Digital Commons Network^™

Enhancing Hpv Vaccination Engagement And Uptake Among Young Adults Aged 17 To 26 Through A Multilevel, Multicomponent Intervention, Sarah Dianne Girlinghouse

Doctoral Dissertations

Background: Human papillomavirus (HPV) remains one of the most common vaccine-preventable infections, with vaccination rates among young adults aged 17 to 26 remaining below Healthy People 2030 targets. University health settings represent a critical opportunity to improve vaccine uptake. Prior to this quality improvement (QI) initiative, student health services (SHS) at a public university in the southern United States did not routinely offer HPV vaccination, resulting in missed opportunities for prevention. Evidence supports provider recommendation, clinical decision support, and improved access as key drivers of HPV vaccination uptake. Purpose: The purpose of this QI project was to increase HPV vaccination …

A Strategy For Standardizing Stimulant And Benzodiazepine Management For Advanced Nursing Practice And Drug Safety, Michael Iheukwu Agugo

Walden Dissertations and Doctoral Studies

No abstract provided.

Nursing Students Applying Active Teaching And Learning To Develop Clinical Judgment Skills, Charlene Lindsay Jones

Walden Dissertations and Doctoral Studies

No abstract provided.

Motivation And Leadership Development Among Federal Nurse Leaders, Sarah Davis-Arnold

Walden Dissertations and Doctoral Studies

No abstract provided.

Advance Care Planning In Metastatic Lung Cancer Patients: A Quality Improvement Initiative, Khanh H. Thai

Student Theses

Background: Advance care planning (ACP) is essential in achieving goal-concordant care for patients with metastatic lung cancer (MLC), yet it remains underutilized.

Local problem: Despite its benefits, ACP has been inconsistently integrated into outpatient oncology settings, and a baseline evaluation at the project site revealed that only 11% of patients with MLC had ACP documented in the outpatient care clinic.

Methods: This Quality Improvement initiative implemented a formal, Nurse Practitioner (NP)-led intervention into routine oncology care. Using a quasi-experimental nonrandomized design, 13 eligible patients diagnosed with MLC without prior ACP documentation were enrolled in a four-week study. These participants were …

The Effectiveness Of Online Recovery Meetings Among Inpatients With Substance Use Disorders, Lorna Kalesnick Rn

Nurse Residency

In hospitalized patients with alcoholism and substance use disorder, does participation in online recovery meetings during inpatient stay, compared with standard care without online meetings, reduce relapse and hospital readmission rates ninety days after discharge?

The Use Of Pressure-Mapping Technology To Decrease Pressure Injury Prevalence, Acadia Morse Bsn, Rn

Nurse Residency

Does the use of pressure-mapping, as compared to a standard repositioning schedule, decrease the rate of pressure injuries in acute care patients at a high risk of skin breakdown?

The Healthcare Transition Experiences Of Emerging Adults With Congenital Adrenal Hyperplasia, Leslie Noojin Pitts

ETDs from 2020-2029

Congenital adrenal hyperplasia (CAH) is a group of disorders characterized by enzyme deficiencies impairing adrenal hormone production and requiring lifelong management. Individuals with CAH experience increased morbidity and mortality due to the underlying condition, steroid exposure, and inadequate preventative care. Despite clinical guidelines recommending a structured healthcare transition (HCT), little is known about the HCT experiences of emerging adults with CAH. Understanding these experiences is critical for identifying practice gaps and developing interventions to improve health outcomes. This qualitative descriptive study explored the HCT experiences, challenges, and outcomes of emerging adults with CAH, as guided by the refined Social Ecological …

Co-Designed Interventions Package For Enhancing Women's Resilience In Reproductive And Child Health Through Income-Generating Associations: A Human-Centered Design Study In Tanzania, Kahabi Isangula, Aminieli Itaeli Usiri, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Background: Maternal and under-five mortality remain major public health concerns in many low- and middle-income countries, including Tanzania. Despite their widespread use in strengthening economic resilience, income-generating associations (IGAs) have not fully utilized their potential as platforms for addressing reproductive and child health (RCH) challenges.

Objective: This study aimed to co-design an intervention package with women participating in income-generating associations to enhance their preparedness and resilience in addressing RCH challenges in Tanzania.

Methods: A qualitative descriptive study guided by a Human-Centered Design (HCD) framework was conducted in the Arusha and Shinyanga regions of Tanzania. The study followed …

Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery At Swedish Cherry Hill, Jacinta Smith

All Podium Presentations

No abstract provided.

Innovating Cauti Prevention: The Cauti Café And Multidisciplinary Catheter Stewardship At The Bedside, Erik Enquist, Jennifer Neal, Naz Akhavan, Harnishad Binner

All Podium Presentations

No abstract provided.

Birth Satisfaction, As Measured By The Birth Satisfaction Scale–Revised (Bss-R), And Its Role In Predicting Breastfeeding Duration, Maternal-Infant Attachment, And Postpartum Depression, Molly Parker

University Honors Theses

Birth satisfaction has been consistently associated with improved maternal outcomes such as reduced postpartum depression (PPD), stronger maternal-infant attachment, and longer breastfeeding duration. However, the extent to which birth satisfaction independently predicts these outcomes remains unclear. This study examined whether birth satisfaction, as measured by the Birth Satisfaction Scale–Revised (BSS-R), predicts postpartum depression, maternal-infant attachment, and breastfeeding duration in a longitudinal cohort.

Data were drawn from the Prenatal Environmental And Child Health (PEACH) study. Birth satisfaction was assessed at 12 months postpartum using the BSS-R. Postpartum depression was measured using the Edinburgh Postnatal Depression Scale (EPDS), maternal-infant attachment using the …

Phenome-Wide Association Study Of P2rx7 Identifies Schizophrenia And Mood Disorders As Primary Associated Phenotypes, Ling Zhu, Qiao Mao, Zhixiong Luo, Bin Chen, Yong Zhang, Xiaowei Lu, Ping Liu, Jiawu Ji, Xiaoping Wang, Kesheng Wang Phd, Ma, Bs, Xinghua Pan, Yuping Cao, Na Liu, Jennifer Luo, Lingjun Zuo, Zhiren Wang, Xingguang Luo, Xiaoyun Guo

Faculty Publications

Objectives: P2RX7 has been implicated in bipolar disorder, major depressive disorder, schizophrenia, anxiety disorders, Alzheimer's disease, and Parkinson's disease. However, the specificity and comparability of these as sociations remain unclear. This study aimed to systematically evaluate multiple neuropsychiatric disorders to identify those most robustly associated with P2RX7.

Methods: We analyzed 1861 imputed SNPs spanning the P2RX7 gene in 1,087,925 individuals from 72 inde pendent cohorts across 18 neuropsychiatric disorders. SNP-disease associations were assessed within each cohort, followed by meta-analysis and false discovery rate (FDR) correction to identify significant disease-risk variants. P2RX7 mRNA and protein expression across tissues or cells …

Fundamentals First: Embedding Social Determinants Of Health, Relational Care, And Interprofessional Collaboration In Critical Care Nurse Onboarding, Michael Defrancisco, Emily Bovino, Kristen Stogsdill

MaineHealth Maine Medical Center

No abstract provided.

Impacts Of The Early Collaborative Intervention On Mother-Preterm Infant Interaction At One Month Of Age: Secondary Analysis Of A Randomized Controlled Trial, Charlotte Sahlén Helmer, Ulrika Birberg Thornberg, Thomas Abrahamsson, Evalotte Mörelius

Research outputs 2022 to 2026

Background A sensitive, well-functioning maternal interaction is vital for healthy infant development. For moderate to late preterm infants, this is even more important as this group of infants are at increased risk of facing neurodevelopmental disorders. The Early Collaborative Intervention supports parent-preterm infant interaction and includes three sessions, two in the hospital and one after discharge. Objective To investigate the impact of the Early Collaborative Intervention, compared with standard care, on mother-preterm infant interaction at one month corrected age. Design A longitudinal randomized controlled trial, reporting secondary outcomes from the first follow-up. Setting The intervention was conducted at a pediatric …

Screening Tools For Maternal Mental Health In Africa: A Systematic Review, Joyce Jebet, Irene Mageto, Benard Mutwiri, Abednego Ongeso, Ruth Wagathu, Rose Maina, Denis Munene, Kawira Kithuci, Peter Gatiti

School of Nursing & Midwifery, East Africa

Background:

Maternal health during pregnancy and the postnatal period encompasses mental health, which is a key aspect in enhancing a positive outcome. Despite screening for other possible complications during pregnancy and the postnatal period, very little attention has been paid to screening for mental health. Screening is a key tool in early diagnosis and, eventually, timely diagnosis and management in cases where complications arise.

Aim:

This study aimed to assess the available maternal mental health screening tools and compare the outcome on their utilization during pregnancy and postnatal periods in the African continent.

Methodology:

This was a …

Factors Impacting Western Australian Midwives' Intention To Stay: A Mixed Methods Study, Christine Atkinson, Dianne Bloxsome, Zoe Bradfield, Kate Buchanan, Sarah Dawson, Frances Finch, Sadie Geraghty, Sara Bayes

Research outputs 2022 to 2026

Problem Midwifery workforce sustainability remains a critical concern for maternity services. Existing literature predominantly focuses on burnout and attrition, offering limited insight into what influences midwives’ decisions to remain within specific workplaces. Background Midwives consistently report strong professional commitment alongside growing workforce instability. National data indicate that uncertainty about current roles does not necessarily reflect disengagement from the profession. Understanding workplace-level influences on retention is therefore essential for targeted workforce strategy. Aim To examine how workplace stress and satisfaction with the practice environment are associated with Western Australian midwives’ intention to stay in their current job and in the profession. …

Maternal Prenatal Anxiety And Risk Of Preterm Birth And Low Birthweight: Evidence From A Cumulative Meta-Analysis With Stability Thresholds, Bereket Duko, Desta, Biniyam Sahiledengle, Yohannes Tekalegn Efa, Tenaw Tiruye, Lisa Whitehead, Gavin Pereira, Amanuel Tesfay Gebremedhin

Research outputs 2022 to 2026

Background: We conducted cumulative meta-analyses to quantify the degree to which maternal prenatal anxiety impacts preterm birth (PTB) and low birthweight (LBW), and to identify when findings reached stability, enabling confident recommendations for early interventions. Methods: Following PRISMA guidelines, we systematically searched PubMed/MEDLINE, PsycINFO, Scopus, EMBASE, CINAHL (EBSCO), ProQuest, and the Cochrane Library from database inception to May 7, 2025. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale. Inverse variance weighted random-effects cumulative meta-analysis was performed to pool adjusted odds ratios (AORs) with sequential inclusion of newly published studies. Stability thresholds were computed to assess sufficiency …

Improving Antihypertensive Medication Adherence Through Education And Follow- Up Phone Calls In A Primary Care Setting, Sarah Peterson

Doctor of Nursing Practice Final Manuscripts

Hypertension affects nearly half of adults and significantly increases the risk of stroke and cardiovascular disease; however, poor medication adherence remains a primary barrier to effective blood pressure management. The purpose of this evidence-based practice (EBP) project was to improve antihypertensive medication adherence among adult patients in a primary care setting. Guided by the Iowa Model of Evidence-Based Practice to Promote Quality Care, the project utilized a pre-test/post-test design at a private practice clinic. The sample included adults with a hypertensive diagnosis and active prescriptions. Medication adherence was defined as the Morisky Medication Adherence Scale (MMAS-8) scores, measured before and …

Closing The Gap: Integrating A Standardized Depression Screening In Primary Care, Cyndy Marie Oreas

Doctor of Nursing Practice Final Manuscripts

Objective: The purpose of this evidence-based practice (EBP) project is to implement the routine use of the Patient Health Questionnaire-9 (PHQ-9) screening instrument in the primary care setting to improve early diagnosis, treatment, and referrals to mental health.

Background: Depression is frequently underdiagnosed in primary care despite its significant impact on health outcomes. Inconsistent screening practices and a lack of standardized workflows contribute to missed opportunities for early identification and intervention. Routine PHQ-9 screening has been shown to improve detection and facilitate timely referral to behavioral health services.

Methods: A standardized PHQ-9 screening was implemented for adult patients aged 18 …

Reducing Preoperative Anxiety In Patients Undergoing Gynecologic-Oncology-Related Surgeries, Iman Sean Lavine-Richardson

Doctor of Nursing Practice Final Manuscripts

Elevated levels of preoperative anxiety are associated with adverse effects in the postoperative period. Evidence demonstrates the effectiveness of incorporating multimedia into preoperative education to alleviate preoperative anxiety. This project aims to decrease preoperative anxiety levels and increase satisfaction and feelings of preparedness in patients scheduled to undergo gynecologic-oncology-related procedures through the implementation of an evidence-based practice (EBP) informational video. The San Diego 8A’s EBP model was utilized to guide this project. Data was collected, anonymously, through online questionnaires which included the Anxiety Specific to Surgery Questionnaire (ASSQ) to assess anxiety levels and Likert-scale questions to assess satisfaction and feelings …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Text Message Delivery Of Pre-Procedural Recommendations Prior To Lip Augmentation With Hyaluronic Acid Filler: An Evidence-Based Pilot Project, Jenna De Jonge

Doctor of Nursing Practice Final Manuscripts

Patients seeking lip augmentation procedures commonly experience self-resolving soft-tissue complications such as swelling and bruising. There are many widely accepted pre-procedural recommendations available to help patients minimize the risk of these undesirable outcomes. At a Medical Aesthetics practice in Southern California, lip augmentation patients often arrived to their appointment non-adherent to pre-procedural recommendations that were available on the practice website. Text message delivery systems have been used to improve patient adherence to healthcare instructions across a variety of healthcare settings. To address this gap, I implemented text message delivery of pre-procedural recommendations to lip augmentation patients prior to their appointment. …

Optimizing Lactation Support: Enhancing Patient-Centered Care And Breastfeeding Self Efficacy Through Data-Driven Survey Analysis, Jessica L. Doshay

Doctor of Nursing Practice Final Manuscripts

Objective: The objective of this project was to implement evaluation of an integrated lactation support model within a multi‑site pediatric primary care organization to assess patient experience and breastfeeding confidence associated with a lactation consultation.

Background: Optimizing the patient experience is an indicator of healthcare quality. Improving breastfeeding outcomes remains a national priority. Structured lactation support delivered by International Board-Certified Lactation Consultants (IBCLCs) enhances breastfeeding outcomes, the impact of this is often undocumented in primary care settings.

Methods: This quality improvement project was conducted within the lactation department of a multicenter pediatric clinic in Southern California. Pediatric clinicians who were …

Implementation Of Comprehensive Checklist For Opioid Use Disorder Treatment In Primary Care, Sophia R. Madden

Doctor of Nursing Practice Final Manuscripts

Background: The escalating opioid crisis demands a comprehensive approach to Opioid Use Disorder (OUD) management. Patients often face comorbid mental illnesses, infectious diseases, concurrent substance use, and social determinants of health (SDOH)—all of which increase the risk of treatment attrition. Standardizing care through evidence-based clinical practice guidelines and tools is essential for improving treatment quality and consistency.

Purpose: This project aimed to increase comorbidity screenings and improve resource access for OUD patients at a San Diego Internal Medicine primary care office by implementing a comprehensive care checklist based on the American Society of Addiction Medicine (ASAM) guideline.

Methods: The ASAM …

Empowering Healing And Recovery: Adverse Childhood Experiences Screening In A Cognitive Behavioral Therapy Intensive Outpatient Program, Serena C. Lee

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice project implemented Adverse Childhood Experiences (ACEs) screening in an adult Cognitive Behavioral Therapy Intensive Outpatient Program (COG IOP) at San Diego's largest behavioral health hospital to identify ACE exposure, deliver supportive interventions, and enhance clinician competency in trauma-informed care.

Background: ACEs are potentially traumatic experiences occurring before age 18 that are associated with toxic stress and worsening health outcomes. Despite evidence linking ACEs to adverse outcomes and substantial healthcare costs, routine ACE screening is not standardized in behavioral health settings.

Methods: Guided by the San Diego 8A's Evidence-Based Practice model, eligible patients were offered ACEs screening …

Enhancing Tardive Dyskinesia Screening In An Outpatient Psychiatry Training Clinic: A Quality Improvement Initiative, Ariel Davalos

Doctor of Nursing Practice Final Manuscripts

Background: Tardive Dyskinesia (TD) is a debilitating, often irreversible movement disorder caused by prolonged exposure to dopamine receptor-blocking agents, affecting 15-30% of patients on long-term antipsychotic therapy. Despite endorsement of the Abnormal Involuntary Movement Scale (AIMS) as the gold standard for TD screening, the condition remains significantly under-diagnosed. Purpose: This quality improvement project evaluated whether a 45-minute educational intervention could improve PMHNP trainees’ confidence and competence in TD recognition and AIMS administration. Methods: Guided by the Iowa Model of Evidence-Based Practice, the project used a pre-post survey design with a planned one-month follow-up across two clinical training sessions. Ten PMHNP …

Supporting Nurse Practitioner Autonomy: A Policy Proposal To Advance Hospice Np Scope, Lauren Hochart

Doctor of Nursing Practice Final Manuscripts

The Nurse Practitioner (NP) profession has achieved many advancements in its autonomy and scope of practice in the last 61 years since becoming a recognized advanced practice registered nursing role. However, some areas of healthcare still limit the NPs ability to practice autonomously even though it is within their scope of practice. This is notable in the subspecialty of hospice care with regards to certifying a terminal diagnosis as part of eligibility determination for a Medicare beneficiary to be able to receive covered hospice services. This health policy paper reviews current hospice regulations and provides evidence to support the benefits …

Exercise Prescription For Adults With Prediabetes In The Primary Care Clinic, Katherine W. Hall

Doctor of Nursing Practice Final Manuscripts

Prediabetes affects approximately one in three adults in the United States, with an estimated 10% progressing to Type 2 Diabetes Mellitus (T2DM) annually. Despite strong evidence supporting exercise as a first-line intervention to prevent disease progression, most patients in primary care settings do not receive structured physical activity counseling. This evidence-based project (EBP) aims to address this gap by implementing a standardized protocol to assess baseline physical activity levels and deliver individualized exercise prescriptions to adults with prediabetes in the primary care clinic.

Eligible participants, defined by HbA1c values between 5.70% and 6.49%, were identified during routine primary care visits …