Digital Commons Network^™

Clinical Practice Guideline For Universal Anxiety Screening For Advanced Practice Providers, Kelechi Blanton

Walden Dissertations and Doctoral Studies

This project was a clinical practice guideline (CPG) focused on anxiety screening in a primary care setting using the Generalized Anxiety Disorder (GAD-7) screening tool. The practice problem addressed general anxiety disorder and the need for standardized assessments for risk, as recently been recommended by the U.S. Prevention Service Task Force (USPSTF). Anxiety disorder is common but frequently untreated, due in part to low rates of screening. Lack of an evidence-based guideline for anxiety screening may contribute to delayed diagnosis and inconsistencies. The practice-focused question was, Does the evidence support development of an evidence-based CPG for universal anxiety screening in …

Mental Health Impacts Of Racism And Limited Diversity In Christiansburg, Virginia, Shuchi Sanyal

Selected Social Change Portfolios in Prevention, Intervention, and Consultation

Goal Statement

In this portfolio, I identify and address the prevention needs of racially and ethnically marginalized adolescents in Christiansburg, Virginia, examining how racism and limited diversity affect mental health and proposing culturally responsive, developmentally appropriate prevention strategies.

Significant Findings

Adolescents of color in predominantly White, semi-rural communities face racial isolation, microaggressions, and limited culturally responsive supports, increasing risk for anxiety, depression, and identity-related distress. Using a social-ecological framework, findings show that individual vulnerability is influenced by school climates, relationships, and community norms that may minimize racialized experiences. Protective factors include relational safety, identity affirmation, mentorship, and trauma-informed practices. Evidence-based …

Survivors Of Sexual Trauma: Abortion Experiences Of Black Women In The Southern United States, Katie Grace Geter

Walden Dissertations and Doctoral Studies

Women who experience both sexual trauma and abortion within their lifetime are highly likely to struggle with serious mental health symptoms; however, social work students and practitioners lack education and knowledge on how to serve these women. Recent events, including the uprising of gender and race related movements, COVID-19, heightened political division, and increased governmental control on abortion rights also impact social-work practice. Acknowledging intersectionality, the purpose of this qualitative study was to explore the experiences of abortion for Black women in the Southern United States who have a history of sexual trauma. The experiences of 6 Black women with …

The Relationship Between Medical Mistakes, Organizational Culture, And Patient Safety In South Florida Hospitals, Tachaumbi Lamaya Williams

Walden Dissertations and Doctoral Studies

The present study investigated the relationship between safety-promoting management structures and medical errors in South Florida hospitals. The purpose of the study was to determine if safety-promoting management frameworks reduce medical errors. Using Donabedian’s model, the main research question focused on whether specific organizational management systems are significantly associated with the frequency and severity of medical mistakes in these hospitals. Using a quantitative, cross-sectional research design, the study analyzed secondary data, initially collected by Leapfrog group. Data analysis involved descriptive statistics to profile the sample’s demographics and baseline characteristics, followed by inferential statistical tests to assess the primary hypothesis. Findings …

Staff Education On Preventing Benzodiazepines Related Falls In Older Adults, Dafnee Gilles

Walden Dissertations and Doctoral Studies

In geriatric psychiatric setting, falls rates are higher than general wards and could reach up to 13-25 falls per 1000 hospital days. High use of benzodiazepines in older adults is a major cause of increased falls despite recommendations to avoid its prescription to the population. This DNP staff education project focused on training nurses working in an 80 bed capacity geriatric psychiatric facility on best evidence based practice of preventing falls associated with use of BZDs. The identified practice issue was knowledge deficit on evidence based best practices to prevent falls in older adults under BZDs medications. The project aims …

Determinants Of Clinical Supervisor Self-Efficacy In Substance Use Disorder Counseling, Victoria A. Nagel

Walden Dissertations and Doctoral Studies

Substance use disorder counselors face increasing challenges in responding to a growing and more severely affected population, often presenting with co-occurring mental health conditions and complex clinical needs. Clinical supervision plays a critical role in supporting counselor development, yet little is known about the factors that contribute to clinical supervisors’ self-efficacy in providing supervision for alcohol and drug counselors. The purpose of this quantitative correlational study was to examine whether years of counseling experience, years of substance use disorder (SUD) counseling experience, years as a clinical supervisor, professional counseling credentials, and supervisory credentials predicted self-efficacy among clinical supervisors. This study …

Staff Education To Improve Knowledge On Early Recognition Of Staff Burnout In Nurses Working In Long-Term Care, Geraldine Ndeng Akonwah

Walden Dissertations and Doctoral Studies

This doctoral project was a practice-based staff education project aimed at educating nurses concerning early burnout recognition. The educational intervention was chosen to promote awareness and knowledge related to the concept of burnout and self-care among nurses employed in a long-term care facility. The practice problem addressed was the high prevalence of nurse burnout and the limited ability of nurses to recognize early signs of burnout. The problem is significant in nursing practice as burnout is detrimental to the clinical judgment, patient safety, job satisfaction and staff retention. The guiding question of the project was as follows: Does a staff …

Improving Nursing Knowledge Of Medication Adherence In Bipolar Disorder, Abisola Omobolanle Disu

Walden Dissertations and Doctoral Studies

The purpose of the project was to improve staff knowledge using a structured educational intervention. The project was guided by the Johns Hopkins evidence-based practice model. Approximately 30 relevant articles were identified, with 20 meeting inclusion criteria and levels of evidence ranging from Level I to V, indicating moderate overall strength of evidence. The educational intervention consisted of a single, in-person, staff education session delivered to 11 outpatient mental health staff members. I administered a project-developed pre- and postknowledge assessment to evaluate participants’ knowledge change. De-identified data were analyzed using descriptive statistics. Results demonstrated increased staff knowledge, with mean scores …

Faculty Perceptions About The Challenges Of Declining Enrollment In A Caribbean University, Courtney Palmer

Walden Dissertations and Doctoral Studies

The precipitous decline in enrollment is a concerning aspect of higher education. The problem addressed in this study was that faculty members at a local university on a Caribbean island have faced an approximate 44% reduction in student enrollment over the past six years. Guided by the new learning compact framework (NLC), the purpose of this basic qualitative study was to explore industrial technology lecturers' perceptions from one Caribbean Island university about the challenges they experience from declining enrollment and examine their suggestions to improve enrollment. Twelve lecturers with tertiary-level teaching experience at the institution were interviewed using semi-structured interviews. …

Invisible Man: Mental Health Providers And How Implicit Bias Manifests When Treating African American Men, Jamila Kali Robinson

Walden Dissertations and Doctoral Studies

African American men continue to face disproportionate barriers to engagement, accurate diagnosis, and equitable nonbiased treatment in mental health settings. The purpose of the qualitative narrative inquiry was to explore how implicit bias and sociocultural assumptions manifest among mental health providers who diagnose and treat African American men. Bronfenbrenner’s ecological systems theory, which considers the influences of all the systems that shape an individual’s lived experiences, was the study’s theoretical framework. Semi-structured interviews were conducted with five licensed mental health providers who worked in large hospital systems, private practice, or community-based clinics. The interview data were analyzed using Braun and …

Exploring Strategies For Leadership In Small Businesses, Edward B. King

Walden Dissertations and Doctoral Studies

Small businesses face challenges in maintaining leadership continuity. Unstable leadership transitions can jeopardize business survival. Business leaders are concerned with selecting qualified succession leadership to avoid increased business costs and operational disruptions. Grounded in replacement planning theory, the purpose of this qualitative pragmatic inquiry project was to identify and explore successful strategies used by business leaders in small Oklahoma enterprises to select qualified leadership successors. The participants were six leaders of small businesses in the U.S. state of Oklahoma who had successful strategies for selecting qualified leadership successors. Data were sourced from semistructured interviews and publicly available organizational documents. Thematic …

Emergency Nurses’ Perspectives On Workload, Stress, And Violence In The Context Of The U.S. Nursing Shortage, Wanda Marie Haynes

Walden Dissertations and Doctoral Studies

The nursing shortage is a critical global issue that significantly impacts emergency nurses (ER), leading to increased workloads, psychological stress, and heightened exposure to workplace violence (WPV). This phenomenon raises concerns among healthcare administrators and nurse leaders who seek strategies to improve retention and ensure quality patient care. The purpose of this qualitative study was to explore the meaning of workload, stress, and WPV among ER nurses during the U.S. nursing shortage. Guided by Herzberg’s two-factor theory, the study employed a phenomenological approach to capture nurses’ lived experiences. Data were collected through semi-structured interviews with eight ER nurses from diverse …

Staff Education To Improve Antipsychotic Medication Adherence, Okikiola Oluwabunmi Ogunbunmi

Walden Dissertations and Doctoral Studies

Non-adherence to antipsychotic medication among patients with schizophrenia and other severe mental illnesses is a critical issue, contributing to high rates of relapse, rehospitalization, and increased healthcare costs. Despite the necessity of these treatments, patients often struggle with compliance due to lack of insight, side effects, or complex regimens. The project aimed to evaluate how structured staff education interventions increase knowledge and confidence among healthcare providers, regarding medication adherence strategies, including the use of Long Acting Injectable (LAI) antipsychotics and the “teach-back” methods. Staff education programs typically utilize evidence-based tools, pre-and post-intervention assessments, and training sessions to enhance knowledge on …

North Dakota Emergency Medical Personnel’S Perceptions Of Human Trafficking, Jessica Evans

Walden Dissertations and Doctoral Studies

Human trafficking is an abhorrent human rights violation, and victims experience a myriad of health disturbances while being exploited. Victims often seek emergency medical care, but research consistently shows that emergency medical personnel (EMP) are largely unprepared to screen, identify, and respond to them. However, there has been no research exploring their preparedness to screen, identify, and respond to victims of human trafficking, the barriers and challenges to identification of human trafficking victims, and training needs to improve screening, identification, and response to human trafficking victims in North Dakota. This study employed a generic qualitative approach grounded in constructivism. The …

The Moderating Role Of Self-Esteem In The Relationship Between Perceived Gender Bias And Job Satisfaction Among Women In The Technology Industry, Roberta L. Minicola

Walden Dissertations and Doctoral Studies

Women employed in the technology industry continue to experience gender-based bias that may adversely affect job satisfaction. Although the deleterious impact of gender bias on women’s job satisfaction has been well documented, the potential of self-esteem to mitigate this impact has not yet been examined. Informed by social dominance theory, the purpose of this quantitative, cross-sectional, correlational study was to examine the moderating effect of self-esteem on the relationship between perceived gender bias (i.e., insufficient support, devaluation, hostility) and job satisfaction among women working in the U.S. technology sector. Data were collected from 138 female technology professionals recruited through Amazon …

Understanding Reporting Decisions: Qualitative Exploration Of Hate Crime Underreporting Among Minority Transgender Individuals, Shanise Anita Benitez

Walden Dissertations and Doctoral Studies

Minority transgender individuals experience disproportionately high rates of hate‑motivated violence, yet these incidents remain substantially underreported. This qualitative study examined the social, structural, and identity‑based factors that influence reporting decisions among minority transgender adults in the United States. Guided by Bandura’s social learning theory and Crenshaw’s intersectionality theory, the study examined how participants’ lived experiences, community-based observations, and intersecting marginalized identities influence their perceptions of safety, trust, and institutional legitimacy. Semi‑structured interviews with minority transgender participants were analyzed using thematic analysis to identify patterns related to reporting behaviors, community‑driven coping strategies, and barriers to formal engagement with law enforcement. Findings …

Teachers And Administrators' Perceptions Of School Resource Officers, Shameka J. Duncan

Walden Dissertations and Doctoral Studies

School Resource Officers (SROs) play a significant role in middle and high schools in Metro Atlanta; however little research has included the perceptions of school administrators and teachers about their roles. The purpose of this descriptive qualitative study was to explore the perceptions of teachers and administrators regarding the roles of SROs and their perspectives on the practices that could enhance collaboration among these stakeholders in ensuring school safety. Informed by Gregory’s theory of perception, the study investigated how educators and administrators described their interactions with SROs. Data was gathered via semi-structured interviews with three teachers and three administrators and …

Optimizing Workforce Planning To Reduce Outsourcing Of Clinical Roles In Physician Practices, Heidi Sontag

Walden Dissertations and Doctoral Studies

The increasing reliance on outsourcing of clinical roles in physician practices has raised concerns regarding continuity of care, staff morale, and organizational control over service quality. While outsourcing may offer temporary financial relief, outsourcing often introduces inefficiencies and declines in patient satisfaction. In this integrative review, I identified workforce planning strategies that reduce outsourcing reliance while enhancing organizational efficiency and patient care outcomes. Using the Johns Hopkins evidence appraisal tools, I analyzed sources published between 2022 and 2025 grounded in resource dependency and Herzberg’s two-factor theories. Five thematic areas emerged: organizational efficiency, patient satisfaction, cost management, staff morale and engagement, …

Depression, Education, And Quality Of Life In Women With Endometriosis, Ria N. Gajar

Walden Dissertations and Doctoral Studies

Endometriosis is a chronic gynecologic condition associated with substantial physical, psychological, and social burden, and depressive symptoms are consistently linked to poorer health-related quality of life (HRQoL) among affected women. However, limited population-based research has examined how depressive symptoms intersect with social factors. Guided by Engel’s biopsychosocial model, nationally representative data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES)—the most recent cycle to include an item on endometriosis diagnosis—were analyzed among U.S. women with self-reported endometriosis (N = 4,137). Complex samples logistic regression models were used to examine associations between depressive symptoms and HRQoL across general, physical, and …

Effects Of The Efficient Implementation Of Corporate Finance Strategy On Company Performance, Benjamin Adewale Olugbemiro

Walden Dissertations and Doctoral Studies

The present global business environment requires organizations to be proactive, dynamic, innovative, and resilient in the face of increasing competition. Corporate executives must understand how effective implementation of finance strategies influences performance and how these strategies can be leveraged to support sustainable, socially responsible initiatives. The purpose of this qualitative case study was to improve the understanding of corporate executives’ perspectives about the effects of the efficient implementation of corporate finance strategy on company performance. The conceptual framework included Modigliani and Miller’s capital structure theory, stakeholder theory, and agency theory. The participants comprised 13 senior corporate executives and finance managers …

Association Between Environmental Exposures To Perfluoroalkyl And Polyfluoroalkyl Substances And Military Veterans Cancer Determination, Stephen A. Pereira Jr

Walden Dissertations and Doctoral Studies

This study involved evaluating whether cumulative exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) was associated with kidney cancer, bladder cancer, and adult leukemia among U.S. veterans. Pooled National Health and Nutrition Examination Survey (NHANES) data from 2005–2015 were analyzed for sample of 2,500 veterans with available serum PFAS measurements and physician-diagnosed cancer histories. This study employed a cross-sectional, correlational design grounded in a post-positivist paradigm. Inclusion required complete data for (a) serum PFAS concentrations, (b) kidney cancer, bladder cancer, and adult leukemia, and (c) covariates age, sex, race/ethnicity, smoking status, and body mass index. Cumulative PFAS was modeled as a …

Impact Of Incentive Policies On Mathematics And Science Teachers’ Retention In Guyana’S Rural Secondary Schools, Verna Adrian

Walden Dissertations and Doctoral Studies

Research on teacher retention in rural areas highlights persistent challenges, including geographic isolation, limited resources, and inadequate support. Studies have shown that financial incentives are critical for sustaining teacher retention, but a gap in the literature exists as to what specific non-financial challenges may also be important in influencing teachers’ long-term commitment. To address the social problem of teacher retention in rural secondary schools in Guyana, this study assessed the effectiveness of incentive policies in retaining teachers across four selected regions facing unique challenges. Data were collected through semi structured interviews and analyzed using thematic analysis. The purpose of this …

Experiences Of Care-Seeking Parents With Children With Autism Spectrum Disorder In India, Yash Navnit Patel

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD) affects approximately 18 million individuals in India, yet the factors influencing parental care-seeking behavior were not well understood. Guided by the health belief model, the purpose of this basic qualitative study was to explore how parents’ perceived severity of a child’s symptoms, parental beliefs about the causes of autism, and perceived mental and physical health outcomes of caregiving influence parents’ intention to seek services for children aged 1–10 years diagnosed with ASD in India. Data were collected using semistructured interviews with 10 mothers of autistic children. Data were analyzed using Braun and Clarke’s six-step thematic analysis. …

Preventing Burnout In School-Based Behavioral Health Clinicians: Organizational Strategies For Mitigating Work-Related Mental Health Impairment, Virginia W. Lee

Walden Dissertations and Doctoral Studies

This is a qualitative case study on Organization X that used the Baldrige Framework to investigate employee burnout, a growing concern associated with staff turnover, reduced job satisfaction, depression, and disengagement. The goal was to examine how organizational leaders assess the effectiveness of burnout prevention strategies, identify organizational factors and leadership practices that either mitigate or increase burnout, and discover key factors that contribute to burnout. Semi-structured interviews, guided by the Baldrige Framework, were conducted with three leaders at Organization X. The themes resulting from interviews included burnout, open-ended communication, team cohesion, real-time protection, ethical leadership and authenticity, restoring norms, …

Proposal For An Intensive Outpatient Program, Dorcas Olatokunbo Ogundemuren

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) executive leadership systems improvement program presents the design of an evidence-based intensive outpatient program (IOP) in a community psychiatric clinic in the central region area of Maryland, to address the practice problem of fragmented transitions from inpatient psychiatry to routine outpatient services. This practice gap contributes to avoidable 30-day readmissions and prolonged emergency department boarding. The guiding practice question was as follows: In behavioral health organizations, how does a leadership-driven IOP implementation affect care transitions, staff engagement, and protocol adherence compared with existing discharge workflows? Local organizational indicators reveal elevated psychiatric readmission rates and …

Program Proposal For A Nurse Led Pre-Procedure Readiness Program, Walter Magramo

Walden Dissertations and Doctoral Studies

Same-day outpatient procedural cancellations represent a persistent challenge for healthcare organizations, negatively affecting patient safety, access, operational efficiency, and financial performance. This Doctor of Nursing Practice (DNP) executive leadership project proposes the implementation of a nurse-led, artificial intelligence (AI)–enhanced preprocedural readiness program within an outpatient procedural department. The initiative integrates standardized nurse-led readiness checklists, AI-supported clinical decision support embedded in the electronic health record, structured nurse-led outreach, and standardized patient and staff education to proactively identify and address preventable barriers to procedural readiness. Internal organizational data identified a sustained same-day cancellation rate of approximately 22%, with most cancellations attributable to …

Reasons For Digital Transformation Project Failures Based On U.S. Project Managers’ Lived Experiences, Susan D. Landes

Walden Dissertations and Doctoral Studies

Digital transformation projects have a failure rate of 66% to 84%, costing U.S. companies billions of dollars each year. Organizational leaders need to understand the implications of these costly failures, leading to substantial financial losses. The purpose of this qualitative descriptive phenomenological study was to explore the reasons for digital transformation project failures from the perspective of the lived experiences of U.S. project managers. The conceptual framework consisted of Lewin’s 3-stage change management model, Correani et al.’s digital transformation implementation model, Herzberg’s 2-factor theory of motivation-hygiene, and von Bertalanffy’s systems theory. The participants were 13 U.S. active, certified professional project …

Community Reintegration Programs For Successful Reentry For Individuals Deemed Not Guilty By Reason Of Insanity, Joanna Baker

Walden Dissertations and Doctoral Studies

Very little research has been conducted on the institution of community reintegration programs for individuals deemed not guilty by reason of insanity (NGRI). In the United States, each state can determine the path for community reentry with the NGRI population. California has a strategic and supportive reentry program that requires services such as drug testing, individual therapy, and close monitoring. Other states, including North Carolina, do not have a reentry program in place for the NGRI population. No research exists comparing states with conditional release programs and states without these programs. Consistence in community reintegration programs among all states can …

Trauma Coping Mechanisms Among Police In Small Departments, Peter Michael Ungaro

Walden Dissertations and Doctoral Studies

Mental health services are available to police officers, but many do not utilize these resources due to stigma, shame, and fear of job loss. This reluctance often forces officers to handle mental health issues alone, frequently leading to unhealthy coping strategies that negatively impact their well-being and job performance. While advancements in mental health support exist, they primarily serve larger departments, leaving the needs of small departments largely unmet. The foundation of the study was rooted in resilience theory, which holds that the impact of trauma on an individual is determined not by the event itself but by the coping …

Staff Education Project On Enhancing Provider Knowledge And Confidence In Adolescent Depression Assessment Using The Phq-9 Tool, Beatrice Ogoh Stephens

Walden Dissertations and Doctoral Studies

Adolescent depression is a developing public health issue, especially in underprivileged areas where delayed diagnosis and treatment are caused by uneven screening procedures and inadequate provider training. By increasing provider and staff knowledge, confidence, and use of the Patient Health Questionnaire-9 (PHQ-9) for systematic teen depression screening, this staff education project filled a practice gap in a primary care clinic. Fifteen clinic staff members who provide adolescent care participated in a four-hour evidence-based educational intervention that was guided by the ADDIE instructional design approach. Fifteen clinic staff members who provide adolescent care participated in a four-hour evidence-based educational intervention that …