Digital Commons Network^™

Exploring Factors Informing The Choice Of Caesarean Sections Among Couples, And Healthcare Workers: A Case Of The Nairobi Hospital, Kenya, Mercy Mukubwa

MSc in Advanced Practice Midwifery

Background: A caesarean section (C/S) is a lifesaving procedure to reduce maternal and newborn morbidity and mortality. It is associated with more risks compared to a vaginal birth. The rates of C/S have been on an upward trend globally and are expected to continue to rise further. C/S predisposes neonates to poor outcomes, some of which could be life-threatening compared to vaginal birth. Similarly, C/S mothers are at greater risk for serious complications.

Objective: The primary objective of this study was to investigate the factors influencing the decision to undergo a caesarean section among couples and healthcare workers …

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 …

Improving Early Detection Of Suicidal Ideation Through Routine Screening In Adults With General Anxiety Disorder, Brittanie N. Bush

Doctor of Nursing Practice

Suicide is a leading cause of death in the United States, with anxiety and depression recognized as independent risk factors for suicidal ideation (Centers for Disease Control and Prevention, 2024 September 26; Grant et al., 2023; Li et al., 2022; Moon et al., 2025; Wiebengo et al., 2021). Incorporating valid screening tools like the General Anxiety Disorder-7 and the Columbia-Suicide Severity Rating Scale can help identify suicidal ideation early, enabling quicker provider intervention (Johnson et al., 2019; O’Connor et al., 2022). The purpose of this project was to implement the Columbia-Suicide Severity Rating Scale as a standardized screening tool for …

Enhancing Adherence To Veterans Affairs/Department Of Defense And American Psychiatric Association Clinical Guidelines For Alcohol Use Disorder, Corinna M. Trevino

Doctor of Nursing Practice

Alcohol use disorder continues to be significantly undertreated within outpatient behavioral health settings, particularly concerning pharmacological interventions. Despite the presence of robust national clinical guidelines recommending medications such as naltrexone for individuals with moderate to severe dependence, the rates of prescribing these medications remain modest owing to inconsistent screening procedures, limited referral practices, and provider follow-through barriers. This project was implemented at a substance use treatment center in a large metropolitan area to improve adherence to clinical practice guidelines. The purpose of this project was to increase prescribing of naltrexone and improve referral for patients with moderate to severe alcohol …

Determinants Of Mental Health-Seeking Behaviour Among Upgrading Nursing Students At The Aga Khan University, Kenya, Cecilia Wanjiru Ndungu

MSc in Advanced Practice Nursing

Background: Mental health challenges are increasingly recognised, and nursing students often report higher stress and anxiety than other peers.Working nurses in upgrading programmes face additional pressure from balancing work, study and family,yet remain under-studied. At Aga Khan University in Kenya, the determinants influencing mental health-seeking behaviour among upgrading nursing students have not been documented, which is critical for addressing mental health needs. This study aimed to investigate the biological, psychological, and sociological factors influencing mental health-seeking behavior in this cohort.

Methodology: A descriptive cross-sectional study was conducted among 106 upgrading nursing students at AKU, utilizing structured questionnaires to …

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 …

The Role Of Psychological Capital And Case Management Intensity In Patient Activation In Permanent Supportive Housing Residents., Sarah J. Carter

Electronic Theses and Dissertations

This dissertation explores patient engagement with health, or patient activation, in the formerly homeless population housed in Permanent Supportive Housing (PSH) and receiving case management support. Research is limited on patient activation in PSH residents; consequently, there is minimal understanding of factors contributing to one’s attitudes and behavior towards health care in this group. Psychological Capital refers to the components of hope, self-efficacy, resilience, and optimism. Research in other marginalized groups indicates increasing psychological capital may improve health behaviors. Case management provides support to PSH residents and forms of social support have been associated with improved health outcomes. Applying the …

The Effect Of Simulation On Nurses’ Confidence With Providing Post-Fetal Death Support To Bereaved Parents, Monique Scholine, Shannon Zalewski, Erin M. Franklin, Sandria Jamieson, Janelle Diaz, Donna Davis, Kristi Vargo, Nicole Adokou, Kettia Antoine, Natalie Bermudez

Nursing & Health Sciences Research Journal

Introduction: Fetal death (FD) affects one in 10 women worldwide and is associated with negative sequelae such as complicated grief. The negative effects of FD may potentially be mitigated through provision of bereavement support (BS) by trained healthcare workers.

Purpose: The purpose of this study was to explore the effect of simulation on registered nurses’ (RN) confidence in providing BS following FD.

Methods: This was a quasi-experimental study conducted within a South Florida community hospital. Nurses were recruited via email/flyers. Participation in the study entailed attending a post-FD simulation session, and completion of the Perinatal Bereavement Care Confidence Scale (PBCCS) …

Midwife-Led Birth Debrief: A Concept Analysis, Kate Buchanan, Elliesha O'Reilly, Georgia Wilcox, Sara Bayes, Lauren Kearney, Linda Sweet, Hazel Keedle

Research outputs 2022 to 2026

Background: Psychological birth trauma (PBT) affects approximately 19 % of postnatal women, making its prevention a global priority. Midwives are responsible for providing psychosocial care during the postnatal period to foster the mother-infant relationship, provide education and screening and support positive transitions to parenting. However, the specific attributes of a birth debrief and the role of the midwife in a supporting a woman to review their birth experience is less well documented in regulatory frameworks or scientific literature. This has created significant ambiguity in both clinical practice among health professionals and in research contexts. The lack of a clear understanding …

The First Year Of Assisted Dying In New Zealand Through The Lens Of Healthcare Professionals Not Directly Involved In The Process, Waqas Arshad, Aida Dehkhoda, Melissa Carey, David B. Menkes, Nicholas Hoeh, Frederick Sundram, Rosemary Frey, Gary Cheung

Research outputs 2022 to 2026

Background: New Zealand’s End of Life Choice Act 2019 was enacted in 2021, allowing terminally ill people experiencing unbearable suffering to request assisted dying if they are expected to die within six months. Healthcare professionals not directly involved in assisted dying provision may have unique perspectives on implementation, yet this remains under-explored. Methods: This qualitative study was conducted between June and November 2022. We used purposive and snowball sampling to recruit potential participants through various sources, including the Ministry of Health’s assisted dying training and communication email list. A multidisciplinary research team developed a semi-structured interview guide. The individual interviews …

Barriers To Mental Health Access Among Immigrant Populations In The U.S., Cecilia Menzinger

Capstones

No abstract provided.

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 …

Metabolic Screening In Veterans On Antipsychotics Mood Stabilizer, Joy Nneka Eke

Walden Dissertations and Doctoral Studies

Summary This Doctor of Nursing Practice project was conducted to examine a quality improvement initiative that sought to address metabolic syndrome screening consistency for veterans on antipsychotic medications at a U.S. Department of Veterans Affairs health system located in the Midwest region of the United States. The project centered on whether the quality improvement program assessing compliance with the current metabolic syndrome screening process reflects increased early detection of metabolic syndrome to prevent cardiovascular complications. Data collection involved comprehensive chart reviews of 50 veterans’ records. The data collected were analyzed using a specially designed quality improvement initiative assessment form developed …

Caring For Caregivers: Fostering Empathetic Educational Practices Among Undergraduate Nursing Faculty, Karlee Hedrick

DNP Projects

BACKGROUND: Trauma is highly prevalent among nursing students, and unrecognized responses to that trauma can negatively impact learning, psychological safety, and academic performance (Doughty, 2020). Although trauma-informed care (TIC) principles are described in clinical settings, its use in undergraduate nursing programs remains limited. Faculty often lack formal TIC training, reducing their ability to support students with lived traumatic experiences. TIC education can improve awareness, responsiveness, and educator confidence (Bosse et al., 2021; Doughty, 2020; MacLochlainn et al., 2022). This project aimed to improve faculty knowledge and explore attitudinal shifts following a structured TIC educational intervention.

METHODS: Two Plan-Do-Study-Act (PDSA) cycles …

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 …

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, …

Evaluating Healthcare Professionals’ Perceptions Of The Ist Algorithm In Maternal-Fetal Health Clinic: Usability And Satisfaction, Terri Taylor

Doctor of Nursing Practice Projects

Background: Standardizing substance-use screening in perinatal care is essential for optimizing clinical decision-making and promoting equitable patient outcomes. To address gaps, the Integrated Screening Tool (IST) algorithm was introduced in a Maternal–Fetal Medicine (MFM) clinic. However, 2023 data revealed inconsistent utilization. Evaluation Question: This Doctor of Nursing Practice (DNP) project evaluated: (1) How do nurse practitioners, medical doctors, and registered nurses perceive the usability of the IST algorithm for standardized drug screening in pregnancy? (2) How do these providers rate their satisfaction with the IST algorithm in managing patients with positive drug screens? Methodology: A cross-sectional survey was conducted with …

Safety In Stability: A Cdc-Guided Evaluation Of Hospital Fall Prevention Practices, Matthew C. Dougherty

Electronic Theses and Dissertations 2020 - Present

Hospital falls remain a persistent and preventable cause of patient harm, emphasizing the need for continuous evaluation of fall prevention practices. This project assessed the effectiveness of AdventHealth Orlando’s fall prevention policy using the Centers for Disease Control and Prevention (CDC) Program Evaluation Framework. A mixed-methods design incorporated quantitative analysis of 12 months of fall data and qualitative feedback from frontline staff surveys and discussions. Results demonstrated a decrease in total falls from 549 in the previous year to 528 in the current year, indicating early progress despite the incomplete reporting period. Unit-level analysis showed a mean improvement of 16.9% …

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 …

Breaking The Silence With Routine Genitourinary Syndrome Of Menopause Screening: A Quality Improvement Project, Ashley R. Noel

Electronic Theses and Dissertations 2020 - Present

Affecting upwards of 87% of women in post menopause, genitourinary syndrome of menopause is greatly under-diagnosed, and consequently, under-treated. Genitourinary syndrome of menopause refers to health conditions impacted by hypoestrogenic state experienced in menopause. Common symptoms of GSM include vaginal dryness, irritation, clitoral or labial atrophy, dyspareunia, decreased libido, anorgasmia, dysuria, recurrent UTI, urinary incontinence (Kaufman et al., 2025). Despite the burdensome consequences of GSM, women are unlikely to vocalize their symptoms and seek treatment. Additionally, societal beliefs of shame surrounding sexual health impede patients and clinicians from addressing GSM specifically (Mili et al., 2021). As a result, the North …

Mental Health In Adult Oncology Patients, Jenna Pope

Capstones

Adults with cancer suffer from mental challenges that frequently go under diagnosed and under treated (Fernando et al., 2023). This can lead to lower quality of life, resulting in reduced adherence to treatment, more frequent hospital stays, increased healthcare costs, and increased mortality rates (Matthews et al., 2025). There are currently no policies on mental health screening for adult oncology patients at every outpatient appointment. By consistently utilizing standardized screening tools such as the PHQ-9 and GAD-7 during all oncology appointments, this can close the gap in policy to address mental health needs of these individuals. It is vital to …

Black Women’S Experiences Accessing Health Care And Law Enforcement After Intimate Partner Violence: A Qualitative Pilot Study, Kaylen M. Moore, Linda M. Wesp, Jeneile Luebke, Peninnah M. Kako

College of Nursing Faculty Research and Publications

Background:

Intimate partner violence (IPV) is a global public health issue impacting millions of people each year. Black women constitute 14% of the US population but alarmingly comprise 31% of homicides resulting from IPV. African American women survivors of IPV experience intersecting impacts of racism, sexism, and historical mistrust. This research aimed to raise awareness about their experiences of violence and perceptions of institutional support.

Objective:

This study sought to explore African American women’s experiences with IPV and navigation of health care and law enforcement after experiences of violence.

Method:

Critical ethnography was used as an approach for this qualitative …

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?

Implementing Phq-2 In An Outpatient Mental Health Practice, Krishona Poignard

Doctor of Nursing Practice Projects

Depression remains widely underidentified in outpatient behavioral health settings, where variable screening practices limit early recognition and appropriate treatment. This quality improvement project addressed this gap by standardizing screening through targeted clinician education. The purpose was to improve clinician confidence and adherence to validated tools, specifically the Patient Health Questionnaire-2 (PHQ-2) and, when indicated, the Patient Health Questionnaire-9 (PHQ-9). The project aimed to increase consistent tool use through an evidence-based educational intervention guided by Lewin’s Change Theory and the Iowa Implementation for Sustainability Framework. A quasi-experimental, single-group pretest–posttest design was employed with licensed clinical staff, including licensed social workers (LSWs), …

Enhancing Patient Satisfaction Among Coronary Heart Disease Patients Through Islamic Spiritual Care With Murottal In Nursing Practice, Aris Citra Wisuda, Citra Suraya, Suzanna Suzanna, Muhamad Andika Sasmita Saputra, Manisha Manisha, Hesly Devitasari, Dian Emiliasari, Tukimin Bin Sansuwito

Jurnal Keperawatan Indonesia

Spiritual care is essential in nursing, especially for patients with chronic or palliative conditions such as coronary heart disease. Although medical intervention is crucial, Islamic spiritual therapy using murottal has a significant impact on patient satisfaction. This study aims to evaluate the effectiveness of murottal in enhancing patient satisfaction among individuals with coronary heart disease. A quasi-experimental pretest-posttest design was used with 52 participants at Siti Khadijah Islamic Hospital, Palembang, Indonesia. Total sampling was applied, and data were analyzed using the paired sample t-test. Patient satisfaction was measured using a Likert-scale questionnaire to assess the impact of murottal spiritual care. …

Restorative Masculine Integration Theory, Todd Angelucci, Julian L. Gallegos

School of Nursing Faculty Publications

The Restorative Masculine Integration Theory (RMIT) introduces a strengths-based, systems-oriented framework for promoting healthy masculinity through healing, leadership, and relational engagement. Developed in response to the adverse effects of masculine suppression, such as emotional disengagement, burnout, and polarity collapse, RMIT outlines a five-phase Cycle of Masculine Restoration: reclaimed masculinity, emotional safety and trust, grounded leadership, rebalanced gender polarity, and healing with cultural renewal. These stages are underpinned by core concepts including psychological safety, peer mentorship, emotional literacy, and authentic masculinity. Drawing from interdisciplinary foundations in gender studies, emotional intelligence, trauma-informed practice, polarity theory, and servant leadership, RMIT offers an adaptable …

Psychological Distress And Quality Of Life Among Infertility Couples Undergoing Infertility Treatment In Malaysia, Farrahdilla Hamzah, Zamzaliza Abdul Mulud, Malini Mat Napes, Sarah Abdul Mubarak, Rosliza Shafie

Jurnal Keperawatan Indonesia

Infertility often leads to stress, anxiety, and depression, significantly affecting the quality of life of affected couples. This study explored the sociodemographic and psychological factors influencing the quality of life among infertile couples undergoing in vitro fertilization (IVF) treatment in Malaysia, using a cross-sectional design. A total of 126 infertile couples were purposively sampled from three public hospitals offering IVF treatment. The Depression, Anxiety, and Stress Scale (DASS-21) measured psychological distress levels, while the Fertility Quality of Life (Ferti-QoL) scale assessed fertility-related quality of life. Data collection adhered to strict ethical standards, with confidentiality ensured. Participants provided informed consent and …

Assessing Community Readiness And Benefits Of A Nursing Program: Implications For Healthcare And Education, Mary Anne Frances D. Reyes, Aaron A. Funa, Robert Jamisola, Ma. Joahna D. Perdigon, Jerica D. Latonero

Jurnal Keperawatan Indonesia

In response to recent policy shifts allowing the establishment of new nursing programs in the Philippines, this study assesses the perceived readiness of Sorsogon, a geographically underserved province, to implement a bachelor of science in nursing program. It also explores the anticipated benefits that such a program may offer to students and the local community. A cross-sectional survey of 375 stakeholders, selected through purposive sampling, was conducted using a validated instrument developed through expert consultation. Quantitative data were analyzed using descriptive statistics, while qualitative responses were examined through thematic analysis. The findings reveal widespread support for the proposed program, emphasizing …

Quality Improvement Project: Standardized Medication Reconciliation Process Training: A Path To Improve Staff Medication Confidence, Christologus Obi

Doctor of Nursing Practice Projects

Medication reconciliation represents a critical safety process in psychiatric healthcare, where medication discrepancies affect up to 67% of hospitalized patients, with 30-40% potentially causing significant harm. This quality improvement project implemented a standardized medication reconciliation training program at a Texas mental health facility to address knowledge and confidence gaps among clinical staff. Using Kotter's 8-Step Change Model and the Iowa Model of Evidence-Based Practice, this quasi-experimental pre-post intervention study delivered three 30-minute interactive sessions to 12 multidisciplinary healthcare professionals. The evidence-based intervention introduced a 3-phase reconciliation model focused on obtaining accurate medication histories, documentation, and discrepancy resolution. Data collection used …