Digital Commons Network^™

Optimizing Compression In Venous Leg Ulcers To Improve Wound Healing Rates Through Wound Care Nurse Support: A Quality Improvement Project, Temilola Obisesan

DNP Scholarly Projects

BACKGROUND: Venous leg ulcers (VLUs) are the most common lower extremity ulcers, accounting for 75% of chronic leg wounds and affect up to 2% of the population in developing countries. Generally, it has a 1-year recurrence rate of 40-70%. VLUs costs about $11B in the USA and other developed countries annually. Patients with VLUs spend about $7,000 more annually. Compression therapy along with local wound care is the best approach for VLU management, with compression therapy as the gold standard. Currently, compression therapy is underutilized in VLU care. The goal of this QI project is to provide wound nurses who …

Feeding With Competence: Empowering Parents In Ng Feeding For Nicu Graduates: A Quality Improvement Project, Karen Marsh

DNP Scholarly Projects

Abstract

Background: Infants who are born prematurely stay in a neonatal intensive care unit (NICU) until they are able to take full enteral nutrition by mouth. While in the NICU a nasogastric tube (NG tube) would be used to supplement the volume needed to be ingested for optimal nutrition. Infants typically feed better with a consistent caregiver and at home in an environment with less stimulation. Allowing infants to be discharged with an NG tube allows the parents to be more involved in their infant's care with a shorter hospital stay. An increased number of infants being discharged home with …

A Quality Improvement Project To Enhance Chronic-Condition And Self-Care Knowledge In Adolescents With Spina Bifida, Ann Paris

DNP Scholarly Projects

Background: Spina Bifida is the most common central nervous system disorder in the United States (CDC, 2024). Even with early surgical repair, patients may have chronic, disabling, multisystem needs (Phillips et al., 2017). Adequate care of Spina Bifida requires a multidisciplinary approach. As such, patients with spina bifida require multiple specialty providers, clinic appointments, care-tasks, and interventions (CDC, 2024, Phillips, et al., 2017). Synthesizing information from multiple care providers can be daunting, especially for adolescents as they grow more autonomous in their care, and especially as they enter the age of pediatric-to-adult transition (Psihogios et al., 2015).

Purpose: …

Advance Care Planning Utilization Among Non-White Individuals With Heart Disease And Cancer Using Health Retirement Study (Hrs) Data, Trizah M. Njoroge

Nursing Dissertations - Archive

Advance Care Planning (ACP) is a critical component of patient-centered care, yet its utilization remains disproportionately low among Non-White populations in the United States, particularly among individuals with chronic illnesses such as heart disease and cancer. This article explores racial disparities in ACP engagement using secondary analysis of the 2018 and 2020 waves data from the Health and Retirement Study (HRS), guided by Bandura’s self-efficacy theory (SET). The study examines how race, disease type, comorbidity, and survey year predict ACP service utilization, defined as completing five key ACP components: a legal will, a medical care discussion, surrogate assignment (DPOA), a …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …

Improving Glucose Levels In Adults With Type 2 Diabetes, Kaitlin Castillo

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Type 2 diabetes is a growing health crisis, posing significant challenges not only to individual well-being but also to healthcare systems' financial sustainability. The prevalence of type 2 diabetes continues to rise annually, contributing to increased medical costs, hospitalizations, and long-term complications. Houston, Texas, has a diabetes prevalence of 13.5%, exceeding the national average of 10%. A clinical gap exists in providers’ ability to prevent and manage type 2 diabetes. Prioritizing prevention, early intervention, and improved patient monitoring can reduce incidence rates, lower healthcare costs, and enhance overall population health. A Plan Do Study Act model was utilized for the …

Reducing Stress Related To Injection Therapy: A Zen Bundle Approach, Valoree Bowen

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Needle fear and stress are common barriers preventing adults from seeking necessary medical treatments, including intramuscular (IM) injection therapy. Research highlights the need for evidence-based interventions to mitigate this fear and improve patient experience.

Objective: This evidence-based pilot project included a Zen Bundle—an intervention incorporating shared decision-making, aromatherapy, and distraction—to evaluate the impact on stress reduction and patient satisfaction in a retail vitamin shop in North Texas.

Methods: The project utilized a pre-and post-intervention design over eight weeks. Participants completed pre-surveys assessing stress levels using a Visual Analog Scale before choosing an intervention (aromatherapy, distraction, or both) during IM …

Management Of Obesity In Adults 18 And Older, Donna Callicoat

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Obesity is a significant public health concern in the United States, with increasing prevalence and substantial healthcare costs. Despite evidence-based guidelines for obesity management, primary care clinics often fail to implement them effectively, leading to missed opportunities in preventing obesity-related comorbidities such as cardiovascular disease, type 2 diabetes, and certain cancers.

Purpose: This evidence-based project aimed to implement the American Heart Association/American College of Cardiology/Obesity Society (AHA/ACC/TOS) obesity guidelines in a rural Texas primary care clinic. The goal was to assess the effectiveness of these guidelines in reducing weight, body mass index (BMI), and waist circumference among adults with …

Multidisciplinary Approach To Reduce The Heart Failure Readmission Rate, Nisha Thekkedam

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States, 6.7 million adults have been diagnosed with heart failure (HF), a number projected to rise to 8.5 million by 2030. National data indicate a 30-day readmission rate of 18.2% among HF patients from 2010 to 2017. In Texas, around 12% of the Medicare population in Texas, and specifically 11% of the Medicare population in North Texas County, have been treated for HF. A North Texas hospital reports an 18-20% HF readmission rate over the past several years. Purpose: This EBP project included the implementation of a care bundle using the Dutch Heart Failure …

Evidence-Based Discharge Bundle To Reduce Heart Failure Readmissions, Chelsea Zepeda

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Heart failure (HF) affects over 6.7 million adults in the United States, resulting in frequent hospitalizations and readmissions, increased mortality, and billions of dollars spent annually on healthcare costs. Reducing readmission rates is a priority for the healthcare industry.

Objective: This evidence-based practice project aimed to reduce HF readmission rates through a bundled approach to address socioeconomic factors that place patients at higher risk for readmission, provide patient-centered education for HF management at home, and provide follow-up phone calls after discharge to assess patient symptoms.

Methods: English-speaking patients, aged 65 or older, with any active diagnosis of HF were …

Implementing The Gad-7 Screening Tool In An Adult Outpatient Psychiatric Clinic, Elizabath George

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Anxiety disorders are among the leading causes of disability worldwide and the most prevalent mental illness in the United States. Despite affecting 6.8 million adults annually, fewer than half with Generalized Anxiety Disorder (GAD) receive treatment. Many patients present with somatic complaints, leading to underdetection. Standardized screening tools such as the Generalized Anxiety Disorder-7 item (GAD-7) can improve identification and outcomes.

Purpose: This quality improvement (QI) project implemented the GAD-7 screening tool in an adult outpatient psychiatric clinic in North Texas and evaluated its impact on identifying patients with GAD, compared to the prior year without structured screening. …

Recognizing And Responding To Moral Distress: Using Transformational Leadership To Increase Nurse Leader Thriving, Miriam Dowling-Schmitt

DNP Scholarly Projects

Background: Moral distress, burnout, and compassion fatigue in acute care nurses has increased significantly since the Covid-19 pandemic and has been associated with high levels of nursing turnover and increased costs to healthcare systems. Nurse leaders at the study organization had never received education on recognizing and responding to moral distress. Nursing engagement scores were low at the study organization in the areas of leadership support and well-being investment in nurses.

Problem Description: Between 2017 and 2021 job satisfaction for nurses with direct patient care responsibilities decreased in 20 of 21 categories according to the Bureau of Health Workforce. High …

Diabetes Device Knowledge And Confidence Among School Nurses: A Mixed Methods Study, Cassandra F. Moffitt

Nursing Theses and Dissertations

Problem: Type 1 diabetes is one of the most common chronic medical conditions in childhood. While manageable, these children may spend half of their day in the school setting and often need assistance from a school nurse to manage their care.

Theory: Bandura’s Social Cognitive Theory (1977) served as the theoretical framework for this study.

Research Questions: The research questions explored knowledge, confidence, and additional predictors of confidence related to diabetes devices.

Design/Methods: An explanatory sequential mixed methods design was used. The Diabetes Device Confidence Scale (DDCS) was used to measure device confidence, while Subscale 10 of the KAT-1 instrument …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

Implementation Of The Novel Nurse Intuition Patient Deterioration Scale To Assess For A Correlation Among Nurse Intuition And Patients Returning To The Intensive Care Unit, Janie L. Walsh

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: Adult hospitalized medical and surgical patients at an academic medical center are being transferred out of the Intensive Care Unit (ICU) to the step-down floor and having rapid response calls in less than 48 hours after the transfer. Nurse intuition is not a consideration in the decision to transfer a patient. Physiological variables such as Modified Early Warning Scores (MEWS) and vital signs are relied on heavily as indicators for escalation or de-escalation of care. There is evidence supporting the use of acknowledging nurse intuition to better predict a patient’s readiness for transitions of care.

Purpose: To evaluate the …

Child And Family Centred Care: A Three-Phased Principle-Based Concept Analysis, Maggie Zgambo, Julie Blamires, Mandie Foster, Mohammad Al-Motlaq, Therese A. O'Sullivan, Davina Houghton, Evalotte Mörelius

Research outputs 2022 to 2026

Introduction: Despite a growing multidisciplinary interest in the Child and Family Centred Care approach, its meaning remains unclear in extant literature. It is, therefore, crucial to explore, analyse, describe, and clarify the concept of the Child and Family Centred Care approach and its associated terms. Method: A three-phased principle-based concept analysis approach was used to analyse the concept of Child and Family Centred Care. A systematic search of literature was completed using the CINAHL, PsycINFO, Medline, Scopus, and Web of Science databases. Peer-reviewed articles on Child and Family Centred Care, published from inception to 2023 were included if they were …

Determining Space Requirements For Small And Sick Newborns And Their Mothers In Health Facilities: A Systematic Review, Natalie Strobel, Georgia Whisson, Derek Swe, Rajesh Mehta, Amy Budrikis, Karen Edmond

Research outputs 2022 to 2026

Background There are currently no World Health Organization and United Nations Children Fund benchmarks or ‘norms’ for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Specifically, there is limited evidence on optimal bed space requirements in SSN units such as special care nurseries and neonatal intensive care units (NICUs). Through this systematic review, we aimed to gather evidence on the optimal space requirements needed for SSNs and their mothers in health facilities, particularly at level 2 district hospitals. Methods We included simulation, experimental, and observational studies, as well as guidelines …

Determinants Of Short Interpregnancy Intervals In High-Income Countries: A Systematic Review, J. Dunne, D. Foo, J. Jancey, G. Pereira, B. Kefale, D. G. Belay, G. Dhamrait, A. T. Gebremedhin, K. B. Mruts, S. D. Nyadanu, A. Roy, G. A. Tessema

Research outputs 2022 to 2026

Short interpregnancy intervals (IPIs) of <6–18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.

Of Scents And Cytokines: How Olfactory And Food Aversions Relate To Nausea And Immunomodulation In Early Pregnancy, Dayoon Kwon, Daniel M.T. Fessler, Delaney A. Knorr, Kyle S. Wiley, Julie Sartori, David A. Coall, Molly M. Fox

Research outputs 2022 to 2026

Background: During pregnancy, the maternal body undergoes extensive physiological adaptations to support embryonic growth, including whole-body remodeling, that may induce odor and food aversions, as well as nausea and vomiting. The biological mechanisms behind odor and food aversions, as well as nausea and vomiting in early pregnancy, remain largely unexplored. Our study investigated associations between these changes and cytokine profiles during pregnancy. Methodology: A cohort of pregnant Latina women in Southern California (n = 58) completed a structured questionnaire on pregnancy "morning sickness"-related symptoms and aversions. Maternal plasma cytokine levels were measured between 5 and 17 weeks' gestation. Results: About …

A Brief History Of Antenatal Colostrum Expression, And Where To From Here, Therese A. O’Sullivan, Connie N. Ihlein

Research outputs 2022 to 2026

The practice of antenatal colostrum expression (ACE), or the extraction of colostrum from the breasts during pregnancy, has an interesting history and continues to evolve. This narrative review aims to describe how perception and practices of ACE have changed over time, summarise the evidence on ACE in maternal and infant care, and highlight areas for future research. The literature demonstrates that ACE is safe for low-risk women when done from around 36 weeks’ gestation. Women should be reassured that the skill of hand expressing is a valuable tool post-birth, regardless of whether they are able to collect colostrum antenatally or …

Evaluation Of A Virtual Home Health Heart Failure Program: Mixed Methods Study, Nilufeur Mckay, Rosemary Saunders, Helene Metcalfe, Sue Robinson, Peter Palamara, Kellie Steer, Jeannie Yoo, Miles Ranogajec, Lisa Whitehead, Beverley Ewens

Research outputs 2022 to 2026

Background: Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing a significant burden on patients, families, and health care systems. Despite advancements in medical treatments, the gap in effective, continuous, and personalized supportive care remains glaringly evident. To address this pressing issue, virtual health care services delivered by interdisciplinary teams represent a promising solution. Understanding the outcomes and experience of remote monitoring–enabled interdisciplinary chronic disease management programs can inform resource allocation and health care policy decisions. Objective: The purpose of this study was to evaluate the clinical and behavioral outcomes of patients undertaking a Virtual Home …

Self-Determined Strategies For Physical Activity Motivation Among Women With Polycystic Ovary Syndrome, Pamela J. Wright Phd, Ms, Med, Rn, Cen, Cynthia Corbett Phd, Rn, Faan, Bernardine M. Pinto Phd, Fapa, Fsbm, Fabmr, Michael D. Wirth Msph, Phd, Face, Robin M. Dawson Phd, Rn, Cpnp-Pc

Publications

BACKGROUND: According to clinical practice guidelines for polycystic ovary syndrome, first-line treatment includes performing 150 min of moderate-to-vigorous physical activity on most days of the week plus at least 2 days of resistance training. However, < 40% of women with polycystic ovary syndrome engage in regular physical activity, and about 60% are sedentary. Research evidence supports theory-informed physical activity interventions to improve motivation for physical activity. This study examined the fit of a behavioral change theory for women with polycystic ovary syndrome. OBJECTIVES: The purposes of this qualitative study were to analyze physical activity barriers through the lens of self-determination theory and identify motivational strategies that may promote initiation and maintenance of physical activity among women with polycystic ovary syndrome. DESIGN: The study involved a qualitative, descriptive design using theory-driven thematic analysis. METHODS: After emailing a demographic questionnaire and Personal Health Questionnaire-8 to screen for depressive symptoms, participants (n = 7) met three times via Zoom during the summer of 2021. Meetings were audio-recorded, transcribed, and analyzed. RESULTS: Participants were aged 33.9 (±8.1) years, premenopausal, mostly White (71%), educated (100% with at least some college), employed full-time (86%), and married (86%) with a mean depressive symptoms score of 6.4 (±3.4) indicating mild depression. Strategies such as a buddy system, physician support, technology, and behavioral change techniques are necessary to meet the psychological needs of autonomy, competence, and relatedness among women with polycystic ovary syndrome to help increase exercise motivation. CONCLUSION: Findings supported the use of self-determination theory by emphasizing that the social context of polycystic ovary syndrome can undermine physical activity behavior. Thus, physical activity interventions should consider the social context, peer support system, and mental health status of women with polycystic ovary syndrome, and include tailored programs and motivational strategies to help meet the psychological needs of autonomy, competence, and relatedness.

Navigating “Being Seen”: Experiences Of Older Adult Arab Immigrants And Family Caregivers Accessing Health Care Services In Ontario, Selma Tobah, Lorie Donelle Phd, Rn, Fcan, Jodi Hall, Lloy Wylie, Sandra Regan

Publications

Immigrants to Canada face unique barriers to accessing health care including communication barriers, socioeconomic limitations, and a lack of health care system navigation knowledge. Arabs in particular face mainstream negative attitudes, propagated through political discourses as well as entertainment media. We sought to understand how older adult Arab immigrants and family caregivers accessed and experienced health care in Ontario. We conducted a critical constructivist grounded theory, using Charmaz’s approach to grounded theory. A critical constructivist grounded theory method asks not only “what” social processes are happening and “how” but also “why” and “who” benefits. Both older adult immigrant Arabs and …

The Association Between Implicit Bias From Healthcare Providers And Postpartum Depression Among Black Women., Chelsea T. Costa

Honors Undergraduate Theses

Postpartum depression is one of the most common issues that women face after birth. Many different factors can contribute to the development of postpartum depression, including perinatal complications, prenatal depression, or social factors. One of the social factors that Black women, specifically, face leading to postpartum depression is discrimination. The purpose of this literature review is to identify research that focuses on whether implicit bias and discrimination by healthcare providers contributes to postpartum depression among Black women. A literature review was conducted using databases including CINHAL Plus Text, CINHAL ULTIMATE, Medline, and APA Psycinfo, with terms that included “healthcare provider* …

Addressing Barriers In The Primary Prevention Of Hypertension In Black People, Makalah Pierre Rn Bsn

Honors Undergraduate Theses

Hypertension is a significant health concern among minority groups, and the black population is most at risk (Abrahamowicz et al., 2023). The black population experience higher prevalence rates of hypertension compared to other racial groups and are more likely to experience hypertension-related problems, including cardiovascular disease (CVD) and chronic kidney disease (CKD).  This literature review explores various nursing interventions aimed at preventing hypertension within this population. In this review, the term “black people or persons” is a broad term used to describe both African Americans and people of Afro-Caribbean decent. This includes various backgrounds such as Haitian, Jamaican, or otherwise …

Evaluating Coffee And Caffeine Intake In Adults With Cardiovascular Disease: A Comparative Literature Review, Adam Harrington

Honors Undergraduate Theses

Coffee is among the most commonly consumed beverages worldwide, and its bioactive components, including caffeine, affect the cardiovascular system through multiple physiological mechanisms. Patients with cardiovascular disease are typically advised to limit coffee and caffeine consumption because of potential cardiovascular harm, but emerging research challenges this recommendation. This review evaluates recent evidence regarding consumption of whole coffee, caffeine, or decaffeinated coffee in adults with established cardiovascular disease. Database searches conducted across three platforms for studies published after December 2021 yielded 360 records. Following screening against inclusion criteria, 11 studies were reviewed included in the final review. The studies showed variable …

Effect Of Implementing An Educational Program About Post Kidney Transplant Care On Critical Care Nurses' Knowledge, Marwa Abdo, Asmaa Ibrahim Aboseda

Nursing

Background: Critical care nurses (CCNs) play a pivotal role in post-kidney transplant care, necessitating a comprehensive understanding of transplantation procedures, complications, and patient management. So, any knowledge gaps among CCNs may impact the quality of care provide to kidney transplant program. Aim: This study aimed to assess the effect of implementing an educational program about post-kidney transplant care on critical care nurses’ knowledge. Methods: A quasi-experimental study was conducted among 50 critical care nurses. A structured educational program was implemented, and nurses’ knowledge was assessed pre- program, post- program, and three months follow-up. Data was collected using a kidney transplantation …

Examining The Best Dietary And Lifestyle Interventions To Prevent Hyperinsulinemia And Insulin Resistance In Women With Polycystic Ovarian Syndrome, Erica C. Morman

Honors Undergraduate Theses

Polycystic Ovarian Syndrome (PCOS) is a complex reproductive and metabolic disorder that affects up to 15% of women, contributing to insulin resistance, hyperinsulinemia, risk for developing type 2 diabetes. The interconnected hormonal and metabolic disruptions in PCOS create a feedback loop that exacerbates symptoms, making dietary and exercise interventions critical in its management. This literature review evaluates the efficacy of various dietary interventions including the ketogenic diet, high-protein diet, low-carbohydrate diet, and high-fiber diet, as well as exercise interventions such as high-intensity interval training (HIIT), resistance training, and moderate-intensity aerobic exercise. Results found that modifying carbohydrate intake, and increasing fiber …

The Effects Of Nurse-Led Physical Activity On The Aging Population, Kaitlyn P. Carruba

Honors Undergraduate Theses

The aging population in the United States is increasing in proportion, yet older adults' physical activity levels have not increased much. The lack of physical activity leads to numerous health complications, such as an increased risk for cardiovascular disease, increased risk for falls and fractures, as well as lead to obesity and diabetes. Unfortunately, few healthcare facilities monitor or audit physical activity. Older adults are frequently placed on fall risk precautions, which heavily encourages a sedentary hospital stay. This commonly leads to older adults with declining abilities to accomplish their activities of daily living (ADLs) after hospitalization. Nurses, spending the …

The Effects Of School-Based Menstruation Education Programs On Anxiety And Self-Efficacy In Adolescent Girls: A Systematic Review, Hannah C. Hart

Honors Undergraduate Theses

A significant global knowledge gap exists for adolescent girls regarding what constitutes a healthy menstrual cycle, proper menstrual hygiene practices, and the implications of reproductive maturity that is ushered in by menarche. This limited understanding can lead to poor health outcomes and the development of negative sentiments and beliefs surrounding the normal experience of menstruation.

This systematic review aims to comprehensively investigate the current state of research regarding the effects of school-based, formal menstruation education programs on adolescent girls, particularly the effects on anxiety and self-efficacy related to the management of menstruation. Furthermore, this work aims to take a stance …