Medicine and Health Sciences Commons^™

Influences On Ethical Decision-Making By Nurses Employed In Federal Health Care Facilities, Cecil Dean Blount

Walden Dissertations and Doctoral Studies

Healthcare professionals are tasked with making key decisions involving new and controversial approaches such as organ transplantation and life-prolonging technologies and treatments that raise various ethical issues. Suboptimal ethical choices by nurses can lead to negative patient outcomes and lower the quality of life in federal healthcare facilities. The purpose of this nonexperimental quantitative correlational study was to identify the factors that influence nurses’ ethical decision-making processes in U.S. federal healthcare facilities. The theoretical framework was based on Beauchamp and Childress’ ethical system of principlism. Three research questions addressed the nature and extent of the relationship between nurses’ Ethical Behavior …

Depression And Awareness Of Mental Health Resources Among Minority And Non-Minority College Students, Henry David Browne

Walden Dissertations and Doctoral Studies

Minority college students experience higher levels of psychological stress and depression, and lower utilization of mental health resources (MHR) compared to the general student population. The purpose of this quantitative study was to examine the association between self-reported depressive symptoms and awareness of mental health services among college undergraduate minority and non-minority students, controlling for sex, interest in MHR information, and history of mental illness. The self-determination theory guided the study. The study utilized a cross-sectional research design using secondary survey data from the National College Health Assessment (NCHA). The NCHA dataset included 354,262 respondents from 52 self-selected U.S. colleges …

Nutritional Assessment Of Patients In The Intensive Care Unit, Jennifer Maureen Brown

Walden Dissertations and Doctoral Studies

Impaired nutrition is associated with prolonged hospitalization, poor patient outcomes, high mortality, and increased health costs. Nutritional assessment in intensive care unit (ICU) patients is important in recognition of changes in the patient’s nutritional status from admission to discharge and may promote early nutritional interventions by the health providers to prevent complications of poor nutrition. The purpose of this staff education doctoral project was to assess ICU nurses’ knowledge of nutritional assessment for critically-ill patients and to provide education on an assessment tool for patient nutritional assessment- the malnutrition universal screening tool (MUST). The guidelines from the American Society for …

Educational Program For Decreasing Catheter-Associated Urinary Tract Infections, Josephine Crentsil

Walden Dissertations and Doctoral Studies

Catheter-associated urinary tract infection (CAUTI) is the most common hospital-acquired illness. Insertion and maintenance of urinary catheters are critical factors that predispose patients to CAUTI. Studies have shown that many nurses have a knowledge deficit regarding evidence-based practices in the insertion and management of urinary catheters, which can help prevent CAUTI. This is a concern because nurses are typically the first point of contact with patients and are responsible for the promotion of evidence-based practice and preventative measures. Therefore, this project aimed to develop an educational intervention for nurses with a focus on proper insertion and maintenance of indwelling urinary …

Improving Glycemic Control For Post-Orthopedic Surgery Patients With Type 2 Diabetes, Allison Dale

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a growing problem within the United States and a leading cause of mortality. The complications and comorbidities associated with type 2 diabetes cause a great financial and resource burden on the healthcare system, and cause negative mental and physical health outcomes for the individual living with it. The complications of poor glycemic control are especially notable following a surgical procedure that requires an inpatient stay. The practice problem for this project is glycemic control following an orthopedic surgery requiring hospitalization. To further analyze the practice problem and to create a clinical practice guideline a robust literature …

Motivating Factors For Nurses Aged 65 Years And Older To Extend Their Work Life, Dr. Cynthia M. Dobek

Walden Dissertations and Doctoral Studies

Nurses age 65 years and older who retire will leave a knowledge gap in the workforce unless motivated to continue working. A knowledge gap in the workforce is of concern to human resource professionals because healthcare professionals may not be able to keep pace with the increase in patients needing medical care. Grounded in Maslow’s hierarchy of needs theory, the purpose of this qualitative single case study was to explore what factors motivated nurses aged 65 years and older to extend their work life. The participants comprised 6 nurses aged 65 years and older who were still working or semiretired …

Demographic, Lifestyle, And Psychosocial Predictors Of Obesity Among Nigerian Igbo Immigrants, Ahamefula Arthur Duru

Walden Dissertations and Doctoral Studies

Obesity is known as a risk factor for chronic diseases, and a contributor to health disparities among minorities and vulnerable persons. There is a paucity of data on Nigeria Igbos on obesity risks in the United States; therefore, studying obesity in this population may help policymakers tailor interventions that could reduce the prevalence of obesity. The purpose of the study was to examine the predictors of obesity among Nigerian Igbo immigrants in the United States. This study sought to examine lifestyle, psychosocial, and demographic factors as unique predictors of obesity in Nigeria Igbo immigrants. The social-ecological model and acculturation theory …

Understanding Male Perpetrated Intimate Partner Violence And Women’S Demands For Condom Use, Linda Musu Edwards

Walden Dissertations and Doctoral Studies

Sub-Saharan Africa is host to more than 70% (25.5 million) of people with HIV/AIDS. More than half of the reported cases of people living with HIV/AIDS are women who are twice as likely to contract HIV than males in sub-Saharan Africa. The purpose of this study guided by the Theory of Planned Behavior was to determine if a relationship between female demands for male partner condom use and male perpetrated intimate partner violence (MPIPV) in opposite sex cohabitating or married couples, as well as examine the relationship between the risk factors of age, education level, socioeconomic status, history of MPIPV, …

Moderate-Intensity Risk Reduction Counseling And Acquisition Of Sexually Transmitted Infection, Cindy M. Farina

Walden Dissertations and Doctoral Studies

Sexually transmitted infections (STIs) are a public health problem in the United States, with adolescents and young adults to age 25 bearing a disproportionate burden of infection. Risk reduction counseling (RRC) as a strategy to decrease STI incidence has been a focus of scholars. Research examining RRC efficacy has suggested that RRC is effective for 6 to 12 months after treatment. However, study samples have varied by age, ethnicity, race, gender, and geographic location. Whether RRC is effective for more than 1 year is unknown. The purpose of this post hoc chi-square study was to examine the efficacy of moderate-intensity …

Incivility Among Nurses, The Influence Of Structural Empowerment: A Systematic Review, Jennifer Gardner

Walden Dissertations and Doctoral Studies

Workplace nurse-on-nurse bullying is a well-known phenomenon in health care organizations at both national and global levels. Healthcare organizations struggle to find effective solutions to help nurses to mitigate bullying and incivility and create safer work environments. The purpose of this systematic literature review doctoral project was to critically appraise the literature to find the best research evidence to show that higher levels of structural empowerment lead to lower levels of incivility and increase nurses’ ability to create safer and more positive work environments. Kanter’s theory of structural empowerment served as the theoretical framework for this review. The evidence-based question …

Pulmonary Rehabilitation: A Quality Improvement Evaluation, Michelle Groth

Walden Dissertations and Doctoral Studies

COPD is a progressive, multifaceted, chronic disease with steadily increasing worldwide rates of prevalence, morbidity and mortality, making improved COPD care a global health priority. Current practice guidelines are in place, but the literature continues to demonstrate inadequacies in practice, for example the inconsistent use of pulmonary rehabilitation (PR). The purpose of the project was to conduct a quality improvement initiative evaluation of the PR program at a hospital in south-central Idaho. The practice-focused question was: What impact has implementation of a PR program had on COPD care in the area? Donabedian’s framework for healthcare quality evaluation was the theoretical …

Community-Based Workers’ Treatment And Relationship With African American Men With Dual Diagnosis, André V. Haley

Walden Dissertations and Doctoral Studies

Helping professionals have a role as service providers when working with African American men with dual diagnosis and incarceration histories. The purpose of this qualitative single case study was to understand how helping professionals provided community-based treatment and established a helper/helpee relationship with this population of African American men. Hirschi’s social control theory provided the framework for the study. Semistructured interviews were used to collect data from 9 helping professionals who worked with this population in the Northeast United States. Yin’s 5-step model for case studies was used for data analysis and thematic coding. Findings indicated that professionals lacked competency …

Epidemiology Of Marijuana Use And Mental Health In The Context Of Changing Policies, David G. Harvey Ii

Walden Dissertations and Doctoral Studies

There is a growing body of evidence supporting the association between cannabis use and the development of mental health disorders, but few studies have addressed this association following the recent increase in marijuana legalization laws. Therefore, using the social ecological model and the self-medication theory of addiction as theoretical frameworks, the purpose of this retrospective database study was to assess the relationship between marijuana use and major depression and suicidal ideation in both adults and adolescents in 2008 and 2017. Data from the National Survey on Drug Use and Health were analyzed using logistic regression at the p < .05 threshold for statistical significance. Results demonstrated positive, statistically significant relationships between marijuana use and both major depression and suicidal ideation for both adults and adolescents in both 2008 and 2017. Further, the strengths of these relationships generally increased between 2008 and 2017, coincident with the increase in marijuana legalization laws. These findings provide empirical support to the association between cannabis use and the development of mental health disorders, and that the strength of these associations is increasing following the increase in marijuana legalization laws. This study has important implication for positive social change by identifying significant relationships between cannabis use and the development of mental health disorders and revealing that these relationships are strengthening over time, coincident with the increase in marijuana legalization laws.

Perceptions Of Clinical Adjunct Instructor Preparedness In Nurse Education, Melissa Ann Harvey

Walden Dissertations and Doctoral Studies

This project study addressed the perceptions of novice adjunct clinical instructors as they transition from clinician to novice educator within an associate degree nursing program in Ohio. Lack of formal training in educational preparation has caused the disorientation of effective supervisory practices in the clinical setting and prevents the optimal transfer of knowledge from educators to nursing students. Mezirow’s transformative adult learning theory and Schoening’s nurse educator transition model were the two conceptual frameworks that guided this study. A qualitative exploratory research design was used to study the role transition process and perceptions of supervision, challenges, and strategies or support. …

Public Health Care Policies And Their Impact On Patient Satisfaction, Bryan John Henderson, Ph.D.

Walden Dissertations and Doctoral Studies

Health care is a trillion-dollar industry, but without public policies in place to support a sustainable health care system, life would decline. For instance, health care providers now receive decreased payments from federal agencies if their health facility scores do not meet national benchmarks. The purpose of this retrospective, quantitative, comparative study was to examine the extent to which patient satisfaction was impacted by national public health policies in the United States and Canada. The research questions related to how health care reimbursement policies and patients’ financial responsibility of both the eastern United States and eastern Canada would predict country-specific …

Clinical Practice Patient Education Guideline For Elective Induction Of Labor, Allison Keleske

Walden Dissertations and Doctoral Studies

In 2018, the state of Florida had a cesarean section birth rate of 38.3% which was the 3rd highest in the nation with the national average being 31.9%. Elective induction of labor (EIOL) involves the initiation of labor for convenience and not because of medical necessity. EIOL carries risks for the mother and fetus, including an unplanned cesarean section. The problem identified in this project was the lack of informed decision-making by pregnant women related to risks, benefits, and management of EIOL. Using the Informed Decision-Making through Engagement Model, the purpose of the project was to develop an evidence-based clinical …

Veterans' Perceptions Of Behavioral Health Services For Posttraumatic Stress, Larence Kirby

Walden Dissertations and Doctoral Studies

Behavioral health services exist for Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans diagnosed with posttraumatic stress disorder (PTSD); yet, untreated diagnoses may lead to the risk of compromised behavioral health. The purpose of this hermeneutic phenomenological study was to understand the lived experiences of OEF/OIF veterans regarding their decision to seek and retain behavioral health services for addressing PTSD. The research focus and questions were employed through the theoretical concepts of Heidegger’s hermeneutic phenomenological theory, Heider’s attribution theory, and Beck’s cognitive behavioral theory. In-person interviews were conducted to collect data from 8 OEF/OIF veterans who had encounters with behavioral …

African American College Students’ Attitudes Toward Help Seeking For Mental Health Illness, Sylvia Krow

Walden Dissertations and Doctoral Studies

Past research has shown that African Americans are less likely to seek treatment for mental health illness compared to individuals in other ethnic groups. Research has also revealed that African American college students’ attitudes, perceptions, and stigmas against mental illness impacts their willingness to seek treatment for mental illness. The purpose of this quantitative, nonexperimental, correlational study was to investigate the predictive relationships between ethnic identity, perceptions of mental illness, stigma and attitudes toward seeking professional help for mental illness among African American college students attending Historically Black colleges and universities. The research question addressed the predictive relationships between ethnic …

Mortality Disparities Among Puerto Rican Infants In 2015, Maria Del Carmen Medina

Walden Dissertations and Doctoral Studies

There is a well-established disparity between infant mortality rates among women residing in rural areas in Puerto Rico in comparison with woman residing in urban areas of Puerto Rico. There is a significant amount of research that connects infant mortality to low birth weight, congenital malformations, and premature births. The purpose of this study was to determine infant mortality and its relationship with the geographical location of Puerto Rican mothers. The study also examined whether there is a relationship between infant mortality and the area of residence (rural/urban) of the mother, marital status, race, and education level of the mother. …

Association Of Landfall Atlantic Tropical Storms And Human Cases Of Locally Acquired West Nile Virus Infection In Florida, Jackson G. Mosley

Walden Dissertations and Doctoral Studies

West Nile virus (WNv) is the most widely distributed flavivirus and considered a vector-borne pathogen of global significance. During the study period from 2002 to 2018, WNv had the highest incidence of locally acquired human cases when compared to any other mosquito borne illness in Florida with 373 cases documented during the study period. The purpose of the study is to determine if there is an association between Florida landfall tropical storms (LTS) and the incidence of locally acquired human WNv cases from 2002 through 2018. The study used a retrospective ecological study design guided by the epidemiological triad model …

Evidence-Based Colorectal Cancer Screening Staff Education, Chantal Navalah

Walden Dissertations and Doctoral Studies

Colorectal Cancer (CRC) is the leading cause of cancer-related death, although it is considered preventable with adequate routine screening. Despite the decline in prevalence and mortality of CRC in the United States, the African American population persist in having the highest rates of death and shortest survival for CRC. This doctoral project focused on the gastrointestinal (G.I.) staff knowledge gap about the importance of CRC screening to achieve better patient outcomes. The purpose of this project was to address the knowledge gap among the G.I staff as it relates to CRC screening. The health belief model served as a guide …

Population-Level Determinants Of Cholera Incidence In African Countries, Ngoy Nsenga

Walden Dissertations and Doctoral Studies

Cholera remains endemic in Africa, with limited access to safe drinking water and inadequate sanitation as 2 of the main drivers of its dissemination. Few studies have examined the impact of health system capacity, even though it plays an important role in prevention, early detection, and response to a cholera outbreak. Grounded in the ecosocial theory of infectious disease dissemination, this quantitative ecological study explored the effect of social vulnerability (as measured by access to safe drinking water and sanitation, rate of open defecation, poverty, income inequality, gender inequality, and adult literacy) and health system (as measured by health financing …

How Older Nigerians View The Impact Of Migration On Their Health, Jayne Nwankwo

Walden Dissertations and Doctoral Studies

Migration into the United States opens windows of opportunity, but also involves difficult experiences that impact the health of migrants. In this qualitative study, the meanings that Nigeria migrants (aged 65–80) placed on their migration experiences were explored in relation to their health and well-being. Literature revealed no prior migration study on this population. The social constructivist approach provided the framework for this study. Purposive sampling was used to recruit 13 participants that fell within the selection criteria. Face to face interview was used to obtain participants’ view of health; their challenges to adaptation to the United States; the impact …

Hiv Knowledge And Behaviors Among Young People In Kenya And Lesotho, Beatrice Ochieng

Walden Dissertations and Doctoral Studies

Sub-Saharan Africa (SSA) has a great burden of human immunodeficiency virus (HIV) and high new HIV infection rates among youths age 15-24 years. Suboptimal practice of HIV risk-reducing sexual behaviors among youths threatens to reverse the gains made in preventing the spread of HIV in SSA. The purpose of this quantitative cross-sectional study was to investigate the effects of comprehensive knowledge of HIV transmission and prevention, on individuals’ attitude toward people living with HIV, and ability to obtain condoms (if needed) on practice of HIV risk-reducing sexual behaviors, in adolescents age 15-19 years and young adults age 20-24 years in …

Demographic Factors Associated With Childhood Obesity Among Women, Infants, Children (Wic) Participants In 2014, Olukayode Wisdom Oduwole

Walden Dissertations and Doctoral Studies

In the past few years, there has been an alarming increase in childhood obesity in the United States and worldwide, however there is little consensus around how to respond to the problem. What has now become an epidemic, was uncommon decades ago. This study assessed the demographic factors associated with childhood obesity among WIC participants in 2014. The study utilized demographic data from 3,011,119 participants in 2014 nationally representative National Health and Nutrition Examination Survey, and social cognitive theory (SCT) to understand the demographical factors associated with childhood obesity. Adjusted odds of obesity were calculated to assess association between males …

Readiness Of Stakeholders To Adopt Community Paramedicine Programs In Tennessee, Roger Lloyd Ritchie

Walden Dissertations and Doctoral Studies

Abstract

Community paramedicine is an emerging model of care that promulgates EMS in a more community-based and integrated role within the broader health care system. A hallmark characteristic of community paramedicine is that programs are designed to meet the specific needs of a given community, rendering programs unique but perplexing. A need for research aimed at exploring possible barriers that may impede the adoption and implementation of community paramedicine programs has been identified by the National EMS Advisory Board, the North Central EMS Institute, and the Joint Committee on Rural Emergency Care. The purpose of this study was to explore …

Analysis Of The Impact Of Family Structure And Type 2 Diabetes Among Adolescents, Danny Lee Self

Walden Dissertations and Doctoral Studies

Type 2 diabetes (T2D) has increased among the adolescent population in the United States within the past 30 years. While the increase in T2D is linked to obesity and a lack of physical activity, it lacks contextual analysis within the structure of the non-traditional family unit. The purpose of this quantitative study was to examine family structure and prevalence of T2D among adolescents. Krieger’s ecosocial theory guided the study. The research questions were designed to investigate whether family structure directly impacts T2D prevalence or indirectly through socioeconomic status. The research design was quantitative with cross-sectional analysis of secondary data. The …

Small Business Leaders’ Strategies For Recruiting Veterans, Jamillah Deangela Stackhouse

Walden Dissertations and Doctoral Studies

Small business hiring managers who fail to implement recruitment strategies for

transitioning military veterans face hiring challenges with this population of workers.

Failed recruitment strategies are essential to small business leaders, as failure to attract

highly qualified military veterans places the organizations at a competitive disadvantage.

Grounded in recruitment theory, the purpose of this qualitative multiple case study was to

explore strategies used by leaders of small businesses to recruit, hire, and retain qualified

veterans. The participants included 3 purposefully selected hiring managers from 3 small

businesses in southeastern Virginia, who used successful strategies to recruit, hire, and

retain veterans. …

Treatment Interventions For Tobacco Cessation At An Inpatient Mental Health Facility, Stephanie Marie Stansell

Walden Dissertations and Doctoral Studies

Tobacco use is the leading cause of preventable death and disease in the United States. According to the Centers for Disease Control and Prevention, 36.5% of adults with any mental illness use tobacco compared to 25.3% of adults without a mental illness; however, there are limited data to determine the best approaches for tobacco cessation among the mentally ill. The purpose of this quantitative, quasi-experimental study was to investigate the differences among 1-on-1 counseling versus group counseling in tobacco cessation rates among psychiatric patients aged 18 years old and older who were identified as a tobacco user upon admission to …

Using Patient-Staff Ratio To Improve Patient Care Outcomes, Fadekemisola Oludayo Timothy

Walden Dissertations and Doctoral Studies

The persistence of nurse scarcity has been documented by many researchers as the leading problem in the critical care setting. A high nurse to patient ratio leads to poor healthcare outcomes associated with increased nurse burn out, medical errors, and low-quality care services. Solving the issue of nurse scarcity is still a challenge due to lack of an effective multidimensional staffing model. In this project, a multidimensional staffing model was developed based on the relationship between patient-to-staff ratio, together with and other factors in the care environment which impacts patient outcome. The project was framed on Donabedian's structure, process, and …