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Navigating The Political Waters Of Rural Superintendency In Texas, Brian D. Aiken

Electronic Theses and Dissertations

Superintendents frequently report job-related stress and politics as primary reasons for early resignations. Rural superintendents and school boards engage extensively with community stakeholders, intensifying the impact of local political influence on decision-making. The purpose of this study was to describe how five rural superintendents in Texas experience the influence of political will on decision-making and, subsequently, on their well-being. Perceptions of sources of political influence and the strategies used by superintendents to navigate political influence were investigated. Participant data were gathered through district documents and semistructured interviews. The research captured the challenges the rural superintendents face. The participants in this …

Infant And Maternal Psychological Factors As Predictors Of Maternal Stress In Early Motherhood, Anna Muma

Honors College Theses

No abstract provided.

Noise Characterization And Mitigation In Intermediate-Scale Quantum Systems, Muhammad Qasim Khan

Dartmouth College Ph.D Dissertations

Current quantum processors, at the intermediate scale of tens to hundreds of qubits, remain error-limited. This thesis studies two related sources of error. The first is environmental noise, which may have temporal and spatial correlations and nonclassical components. The second is state-preparation and measurement (SPAM) error, which arises in the operations used to characterize this noise, a prerequisite for boosting operational fidelities. Neither can be characterized alone. Noise spectroscopy techniques use imperfect preparation and readout, while SPAM characterization is affected by qubit decoherence. Our methods vary measurement depth, drive duration, or sequence repetition so each source changes the measured signal …

Analysis And Design Of Multi-Winding Current Ballasted Magnetics For Integrated Dc-Dc Conversion, Kishalay Datta

Dartmouth College Ph.D Dissertations

Power conversion circuits have become a bottleneck in terms of reducing the size and cost of modern electronic systems in a vast number of applications ranging from personal devices, to automotive systems, to data centers. This has motivated designs at higher frequencies where smaller passive components can be used. Unfortunately, magnetic components scale poorly to smaller dimensions. In addition, the AC resistance of magnetic components deteriorates due to current crowding effects at high frequencies. This has resulted in fully- integrated power converters with planar magnetic components having efficiencies lower than what may be theoretically achieved. In this work, we investigate …

Enhancing Care Coordination: Nurse-Physician Bedside Communication To Improve Outcomes, Harriet Chinakwe

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Inconsistent nurse-physician bedside communication on a 28-bed hybrid intermediate stepdown unit contributed to gaps in care coordination, patient engagement, and discharge readiness. Baseline Centers for Medicare & Medicaid Services (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (2026), Press Ganey (2022) communication scores were below the national 90th-percentile benchmark; nurse communication at 58% and doctor communication at 46%, indicating the need for a structured communication process.

Aim of the Project: The quality improvement project aimed to improve nurse-physician communication during daily bedside rounds by implementing a TeamSTEPPS-informed, structured bedside rounding process using the PATIENT tool over 12 …

Cdc’S Steadi Fall Toolkit To Decrease Adult Inpatient Medical-Surgical Fall Rates, Kevin Graham

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Adult inpatient falls are a persistent patient safety concern that can result in injury, prolonged hospitalization, and increased healthcare utilization. The identified medical-surgical unit had a baseline fall rate of 4.88 falls per 1,000 patient days, exceeding the organizational goal of fewer than 3.0 falls per 1,000 patient days. An organizational assessment identified inconsistent fall-risk assessment, documentation, patient education, and individualized prevention strategies as practice gaps.

Aim of the Project: The aim was to reduce the inpatient fall rate to fewer than 3.0 falls per 1,000 patient days through implementation of the CDC’s Stopping Elderly Accidents, Deaths & Injuries …

Fall Prevention In The Inpatient Oncology Unit Using Fall Boards And Visual Cues, Rachel Miller

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls remain a significant patient safety concern in hospitals. In an inpatient oncology unit at a large academic medical center, falls increased from 33 in 2024 to 46 in 2025, while the fall rate increased from 2.86 to 3.95 falls per 1,000 patient days. A gap analysis revealed that only 5% of high fall-risk patients had fall boards and visual cues in place.

Aim of the Project: The aim of this quality improvement (QI) project was to increase the utilization of fall boards and visual cues for high fall-risk patients through implementation of a standardized fall prevention education bundle …

Implementing An Evidence-Based Checklist To Improve Hypertension Clinical Performance, Angelica Wilson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hypertension is a significant chronic disease management challenge at an urban Federally Qualified Health Center (FQHC), where about 26% of adults aged 18 to 85 years have uncontrolled blood pressure (BP). Despite the organization achieving a hypertension control rate of 74%, which exceeds the national FQHC average of 57.6% and approaches the goal of 80%, there remains inconsistent implementation of evidence-based hypertension management. The lack of standardized workflow has led to variances in BP reassessment, treatment management, lifestyle counseling, documentation, and follow-up, resulting in missed opportunities for guideline-directed care.

Aim of the Project: The quality improvement (QI) project aimed …

Strengthening Post-Fall Huddle Practices In Long-Term Care, Janette Perry

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: High resident fall rates and repeat falls caused by an unreliable nurse-only post-fall huddle (PFH) process that lacked structure, interdisciplinary participation, and timely root-cause analysis.

Aim of the Project: To reduce falls and fall-related injuries in long-term care units by implementing a standardized, evidence-based PFH workflow that strengthens root-cause analysis, improves interdisciplinary communication, and increases PFH reliability.

Review of the Evidence: Evidence from fourteen high-quality, peer-reviewed studies demonstrates that structured, interdisciplinary post-fall huddles are more effective than informal, nurse-only approaches in improving fall analysis and reducing repeat falls in long-term care settings. Structured PFHs strengthen root-cause analysis; interdisciplinary participation …

A Policy Analysis Of Nurse Practitioner Requirements In California Children’S Services Programs, Erna Josiah-Davis

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

California Children’s Services (CCS) is a state and federally funded program administered by the Department of Health Care Services that provides care coordination, therapy services and referrals for residents under the age of 22 years. CCS Numbered Letter 07-0123 outlines the requirements for nurse practitioner (NP) practice in CCS’ Special Care Centers. The Numbered Letter (NL) policy may have workforce and operational impacts that have not been assessed.

Aim of the Project:

The policy analysis’ aims were to describe policy impacts of the Numbered Letter on CCS programs, clients and providers, communicate impacts with stakeholders, and share policy recommendations …

Improving Abnormal Involuntary Movement Scale Screening Consistency In Outpatient Psychiatric Practice, Jeriece Lovelace

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) are potential adverse effects of long-term antipsychotic use that require ongoing monitoring. At the project site, inconsistent staff education, a lack of a standardized screening process, and the absence of electronic health record (EHR) reminders contributed to missed Abnormal Involuntary Movement Scale (AIMS) screenings. Baseline screening compliance was 54.7% (106/194).

Aim of the Project: The aim of this quality improvement project was to increase AIMS screening compliance among adult patients receiving long-term antipsychotic therapy from a baseline of 54.7% to 90.7% within 12 weeks.

Review of the Evidence: Literature review has shown …

Analysis Of The Deborah Sampson Act Of 2020: Improving Women Veterans’ Care, Jessica N. Shipp

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Women Veterans are one of the fastest-growing populations served by the Veterans Health Administration (VHA), yet gaps persist in access to gender-responsive, trauma-informed care. Despite requirements established by the Deborah Sampson Act (DSA) of 2020, implementation remains inconsistent in Women's Health Primary Care Provider (WH-PCP) access, women's mental health (MH) services, military sexual trauma (MST) care, workforce capacity, care coordination, and accountability.

Aim of the Project: The aim was to evaluate the effectiveness, feasibility, equity, and implementation fidelity of the DSA using the Centers for Disease Control and Prevention (CDC) Policy Analytical Framework (POLARIS) and identify evidence-based recommendations to …

Program Evaluation: Effectiveness Of Case Management Carehub For Skilled Nursing Facility Transitions, Rachel Choudhury

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Ineffective communication during transitions from acute care hospitals to skilled nursing facilities (SNFs) contributes to avoidable bed days (ABDs), prolonged length of stay (LOS), and discharge delays. Although evidence-based tools such as InterQual and Milliman Care Guidelines supported clinical decision-making, a standardized communication process among case managers, social workers, payers, and SNF partners was lacking. This program evaluation examined the effectiveness of a standardized CareHub communication workflow designed to improve discharge coordination and transitions to SNFs.

Methods: Guided by the Centers for Disease Control and Prevention Program Evaluation Framework, a 90-day program evaluation (February-April 2026) was conducted in a …

Improving Outcomes Through Early Management Of Pre-Eclampsia Risk Factors, Ada Licin-Odnez

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Pre-eclampsia is a serious pregnancy condition characterized by high blood pressure and proteinuria, typically occurring after 20 weeks. Pre-eclampsia affects 2–8% of pregnancies globally. Early detection and proper care are essential. The OBGYN clinic reports a 20% rate among high-risk patients, significantly higher than the national 5–8%, attributed to limited education, poor care coordination, and inadequate postpartum support. A medication-only approach without proper education has not effectively reduced the rates.

Aim of the Project: The overarching aim of the Quality Improvement project was to improve maternal and infant outcomes by managing pre-eclampsia risk factors. The QI project reduced the …

Improving Guideline-Directed Sodium–Glucose Cotransporter-2 Inhibitor Use In Reducing Proteinuria In Chronic Kidney Disease, Tamara Martin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Chronic kidney disease (CKD) is a progressive condition associated with increased risk for end-stage kidney disease, cardiovascular complications, hospitalization, and substantial healthcare costs. Proteinuria is an important marker of kidney damage and contributes to CKD progression. Although evidence-based guidelines support sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy in eligible patients with CKD, an outpatient nephrology clinic identified underutilization of SGLT2i therapy among patients with proteinuric kidney disease. Pre-implementation practice relied primarily on renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, with inconsistent use of adjunct SGLT2i therapy.

Aim of the Project: The purpose of this quality improvement (QI) project was to increase guideline-concordant SGLT2i …

Implementing A Fall-Prevention Bundle To Reduce Falls In A Skilled Nursing Facility, Ginette Lubin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a persistent patient-safety concern in skilled nursing facilities (SNFs), contributing to injury, functional decline, reduced quality of life, healthcare utilization, and costs. At the project site, a short-term rehabilitation unit in an urban SNF, 13 resident falls occurred during the baseline period, with 23% resulting in injury, and prevention relied on routine risk assessments, environmental checks, and post-fall reporting rather than proactive strategies.

Aim: To decrease the overall fall rate by 20%, reduce fall-associated injuries from 23% to 15% or less, and raise staff adherence to evidence-based fall-prevention interventions to 90% or higher within 12 weeks.

Evidence: …

Lowering A1c In Haitian Creole Adults With Type 2 Diabetes, Tammy W. Russell

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Haitian Creole–speaking adults with type 2 diabetes receiving care in a federally funded primary care clinic experienced gaps in glycemic control, follow-up attendance, preventive kidney screening, and access to linguistically appropriate diabetes care. The organizational baseline urine albumin-to-creatinine ratio (UACR) screening rate was 41.8%, demonstrating an opportunity to improve preventive diabetes management.

Aim of the Project: The aim was to implement a Chronic Care Model (CCM)-based interdisciplinary intervention over 12 weeks to improve diabetes outcomes, follow-up care, and UACR screening among Haitian Creole–speaking adults with type 2 diabetes.

Review of the Evidence: Current evidence supports structured chronic disease management, …

Implementing A Risk-Stratified Fall Prevention Bundle To Reduce Inpatient Falls,, Nana A. Tabiri

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Step-Down Unit (SDU) had a high fall rate of 4.8 falls/ 1,000 patient days, falling short of the 3.0 falls/1,000 patient days organizational target. Despite the high fall rate, the unit used a one-size-fits-all approach, which was ineffective. Also, nursing practices in the unit were unevenly adopted.

Project Objective: The project aimed to lower the fall rate in SDU by 10% and increase compliance with risk-stratified documentation to at least 90%.

Evidence Review: A huge pool of evidence supported the adoption of a multifactorial, person-centered fall prevention approach as opposed to universal precautions. The AHRQ …

Enhancing Suicide Risk Assessment Using The Columbia-Suicide Severity Rating Scale, Elizabeth Gyang

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Suicide risk assessment is a critical component of mental health care; however, inconsistent use of standardized assessment methods can lead to variability in risk identification and clinical decision-making. At the outpatient mental health project site, standardized use of the Columbia-Suicide Severity Rating Scale (C-SSRS) had not been established, indicating a practice gap.

Aim of the Project: The goal of the 12-week Quality Improvement (QI) project was to improve nursing staff knowledge, skills, competence and organizational readiness for standardized suicide risk assessment through structured C-SSRS education and implementation support.

Review of the Evidence: The C-SSRS is a standardized tool with …

Implementing Medication-Focused Fall Risk Assessment To Reduce Falls In Acute Care, Jill Shultz

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a significant patient safety concern among hospitalized older adults. The existing fall risk assessment did not evaluate medications, creating a gap in identifying fall-risk-increasing drugs (FRIDS).

Aim of the Project: The aim was to improve FRID identification by implementing a medication-focused fall risk assessment tool (MFRAT) for older adults admitted to an orthopedic and neurological medical-surgical unit. The American Society of Consultant Pharmacists & National Council on Aging Falls Risk Checklist was the chosen tool.

Review of the Evidence: Evidence identified three recurring themes: standardized MFRAT use, FRID identification, and healthcare worker education on FRIDs. Findings supported …

Improving Screening And Referral Of Adolescent Depression In Pediatric Primary Care, Eleanor Shaw

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: A practice gap existed in a rural primary care clinic where adolescents aged 12–18 years were not routinely screened for depression during annual well-child visits. A retrospective review of 22 adolescent charts identified no routine PHQ-9 screenings during well-child visits, establishing a baseline routine screening rate of 0%.

Aim of the Project: The aim was to implement a standardized Patient Health Questionnaire-9 (PHQ-9) screening process and increase routine depression screening to at least 90% of eligible adolescents while achieving documented follow-up within 14 days for at least 85% of adolescents with positive screens.

Review of the Evidence: Evidence supports …

Improving Patient Safety Through Daily Evaluation Of Central Line Necessity, Lakeesha Cunningham

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: At the project site, central line-associated bloodstream infection (CLABSI) rates and central line utilization exceeded national benchmarks. Between July 2025 and March 2026, 32 CLABSIs occurred hospital-wide, with a standardized infection ratio (SIR) of 1.35, more than seven times the national target of 0.19. The standardized utilization ratio (SUR) was 0.72 (target: 0.57), while the surgical intensive care unit (SICU) baseline SUR was higher at 1.06.

Aim of the Project: This Doctor of Nursing Practice (DNP) quality improvement (QI) project used an evidence-based central line checklist from the Agency for Healthcare Research and Quality (AHRQ) to improve the timely …

Improving Hospital Throughput Through Early Mobilization And Proactive Case Management, Sadaf Mir

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Prolonged length of stay (LOS) reflected through throughput inefficiency at a Level II trauma center in western United States. Average hospital LOS was 5.3 days, exceeding the organizational benchmark and national average of 4.9 days. Gap analysis identified lack of standardized early mobilization (EM) and inconsistent case management (CM) participation in rounds, contributing to delayed progression, reactive discharge planning, higher costs, reduced bed capacity, and complication risk.

Aim: To reduce hospital LOS by targeting adult trauma patients as a pilot population, aiming to decrease average LOS from 5.3 to 4.9 days over 12 weeks through an early mobility bundle …

Improving Prn Pain Medication Reassessment For Veterans In Acute Care, Safo Adu-Gyamfi

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Chronic pain is a significant health problem, and veterans experience higher pain severity than nonveterans. On an acute care unit of a Veterans Affairs Medical Center, pro re nata (PRN) pain medication reassessment was inconsistent and below the facility’s 92% benchmark. PRN pain reassessment compliance averaged 81.6% from November 2025 to January 2026. The Joint Commission requires timely pain assessments. The facility’s Medical Center Policy (MCP) mandates reassessing PRN pain medication within 120 minutes of administering it. The acute care unit leadership identified limited visual or electronic prompts as contributing factors to the practice gap.

Aim of the Project: …

Enhancing Collaboration Through Post-Round Huddles, Kristen Ramirez

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: On a 16-bed medically supervised detoxification unit at a northeast Ohio community hospital, the interprofessional team had no consistent, structured way to communicate after physician rounds, fragmenting coordination and threatening patient safety for a complex, co-occurring population. Organizational HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) communication scores fell below the 80% national benchmark, confirming a modifiable, systems-level concern.

Aim of the Project: The quality improvement (QI) project aimed to enhance care quality and coordination by standardizing a shared plan of care across the interprofessional team.

Review of the Evidence: A systematic search retained 12 …

Mitochondrial Nad Metabolism In T Cell Responses, Alicia Marie Bostwick-Galaviz

Dartmouth College Ph.D Dissertations

Metabolism is critical to CD8 T cell differentiation and response to intracellular infections and cancer. Mitochondrial NAD is a key component of cellular metabolism; however, the biology of this metabolite in CD8 T cells is poorly understood due to limitations of existing NAD analysis techniques. In this thesis, we develop the mitochondrial NAD redox index and capacity analysis (RICA) assay, a powerful flow-cytometry based technique for assessing mitochondrial NAD content and redox state in living cells. We use this assay to profile mitochondrial NAD dynamics across the course of CD8 T cell differentiation and in multiple in vitro and ex …

Experience Of Working And Studying In Nursing School: A Qualitative Study, Fatimah O. Azeez

Undergraduate Honors Theses

It is hypothesized that some student nurses enrolled in a higher education degree program face academic challenges when retaining employment while attending school. This study aims to explore the various experiences of working students compared to non-working students. Specifically, to quantify and correlate the effects of working while studying in nursing school. The Cognitive Load Theory will be used to guide the research and implementation of the effects of working while simultaneously attending nursing schools on nursing students. Cognitive Load Theory suggests that the human brain has a limited capacity to process information and overloading it with too many tasks …

The Aesthetics Of Violation: Visual Rhetoric And The Ethics Of Spectatorship In Venetian Ovidian Painting, Khira Rudolph

Theses

In this thesis, we will consider how 16th-century Venetian painters used sophisticated visual methods, colorito, glowing atmospheric glazes, serpentine lines and spatial buffering to camouflage the physical violence of Ovidian abduction stories. Most historical art literature in the past has hailed high Renaissance masters Titian and Paolo Veronese as technical bravura, lyrical colorism and visual appeal in the face of social and emotional tragedy in their work on canvas. In comparing Titian’s The Rape of Europa, Paolo Veronese’s The Rape of Europa, Paolo Veronese’s circle Scene from the Metamorphoses of Ovid: The Rape of Proserpine and Rembrandt …

Formed Together: A Value-Based Model Of Mutual Spiritual Formation For Pentecostal Pastors And Churches Under 500, W. T.A. Mcmillan

Doctor of Ministry (DMin)

“Pay careful attention to yourselves and to all the flock” (Acts 20:28) is both a warning and an invitation. It insists that the pastor's inner life and the congregation's shared life cannot be pulled apart without doing damage to both. This dissertation grows out of that conviction and out of years of pastoral ministry in Pentecostal churches where the pressure to perform often overwhelms the slow work of being formed. It asks a simple but searching question: How do Assemblies of God pastors serving congregations under 500 in attendance understand the connection between their own spiritual health and the spiritual …

Sanctified Rhythms Of Rest: Reclaiming Sabbath And Spiritual Retreat For Pastoral Renewal And Burnout Mitigation In The Georgia Assemblies Of God, Philip Sosebee

Doctor of Ministry (DMin)

“Sanctified Rhythms of Rest: Reclaiming Sabbath and Spiritual Retreat for Pastoral Renewal and Burnout Mitigation in the Georgia Assemblies of God” explored how intentional rhythms of Sabbath observance, solitude and silence, and spiritual retreat shaped the lived experiences of credentialed ministers within the Georgia District of the Assemblies of God. Pastoral burnout, emotional exhaustion, and unsustainable ministry expectations continue to affect ministers across denominational contexts, raising questions regarding the role of biblically grounded rhythms of rest in fostering pastoral renewal and sustainability. Using a six-month longitudinal hermeneutic phenomenological design, twenty-nine credentialed ministers participated in the intentional practice of weekly Sabbath …