Digital Commons Network^™

Identifying Barriers To The Utilization Of Translation Services Among Immigrant Populations With Limited English Proficiency, Adama Barry

Doctor of Nursing Practice Projects

Background: The number of patients with limited English proficiency (LEP) has increased in the United States, indicating the growing importance of addressing their healthcare needs. Aim: To examine existing translation services and explore the challenges healthcare providers encounter in their use.

Methods: A mixed-methods cross-sectional survey was conducted among providers, registered nurses, and medical assistants at a diverse urgent care clinic in a city in Washington State.

Results: Interpreter availability, technological disruptions, training gaps, and interpreter accuracy emerged as significant barriers.

Implications for Practice: Comprehensive improvements in interpreter service accessibility, technological reliability, and cultural competency training.

Assessing The Impact Of Provider Knowledge Through A Pelvic Floor Health Assessment Tool, Kiana Ghamarifard, Vanessa Trinidad

Doctor of Nursing Practice Projects

Introduction Pelvic Floor Dysfunction (PFD) is a prevalent yet under-addressed concern affecting individuals throughout the course of their lifetime, including within pregnancy, postpartum, and menopause. Health care providers are responsible for providing up to-date education and resources to best support their patients facing PFD. Introducing an effective assessment strategy can prompt discussions regarding pelvic floor health (PFH).

Methods We conducted a primary data analysis of pre- and post- assessment tool surveys submitted by voluntary participants of Certified Nurse-Midwives (CNM) in a PFD assessment module. Pre- and post- test surveys were performed using Likert-scale scoring statements from April 2025 to May …

Address The Gap In Nursing Knowledge Regarding Patients At End Of Life In An Inpatient Oncology Setting, Sala Oh, Tracey Trinh

Doctor of Nursing Practice Projects

Background: Nurses often lack the knowledge of providing end of life (EOL) care and do not feel adequately prepared to confidently provide care. Identifying barriers to providing quality care could demonstrate improved symptom management for EOL patients and nursing confidence.

Aims: To identify knowledge gaps for oncology nurses working with EOL patients, develop nursing education, and ultimately improve patients’ symptom management.

Methods: This was a needs assessment of nurses (n=79) working in an inpatient oncology unit. A survey was distributed to obtain barriers in nursing knowledge and an educational module was created. A quality improvement study was then performed to …

Assessing Pain In People With Dementia Using The Pacslac-Ii Scale, Audrey L. M. Breton, Pardeep Singh

Doctor of Nursing Practice Projects

This Doctor of Nursing Practice project aimed to educate caregiving staff on the use of the PACSCLAC-II, a validated pain tool, for residents with advanced dementia unable to selfreport pain. It also evaluated whether training the staff to use the PACSLAC-II enhanced pain assessment accuracy compared to the staff’s clinical judgement when detecting the presence of pain. Participants included on-site caregivers – a nurse, certified nursing assistants, and licensed medical technicians – who provide direct care to residents with dementia. Staff completed an assessment form featuring a Likert scale for staff clinical judgement on one side of the paper and …

Integrating Oral Health Into Diabetes Patient Education, Lindsey Van, Jeztine Clavecillas, Queena Chae

Doctor of Nursing Practice Projects

No abstract provided.

Unmet Perinatal Mental Health Needs Of Racially And Ethnically Marginalized Pregnant Birthing People, Courtney Sholar

Doctor of Nursing Practice Projects

Background: The negative impacts of perinatal mental illness are vast, including impaired physiological health of the birthing parent and child, impaired bonding, poor childhood socioemotional development, and financial burden. Although birthing parents of all racial and ethnic backgrounds can experience such outcomes, racially and ethnically marginalized birthing parents and their children are subject to compounded risk for poor outcomes. Little to no studies have specifically and solely examined perinatal mental health needs and preferences of racially and ethnically marginalized birthing parents in the Seattle area. Examination of such needs are necessary to implement interventions downstream that effectively reduce the perinatal …

Blood Pressure Self-Monitoring Intervention Among Low-Income Pregnant And Postpartum Individuals In Nurse-Family Partnership: A Qualitative Program Evaluation Assessing Self-Efficacy And Health Literacy, Sherilynn Soo, Antonia Powicki

Doctor of Nursing Practice Projects

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality in the United States, disproportionately affecting low-income and marginalized populations. Blood pressure self-monitoring (BPSM) has emerged as a promising intervention to support management of HDP. This study evaluated the impact of a BPSM program on self-efficacy and health literacy among low-income, first-time pregnant and ostpartum individuals enrolled in Snohomish County’s Nurse-Family Partnership (NFP) program.

Methods: This qualitative program evaluation involved semi-structured interviews with 10 participants enrolled in the BPSM program. Interviews were conducted via secure video conferencing, transcribed, and analyzed using inductive thematic analysis supported …

Evaluation Of Pain Neuroscience Education Among Veterans With Chronic Pain, Ghee-Hee Yang, Lilly Prochoda

Doctor of Nursing Practice Projects

Background: Chronic pain and opioid overuse remain critical public health issues in the United States, disproportionately affecting military veterans. Traditional pharmacologic treatments often fall short of addressing the complex biopsychosocial dimensions of chronic pain. Pain Neuroscience Education (PNE) is a promising, evidence-based approach that empowers patients by helping them reframe their understanding of pain, thus potentially reducing pain severity and reliance on medications.

Purpose: This quality improvement project aimed to evaluate the effectiveness of PNE in reducing perceived pain severity, enhancing self-efficacy, and reframing pain narratives among veterans experiencing chronic pain.

Methods: The intervention consisted of three …

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, …

Neurotensin Regulates Primate Ovulation Via Multiple Neurotensin Receptors, Andrew C. Pearson, Jessica S. Miller, Hannah J. Jensen, Ketan Shrestha, Thomas E. Curry Jr., Diane M. Duffy

Department of Biomedical and Translational Sciences Faculty Publications

Neurotensin (NTS), a small neuropeptide, was recently established as a key paracrine mediator of ovulation. NTS mRNA is highly expressed by granulosa cells in response to the luteinizing hormone (LH) surge, and multiple NTS receptors are expressed by cells of the ovulatory follicle. To identify the role of NTS receptors NTSR1 and SORT1 in ovulation in vivo, the dominant follicle of cynomolgus macaques (Macaca fascicularis) was injected with either vehicle control, the general NTS receptor antagonist SR142948, the NTSR1-selective antagonist SR48692, or the SORT1-selective antagonist AF38469. Human chorionic gonadotropin (hCG) was then administered to initiate ovulatory events. …

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 …

Enhancing Trust In Ai For Healthcare: A Quantative Evaluation Of Explainable Methods In Clinical Decision Support Systems, Abdul Aziz Noor

Masters

The integration of Artificial Intelligence (AI) into healthcare has revolutionized Clinical Decision Support Systems (CDSS) by enabling sophisticated predictive capabilities. However, the opaque nature of many machine learning models, commonly referred to as "black-box" systems, poses significant challenges to their adoption in critical clinical settings where transparency, interpretability, and trust are paramount. This thesis addresses these challenges by developing a rigorous, mathematically grounded framework to evaluate Explainable AI (XAI) methods and enhance their integration into CDSS.

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 …

Insights On The Cranial Anatomy And Osteohistology Of Cyonosaurus, Alexander Acker

Dissertations

This study investigates the cranial anatomy and life history of the small-bodied gorgonopsian Cyonosaurus. Previous research on gorgonopsians has disproportionately focused on larger members of the clade, leaving smaller forms relatively understudied. This gap has led to several unresolved questions, the most pressing of which concerns gorgonopsian ontogeny. Specifically, it remains unclear whether small-bodied gorgonopsians represent genuinely diminutive adult individuals or juveniles of larger species. The specimen NHCC LB1087 presents an ideal opportunity to address this issue and gain new insights into the biology of small-bodied gorgonopsians. The first chapter focuses on cranial anatomy. Due to the specimen’s preservation, many …

Appendix: Selected Quotes From Prosecutors' Interview Responses, Anna Arons

Faculty Publications

No abstract provided.

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 …

The Criminal System Under Racial Capitalism, Sandeep Singh Dhaliwal

Faculty Publications

In 2021, major segments of the business lobby converged around a consensus for criminal system reform. As the United States experienced historic levels of labor market tightness, business groups argued for removing “barriers” to employment that system-involved people face. Just a few months later, the orientation of business to the criminal system was decidedly more mixed. By March 2022, the U.S. Chamber of Commerce, the country’s most powerful business lobby, had stepped to the forefront of the national moral panic around retail theft, launching a vigorous campaign to defend and even strengthen criminal punishment across the country.

Anchoring its analysis …