Health and Medical Administration Commons^™

Facilitating Environmental Enrichment In Senior Care Activities With Professional Development, Celia Mary Ross

Walden Dissertations and Doctoral Studies

There is little known about the current state of professional development and continuing education practices for empowering activity professionals to better enhance environmental enrichment in long term care. The purpose of this qualitative study was to explore the activity professional's perceived role and best strategies for professional development to enrich the long-term care environment. The study used social cognitive theory as its theoretical framework to develop research questions focused on the views of activity professionals concerning professional development and continuing education to support care for long-term care residents. Using a narrative approach, 9 activity professionals were recruited through networking at …

Factors Influencing Doctors Ordering Of Clinical Lab Tests: A Qualitative Study, Lakshmanan Suresh

Walden Dissertations and Doctoral Studies

Qualitative studies exploring the factors behind a doctor's decisions to order clinical laboratory blood testing are lacking. A better understanding of these factors can help in formulating interventions that could improve the quality of health care and limit costs. The purpose of this qualitative case series study was to identify factors that influence a doctor's decision to order routine clinical laboratory blood tests. Fifteen doctors from Western New York, working in different hospital settings, were interviewed. There were 5 doctors in each case type: major, community, and private hospitals. When analyzed by case, there was a difference between the three …

Health Care Transition And Patient-Perceived Quality Of Life In Sickle Cell Disease, Karen Alicia Haynes

Walden Dissertations and Doctoral Studies

Because of the high mortality rate of sickle cell disease (SCD) patients who do not continue care into adulthood, researchers have paid increasing attention to the health care transition experiences of SCD patients. However, a gap exists regarding patients' perspectives of care transition related to their quality of life. The purpose of this phenomenological study, guided by the biosocial-ecological systems model, was to explore the lived health care transition experiences of SCD patients in relation to their health-related quality of life. Data collection included open-ended interviews with 12 patients in the Southwestern United States. Colaizzi's (1978) method of phenomenological data …

Health System Predictors Of Access To Maternal Health Medicines In Low And Middle Income Countries, Chinonso Esther Nnorom

Walden Dissertations and Doctoral Studies

The strength of health systems predict access to medicines that prevent death from pregnancy related complications (essential maternal health medicines). But little is known about the relative impact of each health system building block on access. This quantitative cross-sectional study applied Ishikawa model to examine the relative effect of health systems governance, facilities, service delivery, financing and medicine procurement and distribution (independent variables), on availability, affordability and accessibility (dependent variables) of maternal health medicines in resource poor settings. Data analyzed was pulled from 37 WHO pharmaceutical country profiles and USAID MCHIP survey that assessed national programs for the prevention and …

Strategies For Health Care Administration Leaders To Reduce Hospital Employee Turnover, Malee Kirk

Walden Dissertations and Doctoral Studies

Staff turnover is high in the hospital industry, influencing health care administration leaders to implement successful strategies to decrease staff turnover. The purpose of this case study was to explore successful strategies to reduce hospital employee turnover. Five health care leaders from Raleigh, North Carolina hospitals were in the sample drawn from the population of medical professionals with successful employee retention in their hospital settings. The conceptual framework for this study was the Herzberg dual-factor theory with the supporting theory, Maslow's hierarchy of needs theory, and the opposing theory, Vroom's expectancy theory. Semistructured interviews occurred with 5 leaders. The review …

Leadership Strategies For Addressing U.S. Pharmaceutical Drug Shortages And Supply Chain Disruptions, Adrian Grant Scioli

Walden Dissertations and Doctoral Studies

Health care providers in the United States expend more than $400 million in unnecessary direct costs annually managing the effects of widespread drug shortages. Based on the theory of complexity and complex adaptive systems, the purpose of this exploratory multiple case study was to identify the strategies that health care pharmaceutical procurement leaders from the Eastern region of the United States use to address widespread drug shortages. Data were collected from 5 semistructured interviews with pharmaceutical procurement leaders, recorded field notes, and a review of public documents from company websites. Data analysis included deductive and open coding techniques. Emergent themes …

Voluntary Employee Turnover: Retaining High-Performing Healthcare Employees, Jesse J. Boyd

Walden Dissertations and Doctoral Studies

Voluntary employee turnover in the healthcare industry is one of the most expensive and disruptive business problems that healthcare organizations encounter. Healthcare organizations can expect employee replacement costs to represent up to 150% of a departing employee's annual salary in new employee acquisition and decreased productivity. Guided by the leader-member exchange theory, the purpose of this single case study was to explore the strategies healthcare managers used to retain high-performing healthcare employees. Using semistructured interviews, the targeted population encompassed 6 healthcare managers from a healthcare organization in Central Texas who have demonstrated successful strategies for retaining high-performing healthcare employees by …

Researchers', Stakeholders', And Investors' Perceptions Of U.S. Stem Cell Research Policy, Dorothy King-Moore

Walden Dissertations and Doctoral Studies

Federal support and funding for human embryonic stem cell (hESC) research in the United States lags behind stem cell programs in many countries because of the divisive debate over hESC research and the continually evolving federal policies that have hindered research efforts. The purpose of this phenomenological study was to explore the perceptions of stem cell researchers, stakeholders, and investors in the United States about the effects of the current federal stem cell policy on stem cell research in the United States, the moral disagreement with stem cell research, and their recommendations to improve stem cell research policy in the …

How Heroin-Addicted Offenders Experience Sobriety Upon Release From Jail, Rebecca Lynn Foster

Walden Dissertations and Doctoral Studies

Heroin addiction is a growing epidemic in the United States. The need for proper treatment programs accessible by heroin users who wish to or are mandated to participate in recovery programs is a growing need, and pathways to sobriety for ex-offenders have presented in literature as understudied. The purpose of this study was to examine heroin-addicted offenders' experiences prior to and after release on their paths to sobriety. This study followed a qualitative phenomenological approach based on the theory of personal causation, which posits that individuals see events in life as either driven by themselves or caused by others, both …

Patients And Nurses Attitudes To Hysterectomy And Postoperative Pain Management, Blessing Agu

Walden Dissertations and Doctoral Studies

Over 500,000 hysterectomies are performed yearly in the United States, and they often result in a moderate to severe amount of pain. Nurses play a significant role in postoperative pain management. However, studies have shown that despite technological advances and nurses' theoretical knowledge of pain, postoperative pain management remains a challenge among healthcare providers. The purpose of this study was to examine how nurses' and patients' attitude towards abdominal hysterectomy can impact postoperative pain management and hospital length of stay after a hysterectomy. Informed by the theory of reasoned action, the study examined the differences in the nurses' and patients' …

Leadership Attributes And Behaviors As Predictors Of Organizational Resilience In Academic Health Care Systems, Patti Lynn Besuner

Walden Dissertations and Doctoral Studies

Research intentionally addressing how leadership attributes and behaviors collectively contributed to the socioecological perspective of organizational resilience were not found. This is a problem for organizations who must hire without benefit of how a collective leadership effect might influence their psychological capital. The purpose of this study was to explore whether or not self-efficacy, psychological empowerment, personal resilience, and leadership style were associated with or predicted organizational resilience among clinical managers in an academic medical center setting. Metatheory of resilience and resiliency was used to frame the study. A quantitative correlational design was used. Self-reported data was collected via the …

The Relationship Between Nurse Manager Leadership Style And The Enculturation Of Shared Governance, Anna Elizabeth Keane

Walden Dissertations and Doctoral Studies

Shared governance, a participative model of governance, implemented by healthcare organizations for more than 30 years has been associated with empowerment, job satisfaction, and retention of registered nurses. Recent studies document a lack of participation in shared governance by registered nurses; the reason for the change is unknown. The nurse managers' role in this change is unknown. The purpose of this non-experimental, cross-sectional survey design study was to test Bass' theory of transformational leadership that examines the relationship between the leadership style of the manager and the enculturation of shared governance in acute care hospitals in the United States. A …

Exploring Customer Service Through Hospital Management Strategies, Delores Leonard Leonard

Walden Dissertations and Doctoral Studies

Patient demand for a better quality of healthcare and services has increased as insurance companies have decreased payments to hospitals. The purpose of this qualitative single exploratory case study was to explore hospital managers' strategies to improve customer service. Data were gathered from semistructured interviews with 5 hospital managers who implemented customer service strategies in their hospital systems, hospital policy and procedure documents, and qualitative data from the Consumer Assessment of Healthcare Providers and Systems Hospital Compare website. Expectation-confirmation theory served as the conceptual framework that grounded the study. Data were analyzed using methodological triangulation, and 3 themes emerged: the …

Influences Of Provider-Patient Communication On Health Literacy And Public Policy Relevant Outcomes, Rachel Carla Cartwright-Vanzant

Walden Dissertations and Doctoral Studies

Several artifacts of federal policy address the connection between health literacy of patients and health outcomes. These laws include The Plain Writing Act, Health Information Technology for Economic and Clinical Health, and the Health Insurance Portability and Accountability Act. Even with this policy structure, little is known about how nurses' knowledge of health literacy may influence patient understanding of medical information and health outcomes. Using Knowles' principles of effective communication, the purpose of this mixed-methods study was to concurrently examine the relationship between nurse knowledge of health literacy and communication techniques used by nurses to identify any causal relationships in …

Managerial Strategies For Improving Employee Engagement: A Single Case Study, Ann-Marie Alcala

Walden Dissertations and Doctoral Studies

In 2013, 1% of Medicare reimbursements were withheld from U.S. hospitals, with a

proposed cap of 2% in 2017 for redistribution to those hospitals that improve overall care and patient satisfaction. The purpose of this single case study was to explore the engagement strategies that some hospital middle managers used to improve employee performance to increase patient satisfaction. The sample included 4 health care middle managers in 1 hospital in northeast Connecticut. The conceptual framework that grounded this study was Kahn's personal engagement theory. Data were collected via semistructured interviews, participant observations, and review of hospital and public government documents. …

Nurse Practitioner Navigator Policy And Procedure Protocols In Private Practice, Wendy Grose

Walden Dissertations and Doctoral Studies

In 2010, the Patient Protection and Affordable Healthcare Act (PPACA) implemented changes to reduce healthcare spending that incorporated Centers for Medicare and Medicaid (CMS) incentive programs to reduce 30-day readmission rates in seniors with heart failure. This project includes a policy and procedure for private practice using a nurse practitioner navigator (NPN) led multidisciplinary team (MDT) for the patient-centered medical home (PCMH) to improve communication between hospitals and PCMH to decrease readmission rates in seniors with heart failure (HF). This practice change will provide an implementation and evaluation plan along with plans for future expansion. Meetings were held twice weekly …

Identifying Communication Barriers And Trust Issues Of Black Women Seeking Preventive Health Services In Houston, Texas, Melissa E. Shelton

Walden Dissertations and Doctoral Studies

Black women mortality rates are perceived to be impacted by communication barriers, trust issues, and the lack of quality preventive health services. The purpose of this phenomenological study was to explore communication barriers and trust issues perceived by Black women when seeking preventive health services. HMB was used to identify public attitudes around receiving preventive health services and to construct each question based on perceived susceptibility and perceived severity of communication barriers and trust issues. An ecological model of the communication process was used as a framework to identify fundamental relationships between the Black female patients and health care providers. …

Psychological Resilience In Correctional Officers: The Role Of Demographics, Manuel Chapa Villarreal

Walden Dissertations and Doctoral Studies

Correctional officers occupy an important societal role in maintaining safety and assisting in the rehabilitation of inmates; however, both their performance and mental health are highly susceptible to fatigue because of working in a high stress environment. This study investigated the relationship between correctional officers' demographic factors (level of education, marital status, gender, and race/ethnicity) and their psychological resilience. The Connor-Davidson Resilience Scale 10 (CD-RISC-10) was used to measure correctional officers' resilience when responding and or coping with stress. This study utilized the stress-vulnerability model as a framework to investigate protective factors against and risk factors for psychopathological symptoms. Participants …

How Does Organizational Culture Impact Rn Engagement, Veronica Anntionette Ruffin-Ellis

Walden Dissertations and Doctoral Studies

Lack of RN engagement in the acute care setting can result in poor staffing, nursing shortages, increased stress levels for nurses and decreased morale. When nurses are not engaged in their work setting, quality of care suffers. A wide range of literature focuses on the importance of RN engagement; however, few health care organizations have taken the initiative to implement programs that foster RN engagement, demonstrating a gap in practice. This study examined the relationship between the levels of RN engagement and their perceptions of their organizational culture. Kolcaba's humanistic approach to meeting the needs of RN staff was used …

Effective Strategies Employed By Retail Store Leaders To Reduce Employee Turnover, Alexandro Beato

Walden Dissertations and Doctoral Studies

Employee turnover affects retail organizations in the form of lower productivity, decreased profitability, and reduced sustainability. In 2014, organizations lost over $11 billion in tangible and intangible assets as the result of employee turnover. High employee turnover rates have an adverse effect on productivity, which lead to unsustainable business practices. The number of retail employees who quit their jobs each month increased from 432,000 in December 2016 to 464,000 in January 2017, which indicates that some managers lack strategies to reduce employee turnover. Using the transformational leadership theory, the purpose of this single case study was to explore effective strategies …

Work-Family Conflict: Does Romance Matter?, Christie Marie Charles

Walden Dissertations and Doctoral Studies

Research has shown that being in a romantic relationship has related negatively with work-family conflict. Using social exchange theory, the investment model, and role theory, this study examined the relationships among the dimensions of perceived partner support, romantic relationship interdependence, and work-family conflict. A sample of 192 adults in paid employment, currently involved in a romantic relationship, were recruited from SurveyMonkey Contribute. Study participants completed online a demographic survey, the revised Support in Intimate Relationships Rating Scale (SIRRS), the Investment Model Scale, and work-family conflict scales. Correlation analyses showed that work-to-family conflict and family-to-work conflict correlated negatively with commitment and …

A Phenomenological Inquiry Of Nurses' Lived Experiences Of Implementing Evidence In Practice, Monnie Abraham

Walden Dissertations and Doctoral Studies

Research-informed practice is crucial to ensure best possible decisions are made during care delivery. In reality, research-based evidence often does not reach patient care due to many elements that impede the implementation process. The purpose of this phenomenological study was to discover the lived experiences of nurses involved in implementing evidence-based practice (EBP) in clinical settings within hospitals in United Arab Emirates. The theoretical and conceptual basis for the study was derived from Promoting Action on Research Implementation in Health Services framework for knowledge translation and Benner's Novice to Expert theory. Twelve nurses who had experience implementing evidence to practice …

Use Of Physician Credentialing Standards By U.S. Medical Services Professionals, James Allen Reeder

Walden Dissertations and Doctoral Studies

Credentialing in hospitals is the first line of defense for improving patient safety and reducing medical errors by verifying a physician's medical knowledge and skills. There is no single set of standards for physician credentialing followed by all hospitals in the United States. Using May's normalization process theory, the purpose of this quantitative study was to survey medical services professionals (MSPs) to determine which physician credentialing standards were being used, the sources being used, and the frequency of standards used. The dependent variables in this study were the 13 ideal credentialing standards developed by the National Association of Medical Staff …

Primary Care Nurse Practitioners And Organizational Culture, Leanne Christine Rowand

Walden Dissertations and Doctoral Studies

Nurse practitioners (NPs) were introduced to the British Columbia healthcare system 12 years ago. Integration challenges related to infrastructure and relationships between administrators and physicians continue. The purpose of this project was to understand how nurse practitioners, working in primary care roles, experience the organizational climate within their healthcare agency. Kanter's empowerment theory guided this project. Data were collected using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. A total of 64 NPs relayed their degree of perceived organizational support. NPs scored highest on Autonomy and Independent Practice (Mean [M] = 3.54, Standard Deviation [SD] = 0.59). Organizational Support and …

Length Of Stay And Reimbursement Rates For Medicare Patients, Wandella Ezell

Walden Dissertations and Doctoral Studies

Medicare reimbursement rates across the United States have varied by as much as 49-130% across healthcare facilities. Geographic adjustments and severity of medical diagnoses attribute to some dissimilarity; however, the source of longer hospitalization and higher re-admission rates among Medicare patients requires financial consistency. The research encompassed (N = 3000) patients with hypertension as the focus for the study because this is a critical group of Medicare patients with a chronic disease that has been identified as a silent killer. The principal goal that drove this research study was to explain the variations in length of stay for Medicare patients …

Barriers And Perceptions Of Black American Men About Prostate Cancer In Georgia, Martins M. Nnoko

Walden Dissertations and Doctoral Studies

In 2016, prostate cancer was the second leading cause of fatality in the United States. However, the population in this study 'Black American men, ages 40 and older, in selected counties in Fulton, DeKalb, Gwinnett, Clayton and Atlanta metropolitan areas' tended to underutilize prostate cancer care. The purpose of this quantitative, nonexperimental descriptive study was to determine whether socio-economic barriers and perceptions of Black American men about prostate cancer reduce their ability to access quality care in this county in Georgia. The Health Belief Model (HBM) was used to inform the predictive validity of perceptions, attitudes, and belief on individual …

Policing The Mentally Ill In Coronado, Ca, Jennifer Susan Ayres

Walden Dissertations and Doctoral Studies

The growing number of individuals suffering from mental illnesses and their inability to access intervention methods has adverse effects on the criminal justice system. These impairments increase the likelihood that police officers will have negative attitudes about persons with mental illnesses. This study sought to understand whether police officers' empathy, education, experience outside of work as well as on the job, and officers' training in the field of mental health all related to police officers' attitudes relating to persons with mental illness. The purpose of this study was to expand the body of knowledge and determine how factors such as …

Barriers To Preventive Healthcare For Immigrants In Michigan, Sondos Ghazi Al-Hachim

Walden Dissertations and Doctoral Studies

The Affordable Care Act expanded insurance coverage to the general population; however, expanding insurance coverage to immigrants might not be sufficient to improve utilization of annual physical preventive exams. This study evaluated adult Michigan immigrants' individual demographics, perceptions, and behaviors, as well as the collective cultural and system characteristics that might act as barriers to the utilization of annual physical preventive exams. Ken Wilber's integral operating system model for medicine conceptual framework was used to create a comprehensive map of factors and bring more clarity and understanding to the barriers to annual physical preventive exam. The quantitative survey was the …

Exploring The Strategies To Implement A Sustainable Energy Program In Hong Kong Public Hospitals, Terry Ting

Walden Dissertations and Doctoral Studies

Healthcare is one of the most energy-intensive industries because of its 24 hour-a-day and 7-days-a-week operation model. Climate change, due to environmental pollution, has increased the incidence of respiratory disease, cardiovascular disease, and cancer, which further overload the financial burden of our healthcare system. The National Health Service Sustainable Development Unit suggested that a sustainable healthcare sector also requires using their resources in an efficient and responsible way. Hong Kong public hospitals are facing this problem along with high energy expenditure. The purpose of this qualitative, multiple site case study was to explore strategies for Hong Kong's public hospital leaders …

Performance Improvement Data And Staff Responsibility, Tabitha Anne Bentley

Walden Dissertations and Doctoral Studies

Improving the role the nurse plays in health care delivery should be embodied in the performance improvement initiatives to successfully improve the quality of care that is delivered. The purpose of this evidence-based practice project was to collect performance improvement data and present it to staff who, in turn, used the information to improve practice and influence patient safety outcomes. The practice-focused question addressed what would occur if a tool that allowed frequent data trending was used to measure effectiveness of care and thereby influence key outcome measures. Duffy's quality caring model provided a framework for the study to support …