Medicine and Health Sciences Commons^™

'Guide The Tide' - Supervision Of International Medical Graduates In The Emergency Department: A Mixed Methods Study, Purnasankar Bhowmik

Theses

Australia’s emergency departments (EDs) have experienced significant stress since the COVID-19 pandemic. An increase in the number of patient presentations, a lack of in-patient beds for the disposition of admitted patients and long waiting times are contributing factors jeopardising patient safety. In addition, the shortage of skilled staff to look after patients in the ED is the paramount concern currently and moving forward. Similarly to many other specialty areas of medicine, EDs rely on international medical graduates (IMGs) to fill the gaps in the medical workforce. However, concerns have been raised regarding IMG diversity in training requirements, clinical skills and …

Opioid Abuse: Community Education, Meggan N. Wolff-Jackson

Doctor of Nursing Practice Projects

The opioid epidemic in the United States has persisted for over two decades and has become one of the leading causes of accidental deaths nationwide (Robert et al., 2022). The opioid crisis represents a widespread public health emergency that extends beyond individual and community boundaries, imposing burdens on both the national economy and the healthcare system (Kyei et al., 2024). Although the opioid epidemic is a global concern, it is particularly concerning in the target community located in the western part of North Carolina. This region has some of the highest rates of opioid overdoses within the state, with 118 …

Improving Overall Morale Of Nurses By Implementing A Serenity Room, Ruth B. Clarke-Johnson

Doctor of Nursing Practice Projects

Nursing, while a highly respected profession grounded in research and scientific practice, continues to face persistent challenges related to staff retention and morale. Key contributors include burnout related to high workloads, challenging staffing ratios, lack of supportive leadership, and an aging workforce. Together, these factors hinder healthcare organizations’ ability to sustain a stable and experienced staff. The implementation of a serenity or relaxation room is supported by growing evidence highlighting its positive effects on nurse morale and stress reduction. A review by Mileski et al. (2022) found wellness spaces significantly reduced burnout, emotional exhaustion, and stress while improving resilience, job …

Integrating Lactation Education Into Centering Pregnancy To Enhance Maternal Confidence And Lactation Initiation Rates, Courtney Barbee

Doctor of Nursing Practice Projects

Introduction: Breastfeeding remains the gold standard for infant nutrition providing physical and psychological benefits for both mother and baby. The inadequacy of lactation education and support continue to hinder breastfeeding initiation in the rural areas of North Carolina. Integrating a board-certified lactation consultant into the Centering Pregnancy model provides an evidence-based strategy to improve maternal confidence and increase lactation initiation rates within the target community.

Method: Using a quality improvement framework, the project targeted expecting mothers participating in Centering Pregnancy. Pre- and post-surveys assessed confidence levels after receiving two educational sessions with a board-certified lactation consultant.

Results: …

Beat By Beat: Empowering Communities With Lifesaving Cpr Skills, Allyssa Mb Hutchins

Doctor of Nursing Practice Projects

Introduction: This doctoral project was created to increase bystanders' willingness and ability to perform CPR by building their confidence in performing it effectively. A total of 13 participants participated in this project to increase knowledge and confidence in CPR interventions.

Background: Cardiac arrests remain a leading cause of death, yet research indicates that rural communities have lower rates of bystanders trained and willing to assist. Increasing CPR awareness and eliminating barriers to care for classes can improve CPR confidence and have a positive community impact.

Methods: Three 4-hour CPR classes were held in Zirconia, NC, at no …

Safe And Effective Injection Practices For Insulin And Glp-1 Users, Lydia A. Anderson

Doctor of Nursing Practice Projects

Improper insulin and GLP-1 injection techniques can reduce treatment effectiveness in patients diagnosed with diabetes mellitus. This quality improvement project aimed to improve patients' knowledge and safety regarding insulin and GLP-1 medications by conducting an educational session and demonstration of proper injection techniques. The project took place at a community senior center where individuals reported not receiving instruction or education on correct injection practices when prescribed these medications. Pre- and post-intervention surveys assessed changes in patient knowledge, confidence, and understanding of proper injection methods. Results demonstrated clear improvements in patient knowledge, confidence, and technique. This project highlights the significance of …

Enhancing Uncontrolled Hypertension Compliance And Self-Management In A Senior Center, Kimberly D. Strickland

Doctor of Nursing Practice Projects

Hypertension is a complicated, chronic condition that affects individuals worldwide. The prevalence of this condition has increased nearly 48% in the last decade in America. This project served to determine if participants in a targeted area/community would show increased knowledge and awareness of hypertension after implementation of educational sessions. A post-session survey was provided to determine if the educational sessions were effective. Data was collected and analyzed that showed an increase in awareness and knowledge regarding the prevalence of hypertension, diet modification, lifestyle, and compliance.

Increasing Awareness Of Obesity And Its Associated Risks In Adults, Esther E. Bayode

Doctor of Nursing Practice Projects

Obesity is a significant and growing public health concern in a metropolitan area of North Carolina, reflecting statewide and national trends. With 36% of adults in North Carolina classified as obese, the condition contributes to chronic diseases such as hypertension, diabetes, heart disease, and certain cancers. This project targeted adults aged 18 and older within a local faith-based community, where preliminary findings showed a strong association between elevated body mass and increased chronic disease burden. To address this issue, a two-session educational intervention was implemented in partnership with a religious organization to increase knowledge about obesity, its causes, associated risks, …

The Essentials Of Heart Failure Management, Emily W. Greene

Doctor of Nursing Practice Projects

Heart failure remains a leading cause of hospitalization among older adult women, often due to delayed recognition of symptom exacerbation and limited knowledge of self-management strategies. The purpose of this quality improvement project was to evaluate whether a brief educational intervention could improve knowledge of heart failure management among older adult women at a community senior center. The DNP project leader conducted two educational sessions focusing on early recognition of heart failure symptoms, heart-healthy diet, and when to contact a healthcare provider. Participants completed a pre- and post-test survey containing four knowledge questions and one Likert-scale question on perceived knowledge …

Spreading Awareness To College Athletes About Skin Cancer And Improving Sun Protection Habits, Baylee B. Whiteside

Doctor of Nursing Practice Projects

Introduction: The intention of this Doctor of Nursing Practice evidence-based project was to provide education on improving awareness of skin cancer to potentially improve sun protection habits. A total of 100 college athletes participated in this project. The goal was to increase educational knowledge and practice intentional sun protection habits.

Background: One in 5 people will develop a type of skin cancer by age 70 (Skin Cancer Foundation, 2024). Several studies have proven that young adults, ages 15-25, are at an increased risk of sun exposure due to decreased knowledge about skin cancer. Teaching and improving the knowledge in this …

Increasing Teens' Knowledge On The Health-Related Effects Of Vaping, Anteja Gore

Doctor of Nursing Practice Projects

Vaping in teens has become an increasing public health issue related to the growth in the number of teens who are using vapes. Many teens are not aware of the potential associated risk of using vapes, as they perceive them to be a safer alternative to smoking cigarettes. The purpose of this project was to increase the middle school teens’ knowledge of the potential health risks associated with vaping through an educational awareness session. This project was implemented in the middle school setting, targeting students aged 12-14 years. The students who participated completed anonymous pre- and post- questionnaires that evaluated …

Spreading Awareness To Adults About Cardiovascular Disease And Improving Healthy Lifestyle Habits, Madison L. Eldridge

Doctor of Nursing Practice Projects

Introduction: The intention of this Doctor of Nursing Practice evidence-based project was to evaluate if providing education to the target community would increase awareness and knowledge of cardiovascular disease and healthy lifestyle habits. The goal was to increase educational knowledge and promote awareness of cardiovascular disease and healthy lifestyle habits.

Background: Cardiovascular disease (CVD) is a critical health issue that prevails across the state of North Carolina, while continuing to remain one of the leading causes of death across the south-center Piedmont area of North Carolina. Several studies have proven that increasing knowledge on cardiovascular risks, promoting healthy exercise, and …

Effects Of Educational Programs On Reducing Sexually Transmitted Infection Rates, Phierica D. Gardin

Doctor of Nursing Practice Projects

Sexually transmitted infections (STIs) remain a significant public health concern in the United States, with increasing rates reported in many states, including North Carolina. Limited sexual health education, stigma surrounding sexual health discussions, and lack of awareness regarding prevention and screening contribute to ongoing transmission, delayed diagnosis, and potential long-term complications associated with untreated STIs. The purpose of this Doctor of Nursing Practice (DNP) project was to implement a sexual health education program aimed at increasing knowledge of STI transmission, prevention strategies, and the importance of screening among adults aged 18 years and older. Two educational sessions were completed within …

Combating Pressure Injuries In Critical Care: A Dnp Project On Nursing Education And Prevention Strategies In The Icu, Tijuana M. Johnson

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries (HAPIs) are preventable complications that significantly increase patient morbidity, mortality, length of stay, and healthcare costs, particularly in intensive care units (ICUs). At a rural 146-bed hospital, the ICU pressure injury rate of 1.17 per 1,000 discharges exceeded the national benchmark of 0.58 per 1.000 discharges, identifying a critical gap in prevention practices. This Doctor of Nursing Practice (DNP) project aimed to improve ICU nurses' knowledge of pressure injury prevention and reduce unit-based educational intervention grounded in Patricia Benner’s Novice to Expert Theory and implemented using the Plan-Do-Study-Act (PDSA) quality improvement framework.

A pre-and post-intervention design was …

Building Clinical Competency In Central Line Care: A Nurse-Focused Initiative To Prevent Clabsis, Glenda A. Robbins

Doctor of Nursing Practice Projects

Central line-associated bloodstream infections (CLABSIs) are a significant yet preventable source of increased morbidity, mortality, and healthcare costs in acute care settings. Despite established evidence-based prevention bundles, inconsistent nursing adherence remains a primary contributor to elevated CLABSI rates. A 241-bed acute care hospital reported CLABSI rates above the national benchmark. This Doctor of Nursing Practice (DNP) project utilized Neuman’s Systems Model. The intervention consisted of a structured educational module on central line care and maintenance, including pre- and post- knowledge assessments. Additionally, standardized daily central line visual audits were reinforced by the Vascular Access Team. A total of 363 bedside …

Diabetes Education In Buncombe County, Deonna Nicole Blount

Doctor of Nursing Practice Projects

The growing number of Americans living with diabetes has reached an all-time high. According to the Centers for Disease Control and Prevention (CDC) (2026), there are 40.1 million people diagnosed with or underdiagnosed with diabetes. Evidence has shown that with education tailored to the patient's lifestyle, changes can be made and healthier lifestyles exhibited. Understanding the why of the patients can assist in changes that are feasible and can be implemented for the now and the future. Several studies outlined by Alonso-Carril et al. (2024), Lander et al. (2022), and Hodges et al. (2019) showed that education was implemented and …

Mental Health First Aid Training In The Community, Vester Agbley Gideon

Doctor of Nursing Practice Projects

Mental health issues impact one in five adults in the United States; however, many individuals lack the requisite knowledge and skills to effectively respond to mental health crises. Mental Health First Aid (MHFA) training empowers individuals to recognize and address mental health concerns, thereby fostering early intervention and support. This review analyses the efficacy of MHFA training, best practices for its implementation, and its influence on mental health outcomes. Empirical evidence indicates that MHFA training enhances mental health literacy, diminishes stigma, and encourages supportive behaviors. Customized approaches for targeted populations, such as youth and older adults, have also shown significant …

Improving Timeliness Of Extubation Post-Cabg: An Educational Intervention Utilizing A Nurse-Driven Checklist, Christy Scott

Doctor of Nursing Practice Projects

Background: Timely extubation following coronary artery bypass graft (CABG) surgery is associated with improved patient outcomes. In a rural six-bed cardiovascular intensive care unit (CVICU) in North Carolina, extubation times were previously reported at approximately 15 hours. A lack of a standardized nurse-driven process and inconsistent familiarity with extubation readiness criteria contributed to variation in practice.

Purpose: The purpose of this DNP project was to implement and evaluate an educational intervention using a nurse-driven extubation checklist to improve nurses' knowledge, confidence, communication, and role clarity related to post-CABG extubation readiness in the CVICU.

Methods: The staff education …

Musical Measures: Nurse Education On Music-Based Interventions To Reduce Patient Restraints, Crystal D. Tucker

Doctor of Nursing Practice Projects

The use of physical restraints in acute psychiatric settings poses significant risks to patient safety, including physical injury and psychological distress. Evidence supports the need for alternative, non-pharmacologic interventions to reduce reliance on restraints. This Doctor of Nursing Practice quality improvement project aimed to evaluate the impact of an educational intervention on nurses’ knowledge and confidence in implementing music-based interventions, specifically binaural beats, to manage patient anxiety and agitation.

The project was conducted on a medical observation and behavioral health holding unit and utilized a pre- and post-intervention design. Registered nurses participated in educational sessions on music-based interventions and were …

Three Essays On Disparities And Outcomes Among Patients With Diabetes, Aiemere O. Oikeh

Theses and Dissertations--Health Services Research (HSR)

The American Diabetes Association (ADA) recommends that patients with diabetes adopt 7 preventive care measures to improve their health outcomes. The recommendations are to check their blood glucose levels daily, undergo biennial hemoglobin A1c tests, undergo dilated eye exams once every 2 years, engage in regular physical activity, check their feet daily, have annual feet examinations performed by a clinician, and receive diabetes self-management education services (DSMES). Marital status has been found to be associated with positive health outcomes; thus, it is ideal to evaluate if there is an association between marital status and diabetes preventive care. The ADA also …

Art As Medicine: Exploring The Intersection Of African Cultural Practices And Art Therapy To Examine Its Efficacy In Pain Management And Healing Among Black Women With Lupus, Kandace I. Simmons

Art Therapy | Master's Theses

This thesis examined the intersection of chronic illness and systemic inequities faced by Black women living with lupus. These women often encountered unique challenges in managing their health and well-being, exacerbated by both the physical and sociocultural implications of the disease. Through a Black Feminist/Womanist theoretical lens, this research investigated the potential of art therapy to serve as a transformative instrument for pain management and healing when infused with culturally relevant practices. Employing a narrative approach and qualitative methodology, this study explored the lived experiences of African American women with lupus, incorporating their art and personal stories to inform the …

The Use Of Visual Autobiographies In First, Second, And Third-Generation Children Of Immigrants In Navigating Belonging And Identity, Sorprisela Martinez

Art Therapy | Master's Theses

This study explored how autobiographical artmaking supports adolescents of immigrant-origin in understanding identity and sense of belonging through visual and narrative reflection on personal stories. The qualitative research approach was guided by three research questions examining: (1) the ways autobiographical work expresses complexities of immigrant heritage and multiple identities; (2) how narrative lens supports a deeper interpretation of autobiographical expressions; and (3) how adolescents’ understanding of their parents’ migration stories contributes to their own identity formation and self-presentation. Seven adolescents participated in a two-session, arts-based process that included creating autobiographical books, discussion of their images, and reflection on their cultural …

Wise Beyond Our Years: Menopause, Negative Body-Image, And Art As A Catalyst To Self-Acceptance, Nicole Lea

Art Therapy | Master's Theses

This mixed methods study examined the impact of menopause on women’s body image and self-acceptance through an arts-based group intervention. Quantitative data was collected using the Body Image Self-Compassion Scale, and qualitative data was gathered through art-making, group discussion, and individual interviews. Participants were (n=5) menopausal women aged 46-52 from the Bay Area who reported negative body image related to menopause. The intervention consisted of four one-hour open studio workshops with a fifth meeting added in which participants created altered books while engaging in peer support and discussion. Descriptive statistics indicated an increase in mean body image self-compassion scores from …

Improving Psychiatric Paraprofessional Preparedness Through Mental Health First Aid Training In An Outpatient Mental Health Clinic, Anisha Hampton

DNP Scholarly Projects

BACKGROUND: Paraprofessional staff in outpatient mental health clinics play a critical role in monitoring clients with serious mental illness (SMI) and supporting continuity of care in community-based settings. However, the absence of standardized training contributes to variability in staff knowledge, confidence, and ability to recognize early signs of mental health deterioration. Mental Health First Aid (MHFA) is an evidence-based training designed to improve mental health literacy and crisis response skills among frontline workers.

METHODS: This quality improvement project utilized a pre-post design within a Plan-DoStudy-Act (PDSA) framework at an outpatient mental health clinic. Paraprofessional staff completed the Mental Health Literacy …

Integrating Brief Cognitive Behavioral Therapy Into Telepsychiatry: A Professional Development Model For Pmhnps, Catherine A. Roberts

DNP Scholarly Projects

Background: Mental illnesses remain among the most prevalent health conditions in the United States, affecting approximately 23% or nearly one in five adults in 2025 (Centers for Disease Control and Prevention [CDC], 2025); National Institute of Mental Health [NIMH], 2024a). Despite this high prevalence, only 50.6% of adults living with mental health disorders receive treatment (NIMH, 2024a); although the expansion of telepsychiatry has improved access to mental healthcare, medication-management visits are frequently brief and primarily focused on pharmacotherapy thereby limiting opportunities for delivery of psychotherapeutic interventions. This limitation highlights the need for structured, evidence-based psychotherapeutic approaches that can be …

The Effects Of Stress-Related Hormones On Excitatory Synapse Formation, Autumn C. Garvey

Honors Undergraduate Theses

Stress profoundly influences brain function through neuromodulatory hormones that regulate synaptic plasticity, yet how temporal patterns of hormone exposure shape excitatory synapse formation remains poorly understood. This study investigates how exposure to stress hormones, norepinephrine and cortisol, affects excitatory synapse development. While existing research primarily compares concentration models, real-world stress occurs in variable patterns that may produce distinct neural outcomes. To address this gap, differentiated Neuro2A neuronal cells are exposed to norepinephrine or cortisol under a continuous treatment paradigm designed to model chronic stress conditions. Following treatment, immunofluorescence imaging is utilized to quantify excitatory synapse formation through analysis of presynaptic …

Comparative Analysis Of Serum-Free Culture Conditions On Cell Proliferation And Extracellular Vesicle Production By Adipose-Derived Stem Cells, Ayna Ghulldu

Honors Undergraduate Theses

Adipose-derived stem cells (ADSCs) are promising candidates in regenerative medicine due to their proliferative capacity, self-renewal, and secretion of extracellular vesicles (EVs) that mediate intercellular communication. Serum-free media has been increasingly explored for MSC culture as it eliminates xenogeneic components, improving human therapeutic suitability. However, comparative evaluation of distinct serum-free formulations on ADSC proliferation and EV output simultaneously remains limited. This study compares a serum-containing medium to three proprietary serum-free media prototypes differing in composition, including the presence or absence of extracellular matrix proteins, to inform the optimization of culture conditions for clinical use. Proliferation, EV characteristics, and gene expression …

The Impact Of Gastric Sleeve And Roux-En-Y Gastric Bypass On Chief Cell Function And Protein Digestion In Obese Patients, Garikoitz Mikel Gainza

Honors Undergraduate Theses

Obesity has become one of the largest global health concerns of the 21^st century, correlating with numerous associated diseases. To help address the growing prevalence and burden of obesity, sleeve gastrectomy and Roux-en-Y gastric bypass have become two commonly performed surgical procedures done to promote weight loss by altering the anatomical structure of the stomach and surrounding organs of the gastrointestinal system. Although the benefits of improved metabolism linked to these surgical procedures are well studied, their impact on the physiology of gastric cells, and more specifically chief cells as they relate to protein digestion post-surgery, is yet to …

Guideline For A Burnout Bundle For Nurses In Psychiatric Mental Health Units, Festus Irabor

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Problem: Burnout among nurses, especially in psychiatric mental health units, significantly impacts both their well-being and the quality of patient care. Despite its severity, with approximately 30% of nurses worldwide affected and contributing to a 31.5% nurse turnover rate (Ge et al., 2023), there are limited formal guidelines specifically targeting nurse burnout prevention in the mental health setting. The issue is particularly acute in the United States, where 91.1% of psychiatric nurses report experiencing burnout, compared to 79.9% of other healthcare professionals (Anger et al., 2024). In the local unit 38.05% have experienced burnout.

Purpose: The PICOTS for this …

Iron Deficiency And Iron Deficiency Anemia: Inconsistent Screening Practices And Delayed Result Processing In Children 12-18 Months, Madonna J. Mahoney Marshall

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction:

Iron deficiency and iron deficiency anemia in children aged 12 to 18 months are prevalent conditions that, if not identified and treated early, are associated with adverse neurodevelopmental outcomes.

Purpose:

This quality improvement project evaluated the impact of a standardized screening and follow-up protocol on laboratory result retrieval, provider review, and caregiver follow-through in a military pediatric clinic.

Method:

A pre-post intervention design guided by the Plan-Do-Study-Act framework was implemented over 11 weeks and included staff education, standardized workflows, and caregiver outreach.

Results:

The intervention improved laboratory completion and caregiver follow-up rates; however, sustainability was limited by staffing constraints …