Digital Commons Network^™

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …

Implementation Of A Standardized Acute Care Plan For Complex Care Medicine Service Patients: A Quality Improvement Initiative, Tracy Markwell

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Care transition plans, locally called Acute Care Plans (ACPs), are created specifically for super utilizers of the Complex Care Medicine Service (CCMS) and are a target for improvement. The purpose of this project was to improve care for CCMS patients by developing, implementing, and evaluating a standardized CCMS ACP. A multidisciplinary approach was chosen to facilitate the transitions of care process during an admission or discharge from the hospital.

LOCAL PROBLEM: The purpose of the ACP is to get a quick summary of how to treat a patient when they come to the hospital. The ACPs are …

Assessing Medical Adherence In A Volunteer Community Health Clinic, Jessica Clark, Matthew Anderson, Janelle L. B. Macintosh, Corinna Trujillo Tanner, Kristen Erekson

Student Works

Purpose: The purpose of this project was to identify the rates of and reasons for nonadherence in medical follow-up care among patients who utilize the Volunteer Care Clinic (VCC).

Background: The VCC is a free outpatient care center for acute medical conditions. The VCC serves uninsured, low socioeconomic residents of Utah County, and many of the patients who come to the clinic primarily speak Spanish. The director of the VCC expressed concern that patients who were assigned medical follow-up care to complete after their visit were not completing these assignments. Nonadherence is associated with increased costs, more hospitalizations, and worse …

Non-Cognitive Factors Influencing The Development Of Clinical Judgment In Undergraduate Nursing Students, Kathryn Robinson

Graduate Theses, Dissertations, and Capstones

A nurse’s ability to form sound clinical judgments is directly related to safe patient outcomes. Pre-licensure nursing programs are focused on developing students’ clinical judgment ability; however, an academic-practice gap continues to exist. The Implicit Theory of Intelligence and Achievement Goal Theory provide insight into how mindset beliefs and goal orientation impact the teaching and learning environment. The performance goal orientation, ineffective learning strategies, and avoidance of challenging tasks associated with a fixed mindset may negatively impact the development of clinical judgment. This exploratory study sought to determine if there is a relationship between the non-cognitive factors, mindset beliefs and …

Educating Nurses On The Components Of A Healthy Work Environment, Kathryn L. Scott

Doctoral Dissertations and Projects

It is essential to look at the entire picture to ensure patient care is offered in the highest quality manner possible. One must look at patient satisfaction, quality outcomes, and job satisfaction experienced by the nursing staff providing care to accomplish this goal. Research has shown that nurse burnout has increased exponentially as of late. Some blame the COVID-19 pandemic; others look at the generation of nurses graduating from nursing school and starting in the field, comparing the baby boomer nurse to the Gen Z nurse. Many factors are involved, and with the recent addition of paying particular attention to …

Examining The Effects Of An Isbarr Educational Intervention On Self-Efficacy Of Senior-Level Nursing Students Within A Transition To Practice Course: A Quasi-Experimental Study, Stacy Nicole Taylor

Doctoral Dissertations and Projects

The purpose of this study was to examine the effects of an introduction, situation, background, assessment, requests/recommendations, and repeatback/readback (ISBARR) educational intervention on self-efficacy of senior-level nursing students' within a Transition to Practice course at one Christian university in the southeast United States. The theoretical framework utilized in this study was Bandura's theory of self-efficacy. This study was a quasi-experimental design with a control and intervention group. The control group was in the Fall 2023 semester, and the intervention group was in the Spring 2024 semester. Each participant completed a pre-test and post-test, which was the New Generalized Self-Efficacy Scale. …

Improving Use Of Water Immersion And Birth Satisfaction During The First Stage Of Labor Through An Educational Handout, Dana E. Taylor

Doctoral Dissertations and Projects

Although using the birthing tub for hydrotherapy during the first stage of labor has been proven to be a safe and effective method of low-intervention pain management, as well as research that indicates potential other benefits such as a reduction in the use of an epidural, improvement in breastfeeding rates, and promotion of physiologic birth, its use is often limited. Chief reasons for the lack of its use include difficulty and time constraints with tub set-up and lack of knowledge about its benefits, especially the length of time used. A quasi-experimental evidence-based project at a suburban magnet-designated hospital using a …

Anticoagulation Stewardship Initiative For The Outpatient Management Of Atrial Fibrillation, Ryleigh Hawker

Doctoral Dissertations and Projects

Anticoagulation prescribing for patients with atrial fibrillation at a local primary care and urgent care office has largely been conservative and unstandardized, leaving patients at risk for cardioembolic strokes. As more and more patients are diagnosed with this condition, the greater the need becomes for appropriate management within these settings. This includes preventing strokes with anticoagulation and utilizing an integrative or collaborative approach between specialty and non-specialty centers. The Anticoagulation Stewardship Initiative is the first step in promoting effective and safe anticoagulation practices in primary and urgent care centers, while simultaneously streamlining care for newly diagnosed patients. Some of the …

The Price We Pay: An Integrative Review Exploring The Effects Of Wellness Culture On Nurse Burnout Rates, Rebekah Lillian Vance

Doctoral Dissertations and Projects

The purpose of this integrative review is to identify cultural factors contributing to nurse burnout and to explore the strategies and effectiveness of wellness culture and cultural changes on nurse burnout rates. Nurse burnout has been attributed to a myriad of factors and has been identified in nursing since the 1970s. While other professions with similar burnout issues have investigated and implemented culture-wide changes to address burnout, nursing has remained stagnant in the field of burnout research, often applying single interventions that fall short of creating significant, lasting change. An integrative review of nursing, peer-reviewed literature was conducted in an …

Provider Implementation Of Probiotics As An Adjuvant Treatment Modality For Patients With Anxiety And Or Depression In A Primary Care Setting, Sarah Dedmon

Doctoral Dissertations and Projects

The prevalence of anxiety and depression among Americans is growing rapidly. Patients are seeking out traditional treatments as offered by their primary care providers, but also frequently look toward integrative or complementary methods of managing their symptoms. The use of dietary supplements is at an all-time high, yet the U.S. Food and Drug Administration does not regulate these substances for potency and purity or evaluate them using quality standards as it does pharmaceuticals. Most providers lack education regarding the physiological interaction their patients may experience when using these substances and are naïve to their place in primary care medicine. The …

The Effects Of An Emotional Intelligence And Empathy Interactive Education Program With Prelicensure Nursing Students, Karen Browne

Doctoral Dissertations and Projects

A dissertation is presented on a teaching program for emotional intelligence (EI) and empathy with a cohort of nursing students enrolled in a traditional, undergraduate nursing college in the Northeast region of the United States (US). An interactive teaching program was used with various media to present new material and learning activities during the spring semester. The importance of teaching nursing students the aspects of EI was to prepare them for the rigors of the profession by allowing them to delve into their own self-awareness and emotional regulation, which in turn helps to connect with patients in a more robust …

Health Policy: Food Allergy Restaurant Education Law, Joanna Ko

Doctor of Nursing Practice Projects

Food allergies are a rising public health concern with no indication of deceleration. The purpose of this Doctor of Nursing Practice (DNP) project is to enact an Arkansas state law to protect the food allergy community in dining out at restaurants to increase quality of life and decrease adverse allergic reactions. The current Arkansas state legislation for restaurant food allergy employee training is absent and action needs to be taken to safeguard the food allergy community from life-threatening reactions. The methodology involved contacting the six states that have previously implemented similar food allergy legislation. It encompassed performing a thorough search …

Toward Concurrent Identification Of Human Activities With A Single Unifying Neural Network Classification: First Step, Andrew Smith, Musa Azeem, Chrisogonas O. Odhiambo, Pamela J. Wright Phd, Ms, Med, Rn, Cen, Hanim E. Diktas, Spencer Upton, Corby K. Martin, Brett Froeliger, Cynthia F. Corbett, Homayoun Valafar

Publications

The characterization of human behavior in real-world contexts is critical for developing a comprehensive model of human health. Recent technological advancements have enabled wearables and sensors to passively and unobtrusively record and presumably quantify human behavior. Better understanding human activities in unobtrusive and passive ways is an indispensable tool in understanding the relationship between behavioral determinants of health and diseases. Adult individuals (N = 60) emulated the behaviors of smoking, exercising, eating, and medication (pill) taking in a laboratory setting while equipped with smartwatches that captured accelerometer data. The collected data underwent expert annotation and was used to train a …

Experiences Of Black Males With Generalized Anxiety Disorder During The Covid-19 Pandemic, Cynthia Lynn Williams

Walden Dissertations and Doctoral Studies

This qualitative research dissertation involved exploring the intersection of race, gender, and mental health via lived experiences of Black males who were diagnosed with generalized anxiety disorder during the COVID-19 pandemic to provide a comprehensive understanding of how the unique sociocultural context of the pandemic influenced their experiences with anxiety. Using a qualitative Interpretive Phenomenological Analysis research design and semi-structured interviews with a diverse sample of seven Black males living in various regions of the United States the interviews involved their personal experiences, coping mechanisms, and perceptions of societal and systemic factors that affected their mental health during the pandemic. …

The Experiences Of Icu Nurses Caring For Covid-19 Patients In Zambia, Mable Kasonde Mwila

Walden Dissertations and Doctoral Studies

The purpose of this research was to explore the experiences of ICU nurses caring for COVID-19 patients in Zambia. The problem was lack of knowledge on what intensive care unit nurses experienced while caring for COVID patients then to investigate the experiences of ICU nurses taking care of COVID patients in Lusaka, Zambia. Using Sister Callista Roy’s nursing adaptation model as a conceptual framework, the qualitative interpretative phenomenology approach was used to interview 14 participants in two hospitals in Zambia. MAXQDA software was used to organize data to develop codes and derive six themes, which were education, emotional and psychological …

Wiping Out Central Line Associated-Bloodstream Infections: Cleaning High Touch Surfaces In The Picu, Emily Heth

Dissertations

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.

Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the …

Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald

Dissertations

Abstract

Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.

Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …

Improving Mental Health Outcomes For Amputees, Zachary Elmore

Dissertations

Problem: depression, anxiety, and other mental health disorders are more commonly diagnosed in the amputee population related to changes in mobility, activities of daily living, and quality of life (Turner et al., 2020.) As the amputation population is projected to reach over 3 million Americans in the next 25 years, additional screening is imperative to identify patients at high-risk for mental health deterioration (Ziegler-Graham et al., 2018).

Methods: this was a project that included screening all patients with the Personal Health Questionnaire for Depression (PHQ-8) meeting the inclusion criteria of being admitted to 7500 Vascular Surgery at Barnes-Jewish …

Restraint Reduction Using The Brøset Violence Checklist, Deanna Kappelmann

Dissertations

Abstract

Problem: Patient aggression, restraint usage and assaults against healthcare workers have numerous negative health outcomes. Patient aggression and restraint usage on inpatient psychiatric units can be identified early with imminent violence predicative tools such as the Brøset Violence Checklist (BVC), where patient de-escalation interventions can subsequently occur.

Methods: This quality improvement project was conducted using a cohort design with a retrospective and prospective chart review. The IHI PDSA model was used for this project. The BVC was administered to male and female patients ages 18 to 64 years old on the adult inpatient psychiatric unit during the implementation period. …

Implementation Of Skin-To-Skin Contact Immediately Post Cesarean Birth: A Quality Improvement Project, Sophia Cooke

Dissertations

Problem: Skin-to-skin contact implemented within the first hour of a newborn’s life improves health outcomes for both mother and infant. One of these health outcomes includes exclusive breastfeeding. The purpose of this quality improve project was to implement an infant securement device within the operating room after cesarean section births to decrease the time to initiate skin-to-skin contact and increase exclusive breastmilk feeding rates at discharge.

Methods: This study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A pre-test, post-test design was utilized to compared retrospective and prospective data. The retrospective data was collected to assess …

Evaluation Of The Grief Of Mothers Affected By Perinatal And Traumatic Loss, Landry Crabtree

Dissertations

Problem: The experience of a perinatal loss can be traumatic for mothers, and complicated grief reactions are common for those who have experienced a perinatal loss. An increase in perinatal loss resources is needed in the United States. The purpose of this program evaluation was to assess outcomes of a pilot perinatal loss support program on the grief of women who have experienced a perinatal loss.

Methods: This project was an evaluation of a perinatal loss support program that employed evidence-based strategies in both individual and group therapy sessions. A retrospective design was used, and data on perinatal …

Implementation Of Postnatal Depression Screening: A Pilot Study, Mollie Gulino

Dissertations

Abstract

Background: Postpartum depression (PPD) is a prevalent problem among women during their childbearing years, affecting approximately 1 in 7 women. Alarmingly, about 50% of PPD cases go undiagnosed and untreated, contributing to poor maternal outcomes, including suicide, which is a leading cause of maternal mortality in the United States.

Issue: Despite its prevalence and severe consequences, PPD often goes unrecognized due to inconsistent screening practices. Current guidelines vary by organization and lack consistent, evidence-based criteria.

Objective: This pilot program aimed to implement universal PPD screening with a validated tool at the six-week postpartum follow-up visit. The goal was to …

Implementation Of The Edinburgh Postpartum Depression Screening Tool For Postpartum Depression In A Midwest Primary Care Clinic, Makenzie Garrison

Dissertations

Problem: Postpartum depression is a prevalent health concern in postpartum women. Screening practices to identify postpartum depression are inconsistent. The purpose of this quality initiative is to determine if the implementation of the Edinburgh Postpartum Depression Screening Tool (EPDS) to screen for postpartum depression in the primary care setting increases the detection of postpartum depression in postpartum women from delivery to one year postpartum.

Methods: This quality improvement project utilizes a descriptive, observational design. A retrospective medical record review was utilized as well as a 12-week data collection period. Retrospective medical record reviews were conducted to assess the rate of …

Nursing Staff Education On Enhanced Recovery After Surgery Related To Nurse-Patient Pain Communication, Kathleen Ranne

Walden Dissertations and Doctoral Studies

Perioperative pain is a significant challenge in terms of care of surgical patients which requires effective communication by nurses to improve patient outcomes and satisfaction. The communication component of the Enhanced Recovery after Surgery protocol is a foundation for improved patient outcomes and pain management. The problem that was identified in this Doctor of Nursing Practice project was lack of staff education during the perioperative period related to nurse-patient communications regarding pain management. Using the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this DNP project was to plan, implement, and evaluate a staff education …

Prelicensure Baccalaureate Nursing Faculty’S Experiences Of Providing Incivility Awareness Education To Students, Emily Vanessa Pappa

Walden Dissertations and Doctoral Studies

This study investigated prelicensure baccalaureate nursing faculty’s lived experiences of providing incivility awareness education to students. The problem was that previous research regarding incivility awareness education to prelicensure baccalaureate nursing students focused on pilot studies to find effective strategies and students’ receptiveness to educational approaches, but it lacked the nurse educators’ experiences of delivering the education. The purpose was to explore the lived experiences of nurse educators providing incivility awareness education to prelicensure baccalaureate nursing students. with at least 1 year of teaching experience in prelicensure baccalaureate nursing programs and had taught the topic of incivility awareness. Using the qualitative …

Depression Screening For Nursing Home Residents, Victor Chukwuocha

Walden Dissertations and Doctoral Studies

The project focused on depression among nursing home residents, an underrecognized and undertreated condition that affects quality of life. Few studies have been conducted on the subject of depression screening for nursing home residents, resulting in a lack of understanding among the nursing profession on managing specific conditions. At a nursing home, there was a need to address depression. The practice-focused question used in this project addressed the process of the translation of evidence to develop a staff education project for depression to enhance the knowledge of nurses working with nursing home residents. The project followed an evidence-based approach to …

Neonatal Nurses’ Intention To Stay In The Nicu, Carolyn Penn-Griffin

Walden Dissertations and Doctoral Studies

Neonatal nursing leaders and national health care organizations within the United States are concerned about the recent shortage of skilled and experienced neonatal intensive care unit (NICU) nurses that may reduce the quality of care delivered to NICU patients. NICU nurses are passionate about caring for premature and ill full-term infants and providing educational and emotional support for their parents, some NICU nurses remain in the NICU long-term, yet others contemplate leaving the specialty. The purpose of this qualitative interpretative phenomenological research guided by Martin Fishbein and Ajezen’s theory of reasoned action was to explore the lived experiences of NICU …

Implementation Of A Mindfulness Approach To Emotional Regulation In A Public High School., Kaelin Cherise Shay

Doctor of Nursing Practice Papers

According to the Gallup and Walton Family Foundation-State of American Youth Survey for 2023, schools in the United States received an average grade of C+ when it comes to supporting their students’ mental health, highlighting a potential area for improvement in the school system (Wilcoxon & Marken, 2023). This quality improvement project aimed to teach high school students about emotional regulation using a mindfulness platform and evidence-based techniques designed for the school environment. The sessions focused on improving the students’ understanding of emotions and emotional regulation and helping them apply techniques to regulate emotions in a healthy manner.

This project …

Evaluation Of An Educational Training On Telehelath Utilization Rates And Hospital Readmissions In A Home Health Setting., Gabrielle A. Coomer

Doctor of Nursing Practice Papers

Background: Hospital readmissions are on the rise and continue to be a concern within healthcare due to their effects on the quality of care and healthcare costs. Telehealth strategies have been utilized across healthcare settings to improve hospital readmission rates.

Purpose: The purpose of this project was to evaluate the effectiveness of a telehealth training program in increasing telehealth utilization rates and reducing the acute care hospitalization rate within a single home health agency.

Intervention: A 30-minute PowerPoint presentation on the definition of telehealth, goals, and benefits of telehealth, patient eligibility, special considerations for clinicians, billing and coding guidelines, …

Lgbt Cultural Competence Education For Nurse Leaders In A Large Metropolitan Healthcare System: Quality Improvement, Trevor Mcguffin, Andrew Mitchell

Doctor of Nursing Practice Papers

Background: In the United States, seven percent of adults identify as LGBT. The LGBT population is disproportionately affected by health disparities and barriers to care when compared to the cis-heterosexual population. Due to healthcare providers’ limited LGBT health education and experience, inconsistencies in LGBT culturally competent care perpetuate health disparities and barriers to care for the LGBT population.

Purpose: The purpose of this quality improvement project was to educate nurse leaders on LGBT cultural competency and facilitate nurse leaders’ behavior change.

Methods: This quality improvement project consisted of three LGBT cultural competence modules and two guided behavior change pathways. Outcomes …