Walden University
  • Minneapolis, United States
Recent publications
The perioperative setting is one of the most demanding areas in healthcare, requiring precise coordination for optimal patient outcomes. However, this environment is susceptible to disruptions from microaggressions and burnout, which can negatively impact communication, collaboration, teamwork, and care quality. These issues can create a toxic work culture, heighten patient anxiety, and lead to poorer patient outcomes. Pediatric surgical nurses face heightened burnout due to emotional overload, increasing workloads, and lack of managerial support. Leadership plays a critical role in addressing these challenges by fostering an inclusive and supportive workplace. Leadership styles must include an authentic commitment to equity, belonging, and representation is essential to improving nurse well-being, job satisfaction, and patient outcomes. Leaders must engage with staff through open dialogue, implement strategies such as education and stress reduction programs, and promote a work-life balance to combat burnout and microaggressions. However, barriers such as limited resources, resistance to change, and generational differences may impede progress. Overcoming these obstacles requires a multifaceted approach, including comprehensive education, stakeholder engagement, and phased adaptation. By leveraging technology and tailoring strategies to suit various generational needs, nurse leaders can foster an environment that supports professional satisfaction, reduces burnout, and promotes excellence in pediatric surgical care.
Background: The emergency department (ED) provides a significant portion of health care services in the United States, and its utilization has increased over the past decade. ED overcrowding remains a considerable challenge to many EDs. The objectives of this study were (1) to evaluate the knowledge of telehealth and readiness to use it among patients who visit EDs in a nonurgent triage category and (2) to estimate their willingness-to-use and willingness-to-pay for telehealth consultations. Methods: A structured questionnaire was administered using a tablet to adult patients who visited the ED of a large medical center and who were triaged into a nonurgent category. Respondents were asked about their sociodemographic and ED visit characteristics and health and telehealth utilization history. Then, we presented them with a hypothetical scenario for visiting a board-certified ED doctor through telehealth instead of in-person visits, and, using a double-bound dichotomous choice iterative bidding algorithm, we solicited their willingness-to-pay for such a telehealth visit. Results: A total of 171 patients agreed to participate in the study. More than half of the respondents (n = 107; 62.6%) said they have health insurance. Almost half of the respondents (n = 71; 41.5%) reported the main reason for going to the ED was an ongoing condition or concern. More than two-thirds of the respondents identified themselves as being very proficient with using a smartphone or tablet (n = 116; 67.8%), and only a few (n = 21; 12.3%) reported not having any internet-capable device. Most respondents (n = 148; 86.5%) had never heard about telehealth. However, after a brief description of telehealth, we found that approximately two-thirds of the patients would be willing to use or consider using telehealth (n = 107; 62.6%), and one-third (n = 64; 37.4%) would not be interested. We did not observe any statistically significant differences in willingness-to-use. However, we observed statistically significant differences in the willingness-to-pay $50 by gender (p < 0.01), by currently having a regular doctor/clinic (p < 0.05), and by health insurance status. Conclusions: Hospitals should consider investigating telehealth services that can be provided to their communities as an option instead of visiting their EDs. While technology does not seem to be a barrier to telehealth, more educational initiatives to inform the public about telehealth are desirable. A targeted advertisement campaign to recommend telehealth for nonlife-threatening ED visits could be developed once more user characteristics are collected.
Background The increase in severe acute respiratory coronavirus virus 2 (SARS-CoV-2) cases due to the omicron strain led to reduced acute care hospital beds at the Veterans Administration (VA) Hospital, North Texas; veterans with non-severe coronavirus disease 2019 (COVID-19) disease were managed at a community living center (CLC), a VA nursing home. The management of non-severe COVID-19 in VA nursing homes has not been extensively described. Methods We describe resident characteristics and outcomes, and infection control practices implemented during 2 COVID-19 outbreak periods (January 12–February 15, 2022, June 28–July 14, 2023). Serial testing of all CLC residents was conducted, and residents with polymerase chain reaction-confirmed SARS-CoV-2 (COVID-19) infection were included in the analysis. Resident data were ascertained from the COVID-19 facility dashboard and medical record system. Results From January 12 to February 15, 2022, and June 28–July 14, 2023, 62 adults residing at the CLC were diagnosed with COVID-19. Overall, the median age was 75 years [interquartile range, 71–80], and 57 (91.9%) were men. Residents were cohorted by COVID-19 test results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning, and doffing of PPE. Thirty-seven (59.7%) residents were symptomatic. Overall, 55 (88.7%) residents were documented to have received the SARS-CoV-2 primary vaccination series. Most residents were managed at the CLC, while 12 (19.3%) were hospitalized in acute care. Conclusions It is feasible to manage high-risk residents with non-severe COVID-19 disease in a CLC utilizing a multidisciplinary approach and implementing Infection Prevention and Control strategies.
Response to Intervention (RTI) is a framework with the primary purpose of early identification and prevention oflearning problems. Screening procedures identify students in need of targeted intervention, but current screeningresearch is limited to the elementary grades. This study explored the use of screening measures: prior yearassessment data, oral reading fluency (ORF), and maze, to predict performance on Georgia’sCriterion-Referenced Competency Test (CRCT-8) for 236 eighth grade students from one district in Georgia.Logistic regression analyses compared the accuracy of the predictor variables. Overall classification accuracywas 96.6% for ORF and maze and 97.1% for CRCT-7; however, this was primarily due to the low base rate ofpoor performance on the CRCT-8 in the sample. A combination of screens did not significantly improveclassification accuracy. A screening process that used CRCT-7 data followed by fall ORF resulted in 100%sensitivity and 90% specificity. Implications for practice are discussed.
The goal is to share policy implications of sensitive, specific internet-based tests in place of current approaches to lowering violence, namely fewer mass murders, suicides, homicides. When used, internet-based tests save lives and money. From 2009-2015, a Chicago field test had 324 fewer homicides (saving 2,089,848,548,ROI=6.42).In60yrs.,conventionalapproachesforhighriskpersons(e.g.,.inappropriatelyreleasingpoor,severelymentallyill)ledtounnecessaryexpenseincludingyearly:(a)300massmurders(592,089,848,548, ROI=6.42). In 60 yrs., conventional approaches for high risk persons (e.g.,. inappropriately releasing poor, severely mentally ill) led to unnecessary expense including yearly: (a) 300 mass murders (59% demonstrating psychiatric conditions); (b) 1-6% having costly personnel challenges; (c) 2,100,000 “revolving door” Emergency-Room (ER) psychiatric admissions (41,149 suicides, 90% mentally ill); (d) 10,000,000 prisoners (14,146 homicides, 20% psychiatric challenges). Current metrics fail [success rates from 25%-73%: (1) for background checks (25%); (2) interviews (M=46%); (3) physical exams (M=49%); (4) other tests (M=73%)]. Internet-based tests are simultaneously sensitive (97%), specific (97%), non-discriminatory, objective, inexpensive, 100/test, require 2-4 hrs.
Purpose: This paper suggests strategies for professionals’ continuous development in healthcare institutions to ensure quality and sustainable healthcare delivery in a cost-effective way. Background: Healthcare services are increasingly becoming expensive, and receiving quality service is often difficult. This plunges practices and healthcare institutions into the sphere of the population’s mistrust. They believe in the degradation of quality due to individual experiences, with the direct corollary of reduction in life expectancy in some areas. We therefore propose strategies for enhancing the quality of those individuals for a sustainable healthcare delivery in an emerging market economy, based on the case in South Africa. Method: Cost-effectiveness analysis is chosen for the purpose of non-monetary analysis, and we make use of the qualitative methodology to explore, in detail, the need of strategies to improve healthcare delivery. Results: We propose a suitable digital ecosystem for the professionals’ development, and we evaluate the proposed methodology and the challenges that come from its realization. Conclusions: We find that the application of these strategies yields efficiency and quality, which, when applied continuously, yields sustainability.
Middle managers play critical roles in the implementation of organizational strategies. Yet, little is known aboutthe views of middle managers on the organizational factors influencing strategy implementation. This paper is anattempt to extend existing understandings on the organizational factors influencing strategy implementation fromthe viewpoints of middle managers, including the contribution of middle managers in the implementation oforganizational strategies and the challenges associated with the implementation process. Data were collectedusing semistructured in-depth email interviews with 12 middle managers. This research demonstrates thatmanagement style, strategic alignment, internal communication, and middle management contribution arecritical factors influencing strategy implementation.
A valid and accurate capital asset pricing model (CAPM) may help investors and mutual funds managers in determining expected returns which may lead to increase their profits and community resources. The problem is that the traditional CAPM does not accurately predict the expected rate of return. A more accurate model is needed to help investors in determining the intrinsic price of the financial asset they want to sell or buy. The purpose of this study was to examine the validity of the single-factor CAPM and then develop and test a multifactor CAPM in the Jordanian stock market. The study was informed by the modern portfolio theory and specifically by the single-factor CAPM developed by Sharpe, Lintner, and Mossin. The research questions for the study examined the factors that may explain the variation in the expected rate of return on stocks in the Jordanian stock market and the relationship between the expected rate of return and factors of market return, company size, financial leverage, and operating leverage. A causal-comparative quantitative research design was employed to achieve the purpose of the study by testing the listed companies on the Amman stock exchange (ASE) for the period from 2000 to 2015. Data were collected from the ASE database and analyzed using the multiple regression model and t test. The results revealed that market return, company size, and financial leverage are not predictors of the expected rate of return while operating leverage is a predictor.
Fuller Hamilton et al. (2015) review provided a suggested model to improve Career and Technical Education (CTE) equity so that this study could be replicated systematically. National resources examining CTE educational equity components did not exist. The problem addressed in the replication study was the need to explore educational inequity within the South Carolina CTE Health Science career cluster. No CTE educational equity research exists in South Carolina, so the purpose of the replication study was to explore educational inequity within the South Carolina CTE Health Science career cluster. Cultural Replication Theory was the conceptual framework used for this replication study. Four research questions were formulated to examine the CTE enrollment patterns in South Carolina concerning four demographic characteristics, namely sex, race/ethnicity, region, and socioeconomic status. Students enrolled in CTE within South Carolina during the 2018-19 school year was the population selected. Secondary data was collected from a sample of 196,318 CTE enrollees and examined using descriptive analysis procedures. Overall results were not uniform. Inconsistent levels of inequity existed within race, ethnicity, and sex. In addition, inequity was present regarding regional effects and socioeconomic status. Future recommendations for research include conducting a qualitative or mixed-method study to further explain the enrollment patterns of CTE programs in South Carolina. Implications for practice to address the inequities in South Carolina include improving the underrepresentation of educators by sex and race/ethnicity, recommending equity audits, examination of access and availability of opportunities within CTE programs, and encouragement of all educators actively adopting and advancing an equity agenda from the original study.
Background: Recent statistics released by the Department of Defense have revealed increasing numbers of military spouse suicide. Although past qualitative research has suggested possible reasons for this phenomenon, there is a lack of wide-scale quantitative research regarding suicide within the military spouse population. To fill this gap, we aimed to examine military spouses' perceptions of suicide and their ability to access mental health care. We also aimed to explore the perceptions of sucide within various subgroups of military spouses. Materials and methods: We recruited military spouse participants (officer and enlisted) through social media to complete a 12-item Likert survey focusing on their perception of suicide in the military spouse community, including the threat level of suicide, their own mental health status, barriers and stigmas to accessing mental health care, the view from the spouse's leadership, and the leading causes for military spouse suicide. A total of 141 military spouses participated in our study. Results: Spouses' perception of the main threats to their mental health and suicides in their community were an ongoing sense of loss of control (27.7%), loss of identity (25.5%), difficulty accessing mental health services (19.1%), and fear of seeking mental health services (10.6%). Additionally, 28.3% of participants were moderately concerned, quite concerned, or extremely concerned about their mental health. The participants also believed that the threat of suicides in their community was moderately prevalent (35.5%), quite prevalent (17.7%), and extremely prevalent (5%). There was no difference between spouses of officers or enlisted service members, spouses of service members in the Army, Navy, or Air Force on perceptions of suicide risk prevalence, stigma, participants' concern for themselves, confidence in their ability to access resources, confidence in their ability to help another spouse, or the perceived importance military leaders place on preventing suicide. Spousal tenure was similarly not significantly related to any of the variables of interest. Conclusions: Our military spouse particpants reported elevated perceptions about the prevalence of suicide threats, concern for themselves, and stigma toward accessing mental health resources, as well as low perceived importance placed on spouse suicide prevention by military leadership. The spouses reported moderate confidence in their ability to help another spouse or access suicide prevention resources. Our participants also reported challenges in accessing mental health services and perceived a stigma associated with receiving counseling services. Continued focus and advocacy is needed to ensure military spouses receive the mental health support needed to prevent suicide within this population.
The paper analyses Soviet influence in Albanian education and culture from 1949–1961. In pursuit of its objectives during the Cold War, the Soviet Union sought to foster a sense of unity across the various elements of society in the Eastern Bloc and satellite states, with the ultimate goal of creating a cohesive and integrated Soviet society. This article uses published archival materials and unpublished and rarely studied records from the State Archives of Albania. As a result, Albanian education and culture were built around the Soviet model and contributed to the Sovietization of Albanian society to immerse Albanians in Russia’s cultural and artistic values. Such values had an enduring impact on future generations of Albanians.
This basic qualitative study explored the intercultural development and experiences of thirteen US undergraduate faculty members. It was grounded in the theoretical frameworks of intercultural development and constructive-developmental theory. Data included two Intercultural Development Inventories® 3–6 months apart; a Subject Object Interview; and a demographic questionnaire. Findings included qualitatively different experiences among participants who did and did not grow interculturally. For example, participants who stayed at the intercultural stage of Minimization experienced wanting to “get it right” but worrying about “getting it wrong” with intercultural interactions. Participants who grew from Minimization to Acceptance described leaning into the fear of getting it wrong. One who grew from Acceptance to Adaptation described valuing risking getting it wrong. Constructive-developmental stage findings suggest that to grow from Minimization to Acceptance, it may be necessary to have some Self-Authorship capacity, including an internally generated value system and an ability to reflect on one’s own assumptions.
Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality in the United States (U.S.), with rates varying by disease severity, comorbidities, and sociodemographic factors. Cognitive impairment has been independently associated with increased mortality, but has not been well studied in relation to COPD despite being a frequently overlooked comorbidity in COPD patients. The purpose of this nationwide study was to assess the relationship between low cognitive performance and the risk of mortality among older adults with COPD while adjusting for major sociodemographic and health-related characteristics. Methods: This study utilized the 1999-2002 National Health and Nutrition Examination Survey (NHANES) and the respiratory mortality data of noninstitutionalized US adults aged over 65 years. Survival curves showing the combined effect of cognitive decline and COPD using the Kaplan-Meier product-limit method to estimate the percent survival of the subject at each point in time were used. Results: The final sample included 2013 older adults, with 39.1% showing low cognitive performance and 12.7% having COPD. Those with low cognitive performance were older, less educated, had lower income, were more likely to be racial/ethnic minorities, and had a history of cardiovascular diseases (CVD); they were also more likely to have COPD or chronic kidney disease (CKD). The adjusted hazard ratio for respiratory-related mortality risk was highest for individuals with both COPD and low cognitive performance (hazards ratio = 8.53), people with COPD alone also had a higher respiratory-related mortality risk (hazards ratio = 4.92), but low cognitive performance alone did not significantly increase respiratory-related mortality risk. Conclusions: These findings provide clearer insights into how cognitive impairment affects mortality risk in older adults with COPD and we discuss potential strategies to address this dual chronic health challenge effectively.
Rural communities present unique challenges for counselors. Farmers experience high rates of suicidality, depression, and substance abuse and are less likely to seek mental health help due to associated stigma, financial strain, time constraints, and lack of specialized training among clinicians. This study sought to understand the lived experiences of counselors in rural Iowa who counsel male farmers. Participants completed a 60-minute semi-structured interview and demographics questionnaire. Hermeneutic phenomenology and the ecological perspective were used to identify and interpret these experiences, illuminating the need for culturally competent, contextually responsive counseling practices in rural settings. Essential themes were categorized within the ecological levels: microsystem, mesosystem, exosystem, and macrosystem. We discuss our findings, their implications, and offer recommendations for further study.
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27,544 members
Gary Burkholder
  • College of Health Sciences and College of Social and Behavioral Sciences
Grace Gachanja
  • School of Health Sciences
Brian Hutchison
  • School of Counselling and Social Service
Sherock James
  • School of Nursing
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Minneapolis, United States
Head of institution
Jonathan Kaplan