Digital Commons Network^™

Providing Safe Gastric Feedings In Pediatric Patients On High Flow Nasal Cannula Respiratory Support, Olivia Joyce Chan

Yale School of Nursing Digital Theses

Purpose: HFNC is used to manage pediatric respiratory distress, but concerns aboutgastric air insufflation and aspiration risk lead to delayed feedings. There is no standardized practice guiding gastric feedings in children on HFNC. This project developed and implemented a decision tree to guide clinical decision-making for gastric feedings for children on HFNC. Methods: A HFNC feeding safety decision tree was developed following literature review and implemented in a Pediatric Intensive Care Unit (PICU). The primary outcome evaluated HFNC flow rates when starting gastric feeds. Secondary outcomes include adverse events (AEs), physiologic distress, and PICU/hospital LOS. Data were analyzed using Chi-Square …

Changing The Paradigm For Newly Graduated Nurses’ Intent To Leave Through An Emeritus Rn Virtual Mentoring Program In An Acute Care Hospital Setting, Lacy Eynon

Yale School of Nursing Digital Theses

The U.S. nursing shortage presents a critical challenge to healthcare organizations, withwide-reaching implications for patient safety and financial sustainability. High nurse turnover contributes to increased staffing costs, estimated at $56,300 average cost per nurse replaced. This shortage directly impacts patient outcomes including increased rates of medical errors, patient mortality and decreased overall quality of care. Supporting early-career nurses through mentorship programs is a promising strategy to improve professional development and retention, thereby addressing clinical and economic consequences workforce shortages. This DNP Project developed and implemented an Emeritus RN Virtual Mentoring Program utilizing experienced emeritus nurses to mentor nurses with less …

Empowering Emerging Air Medical Leaders Through A Novel Professional Development Program Adapting National Nursing And Healthcare Management Competencies To A Multi-State Air Medical Service, Christopher Hardman

Yale School of Nursing Digital Theses

Empowering Emerging Air Medical Leaders through a Novel Professional Development Program Adapting National Nursing and Healthcare Management Competencies to a Multi-State Air Medical ServiceHigh turnover in the nursing workforce has led to clinicians with limited experience being promoted to leadership roles without proper training or support. Nurse leaders directly impact clinical outcomes and retention. The financial burden of turnover is significant, as health systems must continually replace employees. Despite this, limited evidence exists on effective professional development and retention strategies in non-traditional, non-hospital settings. This DNP project sought to adapt and implement a novel professional development program, derived from the …

Transgender And Gender Diverse People – Inclusive Healthcare System Access, Dakota Denielle Lawtum

Yale School of Nursing Digital Theses

Transgender and Gender Diverse People – Inclusive Healthcare System AccessPurpose: This DNP project implemented a dual strategy to increase system-wide access to care and awareness of the needs of transgender and gender diverse people. Background: The 2015 U.S. Transgender Survey is the most recent and largest survey of its kind in the United States comprising a total of 27,715 responses. (National Center for Transgender Equality, 2015, U.S. Transgender Survey). The results of this survey are as follows: 1) 26% of the total national respondents experienced insurance issues for gender affirming healthcare or being denied coverage for routine care; 2) 32% …

Developing A Decision Tree To Address Behavioral And Psychological Symptoms Of Dementia In The Primary Care Setting, Lolita Tramel

Yale School of Nursing Digital Theses

AbstractDeveloping a Decision Tree to Address Behavioral and Psychological Symptoms of Dementia in the Primary Care Setting There are 55 million people living with dementia worldwide. In the United States, there are approximately 7.2 million people living with Alzheimer’s dementia and these numbers are expected to rise. The U.S. Department of Health and Human Services (2022) identified there is a shortage of behavioral health clinicians nationwide. As the population ages, demand for behavioral health clinicians will be high and supply will remain low. Primary care providers (PCPs) will be required to see an influx of dementia patients despite finding it …

Identifying How Pseudomonas Aeruginosa Cells Become Primed For Expression Of Type Iii Secretion System Genes, Kristen Alicia Ramsey

Yale Graduate School of Arts and Sciences Dissertations

Pseudomonas aeruginosa is an opportunistic pathogen known to cause acute infections in individuals with epithelial damage or medically placed devices, leading to sepsis or death in immunocompetent and immunocompromised individuals. Like many other Gram-negative bacteria, P. aeruginosa uses a Type III Secretion System (T3SS) to intoxicate eukaryotic cells. This T3SS is essential for P. aeruginosa to establish an infection and avoid clearance by immune cells and is also linked to increased morbidity and mortality in infections. Despite this necessity, activation of the T3SS slows P. aeruginosa’s cell growth and permits innate immune system detection and resulting inflammation. To balance …

Implementation Of Teamstepps® In A Peri-Operative Environment In An Urban Medical Center, Chris Chantler

Yale School of Nursing Digital Theses

Problem and Context: Preventable Patient Harm (PPH) continues to occur frequently in healthcare. Failures in communication, poorly functioning teams, and a lack of shared mental models (SMMs) continue to challenge healthcare organizations. The purpose of this PI project was to improve communication and teamwork, among team members in a Peri-Operative setting. TeamSTEPPS® was selected as the training curriculum. Multiple parameters, including perceptions of teamwork, and safety metrics were evaluated pre and post-intervention.

Intervention: TeamSTEPPS® was selected as the training curriculum. TeamSTEPPS® is a highly adaptable curriculum designed to address these gaps and to improve team function in the healthcare setting. …

Implementing A Screening Algorithm For Depression Diagnosis, Management And Referrals In Primary Care, Jorge Correia

Yale School of Nursing Digital Theses

Depression is a major cause of mortality, morbidity, disability, and economic costs in theUnited States. Everyday millions of Americans navigate our complex healthcare field to find the best solution to their problem. Due to a shortage of specialized psychiatric providers, often these people must rely on the primary care settings to get the help they need. However, the lack of knowledge in screening and management of mood disorders causes many of these patients to fall through the cracks or get substandard quality of mental health care. The goal of this quality improvement project was to develop and implement a screening …

A Systems Organizational Model Of Professional Role Development For New Apps: Building A Train The Trainer Program, Abigail H.B. Baugh

Yale School of Nursing Digital Theses

Most Advanced Practice Provider (APP) turnover occurs within the first year of practice. It is often linked to feelings of inadequacy caused by limited professional instruction and immediate expectations of full practice integration. These challenges are compounded further in systems with inconsistent onboarding processes and underprepared trainers, further exacerbating turnover rates. At East Carolina University (ECU) Health System, turnover rates for Physician Assistants and Nurse Practitioners reached 20% and 12%, respectively, surpassing national averages (ECU Health, 2024), highlighting the urgent need for a structured onboarding approach.A system-based Train-the-Trainer (TTT) program was developed to address these issues, focusing on essential areas …

Nursing Innovation As A Solution To Improve Care Delivery, Danielle Therese Huseman-Maratea

Yale School of Nursing Digital Theses

Healthcare in the United States is complex and expensive. The 2023 per capita national health expenditure for the United States was $14,570 and 31% of national health expenditures were related to hospital care (Centers for Disease Control and Prevention, 2024). Healthcare innovation is a solution to this problem as it can improve quality and reduce cost (Walker, 2011). The value of nurses’ contribution around innovation tables was demonstrated during the COVID-19 pandemic (Koszalinski et. al, 2021). A 2020 study conducted by Johnson & Johnson, the American Nurses Association, and the American Organization for Nursing Leadership found that only 46 percent …

Improving The Reporting And Tracking Of Hospital-Acquired Pressure Injuries, Melinda Rosado

Yale School of Nursing Digital Theses

Hospital-acquired pressure injuries (HAPIs) affect millions of patients a year, impacting patient safety and creating a significant financial burden for healthcare systems. Inadequate reporting and tracking of HAPIs lead to delays in care, inaccurate data reporting and missed opportunities for quality improvement. This is in large part due to a lack of training and education around HAPIs, poor communication of injuries during hand-off and a lack of system integration. A process improvement program to improve the reporting and tracking accuracy of HAPIs was piloted on two post-surgical units in a large urban cancer center. This initiative combined comprehensive training via …

Cultural Intelligence For Advanced Practice Providers: Moving A Contextually Based Model Forward For Workforce Training, René Padilla

Yale School of Nursing Digital Theses

Cultural Intelligence for Advanced Practice Providers: Moving a Contextually Based Model Forward for Workforce TrainingCultural Intelligence (CQ) among clinicians in primary care for the Hispanic population is inadequate (Da Costa, 2023). Cultural diversity training for patient care has been identified as a need to improve outcomes since the 1960s (Lin et al., 2017). In 2000, the Office of Minority Health (OMH) at the US Department of Health released the National Standards for Culturally and Linguistically Appropriate Services in Healthcare and updated those standards in 2013. Mainous et al. (2020) found that only 35% of primary care providers (PCPs) knew of …

Promoting Mental Health Awareness And Reducing Stigma In Spanish-Speaking Communities Through Educational Interventions, Kelly Medina Prado

Yale School of Nursing Digital Theses

Background: Spanish-speaking Latino populations in the U.S. experience significant disparities in mental health access driven by language barriers, low mental health literacy, and cultural stigma. These factors contribute to the underutilization of services, early treatment dropout, and poor outcomes.

Objective: This quality improvement project aimed to develop, implement, and evaluate a culturally and linguistically tailored mental health education intervention designed to increase mental health literacy and reduce stigma among Spanish-speaking Latino adults in a federally qualified health center.

Methods: A total of four group sessions were conducted over an eight-week period. The sessions were delivered in Spanish and included culturally …

Panel: Program For Advancing Nursing Excellence For Leaders, Christopher D. Tarquinio

Yale School of Nursing Digital Theses

Healthcare organizations strive for nursing excellence, evident through prestigious awards like Magnet® Recognition and the Beacon Award of Excellence®. Nurse leaders play a crucial role in fostering a culture of excellence, but many face challenges due to confidence levels. PANEL educates nurse leaders on the connections between nurse satisfaction, patient satisfaction, and nurse quality measures (NQMs). By applying PANEL principles and transformational leadership, healthcare systems can positively impact nurse satisfaction, patient satisfaction, and NQMs. The aims of this project were: to develop a nursing excellence program for nurse leaders within a community-based healthcare system with the goal of connecting the …

Changing The Vantage Point Of Nurses Toward Evidence-Based Practice: Embedding Storytelling Into A Novel On-Demand Micro-Learning Program, Janet Ruscoe

Yale School of Nursing Digital Theses

CMS withholds billions in payments to fund VBP and incentivize hospitals to improve care. Achievements in TPS, which includes patient satisfaction and safety domains, is an opportunity to earn back incentive payments. Advancing nurses' adoption of EBP helps keep patients safe, improves satisfaction, and supports hospital financial viability (Kemp et al., 2023). However, gaps exist in the competency and application of EBP (Melnyk et al., 2018). A curriculum was developed to improve nurses' perceptions of EBP value. A storytelling, micro-learning approach was utilized to deliver the EBP-relevant knowledge. The digital platform provided on-demand, unlimited re-entry features that optimized flexibility, convenience, …

Provider Mindfulness: Changing Implicit Bias And Improving Perinatal Health Outcomes For Patients With Adverse Social Determinants Of Health, Nina Sarah Simon

Yale School of Nursing Digital Theses

AbstractProvider Mindfulness: Changing Implicit Bias and Improving Perinatal Health Outcomes for Patients with Adverse Social Determinants of Health Purpose: Implicit bias is an unconscious prejudice or preexisting belief developed over time toward another group. It can influence provider judgement, treatment decisions and levels of care. The purpose of this DNP Quality Improvement (QI) project was to improve patient care and provider knowledge on how implicit bias affects perinatal health for those with adverse social determinants of health (SDOH). Methods: A 53-second daily mindfulness intervention was developed and implemented among 8 obstetric providers caring for a population at risk for bias …

Implementing A Patient-Centered Pediatric Obesity Protocol In A Population With Social And Environmental Risk Factors, Carolyn Walsh

Yale School of Nursing Digital Theses

Children and adolescents exposed to adverse childhood experiences (ACEs) and negative social determinants of health (SDoH) have an increased risk of developing pediatric obesity. The American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity (2023) recommends assessing these factors in children with obesity. At a School-Based Health Center (SBHC), the standard of care for pediatric obesity did not include ACEs and SDoH screening, highlighting a gap in practice. This Doctor of Nursing Practice project developed, implemented, and evaluated a patient-centered pediatric obesity protocol incorporating ACEs, SDoH screening, and referrals to patient-centered …

A Model For Improving Nursing Homes' Quality Metrics Through Systems' Policy Change In Widespread Antipsychotic Use, Hugo Masangkay Gozos

Yale School of Nursing Digital Theses

In 2019, more than half of nursing home residents were estimated to have had dementia (PRB, 2023). In 2020, about 300,000 of these residents had been prescribed antipsychotics (Jaffe, 2020). Per the Office of the Inspector General (OIG) (2021), nearly one in three nursing home residents were inappropriately diagnosed to justify the use of antipsychotics. Individuals diagnosed with dementia and prescribed with antipsychotics have a 78% higher risk of death (Kheirbek et al., 2019). Educational training can serve as an effective tool for advancing knowledge of antipsychotics in avoidance of inappropriate use, specifically when directed toward nursing home providers and …

Addressing Intergenerational Retention And Workplace Satisfaction Factors With A Workshop For Nurse Leaders, Elizabeth Labish

Yale School of Nursing Digital Theses

Nursing is a multigenerationally diverse workforce, with up to five generations (Traditionalists, Baby Boomers, Generation X, Millennials, and Generation Z) contributing simultaneously (Gerhardt et. al, 2022). Each generation holds varied work preferences and retention drivers, which manifest as unique drivers of preventable turnover. Leaders can reduce turnover and its associated costs by cultivating a multi-generationally preferred work environment (Koehler & Olds, 2022). The purpose of this project was to deliver a workshop for nurse leaders to improve their knowledge about leading multigenerational workforces. Following literature review, A 2.5 hour in-person workshop was created and delivered at a community hospital. The …

Nativity Status And Tobacco Use Among Hispanic Adults In The Us, Siyan Zhou

Public Health Theses

Background: Tobacco use is the leading cause of preventable mortality. Understanding the consumption patterns of cigarettes and e-cigarettes, two of the most prevalent and harmful tobacco products, is important for population health. Furthermore, as the nation's largest racial or ethnic minority group, the Hispanic population faces tobacco-related disparities despite overall low prevalence of tobacco use. Since the Hispanic population is not homogeneous, it is important to disaggregate it by ancestry and nativity status to better guide policy and targeted interventions.

Methods: The 2022 September Tobacco Use Supplement to the Current Population Survey (TUS-CPS) included 37,540 participants in the US. Rao-Scott …

Laro Kwo-Saving Lives: Evaluating The Role Of Community Health Workers In Healthcare Delivery And Disease Control In Northern Uganda, Brett Albee

Public Health Theses

Background: Northern Uganda faces persistent health challenges due to a legacy of armed conflict, poverty, and fragile health infrastructure. In Pader District, malaria remains the leading cause of under-five mortality, and rural communities face ongoing barriers to accessing timely care. Community health workers (CHWs) serve as critical intermediaries in care delivery, but their effectiveness is limited by structural and resource constraints.Methods: This study employed an exploratory sequential mixed-methods design informed by community-based participatory research (CBPR) principles. Qualitative data were collected through 11 semi-structured interviews and 6 focus group discussions with CHWs across six sub-counties in Pader District. Quantitative data were …

Cost-Effectiveness Of New Monoclonal Antibody And Maternal Immunization For The Prevention Of Respiratory Syncytial Virus (Rsv) Disease In Infants: A Systematic Review, Yuwei Che

Public Health Theses

AbstractIntroduction: Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality among infants and young children worldwide. Given the lack of specific therapeutic treatments for RSV that are suitable for universal use, the development of effective prevention strategies is of paramount importance. Previously, palivizumab was utilized for long-term prophylaxis of RSV infections; however, it was only recommended for specific populations due to its high cost and limited overall effectiveness. In 2023, the U.S. FDA approved RSVpreF maternal vaccine (Abrysvo™, Pfizer), and nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV to newborns. Two newly developed interventions have …

The Impact Of Climate Change On Japanese Encephalitis Trends In China, Jiayi Du

Public Health Theses

Japanese encephalitis (JE) is a mosquito-borne viral disease that poses a significant public health threat across Asia, including China. Climate change has been increasingly recognized as a key driver of JE transmission dynamics, influencing mosquito vector distribution and virus proliferation. This study aimed to assess how climatic variables affect the ecological suitability for Japanese encephalitis virus (JEV) transmission, using species distribution modeling with MaxEnt.

Using climate data from WorldClim and JE incidence data from published sources, we applied the MaxEnt model to identify the key environmental predictors of JE transmission and project future risk areas under changing climatic conditions. The …

Exploring Harm Reduction In Treatment: A Qualitative Study Of Methods And Perceptions Among People In Substance Use Disorder Care, Carson Francis Ferrara

Public Health Theses

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl …

Crowned In My Confidence: The Impact Of Self-Perceptions Of Black Hair & Ethnic Identity On The Mental Health Of Black Teen Girls, Olivia Francis

Public Health Theses

Introduction: Black girls’ mental health is significantly affected by the intersection of racism and sexism, leading to higher rates of anxiety, depression, and psychological distress. Ethnic identity can serve as a protective factor, fostering resilience and self-esteem, but difficulties with identity formation can increase vulnerability to mental health challenges. This paper explores the connection between ethnic identity, self-perceptions of Black hair, and mental health outcomes. Methods: Utilizing survey data from the Dreamer Girls project, which included a sample (N= 201) Black girls between the ages of 13-18 (M= 16), the study explores hair-esteem, ethnic identity, anxiety, depression, and suicidality. Hair-esteem …

Secondhand Smoke Exposure And The Risk Of Tuberculosis In Children: A Systematic Review And Meta-Analysis, Cenyun Guan

Public Health Theses

ABSTRACT

Introduction: Tuberculosis (TB) remains one of the leading causes of death globally, with children and young adolescents having a significant burden of the disease. Smoking is a well-established risk factor for TB, but the association between secondhand smoke (SHS) exposure and TB remains inconclusive. Pediatric populations are commonly exposed to SHS due to living with smokers in their households. Inconsistencies in the findings of previous systematic reviews on the associations between SHS exposure and TB status (infection and disease) highlight the need for an updated systematic review to better establish these associations and provide evidence-based guidance for reducing the …

Effect Of The Lifestyle, Exercise And Nutrition (Lean) Weight Loss Intervention On Stress Among Breast Cancer Survivors, Wenxin Gu

Public Health Theses

Background: Stress, experienced by over one-third of breast cancer survivors, not only leads to significant symptoms and mental health issues, but also increases the risk of breast cancer recurrence and impacts survival. While weight loss lifestyle interventions have been effective in helping breast cancer survivors with obesity lose weight and potentially enhance survival, their impact on stress levels has been inconsistent. The aim of the secondary analysis was to evaluate the effects of a 6-month diet and exercise weight loss intervention on perceived stress in breast cancer survivors.Methods: Breast cancer survivors with a BMI of 25.0 kg/m2 or higher (n=151) …

Environmental Justice Dimensions Of Orphaned Oil And Gas Wells In The United States, Grace Marie Hauser

Public Health Theses

Orphaned oil and gas (O&G) wells can leak methane and other hazardous pollutants,contributing to air and water contamination that threatens public health while also imposing financial burdens on local governments and taxpayers for remediation. However, the environmental and public health impacts remain understudied, in part due to limited understanding of the number and location of orphaned O&G wells. In this thesis we aimed to (1) create a national orphaned wells dataset covering years through 2024, (2) estimate the count and distribution of orphaned wells in the United States through 2024, and (3) evaluate the association between community environmental justice (EJ) …

Effect Of The Lifestyle, Exercise, And Nutrition Weight Loss Intervention On Depressive Symptomatology Among Breast Cancer Survivors, Ziyuan Ma

Public Health Theses

Background: Breast cancer patients have up to a five-fold higher risk of depression compared with the general population, with an estimated prevalence of depressive symptoms of 25%. Depressive symptoms among breast cancer patients can affect treatment adherence, quality of life, and mortality. Some studies indicate lifestyle interventions can lower depression symptoms in general population samples; however, few studies have examined changes in depression among breast cancer survivors enrolled in lifestyle interventions. The purpose of this study was to examine the effect of a 6-month diet-and exercise-induced weight loss intervention versus usual care on depressive symptomatology among breast cancer survivors.Methods: 151 …

Insights Into Medical Surveillance Among Engineered Stone Countertop Workers In The United States Of America, Tony Huy Nguyen

Public Health Theses

Background: An alarming rise in the number of cases of silicosis, a progressive and incurable lung disease, among engineered stone (ES) workers has prompted concern about the extent of the problem in the U.S. and whether ES can be used safely. Overexposure to high levels of respirable crystalline silica (RCS) during fabrication or installation of ES can increase the risk of developing a more severe case of silicosis. Medical surveillance studies on US ES workers are limited.Aim: The overall objective of this study was to better understand the state of medical surveillance for ES workers using employer surveys and employee …