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A Comparison Of Cultural Aspects Of Breastfeeding In The United States Vs Italy, Madison P. Wallace

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Healthcare systems internationally differ from policies, funding and resources available, and it is evident when comparing the United States and Italy. Participation in the Nursing Across the Lifespan study abroad program at the University of Arkansas Rome Center and Tiny Tusk Breastfeeding and Infant Support internship inspired a comparative exploration of breastfeeding practices in the United States versus. Italy. The United States has a mixed public- private insurance system, workplace policies and government assistance, while Italy has a universal healthcare system with a mandated maternal work paid leave to support breastfeeding mothers. Italy's program supports education and physical care needed …

Determinants Of Utilization Of Skilled Birth Attendant Among Women Of Reproductive Age In Habeswein Ward, Wajir County, Kenya, Suada Hassan

MSc in Advanced Practice Midwifery

Background: Maternal care provided by a skilled birth attendant (SBA) during pregnancy, at delivery, childbirth, and the postpartum period is vital for reducing maternal and neonatal mortality. In sub-Saharan Africa, the overall prevalence of usage of SBA in a 2021 study was 63%. Tanzania recorded the lowest rate at 13.8%, while Kenya registered 89.3% in 2023. However, disparities exist within Kenyan counties, for instance, in Wajir County only 57% of births were assisted by skilled health providers, a disparity that could be due to socio-cultural differences.

Aim: This study aimed to determine the factors influencing the utilization of skilled …

Perceived Stress And Coping Mechanisms Among Nurses Working In Oncology Inpatient Units At Kenyatta National Hospital, Bole Ado

MSc in Advanced Practice Nursing

Introduction: Cancer is the second leading cause of death globally and the third leading cause of death in Kenya. Nurses in oncology units often experience stress because of the emotionally demanding nature of providing care for patients diagnosed with cancer. Global studies show that nurses in the oncology unit reported experiencing moderate to extreme work-related stress, with a prevalence of work stress globally varying between 9.2% to 68% globally. Many nurses experience stress, and because of ineffective coping mechanisms, this affects their psychological well-being and negatively impacts the quality of their care as well as patients’ outcomes.

Objective of the …

Enhancing Provider Knowledge And Implementation Of Medication For Opioid Use Disorder (Moud) To Improve Treatment Outcomes: A Quality Improvement Project., Motunrayo Abigael Ibraheem

Electronic Theses and Dissertations 2020 - Present

This quality improvement project sought to enhance healthcare providers' knowledge and attitudes toward Medication for Opioid Use Disorder (MOUD) at Galt Ocean Rehab Center to improve treatment outcomes for patients with opioid use disorder. Despite evidence supporting the efficacy of MOUD, significant knowledge gaps and stigmatizing attitudes among providers create barriers to optimal care. Sixteen healthcare providers participated in a comprehensive educational intervention grounded in Jean Watson's Theory of Transpersonal Caring and the Institute for Healthcare Improvement's Model for Improvement. The intervention consisted of a 4-hour workshop, six weekly reinforcement sessions, and the implementation of standardized buprenorphine management protocols. Pre- …

Characterization Of Antiretroviral Therapy (Art) Adherence Phenotypes And Psychosocial Symptom Clusters Among Black/African American (Aa) And Hispanic/Latine Adolescents And Young Adults (Ayas) With Hiv In The Adherence Connection For Counseling, Education, And Support (Access-Ii) Trial, Ann-Margaret Navarra, Taehoon Ha, Eva Liang, Maurade Gormley, David R. Garcia, Jason Fletcher, Lloyd A. Goldsamt, Michael G. Rosenberg, Karin Hasegawa, Jie Yang

School of Nursing Faculty Publications

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived …

Staff Education To Reduce The Incidence Of Central Line Infections In The Pediatric Intensive Care Unit, Khldon Hassan Al-Omari

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project aimed to reduce the incidence of central line-associated bloodstream infections (CLABSI) in the Pediatric Intensive Care Unit (PICU) by educating clinical staff on the importance of hand hygiene and bundle compliance. Despite established guidelines, CLABSI remains a significant issue in healthcare, particularly in PICUs, where patients are at higher risk for infections. The practice-focused question guiding the project was: How does staff education on hand hygiene and CLABSI bundle compliance impact the prevention of CLABSI in the PICU? Twenty-five PICU nurses participated in the educational sessions. Analytical strategies included pretests and …

The Lived Psychosocial Experiences Of Nursing Students Transitioning From In-Person Learning To Virtual Learning: A Transcendental Phenomenological Study, Lesley I. Gerald-Koram

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to explore and understand the lived psychosocial experiences of nursing students who transitioned from in-person learning to virtual learning at the onset of the COVID-19 pandemic in the northeast region. The study comprised of 15 participants who were enrolled in accredited nursing programs across New York, who experienced the abrupt shift in learning platforms during a global crisis. The abrupt shift significantly affected the emotional, academic, and professional development of the nursing students. This research was rooted in the growing concern of nursing student mental health, academic engagement, and preparation for clinical …

Development Of A Clinical Practice Guideline For The Prevention Of Catheter-Associated Urinary Tract Infections (Cautis) In A Skilled Nursing Facility, Marford Okoye

Walden Dissertations and Doctoral Studies

Abstract (as displayed in your dissertation/thesis): This Doctor of Nursing Practice (DNP) project focused on developing a clinical practice guideline (CPG) and accompanying checklist to prevent catheter-associated urinary tract infections (CAUTIs) in adult inpatients within a skilled nursing facility. CAUTIs represent the most prevalent healthcare-associated infections in both acute and long-term care environments, contributing to increased patient morbidity, prolonged hospitalization, and elevated healthcare costs. A key issue identified was inconsistent adherence to evidence-based practices related to catheter insertion, maintenance, and timely removal—posing a significant threat to patient safety. The guiding practice question for this project was: Will a clinical practice …

Antibiotic Stewardship And The Prevention Of Healthcare-Associated C.Diff, Nevaeh Tyson, Angel Pearson

Scholars Week

Healthcare-associated Clostridium difficile (C.difficile) infections remain a significant burden to many healthcare facilities across North America. This infection is often linked to long-term antibiotic use and ineffective infection control methods. This presentation addresses current evidence-based practice protocols on the prevention of C.difficile, emphasizing the need for increased monitoring of antibiotic therapy and improved infection control strategies.

Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas

Dissertations

Increasing Pediatric HPV Vaccination Rates

Abstract

Problem: The human papillomavirus (HPV) is a sexually transmitted infection that affects more than 80% of the population within the United States (Eisenhauer et al., 2020). HPV can develop into cervical, anogenital, and oropharyngeal cancers (Eisenhauer et al., 2020). About 4,000 individuals die from cervical cancer alone each year (O’Leary, 2022). The HPV vaccine, though recommended by the ACIP and AAP, is below national vaccination rates in comparison to other vaccines (O’Leary, 2022).

Methods: This quality improvement project is a non-randomized controlled trial that observed HPV vaccine dose completion rates for patients aged 9-14 …

Bridging The Gap: An Educational Intervention For The Early Introduction Of Peanut Protein In Pediatric Care, Rachel Gilson Dnp, Rnc-Ob, C-Onqs, Fnp-C, Parkview Health

Nursing Publications, Posters, & Presentations

Presented at the 6th Annual Parkview Nursing Research and Evidence-Based Practice Symposium. Theme: “From Paper to Practice: The Art of Implementation Science,” at the Parkview Mirro Center for Research and Innovation.

The primary aim of this Doctor of Nursing Practice (DNP) project was to improve provider adherence to the NIAID guidelines for the early introduction of peanut protein in infants under one year of age. The project intended to address identified knowledge and practice gaps through a targeted educational intervention at Fort Wayne Pediatrics (FWP).

Utilizing An Evidence-Based Educational Intervention To Assess Health Care Provider Knowledge And Confidence Of Weight Management Strategies In A Primary Care Setting, Fanny Ngwa Shu

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project aimed to address a clinical gap in primary care by enhancing provider and staff knowledge and confidence in delivering weight management counseling. Despite the high prevalence of overweight and obesity, many healthcare providers feel inadequately prepared to initiate weight-related discussions due to factors such as limited training, cultural barriers, and a lack of understanding of social determinants of health (SDOH) that influence patient behaviors. This gap in care can hinder the effective management of chronic conditions like diabetes, hypertension, and cardiovascular disease. The practice-focused question guiding this project was: Can an educational session …

Economic Factors Influencing Utilization Of World Health Organisation-Recommended Anc Visits Among Women In Jordan: An Analysis Of Jordan Population And Family Health Survey 2023, Lilian Nuwabaine, Joseph Kawuki, John Baptist Asiimwe, Benjamin Betunga, Mathius Amperiize, Angella Namulema, Imelda Namatovu, Shamim Nabidda, Patience Annet Nakalega, Quraish Sserwanja

School of Nursing & Midwifery, East Africa

Background: Antenatal care (ANC) is crucial for reducing maternal and neonatal mortality by identifying and managing complications early during pregnancy. In 2016, the World Health Organization (WHO) updated its guidelines, recommending a minimum of eight ANC visits to improve maternal health outcomes. Despite Jordan’s efforts to enhance maternal healthcare, disparities in ANC utilization persist, particularly among vulnerable populations such as refugees. This study aimed to assess the economic factors influencing utilization of the WHO-recommended eight ANC visits among women in Jordan.

Methods: The study used data from the 2023 Jordan Population and Family Health Survey (JPFHS). A two-stage sampling technique …

Identifying And Addressing Barriers To Long Term Follow Up Care Of Patients With Hepatitis C In A Rural Southern Appalachian Clinic, Sarah M. Brown

Doctoral Projects

This project addressed the issue of loss to follow-up (LTFU) among patients infected with hepatitis C virus (HCV), a significant barrier to achieving sustained virologic response (SVR) and improving outcomes. LTFU is particularly critical among marginalized and rural populations who face socioeconomic barriers, stigma, and other social determinants of health (SDOH) that affect treatment adherence. Grounded in the Social Ecological Model (SEM), this project examined systemic, community, interpersonal, and individual factors influencing LTFU (Ahmed et al., 2022; Al-Khazraji et al., 2019; Kilanowski, 2017).

This Doctor of Nursing Practice (DNP) quality improvement initiative sought to improve patient retention in HCV care …

Reducing Aspiration Pneumonia By Implementing An Enhanced Oral Care Toolkit, Jennifer London

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Oral care is essential for reducing bacteria and preventing aspiration pneumonia. The risk of aspiration pneumonia increases when protocols are not followed. In 2024, a regional hospital in the Midwest United States spent approximately one million dollars on the preventable healthcare-associated infection known as aspiration pneumonia. A pre-project chart audit of 100 random patient charts on a medical/surgical step-down unit revealed that only 1 of the 100 charts had oral care documented as completed.

Aim of the Project: The primary aims of this project were to increase nursing documentation of oral care by 50% and to decrease …

Improving Pain Assessment After Bedside Percutaneous Endoscopic Gastrostomy (Peg) Placement, Sherman Cotton

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Baseline audits at a 44-bed critical-illness recovery hospital showed low reliability in two post-PEG practices: (1) pain reassessment within 90 minutes of an intervention and (2) complete PEG-site documentation (skin, drainage, tube position/measurement). Baseline performance averaged 55% and 62%, both of which were below the organization’s 90% benchmark.

Aim of the Project: From May to July 2025 (12 weeks), improve on-time pain reassessment and ensure PEG-site documentation reaches at least 90%, maintaining this level for three or more consecutive weeks; monitor workload to prevent increases in perceived charting time and ensure safety by avoiding a rise in PEG-related …

Implementing A Sepsis Questionnaire To Reduce Readmissions…A Health Plan’S Experience, Vernita L. Kelley

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Sepsis is a life-threatening condition with high readmission risk, threatening patient recovery and survival. In the managed care organization (MCO) where this DNP project was implemented, sepsis ranks among the top five readmission diagnoses. The organization's 30-day readmission rate of 15.5% is substantially higher than the benchmark of 9.29%, highlighting a clinical quality issue, a strain on patient outcomes, and a strain on healthcare resources.

Aim of the Project: This quality improvement (QI) project aimed to reduce sepsis readmissions by embedding a sepsis questionnaire into case management workflows to identify clinical risks and social determinants of health, improve transitions, …

Educating Correctional Nurses On The Use Of A Mindfulness Program To Reduce Work Stress, Victoria Ngozi Emelogu

Walden Dissertations and Doctoral Studies

Correctional nurses deliver care in environments marked by violent incidents, chronic understaffing, and moral distress. These conditions heighten occupational stress, jeopardize patient safety, and accelerate staff turnover, yet few U.S. jails provide evidence-based training in rapid self-regulation strategies. The purpose of this staff education project was to evaluate whether a 2-week curriculum could increase correctional nurses’ knowledge, attitudes, and self-reported skills (KAS) for on-shift mindfulness use. Pender’s health promotion model framed the intervention, Bloom’s taxonomy and Kirkpatrick’s evaluation model informed learning objectives and outcome levels. Five correctional nurses at a large urban jail completed an anonymous 10‑item KAS survey before …

The Relationship Between Nursing Faculty Sense Of Belonging And Faculty Intent To Stay, Heather M. Bowers

Doctoral Dissertations and Projects

The purpose of this quantitative causal-comparative and correlational study was to evaluate the relationship between workplace sense of belonging and intent to stay in the current nursing faculty role among full-time nursing faculty. The shortage of nursing faculty impacts the ability to prepare the next generation of nurses needed to meet worldwide nursing demands. Strategies to effectively recruit and retain nursing faculty are important considering the current shortage and increasing retirements of nursing faculty. While sense of belonging has been studied for student retention and studies are beginning to explore the importance of workplace belonging, the impact of organizational sense …

Association Of Covid-19 Status With Maternal And Neonatal Outcomes Among Pregnant Women At Mombasa County Referral Hospital, Kenya, Salome Mghoi Rajab

MSc in Advanced Practice Midwifery

Background: COVID-19 pandemic has raised global concern regarding maternal and neonatal health owing to physiological and immunological changes that may heighten disease severity. Despite the global evidence linking COVID-19 infection with unfavorable pregnancy outcomes, data from Sub-Saharan Africa remain limited. This leaves an essential vacuum in our understanding of how COVID-19 status affects maternal and neonatal outcomes in counties like Mombasa, where health-care system problems may alter risks. Vertical transmission remains a puzzle to be solved.

Aim: To assess the association of COVID-19 status on maternal and neonatal outcomes between March 2020 to March 2022.

Methodology: A …

Blood Culture Contamination Rates, Jackqueline R. Easley

Walden Dissertations and Doctoral Studies

The timely and accurate collection of blood culture specimens is essential for improving patient outcomes and minimizing complications. Contaminated specimens can lead to unnecessary antibiotic use, prolonged hospital stays, and delays in appropriate treatment. At one eastern healthcare facility, monthly blood culture contamination rates reached an average of 4.5%, prompting the need for a targeted intervention. The objective of this project was to determine whether a structured process and trained team could reduce contamination rates to below 1%. De-identified data were reviewed using descriptive statistics to observe contamination trends over time, by department, and by month. Using the t-test, contamination …

A Comparative Subnational Policy Analysis Of State Covid-19 Vaccine Policies And Application Of The Political Determinants Of Health Model, Demetrius Cianci Chapman

Nursing ETDs

A COMPARATIVE SUBNATIONAL POLICY ANALYSIS OF STATE COVID-19 VACCINE POLICIES AND APPLICATION OF THE POLITICAL DETERMINANTS OF HEALTH MODEL

By

Demetrius Cianci Chapman

Associate of Science Nursing, Jewish Hospital College of Nursing and Allied Health, 1998

Bachelor of Science of Nursing, Saint Louis University, 2000

Master of Public Health, Saint Louis University, 2004

Master of Science Nursing (Research), Saint Louis University, 2004

Doctor of Philosophy, Nursing, University of New Mexico, 2025

ABSTRACT

This study uses the political determinants of health (PDoH) framework to analyze state-level COVID-19 vaccine policies and their impact on population health. The PDoH model examines how structured …

Chlorhexidine Bath Procedures To Increase Clabsi Maintenance Bundle Compliance And Decrease Clabsi And Clambi Incidence Rates., Michael Jabituk

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of the quality improvement (QI) project was to increase the Chlorhexidine (CHG) bath compliance, to decrease Central Line-Associated Bloodstream Infections (CLABSI and Central Line-Associated Mucosal Barrier Injury Infections (CLAMBI) rates in a transplant oncology unit.

Background

CLABSI and CLAMBI are hospital-acquired infections causing morbidity and mortality worldwide. A project targeting CHG bath compliance was developed to address the increased rates of these infections at a 32-bed transplant oncology unit at a hospital in Dallas, Texas.

Methodology

Two simulation-based videos were created on the importance of CHG baths and demonstration of CHG wipe application at bedside and administered …

Improving Intraoperative Antibiotic Stewardship To Reduce Surgical Site Infections: A Quality Improvement, Allyson Nichelle Heard

Doctor of Nursing Practice (DNP) Manuscripts

Purpose: Surgical site infections (SSIs) have been associated with poor pre-surgical incision antibiotic and intraoperative redosing practices and are the leading cause of postoperative readmissions and healthcare-acquired infections. A Quality Improvement (QI) project was developed to evaluate SSIs rates and pre-surgical incision antibiotic dosing and intraoperative redosing practices of anesthesia providers at a Level 1 trauma center in the Midwest. Methods: A pre- and post-intervention knowledge, attitudes, and practices (KAP) survey addressing intraoperative antibiotic stewardship was administered to 138 anesthesia providers. Interventions included education, a reference sheet, and a clinical pathway. Data analysis for surgical procedures involving anesthesia services, …

Increasing Gonorrhea And Chlamydia Testing By Using Universal Trauma-Informed Care And Offering Self-Collected Vaginal Swabs To Patients At A Non-Profit Independent Reproductive Healthcare Center, Dana M. Bloomburg

Doctor of Nursing Practice (DNP) Manuscripts

Background & Significance: The sexually transmitted infection (STI) epidemic in the United States remains a public health concern, with over 2.4 million cases in 2023 (Centers for Disease Control and Prevention [CDC], 2024). Increased screening can help prevent complications and enable treatment for the sexual partners of these asymptomatic infections (CDC, 2024). The American College of Obstetrics and Gynecology recommends that obstetrician-gynecology offices aim to provide universal trauma-informed care (TIC) to all patients (McNicholas et al., 2021). Purpose: Universal TIC practices were used to improve acceptance of gonorrhea and chlamydia (GC/CT) testing among at-risk individuals by adding a self-collected vaginal …

Describing Latent Tuberculosis Infection And Treatment Completion In Virginia: A Social Determinants Of Health Approach, Amber N. Harmon

Electronic Theses and Dissertations

While the treatment of latent tuberculosis infection is a key strategy in tuberculosis elimination nationally and globally, there is a limited understanding of the general prevalence of latent tuberculosis as well as factors related to successful treatment. This dissertation describes the known landscape of latent tuberculosis in Virginia and explores possible factors related to latent tuberculosis infection treatment through three manuscripts. The first manuscript, Chapter 1, outlines the overall proposal for this dissertation research in the style of a National Institute of Health grant proposal. The second manuscript, Chapter 2, describes the current understanding of the factors related to latent …

Evaluating The Effectiveness Of The Comprehensive Unit-Based Safety Program In Reducing Hospital-Acquired Infections, Peta Ann Anderson

Walden Dissertations and Doctoral Studies

This doctoral project is an evaluation of a quality improvement initiative that applied a mixed method approach to evaluate the impact of the Comprehensive Unit-based Safety Program (CUSP) on hand hygiene (HH) compliance and healthcare-associated infection rates. The project was conducted in the United States of America (USA), Florida in an acute care hospital. The practice problem addressed was the persistent low adherence to HH protocols among healthcare staff, a critical issue in nursing practice due to its direct link to preventable patient harm. Quantitative data demonstrated a substantial reduction in infection rates following the implementation of the CUSP program. …

Preventing Hospital-Acquired Pneumonia In Non-Ventilated Oncology Patients, Carmi Villanueva

Master's Projects and Capstones

Problem - Hospital Acquired Pneumonia (HAP) remains the leading cause of death among hospital-acquired infections, underscoring the need for effective prevention strategies. Between October 2023-2024, six HAP infections occurred in non-ventilated oncology patients. A routine audit revealed zero adherence to the existing evidenced based ROUTE “bundle” to prevent HAP. ROUTE indicates Respiratory care (R), Oral Care (O), Up in bed (U), Tube care (T), Education (E).

Context – In a 325-bed hospital in Northern California, a 26-bed telemetry/oncology microsystem serves a mixed population including immunocompromised, non-ventilated oncology patients at higher risk for developing HAP. A quality improvement project was initiated …

Improving Icu Decolonization Compliance Among Nursing Staff, Sarah J. Moore

Student Scholarly Projects

Practice Problem: Hospital acquired infections (HAIs) burden patients and health care organizations by influencing extended hospital stays, increasing mortality risk, and increasing healthcare spending.

PICOT: The Doctor of Nursing Practice (DNP) Scholarly Project was guided by the PICOT question: In ICU nursing staff (P), how does the implementation of a standardized process with visual reminders and checklists (I) compared to no reminders or checklists (C) impact compliance with the decolonization protocol for HAI reduction (O) over four weeks?

Evidence: A review of evidence-based literature demonstrated efficacy in the reduction of HAIs through once daily bathing with 2% chlorhexidine gluconate (CHG) …

Correlation Between Family Support And Depression Among Pre-Elderly Individuals With Hiv In Jakarta, Gracella Tanjaya, Surilena Surilena, Nicholas Hardi, Eva Suryani

Jurnal Keperawatan Indonesia

Depression among pre-elderly with human immunodeficiency virus (HIV) can significantly impact their quality of life. Family is often the primary source of support for this demographic and is recognized as a protective factor against depression. Therefore, identifying protective factors against depression is essential for promoting healthy aging among pre-elderly with HIV. This study aimed to determine the correlation between family support and depression among pre- elderly with HIV in Jakarta. A total of 120 pre-elderly with HIV from the Indonesia AIDS Coalition who were receiving HIV care at health centers across Jakarta participated in this cross-sectional study. The participants were …