Digital Commons Network^™

Improving Sedative Administration In Patients Receiving Paralytics During Intubation: A Quality Improvement Initiative Within A Large Academic Medical Center In West Virginia, David Bryon Underwood

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Awake paralysis (AWP) occurs when long-acting neuromuscular blockers outlast short-acting sedatives during intubation, leaving patients chemically paralyzed but conscious. This highlights the critical need for timely post-intubation sedation.

Background: A 2024 review in the Neurological Critical Care Unit (NCCU) revealed that 72% of patients who received rocuronium were not given a post-intubation sedative. The difference in duration of action of paralyzing agents versus sedatives can result in patients being conscious while paralyzed, potentially resulting in hemodynamic instability and psychological harm.

Purpose: The quality improvement initiative aimed to reduce the number of patients receiving neuromuscular blocking agents without post-intubation sedation. …

Video-Based Heart Failure Education: A Feasibility Study, Avery Pivont

Graduate Theses, Dissertations, and Problem Reports (ETD)

Video-Based Heart Failure Education: A Feasibility Study

Avery Pivont

Background:  Heart failure (HF) is a leading cause of hospitalization in the U.S., contributing to high readmission rates and significant healthcare costs. Many of these readmissions are preventable and often stem from inadequate patient education. Effective patient education is a critical component of HF management; however, many healthcare facilities lack specialized HF nurse educators, resulting in inconsistent patient education.

Problem Statement: A quality improvement team at a large academic hospital identified increased heart failure (HF) readmission rates across an entire health system, largely attributed to inconsistent discharge education and limited availability …

The Effects Of Music Therapy On Anxiety And Sedation Requirements For Total Knee Arthroplasty Patients Undergoing Regional Anesthesia: An Evidence-Based Practice Pilot Initiative, Kyra Marie Savrese

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Excessive noise in the operating room negatively impacts patient comfort and outcomes, particularly in patients undergoing spinal anesthesia who have the potential for awareness.

Background: Research demonstrates that music therapy is a low-cost, low-risk intervention that reduces perioperative anxiety and sedative requirements. Literature supports the use of music as an adjunct to anesthesia care, especially in orthopedic populations.

Purpose: At J.W. Ruby Memorial Hospital, orthopedic procedures with regional anesthesia expose patients to high noise levels, often leading to increased anxiety, sedation use, and longer recovery times. Addressing this problem aligns with institution goals for safe, patient-centered care.

Methods: Using …

Wellness Policies In Action: A Wscc-Based Comparative Analysis Of District-Level Policy And School-Level Practices, Leanne Denise Watson

Graduate Theses, Dissertations, and Problem Reports (ETD)

The United States Department of Agriculture utilized the policy platform to implement and reinforce federal mandates aimed to improve health outcomes for student-aged youth, requiring all schools participating in the National School Lunch and/or Breakfast Program to develop a written wellness policy beginning with the 2016-2017 school year. However, the resulting impacts on school environments are unclear. The Whole School, Whole Community, Whole Child (WSCC) model is a recommended framework to influence wellness policies and school practices and support the holistic development of students. Nonetheless, current literature calls for more research applying the model to support its use. The purpose …

"If I Knew Then What I Know Now": Analyzing Online Narratives Of Regretful Parents, Marina Binti Mohd Hamdan

Graduate Theses, Dissertations, and Problem Reports (ETD)

This exploratory study seeks to understand the extent to which parenthood affects individual self-actualization by identifying the trade-offs, compromises, and sacrifices that parents make within the context of family life. Using a thematic analysis of 221 archived posts from the Reddit community r/regretfulparents, this study examines how social pressures surrounding parenthood may be related to experiences of parental regret. Specifically, it identifies two domains: pressures to be parents, including social norms, familial coercion, and interpersonal conflict, and pressures of parenting, including issues of labor, number of children, and challenging children. Across these domains, this study explores how tensions between personal …

Empowered Choices: A Quality Improvement Women’S Health Initiative In Faith-Based Nursing For Women Recovering From Substance Use Disorder, Jennifer Mewshaw

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Women with substance use disorder (SUD) face higher rates of unplanned pregnancy, reproductive infections, and delayed prenatal care. Faith community nurses (FCNs) often already serve within this community and have a long history of promoting public health interventions. However, they lack the knowledge and confidence in sexual and reproductive health (SRH) education.

Evidence Review: A literature review identified barriers to SRH care for women with SUD and the role of FCNs in community and public health interventions. Evidence supports providing FCNs with the knowledge and skills to deliver SRH education and support for women with SUD using trauma-informed and …

Development Of A Protocol To Improve The Use Of Diabetes-Specific Formula, Lauren Nicole Sanetrik

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Enteral nutrition (EN) is often necessary for hospitalized patients who are unable to meet their nutritional needs orally. Patients with diabetes mellitus (DM) receiving EN are at risk of hyperglycemia, which contributes to poor wound healing, infection, and prolonged hospitalization. Diabetes-specific formulas (DSFs) are designed to optimize glycemic control compared with standard formulas (SFs); however, their use is inconsistent due to the absence of standardized protocols.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement and evaluate a protocol to increase DSF utilization among patients with DM receiving EN, with the goal …

Cultural Perceptions And Willingness Or Reluctance To Use Ai Chatbots For Emotional Support By International African Students In Higher Educational Institutions In The United States, Zakariah Issah

Graduate Theses, Dissertations, and Problem Reports (ETD)

The increasing use of artificial intelligence (AI) chatbots for emotional support underscores the need to understand how cultural perceptions shape their adoption among international African students in higher education institutions in the United States. Guided by the Technology Acceptance Model (TAM) and Social Stigma Theory, this qualitative study explored the perceptions, motivations, and barriers influencing the use of AI chatbots for emotional support. Semi-structured interviews were conducted with 20 undergraduate and graduate students from 10 African countries. The findings reveal that participants viewed AI chatbots as conditional and situational sources of emotional support rather than replacements for human relationships. Convenience, …

Romantic Narrative In Three Early Piano Cycles By Robert Schumann: Papillons, Op. 2; Fantasiestücke, Op. 12; And Kinderszenen, Op. 15, Lingqing Huang

Graduate Theses, Dissertations, and Problem Reports (ETD)

This research project compares Romantic instrumental narrative in Robert Schumann’s Papillons, Op. 2; Fantasiestücke, Op. 12; and Kinderszenen, Op. 15, with particular attention to how pianists communicate cyclic continuity in performance. In this study, narrative continuity refers to relationships formed across ordered short pieces through contrast, interruption, return, literary association, fantasy, memory, tonal and motivic recall, and the shaping of sound and time. Comparative score analysis shows that Schumann creates a distinct form of continuity in each cycle. In Papillons, he creates a public, ballroom-based form through masquerade, waltz-like dance, abrupt entrances, interruption, and the gradual dissolution of the social …

Improving Access To Treatment For Alcohol Use Disorder For Veterans: An Evidence-Based Practice Policy Analysis, Mary Rizzo

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Alcohol use disorder (AUD) is common among veterans and is associated with poor health outcomes. Although extended-release naltrexone (XR-NTX) is an effective treatment, maintenance injections at the VA Pittsburgh Healthcare System are only available at the main medical center, requiring many veterans to travel long distances each month.

Purpose: The purpose of this evidence-based practice policy analysis was to evaluate the feasibility of offering XR-NTX injections at Community-Based Outpatient Clinics (CBOC) and develop a policy recommendation to improve access to care.

Intervention: This project examined the current XR-NTX administration process and compared it with alternative approaches used within the …

A Mixed Methods Study Of The Transition To Adult Health Care For Sexual Minority Young Adults With Chronic Pain: Understanding The Impact Of Stigma, Cecily Newel Conour

Graduate Theses, Dissertations, and Problem Reports (ETD)

Sexual minorities with chronic pain are likely to experience stigma stemming from their sexual identity and chronic pain. Pain stigma and sexual minority stigma are associated with increased health disparities and differences in health care utilization, particularly for adults. The transition to the adult health care system appears to be a critical point to understand the impact of stigma on health care utilization to then improve outcomes. With a sample of 48 sexual minority young adults with chronic pain, the current study investigated transition experiences using an explanatory, sequential mixed-methods design that was both observational and cross-sectional. Participants completed quantitative …

Influences Of Response Rate And Distribution On Accuracy Estimates: The Value Of Replications Based On Analytic Approach, Olivia Brianne Harvey

Graduate Theses, Dissertations, and Problem Reports (ETD)

Accurate observational data are essential for drawing correct conclusions about behavioral phenomena and ensuring the replicability of research findings. Accuracy is the extent to which an observer’s recorded responses correspond with true values (i.e., the actual occurrence of behavioral events). Correspondence is quantified using one of several percentage-based algorithms. However, these accuracy estimates may be influenced by characteristics of the data, such as response rate and response distribution, as well as the algorithm used to calculate them. The purpose of this dissertation was to evaluate how response rate, response distribution, and the algorithm used to evaluate accuracy influences estimates. Across …

Exploring Chinese Students’ Lived Experiences And Perceived Development In A Structured Cross-Cultural International Collaborative Degree Program: A Qualitative Case Study In The Context Of The Wvu–Tufe 3+1 Collaborative Program, Zhongmin Zhao

Graduate Theses, Dissertations, and Problem Reports (ETD)

The purpose of this qualitative case study is to examine the lived experiences and perceived development of Chinese students within the structured 3+1 cross-cultural international collaborative program. Grounded in Schlossberg’s Transition Theory and Chickering’s Seven Vectors of Identity Development Framework and guided by the four theoretical propositions, this study explores how the Chinese students experience the challenging transition from their home institution to the host institution, how the students participating in the program perceive their developmental growth across multiple developmental dimensions, and how the students perceive the program structures and institutional practices as supporting or hindering their development.

Data were …

The Hidden Costs Of Consumption: A Multi-Context Investigation On Stigma And Social Judgment, Siti Nuraisyah Suwanda

Graduate Theses, Dissertations, and Problem Reports (ETD)

Consumption is not always as simple as an exchange of value between a buyer and a seller. In many contexts, what individuals choose to consume or not consume can carry social meaning, leading to judgment and devaluation. While prior research has explored stigma broadly in marketing and consumer behavior, less attention has been given to stigma that caused specifically by consumption choices. This dissertation addresses this gap by examining how consumption becomes socially evaluated and judged across different contexts, with the goal of advancing both theoretical understanding and practical insights into socially sensitive consumption.

Essay One develops the foundation by …

Disaster Exposure, The Perception Of Physiological Pain, And Psychological Distress Across Adulthood, Esha Azhar

Graduate Theses, Dissertations, and Problem Reports (ETD)

Climate change brings with it an increase in the occurrence of natural disasters, such as hurricanes, wildfires, severe storms, etc. In the aftermath, afflicted individuals may suffer adversely, especially in their physical and mental health. Previous research has found older adults to be faring better after experiencing a disaster compared to younger adults, which has been attributed to their better mental health associated with aging and gaining experience with adversities (Strough et al., 2023; 2025). The current study examined the psychological distress and physiological pain of individuals across the adult lifespan after experiencing a disaster. Participants were part of the …

Resilience And Reactivity: The Relation Between John Henryism And Cardiovascular Responses To Laboratory Stressors In An Appalachian Sample, Emma Raycher Thompson

Graduate Theses, Dissertations, and Problem Reports (ETD)

John Henryism active coping (JHAC), named for folk hero John Henry, is defined as the perception that one can overcome stressors through hard work (James et al., 1983). This construct has been tied to numerous health outcomes, showing a negative influence on cardiovascular health (Bennett et al., 2004). Many researchers have examined the relation between JHAC and cardiovascular reactivity to stress, though findings are mixed. Further, despite the legend of John Henry occurring in Appalachia, and traits associated with John Henryism, such as resilience, being prominent within this region, no study has examined the relation between JHAC and reactivity in …

Personal Narratives Of Young Adults With Epilepsy: Exploring The Transition To Adulthood Amidst Stigma And Disclosure Fears, Kirby-Estar Gilene Laguerre

Graduate Theses, Dissertations, and Problem Reports (ETD)

Navigating the transition to adulthood presents unique challenges for young adults with epilepsy, particularly concerning stigma and the fear of disease disclosure. While significant social difficulties, such as increased unemployment rates and decreased relationship satisfaction, are prevalent among individuals with epilepsy, current transition programs often fail to address these psychological and social aspects that are vital for an independent adult life. Instead, the majority of the attention for young adults transitioning into adulthood is focused on the shift to adult-oriented healthcare systems. Consequently, there is a critical need for research that goes beyond a healthcare focus and explores the social …

I Think, Therefore I Can: Self-Efficacy, Self-Regulation, And Sense Of Belonging In Introductory Physics, Danielle Christine Maldonado

Graduate Theses, Dissertations, and Problem Reports (ETD)

Cognitive and affective beliefs in physics classrooms are important indicators of student success beyond traditional measurements of academic performance. This body of work explores major beliefs and processes, including self-efficacy, self-regulation, and sense of belonging, as they relate to academic achievement among introductory undergraduate physics students. First, this dissertation explores the development of physics self-efficacy and physics sense of belonging, two highly correlated variables. This work identifies unique sources of physics self-efficacy and sense of belonging development from current and prior academic experiences, personality factors, and demographic variables. Then, relationships between early- semester self-efficacy and sense of belonging, mid-semester …

Greed, Guilt, And Generative Ai: Emotional Dynamics In Digital Consumer Interactions, Danielle Lynn Hass

Graduate Theses, Dissertations, and Problem Reports (ETD)

Digital consumer interactions are increasingly shaped by complex emotional dynamics. As digital platforms and Generative AI (GenAI) technologies proliferate in our everyday lives, it is critical to understand the emotional undercurrents and how they impact consumer behavior. This dissertation investigates these dynamics through three essays that explore how emotions impact consumer experiences in digital spaces, with an overall goal to offer theoretical and practical insights into the interaction of human psychology and technological advancement in the consumer behavior field.

Essay One examines the paradox of pleasure and pain in online brand communities, where collectors grapple with the opposing forces of …

Effect Of Yoga On Non-Invasive Measures Of Cardiovascular Functioning And Health, Alexis Nicole Thrower

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Cardiovascular disease (CVD) has been the number one cause of death worldwide and within the United States (US) for decades. Effective and practical prevention modalities are needed to reduce the burden of this often-preventable condition. Physical activity is an effective and modifiable behavior for CVD risk management; however, only one in four adults meet current physical activity guidelines. Some types of yoga, including vinyasa yoga, are a form of physical activity, and vinyasa yoga efficiently incorporates moderate-intensity aerobic activity, muscular-strengthening movements, and flexibility components. Yet, minimal rigorous research evaluates yoga’s effects on health. The purpose of this dissertation is …

January 2026 Library & Learning Newsletter, Minnesota State University, Mankato. Library & Learning Dean’S Office Communications Team

Library & Learning Newsletters

PDF version of the January (Volume 4, Issue 6) Library & Learning Newsletter.

Increasing Awareness Of Obesity And Its Associated Risks In Adults, Esther E. Bayode

Doctor of Nursing Practice Projects

Obesity is a significant and growing public health concern in a metropolitan area of North Carolina, reflecting statewide and national trends. With 36% of adults in North Carolina classified as obese, the condition contributes to chronic diseases such as hypertension, diabetes, heart disease, and certain cancers. This project targeted adults aged 18 and older within a local faith-based community, where preliminary findings showed a strong association between elevated body mass and increased chronic disease burden. To address this issue, a two-session educational intervention was implemented in partnership with a religious organization to increase knowledge about obesity, its causes, associated risks, …

Daniel Ezra Subotnik (1942-2024) Obituary

Touro Law Review

No abstract provided.

Dan Subotnik: Life-Long Teacher And Mentor, Rena Subotnik

Touro Law Review

No abstract provided.

The Role Of Legal Uncertainty, Risk, Institutional Size, And Mission In Presidential Selection: Is The Trend To Lawyer-Presidents An Unmitigated Good?, Nora V. Demleitner

Touro Law Review

This Article builds on Patricia Salkin’s May It Please the Campus which documents the extent to which legally trained persons have led U.S. institutions of higher education since colonial times. It explains the perennial attraction of lawyer-presidents despite substantial changes in legal training, in the professional formation of attorneys, and the transformation of higher education, especially with the rise of the modern research university, governmental investment, and heightened regulation of colleges and universities. Governing boards are increasingly attracted to the skills ascribed to lawyers and their personal characteristics, including the common law appreciation for slow change. This Article highlights how …

Front Matter, Michigan Law Review

Michigan Law Review

Front Matter for Volume 124, Issue 4 of Michigan Law Review

Standard Textualism, James A. Macleod

Michigan Law Review

For as long as legal scholars have been writing about the rules-versus-standards distinction, textualism has been understood to produce characteristically rule-like law. This Article argues for the opposite view. Far from generating the “law of rules” that Scalia famously envisioned, the rule of modern textualism produces a law of standards—much more so than anybody, proponent of textualism or critic, appears to have recognized.

Two aspects of today’s textualism produce this result. The first is its emphasis on ordinary language and communication. Modern textualism typically produces standards because ordinary language and communication are typically standard-like. The second is modern textualism’s drive …

Spreading Awareness To College Athletes About Skin Cancer And Improving Sun Protection Habits, Baylee B. Whiteside

Doctor of Nursing Practice Projects

Introduction: The intention of this Doctor of Nursing Practice evidence-based project was to provide education on improving awareness of skin cancer to potentially improve sun protection habits. A total of 100 college athletes participated in this project. The goal was to increase educational knowledge and practice intentional sun protection habits.

Background: One in 5 people will develop a type of skin cancer by age 70 (Skin Cancer Foundation, 2024). Several studies have proven that young adults, ages 15-25, are at an increased risk of sun exposure due to decreased knowledge about skin cancer. Teaching and improving the knowledge in this …

The Ache Of Modernism: Death, Affect, And Intersubjectivity In Twentieth-Century American Literature, Alex Gergely

Theses and Dissertations--English

This dissertation suggests that we can locate, describe, and experience death as an aesthetic mood called the ache of modernism. The ache is an atmosphere found in twentieth-century literature that goes beyond simply “positive” or “negative” feeling and encourages audiences to come to an affective and existential relationship with their mortality. As an intersubjective mood deriving from an attunement on death, it illuminates the historical and philosophical moment of many twentieth-century authors while clarifying their texts’ continued resonance today. This project therefore draws on the thought of major philosophers like Emmanuel Levinas, Martin Buber, Gabriel Marcel, Maurice Merleau-Ponty, Heidegger, …

Cultus: Eco-Phenomenology In The Work Of John Steinbeck, Robinson Jeffers, And Jack London, Carter D. Johnson

Theses and Dissertations--English

In the face of increasingly dire environmental crises, proposed solutions have gravitated toward imperatives for faster, cleaner, and more efficient technologies and resources. While practical solutions are necessary, they are entirely insufficient to deal with an underlying issue driving environmental degradation: unbridled instrumental reason. In this dissertation, I suggest a theoretical posture, cultus, which attempts to balance the necessity of instrumental action with the guiding counterweight of receptivity. Furthermore, I argue that such personal receptivity is uniquely fostered in aesthetic experiences, attuning the individual to the non-identical and renewing a relationship of care.

I examine the life and work of …