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Defining Quality Of Life: The Lived Experience Of Adults With Pulmonary Hypertension And The Impact Of Activity-Induced Respiratory Distress, Bethany Jean Adams

Walden Dissertations and Doctoral Studies

Pulmonary hypertension (PH) is a progressive, life-limiting disease that significantly affects quality-of-life (QoL). Limited research has explored lived experiences of individuals with PH. Guided by Parse’s human becoming theory, this qualitative descriptive phenomenological study explored the lived experiences of individuals affected by PH and examined how activity-induced respiratory distress affected QoL. The research Question was: How do individuals with PH describe the impact of activity-induced respiratory distress on their QoL. I conducted interviews with nine participants, including eight adults diagnosed with PH and one caregiver of an individual with PH. Data were analyzed using Saldaña's comparative coding framework to identify …

Facilitating Palliative Care In The Intensive Care Unit, Crystal Sanchez

Master's Projects and Capstones

Abstract

Problem: Critically ill patients in the intensive care unit (ICU) frequently experience unmet palliative care needs due to inconsistent identification processes and delayed goals‑of‑care (GOC) discussions. Prior to this project, palliative care consultation practices were highly variable and lacked standardized criteria, resulting in missed opportunities for early communication and symptom management. This gap underscored the need for a structured, nurse‑driven approach to improve timely palliative care integration.

Context: This quality improvement project was conducted in a 20‑bed adult ICU within a large community‑based hospital system where palliative care integration was inconsistent and not systematically monitored.

Interventions: A nurse‑driven palliative …

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Scholarly Projects

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Recognizing Appropriate General Inpatient Hospice Patients Time To Stop Normalizing Suffering, Oliver Charles Roth

Walden Dissertations and Doctoral Studies

Hospice patients experiencing uncontrolled pain, dyspnea, agitation, anxiety, delirium, or other severe symptoms may require General Inpatient (GIP) hospice care for intensive symptom management. However, inconsistent recognition of symptom crises can delay escalation to the appropriate level of care, contributing to unnecessary patient suffering, caregiver distress, and avoidable emergency department or hospital utilization. This Doctor of Nursing Practice executive leadership project evaluated the implementation of an educational framework designed to improve clinician recognition and timely escalation of patients who may be appropriate for GIP hospice care. Education emphasized early identification of uncontrolled symptoms, interdisciplinary communication, documentation, and escalation for clinical …

Identifying Palliative Care Needs In The Emergency Department, James Sullivan

All Doctor of Nursing Practice (DNP) Scholarly Projects

This quality improvement project evaluated the implementation of the Palliative Care and Rapid Emergency Screening (P‑CaRES) tool to improve early identification of unmet palliative care (PC) needs among adults with advanced, life‑limiting illnesses presenting to a community emergency department (ED). The problem addressed was the absence of a standardized PC screening process, resulting in delayed recognition, missed referral opportunities, fragmented care, and repeated ED utilization. Guided by Plan‑Do‑Study‑Act cycles and the OhioHealth Change Management Model, the project integrated P‑CaRES into ED workflows, provided staff education, and established structured referral pathways. Over 12 weeks, clinicians completed 65 screenings; 57 patients met …

Intersectional Inequities In End-Of-Life Care Quality: The Roles Of Race, Ethnicity, And Gender, Jessica A. Yauk

USF Tampa Graduate Theses and Dissertations

Persistent gaps remain in end-of-life care quality (EOLCQ) in the United States. Structural factors within the health care system, as well as discriminatory practices, affect the quality of care received by at-risk populations. This dissertation uses a mixed-methods research design to examine perceived EOLCQ across racial/ethnic and gender groups. Study 1 and Study 2 were guided by the intersectionality and Social Determinants of Health (SDOH) frameworks, and examined ten EOLCQ outcomes: pain, dyspnea, sadness or anxiety, having personal care needs met, having decisions made about care without enough input from decedent or family, whether the proxy or family were kept …

Breaking Down Barriers To Pediatric Respite Care Use, Michelle Montanez

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Parents of children with a life-limiting illness provide constant, around-the-clock care, often leaving little time for their well-being. This responsibility is emotionally, mentally, and physically demanding, and without proper support, parents face increased risk of depression, burnout, and deteriorating health. Respite services offer relief by providing a much-needed break and allowing parents the opportunity for self-care and improved well-being. Though the benefits of respite are well documented, these services remain underutilized due to barriers such as limited provider awareness, lack of access, and emotional challenges the parents face. This Doctor of Nursing Practice (DNP) project aims to address these barriers …

Staff Education To Improve End-Of- Life Pain Management Confidence Among Long-Term Care Nurses, Andrea Osuji

Walden Dissertations and Doctoral Studies

No abstract provided.

Ethical Considerations For Hospice Patients In Inpatient Settings: A Systematic Review And Thematic Analysis, Matthew D. Harry

Honors Theses and Capstones

Hospice care is intended to prioritize comfort, dignity, symptom management, and quality of life for individuals with life-limiting illness. However, when hospice-eligible patients are managed within inpatient hospital settings, significant ethical challenges frequently emerge due to the tension between comfort-focused care and the curative, intervention-driven structure of acute care medicine. This paper presents a systematic literature review and thematic analysis examining the ethical considerations surrounding hospice patients in inpatient settings, with particular attention to clinical decision-making, communication, prognostic uncertainty, moral distress among nurses, and conflicts involving patient autonomy and family wishes. A structured review of peer-reviewed literature was conducted using …

Patient-Centered End-Of-Life Care: Balancing Ethics, Communication, And Quality Of Life, Alexis N. Courtney

Integrated Studies

Abstract

End-of-life care is not just a medical treatment, but can be the turning point in someone’s life to end unnecessary suffering and honor their wishes to have quality over quantity in life. This paper will discuss end-of-life care from the perspectives of patient autonomy, communication, ethical decision making, and system influences. It will explore the impact of honoring patient preference. Not to mention how speaking honestly and compassionately may affect enhancing the quality of life of patients experiencing terminal or life-limiting illnesses.

One of the key aspects of this paper is the significance of communication in end-of-life care. Specifically, …

"They Just Gave Me The Syllabus": A Mixed Methods Study Of Music Therapy Educators' Preferred Pedagogies, Christina Danielle O'Brien

West Chester University Graduate Theses, Dissertations, and Final Projects

In 2022, the workforce analysis of music therapists, the American Music Therapy Association reported that approximately 80% of all board-certified music therapists are white/Caucasian-European (Iwamasa, 2025). However, the AMTA does not determine the origins of race or ethnicity among postsecondary music therapy faculty in the U.S., nor does it assess their potential impact on the expansion of multicultural curricula for preservice professionals. The purpose of this convergent mixed-methods dissertation is to examine the perception of lived experiences as a pedagogical tool to enhance effective teaching practices. Twenty-six postsecondary faculty from the U.S. were recruited. Quantitative data were collected via Qualtrics …

Indoor Environmental Quality Perceptions And Self-Reported Symptoms Among West Haven Va Healthcare Employees, Joseph Hyong Kim

Public Health Theses

Background: Indoor environmental quality in workplace settings influences worker well-being, yet the relationship between perceived workplace environment and reported symptoms remains less well characterized in heterogeneous healthcare settings. This study describes perceived workplace environmental quality and self-reported symptoms among employees at the West Haven Veterans Affairs (VA) Medical Center.

Methods: An observational, cross-sectional study was conducted of VA employees across clinical and non-clinical roles to assess perceived work environment, symptoms and indoor exposures using an electronic survey and personal and area air monitoring of indoor volatile organic compounds (VOCs) and viruses. Perceived workplace environmental quality was assessed using the MM-40 …

Beat By Beat: Empowering Communities With Lifesaving Cpr Skills, Allyssa Mb Hutchins

Doctor of Nursing Practice Projects

Introduction: This doctoral project was created to increase bystanders' willingness and ability to perform CPR by building their confidence in performing it effectively. A total of 13 participants participated in this project to increase knowledge and confidence in CPR interventions.

Background: Cardiac arrests remain a leading cause of death, yet research indicates that rural communities have lower rates of bystanders trained and willing to assist. Increasing CPR awareness and eliminating barriers to care for classes can improve CPR confidence and have a positive community impact.

Methods: Three 4-hour CPR classes were held in Zirconia, NC, at no …

Increasing Colon Cancer Screening Completion Rates Utilizing Patient Navigation In Primary Care: A Quality Improvement Project, Anya C. Pennycooke

Electronic Theses and Dissertations 2020 - Present

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. It is highly preventable through routine screening and early detection, yet national data indicate that one in three eligible adults remains unscreened. The purpose of this Quality Improvement (QI) project was to increase colon cancer screening completion rates by implementing a patient navigation program. Kristen Swanson’s Theory of Caring guided the intervention by promoting patient-centered communication. W. Edwards Deming’s Plan-Do-Study-Act (PDSA) model provided the framework for this approach. Patients aged 45-75 years due for colon cancer screening were identified using the electronic health record (EHR) in …

Quality Of Life And Mental Health: A Qualitative Exploration Of Perceived Factors That Impact Older Adults, Chasiti Herring

All-Inclusive List of Electronic Theses and Dissertations

Enhancing quality of life and well-being is a universal phenomenon across the lifespan. As the population ages, older adults are in great need of supportive services to enhance quality of life and their ability to manage their mental health. The purpose of this study is to examine the quality of life (QoL) of older adults. This study aimed to provide valuable research in the area of QoL through the exploration of perceived factors that impact the older adult population. This exploratory qualitative research study consisted of 10 older adult participants between the ages of 65 and 95. Research recruitment prioritized …

Barriers To Hospice Access For The Latino Community, Guadalupe Rivera

Capstone Projects and Master's Theses

The Latino community in Monterey County faces significant obstacles to accessing hospice care, including language barriers and cultural misunderstandings. Many community members are unfamiliar with available hospice services or hold common misconceptions, such as equating hospice only with dying or abandonment. This capstone project, in partnership with the Central Coast Visiting Nurse Association (VNA), investigated these barriers through interviews conducted at a local senior event. An important outcome of the project was the creation of a bilingual (Spanish and English) resource guide for new Social workers which helps social workers efficiently connect Latino families to appropriate services in their preferred …

Advancing Palliative Care Competency Through An Evidence-Based Educational Intervention For Healthcare Providers, Lauren Elizabeth Griffin

Walden Dissertations and Doctoral Studies

A major gap in acute care is the delayed initiation of palliative consultations. Although over 58 million people worldwide could benefit, only 14% receive such care. Despite evidence that early involvement improves outcomes, providers often overlook their value, leading to late referrals, typically after repeated hospitalizations or near end-of-life, when hospice may be more appropriate. This Doctor of Nursing Practice (DNP) educational intervention addressed a critical practice-focused question to enhance healthcare providers’ understanding of palliative care improve hospital-based patient outcomes. The intervention aimed to demonstrate a ≥20% knowledge gain from pretest to posttest scores related to distinguishing palliative care from …

Implementing Pain Reassessment Workflow To Improve Timely Pain Management In Hospice Patients: A Quality Improvement Project, Oluremi Omodara

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely pain reassessment is a vital component of hospice care, directly influencing the quality of life for patients. Despite the high prevalence of pain, which affects 55% of hospice patients due to disease progression or adverse drug reactions, only 51% of those reporting moderate to severe pain at admission receive a documented reassessment. The gap highlights an organizational issue in pain management stemming from the absence of a clearly defined period and workflow for reassessment.

Aim of the Project: The aim of the quality improvement (QI) project was to improve compliance with pain reassessment documentation within 48 hours …

A Study Of Rural Health Care For Chronic Care Management Using Machine Learning To Determine Costs, Joanna Maria Keeling

Doctoral Dissertations

Management of diabetes or heart disease may be uniquely challenging for older individuals with multiple chronic conditions[1]. Chronic Care Management would target patients living with comorbidities in Louisiana, who are not receiving sufficient healthcare services and help them receive the care they deserve[2]. This study is aimed at comparing the results of rural Louisiana Medicaid recipients with comorbidities to the National Averages. We will also use Machine Learning to predict Churn and Medical Costs. To help us identify these patients with comorbidities, we decided to use NCQA Quality Measures. We identified several measures from NCQA that we wanted to use, …

Addressing And Recognizing Secondary Traumatic Stress In Hospice And Palliative Care Clinicians, Laquisha La Chelle Jackson

Walden Dissertations and Doctoral Studies

In the emotionally demanding field of hospice and palliative care, the well-being of clinicians is critical. This Doctor of Nursing Practice (DNP) project focused on implementing a staffing education initiative to address secondary traumatic stress (STS). I designed this staffing education project to enhance clinician awareness, resilience, and coping strategies while informing organizational leadership on how improved staffing models and support systems can mitigate STS. Hospice and palliative care clinicians are uniquely vulnerable to STS due to constant exposure to trauma, death, and grieving families. The guiding question for this project was: In hospice and palliative care clinicians, how does …

Culturally Inclusive End-Of-Life Simulation For Undergraduate Nursing Students, Jodi Olson

DNP Projects

Background
End-of-life (EOL) care is a challenging yet essential aspect of nursing practice. Nursing students often report low confidence and competence in managing culturally and spiritually diverse EOL scenarios. Simulation-based learning has proven to be effective in enhancing students' preparedness for complex clinical situations.

Purpose
This project aimed to evaluate the impact of a high-fidelity, culturally, and spiritually diverse EOL simulation on undergraduate nursing students’ perceived competence in delivering culturally sensitive EOL care.

Methods
A quantitative pre/post design was used with a convenience sample of 50 junior-year nursing students enrolled in a chronic care management course. Students participated in a …

Mindfulness As A Buffer Against Death Anxiety: Implications For End-Of-Life Care, Chad Alexander

University Honors Theses

Death anxiety, defined as the distress associated with the awareness of mortality, has profound psychological and cultural impacts. Western societies often respond to death salience through avoidance and medicalization, reinforcing defensive strategies described by Terror Management Theory. This project aimed to investigate whether mindfulness can serve as a buffer against death anxiety. A structured literature review was conducted using PsycINFO, PubMed, the Portland State University Library, and Google Scholar between January 2025 and April 2025. One study found that mindfulness moderated the effects of death anxiety on health-related quality of life in people living with HIV. Two experiments linked mindfulness …

Exploring Fiber Art Materials In Art Therapy Treatment With Bereaved Families, Elise Leinaweaver

Expressive Therapies Theses

The purpose of this thesis was to explore why families are particularly impacted by negative effects of grief, why it is imperative that the arts be utilized in treatment for bereavement, and why fiber arts are a great vessel for art therapy grief work. The literature was collected and organized through visual coding and reflective tactile methods before being presented in the following review. The first section of the literature review includes definitions of grief, death-related grief, and familial grief and how these experiences cause long lasting impacts and mental health issues. The second and third sections cover the definitions …

Hope After Grief And Loss: A Needs Assessment Of Peer-Led, Non-Denominational Bereavement Support Services At Laurel’S Grief Center, Julia A. Lange

Public Administration Master’s Projects

This needs assessment examines the grief support services provided by Laurel’s Grief Center (LGC), a nonprofit organization in Buffalo, New York, and identifies opportunities to expand tailored services for grieving adults in Western New York. Using a convergent mixed-methods design, this study collected data through semi-structured interviews with LGC board members and surveys with clients and peer volunteers. Key findings highlight the importance of peer-led, non-denominational grief support and creative approaches, such as art therapy, while identifying barriers, such as stigma, limited awareness, and fragmented regional services.

Based on these findings, this study recommends expanding healing arts programs, enhancing outreach …

Improving Hospice Care Awareness In The Hispanic/Latino Community Of Monterey County, Dulce M. Cortez Cruz

Capstone Projects and Master's Theses

Montage Health is a nonprofit healthcare provider in Monterey County, offering many services, including the Hospice of the Central Coast. This hospice agency supports older adults and their families with end-of-life care. Although Monterey County has a large Hispanic/Latino population, only a small number use hospice services—mainly due to language barriers, lack of awareness, and insurance concerns. This project focuses on helping the Hispanic community learn more about hospice care through surveys and Spanish-language presentations in the future. The goal is to clarify misunderstandings and help more families feel comfortable using hospice when needed. By sharing information and building trust, …

The Implementation Of The Edmonton Symptom Assessment System To Standardize Symptom Assessment, Rachel C. Mea Msn, Rn, Ocn

Doctor of Nursing Practice Projects

Background

Evaluating symptoms in patients with advanced cancer is critical to mitigating symptom burden and improving quality of life. Cancer patients experience an array of physical, emotional, and psychological symptoms, which can significantly impact compliance with treatment, daily functioning, and well-being. Early and thorough assessment enables healthcare providers to identify and address these issues, ensuring symptom management strategies are tailored to the patient's needs.

Objective

This project aimed to implement the Edmonton System Assessment System (ESAS) in an inpatient oncology service and evaluate the acceptability (AIM), appropriateness (IAM), and feasibility (FIM) of the assessment by nurses and palliative care providers. …

“How To Have Courageous, Culturally And Soulfully Competent Conversations At End-Of-Life”, Jana Dluehosh

Doctor of Leadership

Signature Healthcare at Home (Hospice, Palliative, and Home Health) workers are often not prepared to facilitate courageous and culturally competent “Goals of Care” conversations with their patients as they approach the End-of-Life. Working in Hospice has given me a direct line of research as I worked on ways to help healthcare workers gain confidence in talking with patients about death and dying in what we call a Goals of Care conversation.

One of the challenges I found in my research was finding healthcare workers who could give the time to participate in stakeholder workshops. Much healthcare operates at high demand, …

Implementation Of A Pediatric Skills And Simulation Workshop Among Rural Nurses, Cassandra Grabiel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

No abstract provided.

Death, End-Of-Life Doulas, And Art:
Exploring Connections Between Death Competency And Art Making, Jill K. Hoefgen

Art Therapy | Master's Theses

Death in the United States is often viewed as a medical event rather than the natural course of life, which results in avoidance of planning for the inevitable. The emergence of Hospice in the 1970s, Medical Aid in Dying (MAID) laws in several states, and the positive death movement have demonstrated a shift in attitudes and priorities about death and dying. Since the early 2000s, end of life doulas (EOLDs) have emerged as practitioners who help people plan for and transition to death. Emotional and existential coping skills are components that emerge from death work, and these elements can be …

A Nurse-Driven Protocol To Increase Music Therapy Referrals To Manage Patient Pain And Anxiety In The Medicine Intensive Care Unit, Ashley Fox

DNP Projects

Background: Critically ill patients often suffer from pain and anxiety. Music therapy is a safe and effective treatment option. However, most nurses never receive education or training on it, resulting in a lack of awareness of its value and its actual usage in care.

Purpose: The purpose of this project was to increase the number of music therapy referrals to manage pain and anxiety in eligible medicine intensive care unit (MICU) patients via a music therapy protocol that increased nurses’ knowledge, attitudes, and skills related to the use of music as an alternative treatment option for pain and anxiety in …