to analyze data from a convenience sample of 65 MGBHNs to understand the relationship between the independent variables …

Medication Reconciliation In An Outpatient Clinical Setting, Tilena Martin

Walden Dissertations and Doctoral Studies

Medication reconciliation is a fundamental step in the delivery of safe care, because if it is not done correctly, it can set the stage for medication errors. Medication reconciliation has been shown to alleviate safety issues that lead to mortality, falls, and adverse drug reactions. The project question examined how in-service training can improve the knowledge of nurse practitioners and medical assistants about medication reconciliation. The project was guided by Knowles’ theory of adult learning and Rosswurm and Larrabee’s health belief model. A 1-hour educational module was prepared, and all participants completed the training prior to a discussion period. Sources …

The Hospital Consumer Assessment Of Healthcare Providers And Systems And Readmissions, Sheri Matson

Walden Dissertations and Doctoral Studies

Patient perception of care has become a main priority in the delivery of high-quality health care. The creation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provided a nationally standardized method of evaluating patient perception to be incorporated in the reimbursement process defined by the Centers for Medicare and Medicaid Services (CMS). The purpose of this study was to examine the relationship between HCAHPS scores and readmission rates in 2 states in the South Atlantic region of the United States. Using social construction theory, this quantitative study utilized multiple regression analysis to analyze HCAHPS scores (independent …

Readmissions Of Heart Failure Patients: The Caregiver’S Perception, Jill Pansini

Walden Dissertations and Doctoral Studies

Heart failure patients account for 27% of readmissions within 30 days of discharge, which is an indicator of poor quality of care. Additionally, heart failure patients report that they do not receive adequate discharge planning, pointing to a need for improved discharge planning and practitioner follow-up. As the severity of heart failure increases, caregivers may be the key to decreasing readmissions. The purpose of this qualitative, hermeneutic phenomenological study was to explore the lived experiences and challenges faced by caregivers of heart failure patients ages 65 and over readmitted within 30 days of discharge. The transitional care model guided the …

Interprofessional Teams As A Strategy To Address Physician Shortages In North Dakota, Judy Ann Solberg

Walden Dissertations and Doctoral Studies

North Dakota health care and political leaders are facing pressure to revise health care delivery in the state. A chronic shortage of health care providers, retention issues, an aging population, and a recent population burst, as well as an abnormally high rate of physician retirement, have made health care access problematic for residents of the rural state. The purpose of this study was to explore and understand the main inhibitors and facilitators of employing interprofessional teams as a strategy to address rural physician shortages in North Dakota. Bandura’s social cognitive theory provided the framework for this phenomenological study of issues …

Learned Helplessness Among Acute Care Nurses And Its Influence On Inpatient Fall Incidence, Jennifer Glendening

Walden Dissertations and Doctoral Studies

Over one million inpatient falls with injury are reported across the United States annually resulting in harm which are consistently linked to the quality of nursing care delivery in acute inpatient settings. Learned helplessness (LH) emerges as a behavioral concept to consider among acute care nurses, specifically medical-surgical nurses, because the effects of LH may include an overall decrease in efforts, persistence, and learning due to the repeated exposure to the challenges of balancing complex patients and working environments. The purpose of this study, guided by Donabedian’s model, was to determine if there was a relationship between acute care nurses’ …

Social And Ecological Determinants Of Physical Activity For Youth With Cerebral Palsy, George E. Gorton

Walden Dissertations and Doctoral Studies

Physical inactivity is a leading cause of morbidity and mortality, increasing risk for noncommunicable disease and compromised physical, social, and mental health. However, fewer than 20% of U.S. youth meet physical activity guidelines; youth with disabilities are even less active. Physical activity is influenced by personal, family, social, organizational, community, and environmental factors acting within a social-ecological framework. To what extent is not well understood. The purpose of this study was to determine the extent to which social and ecological factors are associated with participation of youth with cerebral palsy in physical activity. The research design was a cross-sectional, quantitative …

English As A Second Language Students' Experiences In Associate Degree Nursing Programs, Angie Lundgren

Walden Dissertations and Doctoral Studies

The general nursing shortage experienced in the U.S. leads students who speak English as a second language (ESL) to enter into nursing school programs. Although these students may enter the nursing programs, they may not successfully complete the nursing programs due to various barriers they face during their enrollment. The purpose of this phenomenological study, guided by the NURS model, was to understand the perceptions and experiences of ESL nursing students related to learning and the barriers to learning and success while enrolled in an associate degree nursing program. Semi structured, face-to-face interviews were conducted with 10 associate degree ESL …

Living With Multiple Sclerosis, William Witt

Walden Dissertations and Doctoral Studies

Background: Continuity of care is a crucial characteristic of high quality multiple sclerosis (MS) care. Nevertheless, experiences of MS patients with continuing care are currently understudied, particularly through in-depth methods, such as qualitative approaches. This is despite the significance of continuity of care in improving patient satisfaction and the quality of life of patients with chronic diseases.

Aim: To examine the experiences and perceptions of MS patients with continuity of care through a critical exploration of their lives following hospitalization for an exacerbation.

Design of the study: Qualitative using phenomenological approach.

Participants: Eight participants living with MS. All participants were …

Predictive Factors Of Determinants Of Health And Services Provided At Adult Day Service Centers, Nardia Anthonalla Aldridge

Walden Dissertations and Doctoral Studies

The National Association of Adult Day Service Centers has suggested that adult day service centers can provide services to meet the complex needs of the older adult and delay nursing home placement. Researchers have yet been able to establish the predictive nature of determinants of health in Adult Day Care Centers (ADSCs). The purpose of this correlational study was to examine the relationship between the determinants of health and the presence of therapeutic services and nursing services at ADSCs. The open system theory guided this study. Data sets from the Centers for Disease Control and Prevention, 2016 Adult Day Services …

Childhood Obesity: The Healthy, Hunger-Free Kids Act And School-Aged Children, Frankie Jean Alstin-Brooks

Walden Dissertations and Doctoral Studies

Obesity among children in America is at an all time high, 57.3% of the nation’s children will be obese by the age of 35. The purpose of this study was to examine the effectiveness of the Healthy, Hunger-Free Kids Act (HHFKA) policy. The HHFKA modified the nutritional and physical policies in order to reduce the obesity rates by changing their expenditures. Schools in all 50 states that are subject to federal, state and local nutrition regulations were researched. This was a quantitative, non-experimental, correlation study that measured state compliance with the USDA guidelines and tested for an association between compliance …

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 …