Digital Commons Network^™

Clarifying The Concept Of Virtual Nurse: A Concept Analysis For Aging And Chronic Care, Chia-Hui Chou, Heng-Hsin Tung

International Nursing Research Congress (INRC)

As the global healthcare landscape grapples with aging populations and the growing burden of chronic diseases, digital innovations like the Virtual Nurse (VN)—AI-powered embodied conversational agents—are gaining recognition for their potential to support patient self-management and improve care delivery. This study applies Walker and Avant's 8-step concept analysis to clarify the definition, boundaries, and essential characteristics of the Virtual Nurse. Thirteen peer-reviewed articles published from 2010 to 2021 were reviewed, focusing on their applicability to older adults and chronic disease management. Four defining attributes emerged: (1) clinical interactivity, (2) human-like empathy, (3) accessibility and understandability, and (4) scalability with feedback …

Workforce Solutions For Primary Care Physician Shortages In Veterans Health Administration Outpatient Clinics, Quintin Warner

Walden Dissertations and Doctoral Studies

The shortage of primary care physicians (PCPs) in the Veterans Health Administration (VHA) hospital system highlights the need for strategies to effectively mitigate this issue. The purpose of this integrative review was to examine the literature on primary care physician shortages in VHA hospital-based outpatient clinics and determine evidence-based solutions. The review question centered on strategies and best practices that can be implemented to address PCP shortages in VHA outpatient clinics. The Donabedian Model provided the framework for analyzing structural factors, processes, and patient outcomes. A comprehensive review of the literature resulted in 40 articles being screened for quality and …

Sidama Women's Perceptions Of Female Genital Mutilation/Cutting And Marital Fidelity, Mekonnen Doyamo

Walden Dissertations and Doctoral Studies

Female Genital Mutilation/Cutting (FGM/C) affects women from the Sidama region of Ethiopia differently from women in other parts of Ethiopia, which results in different physical and psychological consequences. The purpose of this qualitative case study was to explore why the Sidama people’s FGM/C custom differs from that of other parts of Ethiopia. A case study methodology was used to answer the following research question: How does the practice of FGM/C among the Sidama people in Ethiopia differ from that in other regions regarding its cultural significance and rituals? Moreover, how do community attitudes and beliefs surrounding FGM/C among the Sidama …

Strategies Human Resource Leaders Use To Implement Holistic Wellness Programs To Reduce Absenteeism And Increase Profitability, Diane Hardy

Walden Dissertations and Doctoral Studies

Human resources (HR) leaders struggle to reduce employee absenteeism and increase organizational profitability due to a lack of effective strategies for implementing holistic wellness programs. Identifying effective strategies for implementing holistic wellness programs is essential for helping HR leaders address absenteeism and strengthen organizational profitability. Grounded in the Pender health promotion model, the purpose of this qualitative pragmatic inquiry was to identify and explore effective strategies for implementing holistic wellness programs to reduce employee absenteeism and increase organizational profitability. Participants were nine HR leaders from medium- to large-sized organizations across the United States who implemented holistic wellness programs to reduce …

Implementation Of An Electronic Gad-7 Screening Tool To Improve Anxiety Screening Completion And Documentation, Obiageli L. Ukatu

Walden Dissertations and Doctoral Studies

Quality Improvement Initiative Implementation of an Electronic GAD-7 Screening Tool to Improve Anxiety Screening Completion and Documentation

Probation Officers’ Experiences Supervising Domestic And Intimate Partner Violent Probationers, Megan Davis

Walden Dissertations and Doctoral Studies

This study includes insights regarding potential supervision challenges that are faced by probation officers overseeing domestic and intimate partner violence (IPV) probationers, emphasizing the importance of effective management to enhance offender accountability and victim safety. The relationship dynamic between probation officers and domestic and IPV probationers influences recidivism rates, highlighting the importance of effective and empathetic supervision. The purpose of this study was to identify gaps in training, supervision strategies, and resources, with a focus on integrating attachment-based practices to improve outcomes. Guided by the attachment theory, the research included key questions about supervision effectiveness and relational dynamics. Employing a …

Implementation Of A Fall-Prevention Clinical Practice Guideline In A Neurological Rehabilitation Center, Ron L. Adolph

Walden Dissertations and Doctoral Studies

This executive summary presents the final plan for implementation of an evidence-based fall-prevention clinical practice guideline on an open neurological rehabilitation unit. It does not propose a new device, a new electronic platform, or a separate education-only initiative. The practice change is the implementation and evaluation of a structured interdisciplinary clinical practice guideline designed to reduce inpatient falls and improve the reliability of daily prevention practices. The unit reports a baseline fall rate of 6.3 falls per 1,000 patient days. Thirty-five staff members from nursing, therapy, and support roles completed the survey, and 57% reported that patients had experienced falls …

Lived Experience Of Secondary School Teachers During The Covid-19 Pandemic, Diane R. Lovett

Walden Dissertations and Doctoral Studies

The study emphasizes the need for a deeper understanding of secondary school teachers' experiences during the COVID-19 pandemic, particularly focusing on their challenges during the transition back to in-person instruction after teaching online. The purpose of this phenomenological study explored the experiences of U.S. secondary teachers during the onset of COVID-19, the shift to virtual teaching, and the return to in-person instruction. The study was grounded in Bandura’s (1986) social cognitive theory, specifically the concept of observational learning and self-efficacy, to understand how teachers learned from peer successes and challenges during the transition to virtual learning and when returning to …

Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of a structured staff educational intervention on ambulatory surgery center (ASC) staff knowledge of Universal Protocol and SOAP (Surgeon, Operating Room, Anesthesia, and Preprocedure Ready) documentation. A practice gap was identified in staff knowledge of perioperative safety processes that are essential for preventing surgical safety events. The purpose of this doctoral project was to improve ASC staff knowledge of Universal Protocol and SOAP readiness documentation through an evidence-based educational intervention designed to strengthen perioperative safety practices. The practice-focused question was: According to the evidence, in multi-specialty ASC staff, what is …

Executive Summary On Prolonged Emergency Department Waiting Period, Peace Adaugo Ezirim

Walden Dissertations and Doctoral Studies

Emergency departments (EDs) are essential access points to healthcare for patients with urgent and emergent conditions. Yet, many EDs face persistent challenges, including overcrowding, prolonged wait times, and delays in care. These challenges can significantly affect patient safety, quality of care, and overall healthcare outcomes. Patients presenting with symptoms, such as cardiac, pulmonary, or abdominal discomfort, may initially appear clinically stable, but their conditions can deteriorate rapidly while awaiting evaluation by a provider. Without structured reassessment processes and efficient communication systems, early warning signs of clinical decline may be missed. ED crowding has become a widespread operational and patient safety …

Staff Education On Evidence-Based Weight Management Strategies For Adults With Mental Health Disorders And Type Ii Diabetes Mellitus, Abimbola Oluwafunmilayo Somoye

Walden Dissertations and Doctoral Studies

Summary The type of project is a staff education project, specifically on evidence-based weight loss strategies that the facility can use to manage adults with type 2 diabetes mellitus (T2DM) and co-morbid mental health disorder(s). The evidence-based practice (EBP) question is: Does educating staff on weight loss strategies for T2DM with mental health disorder(s) improve staff knowledge and confidence within one month of staff education program implementation? The facility’s staff managed these patients using standardized diabetes management practices and have no formal staff education program that focuses on evidence-based weight loss strategies for this population. The staff has a vast …

Staff Education To Increase Knowledge And Shape Attitudes Among Staff To Improve Control Of Hypertension In Primary Care, Doris Marie Mosby-Peterson

Walden Dissertations and Doctoral Studies

This doctoral project was an evidence-based staff education intervention designed to improve healthcare team knowledge, attitudes, and clinical practices related to the management of uncontrolled hypertension within a federally qualified health center (FQHC). The practice problem addressed was the persistent challenge of uncontrolled hypertension among patients receiving primary care services, which contributes to increased risk for cardiovascular disease, stroke, and preventable health disparities. Thus, the practice-focused question that guided the project asked whether a multidisciplinary staff education program at a rural FQHC improve healthcare staff’s knowledge, skills, attitudes, and workflow related to the management of uncontrolled hypertension? Findings demonstrated statistically …

The Relative Strength Of Justice-Related Satisfaction, Posttraumatic Maladaptive Beliefs, And Self-Compassion In Predicting Perceived Control Over Stressful Events, Katherine Mooney

Walden Dissertations and Doctoral Studies

Coercive control and domestic violence perpetrated by men against women are global social problems sustained by patriarchal norms that normalize gender-based violence. These norms often contribute to victims' maladaptive self-beliefs, leading women to believe they provoked the abuse. When survivors seek legal protection, they may experience revictimization through legal processes that minimize their claims and enable perpetrators to continue exerting power and control through the justice system. As a result, dissatisfaction with the legal system may reinforce self-blame, while low self-compassion may further undermine women's perceived control over stressful events in both the short and long term. While previous research …

Effective Leadership Strategies For Sustaining Radiology Departments During And After The Covid-19 Pandemic, Tameron Shanay Reed

Walden Dissertations and Doctoral Studies

Pandemic-driven workforce challenges highlighted the urgent need for radiology leaders to retain skilled staff and sustain service delivery. The COVID-19 pandemic raised considerable concerns for radiology leaders regarding future preparedness for patient safety, care outcomes, hospital expenses, and hospital profitability. Grounded in the Vroom expectancy theory, the purpose of this qualitative pragmatic inquiry was to explore successful strategies radiology department leaders used to retain employees, improve supply inventory management, and develop ambulatory and virtual services during and after the COVID-19 pandemic. Data were gathered through semistructured interviews with six successful radiology leaders and publicly accessible documents in northern Louisiana. The …

A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans

Walden Dissertations and Doctoral Studies

This doctor of nursing practice (DNP) executive leadership project is a practice-focused quality improvement initiative to reduce avoidable 30-day hospital readmissions in a skilled nursing facility by implementing the INTERACT communication tools, SBAR and STOP & WATCH. The practice problem is the lack of a standardized communication process for recognizing changes in resident conditions, contributing to preventable hospitalizations. The project's purpose was to develop an evidence-based communication process that promotes early recognition and timely provider intervention. The practice-focused question asked whether implementing INTERACT communication tools would improve communication and reduce avoidable acute care transfers. A focused literature search was conducted. …

Improving Chronic Disease Monitoring In Patients With Diabetes And Hypertension Through Guideline-Adherent Care, Olukemi Ogunmakinwa

Walden Dissertations and Doctoral Studies

Evidence-based chronic disease monitoring is essential for improving outcomes among adults with diabetes and hypertension; however, inconsistent application of clinical practice guidelines may result from gaps in healthcare providers' knowledge, confidence, and competency. Staff education is an effective strategy for strengthening evidence-based practice and promoting consistent guideline implementation. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to develop, implement, and evaluate a structured educational program to improve healthcare providers' understanding, knowledge, confidence, self-efficacy, and competency in applying evidence-based chronic disease monitoring guidelines in a primary care clinic. Methods: The educational intervention was developed using …

Evaluating Mentorship, Professional Networking Participation, And Leadership Classifications For Women In Health Service Organizations, Marina Nagy Hanna

Walden Dissertations and Doctoral Studies

Despite women comprising a substantial portion of the U.S. health care workforce, they continue to be underrepresented in leadership across health service organizations. Mentorship and professional networking opportunities are commonly used to support women’s professional growth; however, inequities in leadership attainment remain prevalent, particularly among women from racial and ethnic minority backgrounds. The purpose of this quantitative archival comparative study was to examine associations across mentorship participation indicators, professional networking participation indicators, leadership classifications, and racial and ethnic classifications. The study was underpinned by intersectionality theory and social capital theory, which supported examination of how demographic identities and access to …

Organization Change Process Initiative Suicide Risk Assessment Screening Implementation, Dawn Marie Zaccardo

Walden Dissertations and Doctoral Studies

Suicide remains a leading cause of preventable death among individuals receiving psychiatric care, emphasizing the need for consistent suicide risk assessment practices in outpatient behavioral health settings. This Doctor of Nursing Practice (DNP) quality improvement project addressed inconsistent suicide risk screening and documentation by implementing a standardized evidence-based suicide risk assessment protocol in an outpatient psychiatric clinic. Guided by the Johns Hopkins Evidence-Based Practice Model, the project incorporated staff education, workflow standardization, leadership support, and stakeholder engagement to improve provider adherence to organizational policy requiring suicide risk screening during every patient encounter. Deidentified retrospective chart audits conducted before and after …

Higher Education Instructors’ Perspectives On The Challenges Of Implementing Competency-Based Learning In Coursework, Sammie Leo Davis Jr

Walden Dissertations and Doctoral Studies

Higher education instructors face challenges in implementing competency-based learning (CBL) in their coursework. Grounded in Vygotsky’s social constructivist theory, the purpose of this basic qualitative study was to explore the perspectives of higher education instructors on the challenges and their needs to implement CBL in coursework. For this basic qualitative design, semistructured interviews were conducted with 12 higher education instructors who had at least 2 years of experience teaching CBL courses. Data were analyzed using qualitative content analysis and inductive coding to identify codes and categories, with the following five themes emerging: CBL implementation depends on (a) aligned assessment, curriculum …

Faktor Yang Berhubungan Dengan Perilaku Merokok Pada Pekerja Tambang Batubara Di Pt X Kabupaten Kutai Kartanegara, Alma Feriyanti, Lies Permana, Ida Lestari, Rina Tri Agustini

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background. Smoking behavior remains a significant public health concern, particularly in high-risk occupational settings such as coal mining. Coal mine workers are exposed to various occupational stressors and psychological challenges that may contribute to smoking behavior.

Objective. This study aimed identify factors associated with smoking behaviour among coal mine workers at PT X in Kutai Kartanegara regency.

Methodes. A quantitative cross-sectional study was conducted involving 113 respondents selected from total population workers using convenience sampling. Data were collected through a structured questionnaire assesing smoking behavior, length of employment, and psychological stress levels. The chi-square test was applied to examine associations …

Pemberdayaan Pik-R Berbasis Permainan Make A Match Untuk Meningkatkan Pengetahuan Dan Sikap Pencegahan Anemia Remaja Putri Di Smpn 5 Kota Bengkulu, Madu Sarah Fadhilah, Reka Lagora Marsofely, Lissa Ervina

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background. The prevalence of anemia among adolescent girls at SMPN 5 Bengkulu City increased from 26.8% (2023) to 32.9% (2024). Low knowledge and unfavourable preventive attitudes are key determinants, while the integration of the Youth Information and Counselling Centre (PIK-R) with the cooperative “Make a Match” card method has rarely been evaluated in a structured manner.

Aim. To analyse the difference in knowledge and attitude scores on anemia prevention among adolescent girls before and after PIK-R empowerment using the “Make a Match” game at SMPN 5 Bengkulu City.

Methods. A quantitative, pre-experimental study with a one group pretest-posttest design. The …

Peran Reinforcing Factor Dalam Kepatuhan Konsumsi Tablet Tambah Darah Pada Remaja Putri, Helma Roswinda Sidebang, Ratih Indraswari, Aditya Kusumawati

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background. The government is implementing a program to give blood tablets to female teenagers to prevent anemia. In Semarang City, the coverage of compliance with the consumption of iron supplement tablets in 2024 is still low, which is 34.85%.

Aim. To analyze factors associated with compliance in iron supplementation consumption among female teenagers in the working area of Candilama Primary Health Center, Semarang City.

Method. This study uses a cross-sectional design. The subjects of the study were female teenagers who were selected using the proportional random sampling technique. Data were collected through interviews and analyzed using the …

Hubungan Paparan Informasi Anemia Dan Tablet Tambah Darah (Ttd) Melalui Media Digital Dengan Kebiasaan Konsumsi Makanan Ibu Hamil Berdasarkan Food Frequency Questionnaire (Ffq), Muthiah Salsabilah, Bernadette Oktavia Jelita, Thariq Zafar Surapati, Alya Khairunnissa, Primasti Nuryandari Putri, Ratu Ayu Dewi Sartika

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background: Proper nutrition is important for the mother and baby. The media is an important source of information for every pregnant woman, but the information might be inaccurate.

Aim: This study aims to examine the association between exposure to digital media information on anemia and iron-folic acid (IFA) supplementation and the food consumption habits of pregnant women as measured by the Food Frequency Questionnaire (FFQ) at Puskesmas Kecamatan Beji, Depok City in 2024.

Method: This study utilized a cross-sectional design involving secondary data analysis of the 2024 antenatal care (ANC) survey conducted at Beji Primary Health Center, Depok City. Purposive …

Intravenous Thrombolysis Beyond The Conventional Time Window For Acute Ischemic Stroke: A Systematic Review And Meta-Analysis, Shaan Patel, Shiva A. Nischal, Kush M. Kale, Michael R. Gooch, Stavropoula I. Tjoumakaris, Pascal Jabbour

Department of Neurosurgery Faculty Papers

IMPORTANCE: Intravenous thrombolysis (IVT) is an established therapy for acute ischemic stroke when administered within 4.5 hours of symptom onset. However, many patients present beyond this window or with unknown onset, and recent randomized clinical trials (RCTs) have evaluated whether imaging-selected patients may benefit from thrombolysis in the extended window.

OBJECTIVE: To evaluate the functional and safety outcomes associated with IVT administered 4.5 hours or more after stroke onset.

DATA SOURCES: PubMed, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from database inception through March 3, 2026.

STUDY SELECTION: RCTs enrolling adults with acute ischemic stroke treated …

Medical Tourism Patient Guidance: A Content Analysis Of Risk Reduction Guidelines Available To Global Health Seekers., Alicia Mason, Angela Ashmore

Faculty Submissions

This study examines medical tourism (MT) patient guidance messages intended to reduce procedural risks—those directly related to biomedical treatments—and process risks, which involve logistical, administrative, and interpersonal challenges of seeking healthcare abroad. The analysis focuses on print and digital publications authored by individuals independent of the MT industry, including policy researchers, travel health experts, lifestyle reporters, and consumer-focused medical travel writers. Using a two-phase digital and database search strategy, 27 publications from 2009 to 2024 were identified and analyzed using exploratory content analysis methods. Findings reveal important differences in the scope and depth of guidance aimed at reducing risks for …

Influence Of Lumpectomy Cavity Depth On Plan Quality In 3d Arc-Based Simultaneous Integrated Boost For Whole-Breast Radiotherapy, Emmett Dwyer

Masters Projects

Abstract

Purpose: Dynamic conformal arc (DCA) is a three-dimensional (3D) radiation therapy technique that can be used to deliver a simultaneous integrated boost (SIB) during whole-breast irradiation (WBI). This study investigated whether the depth of the lumpectomy cavity affects the feasibility of creating a successful DCA SIB treatment plan for breast radiotherapy.

Methods and Materials: 30 patients who previously received WBI followed by a 3D sequential boost (SeqB) were selected for this retrospective study. A DCA plan was created for each patient and combined with the original whole-breast tangent fields to create a SIB plan. Each plan was required to …

Relationship Of Covid-19-Related Racial Discrimination And Oppressed Identities On Chinese American Mental Health, Allison A. Fong

Doctoral Dissertations

Although anti-Asian hate has been present throughout history, the country witnessed an uptick in race-based violence and discrimination against Asian Americans during the COVID-19 pandemic. Utilizing the framework of intersectionality, this quantitative cross-sectional study aimed to capture the additive impact of various forms of oppression, including COVID-19-related racial discrimination, on levels of depression, anxiety, and life satisfaction in Chinese American college students (n = 35) in the Greater San Francisco Bay Area. Within this relationship, bicultural identity integration was also explored as a possible moderator. Although regression analysis did not show significant relationships between COVID-19-related racial discrimination and intersectional discrimination …

Young-Onset Stroke In The Uae: A Single-Centre Retrospective Analysis Of Risk Factors And Outcomes, Sobia Siddiq, Saryia Adra, Kamel A. Samara, Batool Aldaher, Mohamad Emad Aldeen Mahfouz, Nour Sakan, Fathima Musfira, Roomiyah Riyaz Assadi, Ahlam Mohamed Almarzooqi, Hiba Jawdat Barqawi, Eman Abu-Gharbieh

Abington Jefferson Health Papers

BACKGROUND: Young-onset stroke represents a growing public health concern, yet data from the United Arab Emirates (UAE) remain limited. This study aimed to examine the risk factors and clinical outcomes associated with young-onset stroke in the UAE.

METHODS: A retrospective chart review was conducted on 419 patients aged below 50 years who were admitted at Al Qassimi Hospital, Sharjah, UAE, with a diagnosis of stroke between 2016 and 2022. Data on demographics, comorbidities, stroke subtype, management, and outcomes were collected and analyzed using Python-based statistical libraries.

RESULTS: The study population comprised predominantly of male individuals (78.28%), with most patients originating …

Strings Attached: Science Regulation By Science Funders, Nicholson W. Price Ii

Reviews

Who regulates the physical and informational risks of scientific research? Who makes sure that researchers keep intensely personal data secret, or lock their dangerous chemicals away safely, or don't haphazardly create superviruses that could kill us all? You could be forgiven for assuming it was, well, a regulator—OSHA or the CDC or some similar entity that can promulgate binding rules and enforce them. But as Doni Bloomfield shows in the fascinating How Science Grantmakers Govern, you’d be (mostly) wrong. Instead, a key substantive and procedural regulator of the risky business of scientific research is, in fact, the funder of that …

Hematopoietic Stem And Progenitor Cell Reprogramming During Breast Cancer Progression Promotes Myeloid-Biased Hematopoiesis, Emily Maria Eul

Arts & Sciences Graduate Student Theses and Dissertations

Breast cancer progression is associated with systemic immune dysregulation characterized by the expansion of immunosuppressive myeloid populations that promote tumor progression, metastasis, and resistance to therapy. However, the mechanisms that sustain pathological myeloid expansion remain incompletely understood. In particular, it remains unknown whether solid tumors functionally reprogram hematopoietic stem and progenitor cells (HSPCs) to drive enhanced myeloid output and if bone-derived signals can regulate tumor-associated hematopoietic remodeling. In murine models of primary and metastatic breast cancer, tumor progression induced the remodeling of the hematopoietic compartment, characterized by the expansion of HSPCs, enhanced myeloid differentiation, and systemic accumulation of myeloid populations. …