Medicine and Health Sciences Commons^™

Factors Affecting Adherence To Diabetes Management Recommendations Among Afro-Caribbean Farm Workers, Aretha Meritian Townsend

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a global epidemic, impacting the economy and quality of life of affected individuals. The treatment and management of the disease often rely heavily on self-efficacy and provider guidance. Adherence to provider treatment regimens can help to prevent T2DM-related complications. However, non-adherence to T2DM regimens is a growing concern among minority populations, where T2DM is highly prevalent. Limited research is available for the Afro-Caribbean migrant farmworker (ACMF) with high rates of diabetes and an alarmingly high rate of non-adherence to treatment recommendations which is further complicated by low literacy, common cultural practices, and poor diets. …

Sociodemographic Factors Associated With Abortion Rates Among Black Women In The United States, Lincoln Don Washington

Walden Dissertations and Doctoral Studies

Abortion has been a public health issue since the procedure became legal 47 years ago and, clinicians have performed 60,069,971 abortions from 1973 to 2017 in the United States. In 2014, a significant decline in abortion rates has been recorded in almost every state, as well as across different subpopulations when segregated by age, race/ethnicity, education, income, or geographic locations. However, abortion rates were still significantly higher among Black women relative to the U.S. average, prompting the need to examine the causes of this disparity. The main purpose of this quantitative study was to investigate and determine the sociodemographic causing …

Systematic Review Of Family Nurse Practitioner Utilization Within School Environments, Luz Elena Zapien

Walden Dissertations and Doctoral Studies

The American Academy of Pediatrics and the Institute of Medicine recommend school health screening programs to detect problems that might interfere with a student’s education and general well-being, and many U.S. states require compliance with enrollment requirements such as updated immunizations and physical exams prior to attendance. In low-income areas, however, there is often a shortage of physicians available to meet the healthcare needs of the population. Family nurse practitioners (FNPs) can be utilized in school health settings to deliver health care services that support school attendance and the well-being of school students, yet little is known about their impact. …

Nursing Home Caregivers’ Knowledge Of Decubitus Ulcer Prevention Strategies, Shola Akinfiresoye

Walden Dissertations and Doctoral Studies

Decubitus ulcers (DUs) were a constant concern among the residents of the nursing home in this project. Prolonged immobility, sensory impairment, and urinary incontinence are some of the factors found in the literature as the causes of the disease. However, the lack of useful knowledge regarding evidence-based practices (EBPs) to prevent and treat DUs also contributed to the higher incidence rates at the nursing home. The purpose of this DNP- project was to evaluate the caregivers’ knowledge of EBPs to prevent and treat DUs at the facility. The IOWA Model of Evidence-Based Practice, which healthcare practitioners use to guide clinical …

Staff Education On Fall Reduction Strategies For Residents Of A Long-Term Care Facility, Olivia C. Anaele-Nwogu

Walden Dissertations and Doctoral Studies

Fall-reduction programs are frequently ineffective in reducing falls among geriatric patients in long-term care (LTC) facilities. Multicomponent strategies have proved to be effective in reducing these falls. However, these strategies require staff education to ensure their success. The purpose of this project was to support the integration of multicomponent fall prevention strategies into practice by providing staff education focusing on the appropriateness use of hourly rounding and the 4Ps (pain, position, prompted voiding and placement) in addition to bed alarms to prevent falls among geriatric patients in the local LTC facility. The Johns Hopkins Nursing Evidence-based model was the conceptual …

Physician Assistant Burnout And Fulfillment Related To Career Development And Physician Relationship, Kari Sue Bernard

Walden Dissertations and Doctoral Studies

Physician workforce shortages are driving increased clinical and administrative use of non-physician healthcare providers. As a result, physician assistants (PAs) may experience role expansion in a positive or negative manner. The purpose of this study was to determine if aspects of PA career development related to role expansion interacted with the quality of the collaborative physician (CP) relationship to predict PA well-being. The job demands-resources (JD-R) model was used as the theoretical foundation and the National Academy of Medicine’s conceptual model of clinician well-being was used as the conceptual framework. Research questions addressed whether PA experience level predicted well-being, and …

Health Care Providers’ Use Of Nudging With Families Of Older Patients Making Discharge Decisions, Tabatha Bowers

Walden Dissertations and Doctoral Studies

The health care system has focused on reducing costs associated with longer lengths of

stay while facilitating safe and appropriate discharges. The purpose of this educational

project was to increase awareness among health care providers regarding nudging and

how it influences discharge planning decisions by patients and families. Enhancing health

care providers’ understanding of the impact of discharge communication may address the

issue of alternate level of care (ALC). Transition theory was used to frame the project.

Practice-focused questions addressed how the use of evidence-based case studies about

nudging could improve discharge planning for patients in a large community hospital …

Relationship Between Health Risk Behaviors And Obesity Among American High School Students, Jacques Jean-Paul Cherry

Walden Dissertations and Doctoral Studies

Adolescent obesity is a serious health condition that affects more than 55% of students aged 12 to 19 years in the United States. Recent statistical data have noted that the rate of adolescent obesity has more than quadrupled during the past few decades. Genetics and factors such as tobacco use, alcohol use, and marijuana use have contributed to this critical public health issue. Although uniqueness of prevalence has often been linked to gender and race, associations related to these health risk behaviors and increased body mass index remain relatively unexplored among today’s U.S. youth. Adolescence has been described as a …

A Staff Educational Model For Prevention Of Type 2 Diabetes In The Primary Care Setting, Mieshia Staples Clark

Walden Dissertations and Doctoral Studies

Type 2 diabetes is a chronic, debilitating disease affecting millions of Americans. Though preventable, it is the most common form of diabetes in the United States, costing the U.S. health care system billions of dollars annually. Lifestyle modifications taught, encouraged, and supported in established, evidence-based diabetes prevention programs (DPP) are proven to be more effective than medications alone in preventing Type 2 diabetes. While DPPs are cost-effective and can reduce or delay the incidence of Type 2 diabetes, they are greatly underutilized due to primary care providers’lack of knowledge about the benefits and availability of these programs and also due …

Exploring Young Opioid Users’ Motivation To Seek Treatment For Substance Use Disorder, Patricia Gianotti-Avella

Walden Dissertations and Doctoral Studies

In the past 15 years, the nonmedical use of opioids in the United States has reached epidemic proportions, resulting in a 21% increase in overdose fatalities. This surge in opioid use and dependence represents a shift in the demographic from inner-city populations over the age of 40 to young adults between the ages of 20 and 34 who dwell in primarily white suburban neighborhoods. Research has identified physicians’ liberal prescribing practices as one cause of this epidemic and has documented the ineffectiveness of current interventions with young addicts. The purpose of this narrative study was to gain insight into what …

Experiences Of Resiliency And Family Support In Older Women With Mental Illness, Dawn Harbin

Walden Dissertations and Doctoral Studies

Lack of a support system for older females with mental illness may cause reduced resiliency skills and an increase in mental illness symptoms while they attempt to manage independent living. The purpose of this qualitative study was to explore the individual stories of older women living independently who suffer from a mental illness and have a support system. Social learning theory and self-efficacy theory provided the framework for the study. Data were collected from face-to-face interviews with 8 women ages 65-80 years who are in treatment at a mental health center in South Carolina. Findings from coding analysis showed that …

Experiences And Challenges Of Social Workers Working With Transitioning And Postmilitary Service Members Who Have Mental Health Issues, Joyce M. Hewitt

Walden Dissertations and Doctoral Studies

Active duty service members, veterans, and their family members are faced with a myriad of problems including mental health issues, substance abuse issues, traumatic brain injury, suicide, family integration issues, and family distress. Understanding the organizational, environmental, and person-centered factors that affect the delivery of mental health care treatment to active duty service members, veterans, and their families is urgent to this unique population for social work practitioners (licensed master, advanced, & clinical). This project explored the experiences and challenges that social work practitioners (licensed master, advanced, & clinical) have in providing effective services for mental health care treatment to …

Nurse Educator Perceptions Of Using Simulation For Evaluation Of Nursing Competencies, Angela Elizabeth Horton

Walden Dissertations and Doctoral Studies

Over the past 10 years, simulation technology has been increasingly used in clinical settings to evaluate nursing competencies and ensure safe patient care. However, not all simulation laboratories are used consistently by hospital nursing education departments to support learning. The purpose of this qualitative case study, framed by constructivist theory, was to identify nurse educators’ perceptions of the value of using simulation to evaluate nurse competence. Research questions addressed how nurse educators decided what teaching methods to use when evaluating nursing competencies. The participant sample included 8 nurse educators responsible for the education of new and practicing nurses in the …

Evaluation Of Inappropriate Use Of Antibiotics In The Long-Term Care Community, Charlene A. Hughes

Walden Dissertations and Doctoral Studies

The number of antibiotics prescribed in the 65 and older population significantly increased related to the diagnosis of urinary tract infections (UTIs). Although empiric treatment is necessary at times, it can lead to antibiotic resistance; therefore, clinical symptomology with an active infection verified by diagnostic testing is the requirement for the treatment of a UTI. This project addressed the practice-focused question of how the implementation of an evidenced-based antibiotic stewardship program (ASP) in a nursing home on the East Coast may impact the overuse of antibiotics in that clinical setting. The project, guided by the theory of planned behavior, was …

The Relationship Between Sense Of Coherence And Coping With Stress Among Emergency Room Physicians, Melina Masihi

Walden Dissertations and Doctoral Studies

Physicians face different stressful situations daily when caring for patients in the emergency room (ER). The individual ER physician’s ability to cope with stressful situations varies considerably and affects patient care. Developing a sense of coherence (SOC) is thought to be one of the significant strategies for self-regulation in stressful conditions like those in the ER. The purpose of this research was to examine the relationship between SOC and coping abilities among emergency physicians in the United States. The study used a quantitative, cross-sectional design to assess physicians’ SOC and coping skills using an SOC scale and a coping scale, …

Improving Care Of Patients With Asthma Through Staff Education, Nicholas Moscatelli

Walden Dissertations and Doctoral Studies

Chronic asthma is a health epidemic and an increasing problem in the pediatric population. The purpose of this project was to raise nursing staff awareness of symptom recognition, treatment protocols, preventive measures, and detrimental effects of asthma for children. Adult learning theory provided the framework to support the staff education program on asthma. The project site stakeholders and the DNP student identified educational opportunities to assist staff in meeting caregiver needs, improving symptom recognition, and improving asthma outcomes. Prior to presentation of the educational program to the clinic nursing staff, it was reviewed by an expert panel including the clinic …

Patient Risks And Clinical Care Disruptions In Rural Hospital Mergers, Gabriel Muzanenhamo

Walden Dissertations and Doctoral Studies

Over 440,000 U.S. citizens are dying annually from avoidable, hospital-associated adverse events, with rural inhabitants experiencing more significant health threats than any other group in the United States. The trend of large health systems acquiring and consolidating rural hospitals (RHs) to improve the coordination of clinical care is backfiring, and accumulating patient safety risks. Although arguments for supporting hospital mergers in the past have focused on efficiency and presented a chance for struggling RHs with a financial survival mode, limited research has explicitly examined the impact of rural hospital mergers (RHMs). This study was constructed to explore the relationship between …

Public Health Leadership In The Philippines: Effective Approaches In Malaria Surveillance, Gethro Nullan

Walden Dissertations and Doctoral Studies

Leadership traits that affect and shape cost-effective practices ensure the long-term

growth and success for any organization. The purpose of this single case study was to explore leadership traits that may contribute to cost-effective approaches in a malaria surveillance program in the Philippines. The National Health Service Leadership Framework provided the conceptual framework for this study. The participants included 12 public health leaders/managers who have worked or been involved in malaria surveillance programs with budgetary oversight. Data were collected through in-depth interviews and document analysis. Values coding was used for data analysis, in which participants’ perspectives were coded using the …

Fall-Related Patient Education: An Essential Feature Of A Fall Prevention Program, Immaculata Okonkwo

Walden Dissertations and Doctoral Studies

This project documented the evaluation of a voluntary patient falls prevention education

program (VPFPEP) of a rehabilitative facility in a Mid-Atlantic US state and ascertained

its sustainability. The project was designed using the customized Moore et al. evaluation

model and Lippitt’s planned theory of change to encourage patient engagement in

physical activity (PA) through fall prevention education to allay patients’ fear of falling.

The sample included patients who opted into the facility’s VPFPEP. Evaluation was

performed using run charts to visually and quantitatively monitor trends and patterns of

fall incidents over time. Run charts also facilitated comparison of injuries sustained …

Program Evaluation Of A Black Barbershop Health Outreach Campaign, Berkina Denise Porter

Walden Dissertations and Doctoral Studies

Black-owned barbershops in the Black community lack barber administered interventions to provide education and health screenings to Black men. Increasing knowledge of health assessments in a black barbershop setting increases the number of health screenings and preventative care among Black men. Grounded in general systems theory, the purpose of this qualitative summative program evaluation was to explore the extent to which a nonprofit Black barbershop health program aligns with the Health Research (HR) program objectives. The evaluation was performed for a nonprofit organization located in Maryland, 6 years after the organization implemented the HR Program Network of barbers and salon …

Predictors Of Condom Use Among High School Students In North Carolina, Danielle Cierra Robinson

Walden Dissertations and Doctoral Studies

The spread of sexually transmitted diseases is a major ongoing public health issue in North Carolina. Adolescents between the ages of 13 and 19 years have consistently contributed to this trend. Researchers have found that condom use among high school students has decreased. High school students continue to engage in sex with multiple partners, with lack of knowledge about sexually transmitted diseases, even though sex education and prevention programs have been recommended. The purpose of this quantitative study was to evaluate the predictors of condom use among adolescents. The socioecological model theoretical framework was applied to guide this research involving …

Socioeconomic And Sociocultural Factors Associated With Parenting Choice And Fertility Experience Among Lesbian And Nonlesbian Women, Annette Silvia

Walden Dissertations and Doctoral Studies

Minorities including lesbians may face disparities that contribute to minority stress, which leads to adverse health outcomes. The purpose of this social epidemiology study was to examine the association between insured status, perceived stress, and parental status among lesbians and nonlesbians. The theoretical foundation was minority stress, and the design was quantitative with a convenience sample of women aged 18 years and older. Data on demographics, perceived stress, fertility quality of life, and lesbian identity disclosure were collected via online survey. Among the 314 respondents, 102 self-selected as lesbian (49% parents), and 212 self-selected as nonlesbian (73.1% parents). More than …

Primary Payer Status And 30-Day Readmission Rates Among U.S. Diabetes Patients, Christina Marie Swilling

Walden Dissertations and Doctoral Studies

Diabetes is a leading cause of hospitalization and readmission in the United States. The 30-day readmission rate for diabetic patients represents substantial costs to the nation’s health care system. The purpose of this quantitative study was to examine the relationship between primary payer status and hospital readmission rates among individuals whose primary or secondary reason for admission was Type 2 diabetes mellitus (T2DM). Secondary data from the Healthcare Cost Utilization Program Nationwide Database of the 2015 National Readmission Database was analyzed. Participants in the data set included 41,068 diabetes patients, 53.8% of whom were female. The average age was 67.26, …

The Impact Of Faculty Bullying On Associate Degree Nursing Students, Angela M. Vitale

Walden Dissertations and Doctoral Studies

Bullying is prevalent in the profession of nursing, impacting the quality of health care and health care costs. The foundation of bullying, in the profession of nursing, may be attributed to bullying behaviors in nursing academia among nursing faculty and nursing students. Using Bandura’s social learning theory, the purpose of this study was to determine the relationship between bullying behaviors of nursing faculty and bullying behaviors of nursing students in associate degree nursing programs. Seventy-one randomly selected registered nurses who graduated from associate degree nursing programs in the past 5 years completed an online Incivility in Nursing Education-Revised survey. Spearman’s …

Faculty Members’ Perceptions Of Organizational Culture And Implementation Of Interprofessional Education, Cynthia Voyce

Walden Dissertations and Doctoral Studies

A disparity exists between what is known about the benefits of interprofessional education (IPE) and implementation of IPE at the university under study. The World Health Organization called on institutes of higher education to provide IPE in the education of health professionals to improve the healthcare workforce’s capacity to provide quality care. The purpose of this qualitative study was to understand the perceptions of health professions faculty members (HPFMs) about IPE and how those perceptions might be influenced by the organizational culture at the site. Informed by Hofstede’s dimensions of culture theory, the research questions addressed HPFMs’ understanding of and …

Association Between Metabolic Syndrome And Second Primary Cancer Among Colorectal Cancer Patients, Olukayode Ayodeji Agbeyomi

Walden Dissertations and Doctoral Studies

Colorectal cancer (CRC) is the third most common diagnosed cancer in both women and men in the United States. The gradual increase of incidence of second primary cancer (SPC) among CRC individuals has been a concern in recent times. Many CRC survivals have been forced back to be hospitalized for life-threatening cancers that are nonmetastatic cancers of CRC. Literature has suggested that there may be a relationship between metabolic syndrome (MetS) and CRC cases. The importance of early surveillance, detection, and treatment of SPC in CRC patients is significant to achieve better survival rates. The aim of this retrospective quantitative …

Obesity And Overweightness Among African-American Adolescent Population And Health-Related Quality Of Life, Emmanuel Anene

Walden Dissertations and Doctoral Studies

Obesity and overweightness are a significant public health problem and a risk factor for many chronic diseases. The purpose of this study was to find the associations between gender, race, physical activity, and health-related quality of life (HRQOL) among obese and overweight African American adolescents aged 12 to 19 years. An improved understanding of the health issues could help this population live a longer quality life and prevent serious health implications in adulthood. A quantitative approach with a sample size of 331 was used. The control variables were age and household income, the dependent variable was HRQOL, and the independent …

Mothers’ And Community Stakeholders’ Perspectives About The Vitamin A Supplementation Program In Nigeria, Olufolakemi Mercy Anjorin

Walden Dissertations and Doctoral Studies

Vitamin A deficiency (VAD) affects about one third of children under the age of five in Nigeria. There is low uptake of biannual Vitamin A supplementation (VAS) used since year 2010 as the national response to addressing VAD among children 6 to 59 months. Yet, there is limited research on barriers or facilitators to uptake of VAS. The purpose of this study was to examine the perspectives of stakeholders about the VAS program in Nigeria. The theoretical underpinning was the social marketing framework. The central question related to the views of stakeholders toward the VAS program, and their perception about …

Leadership And End-Of-Life Planning Among Elderly Patients With End-Stage Renal Disease, Elizabeth R. Armstrong-Fears

Walden Dissertations and Doctoral Studies

More than 8-million people in the United States possess no kidney function. The purpose of this quantitative casual-comparative research study is to examine the relationship between ethnicity status of African American and European American patients suffering from end-stage renal disease, and advanced care planning and end-of-life decision-making among patients who are 55 years of age and older. The health belief model is the selected explanatory framework used to examine (a) whether ethnicity status is a significant predictor of whether decedents had written end-of-life care instructions, (b) whether ethnicity status is a significant predictor of whether treatment decisions were made, and …

The Lived Experience Of Child Marriage And Its Health Effects Among Young Mothers In Nigeria, Anastasia Iliwo Ashi

Walden Dissertations and Doctoral Studies

Child marriage has life-threatening implications for the mental, physical, and psychological development of the girl-child. In Sub-Saharan Africa, and other resource poor settings, child brides and very young mothers undergo various negative experiences including economic hardship and health challenges such as obstetric fistulas, birth complications, and even death. The purpose of this phenomenological study was to describe the lived experiences of child marriage and its effect on maternal health among young mothers in Nigeria. The social ecological model provided the conceptual framework for this study. Ten young women ages 18-24 years who had been child brides when age 12-16 years …