Digital Commons Network^™

10-Bed Medical-Surgical Telemetry Unit Expansion To Address Inadequate Inpatient Capacity, Sumitpal Kaur

Walden Dissertations and Doctoral Studies

Inadequate medical-surgical telemetry capacity contributes to emergency department (ED) boarding, patient transfers, decreased patient satisfaction, and operational inefficiencies. This systems-level organizational leadership project evaluated a proposed 10-bed medical-surgical telemetry unit expansion at a medical center in Northern California. The project addressed the question of how a 10-bed expansion would affect ED boarding, patient crossovers to a nearby medical center, patient satisfaction, and financial performance. Trend analysis of occupancy, ED boarding, and crossover data, regional benchmarking, and financial modeling using net present value (NPV) and internal rate of return (IRR) were used to evaluate the proposed expansion. The organization currently operates …

Reducing Copd Readmissions Through An Evidenced-Based Clinical Practice Guideline, Courtney Rye

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and hospital readmissions, with rural critical access hospitals (CAHs) facing unique challenges in delivering consistent, evidence-based care. At the pilot CAH medical–surgical unit, local chart review and practice observation revealed an approximately 18% 30-day COPD readmission rate and significant variation in discharge education, written action plans, inhaler technique assessment, and structured post‑discharge follow‑up. The purpose of this Doctor of Nursing Practice project was to develop and appraise an evidence‑based, Appraisal of Guidelines Research and Evaluation II (AGREE II) and Institute of Medicine–compliant COPD clinical practice guideline (CPG) to …

Enhancing Patient Understanding: Standardizing Cardiac Medication Education Using Teach-Back For Heart Failure, Nicole Valerie Hediger

Master's Projects and Capstones

Problem: The transition from hospital to home places heart failure (HF) patients at risk for medication errors, nonadherence, deterioration, and rehospitalization. In a 28-bed medical-surgical telemetry microsystem, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores indicated an opportunity for improvement: “Communication About Medicines” composite score of 47.9%; 62.5% of patients reported being informed about the medication purpose, and 33.3% reported that staff described potential side effects.

Context: A cohort of HF patients was selected to test teach-back methodology and improve patient understanding. Nurse champions volunteered for a 5-month improvement project.

Interventions: Teach-back methods were implemented. Nurse leader rounding …

Evaluation And Continuation Of Oncology Nurse Mentorship Program, Gurpreet K. Kang

Master's Projects and Capstones

Problem: Newly hired nurses on a busy inpatient leukemia and lymphoma subspeciality unit experienced challenges after transitioning into specialty oncology practice. This resulted in decreased confidence, increased risk of medication errors, and a 40% unit-based annual turnover rate. The cost of replacing one staff nurse is $61,000.  Exit interviews determined root causes of turnover rates, nurse confidence.

Context: A quality improvement program was envisioned to optimize patient and organizational outcomes on a 25-bed inpatient unit to evaluate and sustain an oncology nurse mentorship program.

Interventions: Over one year, cohort 1 (n=8) and follow up 2^nd cohort (n=7) was implemented …

Experiences Of Psychological Recovery From Work In Second-Generation Asian Americans, Laura Yang

Dissertations and Theses

Individuals of Asian descent make up approximately 7.4% of the U.S. population. As one of the fastest-growing minority groups, their population is projected to reach nearly 15% by 2065, with 38% being foreign-born – surpassing all other racial minority groups. Despite their increasing presence in the U.S. workforce, research on Asian workers' nonwork experiences remains limited. One key unexplored area is how Asian workers engage in recovery after work, considering their unique cultural and racialized experiences. Drawing on literature examining psychological recovery from work, this qualitative study employed multiple methods of analysis, both listening guide method and thematic analysis, to …

Literacy Hubs: Human-Centered, Coordinated Approach Towards Advancing Adult Literacy In A Community, Alexandria M. Marzolf

Masters Projects

Low adult literacy skills have been a pervasive and persistent challenge in the United States for more than a century. One in five adults (21%) possesses low literacy skills (National Center for Education Statistics, 2026), a finding consistent with statistics reported by the National Literacy Institute (2024). Despite decades of educational reform, many adults continue to experience limited access to coordinated, community-based literacy support. The purpose of this master's project was to develop a community-based Literacy Hub framework designed to increase access to adult literacy learning opportunities through coordinated partnerships and community engagement. An extensive review of educational research, community …

Sustaining Clabsi Prevention Through Central Line Bundle Compliance: A Focus On Iv Tubing Labeling, Visual Cues And Peer Support, See Elizabeth Vang

Master's Projects and Capstones

Abstract  

Problem: Inconsistent IV tubing labeling compliance on a telemetry unit was identified as a gap in central line maintenance practices that could affect adherence to the CLABSI prevention bundle.

Intervention: A quality improvement project reinforced existing IV tubing labeling practices through a visual job aid, staff education, and peer verification during Nursing Knowledge Exchange (NKE) bedside handoff.

Outcome Measure: The primary outcome measure was IV tubing labeling compliance, with a goal of increasing compliance from 86.5% to at least 95% on 24 bed Telemetry unit.

Results: The project did not achieve the desired improvement in compliance. Multiple concurrent quality …

Threads Of The Frightening: The Uncanny, Alienation, And Horror In Otsuichi's Fiction, Kathryn Lawhon Stephens

Arts & Sciences Graduate Student Theses and Dissertations

The “J-horror boom” of the 1990s and early 2000s saw the international success of films like Nakata Hideo’s Ring (1998), bringing considerable and laudable attention to Japanese horror in the realm of film and media studies. Yet even Ring’s Sadako, one of the most popular contemporary figures in Japanese horror, first appeared as a literary character years before her debut on screen. The average layperson’s unfamiliarity of such a famous horror icon’s literary origins illuminates the comparative lack of literature-centric scholarship on major writers and figures of Japanese horror that this dissertation seeks to rectify.

First interrogating the fluidity …

Application And Development Of Continuum Treatments In Photodetachment Of Anions, Pratichhya Adhikari

Arts & Sciences Graduate Student Theses and Dissertations

This dissertation aims to provide deeper insight into understanding the dynamics of the photodetached electrons and the nature of the parent species. The dissertation provides examples of quasi-bound states of the anion embedded in the continuum of states associated with the neutral species, and shows how they manifest in experimental data, deviating from expectations of direct detachment. This dissertation is primarily computational and applies and develops electronic-structure and continuum models, respectively, and a newly implemented physical dipole treatment of the photoelectron to account for these resonances and to interpret experimental photoelectron imaging data. The content of the dissertation is divided …

The Defining Role Of Ago4 And Its Catalytic Activity During De Novo Rna-Directed Dna Methylation, Tianyi Li

Arts & Sciences Graduate Student Theses and Dissertations

Plant transposable elements and transgenes are continuously targeted for transcriptional repression via the pathway of RNA-directed DNA methylation (RdDM). Although perpetual RdDM of the endogenous genomic loci has been well studied in the field, much less is known about the de novo RdDM pathway, the pioneering round of DNA methylation responsible for triggering and initiating silencing of new transgenes. Despite being two distinct pathways, both perpetual and de novo mechanisms of RdDM require the production of small interfering RNAs (siRNAs) and the key proteins of the ARGONAUTE4 (AGO4) clade. However, the order and likely mechanism of recruitment of AGO4 to …

Transient Activation Of Potent Progenitor Cells Is Required For Spinal Cord Regeneration, Chase Alexander Weinholtz

Arts & Sciences Graduate Student Theses and Dissertations

Mammalian spinal cord injury is an intractable biomedical problem driven by interlocking maladaptive cellular responses that prioritize acute stabilization over long-term recovery. However, this deficient regenerative capacity is not an inherent limitation. The zebrafish, for example, capably regenerates and regains motor function with 2 months of a full transection injury. This ability is thought to rely on the transient expansion of stem cell-like progenitors marked by sox2 expression. Yet our understanding of the identities and contributions of this crucial population remains limited. Here, we determine the molecular identities and cellular contributions of sox2+ progenitors during innate spinal cord repair in …

Interplay Between Patterning And Morphogenesis During Zebrafish Embryonic Development, Chia-Teng Chang

Arts & Sciences Graduate Student Theses and Dissertations

Patterning and morphogenesis occur concurrently during embryonic development. In many contexts, both processes are regulated by morphogen signaling: morphogens specify spatially organized cell identities while also influencing the cell behaviors that shape tissues. This creates a reciprocal problem. Morphogen signaling can affect how cells move, while cell movement can change how cells experience and interpret morphogen signals. This dissertation investigates this reciprocal problem during zebrafish gastrulation and neurulation. First, it examines how the ventral-to-dorsal bone morphogenetic protein (BMP) activity gradient regulates germ-layer morphogenesis during gastrulation. BMP signaling is known to pattern dorsal–ventral cell fate and regulate mesodermal convergence and extension …

Scalable And Accurate Computational Frameworks For Complex Genetic Variants: From Repeat Expansion Discovery To Somatic Mosaicism Benchmarking, Zitian Tang

Arts & Sciences Graduate Student Theses and Dissertations

Whole-genome sequencing (WGS) offers a comprehensive view of genetic variation in human disease, but translating sequencing data into reliable biological and clinical insight depends on both the deployment of appropriate computational tools and the availability of rigorous benchmarking resources to evaluate them. This dissertation addresses both requirements through two complementary lines of work. In a cohort of 788 patients with idiopathic peripheral neuropathy (IPN) from the Peripheral Neuropathy Research Registry, a WGS-based pipeline integrating ExpansionHunter Denovo and ExpansionHunter with unsupervised genotype clustering identified biallelic RFC1 AAGGG repeat expansions in 2.3% of all IPN cases and 6.9% of patients with pure …

Behavioral Effects Of Novel Treatments For Pain Management Using Combinatorial Methods, Rohit Rajeev Nambiar

Theses and Dissertations

Pain, despite being an uncomfortable feeling to experience, is a necessary protective mechanism for the body1. Understanding that pain results from several different mechanisms within the body is important to discovering the optimal way to treat and manage a person’s pain. Modern medicine has seen numerous advancements in treating or managing acute and chronic pain, particularly with opioid drugs. However, these treatments come with potential side effects, including opioid use disorder (OUD) and fatal overdose. Finding new treatment methods, or improving existing methods, is crucial for patients with pain. This thesis explores two projects looking to develop safer analgesia using …

A Graphical Approach To Isospectral Unfoldings, Dallin Seyfried

Theses and Dissertations

Isospectral reductions are mathematical techniques used to shrink a matrix, or a graph, into a smaller, dimensionally reduced form while preserving its spectrum. Simple graphs that share isospectral reductions also share quantum walk properties. As such we further develop the inverse process, isospectral unfoldings, to find graphs that share isospectral reductions. We first prove many conditions relating to isospectral reductions and unfoldings. Afterwards, we define two new unfolding processes: general unfolding which unfolds the graph one vertex at a time, and equitable partition unfolding which excels at larger graph unfolding. In particular, through equitable partition unfolding, we discover many graphs …

Functionality Risk Assessment And Risk-Based Management For Critical Infrastructure Systems, Anteneh Zewdu Deriba

Dissertations and Theses

Critical infrastructure systems such as transportation networks serve as the lifelines of modern society, supporting economic activity and ensuring access to critical services. Their disruption under extreme events can produce consequences extending far beyond physical damage to individual assets. In transportation networks for instance, failures of critical assets such as bridges and tunnels can reduce accessibility of communities, limit freight capabilities for commerce, and increase travel distance and travel time of road users. These consequences associated with the system functionality loss are tied not only to the physical vulnerability and failure of individual assets, but also to the system configuration …

Enhancing Cultural Competency Through Training In A Primary Care Clinic, Rogelio Perez Iii

Doctor of Nursing Practice Projects

Cultural competence remains essential in primary care settings serving diverse populations, yet staff at a small Southern Texas primary care clinic reported no previous formal cultural competency training in workplace orientation or school. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate whether a brief, evidence-based cultural competency intervention improved clinician cultural competency scores. Madeleine Leininger’s Culture Care Theory provided the theoretical framework, Lewin’s Change Theory guided the change process, and the Plan-Do-Study-Act cycle directed implementation and evaluation. The problem addressed was the lack of structured training to support culturally responsive communication, patient trust, and …

Impacting Competency In C-Ssrs Suicide Risk Screening On An Inpatient Psychiatric Unit, Fidelis Sangye

Doctor of Nursing Practice Projects

Suicide remains a leading public health concern, and inconsistent application of the Columbia-Suicide Severity Rating Scale (C-SSRS) may contribute to variability in suicide risk assessment and delayed intervention within inpatient psychiatric settings. The purpose of this quality improvement (QI) project was to evaluate the effectiveness of a standardized C-SSRS-guided educational intervention on staff competency in suicide risk screening. Guided by Lewin’s Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, this quantitative pretest-posttest QI project was conducted on an adult inpatient psychiatric unit. The intervention consisted of a 25-minute instructor-led PowerPoint presentation on standardized C-SSRS administration and evidence-based suicide risk …

Threads Across The Atlantic: A Dialogue Of Feminist Writings Between Portugal And Cape Verde, Elliana Shillig Venancio

Theses and Dissertations

This thesis examines the feminist literary traditions of Portugal and Cape Verde through a comparative analysis of Ana de Castro Osório’s Infelizes and Dina Salústio’s Mornas eram as noites. Separated by nearly nine decades and an ocean, these two works nonetheless converge in their insistence on women’s autonomy, bodily sovereignty, and resistance to patriarchal structures. Drawing on Hélène Cixous’s theory of écriture féminine and Kimberlé Crenshaw’s framework of intersectionality, this thesis argues that despite the significant differences in time, geography, and socio-political context that separate these authors, powerful threads of feminist consciousness bind their writing together. At the same time, …

The Measured Toll: Visualizing The Hidden Impact Of Chronic Painkiller Use, Yun Chia (Lisa) Song

Theses

The Measured Toll: Visualizing the Hidden Impact of Chronic Painkiller Use investigates how clinical data can be reinterpreted through the lens of information design to reveal long-term effects on heart and liver health that are often overlooked or invisible. This project translates complex medical information into a visual language that prioritizes clarity, emotional resonance, and user engagement. Through a series of printed posters and a motion-based introduction, the work employs abstract design strategies—including subtle distortion, radial line structures, and restrained typography—to evoke a sense of internal tension and gradual change. By structuring the visuals to unfold as a narrative, the …

A Retrospective Study Of The Impact Of Standard Versus Staggered Arc Arrangements In Vmat Planning For Localized Prostate Cancer., Samantha J. Arthur

Masters Projects

Purpose: To evaluate whether implementing a staggered beam arrangement in volumetric modulated arc therapy (VMAT) improves treatment plan quality by enhancing normal tissue and organ-at-risk (OAR) sparing in patients with localized prostate cancer.

Methods: Ten patients meeting the study inclusion criteria were retrospectively replanned using both a standard arc technique and a staggered arc arrangement. Both plans were generated using identical optimization objectives and planning parameters. Dosimetric comparisons were performed after normalizing both plans to equivalent planning target volume (PTV) coverage. Dose-volume metrics were evaluated for the PTV, rectum, bladder, and penile bulb.

Results: The staggered beam arrangement produced statistically …

Dis/Ability Critical Race Theory In The Early Childhood Education Classroom, Milo Knickerbocker

Masters Projects

Data shows that many Black and Disabled students are underserved in their current learning environments. This project provides a theoretical introduction to Dis/ability Critical Race Theory (DisCrit), as well as guidance on how to incorporate the theory into the early childhood education setting. This is done in attempt to provide a more equitable and inclusionary learning environment.  This project incorporates a data-driven professional development program surrounding DisCrit and incorporation of anti-racist and anti-ableist inclusionary teaching methods, for the betterment of all students.

Self-Regulation For Early Childhood Classrooms, Emily Fox

Masters Projects

The ability to self-regulate is essential for young children's social, emotional, behavioral, and academic development. However, growing exposure to adverse childhood experiences (ACEs), toxic stress, family instability, and other social and environmental stressors has contributed to challenges in the development of these skills. Children with underdeveloped self-regulation skills are more likely to experience difficulties with executive functioning, peer relationships, classroom behavior, and school readiness, demonstrating the need for early intervention. The purpose of this master's project was to investigate the major social and environmental stressors affecting young children's self-regulation and to develop a research-based intervention to support self-regulation development in …

Teaching Writing With Confidence: A Professional Learning Series To Build Special Education Teachers' Knowledge And Self-Efficacy For Explicit Writing Instruction, Lindsay E. Bowen

Masters Projects

Writing is an essential skill used to communicate ideas effectively, assess understanding, and demonstrate critical thinking across educational and workplace settings. Yet, research demonstrates that a majority of special education teacher preparation programs do not offer standalone courses in writing instruction methods, leaving many special education teachers to enter the profession with limited knowledge of effective writing instruction for students with high-incidence disabilities. This project explores current research on effective sentence-level writing instruction for students with high-incidence disabilities, as well as a research-based approach for applying these practices in a systematic yet adaptable manner to meet the needs of individual …

Fieldwork Educators' Perspectives On Occupational Therapy Students Addressing Sexuality And Intimacy: Expectations, Supports, And Barriers, Elizabeth Deluca-Berg

Student Dissertations

Sexuality and intimacy are recognized as meaningful occupations within occupational therapy practice; however, they remain inconsistently addressed in clinical care. Previous research has identified limited educational preparation as a contributing factor to occupational therapists' discomfort and lack of confidence in addressing these occupations. Although classroom instruction provides foundational knowledge, Level II fieldwork serves as the primary setting in which students apply knowledge within authentic clinical environments. Despite the central role of FW educators in facilitating students' professional development, little research has explored how they prepare OT students to address sexuality and intimacy during fieldwork. The purpose of this basic qualitative …

Understanding The Long-Term Patterns Of Change Of A Tidal Marsh In Mission Bay, San Diego, California, Carrie A. Shuster, Theresa Sinicrope Talley Ph.D., Drew Talley Ph.D., Zhi-Yong Yin Ph.D., Kellie Uyeda Ph.D.

Theses

Coastal marshes are among California’s most productive ecosystems and the most impacted, having been extensively modified by dredging, filling, and urban development. This thesis investigates over a century of change for a marsh in Northern Mission Bay, San Diego, California using ecological and spatial analyses.

Chapter 1 provides an overview of the environmental history and current land use of the Northern Mission Bay marsh, tracing changes from pre-contact Indigenous stewardship through colonial and modern urban development. It also introduces a restoration plant palette derived from historical and contemporary species occurrences, ecological functions, and documented cultural uses. By integrating ethnobotanical knowledge …

Comparing Boost Ptv/Plans Made On The Initial Prone Whole-Breast Ct Vs A Near-Boost Supine Re-Simulation Ct In Hypo-Fractionated Wbi Using A 3-Field Photon Boost Technique, Daniel Garcia

Masters Projects

Purpose: To evaluate dosimetric differences between breast boost plans generated on an initial prone whole-breast computed tomography (CT) simulation and those generated on a near-boost supine re-simulation CT acquired closer to boost delivery.

Methods: Ten patients receiving hypo-fractionated whole-breast irradiation followed by a sequential boost were retrospectively analyzed. Boost plans were generated using a three-field photon technique on both the initial prone CT and a near-boost supine CT. Target volumes, target coverage metrics, conformity index (CI), and organ-at-risk (OAR) doses were compared using paired statistical analyses.

Results: Mean clinical target volume and planning target volume were significantly smaller on the …

Growing Students' Fluency And Comprehension Skills, Makayla Irwin

Masters Projects

Research emphasizes the importance of building strong foundational skills among early readers. While reading is taught everyday in the classroom, there are not enough strategies and knowledge known by teachers to effectively instruct on fluency and comprehension skills. Fluency and comprehension are known as being crucial aspects of the reading process, but they have been inadequately included in many literacy curriculums. This project, grounded in research and well developed theories, holds fluency and comprehension instruction high in regard to the development of a proficient reader.It has been found that educators lack the training, resources, and confidence necessary to successfully teach …

Automated Classification, Measurement, And Semantic Segmentation Of Open-Web Joists From Point Cloud Data, Justin Raymond Dworacek

Theses and Dissertations

This thesis presents a BIM-oriented methodology for the automated classification, measurement, and segmentation of structural trusses from point cloud data. A real truss point cloud and a complementary synthetic dataset derived from CADBIM Revit families were used to develop and evaluate the workflow. Classification was performed using a rule-based Python algorithm based on principal component analysis, side-view feature extraction, and family-specific geometric decision logic, while a separate family-aware script was used to extract key truss dimensions. Semantic segmentation was evaluated using a PointTransformerV3 model to separate truss and non-truss points in mixed point cloud scenes. The results demonstrated strong performance …

Mystical Revelation And Knowledge Of God: Reclaiming Spirituality In Theology Through The Mystics, Elizabeth A. Merski

Electronic Theses and Dissertations

Since the scholastic era, the pursuit of God has occurred preeminently through reason, leading to an imbalanced theology of God that persists to the present day in the form of intellect-centered theology. As a resolution, this work proposes that the mobilization of private, mystical revelation as a source of legitimized theological knowledge of God has the potential to close the existent epistemological gap between reason/belief and theology/spirituality, demonstrating the integral unity between authentic knowledge of God and the receiver’s personal acceptance of God in faith. After examining the required methodological components for the discipline of theology and identifying criteria for …