Digital Commons Network^™

Exploring Prenatal Care Providers' Perceptions Of Barriers To Physical Activity During Pregnancy: A Survey Of Obstacles And Attitudes, Tania Nambo-Escobar

Doctor of Nursing Practice Projects

Despite the well-established benefits of physical activity during pregnancy, most pregnant individuals in the United States fail to meet recommended guidelines. The aim of this quality improvement project, conducted through Seattle University College of Nursing, was to explore prenatal care providers’ perceptions of barriers to physical activity counseling during pregnancy. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, a mixed-methods survey was distributed to midwives and obstetric nurses at Neighborcare Health clinics. The survey assessed providers' beliefs, perceived barriers, and current practices related to physical activity counseling. Results showed that while most providers acknowledged the importance of physical activity, they …

The Impact Of Standardizing Radial Over Femoral Access For Coronary Angiography On Hospital Costs And Length Of Stay, Satinder Kaur

Doctor of Nursing Practice Projects

Local Problem: Trans-femoral Access (TFA) has traditionally been the preferred route for coronary angiography (CA) due to ease of use. However, TFA is associated with complications, extended hospital stays, and increased costs. A quality improvement (QI) project was launched in May 2021 to promote Trans-radial Access (TRA) and same-day discharge (SDD) for elective CA procedures, aiming to reduce complications and improve patient outcomes.

Purpose: The purpose of this QI project was to compare and contrast patient outcomes and length of stays for patients undergoing elective coronary angiography (CA) utilizing Trans-radial Access (TRA) versus Transfemoral Access (TFA).

Methods: A retrospective chart …

An Integrative Approach To Diabetes Education In The Immigrant Somali Community, Bilal Kadri, Amina Osman

Doctor of Nursing Practice Projects

Diabetes mellitus is a chronic disease with numerous health and financial ramifications, especially for vulnerable populations like Somali immigrants. Effective management of diabetes requires adequate knowledge and management skills. Traditional diabetes education programs are ineffective for Somali immigrants because they do not account for their unique social, cultural, and traditional backgrounds. This study implemented a culturally sensitive, in-person, interactive education session for 14 first-generation Somali immigrants with type 2 diabetes. The effectiveness of the study was evaluated with pre- and post-education tests, as well as the participants’ self-confidence in managing diabetes. Mean test scores and a paired t-test were calculated …

Oral Hygiene In Hospitalized Patients: Why Nursing Education Matters, Jieun Jugao, Jordan Cusick

Doctor of Nursing Practice Projects

Daily oral care for non-ventilated acute care patients significantly reduces hospital-acquired pneumonia (NV-HAP), dementia risk, reduces length of stay, and enhances patient well-being. Sustaining these outcomes requires ongoing patient-centered education to reinforce adherence and optimize long-term care practices.

Pain Versus Neuropsychiatric Symptoms In Residents With Dementia: A Nursing Staff Educational Training, Rebecca Hildreth

Doctor of Nursing Practice Projects

BACKGROUND: Pain assessment in patients with dementia is challenging due to cognitive and communication impairments, making the older adult population highly susceptible to poor pain assessment and treatment.

AIM: The purpose of this project is to accurately identify the cause of agitation in residents with dementia. Specific aims include 1) to collect background demographic data on residents, 2) to educate nursing staff on pain assessment in dementia patients, and 3) to educate nursing staff about the risks associated with antipsychotic medications to prioritize using non-pharmacologic interventions to treat agitation.

METHODS: A chart review of residents residing in a suburban, Pacific …

Infectious Disease Response Preparedness: Survey Of Small To Medium Residential Universities, Tara Hicks

Doctor of Nursing Practice Projects

Objective: To improve the understanding of strategies implemented by institutions of higher education (IHE) during the COVID-19 pandemic, including how those experiences and resulting knowledge influenced staff confidence and preparedness for future infectious disease events.

Participants: Small to medium undergraduate residential IHE in CA, OR, and WA.

Methods: A Qualtrics survey collected data 1/26/25 – 2/24/25.

Results: Over 50% of respondents identified 7 of 9 preparedness needs as a major to critical need of their IHE. Statistically significant associations were found between IHE conducting a review of actions during COVID-19 and both self-confidence (ρ 0.46, p=0.018) and confidence in …

Exploring Barriers And Opportunities For Formally Integrating A Compensated Community Health Worker Program To Manage Hypertension Into The Healthcare System In Puno, Peru, Miye Dittmann

Doctor of Nursing Practice Projects

Hypertension is the leading cause of preventable mortality worldwide. Community health workers (CHWs) can be potential aids in managing hypertension in Peru. CHWs in Peru are currently not formally practicing or compensated for chronic disease management. Effectiveness of CHWs for hypertension care is being assessed in the The Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) Trial. Through semi-structured interviews with healthcare providers and healthcare administrators, this study aims to understand scalability and feasibility integrating CHWs into hypertension management into Peru’s national healthcare system. Following transcription of interviews, inductive and deductive analysis identified key themes and subthemes. Participants described a …

Provider Insight And Feasibility Of Screening For Harmful Sibling Aggression In Well-Child Visits, Mindy Gunn, Sara Crauer

Doctor of Nursing Practice Projects

Background: Violence between siblings is prevalent and can have lasting adverse effects, including lowered self-esteem, anxiety, depression, and poor peer relationships.

Aim: Assess feasibility of implementing a sibling aggression tool in pediatric primary care settings and provide resources for support.

Methods: A quality improvement project design, including an educational brief for providers, implementation of the Sibling Aggression Screening Tool, compiled resources for support, and a Post Implementation Provider Survey to collect provider feedback.

Intervention: A Sibling Aggression Screening Tool was implemented over a one-week period with consolidated resources provided for support.

Results: Fifty percent of the providers agreed that it …

Understanding Perceptions And Other Barriers To The Utilization Of Guideline-Directed Medical Therapy In Patients With Heart Failure With Reduced Ejection Fraction: A Provider Needs Assessment, Jessica Cox, Joseph Pfeifer

Doctor of Nursing Practice Projects

Background. Guideline-directed medical therapy (GDMT) is fundamental to the management of heart failure with reduced ejection fraction (HFrEF), yet its utilization remains suboptimal in clinical practice. Despite strong evidence supporting GDMT’s ability to improve survival and reduce hospitalizations, significant underutilization of these medications persist due to patient, provider, and system-level barriers.

Purpose. This project aimed to assess provider knowledge, perceptions, and barriers to prescribing GDMT for HFrEF within a single regional healthcare system. Data from this project will be used to inform targeted quality improvement strategies to enhance GDMT utilization and, ultimately, patient outcomes.

Methods. A cross-sectional survey was distributed …

Undergraduate Nursing Students’ Perceptions, Knowledge, And Barriers To Accessing Student Mental Health Services, Margot Sprague

Doctor of Nursing Practice Projects

Background: While improving the mental health of college students is a worldwide goal of the World Health Organization, programs to address student needs in the United States are underresourced, complex to access, and frequently confusing. In 2024, the National College Health Assessment found that 21% of college students scored high in severe psychological distress, 50% were positive for loneliness, 11% reported self-injury over the previous 12 months, and 28% scored positive on suicidal screening. Nursing students have increased levels of depression, anxiety, sleep disturbances, stress-related illness, and suicide. Aim: The first aim of this project was to identify perceptions, knowledge, …

Mind The Gap: Supporting Freshmen Voice Students Transitioning To Higher Education Through Coaching Conversations, Erica L. Gabriel

Theses and Dissertations--Music

The experiences one may encounter while matriculating through the K-12 system of education are vastly different from the world of higher education. While one feeds directly into the other, the transition can be a difficult one for young singers also navigating the developmental leap from adolescence to adulthood. This is due to several systematic and instructional differences, compounded with unique challenges encountered by freshman voice students in the first year. Gaps in support systems compiled with new and increasing financial, social, and academic demands can lead to a decline in overall student well-being and an increase in stress.

This increase …

Assessment Of Bifidobacterium Longum Itt 13 As A Probiotic Candidate, Eleana Keatley

Masters

Probiotics are live microorganisms that when administered in adequate amounts confer a health benefit on the host. Beneficial microbes are found in several sites throughout the body such as the oral cavity, skin, respiratory tract, vagina, urinary tract, breast tissue and the gut. In this research, the culture Bifidobacterium longum ITT 13, which was previously isolated from a neonatal faecal sample, was examined for its potential as a probiotic candidate. Probiotics can have numerous desirable characteristics. The pertinent ones to this research are being of human or animal origin, not prone to antibiotic resistance, demonstration of antagonistic activity towards pathogens, …

Treating Social Media Addiction In Adolescents: A Scoping Review With Implications For Music Therapy Practice, Roman D. Swain

Theses and Dissertations--Music

With the rapid expansion of online connectivity, concerns have emerged regarding the influence of digital interactions on adolescents’ real-world relationships and mental health. Social media use can expose adolescents to harmful content and disrupt the brain’s pleasure centers, increasing the risk of developing addictive patterns of use. Such disruptions may interfere with daily functioning and contribute to negative mental health outcomes. Given the impact of music on the brain’s reward system, music therapy may offer a beneficial approach for helping adolescents develop mindfulness of social media use and strengthen offline social connections. This thesis presents a scoping review of current …

Statistical Approaches In Evolutionary Biology: Using Threespine Stickleback Fish To Test Fisher's Geometric Model And Evaluate Methods For Handling Missing Data, Aaron Mathew Myrold

Dissertations

This thesis explores two distinct yet complementary aspects of evolutionary biology. The first chapter tests predictions from Fisher's geometric model of adaptation using a finely resolved fossil sequence of Gasterosteus doryssus spanning approximately 21,250 years. I analyze phenotypic changes in three armor traits during adaptation to a new environment and find that while step sizes follow the predicted exponential distribution—with many small steps and few large ones—they do not adhere to the model's temporal prediction that large-effect mutations should fix early in the adaptive walk. This discrepancy likely reflects adaptation from standing genetic variation rather than de novo mutation. The …

Genetic Architecture Of Complex Traits In African Ancestries Across Diverse Environments, Isadore Gregga

Dissertations

Given genetic and environmental diversity, genetic prediction based on African- ancestries individuals in the US or UK may not transfer well to other African diaspora regions. The Modeling the Epidemiological Transition Study (METS) is a longitudinal study of cardiometabolic health in five African-ancestry populations. We performed genome-wide genotyping in METS participants from the US, Jamaica, South Africa, and Ghana. We aimed to explore how genetic models for the transcriptome and body mass index (BMI) built using US- based African-ancestries populations perform in these four diverse populations. A subset of METS participants also had whole blood RNA-Seq data. For these, we …

Characterizing Niche Specialization In Staphylococcus Epidermidis, Sandra Jablonsk

Dissertations

This thesis investigates the microbial diversity of Staphylococcus epidermidis (S. epidermidis) across various anatomical sites in the human body. While traditionally viewed as a benign skin microbe, S. epidermidis also inhabits the urinary, gastrointestinal, and respiratory tracts, raising questions about its genetic variation and adaptability in different environments. The research aims to compare strains of S. epidermidis isolated from the oral cavity, nostrils, urinary tract, and skin of healthy individuals to determine if they share a common ancestor or if they evolved independently in response to specific environmental factors. The study comprises three main aims. Aim 1 focuses on assessing …

Sffa V. Harvard: Racial Triangulation And The Invidious Myth Of Colorblindness, Philip Lee

Faculty Publications

(Excerpt)

In Students for Fair Admissions, Inc. (SFFA) v. President and Fellows of Harvard College, a case in which the Supreme Court ended the longstanding practice of race-conscious admissions in higher education, Asian Americans were used as a wedge between White people and non-Asian minorities to eradicate a mechanism that fostered greater racial diversity in student bodies in many highly selective institutions across the country. A majority of Supreme Court justices justified their decision in the name of “colorblindness.” However, the way the justices positioned Asian Americans against other people of color was not colorblind. It was consistent with …

Queers, Closets, And Corporate Governance, Darren Rosenblum

Faculty Publications

The past few years have seen several corporate diversity initiatives that include Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) people. In 2020, Nasdaq, the world’s second-largest stock exchange, and California, the largest state, both adopted rules to encourage board diversity for underrepresented groups, including LGBTQ+ people. Since that time, the Los Angeles Superior Court struck down California’s law, the Fifth Circuit invalidated Nasdaq’s rule, and the Trump administration initiated a slew of anti-Diversity Equity and Inclusion (DEI) and anti-LGBTQ+ measures. In the context of this sharp ideological turn, this Article attempts to step back and tackle a larger question: how can …

Interactions Between Microplastics, Biofilms, And Antimicrobials In Freshwater Streams, Ryan Thomas Krantz

Dissertations

Microplastics (MPs) are ubiquitous contaminants in freshwater ecosystems that could be hotspots for the interaction of antimicrobial compounds and surface-attached microbial biofilm communities. MPs and antimicrobials are both common in wastewater and urban freshwaters and MPs can adsorb contaminants like antimicrobials to their surface. Within aquatic habitats, MPs also support colonization by microbial biofilms. Therefore, we hypothesized that the adsorption of antimicrobials to MP surfaces would affect microbial communities colonizing MPs, altering their diversity, composition, and antimicrobial resistance. We investigated the effects of these interactions across two studies. The first study, discussed in Chapter 2, used a microcosm approach to …

Examining The Adjustment, Acculturation, And Well-Being Of International Arab Students In The United States: Implications For Policy And Practice, Hassan A A Kh A A Arab

Wayne State University Dissertations

This paper explored Arab international students studying in the United States to see whether they face acculturation stress, adjustment, or well-being issues. I found that my sample (N=95) experienced moderately high well-being distress and acculturative stress. However, the sample showed resilience and positive adjustment in all aspects, psychological (M=34.7), social (M=38.5), and academic (M=37.4). Moreover, well-being score from a modified GHQ survey came with high SD, indicating some students were dealing with serious mental issues, while others were doing well (M=42.92, SD=5.52). The majority of my participants were males (74.7%), single (75.8%), and graduate students (50.5%). Chi-square analysis found a …

Talking About Cancer And Tobacco (Tact) Study With Lgbtq Patients And Their Care Providers, William Bowling

Theses and Dissertations--Psychology

Due to multilevel factors, including a high prevalence of tobacco use, the burden of some cancers is disproportionately higher in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community than the general population. Evidence-based tobacco treatment delivery with high rates of tobacco cessation would be a powerful tool for secondary cancer prevention in the LGBTQ community, yet few studies have explored this issue. The current study aimed to 1) uncover both positive and negative aspects related to the lived experience and treatment of LGBTQ cancer survivors who use tobacco, 2) elucidate barriers and facilitators of tobacco treatment and cessation, and …

Evaluating The Acceptability Of Ptsd Treatment Among Justice-Involved Women In Kentucky With Histories Of Opioid Use, Jesse P. Mccann

Theses and Dissertations--Psychology

Rates of trauma and PTSD as well as histories of opioid use are high among justice-involved women, particularly in Kentucky. However, there are many barriers to receiving treatment. There is a pressing need for brief, trauma-focused interventions that can be more feasibly delivered in jail or prison settings as well as by community clinicians serving women on probation or parole. This study explores the acceptability of treatment for PTSD, particularly Written Exposure Therapy (WET), among justice-involved women on probation or parole with a history of illicit or nonmedical prescription opioid use. The research aims to deepen our understanding of factors …

The Impact Of Victim Posttraumatic Stress Disorder (Ptsd) On Legal Decision-Making In A Rape Trial, Mary M. Levi

Theses and Dissertations--Psychology

Prior psychology and law research has investigated juror perceptions of victims and defendants with mental health issues. However, one factor that has yet to be fully examined empirically is how the presentation of a victim who developed a mental health disorder, such as posttraumatic stress disorder (PTSD), following a rape impacts legal decision-making. Understanding this impact is crucial considering over 36 million individuals in the United States report being a victim of rape in their lifetime, many of which report developing psychological disorders following the crime. Thus, the present study aimed to investigate how presenting mock jurors with victim testimony …

A Dual Process Model Perspective On Associations Between Parent And Offspring Problem Drinking, Karallyn E. Fitisone

Theses and Dissertations--Psychology

Parental problem drinking (PPD) is a well-established risk factor for adolescent alcohol use, yet the complex mechanisms involved remain underexplored. The present study addresses this critical gap by examining how PPD, parent emotion socialization, and emerging adult problem drinking are associated within the framework of the Dual Process Model of Substance Use. Participants were 2,036 undergraduates who completed an online survey assessing PPD, retrospective reports of parental reactions to their negative emotions in childhood, and students’ current levels of problem drinking, negative urgency, negative emotional reactivity, and emotion-regulation difficulties. Structural equation modeling was used to clarify the roles of emotion-related …

Introducing Education On Modified Bedside Nursing Handoff To Reinforce Patient Safety Across High-Risk Populations: A Quality Improvement Project., Sydney P. Hodgdon

Master's Theses and Capstones

BACKGROUND:

The Modified Bedside Nursing Handoff (mBNH) is a process where nurses exchange patient information and responsibility at shift change, ideally at the bedside. A PRISMA-based literature review showed that mBNH may help improve communication, protect patient privacy, and enhance safety when done thoughtfully—sometimes at the bedside, sometimes just outside the room. This quality improvement project was launched on a busy unit that cares for high-acuity patients from across northern New England, including those recovering from strokes, motor vehicle accidents, and serious falls. The goal was to increase both frequency and how standardization that nurses reported using mBNH by at …

Enhancing Faculty Self-Efficacy In Student Retention Through Teas Reading Comprehension Score Education, Katina A. Ennis

Doctor of Nursing Practice Projects

Student retention remains a persistent challenge for Associate Degree in Nursing (ADN) programs, with significant implications for the nursing workforce amid a national shortage. Faculty self-efficacy in interpreting and utilizing academic readiness data, particularly ATI TEAS reading comprehension scores, is often limited, leading to missed opportunities for early intervention. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a targeted educational intervention could enhance faculty self-efficacy in using TEAS reading comprehension scores to support at-risk students and improve retention strategies.

The project employed a quantitative pre- and post-intervention design using the validated Teacher’s Sense of Efficacy Scale (TSES) …

Language Barriers In Clinical Trials: Exploring Impacts On Continuity And Participants’ Engagement And Effective Mitigation Strategies, Harsha Ani Das

Master's Theses and Doctoral Dissertations

Clinical trials are crucial for advancing medical knowledge and developing new treatments. However, language barriers can pose significant challenges for participants, particularly in understanding trial procedures, risks, and benefits. Existing policies, guidelines, and studies from 2020 to 2024 identify key challenges in recruiting and retaining non-English-speaking participants. The lack of data on dropout rates highlights the need for improved language services and culturally sensitive communication methods. Findings demonstrate the importance of addressing linguistic disparities to enhance trial inclusivity and success. Innovative strategies to overcome language-related hurdles include the use of professional interpreters, translated materials, and community engagement initiatives. By addressing …

Self-As-Context Moderation Of Relationship Fusion: A Comparison Of Intimate And Familial Relationship Impact On Weight Concern, Carly Carrasco-Wyant

Master's Theses and Doctoral Dissertations

This study explored how fusion in important relationships relates to weight concern and whether these effects are moderated by self-as-context perspectives and racial and ethnic background. Grounded in acceptance and commitment therapy (ACT) and relational frame theory (RFT), eight models were constructed to evaluate influence of important others when absent or present and when moderated by self-as-context, racial and ethnic background and in multiple moderation models analyses using data from 1,323 participants. Results indicated that fusion with family was significantly associated with greater weight concern, when family was absent (ß = 0.10, p = .03) and present (ß = 0.12, …

Caregiver Training To Enhance Care Interactions With Persons With Neurocognitive Disorders: An Additive Treatement Study, Samantha J. Killian

Master's Theses and Doctoral Dissertations

Persons with neurocognitive disorders (NCD) rely on family and friends to help them with everyday tasks, yet informal caregivers might not be aware of the need to scaffold tasks or know how to maximize the care recipients’ engagement. The current study recruited three men who were full-time family caregivers for women (spouses, their mother). The study assessed the care recipients’ need for scaffolding of instrumental tasks and the caregivers’ perception thereof and then trained the caregivers in task analysis and prompting. An additive treatment design examined the differential effects of a two-part training intervention on caregivers’ perceptions of the need …

Latent Classes Of Comorbid Clinical Presentations For Patients With Psychogenic Non-Epileptic Seizures, Joseph W. Tu

Master's Theses and Doctoral Dissertations

Psychogenic non-epileptic seizures (PNES) are episodes of motor, sensory, and/or cognitive seizures without detectable epileptic activity. The integrative cognitive model conceptualizes PNES as an activation of learned mental representations of a seizure often combined with concurrent physiological arousal. PNES are not treatable by antiepileptic medications and are often accompanied by psychiatric and medical comorbidities, complicating treatment following diagnosis. Further, individuals with PNES often incur greater medical costs through hospital admissions and emergency department visits. Multidisciplinary care including behavioral health interventions like cognitive behavior therapy have demonstrated initial success at reducing seizure frequency but impacts on healthcare utilization are unknown. Patients …