Digital Commons Network^™

Parents' Perspectives Of Factors Contributing To Speech Delays In Children Born During The Covid-19 Pandemic, Alva Jessica Daniels

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic significantly disrupted children’s developmental environments by limiting access to childcare, healthcare, and opportunities for social interaction, raising concerns about speech and language outcomes in children born during this period. Grounded in Bronfenbrenner’s ecological systems theory, this qualitative study was an exploration of factors associated with speech and language delays and examined parents’ perceptions and experiences in Philadelphia. The qualitative study included a sample of nine parents who cared for children during the COVID-19 pandemic quarantine period. Analysis of the interview data revealed five emergent themes: (a) limited social interaction during the pandemic, (b) delayed identification and diagnosis …

Staff Education To Improve Staff Knowledge, Confidence, And Competency In The Use Of The Zung Self-Rating Depression Scale, Theresa Buabeng

Walden Dissertations and Doctoral Studies

Staff Education to Improve Staff Knowledge, Confidence, and Competency in the Use of the Zung Self-Rating Depression Scale

English As A Second Language Students’ Perceptions On Their Reasons To Persist In An Adult Learning Program In Connecticut, Laurie Anne Winek

Walden Dissertations and Doctoral Studies

The problem that was addressed through this study is that 30% of the English as a second language (ESL) students drop out of classes after the first 2 weeks in an adult education program in Connecticut. Grounded in Tinto’s model of student departure, the purpose of this study was to explore ESL students’ perceptions on reasons they persisted in an adult education program in Connecticut. For this basic qualitative design, semistructured interviews were conducted with five students. The data analysis procedures used open coding and categories, with eight themes emerging: ESL students persisted when their instructors cultivated lifelong learning; included …

Improving Medication Adherence Through Structured Telephone Follow-Up To Reduce 30-Day Readmissions Among Adult Patients With Heart Failure, Angela Dean Hamilton

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) evidence-based quality improvement (QI) project addressed high 30-day hospital readmission rates among adults with heart failure (HF), a problem associated with poor medication adherence and inadequate transitional care that nurses are uniquely positioned to address through discharge education, medication reconciliation, and postdischarge follow up to improve patient safety and quality of care. The practice-focused question asked: In adult patients discharged with HF, how does a structured, nurse-led, telephone follow-up intervention focused on medication adherence, compared with usual discharge care, affect 30-day hospital readmission rates over a 90-day implementation period? The purpose of this DNP …

Cultural Integration Of Ethiopian Immigrants And Refugees And Role Of Ethnic Nonprofits In Chicago, Aklilu Abraham Adeye

Walden Dissertations and Doctoral Studies

Despite the availability of institutional services and interventions, cultural integration outcomes among refugees and immigrants often remain uneven. Existing literature has demonstrated the important role of nonprofit organizations in supporting refugee and immigrant resettlement and early integration. However, comparatively little research has examined how refugees and immigrants themselves experience the influence of nonprofit services on long-term cultural integration. The purpose of this general qualitative study was to explore how nonprofit services and programs influence the cultural integration experiences of Ethiopian refugees and immigrants in Chicago through the lens of the new assimilation theory and the integration context perspective. Data were …

Effective Strategies Small Business Owners Use To Sustain Their Businesses During Periods Of Disruption, Tracey Starr Moon

Walden Dissertations and Doctoral Studies

Small businesses experience significant challenges sustaining operations during periods of disruption, including economic uncertainty, natural disasters, supply chain interruptions, and other environmental changes. This is a concern for small business owners because disruptions can reduce revenue and strain limited financial and operational resources, putting their continued survival at risk. Grounded in the resilience theory, the purpose of this qualitative pragmatic inquiry project was to identify and explore effective strategies small business owners use to sustain their businesses during times of disruption. The participants were six small business owners in the southern United States. Data were collected through semistructured interviews and …

Implementing Routine Trauma Screening Using The Ace Questionnaire And Pcl-5, Esther Amune

Walden Dissertations and Doctoral Studies

This evaluation of a quality improvement initiative addressed inconsistent trauma screening and electronic documentation at an outpatient site. The baseline trauma-screening completion rate was 60%, below the organization's 80% target. The gap was relevant to nursing because nurses support screening, documentation, referral, coordination, and follow-up. The practice-focused question addressed whether the Adverse Childhood Experiences (ACE) Questionnaire and the Posttraumatic Stress Disorder Checklist for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), or PCL-5, would improve documented screening completion and trauma-informed treatment planning over 10 weeks. The purpose was to incorporate both tools into care and …

Staff Education To Improve Skills In Detecting And Addressing Medication Nonadherence Among The Psychiatric Nursing Staff, Uchenna Owunna

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education project focused on addressing the knowledge gap of medication nonadherence patterns by the psychiatric nurses in outpatient settings. Nonadherence to psychiatric medications is a major health issue that leads to disruptions of care and symptom relapse, hospitalization, and suboptimal treatment outcomes as well as high healthcare costs. Thus, improving the capacity of the psychiatric nurses to enhance medication adherence through staff education is essential. The purpose of this DNP project was to determine if a comprehensive medication adherence education program would increase psychiatric nurses’ knowledge and skills in assessing …

Adults’ Lived Experiences With Placement In Child Protective Services During Adolescence, Michaela First Haynes

Walden Dissertations and Doctoral Studies

Perceptions of safety and emotional support during involvement with child protective services (CPS) during adolescence may play a significant role in shaping attachment experiences and relationships in adulthood. Although researchers have examined the effects of child maltreatment and foster care involvement, limited research has explored how adolescents perceive emotional support and safety during CPS involvement and how those experiences influence attachment in adulthood. The purpose of this qualitative study was to explore the lived experiences of adults who experienced CPS involvement during adolescence and to understand how perceptions of safety and emotional support are reflected in their adult attachment relationships. …

Exploring The Experiences Of Nigerian Army Personnel With Toxic Leadership, Shamsideen Toyin Shafaru

Walden Dissertations and Doctoral Studies

Toxic leadership has been shown to be present in Nigeria, promoting negative consequences for organizations and adverse effects on employee performance. However, how toxic leadership behaviors impact Nigerian Army operations and the performance of personnel have not been studied. Exploring toxic leadership in the Nigerian Army is important because the way in which leaders exercise influence determines the effects it has on followers. The purpose of this general qualitative study was to examine the lived experiences of Nigerian Army personnel who had worked as subordinates of individuals who exhibited toxic leadership traits and its impact on their performance. The theoretical …

The Lived Experiences Of Midlife Black Women In Atlanta Managing Hypertension Through Nonpharmacological Interventions, Beth Feagins

Walden Dissertations and Doctoral Studies

In this qualitative phenomenological study, the beliefs and lived experiences of midlife, low-income Black women with hypertension were explored, concentrating on understanding how social determinants of health influence effects adherence to diet, physical activity and stress management. Social determinants of health and how health beliefs shape adherence to behaviors were examined. The study was guided by a dual theory approach of the social cognitive theory and theory of planned behavior. Six women, identified as Black, between the ages 40-60, diagnosed with hypertension and living in Atlanta, Georgia, participated in the study. Data was analyzed using Moustakas’ phenomenological analysis and revealed …

Implementation Of A Standardized Columbia-Suicide Severity Rating Scale Screening Process In An Outpatient Psychiatric Practice, Dela Mensah Frimpong

Walden Dissertations and Doctoral Studies

This doctoral project was an organizational change initiative designed to implement a standardized suicide risk screening process in an outpatient psychiatric practice. The identified practice problem was inconsistent staff use and documentation of suicide risk screening, which could result in missed warning signs, delayed provider notification, incomplete documentation, and inconsistent follow-up care. Suicide risk identification is an essential nursing responsibility and a key component of patient safety (The Joint Commission, 2024; Zero Suicide, n.d.). The practice-focused question examined whether staff education and implementation of a standardized Columbia-Suicide Severity Rating Scale (C-SSRS) workflow would improve staff compliance, documentation completion, and knowledge …

Staff Education To Improve Clinical Staff Knowledge, Confidence, And Use Of The Patient Health Questionnaire-9 (Phq-9) In Outpatient Depression Screening, Madjou Stella Ngantche

Walden Dissertations and Doctoral Studies

Depression is one of the most common mental health conditions encountered in outpatient practice, yet inconsistent use of standardized screening tools contributes to missed opportunities for early identification and intervention. In outpatient settings, nurses and other clinical staff are often responsible for administering depression screenings; however, many lack formal education on the standardized use of the Patient Health Questionnaire-9 (PHQ-9). To address this practice gap, this Doctor of Nursing Practice (DNP) staff education project was implemented in an outpatient setting to determine whether staff education on the use of the PHQ-9 would improve staff knowledge, confidence, and intent to use …

Staff Education On Medication Nonadherence In Primary Care Clinic, Priscillia Adaugo Obasi

Walden Dissertations and Doctoral Studies

This doctor of nursing practice (DNP) project was a staff education initiative designed to address the practice problem of a lack of evidence-based approaches to patient education on medication compliance in a primary care clinic. A literature search was conducted using PubMed, CINAHL, MEDLINE, and the Cochrane Library search engines/databases, revealing nine studies that supported the premise that patient education can promote medication compliance. A practice-focused question underpinning this project was: Will staff education on evidence-based methods for educating patients about the importance of medication adherence result in increased staff knowledge? Baseline staff knowledge and educational needs were obtained using …

Impact Of Emerging Technologies On Leadership Identity Of Behavioral Health Leaders, Jenah Habermehl

Walden Dissertations and Doctoral Studies

Emerging technologies are reshaping behavioral health leadership by changing documentation, communication, ethical responsibilities, and role expectations. Qualitative case study research methodology was used in this study. The problem addressed in this case study was the limited understanding of how emerging technologies influence the leadership identity and professional values of behavioral health leaders. The Baldrige Performance Excellence Framework guided this study of behavioral health leaders at a privately operated behavioral health organization in the South Atlantic region of the United States. Data were collected by conducting semistructured interviews with four behavioral health leaders at the organization and gathering internal archival and …

Improving Pcu Nurses’ Knowledge Of Evidence-Based Mindfulness Techniques Through Targeted Education, Dairia Moore Mohammed

Walden Dissertations and Doctoral Studies

The progressive care unit (PCU) is a high-acuity setting in which nurses manage patients with complex health conditions, respond to rapid changes in clinical status, and navigate ongoing physical and emotional demands. The practice problem that I addressed was, presently, stress-management support is typically informal, optional, and reactive rather than systematic, evidence-based, and preventive. The purpose of this project was to implement and evaluate a structured educational intervention designed to increase nurses’ knowledge of evidence-based mindfulness breathing techniques that could be integrated into the daily PCU workflow. The practice-focused question was: In PCU nurses in an acute care setting, how …

Terahertz Electromagnetic Effects And Chirality-Induced Spin Selectivity In Dna, F. Matthew Mihelic Md

Faculty Publications

The effects of terahertz electromagnetic stimulation of the DNA molecule can be understood through modeling of the quantum logical mechanics of the DNA molecule.  Coherent conduction of electron spin states along the aromatic nucleotide base pairs and chirality-induced spin selectivity are two characteristics of the DNA molecule that are involved in the precise separation of the double-stranded DNA molecule at a specific location.  Such modeling can inform predictions of DNA strand separation and has significant implications for understanding DNA transcription bubble formation.

Economic Development Corporations In Small Communities, Mary L. Bullock

Certified Public Manager® Applied Research

This study evaluates the effectiveness of Type A and Type B Economic Development Corporations (EDCs) in supporting economic growth in small Texas communities. Using key indicators such as population trends, employment, infrastructure, housing, and legal frameworks, this paper compares how each EDC structure addresses these issues. While both Type A and Type B Economic Development Corporations contribute to economic growth, Type B EDCs are generally more effective in small Texas communities due to their broad ability to fund housing projects, create critical infrastructure, and shape quality-of-life community development projects that have a more immediate and measurable impact on unemployment, population …

The Human Side Of Leadership: How Personality Assessments Build Self-Aware, Accountable, And Emotionally Intelligent Public Sector Leaders, Hillary Faulkner

Certified Public Manager® Applied Research

Public sector organizations face a persistent set of leadership challenges, including miscommunication, inconsistent accountability, and reactive decision-making, that are rarely resolved through technical training alone. This study examines how the intentional use of personality assessments can improve self-awareness, emotional intelligence, accountability, and communication among public sector leaders, and how those improvements contribute to more effective and cohesive leadership teams. Using a qualitative case study design, this research draws on Organization Analysis and Design (OAD) personality assessment data and in-depth interviews with two supervisors at a municipal government organization in Henderson, Texas, who participated in a structured six-month personality-based leadership development …

Succession, Sustainability, And Service: Workforce And Leadership Challenges In Rural Municipal Governments, Dewayne Armstrong

Certified Public Manager® Applied Research

Rural municipal governments across Texas and the United States face a convergence of workforce and leadership challenges that threaten long-term service delivery and organizational sustainability. An aging public-sector workforce, persistent recruitment and retention constraints, and fragile leadership continuity interact in ways that uniquely affect small and rural communities. Public works departments, which play a vital role in infrastructure maintenance and regulatory compliance, are particularly vulnerable as experienced employees approach retirement without adequate succession pipelines or mechanisms for institutional knowledge transfer. At the same time, small-town governments face ongoing difficulty attracting and retaining qualified personnel due to constrained fiscal capacity, geographic …

Interpreting Continuous Glucose Monitoring Through Metabolic Physiology: A Framework For Precision Nutrition In Type 2 Diabetes, Jitendra D. Belani

College of Pharmacy Faculty Papers

Background: Type 2 diabetes is characterized by substantial interindividual variability in postprandial glucose responses, yet continuous glucose monitoring (CGM)-derived glucose patterns are commonly described using quantitative metrics without sufficient consideration of the physiological mechanisms that generate them. Objective: To develop a physiology-based framework for interpreting CGM-derived glycemic phenotypes in relation to dietary exposures and individual metabolic characteristics, thereby supporting precision nutrition in adults with type 2 diabetes. Methods: A structured narrative review of the literature was conducted using PubMed to identify studies examining CGM, postprandial glucose regulation, dietary exposures, metabolic physiology, and precision nutrition. Evidence was synthesized within a predefined …

Dose-Expansion Study Of Obi-999, A Globo H-Targeting Antibody-Drug Conjugate, In Patients With Advanced Solid Tumors, Apostolia Maria Tsimberidou, Darren Sigal, Anna Varghese, Daniel Vaena, Li-Yuan Bai, Ming-Huang Chen, Chun-Nan Yeh, Chia-Jui Yen, Mehmet A Baysal, Abhijit Chakraborty, Ingly Lee, Chi-Sheng Shia, Konul Ristoski, Dong Xu

Children’s Nutrition Research Center Staff Publications

Background: OBI-999 is an antibody-drug conjugate consisting of the Globo H-targeting antibody OBI-888 linked to the cytotoxic payload monomethyl auristatin E. In a dose-escalation study, the OBI-999 recommended phase 2 dose (RP2D) was 1.2 mg/kg every 3 weeks. This dose-expansion study evaluated the efficacy and safety of OBI-999 in patients with pancreatic cancer, colorectal cancer (CRC), or other tumor types ("basket cohort") and tumoral Globo H H-scores ≥100 (NCT04084366).

Patients and methods: Patients were treated at RP2D of OBI-999. We assessed response, progression-free survival (PFS), treatment-emergent adverse events (TEAEs), and pharmacokinetics of OBI-999.

Results: Of 29 patients treated, …

Emergency Reinfusion Of Vaginally Salvaged Red Cells After Vacuum-Assisted Vaginal Delivery In A Jehovah's Witness: A Case Report, William Hughes

Peninsula Medical School

Perinatal blood management is critical for all obstetric patients as peripartum haemorrhage is common, unpredictable, and consequences can be severe. Patients who do not consent to allogeneic transfusion of blood products introduce additional complexity and are at greater risk of morbidity and mortality. There is growing evidence that reinfusion of autologous blood salvaged from vaginal deliveries is safe and can be lifesaving. Delivering this potentially lifesaving care requires that staff well trained in intraoperative cell salvage are always resident on the delivery suite, and that the delivery suite multidisciplinary team is familiar with the procedure. Here we present a case …

Predictors Of Adverse Events After Emergency Transfers In Long-Term Care: A Secondary Analysis, Yu-Chi Chen, Yi-Ru Liao

International Nursing Research Congress (INRC)

Long-term care residents worldwide frequently require emergency medical care due to multimorbidity, frailty, and functional impairment. After returning to long-term care facilities, many experience rapid health changes, leading to preventable adverse events, reduced care quality, and safety concerns. Identifying predictors of such events is essential to inform risk stratification and proactive nursing surveillance in long-term care settings. This study aimed to examine predictors of adverse events after emergency transfers, using Taiwan as a population-level case context.

A secondary data analysis was conducted using medical records from 19 long-term care facilities in northern Taiwan between October 2022 and September 2023. A …

Healthcare Professionals' Experiences Of Mental Health Crises Among People Experiencing Homelessness, John P. Gilmore

International Nursing Research Congress (INRC)

Background: People experiencing homelessness face significant barriers to accessing mental health care, often resulting in untreated psychological distress and crisis presentations. In Ireland, the absence of dedicated mental health services for this population means that frontline clinicians frequently manage acute mental health deterioration within generalist settings not designed or resourced for such care.

Aim: To explore the experiences of healthcare professionals responding to mental health crises among individuals experiencing homelessness and to identify systemic, relational, and organisational factors influencing care delivery.

Methods: A descriptive qualitative study informed by critical realism was conducted using semi-structured interviews with 14 healthcare professionals, including …

Gloves On Or Off? A Critical Ethnographic Study Exploring Non-Sterile Glove Use In Hospital Settings, Navisha Weerasinghe, Fiona A. Miller, Lisa Cranley, Quinn Grundy

International Nursing Research Congress (INRC)

Globally, the COVID-19 pandemic sparked a surge in the production and use of plastic single-use medical products, particularly single-use gowns, masks, and gloves. The proliferation of single-use medical products in care work highlights significant tensions between safety, cost, infection prevention and control (IPAC), and environmental concerns. Nurses are critical stakeholders in driving environmental sustainability within health systems as they are uniquely positioned at the intersection of patient care, supply utilization, IPAC, and waste generation. In recent years, ‘gloves-off’ campaigns have been introduced at some hospitals globally and in Ontario to attend to the environmental harms associated with unnecessary glove use. …

Impact Of Electronic Health Records On Nursing In Low-And Middle-Income Countries: A Scoping Review, Wahab Osman, Kimberley Widger, Alexandra Harris, Vida N. Yakong, Charlene Chu, Stephanie Asah-Ofori

International Nursing Research Congress (INRC)

Background: Electronic health records (EHR) are increasingly being implemented in low- and middle-income countries (LMIC), a significant shift from paper-based documentation, with goals to enhance clinical decision-making (1-5). However, implementation challenges such as lack of technical skills, funding constraints, and equipment issues exist (2-4). Furthermore, there is a lack of research focused on the impact of EHR implementation on nurses in LMIC, despite the critical role of nursing documentation on care decisions and planning (1-5).

Aims: To map evidence and identify research gaps from primary studies on the impact of electronic health records on nursing care in LMIC from 2015 …

Characterizing Stigma In Congenital Heart Disease: A Scoping Review, Tieghan Killackey, Valerie Tan, Mark Sochaniwskyj, Maryjo Antonio, Mohit Prashar, Ashley Farrell

International Nursing Research Congress (INRC)

Congenital heart disease (CHD) is the most common congenital malformation in Canada with a prevalence of 1.3%. (1) While medical advancements have improved survival rates, individuals with CHD have reported experiencing social exclusion, isolation, discrimination and bullying due to their condition, which impacts their social, professional, and emotional well-being.(2,3) This type of stigmatization can impact mental health, treatment adherence, and quality of life in patients (4); however limited research has focused on the experience of stigma in patients with CHD.

The purpose of the scoping review is to synthesize evidence on the various manifestations of stigma in the lives of …

Advancing Accessibility: Integrating Inclusive Design And Ai To Support Students With Disabilities, Stephanie Black, Jennifer Green

International Nursing Research Congress (INRC)

 Nursing students with disabilities often face barriers in didactic, simulation, and clinical environments that can limit academic success and contribute to underrepresentation in the nursing workforce. The purpose of this presentation is to highlight practical, evidence-based strategies for promoting accessibility in nursing education through universal design principles, collaboration with internal and external partners, and selective use of emerging technologies, including artificial intelligence (AI). This session will explore approaches such as flexible learning activities and assessments, accessible simulation experiences, and technology-assisted supports that complement traditional accommodations. While AI can enhance accessibility - through adaptive study aids, note-taking supports, and alternative content …

Predictors Of Choking In People With Schizophrenia In A Psychiatric Hospital: A Case-Control Study, Ying-Jyun Tsung, Chiu-Yueh Yang

International Nursing Research Congress (INRC)

Background: Choking risks include advanced age, swallowing disorders, poor dental health, rapid eating, and large bites, especially in older adults and those with intellectual disabilities. Protective factors are adequate chewing and slower eating. More research is needed on psychiatric inpatients, especially those with schizophrenia.

Purpose: This study aimed to identify factors related to choking in psychiatric inpatients with schizophrenia.

Methods: A total of 250 participants were recruited from a psychiatric institution in Northern Taiwan. The case group comprised 50 high choking-risk participants, identified by a history of choking and a Choking Risk Assessment (CRA) score above 20 or a “Yes” …