Medicine and Health Sciences Commons^™

Development And Validation Of A Sepsis Course For Burn Intensive Care Unit Nurses, Colleen Melisa Reid

Walden Dissertations and Doctoral Studies

Sepsis is the most common cause of death in burn patients. Optimal recovery from sepsis requires early recognition and prompt treatment. When sepsis is suspected or detected, the 2016 Surviving Sepsis Campaign guidelines endorse immediate initiation of the Hour-1 Sepsis Bundle. Unfortunately, a random audit of hospital system compliance with the Centers for Medicare and Medicaid Services sepsis core measure was less than 50%. A 2019 performance improvement project uncovered delays in antibiotic administration, and a search of scientific and burn center literature did not elucidate a course that educated burn intensive care nurses about sepsis. The purpose of this …

Promoting New Graduate Registered Nurse Retention Through A Staff Preceptorship Program, Sheba Saelee

Walden Dissertations and Doctoral Studies

The transition from classroom to the clinical setting is challenging for most new graduate nurses (NGRNs). They often report being unprepared and lack confidence in their skills. Preceptors play a significant role in the success of the NGRNs and overall quality of care provided on the floor. However, the training they are provided is lacking. Preceptors tend to view their role as a daunting task and an assigned burden. The purpose of this project was to implement a NGRN preceptor training program. The practice focused question explored if a preceptor education program in a long-term acute care hospital increased the …

Managerial Competencies Driving Successful Change Initiatives: A Multiple Case Study Of Healthcare Administrators, William King Selsor

Walden Dissertations and Doctoral Studies

Healthcare administrators’ competencies for driving successful strategic change initiatives in healthcare organizations remain outdated and limited in the management literature. The purpose of this qualitative, multiple case study was to explore the perceptions of healthcare administrators on the specific nature of management competencies needed to drive successful strategic change initiatives within healthcare organizations. To address the research problem and purpose of the study, qualitative data were collected from multiple sources of evidence, including semi-structured interviews with seven healthcare administrators, archival data, and reflective journaling notes. This study was framed by Kash, Spaulding, Johnson, and Gamm’s conceptual framework, the comparison of …

Clinical Practice Guideline For Transitions Of Patients With Chronic Obstructive Pulmonary Disease, Thomas Stewart

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a public health challenge and a leading cause of readmissions in the United States. Research suggests that many patient readmissions could be prevented by using a multidisciplinary approach to develop quality, evidence-informed clinical practice guidelines. A retrospective review of the electronic health record by the project site’s quality committee revealed a lack of consistency in adhering to best practice recommendations, as evidenced by increased readmission rates. The purpose of this project was to develop a clinical practice guideline with input from a collaborative expert advisory committee for the discharge care of COPD patients. The …

Competition And Services Offered Among General Hospitals In The Deep South, Vanessa Stone

Walden Dissertations and Doctoral Studies

Hospitals, along with other health care providers, are a central part of every health care system and responsible for a great share of healthcare expenditure. In the United States, the cost of health care is much higher than it is anywhere else. High expenditures for hospital services could reduce the resources available for primary care and other services that could do more for population health. The purpose of this study was to explore the competition among general medical and surgical hospitals in the Deep Southern states of Mississippi, Alabama, Georgia, South Carolina, and Louisiana to determine if increasing the level …

Job Satisfaction, Engagement, And Motivation For Nursing Leadership Among Millennial Registered Nurses, Oluwaseyi Stover

Walden Dissertations and Doctoral Studies

There is a shortage of nursing leaders because current nursing leaders who are in the baby boomer generation are retiring. Millennial RNs are needed to fill vacant nursing leadership positions, but millennial RNs are not satisfied in their jobs and lack motivation and engagement, which impedes their interest in nursing leadership positions. The purposes of this quantitative, descriptive, correlational study, guided by King’s theory of goal attainment, were to examine the relationship between job satisfaction, motivation, engagement, and the aspiration of millennial RNs for nursing leadership positions in the acute care hospital setting, and the combined effects of job satisfaction, …

Optimizing The Use Of Antibiotics:Evaluation Of A Quality Improvement Project, Elaine Marie Summers

Walden Dissertations and Doctoral Studies

The overuse and inappropriate use of antibiotics for residents in long-term care facilities (LTCFs) is associated with significant unintended treatment harm with 50% to 70% of residents prescribed an antibiotic at least once in 12 months. The purpose of this project was to evaluate data from a quality improvement quality improvement initiative conducted at a 168-bed LTCF to implement a protocol of an antibiotic stewardship program (ASP) to reduce the overuse of antibiotics. The John Hopkins nursing evidence-based practice model guided this project to analyze health care provider compliance with implementation of protocol guidelines before and after the ASP program …

Mental Health Professional Perceptions Of Barriers To Fidelity For Empirically- Supported Treatments, Chris Streidl

Walden Dissertations and Doctoral Studies

It is estimated that one in five adults in the United State of America experience mental illness in a given year. When mental health organizations implement empirically-supported treatments but fail to maintain them, it can result in individuals not being provided the services that they need. The purpose of this study was to identify perceived barriers to maintaining fidelity for empirically-supported mental health treatments. The study utilized a quantitative cross-sectional correlational research design (N = 154) and the Perception of Barriers Scale (PBS) was developed to measure perceived barriers to maintaining fidelity for empirically-supported treatments. Bandura’s social cognitive theory as …

Socio-Economic Determinants Of Risky Sexual Behavior In Sub-Saharan Africa, Frida Tende

Walden Dissertations and Doctoral Studies

Risky sexual behavior (RSB) is a major public health concern due to health outcomes, such as HIV/AIDS, sexually transmitted infections, and unwanted pregnancies. RSB has been identified as 1 of the main components contributing to the high HIV incidence rate in sub-Saharan Africa. The purpose of the current research was to investigate RSB and its association with education and economic status among men and women in 3 sub-Saharan African countries (i.e., Rwanda, Zimbabwe, and Cameroon) while controlling for gender, age, religion, and place of residence. The social cognitive theory provided the framework for this cross-sectional study that included data from …

Access To Healthcare For American Indians Residing In The Northeast United States, Kristine D. Thomas-Jones

Walden Dissertations and Doctoral Studies

Urban American Indians/Alaskan Natives (AIs/ANs) have limited access to health care in comparison to non-Hispanic Whites (NHWs), which furthers health disparities for indigenous communities. The purpose of this quantitative, nonexperimental study, which was guided by the socioecological model, was to examine the relationship between access to health care and healthcare utilization among urban AIs/ANs and urban NHWs in the Northeast United States. The research questions addressed the difference in access to healthcare based on health insurance, difference in healthcare utilization, and whether there is an association between health care access and health care utilization for AIs in the Northeast United …

Urgent Care Centers And Workers’ Compensation Medical Cost Containment, Drema M. Thompson

Walden Dissertations and Doctoral Studies

In response to healthcare payment policy reforms, billions of dollars in healthcare provider charges are challenged annually. Following the implementation of the Virginia workers’ compensation medical fee legislation, healthcare organizations experienced declining worker compensation medical fee schedule reimbursements and lack of profitability. Grounded in the adaptive cycle model, the purpose of this qualitative single case study was to explore strategies 2 urgent care center (UCC) leaders in Virginia used to increase profits after implementing the Virginia workers’ compensation medical fee legislation. Data were collected via in-depth interviews and a review of company documents. Thematic analysis was used to analyze data. …

Diversity Gap In Healthcare Leadership, Percival Vera

Walden Dissertations and Doctoral Studies

The rapid change of the U.S. population has prompted many organizations in both the private and public sectors to adjust their C-Suite leadership to reflect the population that they serve. Unfortunately, healthcare seems to be the exception to this. Several studies have been done to explore the issue of diversity in general; however, limited research has been done to address the diversity gap in the U.S. Healthcare System C-Suite. The purpose of this qualitative case study is to explore the reasons behind the lack of diversity in the U.S. Healthcare C-Suite. The C-Suite is defined as the group of executives …

The Relationship Between Emotional Intelligence And Assessment Technology Institute Nclex- Rn Predictor Score, Debra Ann Wallace

Walden Dissertations and Doctoral Studies

The ability to pass a rigorous nursing curriculum and subsequently pass the National Council Licensing Examination for Registered Nurses (NCLEX-RN) exam is a requirement for nursing students to enter the nursing profession. Test anxiety may lead students to perform poorly on exams but emotional intelligence (EI) may buffer stress, improve communication, decrease anxiety, and improve nursing performance. The purpose of this descriptive, correlational study, guided by the EI theory, was to determine if there was a relationship among EI, the ATI -RN Comprehensive Predictor score, and first time pass rates on the NCLEX-RN among registered nurses who had graduated from …

Sexual Behavior, Contraceptive Use, And Unmet Needs Among Unmarried Teenage Women In Uganda, Lawrence Were

Walden Dissertations and Doctoral Studies

At 25%, teenage pregnancy in Uganda is one of the highest in the world, and this has been mainly attributed to low contraceptive use and a high unmet need for modern contraceptives. Unmarried women aged 15 to 19 years in Uganda face unique cultural, ethical, financial, and legal barriers to the use of contraception. The purpose of this study was to investigate how sexual behavior, contraceptive use, and unmet needs among unmarried teenage women in Uganda aged 15 to 19 years are influenced by personal and environmental factors. Bandura’s social cognitive theory was used as a theoretical framework for this …

Perspectives Of African Americans Diagnosed With End Stage Renal Disease And Their Perceptions Regarding Accessibility Of Care, Toya Williams

Walden Dissertations and Doctoral Studies

End stage renal disease (ESRD) is the final phase of kidney disease. African Americans make up 35% of all ESRD cases, which is rising. They lead all other racial groups and are 3 times more likely to be diagnosed with ESRD. Researchers have reported quantitative results involving this population, but none have focused on their experiences. The researcher sought to capture the experiences of these patients and their perceptions regarding access to healthcare to determine the role that access to care played in their condition. Interviews were conducted to gain an understanding of their experiences related to their use of …

Nurse Practitioner Approach To Care For Peripheral Vascular Disease, Jessica R. Wozniak

Walden Dissertations and Doctoral Studies

The Amputation Coalition indicates that there were approximately 2 million people with limb loss in the United States primarily caused by peripheral vascular disease in 2019. Those with amputation related to vascular disease have a 5-year mortality rate. The gap in clinical practice at the facility used for this project is that there were no comprehensive program guidelines for nurse practitioners and other health care professionals working with people who are at risk for vascular intervention or limb loss. The practice-focused question was answered that an interprofessional team did develop a prototype for a comprehensive peripheral vascular program that serves …

Association Between Obesity, Socioeconomics, Mental Illness, And Education In Native American Communities, Darrell D. Wright

Walden Dissertations and Doctoral Studies

Obesity is a profound health epidemic that adversely affects the health of all ethnicities. This growing health crisis has been found to be linked to several chronic diseases such as stroke, diabetes, and several forms of cancer. As in Native American populations, increased morbidity and mortality rates associated with obesity prevalence in minority populations has been linked to variables such as income, education, mental illness, and age. The purpose of this research was to examine the association of obesity with socioeconomic status, education, mental illness, and age in Native American populations. The theoretical framework used in this study was based …

Changes In Operating Performance In Rural Hospitals From 2012 To 2019, Oluwaseyi Tami Young-Harry

Walden Dissertations and Doctoral Studies

Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American …

Strategies For Reducing Adverse Medical Events From Implanted Medical Devices, Gary John Zack

Walden Dissertations and Doctoral Studies

Managing medical device monitoring processes is challenging and lacks a realtime, life cycle tracking strategy to reduce adverse medical events and revision costs for hospital administrators, physicians, and patients. Understanding the malfunctions of medical devices for cardiac and orthopedic patients could save lives and reduce hospital liability. Grounded in the business process reengineering conceptual framework, the purpose of this single qualitative case study was to explore strategies hospital managers used to redesign the implant recall surveillance process at one hospital in Pennsylvania. The 5 participants selected successfully implemented a medical device surveillance process that reduced adverse medical events and revision …

Registered Nurse Engagement And Patient Falls In The Acute Care Setting, Jenna Zaliauskas

Walden Dissertations and Doctoral Studies

Falls are a critical problem for inpatient medical-surgical adult patients. Past research has indicated a link between nurse disengagement and unsafe care. The purpose of this study was to improve the understanding of the relationship between nurse engagement and patient falls with injury on medical surgical units in health care facilities in the United States using the National Database of Nursing Quality Indicators. Retrospective data were reviewed from 13 U.S. hospitals in the Midwest covering Q1 (2018) and Q2 (2018) on medical-surgical units related to nurse engagement and patient falls. A correlational and MANOVA design was used to determine the …

Impact Of Medicare Utilization On Mortality And Readmission Rates Of Heart Failure Patients 65 Years And Over, Joanna Alexander

Walden Dissertations and Doctoral Studies

Roughly 25% of individuals 65 years and over hospitalized with heart failure are readmitted within 30 days after discharge. Elderly individuals identified with heart failure possess a 5-year mortality approaching 50%. The purpose of this study was to determine if there is a relationship between Medicare-covered services for care, mortality rates, and readmission rates for beneficiaries 65 years and over with heart failure. To address this topic, the chosen approach was retrospective and quantitative. The theoretical foundation was the Chronic Care Model. The research questions sought to determine if there is a relationship between the Medicare-covered services for care and …

Retail Pharmacy Clinic Antibiotic Stewardship Program And Guidelines, Abdulrahman Sudi Amiri

Walden Dissertations and Doctoral Studies

Overuse of antibiotics poses serious consequences for patient's well-being, including the risk for antibiotic resistance and adverse effects from inadequate and timely treatment. The emergence and frequency of multi-drug resistant bacteria are alarming global public health care experts, as these strains are resisting effective management of life-threatening infections. The gap in practice was that a retail pharmacy clinic did not have a practice guideline for the implementation of a wait-and-see prescription program as part of an antimicrobial stewardship program. The purpose of this project was to coordinate an interprofessional team to develop guidelines for this primary care setting. The practice-focused …

Recovering Illicit Substance Users' Perspective About Mandatory Drug Testing In Schools, Julie Bowser

Walden Dissertations and Doctoral Studies

The purpose of this exploratory qualitative study was to examine recovering substance

abusers' perceptions about the usefulness of mandatory drug testing in schools for adolescent substance abuse. Illegal substance abuse has reached epidemic proportions as more than half of U.S. adolescents, aged 12 to 17 years, have engaged in illicit drug use. Substance abuse information has been a part of school health education programs since the United States Drug Free Schools and Communities Act of 1986. Despite substance abuse education and school programs about the effects of drug use, many high school students abuse illicit drugs. Face-to-face interviews were conducted …

The Impact Of Dietary Intake On Mortality Risk In Colorectal Cancer Survivors, Ellen Chow

Walden Dissertations and Doctoral Studies

The colorectal cancer (CRC) survivor population is increasing in the United States. The lack of effective dietary recommendations in recurrence prevention undermines the health-related quality of life of survivors. Grounded in the socioecological model, dietary behavior is a personal-level risk factor that individuals may control. This study investigated the CRC-specific mortality risk as predicted by diet quality, dietary fiber intake, and dietary fat intake in hope of contributing to future dietary recommendations. A secondary analysis using data from 1,166 CRC survivors in the Multiethnic Cohort Study was analyzed via Cox proportional hazard regression models to estimate mortality risk. Results from …

A Health Care Management Organization's Internal Controls Strategy For Managed Care, Elizabeth E. David

Walden Dissertations and Doctoral Studies

A lack of effective operational internal controls among health management organization (HMO) leaders could lead to poor operational practices, mismanagement of the government's health care funds, increased health care spending, and a negative impact on patient health outcomes. Grounded in transformational leadership theory, the purpose of this qualitative, single case study was to explore successful internal control strategies used by leaders at a southeastern Pennsylvania HMO. Data were collected from semistructured interviews with 5 participants who held positions of director or above within the organization for at least 3 years, had institutional knowledge, and had responsibility for overseeing the organization's …

Experiences Of Postpartum Women With Nurse-Delivered Education And Postpartum, Krystal Evans

Walden Dissertations and Doctoral Studies

Postpartum depression affects many women globally, yet largely remains underdiagnosed. It is thus important for nurses to have all available tools when delivering education and care to the postpartum patient. Yet, there is a lack of information on the experiences of postpartum women related to postpartum education and postpartum depression. The purposes of this quantitative study, for which Beck's postpartum theory was the framework, were to explore postpartum women's perceptions of education experiences and to determine if a correlation exists between the satisfaction with education and scores on the Edinburgh Postnatal Depression Scale. Sixty study participants who were 6-8 weeks …

Improving Rabies Aftercare By Educating Emergency Department Providers Of Care, Gloria Denise Evans

Walden Dissertations and Doctoral Studies

According to an evaluation completed by the local health department in the state where the project was conducted, patients were not returning to the emergency department (ED) for post-exposure prophylaxis (PEP) rabies vaccine as recommended. Educating the ED providers on care, who are usually the first point of contact after an animal bite with possible rabies virus transmission, is critical to improving patients' outcomes secondary to rabies postexposure. The focused for this project is educating ED personnel about rabies PEP administration after rabies virus exposure which will their increase knowledge regarding rabies follow-up care. Lewin's change theory provided the theoretical …

Voluntary Male Circumcision And Risk For Human Immunodeficiency Virus In Homa Bay, Kenya, George Obhai Gabriel

Walden Dissertations and Doctoral Studies

The role played by the belief about voluntary medical male circumcision (VMMC) in predicting HIV status has not been examined. The purpose of this study was to investigate whether there were any differences between belief about VMMC, unprotected sex, age, number of sexual partners, relationship status, and HIV status among circumcised males aged between 18-49 years in Homa Bay County, Kenya. Drawing from the health belief model and case-control study design, 936 men were recruited based on their HIV status (468 HIV cases and 468 controls). A bivariate logistic regression was applied, and the results indicated that unprotected sex, age, …

Prostate Cancer Screening Intention Among African American Males Ages 40 To 65 Years, Paul L. Johnson

Walden Dissertations and Doctoral Studies

African American men are at a higher risk of developing and dying from prostate cancer (PCa) compared with any other race or ethnic group. Despite prostate cancer screening (PCS) recommendations, African American men are less likely to be screened for PCa compared with any other race or ethnic group. The purpose of this study was to identify factors that influence the intentions of African American men to obtain a PCS. A nonexperimental cross-sectional research design was used to identify factors associated with the intention to obtain PCS. The theoretical framework for the study was the social-ecological model which posits that …

Work-Life Balance Of Rotational Workers In The Nigerian Energy Sector, Israel Olalekan Jolaolu

Walden Dissertations and Doctoral Studies

Rotational workers in the Nigerian oil and gas industry otherwise referred to as the energy sector, are confronted with challenges and stresses of work-life balance (WLB). Using boundary theory, 15 oil and gas workers with more than 5 years of rotational work experience were recruited to examine the strategies they employed to deal with the stresses and work-life balance required for the social well-being of the workers, which translates to improved job performance in the oil and gas sector in Nigeria. The research question was designed to explore the lived experiences of rotational workers with more than 5 years in …