Transition-To-Practice Program For Aprn Msn Graduates, Jennifer Nneoma Nwosu

Walden Dissertations and Doctoral Studies

The transition from graduate education to clinical practice marks a pivotal point in the professional journey of advanced practice registered nurses (APRNs). Despite rigorous preparation, many APRN MSN graduates struggle to adapt to the complex expectations of autonomous practice. The lack of structured mentorship, inconsistent orientation processes, and unclear performance expectations contribute to high stress, role confusion, and early turnover. This Doctor of Nursing Practice Executive Leadership project addressed this critical issue by evaluating whether an interprofessional team could achieve consensus on developing a best practice program to guide APRN MSN graduates’ transition to independent clinical practice. This initiative was …

Enhancing Exercise Engagement And Gait In Parkinson Disease: Participation Factors, Novel Approaches, And The Role Of Rhythmic Auditory Cueing, Allison Haussler

WUSM Theses and Dissertations – All Programs

Parkinson disease (PD) is the second most common neurodegenerative disease, characterized by gait and balance impairments that reduce independence and diminish quality of life. Exercise and other rehabilitation strategies, such as rhythmic auditory cueing, are well-researched methods to address motor impairments. However, despite the strong body of research supporting these approaches, many individuals with PD remain sedentary and do not meet current exercise recommendations. This highlights a critical gap between evidence and real-world behavior.

While prior research identified general motivators and barriers to exercise in people with PD, emerging exercise modalities and the growing diversity of community-based programs emphasize the …

A Clinical Practice Guideline For Screening For Insomnia In College Students, Ashly Bliss

Walden Dissertations and Doctoral Studies

Insomnia and sleep deprivation are highly prevalent issues among the U.S. college student population, contributing to a significant health care gap due to the inconsistent performance of routine clinical screening. This Doctor of Nursing Practice (DNP) project sought to determine the rigor and applicability of a Clinical Practice Guideline (CPG) designed for the early identification of insomnia in college students using a best-evidence screening tool within a rural health clinic. The primary practice-focused question was: In a rural health clinic, will a CPG for implementation of a screening tool based on best evidence for early identification of insomnia in college …

Impact Of Staff Education To Clinical Documentation Integrity Team, Leyna Belcher

Walden Dissertations and Doctoral Studies

The doctoral project investigates the impact of education on Clinical Documentation Integrity (CDI) nurses in enhancing the accuracy and quality of clinical documentation within healthcare organizations. Clinical documentation plays a crucial role in accurately reflecting patient care and is essential for capturing proper diagnoses, coding, and reimbursement. In contrast, inaccurate or incomplete documentation can lead to misdiagnoses, poor patient outcomes, and financial deficits. Due to frequent updates in clinical guidelines and coding standards, CDI professionals require continuous, specialized training to stay informed with ever-changing medical terminology, disease processes, and coding regulations. By enhancing the CDI education, the aim is to …

Development Of An Evidence-Based Nutrition Protocol For Professional Pickleball Athletes, Laura Morales

Department of Nutrition Student Projects

Professional pickleball has expanded rapidly, yet sport-specific nutrition guidance remains absent. Current information available to athletes comes largely from non-professional or industry sources and lacks an evidence-based foundation. This project aims to address that gap by developing a nutrition protocol tailored specifically for professional pickleball players. The approach synthesizes data from pickleball workload studies, racket-sport physiology, and established sports nutrition consensus statements. Key focus areas include fueling strategies, protein distribution for recovery, hydration and sodium planning, heat acclimation and cooling practices, travel and jet-lag management, altitude considerations, and evidence-based supplementation. By integrating findings from racket-sport analogs and intermittent high-intensity training …

Early Depression Screening In Adults With Opioid Use Disorder, Ekaterina Versace

Walden Dissertations and Doctoral Studies

Abstract This Doctor of Nursing Practice project involved the development and quality appraisal of a clinical practice guideline (CPG) for early depression screening in adults with opioid use disorder (OUD), addressing the absence of standardized, evidence-based screening protocols in addiction treatment settings. Guided by the practice-focused question of whether existing evidence supports the development and evaluation of such a guideline using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, a systematic synthesis of 35 research articles was conducted, with 15 high-level studies informing guideline development. A multidisciplinary panel of four experts evaluated the CPG using the …

Violence Between Residents In Nursing Homes Is An Enduring Problem. The Agencies, Nursing Homes, And Residents Are Playing Hot Potato With The Responsibility, Cindy Marchionda, Rafael Escalara Montoto

Capstones

Resident-to-resident aggression in nursing homes is a persistent issue, far more common than the general public realizes. While many of these violent situations can be managed, some tragically escalate to fatal outcomes, leaving families mourning the loss of their loved ones at the hands of a facility that was meant to provide safety and care during their final years. Experts agree that this issue is largely driven by chronic understaffing and insufficient training for employees on how to manage patients with dementia and aggression issues.

Integrating The Five As Framework To Enhance Person-Centered Care For Adults Living With Obesity, Alexandra Charles

Electronic Theses and Dissertations

Obesity has adverse effects on physical health, emotional well-being, and mental functioning. To effectively address this highly prevalent and multifaceted condition, the use of a structured, evidence-informed framework is essential to support providers in delivering consistent, person-centered care for individuals living with obesity. The Five As is a powerful yet not commonly implemented framework in many primary care practices. The Five As framework (Ask, Assess, Advise, Agree, Assist) offers a structured model to guide clinicians in delivering consistent, supportive, and transformative care for individuals with obesity.

The goal of the project was to implement a timely and cost-effective protocol/tool that …

Mapping Climatic And Environmental Determinants Of Parasitic Helminth Prevalence In Southeast Asia, Angelica Avisado

UNLV Theses, Dissertations, Professional Papers, and Capstones

Climate change is reshaping environmental conditions across Southeast Asia (SEA) through rising temperatures, altered precipitation patterns, and increased droughts. These changes alter transmission dynamics of neglected tropical diseases (NTDs) by shifting spatial distribution, increasing larval development rates, faster pathogen growth development, and increasing transmission rates. NTDs are a group of preventable and treatable infections that disproportionately affect more than 1 billion people globally, specifically in tropical and subtropical regions. A subgroup of NTDs, parasitic helminth infections (PHIs) - particularly schistosomiasis, soil-transmitted helminths, and lymphatic filariasis remains a public health concern in the Southeast Asian region. PHIs and their ecological responses …

Acute And Chronic Effects Of Neuroinflammation On Hippocampus And Anterior Cingulate Cortex Network Dynamics, Lauren A. Crew

UNLV Theses, Dissertations, Professional Papers, and Capstones

Neuroinflammation has emerged as a critical modulator of cognitive function and neural circuit dynamics, yet the distinct contributions of acute and chronic neuroinflammation to brain function remain poorly defined. This dissertation examines how inflammation independently alters large-scale neural activity and behavior, focusing on interactions between the hippocampus (HPC) and anterior cingulate cortex (ACC), regions essential for memory and executive processes. Using in vivo electrophysiological techniques in a rodent model, this study compares the effects of short-term (acute) and prolonged (chronic) neuroinflammatory states, induced via Poly I:C, on neural oscillations, regional coherence, and spatial coding. Findings reveal that even transient inflammation …

Applying Instrumental Neutron Activation Analysis (Inaa) To Characterize Trace Elements In Water Samples Around Lake Mead, Danesha Hunter

UNLV Theses, Dissertations, Professional Papers, and Capstones

Lake Mead, the largest reservoir in the United States is located on the boarder of Nevada and Arizona. Despite reaching historically low water levels, it continues to supply water and energy to millions of Americans in the southwest. It is well known that the United States suffers from negative implications from nationwide drought. The ongoing megadrought affecting the Colorado River Basin and its tributaries undergoes the urgent need to assess the future water quality of Lake Mead as it continues to shrink. With water levels depleting at an alarming rate, water quality is significantly impacted, indicating that heavy metal accumulation …

Transforming Fear Of Falling Care: Bridging Evidence Synthesis And Clinical Trial On Cognitive Behavioral Therapy-Based Multicomponent Interventions For Older Adults, Haehyun Lee

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Fear of falling (FoF) and associated avoidance behavior represent critical health concerns for older adults, with profound impacts on physical functioning, independence, psychosocial well-being, and healthcare utilization. Although fear of falling avoidance behavior (FFAB) is increasingly recognized as a distinct construct and clinically meaningful construct, intervention research remains limited due to fragmented assessment methodologies and incomplete integration of cognitive-behavioral and physical approaches. This dissertation addresses these gaps through two interrelated projects (1) a scoping review of the evidence base, assessment methods, and intervention strategies for Cognitive Behavioral Therapy (CBT) targeting FFAB in older adults; and (2) a randomized controlled …

Ankimedbench: Evaluating Hierarchical Medical Knowledge In Language Model Embeddings, Neel Patel

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite achieving over 90% accuracy on medical benchmarks, recent studies show physicians cannot effectively leverage language models to improve clinical reasoning. Current benchmarks test isolated factual recall, but clinical practice requires hierarchical navigation through diagnostic categories—starting broad and narrowing systematically from chest pain to cardiovascular pathology to myocardial infarction to specific STEMI types. Existing evaluations cannot measure whether models preserve this taxonomic structure essential for clinical reasoning.

We introduce AnkiMedBench, built from 16,512 medical flashcards used by students preparing for licensing exams. Cards are organized across six hierarchy levels spanning 16 broad medical specialties to 672 specific diseases and conditions. …

A Competency Based Pressure Injury Management Program, Madina Qadir

UNLV Theses, Dissertations, Professional Papers, and Capstones

This project aims to implement a simulation-based wound management program to address critical gaps in nurses’ competencies for managing pressure injuries (PIs). The initiative seeks to enhance nurses’ knowledge, clinical skills, and confidence in wound assessment and advanced therapies, fostering evidence-based practice and consistent care delivery. Effective PI management is vital for improving patient outcomes, reducing healing times, and minimizing complications. Yet, nursing education and competency gaps often lead to inconsistent care and increased healthcare costs. A structured competency-based pressure injury management (CB PIM) program integrates evidence-based didactic lectures and interactive simulation-based skills stations to cover essential topics, including wound …

Pediatric Anesthesia And Virtual Reality: Managing Perioperative Pain And Anxiety– A Scoping Review, Moneer Sharafi, Mason Pham, Alec Wiscombe

Doctoral Projects

Pediatric surgery is common, but it often causes considerable anxiety and pain. A staggering percentage of children experience preoperative anxiety, which can heighten pain, delay recovery, and contribute to complications such as emergence delirium and longer-term behavioral issues (Fortier & Kain, 2015). Virtual reality (VR), which immerses users in computer-generated environments, has been proposed as a distraction technique to reduce these challenges. This Doctor of Nursing Practice (DNP) project conducted a scoping review to examine the effectiveness of VR in reducing perioperative pain and anxiety in pediatric patients. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses …

A Program Evaluation Of Universal Screening For Depression In The Primary Care Setting, Samantha W. Burns

Doctoral Projects

Depression is a chronic condition affecting millions of Americans annually and is often associated with poor clinical outcomes, multiple co-morbidities, a negative economic impact, and an increased mortality rate. Many primary care settings have implemented universal depression screening programs following the recommendations of governing healthcare entities such as the United States Preventive Services Task Force (USPSTF) and Center for Medicare and Medicaid Services (CMS). Due to positive benefit, universal depression screenings have now been included as a quality measure in the Merit-based Incentive Payment System (MIPS) to increase organizational reimbursement. The Patient Health Questionnaire-9 (PHQ-9) is a widely used screening …

The Role Of Multimodal Analgesia In Spine Surgery: A Scoping Review Of Its Impact On Opioid Consumption And Surgical Outcomes, Madison Milam, Kristie Mullins, Tatum Trent

Doctoral Projects

The ongoing opioid epidemic emphasizes the need for alternative perioperative pain management strategies, particularly in high-risk surgical populations such as spine surgery patients. This project proposes a scoping review to examine the role of multimodal analgesia (MMA) in reducing opioid consumption and improving surgical outcomes in adult neurosurgical patients. MMA analgesia involves the use of multiple pharmacologic and nonpharmacologic approaches that target different pain pathways in the human body, aiming to enhance patient comfort while minimizing reliance on opioids.

This review synthesizes current literature on MMA strategies used in spinal surgeries, evaluates reported outcomes such as pain control, postoperative complications, …

Behind The Badge: Effects Of Stress And Trauma In Policing -- Understanding The Importance Of Evidence-Based Prevention, Early Intervention, And Wellness Programs, Jessica Rolshouse

Master of Arts in Human Services

Law enforcement officers are exposed to occupational stress and trauma routinely and at rates that far exceed the general population. This chronic exposure places them at risk for physical and psychological injury and negative outcomes to include mental health disorders including burnout, anxiety, depression, and PTSD. Prolonged exposure to occupational stress and trauma also increases the risk of suicidal ideation and dying by suicide, the most tragic outcome of the stress law enforcement officers face. This literature review focuses on individual risk factors, occupational stress, and trauma, and the development of mental health disorders in law enforcement officers. It also …

Nurses' Comfort Toward Caring For The Dying: A Cross-Sectional Descriptive Study, Candies Warren

ATU Theses and Dissertations 2021 - Present

The purpose of this quantitative cross-sectional descriptive research study was to explore nurses’ comfort levels toward caring for dying patients and what factors influence the bedside nurses’ comfort levels in providing end-of-life care in an acute care hospital setting. A convenience sample (N=63) of RNs voluntarily participated in an online survey from January 2025 to March 2025 that provided direct patient care. Data was collected through Question Pro. Data collected included sociodemographic questions, questions about current comfort level, factors that influence nurses’ comfort level, and selected items from the Frommelt Attitude Toward Care of the Dying Patient (FATCOD) scale. Institutional …

The Incorporation Of Salivary Diagnostic Testing In Dental Hygiene Program Curriculum; A Pilot Study Using A Self-Reported Questionnaire, Carrie B. Palmer-Hawkins

Dental Hygiene ETDs

This study evaluated the incorporation of salivary diagnostic testing in dental hygiene program curricula. A recruitment email and survey link were sent to a convenience sample of 296 CODA-accredited program directors in the United States. Using a descriptive research approach, the survey gathered quantitative and qualitative data exploring directors’ perspectives on the role of salivary testing in dental hygiene education. Thirty-seven responses were gathered over three weeks, and 34 participants were included in the study, resulting in a response rate of 13%. Thirty-eight percent (n=13) reported incorporating salivary testing into their dental hygiene program curriculum through didactic or clinical coursework. …

Neurobehavioral Mechanisms Of Psychotic-Like Experiences And Cannabis Use, Ethan Campbell

Psychology ETDs

As cannabis use has increased steadily over the past decade, there is critical need to evaluate early cannabis use as a potential risk factor for the development of psychosis. Neurobehavioral mechanisms underlying novelty salience could clarify how cannabis exposure may influence subclinical psychotic-like experiences (PLEs). The present study leveraged dynamic functional connectivity and task-fMRI to assess the role of novelty processing in cannabis use and PLEs. A group of brain regions dynamically tied to the salience network while viewing short films were found to increase their activation as a function of stimulus novelty during a novelty bandit task. PLEs were …

Using Vaginal Cytology To Confirm Estrus In Swine - Pilot Study, Carly J. Johnson

Honors College Theses

This study aims to determine whether there is a correlation between cellular changes observed in vaginal cytology and the physical signs of estrus in swine. Vaginal cytology is a technique commonly used in dogs, cats, and rodents, and if proven effective in swine, it could serve as a practical tool for producers to confirm estrus status and improve reproductive management.

Patient-Derived Ovarian Cancer Models Provide Insight Into Cancer Cell-Intrinsic And Immune Cell-Dependent Effects On Therapeutic Response, Parisa Nikeghbal

Biomedical Sciences ETDs

Ovarian cancer is the most lethal gynecologic malignancy, largely due to late diagnosis and resistance to chemotherapy. This dissertation applies patient-derived organoids (PDOs), xenograft-derived organoids (PDXOs), and humanized xenografts (huPDX) to investigate therapeutic responses and immune interactions. Organoids were shown to retain critical features of the original malignancy. Across platinum-sensitive, -resistant, and -refractory cases, both PDOs and PDXOs exhibited drug sensitivities that aligned with patients’ clinical classifications. Building on this foundation, a drug screen revealed novel strategies. Auranofin restored platinum sensitivity in Notch3-active models, afatinib broadly reduced viability, and adavosertib–gemcitabine and sorafenib–topotecan combinations produced synergy. Extending this work, immune interactions …

Pediatric Obstructive Sleep Apnea And The Role Dental Hygienists Play In Achieving Optimal Health And Quality Of Life: A Pilot Study, Kari S. Roth

Dental Hygiene ETDs

ABSTRACT

The purpose of this study was to evaluate the current practice, confidence, barriers, and experience of dental hygienists who screen or identify signs, symptoms, and risk factors of those who struggle with pediatric obstructive sleep apnea. This study was designed to provide a brief perspective to identify gaps or needs for improvement in dental hygiene practice. Members of the American Dental Hygienists’ Association participated in an electronic survey. While 231 participants responded, most reported some familiarity with obstructive sleep apnea in children, but many are unaware of guidelines from other professional organizations for screening protocols. Results depict a lack …

What’S That Smell? It’S Climate Change!, Perry Gregory

Capstones

Climate change is going to make New York City smell worse. Reporter Perry Gregory breaks down the process of olfaction and explains how heat affects what we smell. The piece features a collage of voices of New Yorkers describing the current smell profile of the city. The report features insight from several Atmospheric Scientists into why New York City is getting hotter and more humid, and how those climate changes will make the existing smells of the city stronger, and worse. The most economically vulnerable New Yorkers, who cannot afford air conditioning to buffer them from heat, will be the …

Recreating Fiber Recruitment With Fiber Recruitment Using Additive Manufacturing, Natalia D. Mciver

Biomedical Engineering ETDs

Injured ligaments are often repaired with tendon grafts which may over or under constrain the joint; there is a need for an artificial graft option with the mechanical properties of a native ligament. Crimped fibers within ligaments allow for recruitment which means the viscoelastic properties of stress relaxation and creep are not inversely related. A feasibility study using ACLs and large-scale crimp models to study viscoelasticity, led to an in-depth analysis of the scapholunate interosseous ligament. Using the Modified Kelvin spring-dashpot model, for describing viscoelasticity with a variable stiffness property (time dependent fiber recruitment), we defined the relationship between creep …

Stress During Adolescence: A Characterization Of Anxiety-Like Behavior, And The Mrna Expression Of Neuroimmune Factors, Clock And Stress Genes In Corticolimbic Areas., Annette Fernandez Oropeza, Annette K. Fernandez Oropeza

Biomedical Sciences ETDs

Adolescence represents a critical window of frontal cortex (FC) maturation and corticolimbic circuit refinement that supports stress and emotion regulation. Disruption of these processes by early-life insults such as prenatal alcohol exposure (PAE) or adolescent stress increases vulnerability to anxiety and mood disorders, in part through circadian–immune dysregulation. The circadian transcription factor Bmal1 and the proinflammatory cytokine tumor necrosis factor-alpha (TNFα) have emerged as key regulators of neuroimmune signaling and synaptic communication, yet their interactions across developmental risk contexts remain poorly understood. This dissertation examined the effects of mild adolescent isolation stress, with and without PAE, on anxiety-like behaviors and …

The Pathophysiological Role Of Mitochondrial Acid-Sensing Ion Channel 1a In Hypoxic Pulmonary Hypertension, Megan N. Tuineau

Biomedical Sciences ETDs

Pulmonary hypertension (PH) is characterized by increased pulmonary arterial constriction, pulmonary arterial remodeling, and right ventricular dysfunction. While metabolic and mitochondrial derangements are increasingly recognized as central pathogenic features, the underlying mechanisms and effectors are not yet fully understood. Acid-sensing ion channel 1a (ASIC1a) is a proton-gated cation channel involved in the development of chronic hypoxia (CH)-induced PH. ASIC1a represents a potential candidate involved in metabolic-mitochondrial dysfunction, as metabolic byproducts can act as ligands for ASIC1a. Additionally, ASIC1a has recently been identified as a mitochondrial ion channel involved in neuronal death following oxidative stress. Therefore, we hypothesize that ASIC1a functions …

Staff Education To Impact Staff Knowledge Of Depression Screening In Primary Care, Nkeiruka Chinwendu Unaegbu

Walden Dissertations and Doctoral Studies

Summary This doctoral project was a staff education program designed to improve depression screening among patients in an adult primary care setting. The practice problem addressed was the lack of standardized depression screening that led to inconsistent detection, delayed diagnosis, and fragmented mental health care. A move to address the issue is critical in nursing practice since nurses play a central role in early identification, patient advocacy, and integration of behavioral health into primary care. The practice-focused question guiding the project was, Will implementing a nursing staff education program impact their knowledge of Clinical Practice Guideline (CPG) for depression screening …

Program Outcome Evaluation Of A Flexibly Structured Individual Outpatient Program For Severe Obsessive Compulsive Disorder In A Private Practice Setting, Jason R. David

Doctoral Dissertations

The current study is a quantitative program evaluation of the effectiveness private practice for treating obsessive compulsive disorder while incorporating multiple validated components to reduce common barriers of treatment access. There were three outcomes used to evaluate the first being the reduction in symptom severity across treatment, the second being the length of time in treatment before reduction can be seen, and the third being the rates completing treatment as agreed by therapist and participant. The current study was able to complete analysis for the first and third research question, and unable to answer the second. The first and primary …