Medicine and Health Sciences Commons^™

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

The Impact Of Cannabis Use On Pulmonary Function Among Young Adults: A Literature Review, Ava Petersen

Honors Theses

Cannabis is the most used illicit drug among young adults and many of these users perceive cannabis as harmless and do not believe the drug to be addictive. Cannabis is derived from the flower of the hemp plant and contains cannabinoids THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is the psychoactive component that interacts with the endocannabinoid system to produce a coveted euphoric state among users. Cannabis can be consumed in an edible or combusted and inhaled via joint, pipe, bong, etc. The purpose of this review is to examine the effects of inhaled cannabis on pulmonary function with a specific …

Using Chatgpt Ai To Analyze Clinical Judgment In Immersive Virtual Reality Simulation From Prelicensure Nursing Students, Shari Ann Fehrenbach

Dissertations (1934 -)

This retrospective, descriptive study examined how clinical judgment was demonstrated across two immersive virtual reality simulation (IVRS) experiences in a cohort of Direct Entry Master of Science in Nursing (DEMSN) students using a generative large language model artificial intelligence, ChatGPT, for categorization of clinical judgment cognitive processes. The National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (CJMM) guided the study (NCSBN, 2022). Nurse expert-derived CJMM-aligned scoring rubrics were applied to deidentified, developer-generated IVRS performance reports, and ChatGPT categorized whether rubric actions were demonstrated and generated case-level, scored excel files. Total CJMM and cognitive component scores were …

Be Trauma Informed: A Pilot Evaluation Of A Podcast Intervention To Improve Trauma-Informed Care Knowledge, Attitudes, And Practices Among Pediatric Critical Care Nurses, Elizabeth Devries

Dissertations (1934 -)

Trauma-informed care (TIC) is integral to pediatric critical care (PCC) but accessible, scalable education is limited. This mixed-methods pilot study developed and evaluated Be Trauma Informed, a two-episode podcast educational series designed to increase PCC nurses’ TIC knowledge, attitudes, and trauma-informed practices while also assessing implementation outcomes of feasibility, necessity, acceptability, fidelity, safety, and beginning effectiveness. The curriculum for the podcast series was developed by the primary investigator with stakeholder input from PCC and TIC experts. The podcast was professionally produced, and episodes were distributed on major podcast platforms. Using purposive convenience sampling, PCC nurses within the United States completed …

Navigating Screens For Neurodivergent Individuals, Avery Wilson

Honors Theses

As technology becomes more prevalent in everyday life, it is important to consider the implications that this may have for one's mind and well-being. These implications are particularly important for vulnerable populations, such as neurodivergent individuals, who may have unique sensitivities to technology consumption. This paper reviews current literature to provide an overview of the implications of using media on the neurodivergent population, such as individuals with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD), who often possess unique brain sensitivities that influence technology consumption.

To begin, the paper examines the changes in brain structure and functioning in children …

Cervical Cancer Screening Among Women Across The United States, Srivathsan Vijaya Raghavan

Walden Dissertations and Doctoral Studies

While cervical cancer is not among the most frequently diagnosed cancers in the United States, it remains a significant concern due to its preventability through regular Pap smears and Human Papillomavirus (HPV) vaccination. However, incidence rates are rising as screening participation among U.S. women declines. This quantitative study (N = 15714) explored cervical cancer screening behaviors by analyzing levels of community involvement and social functioning, guided by the socioecological model (SEM). The dependent variable was cervical cancer screening, while the independent variables were community involvement and social functioning. The study controlled for health insurance status, age, race, ethnicity, employment, education, …

From Classroom To Career: Developing A Vocational Training And Job Coaching Program For Individuals With Down Syndrome At Gigi's Playhouse, Mason Freiburger

OTD Capstone Projects

This doctoral capstone project was completed through partnership with GiGi’s Playhouse Nashville. GiGi’s Playhouse is a non-profit with 61+ locations across the United States and Mexico, that offers free educational and therapeutic programming for individuals of all ages with Down Syndrome. The primary goal of this project was to develop and implement an evidence-based vocational training program for adults with Down Syndrome to promote work readiness, independence, and community participation. A secondary focus of this project was to support skill generalization through real-world application and individualized job coaching within a community-based internship. Program development included classroom-based instruction targeting communication, executive …

Creating Engaging Activities To Improve Overall Group Participation Within Centennial Adultcare Center, Ava Woessner

OTD Capstone Projects

This doctoral capstone project was conducted in collaboration with Centennial Adultcare Center, an adult day program that is dedicated to providing a stimulating and supportive environment for personal growth and independence through professional care within a reasonable fee. The center serves a variety of diagnosis including but not limited to: dementia, cerebral palsy, intellectual and developmental disabilities (IDD), stroke, and autism. The primary objectives of this project were to develop engaging, member-focused activities through the use of graded interventions and adaptive equipment, provide staff members with effective resources, and enhance the visibility and promotion of adult day services through social …

Incorporating Occupational Therapy Programming In An Inclusive Post-Secondary Education (Ipse) Program At The University Of Georgia, Kathleen S. Chitty

OTD Capstone Projects

This capstone project focuses on incorporating occupational therapy in an inclusive post-secondary education (IPSE) program at the University of Georgia. The Destination Dawgs program is an IPSE program at The University of Georgia for young adults with intellectual disabilities. This capstone project identifies how an occupational therapist can assist with wellness, independent living, social skills, and emotional regulation skills in IPSE programs.

Promoting Postural Care Across The Lifespan: Development Of Educational Materials For A Seating And Positioning Clinic, Tori Knox

OTD Capstone Projects

This doctoral capstone project was completed in collaboration with the Department of Disability and Aging’s Middle Tennessee Seating and Positioning Clinic and focused on developing educational materials to support the implementation of 24-hour postural care management. The clinic serves individuals with complex seating and positioning needs by providing both commercially available and custom-fabricated equipment. Postural care management is a preventative and therapeutic approach that promotes optimal body alignment, reduces secondary complications, and enhances quality of life for individuals with mobility impairments across all daily positions. This project aimed to increase awareness and understanding of postural care management among clients, caregivers, …

Evaluating An Lgbtq+ Adolescent Sexual Health Toolkit: Boosting Confidence And Provider Knowledge, Joslyn Lypka

Doctoral Dissertations & Projects

When leveraged correctly, sexual health education empowers youth to build resilience, deepen self-understanding, and confidently navigate gender and sexual identities. However, many school-based programs emphasize cisgender and heterosexual norms, leaving LGBTQ+ adolescents with limited access to inclusive and affirming sexual health information. This project aimed to develop and evaluate an online sexual health education toolkit designed to increase knowledge and support self-advocacy among LGBTQ+ adolescents, parents/caregivers, and healthcare providers. In collaboration with a Midwest nonprofit organization serving sexual and gender-diverse individuals, an online toolkit was developed and evaluated using two sequential Plan–Do–Study–Act (PDSA) cycles. During the first cycle, subject matter …

Quality Improvement Project: Improving The Clinical Teaching Experience Through Clinical Adjunct Orientation, Elissa Saunders

Doctor of Nursing Practice Projects

Clinical adjunct nursing faculty often transition into academic roles without formal preparation, leading to role insecurity and high turnover rates that negatively impact student clinical experiences. The purpose of this quality improvement (QI) project was to implement a structured orientation checklist to improve perceived clinical teaching competency among novice clinical adjunct faculty. The project aimed to standardize onboarding and support the transition from clinical practice to academia. A quantitative pre-post intervention design was used with a convenience sample of clinical adjunct faculty employed for less than one year at a rural university nursing program. The project was guided by Kotter’s …

Enhancing Provider Self-Efficacy And Documentation In Hypertension Management, Stephanie Nsiah

Doctor of Nursing Practice Projects

Primary care providers often experience inconsistent confidence and incomplete documentation when managing hypertension, contributing to suboptimal blood pressure control. This quality improvement project addressed the need for structured provider education at an outpatient family clinic. The purpose was to evaluate the impact of a structured educational intervention on provider self-efficacy and documentation completeness. Using a quasi-experimental pre-post design guided by the Plan-Do-Study-Act model and Lewin's Change Theory, a 60-minute educational session was delivered to 12 licensed providers. Participants completed pre- and post-intervention self-efficacy surveys using the Acceptability of Intervention Measure (AIM) and Intervention Appropriateness Measure (IAM) and Feasibility of Intervention …

Strengthening Evaluation For Student Success, Hollan Scrivner

Doctor of Nursing Practice Projects

Student evaluation is an important factor in guiding students to develop self-confidence and gain competency in nursing skills. For evaluation to be effective, it must be consistent. The purpose of this quality improvement project is to implement a training program to improve consistency and interrater reliability among faculty conducting skill evaluations. The impact of the training program will be measured by a pre- and post-grading exercise using a skills rubric. Data will be extracted from the rubrics and entered into a codebook for data analysis. The project was guided by the theoretical framework of Stephens’ Star Model of Knowledge Transformation …

Implementation Of A Process For Tracking Hgb A1cs In A Community Mental Health Organization, Devin Gill

Doctoral Dissertations & Projects

Background: Individuals with a serious mental illness (SMI) are 2 to 3 times more likely to develop type 2 diabetes, yet are less likely to receive routine screening of hemoglobin A1c (HbA1c) testing. The purpose of this quality improvement project is to implement a standardized workflow process to ensure consistent tracking of HbA1cs in adult consumers greater than 18 years of age with SMI receiving services at a rural community mental health (CMH) organization.

Methods: The primary intervention is a workflow process, with focus on the clinical information systems and organizational system. This quality improvement project was guided utilizing the …

Quality Improvement Project Enhancing Maternal Health Outcomes: Evaluating The Impact Of Universal Social Determinants Of Health (Sdoh) Screening In An Interdisciplinary Pregnancy Care Model, Shannon Morgen

Doctor of Nursing Practice Projects

Social determinants of health (SDOH), including housing instability, food insecurity, transportation barriers, and interpersonal violence, significantly influence maternal outcomes and contribute to disparities such as preterm birth and maternal morbidity. Despite national recommendations for universal SDOH screening, implementation in prenatal care remains inconsistent, limiting opportunities to identify and address social needs. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement and evaluate a standardized SDOH screening and documentation process to improve referral completion and examine its impact on hospital readmissions among obstetric patients. Guided by Bronfenbrenner’s Socio-Ecological Model and the Plan-Do-Study-Act framework, the project …

Quality Improvement Project: Enhancing Efficacy And Reducing Urine Contamination Through Simulation In The Ed, Kimberley Strong

Doctor of Nursing Practice Projects

Urine specimen contamination in emergency department settings contributes to diagnostic inaccuracies, unnecessary antibiotic use, increased healthcare costs, and decreased patient satisfaction. This quality improvement project evaluated the impact of a simulation-based educational intervention on staff knowledge, self-efficacy, and urine specimen contamination rates among emergency department nurses and patient care technicians with less than six years of clinical experience in a rural Texas hospital. The aim of this project was to enhance knowledge and self-efficacy while reducing contamination rates over a six-week period. The project was guided by Knowles’ Adult Learning Theory as the theoretical framework, supported by Lewin’s Change Theory, …

Implementing Simulation-Based Learning In Fieldwork Bootcamp To Enhance Level Ii Fieldwork Preparedness, Kathryn Livingston

OTD Capstone Projects

This doctoral capstone project was completed in collaboration with Belmont University’s School of Occupational Therapy (OT) and the Center for Interprofessional Engagement & Simulation. A needs assessment of OT Faculty, Level II Fieldwork Educators, and the OTD Class of 2026 identified essential skill expectations and common areas of difficulty related to Level II placements. In response, this project developed multiple simulation experiences for Fieldwork Bootcamp to provide students with hands-on practice of core skills in preparation for their Level II placements. A resource manual was developed containing case studies, training guides, debriefing scripts, and setting-specific materials for use during Fieldwork …

Promoting Participation In Leisure Activities At The Center For Living And Learning, Katie Eison

OTD Capstone Projects

The Center for Living and Learning is a private nonprofit residential treatment facility on a 30-acre farm in Franklin, TN, housing adults who experience severe and persistent mental illnesses such as schizophrenia and schizoaffective disorder. The Center provides opportunities for leisure activities during the day; however, due to symptomology such as avolition, anhedonia, and social withdrawal, residents often struggle with participation in valued leisure activities. This doctoral capstone project aimed to promote participation in leisure activities, social participation, and community engagement. The Interest Checklist and Leisure Satisfaction Measure were administered to determine residents’ individual interests and satisfaction levels with leisure …

Quality Improvement Project: The Impact Of The Clinical Judgment Measurement Model In Nursing Faculty, Lamia Zeidan

Doctor of Nursing Practice Projects

Clinical judgment is essential for nursing practice and can be taught using the Clinical Judgment Measurement Model (CJMM). A needs assessment conducted at the project site revealed that students had limited clinical judgment skills, there was no emphasis on clinical judgment in nursing skills courses, and the faculty had a limited understanding of the CJMM. In response to the findings of the needs assessment, the quality improvement (QI) project was developed using a quasi-experimental design. Guided by Lewin’s Change Theory and Benner’s Novice to Expert Educator theoretical framework, the project aimed to provide faculty with education on the CJMM and …

Analyzer-Less X-Ray Interferometry With Super-Resolution Methods, Murtuza S. Taqi

LSU Master's Theses

X-ray interferometry provides valuable information on attenuation, small-angle scattering, and differential phase contrast. This multi-modal contrast can aid in many clinical applications, such as lung diseases and breast cancer. However, standard inter- ferometry has an analyzer grating that can increase the dose requirement to maintain the same image quality as a standard X-ray. We propose the use of super-resolution methods for X-ray grating interferometry without an analyzer, with detectors that fail to meet the Nyquist sampling rate needed for traditional image recovery algorithms. Detector phase- steps are used to nominally recover the sampling and iteratively recover the visibility and the …

Impact Of Provider Self-Efficacy On Caring For Patients With Prediabetes, David R. Knight

Doctor of Nursing Practice Projects

Prediabetes affects millions of adults in the United States, yet inconsistent provider knowledge and confidence limit evidence-based screening and management in primary care, a gap well-documented in the literature. The purpose of this quality improvement project was to evaluate whether a structured educational intervention improved provider self-efficacy related to prediabetes identification and management. Guided by Social Cognitive Theory and the Transtheoretical Model, with implementation guided by the Plan-Do-Study-Act cycle, this project asked: among family practice providers, how does prediabetes education affect provider self-efficacy over four weeks? A quasi-experimental pre/post design was used. Four asynchronous educational modules focused on evidence-based screening, …

Quality Improvement Project: The Critical Role Of Provider Knowledge In The Golden Hour, Kimberly Mcglothan

Doctor of Nursing Practice Projects

Maternal and infant mortality rates in the Southern United States remain disproportionately high, and inconsistent implementation of the Golden Hour, defined as uninterrupted skin to skin contact for at least the first hour after birth, continues to limit its evidence based maternal and neonatal benefits. The aim of this Doctor of Nursing Practice (DNP) quality improvement project was to evaluate the impact of a structured provider education intervention on Golden Hour compliance and provider confidence. Guided by Benner’s Novice to Expert Theory and implemented using Kotter’s 8-Step Change Model, a quantitative, quasi experimental pre-post design was used. The project was …

Quality Improvement Project: Faculty Preparedness For Recognition, De Escalation, And Reporting Of Violence In Clinical Education Settings, Dawn "Deedee" D. Moline

Doctor of Nursing Practice Projects

Violence and aggression in healthcare settings present ongoing safety concerns for nursing faculty supervising students during clinical education, particularly when teaching occurs in hospital environments where faculty are not employed. Faculty often rotate across multiple clinical sites and may lack consistent preparation or access to standardized safety education and reporting systems. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the effect of a targeted educational intervention on nursing faculty perceived preparedness to recognize, de escalate, and report aggression encountered during clinical instruction. Guided by Bandura’s Social Cognitive Theory and Lewin’s Three Stage Change Model, …

Astrocyte Circadian Regulation In Neurodegeneration: In Vivo Bmal1 Occupancy Mapping Using Macs-Calling Cards, India Reiss

Arts & Sciences Graduate Student Theses and Dissertations

Astrocytes maintain neuronal homeostasis through cellular programs that are frequently disrupted early in neurodegenerative disease, many of which are regulated by the circadian clock. The core clock transcription factor BMAL1 is required for normal astrocyte function, yet whether its regulatory activity is altered during neurodegeneration remains unclear. BMAL1 expression changes in disease are often inconsistent, suggesting that transcription factor binding, rather than expression, may be a more informative readout of BMAL1 function. We used a Cln3Δex7/8 model of neurodegeneration, which exhibits early astrocyte dysfunction prior to widespread neuronal loss, to test whether degenerative pathology reprograms BMAL1 binding in astrocytes. We …

An Educational Intervention To Increase Nurses’ Knowledge And Confidence Of Patient Mobility, Debbie Ann Pytak

Walden Dissertations and Doctoral Studies

Immobility is a significant concern given that nearly half of all hospitalized adults are immobile during their hospitalization, placing them at increased risk for adverse outcomes. As a result, it is critical for nurses to implement strategies that promote safe, structured patient mobility. Thus, the purpose of this Doctor of Nursing Practice (DNP) project was to determine if an educational intervention focused on patient mobility and standardized mobility tool utilization increased knowledge and confidence among nursing staff in an acute care setting. Ten participants volunteered to attend the educational intervention. The average age of the participants was 44.30 years (SD …

Enhancing Post‑Discharge Outcomes: A Quality Improvement Project To Reduce 30‑Day Readmission Rates For Patients With Schizoaffective Disorder, Samson Laryea Norteye

Walden Dissertations and Doctoral Studies

This DNP quality improvement project aimed to reduce 30-day readmission rates for patients with schizoaffective disorder (SAD) by enhancing discharge planning interventions. Using pre- and post-intervention methods, the project compared readmission rates before and after implementing interventions and gathered feedback from patients and staff to identify barriers and facilitators. The intervention bundle included patient education, participation in psychotherapy or support groups, medication reconciliation, and the use of long-acting injectables (LAIs) during hospitalization and prior to discharge. Evaluation of postintervention data revealed that none of the 10 patients in the intervention group were readmitted within 30 days, indicating a significant reduction …

Geographical And Anatomical Microbiome Variation In Invasive Green Iguanas (Iguana Iguana), Amanda A. Diaz

All HCAS Student Capstones, Theses, and Dissertations

The common green iguana (Iguana iguana) was introduced to South Florida in 1965 and has since been an especially pernicious threat both environmentally and economically. This highly invasive species is also expanding in range and populations at an astonishing rate. Understanding how this reptile is able to adapt and thrive in novel environments is of imperative need in order to begin managing their disruptive populations. Notwithstanding their negative impacts and significance, the microbiome of wild populations has not yet been characterized. Here, using 16S ribosomal RNA gene sequencing, this study is the first to characterize the microbiome composition …

Development Of 6-Week Tier 2 Intervention Tracks Within An Elementary Mtss Framework, Maxwell Lyle

Capstone Projects

The Multi-Tiered System of Supports (MTSS) is designed to provide levels of support with differing intensity that align with student needs. Tier 1 is universal instruction provided to all students in the classroom. Students who do not demonstrate adequate progress may receive Tier 2 interventions, which are primarily small-group and, when appropriate, individual interventions that are skill-specific, time-bound (6–8 weeks), and include progress monitoring. Students who do not respond to Tier 2 may require Tier 3 supports, which are intensive, individualized interventions. Many school systems lack consistent, structured Tier 2 supports, particularly in Occupational Therapy-related skills, such as fine motor …

The Missing Link Between Occupational Therapy And Hemodialysis: Program Development And Implementing Intradialytic Ot In A Rural Hospital Setting, Madison Maki

Capstone Projects

Occupational therapy (OT) has demonstrated effectiveness in supporting individuals undergoing hemodialysis, a life‑altering yet lifesaving treatment for end‑stage renal disease (ESRD) and chronic kidney disease (CKD). Despite this, hospitalized patients who require dialysis often receive reduced rehabilitation services due to the time‑intensive nature of dialysis and the productivity demands placed on therapists. Additionally, gaps in therapist knowledge regarding the unique functional deficits and educational needs of this population further limit service delivery.

This doctoral capstone project (DCE), conducted at Upper Peninsula Health System (UPHS), a hospital in rural Northern Michigan, addressed these barriers through the development of a comprehensive resource …