Medicine and Health Sciences Commons^™

Deployment And Travel Medicine Knowledge, Attitudes, Practices, And Outcomes Study (Kapos): Malaria Chemoprophylaxis Prescription Patterns In The Military Health System, Patrick W. Hickey, Indrani Mitra, Jamie Fraser, David Brett-Major, Mark S. Riddle, David R. Tribble

Journal Articles: Epidemiology

The Deployment and Travel Medicine Knowledge, Attitudes, Practices, and Outcomes Study (KAPOS) examines the integrated relationship between provider and patient inputs and health outcomes associated with travel and deployments. This study describes malaria chemoprophylaxis prescribing patterns by medical providers within the U.S. Department of Defense's Military Health System and its network of civilian healthcare providers during a 5-year period. Chemoprophylaxis varied by practice setting, beneficiary status, and providers' travel medicine expertise. Whereas both civilian and military facilities prescribe an increasing proportion of atovaquone-proguanil, doxycycline remains the most prevalent antimalarial at military facility based practices. Civilian providers dispense higher rates of …

Educating Nurses About Poststroke Depression And Using The Phq-2/9, Mary Mcmullen

Walden Dissertations and Doctoral Studies

Stroke has affected more than 7 million people and up to 33% of those patients reporting depression. The lack of screening for depression for patients post stroke can delay treatment for depression and hinder or lengthen recovery. The purpose of this project was to develop a nursing staff education program on using the Patient Health Questionnaire (PHQ) tools (PHQ-2 and PHQ-9) at the bedside to detect signs and symptoms of depression and identify nurse-driven interventions. Using the Johns Hopkins nursing evidence-based practice model and Orem's self-care model for guidance, an interdisciplinary team was assembled to collaborate on the development. A …

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 …

Effects Of Transformational Leadership On Direct Home Healthcare Employee Turnover, Lisa K. Johnson

Walden Dissertations and Doctoral Studies

Ineffective leadership and excessive direct home healthcare workers’ intent to resign may decrease home healthcare worker satisfaction, increase workplace accidents, and hinder the quality of patient home healthcare. Home healthcare leaders have a problem of retaining direct home healthcare workers and can benefit from comprehending the factors that enhance leadership and mitigate the turnover of home healthcare workers. Grounded in transformational leadership theory, the purpose of this quantitative correlational study was to examine the relationship between the perception of transformational leadership behaviors and direct care intent to resign. The population consisted of direct home healthcare workers who reported to frontline …

Lived Experiences Of African American Nursing Students In An Associate Degree Nursing Program, Monique Renee Merritt

Walden Dissertations and Doctoral Studies

Despite recognition of the barriers that African American nursing students encounter while pursuing nursing education, leaders of U.S. nursing programs continue to struggle to retain these students and promote their degree completion. Poor retention and lack of completion contributes to the unequal representation of African American nurses in the U.S. healthcare workforce compared to the overall population. The purpose of this qualitative study was to examine the experiences that helped to promote African American nursing students’ success or served as barriers to successful completion of an Associate Degree Nursing program. Tinto’s integration model was used as the theoretical framework. Semistructured …

Adult Attachment For African American Women Who Have Mothers With Borderline Personality Disorder, Elizabeth Uchechi Onyeali

Walden Dissertations and Doctoral Studies

The effects that borderline personality disorder (BPD) can have on the loved ones of those who suffer from the mental illness is significant and can be deleterious and enduring. Maternal BPD can adversely impact mother-daughter relationships by fostering abnormal connections and insecure attachment bonds. This is particularly the case for African American mothers, of whom research suggests that the early attachment bond between them and their daughters significantly shapes how their daughters behave, perceive themselves, and relate to others. The purpose of this qualitative transcendental phenomenological study was to explore how the experiences of being raised by a mother diagnosed …

Strategies Used In Ehealth Systems Adoption, Joshua Adams

Walden Dissertations and Doctoral Studies

Failure to adopt an interoperable eHealth system limits the accurate communication exchange of pertinent health-care-related data for diagnosis and treatment. Patient data are located in disparate health information systems, and the adoption of an interoperable eHealth system is complex and requires strategic planning by senior health care IT leaders. Grounded in DeLone and McLean’s information system success model, the purpose of this qualitative case study was to explore strategies used by some senior information technology (IT) health care leaders in the successful adoption of an eHealth system. The participants were 8 senior health care IT leaders in the eastern United …

An Educational Program For Providers On Asthma Management For Pediatric Clients, Ngozi Anyatonwu

Walden Dissertations and Doctoral Studies

Asthma, a chronic inflammatory respiratory disease, is the third-ranking cause of hospitalization among children under the age of 15. Of the 25 million Americans living with asthma, 6.2 million are children under the age of 18. In 2018, more than 11.4 million people with asthma, including more than 3 million children reported having one or more asthma exacerbations. The burden of pediatric asthma accounts for more than 13.8 million missed school days among children ages 5 to 17 years, $3 billion in losses due to missed work, $29 billion due to asthma-related mortality and $50.3 billion in medical costs. Asthma …

Predictors Of Colorectal Cancer Screening Among Maryland Adults, Aged 50–75 Years, Pamela Manwi Asangong

Walden Dissertations and Doctoral Studies

Screening plays an essential role in reducing colorectal cancer (CRC) incidence and mortality rates, yet CRC screening use remains low in Maryland and lower in some age and racial/ethnic groups with limited resources to participate in CRC screening programs. The purpose of this quantitative, cross-sectional study is to investigate whether age group, sex, race/ethnicity, education level, income level, health insurance coverage, and access to health care professional can predict an individual, 50–75 years of age, in Maryland to take action to fully meet the United States Preventive Services Task Force CRC screening test recommendation within the recommended time interval. The …

Impact Of Mentoring On First Year Nursing Student Anxiety, Heather Ann Clesi

Walden Dissertations and Doctoral Studies

First-year nursing students (FYNS) experience anxiety that can decrease academic achievement and result in attrition from the nursing program (NP). Research has not evaluated the impact of faculty mentoring (FM) offered by the NP on FYNS anxiety level and academic achievement in didactic courses. This study, guided by Neuman’s system model, used a descriptive cross-sectional design. An online survey link was distributed to FYNS in a southwestern state via NP directors and social media. FYNS were asked if their NP offered FM and were sorted into groups based on their response. Responses were received from 321 participants with 75 meeting …

Association Of Social Support And Depressive Symptoms Among African Americans, Jacketta Renee Cobbs

Walden Dissertations and Doctoral Studies

Depression affects over 120 million individuals worldwide; in the United States, depression is a leading cause of disability for individuals’ ages 15-44 years. Social support can affect both physical and depressive symptoms; therefore, most patients with heart failure (HF) need support from family and/or friends to effectively manage their health condition. This indicates family and/or friends are expected to be the core support system for long term care of those with HF. The purpose of this study was to determine whether social support contributes to depressive symptoms among African Americans with HF. The research questions examined the experience of different …

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 …