Health and Medical Administration Commons^™

Educating Registered Nurses On Decreasing Missed Care Events, Marie St. Clair Dixon-Brown

Walden Dissertations and Doctoral Studies

Abstract

Missed care or partially completed nursing care is a prevalent problem in healthcare with negative consequences for patients, nurses, and healthcare organizations. This project was developed to address a gap in practice by providing staff education regarding the current evidence about missed care along with practical evidence-based strategies to decrease missed care events. Kalisch’s missed nursing care model framed the project. The staff education program used a PowerPoint presentation with interactive discussion and role-play opportunities for nurse participants to engage in and employ strategies to prevent missed care events. A 10-item multiple-choice post-education quiz and 4-point Likert-type program evaluation …

Impact Of Social Economic Factors On U. S. Veterans’ Access To Care, William Kwaku Adjei Ofori

Walden Dissertations and Doctoral Studies

Coronary heart disease (CHD), the leading cause of death worldwide, affects about 8.45 million United States veterans, individuals honorably discharged from the active military, naval services, and air services. The purpose of this study was to determine whether veterans’ access to care is associated with income level determinants, such as job status, education level, and location. Using the social cognitive theory as the framework, the study examined the extent to which income level and the other social determinants, impacted access to care for veterans with CHD. The 2016 Behavioral Risk Factor Surveillance System, the nation’s leading data system was the …

Perceptions And Beliefs Of African American Men And Women 30 Years And Older About The Health Care System In The United States, Jacqueline Chadwick Mcnair

Walden Dissertations and Doctoral Studies

This qualitative study described perceptions and beliefs of African American men and women ages 30 and over regarding their experiences with the health care system in the United States. The health belief model was the theory that drove this research, and it was grounded in the concept of cultural competency. The study used grounded theory methodology as well as phenomenology to describe the lived experiences of the participants and ethnography to describe the cultural characteristics of African American men and women ages 30 and over as related to their perceptions and beliefs about health care in the United States. The …

Racial Differences In Hospital Readmission And Reimbursement Rates For Patients With Congestive Heart Failure, Catherine Talongwa

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is associated with a significant economic burden that includes frequent emergency department visits, hospitalizations, and readmissions. The purpose of this study was to examine the differences, if any, between hospital readmission rates and insurance reimbursement rates for non-Hispanic Black and White CHF patients in California. The theoretical framework was Bandura's social cognitive theory. Secondary data for this quantitative study were obtained from the Office of Statewide Health Planning and Development and State Inpatient Databases from Healthcare Cost and Utilization for calendar year 2014-2016. A t-test and Levene's test for equality of variance were conducted on a …

Evaluation Of The Tuberculosis Management Program In Ghana, Boampong Akese

Walden Dissertations and Doctoral Studies

Tuberculosis (TB) is a major health issue estimated to be affecting about 1/3 of the world’s population. TB is a major health problem in Ghana primarily because of weak health infrastructure and poor TB case detection and management practices. Measuring and evaluating the performance of health programs is an important aspect of health care services in any country. The purpose of this quantitative study was to evaluate the TB management program in Ghana. A cross-sectional research design was used to answer the research questions. Secondary data were obtained from the Ghana District Health Information Management System database. The theoretical foundation …

Public Stigma, Familiarity With Mental Illness, And Attitudes Toward Seeking Mental Health Services, Eugenia Combie-Knowles

Walden Dissertations and Doctoral Studies

Public stigma and adverse beliefs and attitudes toward individuals with mental illness can negatively influence help seeking. The purpose of this quantitative cross-sectional study was to assess associations and the effect of stigmatized attitudes toward mental illness and familiarity with mental illness on help-seeking attitudes in three community health clinics in the Bahamas. Attribution theory and theory of planned behavior provided the framework for the study. Data were collected from a convenience sample of 366 individuals who completed a self-administered questionnaire consisting of sociodemographic questions, the Attribution Questionnaire that assessed stigmatizing attitudes and beliefs toward individuals with mental illness, and …

Structural Predictors Of Lights And Sirens Use By Emergency Medical Services, Justin Alex Sleffel

Walden Dissertations and Doctoral Studies

Ambulances regularly respond to scenes and transport patients while using lights and sirens (L&S), which are associated with an increased risk of vehicle crashes. The use of L&S persists, despite the risks, which impact emergency medical service (EMS) workers, patients, and other drivers and pedestrians on U.S. roadways. To understand the factors associated with ambulance crashes while using L&S, this study applied the Donabedian model to the problem. The purpose of this study was to investigate the association between 3 organizational structural factors—organizational type, organizational status (staffing model), and level of service—and ambulance crash rates while using L&S. This study …

Implementing A Diabetes Optimization Protocol For Elective Surgery Patients, Barbie Denise Harbaugh

Walden Dissertations and Doctoral Studies

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Disparities In The Qulaity Of Bariatric Care Among African American Women, Tracey S. White

Walden Dissertations and Doctoral Studies

Improving the quality of health care in the United States has been an ongoing challenge for decades. As health care providers seek to provide unsurpassed levels of health care, disparities continue to exist among races. Racial and ethnic disparities in the quality of health care persist that affect African American women disproportionally. The purpose of this study was to explore the lived experiences of African American women with regard to quality health care following bariatric surgery. Using a phenomenological approach, semistructured interviews were conducted with 10 African American women who had suboptimal weight loss outcomes following bariatric surgery. Data from …

Antibiotic Stewardship And The Quality Of Life For Residents Over 65 Years, Reshma Beharry-Guest

Walden Dissertations and Doctoral Studies

Antibiotics were often over-prescribed in long term care facilities (LTCFs) and antibiotic stewardship guidelines, established by the CDC were not followed. The nursing home administrator was responsible for the quality of care for the residents and ensured that the facility met and/or exceeded the CMS antibiotic stewardship standard of care. The purpose of this quantitative study was to analyze operational secondary data collected from a Texas LTCF regarding antibiotic utilization for male and female residents over 65 years. The theoretical framework of the social cognitive theory was applicable for quality improvement in the LTCF setting. The data analysis showed that …

Comparison Of Diagnosis And Hospital Referral Rates Between Physician And Non-Physician Practitioners, Joshua Alan Fisher

Walden Dissertations and Doctoral Studies

Physician extenders as support in healthcare facilities has been increasing in the United States and has the potential to help in currently under served communities. This study evaluated the quality of care provided by physician extenders through the examination of average diagnosis and referral rates that may inform healthcare leaders and policymakers in future decisions. The literature review pointed to a gap in the research related to the quality of care based on patient diagnosis and referral rates by physicians and physician extenders. The conclusions were based on a quantitative analysis of secondary data from the National Ambulatory Medical Care …

Respiratory Therapists' Roles In Reducing 30-Day Readmission Rates For Patients With Copd, Soumaya M. Osen

Walden Dissertations and Doctoral Studies

Since 2014, hospital administrators initiated several measures to reduce the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD). The research problem was that the respiratory therapists (RTs) were excluded from the discharge planning teams in many hospitals while 20% of patients with COPD continue to be readmitted within 30-day post discharge. The purpose of this qualitative study was to seek understanding of the care managers’ perceptions regarding the potential role of the respiratory therapists in the discharge planning for patients with COPD. The theoretical framework for this study was the systems theory in management. The research questions …

Healthcare Organizational Design Strategies To Improve Performance, Katherine Madonna Chubbs

Walden Dissertations and Doctoral Studies

Business leaders are exploring ways to improve organizational performance through organizational design, including reviewing the structures of their organization. Grounded in McKinsey’s 7S framework, the purpose of this qualitative single case study was to explore organizational design strategies healthcare leaders used to improve organization performance. Participants were 6 leaders within a healthcare organization in Alberta, Canada, who successfully developed and implemented organizational design strategies to improve organizational performance. The data collection techniques included a review of internal and external documents, a reflective journal, and semistructured interviews. I used methodological triangulation and thematic analysis to complete the data analysis. The data …

The Complete Care Model: Improving Diabetic Patient Outcomes In Correctional Facilities, Chad Williams

Walden Dissertations and Doctoral Studies

Diabetes is a growing problem, becoming an increasing concern within prisons. Research suggests that as many as 4.9% of the inmate population is diagnosed with diabetes. To provide constitutionally required healthcare to the inmate population, corrections officials must identify a validated diabetes treatment modality geared toward improving diabetes outcomes. The purpose of this quantitative study was to evaluate the impact of a patient centered medical home (PCMH) based model of healthcare within the California Correctional Health Care Services (CCHCS) on diabetic prisoners. Using the social construct theory as the framework, the research questions were focused on determining whether there was …

Mindfulness In Healthcare: Exploring The Gap Between Leadership Practice And Employee Burnout, Bryn Saunders

Walden Dissertations and Doctoral Studies

A healthcare employee’s ability to provide proficient, or quality, care to patients is impeded by burnout. Previous studies showed high levels of burnout is a common problem in healthcare, indicating there is a lack of support for employee health. The purpose of this quantitative study was to determine whether mindfulness training reduced burnout in healthcare professionals. The study focused on increasing knowledge between the leadership practices and programs used to improve healthcare proficiency by analyzing the relationship between mindfulness and three measures of burnout: sense of efficacy, depersonalization, and emotional exhaustion. The Western concept of mindfulness that emphasizes self-awareness and …

Staff Education On Type 2 Diabetes Mellitus, Joan P. Williams

Walden Dissertations and Doctoral Studies

Diabetes mellitus is a major health concern that affects the physical and financial facets of communities. During the past 4 years, a multidisciplinary health care clinic in a northern state reported an increase in the number of type 2 diabetes (T2D) patients. Forty-three percent (43%) of adults with T2D had an elevated glycated hemoglobin A1c of 7.5% or higher. Yet, the staff at the clinic lacked current knowledge of T2D, quality of care, and prevention strategies for patients with T2D. This resulted in increased serious health care issues, associated costs, and increased complications of the patients with T2D. The purpose …

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 …

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 …

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. …

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. …

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, …

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 …

Leadership Strategies To Achieve Organizational Excellence, Cherron Lakisha Blakely

Walden Dissertations and Doctoral Studies

Inadequate quality management tools and processes can lead to inefficient hospital operations and poor organizational performance. Community hospital leaders who fail to improve operations and organizational performance risk negatively impacting patient care and profitability. Grounded in the theory of high-performance work systems (HPWS), the purpose of this qualitative single case study was to explore strategies community healthcare leaders use to effectively employ quality management approaches to improve operations and achieve organizational excellence. The participants comprised 5 community healthcare leaders in the northeast United States who effectively used quality management approaches to improve operations and achieve organizational excellence. Data were collected …

An Exploratory Study To Identify Strategies For Retaining Laboratory Professionals In Hospital Setting, Ambrose E. Ewane

Walden Dissertations and Doctoral Studies

Medical laboratory professionals have faced more than 20 years of workforce shortages. The causes of these workforce shortages include poor retention of new professionals and an insufficient number of new graduates who enter the workforce. The purpose of this qualitative case study was to explore the strategies that are used by managers in hospitals for the retention of laboratory professionals. The theoretical framework comprised Mobley’s theory of turnover and Porter’s organizational commitment theory. The research questions for this study addressed what managers perceived as the biggest challenges for the retention of laboratory professionals and what effective strategies they thought could …

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 …

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 …

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 …

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 …

Understanding Behavioral Health Stigma Within The Healthcare Workforce, Jason Robert Martin

Walden Dissertations and Doctoral Studies

Individuals who seek mental health treatment in the United States face significant barriers. One such barrier is the belief that those seeking mental health treatment are subpar people with some moral failure. One area where this phenomenon exists is the behavioral healthcare workforce. This study was conducted to understand the phenomenon of stigma that behavioral healthcare leaders exhibit toward behavioral healthcare patients using the Baldrige framework as its conceptual framework. Using a qualitative approach and case study design, interviews were conducted with 6 leaders within a large healthcare system in the suburbs of a major metropolitan area to evaluate their …

Influence Of Supervisor Support And Resilience On Productivity And Turnover Intentions In Pediatric Health Care, Adrienne Y. Martin

Walden Dissertations and Doctoral Studies

Workplace violence has become a critical safety issue in the health care setting, often leading to increased stress levels and employees that feel unsupported and inadequately prepared; which leads to increased turnover, and subsequently, diminished overall organizational productivity and poorer patient outcomes. The purpose of this study was to examine whether supervisor support and resilience affect productivity and turnover intent related to professional role and work experience following workplace violence in the pediatric health care setting. Organizational support theory and the framework of the resilience model provided the theoretical structure for this study. Data were collected through anonymous surveys with …