Digital Commons Network^™

Holistic Approaches To Lyme Disease Symptom Management, Leah Van Antwerp

Honors Theses

Lyme disease is a multisystem tick-borne infection that can lead to long-lasting symptoms even after standard antibiotic therapy, with Lyme arthritis being one of the most common and persistent complications. Due to limited research on this issue, rheumatoid arthritis (RA) will be discussed as a reference for understanding treatment options because it is a similar condition. Since many people continue to experience debilitating pain and reduced quality of life after treatment for Lyme disease, holistic approaches have become increasingly popular for symptom management. This literature review examines three holistic modalities-yoga, acupuncture, and diet modifications- and their effectiveness in alleviating arthritic …

The Effect Of Community-Based Exercise For Individuals With Pre-Existing Health Conditions, Amy M. Stahl

Doctoral Dissertations and Projects

Physical inactivity is a growing problem for the health and wellbeing of the world’s population. Increases in physical activity may help to improve health outcomes for the general population of the United States. This study is two-fold and seeks to determine if community-based exercise groups are successful in improving the health of people with preexisting conditions and encouraging community members to adhere to an exercise program. A quasi-experimental 12-week comparison study consists of a control group of standard care and an intervention group that participates in a three-day a week community walking group. The purpose of the group is to …

Enhancing Alzheimer's Care: Impact Of Staff Education On Behavioral Outcomes, Laura Caton Rn

Nurse Residency

Would additional staff training and education in Alzheimer’s patient interactions compared to minimal/or no staff training and education in Alzheimer’s patient interactions lead to reduced behavioral events in bedside nursing?

Implementation Of The Modified Severity Assessment Scale (Msas) For Alcohol Withdrawal In An Inpatient Psychiatric Unit, Grace R. Lindsey

Doctor of Nursing Practice

Background: Alcohol withdrawal is a potentially life-threatening condition frequently seen in psychiatric inpatient settings, especially among individuals with co-occurring alcohol use disorder and mental illness. The Clinical Institute Withdrawal Assessment for Alcohol Scale-revised, while widely used, depends on patient self-report, making it less effective for individuals with altered mental status or psychosis.

Purpose: This quality improvement project implemented the Modified Severity Assessment Scale, an objective, observation-based alcohol withdrawal protocol, in an inpatient psychiatric setting to improve safety, treatment accuracy, and care standardization.

Objectives: The project focused on ensuring full staff adoption of the protocol, reducing intensive care unit transfers …

Impact Of Multimodal Analgesia In Comparison To Conventional Analgesia In Coronary Artery Bypass Graft Patient With Implementation Of An Enhanced Recovery After Surgery Order-Set, Rhoda Musyoka, Radhan Gopalani, Maura Falli, Maria Ruiz, Cathleen Charles, Yanija Zhang, Esty Trimino, Laura Dominguez Vasquez, Tom Nguyen

Nursing & Health Sciences Research Journal

Background: An Enhanced Recovery After Surgery (ERAS) pilot program was implemented for coronary artery bypass graft (CABG) procedures under a single cardiothoracic surgeon in May 2024 across two community hospitals. We assessed the impact of multimodal analgesia facilitated through the ERAS CABG order-set compared to the non-ERAS (conventional) CABG order-set.

Methods: This study was an Institutional Review Board-approved, multi-site, retrospective chart review of participants admitted to two community hospitals for a CABG procedure from June 2024 to January 2025. Participants who utilized the preand post-ERAS or the pre- and post-conventional CABG order-sets were included. The primary outcome was the opioid …

Breastfeeding Safety Following Maternal Anesthesia: A Guideline Development, Megan Honea, Mary Johnson

Doctoral Projects

Recommendations regarding breastfeeding following maternal anesthesia are inconsistent and often not up to date with current best practice guidelines. Previous recommendations have led to mothers unnecessarily “pumping and dumping” breast milk has benefits for both mother and baby. These benefits include (a) increasing the infant’s access to colostrum, (b) encouraging mother-baby bonding, (c) improving the mother’s breastfeeding experience, (d) and providing significant health benefits to the infant. The purpose of this scholarly project was to develop a set of evidence-based recommendations that focus on mothers who desire to breastfeed following general anesthesia. These recommendations will highlight maternal- fetal transfer of …

The Effect Of Exercise On The Development Of Gestational Diabetes Mellitus In Pregnancy: A Systematic Review Of Literature, Abigail Reiche

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this systematic review is to synthesize literature examining the relationship between using exercise as a preventative method for gestational diabetes development during pregnancy, and the effect it may have on lowering glycemic levels. Health Source: CINAHL and PubMed were systematically searched for peer-reviewed journal articles that studied pregnant women (P), and the relationship of consistent exercise (I), compared to no physical exercise (C), on lowering glycemic levels resulting in positive pregnancy outcomes (O), throughout gestation (T). Twenty articles were retrieved in accordance with the PICOT objectives. Additional criteria included only articles from 2019-2024 and articles that were …

From Awareness To Action: Improving Advanced Directives With The Five Wishes In College Aged Young Adults, Dina M. Giovanetti

Electronic Theses and Dissertations 2020 - Present

This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of …

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- …

A Scoping Review Of Maternal Active Smoking During Pregnancy And Low-Birth Weight, Naomi Sondang, Nindi Oktavia, Qorinah Estiningtyas Sakilah Adnani, Lani Gumilang, Hadi Susiarno, Victor Abiola Adepoju

Journal of Asian Midwives (JAM)

Background: Low-birth weight (LBW; < 2.5 kg) infants are at increased risk of early mortality, impaired growth, neuro-developmental delay and chronic disease later in life. Maternal behavior, especially cigarette smoking, remains one of the most modifiable determinants of birth weight. We therefore synthesized recent evidence on the association between active maternal smoking during pregnancy and LBW.
Methods: Following PRISMA guidance, we systematically searched PubMed, Scopus and ScienceDirect for the period January 2020 to 31 January 2025 for English-language observational studies that quantified the relationship between active prenatal smoking and LBW. Risk of bias was appraised, and findings were summarized narratively.
Results: In total 26,650 papers were found and eight eligible studies (four cohort, three cross-sectional, one case-control) from Asia, Europe and the Middle East were included. Across all designs and exposure metrics—self-report, exhaled carbon-monoxide, urinary cotinine, and cord-blood DNA-methylation, active smoking was consistently associated with …

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 …

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …

Lived Experiences Of Chemotherapy-Induced Nausea And Vomiting Among Patients Diagnosed With Cancer At Machakos Level Five Hospital, Nancy Njeri Kamau

MSc in Advanced Practice Nursing

Background: Chemotherapy-induced nausea and vomiting (CINV) remains one of the most prevalent and distressing adverse effects of cancer treatment, affecting a substantial proportion of patients and significantly compromising their physical functioning, nutritional status, treatment adherence, and overall quality of life. However, there is a paucity of localized evidence on the magnitude and functional burden of CINV among patients diagnosed with cancer receiving chemotherapy at county referral hospitals, such as Machakos Level 5 Hospital, hence the current study.

Aim of the study: The study aimed at exploring the lived experiences of chemotherapy induced nausea and vomiting among patients diagnosed with …

Augmenting Large Language Models To Predict Social Determinants Of Mental Health In Opioid Use Disorder Using Patient Clinical Notes, Madhavi Pagare, Deva Sai Kumar Bheesetti, Inyene E. Essien-Aleksi, Mohammad Arif Ul Alam

Health Sciences Faculty Publications

Objective

Identifying social determinants of mental health (SDOMH) in patients with opioid use disorder (OUD) is crucial for estimating risk and enabling early intervention. Extracting such data from unstructured clinical notes is challenging due to annotation complexity and requires advanced natural language processing (NLP) techniques. We propose the Human-in-the-Loop Large Language Model Interaction for Annotation (HLLIA) framework, combined with a Multilevel Hierarchical Clinical-Longformer Embedding (MHCLE) algorithm, to annotate and predict SDOMH variables. Materials and Methods

We utilized 2636 annotated discharge summaries from the Medical Information Mart for Intensive Care (MIMIC-IV) dataset. High-quality annotations were ensured via a human-in-the-loop approach, refined …

Congolese Mothers' Beliefs That Influence Health-Seeking Behaviors For Their Infants., Shawn Meiman

Electronic Theses and Dissertations

In 2024, approximately 100,000 refugees were admitted to the United States, with 20% coming from the DRC, while Kentucky continues to rank fourth in the country for refugee resettlement. The increasing number of Congolese refugee children in the United States and Kentucky necessitates a greater understanding of these beliefs and practices to ensure equitable, quality, and culturally informed health services. The purpose of this study was to explore Congolese refugee mothers’ culturally and socially situated beliefs, perceptions, practices, and resources related to health care that may influence their views and practices of preventive well-child health care for their infants in …

The Kangaroo Care Project: Implementation Of Skin-To-Skin (Sts) In Sutter Medical Center, Sacramento, Neonatal Intensive Care Unit, Bianca Wong, Katherine Do, Martha Calero, Lydia Nambala

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: Skin-to-skin contact, also known as kangaroo care or kangaroo mother care, is an intervention typically done after birth to promote physiologic stability, bonding, and breastfeeding.

Aim: The Kangaroo Care project aimed to increase the incidence of skin-to-skin contact in the neonatal intensive care unit at Sutter Medical Center, Sacramento.

Methods: A pre-survey was conducted to assess staff comfort with skin to skin. Interventions to increase skin-to-skin rates included staff e-learning, unplanned extubation mock codes, nurse champions, and a policy change to Sutter Medical Center, Sacramento’s handbook.

Results: TBD. Preliminary results indicated use of STS in the NICU and post-results …

Staying Ahead Of The Pressure: A Multimodal Intensive Care Unit Hospital-Acquired Pressure Injury Quality Improvement Project At Sutter Medical Center, Sacramento, Mijung Lim, Daniela Tobler, Raquel Youkhana

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Background: Hospital-acquired pressure injuries (HAPIs) are a major quality and safety concern, particularly in the intensive care units (ICUs) where critically ill and immobile patients face elevated risk. At Sutter Medical Center Sacramento (SMCS), nine confirmed HAPIs and two under investigation were reported within the medical ICU, cardiac ICU, and neurosurgical ICU by May 2025, exceeding the hospital’s target and prompting a system-wide quality improvement initiative.

Aim: The aim of this project was to: (a) reduce ICU-acquired HAPIs to fewer than four cases per quarter by December 2025 and (b) increase nursing compliance with early and ongoing prevention strategies, including …

Promoting Self-Reflection And Implicit Bias Awareness In Nursing: A Mixed-Method Study Advancing Practice And Fostering Healthcare Equality, Diane S. Kramer, Victoria Y. Mccue, Anshul Saxena, Jeanette B. Deniz, Nicole Burks, Patricia Russell

Nursing & Health Sciences Research Journal

Background: Implicit biases influence how nurses perceive and interact with patients and shape clinical practice. Awareness is crucial because implicit biases are difficult to detect. Our study evaluated how educational sessions impacted awareness and understanding of implicit bias. In our study, we sought to mitigate effects of these biases on patient care to promote equitable healthcare outcomes.

Methods: The research involved registered nurses from all levels employed at nine hospitals. Data were collected anonymously through voluntary participation to ensure confidentiality. A mixed-methods approach with a quasi-experimental prepost design was utilized to measure the effectiveness of the educational session. Descriptive statistics …

Promoting Healthy Diet Adherence Using A Multisensory Approach For Post-Stroke Patients: A Pilot Randomized Controlled Trial, Stacey Myers, Yuki Asakura Strempek, Sarah Kaster, Clare Hall

Nursing & Health Sciences Research Journal

Introduction: Evidence supports a healthy diet for secondary stroke prevention; however, programs to implement nutrition education remain inconsistent. This study assessed the feasibility and efficacy of using a multisensory approach called the “Hands-on Training” program (HOT) to improve healthy diet adherence among patients rehabilitating after stroke.

Methods: This pilot randomized controlled study was conducted at an inpatient rehabilitation facility. Stroke patients were randomly assigned to either an experimental group who received HOT or a control group who received conventional education. The HOT group received real-time meal choice coaching, a healthy meal preparation experience, and additional written education. The Mediterranean Eating …

Retrospectively Examining The Probability Of Acute Skin Failure Among Hospitalized Patients With Hospital-Acquired Pressure Injuries, Tori C. Hatch, Jeanine M. Salamone, Pierna F. Vaughner, Natalie Bermudez

Nursing & Health Sciences Research Journal

Introduction: Acute skin failure (ASF) in hospitalized patients is a growing concern and a product of multisystem organ failure. Unlike hospital-acquired pressure injuries (HAPIs), ASF is not preventable despite prevention measures. The Skin Failure Clinical Indicator Scale (SFCIS) was recently developed to assess the probability of ASF. The purpose of this study was to retrospectively examine the probability of and factors associated with ASF in hospitalized individuals with HAPIs.

Methods: Data were collected from the electronic health records of in-patients with stage 3 or greater HAPIs over two years. Collection included demographics, comorbidities, COVID status, wound staging, injury location, SFCIS, …

Glp-1 Medications For Kids: Do They Work, And At What Price?, Sylvia Peña, Marilyn Frenn

College of Nursing Faculty Research and Publications

Context

Childhood obesity continues to increase along with the numbers of children with severe obesity and related comorbidities. This meta-analysis1 sought to determine whether or not glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications are safe and effective for children and adolescents.

Methods

Appropriate search and abstraction approaches were used in the meta-analysis of randomised controlled trials making it the highest level of evidence. Included studies were those with participants younger than 18 years with obesity, overweight, pre-diabetes or type 2 diabetes (T2D) assessing GLP-1 RAs alone or with lifestyle modification versus placebo published between 2023 and 2025. Most participants …

Effectiveness Of Intradialytic Resistance Training On Muscle Mass And Strength In Patients On Hemodialysis, Sandra Vasquien, I Ketut Swarjana, A.A.A. Yuliati Darmini, I Nyoman Arya Maha Putra

Jurnal Keperawatan Indonesia

Hemodialysis (HD) patients with chronic kidney disease (CKD) lose muscle mass and strength due to protein energy wasting (PEW). The purpose of this study was to test the effectiveness of intradialytic resistance training (IRT) in increasing muscle mass and strength. It used a pre-experimental, one-group pretest-posttest design. Based on a sample size estimate using G*power software, 33 CKD patients undergoing HD at a private hospital in Bali were included. The patients were selected using purposive sampling. Muscle mass was measured using Bioelectrical Impedance Analysis (BIA), while muscle strength was measured using the Medical Research Council Muscle Scale. The Wilcoxon test …

Exploring Recruitment Strategies For Place-Based Research In Rural Areas Of Australia: A Comparative Case Study Analysis, Tracy L. Schumacher, Anna K. Jansson, Lucy Kocanda, Jennifer May Phd, Rn, Anp-Bc, Leanne J. Brown, Clare E. Collins

Publications

BACKGROUND: Recruitment of participants into research studies is commonly challenging and becomes more difficult when targeting underrepresented population groups. Recruiting individuals living in rural locations, must use appropriate strategies if the sample size is to be achieved. The aim of this case study was to explore factors associated with research capacity, and to determine their impact on recruitment strategies, including timeframe and participant recruitment outcomes.

METHODS: This case study investigated the recruitment outcomes of four rurally based research projects performed between 2016-2024. Participants were enrolled either directly by the researchers (face-to-face method [f2f]), or through General Practitioners as trusted local …

Munch N’ Learn: Building Competence And Confidence In Pediatric Hematology Oncology Nurses, Shareta N. Jackson, Jaime N. Gebhard

2025

INNOVATION & LEADERSHIP

Background: As clinical nurse educators, we have observed a significant gap in continuing education opportunities for experienced nurses, particularly in the wake of the COVID-19 pandemic. Lifelong learning is essential for enhancing personal development and professional responsibility, enabling nurses to stay updated with evolving medical practices and improve patient care. The COVID-19 pandemic shifted nursing education priorities toward onboarding new hires and graduate nurses, leaving experienced nurses with limited continuing education opportunities. This gap has created a need for educational programs that cater specifically to the needs of seasoned nurses, helping them stay current with evolving …

Importance Of Expressed Breast Milk Verification And Patient Identification, Deb Lathrop

2025

QUALITY IMPROVEMENT

Background: Due to changes in Texas reimbursement, the Plano campus was transferring neonates, infants under 28 days of life, to the Dallas campus. It was decided in 2023 to obtain a neonatal designation for the Plano campus. A Program Manager was hired as part of the requirements and a quality and Patient Safety committee was formed. As part of the program, quality data collection was required. As a Level I designated facility, expressed breastmilk verification was one of the required data sets to be collected. It was discovered that staff at the Plano campus were not scanning …

The National Landscape On Wellness Culture And Well-Being Best Practices In Healthcare Systems And Academic Institutions: Results From The Fourth National Summit On Promoting Clinician Well-Being, Megan Amaya, Bernadette Mazurek-Melnyk, Josh Winn, Jeff Messinger

Journal of Wellness

Introduction: The health of our nation’s healthcare workforce continues to decline. A comprehensive, whole-system, evidence-based approach is key to a successful wellness initiative and is the foundation for culture change. Building a culture of wellness leads to better mental health outcomes, healthier lifestyle behaviors, higher levels of engagement and job satisfaction, improved patient satisfaction and employee retention, and a positive return (ROI) and value on investment (VOI).

Methods: The purpose of this cross-sectional, descriptive, anonymous survey was to assess the organizational wellness culture of participants who attended the National Summit on Promoting Well-being and Resilience in Healthcare Professionals. …

Introducing The Catch Phrase "Don't Leave Your Patient In S.H.A.M.B.L.E.S" To Reduce The Incidence Of Hapis In Imcu, Angelica Taneca, Bsn, Rn, Pccn, Rebeca Zamora, Bsn, Rn, Pccn

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Norms For Scaling Up Small And Sick Newborn Care: An Overview Of Reviews, Natalie A. Strobel, Georgia Whisson, Derek Swe, Amy Budrikis, Karen M. Edmond

Research outputs 2022 to 2026

Background: The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) currently have no benchmarks or 'norms' for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Our objective was to understand which systematic reviews had addressed the following norms in the last five years: number of SSN beds per live births in a district or similar administrative unit (admission beds); space requirements for SSN units, including mother-infant dyads (space); health workforce ratios in SSN units (workforce); and travel time to health facilities with SSN units (travel time). Methods: …

Staff Education Workshop Focusing On Enhancing Nurse Knowledge And Adherence To The Time (Tissue, Infection/Inflammation, Moisture, Edge) Framework To Improve The Quality Of Wound Assessment And Care, Ijeoma G. Onyejiji

Walden Dissertations and Doctoral Studies

This staff educational project focused on implementing training on the tissue, infection/inflammation, moisture, edge (TIME) framework to address gaps in nurses’ knowledge and improve adherence to the TIME framework during wound assessment. Current evidence shows inconsistent use of standardized wound assessment among nurses, which can lead to inappropriate treatment, delayed wound healing, increased infection risk, and higher healthcare utilization. This project’s question sought to assess whether implementing a staff education workshop focusing on the TIME framework would enhance nurse knowledge and adherence to the TIME framework. Six nurses participated in the training. Pre/post questionnaires were used to evaluate knowledge before …

Nursing Students As Advocates: Addressing Social Determinants Of Health Through Service-Learning, Rebekah Mullins

Nursing Theses and Dissertations

Advocacy is at the heart of nursing practice, and advocating for the social determinants of health (SDOH) is crucial when providing care to patients from vulnerable populations. Service-learning is a strategy that can be used to teach students advocacy skills. Chapter 2 of this dissertation portfolio presents a concept analysis that explores the definition of advocacy using the Walker and Avant method (2019). The concept analysis informed the development of the case study presented in Chapter 3 and the research study presented in Chapter 4. The portfolio includes original, qualitative research that was guided by the interpretive descriptive method. The …