Ask, Advise, And Act: A Smoking Cessation Bundle For Cancer Patients, Crystal Tencate

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Smoking is the number one cause of preventable illness and death in the United States. For patients undergoing cancer treatment, continued tobacco use poses serious risks. In surgical oncology, smoking is associated with poorer treatment outcomes, increased postoperative complications, delayed wound healing, and higher mortality. For patients requiring reconstructive surgery, smoking-related complications can be devastating, sometimes resulting in significant wound complications or loss of the reconstruction. Despite these well-established risks, smoking cessation interventions are not consistently integrated into clinical practice.

To address this gap, a quality improvement project was implemented to strengthen smoking cessation efforts among advanced practice providers (APPs) …

Nursing Bundle To Improve Quality Metrics For Postoperative Patients, Kristine G. Coronado

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Postoperative pulmonary complications and inconsistent implementation of preventive nursing interventions remain significant challenges on acute care surgical units. The purpose of this quality improvement project was to reduce postoperative respiratory failure, hospital readmissions, and length of stay while improving nursing compliance with evidence-based interventions. A nursing care bundle, RISE—Respiratory therapy (structured, nurse-guided incentive spirometry), Incentivize movement (early ambulation), Sit up (head-of-bed elevation ≥30 degrees), and Eliminate germs (twice-daily oral care)—was implemented on an acute care surgical ward in South Texas. Nursing compliance with the preventative measures and patient outcomes were compared between pre- and post-implementation cohorts. Following implementation, nursing compliance …

Improving Asthma Management In Schools: A Comprehensive Approach To Education, Environmental Enhancements And Asthma Action Plans, Yesenia Trevino

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Asthma contributes to school absenteeism, especially in underserved communities. This project aimed to enhance asthma management at a South Texas elementary school through staff and student education, monthly air filter changes, and personalized Asthma Action Plans (AAPs).

Methods

A quality improvement project at a South Texas elementary school involved 40 asthmatic students over eight weeks, using the Plan-Do-Study-Act (PDSA) framework. It included staff and student education, air filter maintenance, and facilitation of Asthma Action Plans (AAPs). Pre/post surveys, custodial logs, AAP audits, and attendance were analyzed, with paired t-tests used to assess changes (N=32).

Results

There was 71.9% …

Starting Strong: Improving Mmr Vaccination Rates In Kindergartners, Regina Bryan

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

During the 2023–2024 academic year, measles, mumps, and rubella (MMR) vaccination coverage among kindergarten students in this school district did not meet the Healthy People 2030 target, thereby elevating the risk of disease outbreaks. This quality improvement project aimed to improve MMR vaccination initiation and completion through coordinated, school-based interventions.

Methods

Guided by the Plan-Do-Study-Act framework, an eight-week immunization bundle was implemented across 14 elementary schools in South Texas. Interventions included reminder calls, multilingual education, districtwide communication, and a partnership with a nonprofit clinic that provides free or reduced-cost vaccines through on-site and community clinics. Pre- and post-intervention …

Ambient Listening: Using Artificial Intelligence To Transcribe Provider Office Visits, Odia Russette

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Electronic health record (EHR) documentation burdens contribute to increased “pajama time” or after–hours charting, reduced job satisfaction, and provider burnout. Provider burnout leads to provider and critical access point losses. Ambient–listening artificial intelligence (AI) technologies have emerged as a possible tool to reduce charting burdens; however, evidence from outpatient wellness settings remains limited.

Local Problem: At an urban adult wellness clinic in Texas with limited resources for completing tasks, in-clinic and after-hours “pajama time” charting burdens contributed to provider fatigue, job dissatisfaction, and burnout.

Methods: A quality improvement (QI) project using the Plan-Do-Study-Act (PDSA) framework implemented an AI ambient …

A Quality Improvement Project To Decrease Medication Prior Authorization Approval Times, Amena Guinn Babers

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Medication prior authorization requirements add to administrative burden, increase labor costs, and delay patient access to treatment in outpatient specialty settings. This bottleneck directly influences nursing workload and economic performance.

Purpose: To evaluate the fiscal and performance significance of implementing an electronic prior authorization (ePA) process, standardized tracking tools, and staff education in a small orthopedic clinic.

Methods: A pre–post quality improvement design was used. Descriptive statistics and inferential analyses (independent‑samples t tests and Mann–Whitney U tests) were conducted to compare time to approval, staff hours worked, satisfaction scores, and medication pickup timeframes.

Results: Significant reductions were observed in …

Inpatient Stroke Quality Improvement, Briyawna N. Wyatt

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient nursing documentation for stroke care is essential for meeting quality metrics, maintaining continuity, and supporting timely decisions. Gaps can lead to inconsistent care, metric failures, and reduced staff confidence. This quality improvement initiative aimed to improve metric compliance, documentation consistency, and nursing knowledge and satisfaction. A three-part intervention included targeted education, a standardized documentation verification form, and ongoing feedback from stroke champions. Outcomes measured were metric compliance, knowledge (pre/posttests), documentation completeness (Venous Thromboembolism (VTE), education, Modified Rankin Scale), and staff satisfaction. Results showed significant improvement in nursing knowledge (p < .005), reduced metric fallouts, and better documentation across all indicators. Staff satisfaction increased by about 20%. Overall, combining education, standardized tools, and continuous feedback improved documentation practices, enhanced compliance with stroke metrics, and increased nursing knowledge and satisfaction, supporting better care processes and patient outcomes.

"It Made Me Want To Get Into Healthcare Even More": A Simulation-Based Healthcare Mentoring Program, Jack Mccarthy

Yale Medicine Thesis Digital Library

The healthcare industry in the United States continues to experience rapid growth, yet workforce shortages persist across a wide range of medical professions. In order to increase the pool of qualified individuals pursuing healthcare, innovative strategies are needed to increase interest in healthcare fields among youth. Prior research has identified that healthcare career interest is driven in part by motivational characteristics including interest in math and science, self-efficacy, and social factors like the expectations of parents and caregivers. Mentoring, career exploration, and informal learning have been identified as strategies that increase student interest in and commitment towards healthcare careers. This …

Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

Improving Early Detection And Response To Clinical Deterioration Among Nurses Through Competency-Based Interventions, Courtney E. Miller

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Clinical deterioration among hospitalized patients remained a significant contributor to preventable morbidity and mortality, often due to delayed recognition and response in general care settings (Choi et al., 2025; Chung & Jung, 2024).

PICOTS: For registered nurses working on a general level of care inpatient hospital unit (P), how did a competency-based training program bundle incorporating didactic educational intervention of learning how to use technology, machine learning (ML) based early warning system (EWS) of trends and patterns to identify at risk patients, and low-fidelity simulation-based education (SBE) (clinical readiness to improve confidence with education and coaching) (I), …

Implementing A Standardized Resilience Bundle For Neonatal Intensive Care Nurses, Jennifer Bouzid

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Nurse resilience is associated with improved psychological well-being, professional satisfaction, and retention. Neonatal intensive care unit nurses are frequently exposed to emotionally traumatic clinical events that may contribute to burnout, compassion fatigue, and turnover. A women’s hospital in central Texas identified increased nurse turnover and lower employee engagement scores related to well-being and intent to stay within the neonatal intensive care unit.

Purpose: The purpose of this quality improvement project was to implement and evaluate a standardized resilience support bundle for nurses following traumatic clinical events.

Methods: Guided by the Plan-Do-Study-Act framework, the project implemented a resilience bundle that …

Kinematic And Muscle Activity Differences During Dual Task Cutting In Ncaa Soccer Players, Abigail Mccarthy

Open Access Master's Theses

Lateral ankle sprains (LAS) are one of the most common musculoskeletal injuries in collegiate soccer, but also in the world. Professional soccer observes a prevalence of around 10-18 percent (Walden et al., 2013). The United States alone reports up to 2 million acute ankle sprains annually (Herzog et al, 2019). LAS ranked top 3 in types of injuries within collegiate soccer with hamstring tears and concussions (Chandran et al., 2021). Around 40 percent of people who experience a lateral ankle sprain will experience chronic ankle instability, and since spraining ankle once at a greater risk now for spraining ankle again. …

Test-Retest Reliability And Validity Of The Gas Exchange Threshold, Erik Ryan Snell Mr.

Theses and Dissertations--Kinesiology and Health Promotion

Theoretically, the gas exchange threshold (GET) demarcates the moderate and heavy intensity domains, whereby exercise performed at and below the GET results in a change in oxygen consumption ([ΔVO₂] ≤ 200 mL), and exercise above the GET results in a slow component (ΔVO₂ > 200 mL). This study examined the reliability and validity of the GET. 14 subjects performed two maximal graded exercise tests (GXTs) to determine the GET and its reliability. The minimal difference (MD = 21W) was applied to determine the GET above (GET_+MD) and below (GET_-MD) power outputs for 30 min …

Biomechanical Effects Of Exercise-Based Interventions In Chronic Nonspecific Low Back Pain: A Systematic Review And Meta-Analysis, Lara De Vecchi Machado

Theses and Dissertations--Kinesiology and Health Promotion

Chronic nonspecific low back pain (CNLBP) is the leading cause of years lived with disability worldwide and represents a complex, multifactorial, and heterogeneous condition. It is characterized by substantial interindividual variability in muscle activation patterns, lumbo-pelvic coordination, and movement strategies. Although exercise is widely recommended as a first-line intervention and its clinical benefits are well established, the biomechanical mechanisms underlying functional improvement remain fragmented in the literature and are rarely synthesized quantitatively.

This dissertation conducted a systematic review with meta-analysis to investigate the biomechanical effects of exercise-based interventions in individuals with CNLBP. A total of 39 studies were included and …

A Specification-Driven Framework For Self-Supervised Learning In Specialized Vision Domains, Mahmut S. Gokmen

Theses and Dissertations--Computer Science

Self-supervised learning (SSL) has emerged as a principled approach to visual representation learning that derives supervisory signal directly from unlabeled data, enabling foundation models to be trained at scale without manual annotation. Deployments in medical imaging and biometric recognition have demonstrated the potential of this paradigm, yet the assumptions that make SSL effective on natural image benchmarks fail systematically in specialized domains. Generic SSL pipelines encode a tacit assumption that the most informative correspondence is spatial proximity within a single acquisition. In specialized domains this assumption breaks at the level of the data-generating process: the signal that carries domain-specific information …

From Mandate To Meaning: Designing Implementation Supports For Organizational Readiness In Behavioral Health Service Planning, Lauren K. Mergen

Theses and Dissertations--Education Sciences

Behavioral health agencies often struggle to translate the Transformational Collaborative Outcomes Management (TCOM) framework into practice when implementation is externally mandated. This study examined how educational leaders can support meaningful use of TCOM tools under a Midwestern state’s October 2024 requirement that behavioral health providers use the state Child and Adolescent Needs and Strengths assessment in service planning.

Using a Mixed Methods Action Research design, the study progressed through six phases: Diagnosis, Reconnaissance, Planning, Acting, Evaluation, and Monitoring. The Diagnosis Phase identified a knowledge-to-practice gap and weaknesses in implementation support infrastructure. Practitioner surveys administered immediately after training and six months …

Metabolism As A Regulator Of Sleep And Cortical Activity In Health And Alzheimer’S Disease, Nicholas J. Constantino

Theses and Dissertations--Neuroscience

Metabolic flexibility is essential for maintaining normal physiological function, enabling an organism to sense, flux, utilize, and switch fuel sources in response to changing energetic availability, demand, and cellular needs. Energetic demands are state-dependent, with wake and sleep exhibiting distinct metabolic profiles. Sleep is highly sensitive to changes in metabolism and requires metabolic flexibility to both transition into and maintain sleep stability. Alzheimer’s disease (AD) is increasingly recognized as a disease of altered metabolism yet is often framed as a disease of energetic failure. We instead define AD as a disease of metabolic inflexibility, characterized not by insufficient energy availability, …

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

The Immune Hangover: Understanding The Influence Of Alcohol Use, Abstinence, And Post-Abstinence Drinking On Monocyte Plasticity, Madison B. Blanton

Theses and Dissertations--Pharmacy

Alcohol consumption is widespread in the United States, with 80% of individuals aged 12 and older reporting alcohol use and 1-in-4 engaging in risky drinking behaviors. Alcohol misuse heightens susceptibility to infections and delays wound healing, indicating a disrupted immune system. Previous studies show alcohol rewires immune cells, especially monocytes and macrophages, which play critical roles in tissue homeostasis and host defense.

Using a rhesus macaque model of ethanol self-administration, we demonstrate that after 6-months of drinking, monocytes exhibit decreased cytokine production and significant transcriptomic changes, indicating a hypo-inflammatory state. In contrast, 12-months of chronic alcohol use induces hyperinflammatory responses, …

Investigating The Potential Role Of Toxoplasma Gondii In The Development Of Equine Protozoal Myeloencephalitis, Brooklyn Nicole Shirah

Theses and Dissertations--Veterinary Science

Equine protozoal myeloencephalitis (EPM) is a neurologic disease of horses prevalent in the Americas, caused by the coccidian parasites Sarcocystis neurona and Neospora hughesi. Toxoplasma gondii is a related parasite that infects nearly all warm-blooded animals, including horses. Prior studies show conflicting results on whether T. gondii contributes to EPM, in part because no validated T. gondii serologic assay exists in horses. This study developed a recombinant TgSAG1 ELISA and confirmatory Western blot. These assays evaluated T. gondii seropositivity in 789 serum samples from healthy and neurologic horses across multiple geographic regions and examined 31 paired serum:CSF samples for …

Molecular Mechanisms And Metabolic Consequences Of Glucocorticoid Resistance, Genesee J. Martinez

Theses and Dissertations--Pharmacology and Nutritional Sciences

Glucocorticoids are vital steroid hormones that govern metabolism, stress responses, and immune functions through intricate, tissue-specific mechanisms, both genomic and non-genomic. These hormones bind to the glucocorticoid receptor (GR), which then acts as a transcription factor to modulate gene expression. Chronic elevation of glucocorticoid levels may lead to glucocorticoid resistance, resulting in adiposity, inflammation, and insulin resistance, thereby adversely affecting multiple metabolic tissues. Whether produced endogenously or administered exogenously, excessive, chronic glucocorticoid concentrations impair glucocorticoid signaling. Although there are two primary isoforms of the receptor, GR⍺ and GRβ, only GR⍺ interacts with glucocorticoids.Through the research conducted in this dissertation, we …

Expanding The Role Of Muscle Stem Cell Fusion In Muscle Under Hypertrophic Stimulus, Jensen Goh Zhong Sheng

Theses and Dissertations--Physiology

Muscle stem cells (MuSCs) are a unique stem cell population that can activate in response to both injury and growth stimuli. Studies on muscle regeneration have shown MuSC activation follows a uniform progression through proliferation, differentiation, and fusion. Therefore, to determine whether MuSC replication is a prerequisite for differentiation under hypertrophic stimulus, I used a lineage-tracking mouse model (Pax7^rtTA; TRE-H2B-GFP) to label MuSC nuclei and simultaneously tracked DNA synthesis via EdU incorporation. This dual-labeling approach allowed us to not only distinguish MuSC-derived nuclei but also demarcate which MuSC had proliferated prior to fusion. I then employed a mechanical …

A Tale Of Two Serpins: Pathologic And Protective Roles Of Agt And Pai-1 In Metabolic And Cardiovascular Disease, Alex C. Pettey

Theses and Dissertations--Physiology

Metabolic and cardiovascular diseases are leading causes of morbidity and mortality worldwide. Conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD), aortic aneurysm, and cardiac fibrosis have limited pharmacological therapies, underscoring the need for deeper mechanistic investigations. Serine protease inhibitors (serpins) have been implicated in these pathologies and represent potential therapeutic targets. Despite structural homology, serpins regulate diverse physiological processes through both protease inhibition and non-inhibitory mechanisms. This dissertation examines the roles of two serpins, angiotensinogen (AGT) and plasminogen activator inhibitor-1 (PAI-1), in preclinical models of metabolic and cardiovascular disease to identify novel mechanisms that may inform future therapeutic strategies. …

Investigation Into The A/Ss Of Cervical Cancer And Its Effects On Tumor Control Probability In Radiation Therapy, Cameron Thayer-Freeman

Theses and Dissertations--Radiation Medicine

The standard of care for locally advanced cervical cancer is chemoradiation, consisting of conventional external beam therapy (EBT) followed by a boost of high dose rate (HDR) brachytherapy. These two radiation treatments will illicit different degrees of biological response depending on the tissue in question, and quantifying the overall effect the combined treatments will have require some form of biological modeling. The linear quadratic (LQ) model of cell survival is the most widely used radiobiological model in clinics across the nation.

It is quantified by the parameters a and ß, which model how radiation generates lethal damage in a population …

Environmental Detection And Quantification Of Equid Alphaherpesviruses In Equine Facilities Using Air Sampling, Emma E. Hyde

Theses and Dissertations--Veterinary Science

Equid alphaherpesvirus 1 and 4 (EHV-1/-4) circulate at equestrian facilities, contributing to outbreaks. Due to the complexities of the pathogen, including the limited predictability of reactivation from latency and the effects associated with secondary sites of viral replication, abortion, and neurologic disease, EHV infections are of utmost concern to the equine industry. Recent studies have highlighted the prevalence of the viruses in stabling areas at competitions, though little is known about this phenomenon in other high-traffic equine environments. This thesis presents two studies using air sampling surveillance methods to further explore the viral detection in other equine environments (veterinary facility …

A Quality Improvement Project: Nurse-Led Nutritional Support To Reduce Missed Chemotherapy Appointments, Eva Balboa

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction/Background

Malnutrition affects approximately 43% of cancer patients nationally and is associated with missed chemotherapy appointments, treatment interruption, and poor clinical outcomes. At a 30-chair outpatient cancer center in South Texas, a retrospective chart review revealed that 45% of patients experienced malnutrition-related symptoms contributing to appointment disruptions. Despite evidence-based recommendations for routine nutritional screening and support, no standardized protocol existed at this site.

Objectives

 The purpose of this quality improvement project was to implement a nurse-led nutritional support protocol and evaluate its effectiveness in (1) reducing the missed chemotherapy appointment rate from 10% to 5%, (2) achieving 100% compliance with …

A Guideline For Underserved Adult Residents In Need Of Affordable Transportation Access To Healthcare, Tammie E. Walker

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

During the development of the 2022 Tarrant County Public Health Community Health Assessment, two gaps were identified that contribute to disparities: transportation and access to healthcare in areas of high need (Y. M. Wingate, Ed.D., Community Health Assessment Division Manager, Tarrant County Public Health, personal communication, June 20, 2025). As of 2017, 5.8 million individuals reported delaying medical care due to a lack of accessible transportation in the U.S. (Wolfe et al., 2020). The National Health Interview Survey (NHIS) of 2022 reported that 5.9% of residents living in the West South-Central region, which includes Texas, found that, within the …

Non-Invasive Detection Of Intracranial Pressure, Andrei V. Nesterenko

Honors Undergraduate Theses

Intracranial pressure is a critical metric used when managing tumors, strokes, TBIs, hydrocephalus, and other operative conditions. Traditional methods for continuous ICP monitoring, intraparenchymal catheters, epidural transducers etc., are invasive and carry a high risk of infection. Previous attempts to create accurate, easy to use, and non-invasive ICP monitoring techniques have been unsuccessful. In this study, we investigated the utility of supraorbital and posterior auricular photoplethysmography to monitor changes in ICP during orthostatic tilt and hyperventilation, which increase and decrease ICP respectively.

Through a continuous 5-minute recording on a tilt-table we characterized SOA and PAA waveforms in 12 participants (ages …

Evaluating The Burnout Mitigating Effects Of A Structured Mentorship Program In Newly Hired Advanced Practice Providers, Melissa Soper

DNP Projects

Importance: Burnout is a leading driver of clinician intent to leave, lower productivity, increased medical errors, and increased resource use.

Objective: The purpose of this project was to evaluate the effects of an evidence-based mentorship program on newly hired advanced practice providers’ (APPs’) level of stress, burnout, and professional fulfillment.

Results: At baseline, APPs demonstrated higher stress levels, moderate professional fulfillment, and low burnout. Outcomes showed improvement at the end of a mentorship program.

Conclusion: Longitudinal studies with larger sample sizes are needed to determine the true effect of a 6-month mentorship intervention on APP burnout, stress, and professional fulfillment.

Establishing An Advanced Practice Provider-Led Transient Ischemic Attack Clinic: A Quality Improvement Initiative, Brittany A. Young

DNP Projects

Background: Due to lack of subspecialized neurological care in many rural community settings, care in tertiary hospitals is in demand. Insufficient care pathways can lead to lack of bed and provider availability. Advanced Practice Provider Transient Ischemic Attack clinics have been shown to be safe alternatives to hospital admission, for patients who meet criteria. This study targeted practice change at a 1000 bed tertiary academic hospital.

Methods: The quasi-experimental study sample inclusion criteria included Transient Ischemic Attack patients presenting to the emergency department with an ABCD2 < 4, complete symptom resolution, and no new cardiac changes on monitoring. A pre and post survey with educational PowerPoint intervention was provided to all emergency department and Neurology providers and nurses. A Transient Ischemic Attack clinic was established with a corresponding order set to be utilized for streamlined outpatient work up.

Results: During the pilot period, 29 admissions were deferred with 69% …