Public Policy Commons^™

Retention Of Foster Parents For At-Risk Youth In Tennessee, Marvin Amos

Walden Dissertations and Doctoral Studies

Federal legislation with the Family First Prevention Service Act (FFPSA) of 2017 required Tennessee to increase foster parent retention strategies. Tennessee does not have enough available foster homes for adolescents. The purpose of this generic qualitative study was to explore foster parent retention in Tennessee and to inform policymakers on how to adapt policy to increase the retention. The theoretical foundation for this study was based on the policy feedback theory, to identify the policy scope in Tennessee, and the two-factor theory, to guide the data analysis in the context of employee satisfaction and retention measures. Purposive sampling techniques were …

Examining The U.S. Disaster Management Program: A Case Study Of The U.S. Virgin Islands Hurricanes Irma And Maria Evacuation, Victoria F. Vachon

Walden Dissertations and Doctoral Studies

AbstractWhether from natural or human causes, every global community is at risk for overwhelming, destabilizing incidents. Hurricanes Irma and Maria devastated the U.S. Virgin Islands in late August and early September 2017, necessitating the urgent evacuation of hemodialysis patients over 1000 miles to the U.S. mainland. Because the damage and response to the U.S. territory were unprecedented, the public health implications of the government’s strategies on the evacuated population subset were unexplored. However, available information suggested that some evacuees sustained avoidable harm while in the protracted care and custody of the government. This qualitative case study, conceptually framed by Bronfenbrenner’s …

The Effect Of Community Health Linkages On Suicide Rates In Veterans, Erica Anderson

Walden Dissertations and Doctoral Studies

Suicide risk is a public health issue. It is a complex and poorly understood mental health and societal threat. This study examined veteran suicide rates and their relationship to family and social support, as measured by the social association rate, mental health funding per capita, and the lethality of the method rate. The interpersonal-psychological theory of suicide and the social-ecological model are the theoretical frameworks that guided the study. Both theories emphasize the complexity surrounding suicide at the state level as it is related to the individual, social, environmental, and political landscape related to veteran suicide. The quantitative bivariate correlation …

Self-Care And Psychosocial Factors That Predict Sickle Cell Disease-Related Outcomes Among African Americans In The Usa, Datonye Agina-Obu

Walden Dissertations and Doctoral Studies

Existing beliefs and conceptions regarding sickle cell disease (SCD) have had a significant impact on the appropriate management of the condition, including self-care and psychosocial factors, particularly among African Americans. The aim of this study was to examine the influence of self-care and psychosocial factors on SCD-related outcomes among African Americans in the United States. The study was grounded in the self-care management theory and employed a cross-sectional, quantitative design. Regression analyses were conducted to explore the associations between self-care and psychosocial factors and SCD-related outcomes sample of 180 individuals. The results indicated three factors showed significant relationships for sickle …

Perceptions Of Implicit Bias In New York City Healthcare System During Covid-19, Kiesha Jackson

Walden Dissertations and Doctoral Studies

Implicit bias has been identified as a significant problem that hinders effective healthcare delivery. The purpose of this qualitative exploratory phenomenological study was to examine whether implicit bias influenced healthcare services for African Americans with comorbidities aged 30 and over living in New York City during the COVID-19 pandemic. Current studies show healthcare disparities, revealing barriers with healthcare delivery; however, they do not disclose a patient’s lived experience qualitatively, which constituted a gap in the literature. The frameworks of the behavioral model of health services use, and social construction and policy design guided this study. Research questions addressed (a) whether …

Chronic Obstructive Pulmonary Disease 30-Day Readmission Rates In California, Illinois, And New York, Theresa Teverbaugh

Walden Dissertations and Doctoral Studies

AbstractThe Centers for Medicare and Medicaid Services (CMS) have implemented financial penalties to reduce hospital readmissions for various conditions, including chronic obstructive pulmonary disease (COPD). As a result, hospital administrators explore ways to prevent financial penalties for excessive COPD 30-day hospital readmissions. The purpose of this quantitative study was to determine if there was a correlation between hospital Medicare reimbursement, quality-of-care measures related to patient satisfaction, and 30-day readmissions rates for COPD patients in California, Illinois, and New York. The quality-of-care measures included communication with nurses, communication with doctors, the hospital staff's responsiveness, and medicine communication. The secondary data were …

Factors That Predict Prescription Opioid Misuse By Type Of Healthcare Insurance Coverage, Keon Green

Walden Dissertations and Doctoral Studies

The opioid epidemic remains one of the leading causes of unintended deaths in the United States and is still one of the focal points of the public health field. Previous research has increased awareness of the opioid crisis and has focused on sociodemographic factors that may cause or predict prescription opioid misuse. The purpose of this study was to investigate sociodemographic factors that may predict prescription opioid misuse while controlling for healthcare insurance. The theoretical foundation for this secondary data analysis project was the socioecological model using the 2019 National Survey on Drug Use and Health. The population was 56,136 …

Exploring African American Single Mothers’ Experiences With Child Welfare System, Paul J. Melbourne

Walden Dissertations and Doctoral Studies

African Americans are overrepresented in the child welfare system in New York City (NYC). They face racial and ethnic bias, complex procedures, and policies that govern child welfare. The main research question for this study explored the experiences of African American single mothers with the child welfare system. This qualitative study was guided by policy feedback theory; data were gathered from 10 African American single mothers who have had experiences with child welfare investigation within the past 10 years. Participants were interviewed using semistructured questions designed to capture their experiences with the child welfare system. The data were coded for …

Appraisal Of Institutional Antimicrobial Stewardship In Selected Public Health Facilities In Nigeria, Joshua Olusegun Obasanya

Walden Dissertations and Doctoral Studies

The misuse of antimicrobials (AM) constitutes a huge problem in developing countries, including Nigeria, posing severe public health threats to the populace’s health. Misuse contributes to the high consumption of AM, driving the emergence and spread of antimicrobial resistance (AMR). Establishing functional antimicrobial stewardship (AMS) programs at the health facility levels is recognized as an effective and efficient strategies to tackle AMR. Literature is replete with evidence of poor prescription practices, but few studies assessing the factors contributing to inappropriate use of AM in Nigeria exist. The purpose of this study was to improve the understanding of AMS practice at …

Legislative Efforts And Community Change To Combat Female Genital Mutilation In Egypt, Maryam Berkshire

Walden Dissertations and Doctoral Studies

Female genital mutilation is recognized as a violation of human rights as it violates the bodily rights of young girls by cutting part of their bodies without their consent and leaves long term psychological, physical and sexual harm to women who were exposed to the practice. The World Health Organization estimates that 130 million girls and women are subjected to Female Genital Mutilation/Cutting (FGM/C) in African and Middle Eastern Countries. According to a UNICEF 2020 report, Egypt will not meet the SDG goal of eradicating FGM as the decrease in the practice is too slow despite the policy and community …

Exploring Infant Massage As Standard Nonpharmacological Treatment For Neonatal Opioid Withdrawal Syndrome, Christine Ann Perez

Walden Dissertations and Doctoral Studies

The opioid epidemic in the United States has increased opioid use in women of reproductive age, leading to in utero exposure causing withdrawal symptoms in newborns known as neonatal opioid withdrawal syndrome (NOWS). State perinatal quality collaboratives (SPQCs) have been used in hospitals with quality initiatives (QIs) to improve standardization for NOWS; however, there remains a gap in knowledge in interventions to support the mother-infant dyad such as infant massage. This general qualitative research study explored the process and experiences of implementing infant massage as a standard practice for NOWS to inform national, state, and local policy. Participants in the …

An Examination Of The Absence Of A Comprehensive Smokefree Law In Georgia On College And University Campuses, Nakki Price

Walden Dissertations and Doctoral Studies

AbstractCigarette smoking is the number one preventable cause of death and disability in the United States. Although there are policies that govern the use of tobacco products, there are jurisdictions that do not employ these policies. Comprehensive smokefree laws govern private-sector entities and prohibit smoking in public places, specifically restaurants, bars, and workplaces. While states have the authority to implement these laws, some include exceptions that limit the intention of the law. Colleges and universities are specific communities for learning and serve as housing for students and an employer for the greater community. There is a gap in the literature …

A Phenomenological Exploration Of How Nursing Experience Shapes The Transitional Performance Of Primary Care Nurse Practitioners, Helen Okeke

Walden Dissertations and Doctoral Studies

AbstractPoor access to healthcare and a shortage of primary care providers in underserved communities paved the way for reliance on advanced practice registered nurses (APRNs). This increased reliance on APRNs as primary care providers necessitates expanded public policy on APRN practice; however, information on APRN transitional experiences remains inadequate to inform policymakers effectively. Illinois’ Nurse Practice Act requires APRNs to incorporate the scope of practice of registered nurses into their practice but does not describe what that experience should be. Using Kanter’s theory of organizational structural empowerment and Benner’s novice to expert nursing model as theoretical lenses to ground the …

Perspectives Of Key Court Personnel On The Prosecution Of Domestic Violence Cases, Crystal M. Schoeder

Walden Dissertations and Doctoral Studies

Domestic violence (DV) continues to be a public health and criminal justice problem. Several criminal justice system changes have been made to combat DV, such as mandatory arrest policies, no-drop prosecution policies, and specialized DV courts. Perspectives on these policies, DV, and the criminal justice system have been obtained from the victims, police officers, and victim advocates. However, perspectives from those within the criminal justice court system are missing. The purpose of this qualitative phenomenological study was to obtain the perspectives of key court personnel in small rural communities regarding the prosecution of DV cases. Narrative policy framework was used …

Challenges To Successful Health Care Transition Among Hiv Positive Youth With Perinatal Acquisition, Tyler Andrew Termeer

Walden Dissertations and Doctoral Studies

To ensure stability in the continuum of health care for HIV-positive youth with perinatal acquisition, there is a need for a successful transition from pediatric to adult primary care. However, there are a growing number of perinatally infected HIV-positive young persons remaining in pediatric care beyond the age of 21. Using Mohr’s program theory and a phenomenological approach, the lived experiences of Ohio HIV clinicians were examined to determine why many perinatally infected HIV-positive youths are remaining in pediatric care beyond the age of 21. Audio recorded video interviews via SKYPE were conducted with 12 participants, transcribed, underwent thematic analysis, …

Medical Brain Drain And Its Effect On The Nigerian Healthcare Sector, Oluwakemi Osigbesan

Walden Dissertations and Doctoral Studies

Nigeria suffers from a huge brain drain issue across different sectors, particularly in the healthcare sector. The WHO assessed that there is a current shortage of 2.8 million physicians in the world A heuristic phenomenological method was used in this study to explore the lived experiences of 12 Nigerian healthcare practitioners that migrated to the United States. The push-pull theory served as the theoretical framework that grounded this study. The central research questions for this study focused primarily on the reasons healthcare practitioners are leaving Nigeria and what the impact of those decisions have on the Nigerian healthcare sector. Qualitative …

Effects Of Government Regulations And Reimbursement Policies On Home Health Administration In Illinois., Sally Nwafor

Walden Dissertations and Doctoral Studies

Recent changes in government regulations and reimbursement policies threaten the financial viability and the ability of home health agencies to provide the necessary services. There is a gap in knowledge about the effect of the changes in healthcare policies on the administration of home health businesses in Illinois. The purpose of this study was to bridge the knowledge gap by investigating the effect of the regulatory and policy changes on home health administration in Illinois. The research question focused on the challenges that home health administrators face due to the changes in government regulation and reimbursement policies, and the strategies …

Barriers To Mental Health Services Related To Stigma In Northern California, Kandalena Ary

Walden Dissertations and Doctoral Studies

California Senate Bill 1041 recognized mental health as a contributing barrier for individuals struggling to achieve independence from aid through the California Work Opportunity and Responsibility to Kids (CalWORKs) program to meet the needs of the state's low-income families while reducing barriers to self-sufficiency. As mental health illnesses continue to increase, the engagement and utilization of services have not increased. The purpose of this study was to explore county policy infrastructure addresses making mental health services known, accessible, and increase participation to decrease barriers in utilization of available resources. The research questions were used to examine the effectiveness of processes …

Georgia Government Leaders' Lived Experience Creating And Implementing Health Equity Policies, Tracy M. Clopton

Walden Dissertations and Doctoral Studies

Georgia’s racial and ethnic minority communities have a continual problem of disproportionately worse health outcomes, including higher chronic disease and behavioral risk factors, compared to their nonminority counterparts. The average cost per year for chronic disease between 2016 and 2030 could be $64.6 billion in medical costs and $26.8 billion in lost employee productivity for Georgia. The purpose of this study was to explore the lived experience of Georgia legislators and health program staff to determine policy solutions to reduce chronic disease and behavioral risk factor disparities in the racial and ethnic minority population. The theoretical lens for the study …

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

Walden Dissertations and Doctoral Studies

Abstract

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

Bioterrorism: Exploring Factors For Improving Nurse Preparedness, Policies, And Practices, Leone Okey Tom-James

Walden Dissertations and Doctoral Studies

Ebola virus release/attack in New Jersey could go unnoticed but have immediate and long-lasting effects on the broader population and security. The risk underscores the need to prepare and enhance the state’s efforts to deal with a release and treat the confirmed cases. This descriptive single case research explored factors for improving nurses’ preparedness, policies, and practices for a bioterrorism release/attack. The epidemiological triangle conceptual framework was used descriptively in exploring, and developing a knowledge base of Ebola virus pathogenicity, characteristics, routes of transmission, and infection. The unit of analysis was Summit Ridge Genesis Healthcare Center. The theory of robust …

Chronic Pain Management In The Primary Care Setting, Rebecca Ann Day

Walden Dissertations and Doctoral Studies

Chronic pain is pain that lasts longer than 12 weeks, affects an individual physically in some mental or psychological way, influences an individual’s job performance, and may create a social complication over time. Ensuring the best possible care for the patient’s pain with the least possible complications is the responsibility of the health care provider, including nurse practitioners. Providing a clinical practice guideline (CPG) for the management of chronic pain in the primary care setting was the focus of this project. The comfort theory model was used as a framework for this project as well as the basis of nursing …

Community Health Worker's Perceptions Of Integration Into The Behavioral Health Care System, Juliette Swanston Jenkins

Walden Dissertations and Doctoral Studies

Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence …

Effects Of Psychiatric Hospital Closures On Local Jail Administrators, Correctional Staff, And Inmates, Mark Christian Lasko

Walden Dissertations and Doctoral Studies

A series of psychiatric hospital closures has led to a movement of care for individuals with mental illness from state-run facilities to managed care centers. Many of the individuals who no longer reside in psychiatric hospitals have become ensnared in the criminal justice system. Correctional facilities have an increased burden to care for the needs of the mentally ill, but lack the training and facilities to do so adequately. In this study, the lived experiences of correctional staff who have experienced the process of a hospital closure were examined. Psychiatric rehabilitation and gatekeeper theories served as the theoretical framework for …

The Shortage Of Licensed Social Workers In Central Florida, Helen M. Burrows

Walden Dissertations and Doctoral Studies

For several decades, a national shortage of licensed clinical social workers has been growing in the United States. Licensed social workers provide counsel and advocacy for those affected by mental illness, addiction, abuse, and discrimination, among other economic difficulties, and are the largest group of providers of mental and behavioral health services. The research questions for this project addressed what challenges unlicensed social workers in central Florida identify as barriers to pursuing clinical licensure. This study also explored strategies that unlicensed social workers in central Florida reported to address these barriers and encourage the pursuit of clinical licensure. The purpose …

Maintaining Confidentiality Among Hiv Infected Couples: Physicians' Patterns Of Decision In Nigeria, Francess Uju Ayaebene

Walden Dissertations and Doctoral Studies

Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided …

Effect Of Access To Health Services On Neonatal Mortality In Uganda, Imelda Atai Madgalene Musana

Walden Dissertations and Doctoral Studies

Since 2006, Uganda has experienced a nonchanging neonatal mortality rate of 27 out of 1,000 live births, which is higher than the global average of 19 deaths for every 1,000 live births. The purpose of this retrospective cross-sectional study was to determine factors affecting access to health services and their impact on newborn deaths in Uganda. Mosley and Chen's model for child survival in developing nations provided the framework for the study. Secondary data from the 2016 demographic and health survey (UDHS) collected by the Uganda Bureau of Statistics (UBOs) was used. A total of 7,538 cases were used and …

Logistical Resource Capability During A Mass Casualty Event In Washington State, Todd Devin Brauckmiller

Walden Dissertations and Doctoral Studies

The need for increasing efficiencies for medical resource delivery during a mass casualty incident/event is a paramount logistical planning factor that could mean life or death to the citizens affected by a disaster. As such, Washington State has prioritized emergency management and preparedness. Using the just-in-time system by way of Baghbanian' s complex adaptive decision-making theory as the foundation, gave purpose to this qualitative study. This was accomplished by analysis of emergency management professional responses, and to what degree, improvements can be made to the medical resource delivery system during a mass casualty incident/event. Data were collected through semi structured …

The Impact Of Congressional Attention And Policy Mood On Public Health Funding, Evelyn Denise Dunn

Walden Dissertations and Doctoral Studies

Congressional appropriations for federal public health agencies are subjected to external factors throughout the congressional appropriations process, resulting in fluctuations in funding. Recent literature has focused on externals factors, such as political attention and public attitudes, that could influence government funding levels; however, the impact of these factors on federal public health funding was not addressed. The purpose of this study was to determine whether a relationship exists between these external factors and federal public health appropriations. A quantitative study was used to examine congressional attention, policy mood, and the influence on the change in the level of federal public …

Preventing Obesity And Type 2 Diabetes In Immigrant Populations, Maxwell K. Chikuta

Walden Dissertations and Doctoral Studies

Obesity-related diseases have been increasing in African immigrants throughout the United States. Although research has been done to identify risk factors associated with many ethnic groups in the United States, only a few studies exist that explore obesity and type 2 diabetes diseases among Central African immigrants. The conceptual framework for this qualitative case study was social constructivism and the health belief model. The primary research question addressed the potential underlying causes for an increase in obesity and type 2 diabetes among Central African Immigrants. The secondary research questions explored how culture, illiteracy, and religion contribute to the problem of …