Medicine and Health Sciences Commons^™

Building Insight One Tray At A Time: A Systematized Review Of Sandtray Expressive Arts On Counselor Trainees’ Self-Awareness, A'Lyse M. Miranda

USF Tampa Graduate Theses and Dissertations

This study examines the impact of sandtray expressive art interventions on the self-awareness of counseling students, recognizing the vital role self-awareness plays in counselor development. It is essential for counselors to practice self-awareness so that they may connect effectively with clients, make ethical decisions, and enhance their professional competence. Self-awareness is best identified as a transformative and reflective integration process. While traditional methods like journaling and supervision are commonly studied, the use of sand tray therapy as an expressive art intervention has received limited attention. This review synthesizes existing literature on self-awareness and sandtray expressive art interventions in counselor education, …

Subjective Excessive Daytime Sleepiness And Frailty Progression In Veterans Over 50 With Insomnia, Mona Amirmazaheri

Walden Dissertations and Doctoral Studies

Frailty is common in aging veterans and linked to adverse outcomes. This retrospective cohort study of 6,824 veterans with insomnia examined whether excessive daytime sleepiness, sleep treatments, and PTSD affected frailty progression over four years. Frailty was measured using a validated index, with models adjusted for demographics and comorbidities, including chronic coronary insufficiency. Manuscript 1 showed that a higher Epworth Sleepiness Scale (ESS) score (range 0-24) was independently associated with a higher frailty index (FI) (p < .001). A clinical threshold of ≥11 indicated EDS and greater odds of frailty worsening compared to scores <11 (adjusted odds ratio (aOR) = 1.16, 95% CI [1.02, 1.32], p = .021). There was no significant interaction between ESS and time, suggesting that sEDS reflects persistently elevated frailty levels rather than accelerated decline. Manuscript 2 showed that nonpharmacologic sleep interventions were protective, while pharmacotherapy was associated with increased frailty risk. Cognitive behavioral therapy for insomnia was associated with lower odds of frailty worsening (aOR = 0.31, 95% CI [0.19, 0.53], p < .001), and continuous positive airway pressure therapy also reduced risk (aOR = 0.55, 95% CI [0.39, 0.76], p < .001). In contrast, sleep medications were associated with increased odds of frailty progression (aOR = 1.16, 95% CI [1.02, 1.32], p = .021). Manuscript 3 showed that PTSD was not associated with baseline frailty levels but showed a significant time interaction (B = 0.001, p = .008), indicating modest acceleration of frailty progression among affected veterans. Findings support positive social change through early sEDS screening and trauma-informed, nonpharmacologic sleep care to reduce frailty in veterans.

Staff Education On Antibiotic Stewardship For Urgent Care, Darla Michelle Taylor

Walden Dissertations and Doctoral Studies

This doctoral project focused on a staff education initiative designed to improve antibiotic stewardship among urgent care providers. It evaluated changes in provider knowledge and prescribing intent following an evidence-based educational intervention by asking, “Does staff education on antibiotic stewardship in an urgent care setting enhance knowledge when compared to pre- and post-education assessments?” The purpose was to increase provider knowledge, confidence, and adherence to stewardship principles while influencing prescribing intent. The project consisted of an educational presentation with pre- and post-education surveys. Data was collected using pre- and post-education surveys featuring Likert-scale items that measured provider confidence, knowledge, and …

Self-Management Experiences Of Heart Failure Patients Who Received Telehealth Services During The Covid-19 Pandemic, Christie Devine

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic increased the utilization of telehealth in managing chronic conditions such as heart failure. Existing research has primarily focused on patient experiences with specific telehealth platforms or settings, limiting generalizability within the diverse United States healthcare system. The purpose of this qualitative study, guided by the health promotion model, was to describe patient experiences with self-management of heart failure while receiving medical care through any type of telehealth service (e.g., telephone, video calls, remote monitoring) in the United States. Twenty-two participants were interviewed who met the criteria of having a diagnosis of heart failure and using telehealth since …

Staff Education To Improve Knowledge Of Venous Leg Ulcer Prevention, Bini John

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project implemented a standardized program to strengthen knowledge, confidence, and adherence to venous stasis ulcer (VSU) prevention among staff in an outpatient vascular clinic. The practice problem was the lack of standardized staff education, leading to inconsistent patient teaching and recurrent ulceration. VSUs are a significant public health challenge, increasing morbidity, healthcare utilization, and reducing quality of life (He et al., 2024). The practice-focused question for this project was: In frontline medical staff at a vascular outpatient clinic, does a staff education program on a standardized approach to patient education for VSU …

Staff Education On Oral Health To Night Shift Staff, Uzoamaka Mbionwu

Walden Dissertations and Doctoral Studies

Hospital-acquired pneumonia (HAP) remains the most common hospital-acquired infection in the United States, with nonventilated adult patients particularly at risk. This doctoral project focused on improving oral care practices among night shift nursing staff on a medical-surgical unit to reduce the risk of HAP. The practice gap identified was the inconsistent and inadequate delivery of oral hygiene during night shifts, primarily due to staff knowledge deficits, time constraints, and a lack of standardized procedures. The project was guided by the Johns Hopkins Evidence-Based Practice model and addressed the following question: In adult patients on a medical-surgical unit, will staff education …

Mold Exposure And Cognitive Health During Menopausal Transitions: A Quantitative Analysis Using Secondary Data, Holly Jeannette Burns

Walden Dissertations and Doctoral Studies

Mold exposure and menopausal transition have been independently linked to cognitive decline, yet their interaction among socioeconomically disadvantaged populations has not been well examined. This quantitative study is an exploration of how menopausal transition influences the relationship between mold exposure and cognitive health outcomes among women aged 40 to 60 living in low-income housing in the United States. Bronfenbrenner’s ecological systems theory was used to guide the cross-sectional design using secondary data from the 2005–2006 National Health and Nutrition Examination Survey (NHANES; N = 149). Weighted logistic regression and Hayes’ PROCESS (Models 2 and 4) were used to test associations …

Sociocultural Factors Influencing Excess Gestational Weight Gain In Pregnant Puerto Rican Women, Sonia O. Roselló Aponte

Walden Dissertations and Doctoral Studies

More than 50% of women experience excessive weight gain during pregnancy or are overweight at the start of pregnancy, increasing their risk of short and long-term maternal and fetal complications. The literature highlights the relationship between sociocultural factors and excessive gestational weight gain (EGWG) and the need to explore these factors in ethnic subgroups. The purpose of this descriptive qualitative study, guided by Nola Pender’s health promotion model, was to explore the sociocultural factors that influence EGWG for pregnant women living in Puerto Rico. Semi-structured interviews were conducted with seven participants recruited from public and private prenatal clinics in Puerto …

Mental Health Amongst African American Healthcare Workers And Covid Vaccine Mandates, Christopher Brandlin

Walden Dissertations and Doctoral Studies

This qualitative case study investigated vaccine hesitancy among African American healthcare workers in Los Angeles County, California in light of employment loss following the State Public Health Officer Order of August 5, 2021. The literature indicated that vaccination policies have impacted the psychological health of healthcare workers, especially those with vaccine doubts. The research problem addressed in this study was that the mental health effects among African American hospital workers who lost employment as a result of vaccine hesitancy was not known. The purpose of this generic qualitative case study was to explain the factors contributing to vaccine hesitancy in …

Staff Education Project To Reduce Falls In Assisted Living Through Improved Caregiver Knowledge, Attitude, And Skill, Crystal Morrow

Walden Dissertations and Doctoral Studies

Wisconsin has the highest death rates from falls in the nation. In a brief, the Wisconsin Aging Advocacy Network indicated that most falls among individuals over 65 occur in residential settings. Further, a significant number of elderly people will fall each year, resulting in hospitalizations or fatalities. The purpose of this project was to provide staff education in one Wisconsin assisted living facility to effectively improve knowledge, attitude, and skill among frontline staff for fall prevention management. A formal Fall Education Day was provided to improve knowledge and shape positive attitudes among staff. A pretest-posttest design was used to measure …

Exploring The Behaviors Of Women Who Are Mentally Thriving With Autoimmune Disease: A Mixed Methods Approach, Emilie Ann Ellenberg

USF Tampa Graduate Theses and Dissertations

Autoimmune diseases encompass a variety of conditions that impact millions of Americans, with a higher prevalence among women than men. These diseases involve immune system dysregulation, leading to tissue damage and dysfunction. Despite progress in understanding their underlying mechanisms, important aspects remain inadequately understood, such as the relationships among immune dysregulation, medical outcomes, and psychiatric comorbidities. Preliminary qualitative research indicates that perceived diagnostic invalidation leads to the mental health needs among women with autoimmune diseases often being unmet, and behavioral health help-seeking behaviors being reduced. Although perceived diagnostic invalidation can lead to increased mental health symptomology and decreased help-seeking behaviors, …

A Quality Improvement Project To Standardize Sexual Dysfunction Screening In Primary Care, Ashley M. D’Anna

Electronic Theses and Dissertations

Sexual health is an essential aspect of overall well-being but is often overlooked in primary care due to provider discomfort, time constraints, and lack of standardized screening protocols. This quality improvement (QI) project aimed to implement a consistent approach to screening for sexual dysfunction using the Arizona Sexual Experiences Scale (ASEX), a validated five-item tool assessing sex drive, arousal, orgasm, and satisfaction. Guided by Swanson’s Theory of Caring and Pender’s Health Promotion Model, the project emphasized compassionate, patient-centered care and the promotion of health-enhancing behaviors.

Using the Plan-Do-Study-Act (PDSA) framework, the ASEX tool was incorporated into annual wellness visits following …

Improving Suicide Risk Detection And Management In Primary Care, Syndie Volcy

Walden Dissertations and Doctoral Studies

Suicide remains a critical public health issue in the United States, with rates continuing to rise despite national prevention initiatives. Primary care settings serve as a pivotal point for early detection, yet inconsistent use of standardized screening and safety planning tools contributes to under-recognition of suicide risk. This Doctor of Nursing Practice (DNP) project aimed to enhance the identification and management of suicide risk in primary care by developing and implementing an evidence-based clinical practice guideline (CPG). The project addressed the practice-focused question: Does implementing a standardized suicide prevention guideline using validated tools improve risk detection and management in primary …

Utilizing An Evidence-Based Educational Intervention To Assess Health Care Provider Knowledge And Confidence Of Weight Management Strategies In A Primary Care Setting, Fanny Ngwa Shu

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project aimed to address a clinical gap in primary care by enhancing provider and staff knowledge and confidence in delivering weight management counseling. Despite the high prevalence of overweight and obesity, many healthcare providers feel inadequately prepared to initiate weight-related discussions due to factors such as limited training, cultural barriers, and a lack of understanding of social determinants of health (SDOH) that influence patient behaviors. This gap in care can hinder the effective management of chronic conditions like diabetes, hypertension, and cardiovascular disease. The practice-focused question guiding this project was: Can an educational session …

Relationship Of Job Demands And Perceived Usefulness Of Virtual Nursing Technology Among Bedside Nurses In Acute Care Settings, Oluponle Olubajo

Walden Dissertations and Doctoral Studies

Bedside nurses in acute care settings face intensified job demands amid persistent low nursing staff census and rising patient acuity. The purpose of the study, guided by the job demands–resources (JD-R) model, was to examine the relationship between job demands, years of nursing experience, and perceived usefulness of virtual nursing technology among bedside nurses in acute care settings. A cross-sectional online survey was administered to bedside registered nurses (N = 102) currently using virtual nursing technology. Measures included the Intensification of Job Demands Scale and the Perceived Usefulness Scale. Data analyses indicated that the multiple regression was not statistically significant, …

Econometric Analyses Across The Continuum Of Care For Individuals With Hearing Loss, Teresa I. Anthony

USF Tampa Graduate Theses and Dissertations

Hearing loss affects individuals across the age span and, if left untreated, can lead to developmental delays and health and well-being concerns. This dissertation applies econometric analyses to investigate factors influencing diagnostic outcomes in the neonatal intensive care unit (NICU), intervention enrollment rates among babies with permanent childhood hearing loss (PCHL), and utilization and hospitalization outcomes among adults with sensory impairment (SI). The first study evaluates the cost-effectiveness of automated auditory brainstem response (aABR) versus transient evoked otoacoustic emissions (TEOAE) for newborn hearing screenings in a Thailand hospital NICU. Decision tree modeling and economic evaluation suggested that although aABR is …

Improving Cauti Prevention In Long-Term Care: An Educational Intervention To Enhance Staff Confidence And Reduce Infection Rates, Diana Meseha

Doctor of Nursing Practice Projects

Catheter-associated urinary tract infection (CAUTI) is a common preventable healthcare-associated infection in long-term care. knowledge gaps and inconsistent catheter care by staff and increased catheter-associated urinary tract infection rates. The purpose of this quality improvement project aims at testing whether using a structured educational intervention led to improved confidence of staff and reduced catheter-associated urinary tract infection rates. The project employed Bandura's Social Cognitive Theory and Lewin's change model in guiding the behavior and organizational change. A quasi-experimental pretest post-test design was used with the enrolment of nursing employees such as registered nurses, licensed practical nurses and certified nursing assistants …

Educating About Military Culture: Lived Experiences Of Nurse Educators, Jennifer C. Dodge

Walden Dissertations and Doctoral Studies

Despite national initiatives designed to expand healthcare programs and resources for veterans, there is a lack of knowledge about military culture and health problems specific to this demographic among registered nurses who serve in a role to impact the suicide rate among the veteran population. The purpose of this qualitative study, guided by Leininger’s culture care theory and Benner’s novice to expert model, was to understand the lived experiences of associate degree in nursing (ADN) nurse educators in non-Veterans Health Administration-affiliated programs regarding teaching undergraduate nursing students about military veteran culture. Fifteen ADN nurse educators, selected through purposeful sampling, participated …

Association Between Diabetes Mellitus, Hypertension, Obesity, And Diagnosis Of Covid-19 In Puerto Rico, Julian Rene Rivera Rodriguez

Walden Dissertations and Doctoral Studies

The population of Puerto Rico has been heavily affected by chronic diseases; however, data remains limited on the influence of diabetes mellitus (DM), hypertension, and obesity on the probability of COVID-19 diagnosis. The purpose of this quantitative study was to evaluate the association between non-communicable diseases that included DM, obesity, hypertension, and COVID-19 diagnosis, controlling for age and sex and person exposure in Puerto Rico. The sample consisted of 1,463 participants who underwent a polymerase chain reaction (PCR) test for COVID-19 from April 1, 2020, to March 31, 2021. Results from adjusted multivariable logistic regression analyses established that obesity OR …

Staff Education And Competency Assessment For Central Line-Associated Bloodstream Infection Reduction, Shabana Ali

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was an educational initiative to provide comprehensive central line-associated bloodstream infection (CLABSI) prevention education program for staff working in an intensive care unit (ICU). CLABSIs pose a significant threat to patient safety, contributing to increased morbidity, mortality, and healthcare costs, with annual expenditures estimated at $300 million to $2.3 billion and mortality rates ranging from 10% to 30%. Despite existing protocols, the project site facility experienced persistent CLABSI rates. The purpose of the project was to provide a comprehensive educational program to ICU staff members on the unit. The practice-focused question guiding this project …

Factors In The Relationship Between Rural Cancer Patients And Mental Health, Jordan B. King

Theses and Graduate Projects

Cancer patients frequently experience psychological distress, yet many do not access mental health services, particularly those residing in rural areas. The present study examines what factors contribute to utilization of mental health services and attitudes toward seeking mental health services in rural cancer patients who are actively receiving cancer treatments. Participants (N = 102) completed a paper and pencil survey. A logistic regression was used to examine the relationship between five predictor variables (anxiety, depression, social support, geographic location, and number of barriers) on the outcome variable (utilization of services). The model was statistically significant, X²(4) = …

Quality Improvement Project: The Impact Of A Dedicated Education Unit On The Self-Efficacy Of First-Year Associate Degree Nursing Students, Danita Broussard

Doctor of Nursing Practice Projects

Nursing education continues to face challenges in preparing students to meet the complex demands of modern healthcare, particularly due to limited clinical placements and faculty shortages. This quality improvement project addressed the gap between classroom instruction and clinical practice by implementing a Dedicated Education Unit (DEU) model designed to impact students' self-efficacy. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether participation in a DEU impacted the self-efficacy of the first-year associate degree nursing students compared to the traditional clinical model. Guided by Bandura’s Self-Efficacy Theory and grounded in Evidence-Based Practice (EBP) principles, the project …

Proteomic Characterization Of The Neuronal Bin1 Interactome In Homeostatic And Alzheimer’S Disease Mouse Brains, Joseph Mcmillan

USF Tampa Graduate Theses and Dissertations

The gene BIN1 is the second-largest genetic risk factor for late-onset Alzheimer’s disease (LOAD). It is expressed in neurons and glia in the brain as cell-type specific and ubiquitous isoforms. BIN1 is an adaptor protein that regulates membrane dynamics in many cell types. Previously, we reported that BIN1 predominantly localizes to presynaptic terminals in neurons and regulates presynaptic vesicular release. However, the function of neuronal BIN1 in relation to LOAD is not yet fully understood. A significant gap in the field is the unbiased characterization of neuronal BIN1-interacting proteins and proximal neighbors. To address this gap and help define the …

Occupational Therapist’S Role In Medicolegal, Danyl (Jj) W. Litumbe Jr.

Department of Occupational Therapy Entry-Level Capstone Projects

No abstract provided.

Identifying And Examining Access And Barriers To Healthcare For The Transgender And Nonbinary Individual, Allison Gould

Doctor of Education Program Dissertations

The purpose of this qualitative phenomenological study was to explore the lived experiences of transgender and nonbinary (TNB) individuals related to their access to basic healthcare. Currently, the TNB population is experiencing disparities in accessing general and preventative healthcare in comparison to their cisgendered counterparts. I developed the research questions to explore how TNB individuals describe their access to general and preventative healthcare, identify what were perceived as barriers in seeking basic healthcare, and describe what was subjectively identified as a positive healthcare experiences. My personal and professional interest as a physical therapist combined with a thorough literature review, and …

A Quantitative Analysis Of Postmarketing Safety Events Of Breakthrough Medicines, Richard Judson Davis

Walden Dissertations and Doctoral Studies

Adverse events to medicines pose a risk to the public health of patients. Breakthrough therapy medicines are designed to address unmet medical needs and are often approved on an expedited timeline; however they are also criticized for lacking an adequate understanding of their risk profile at the time of approval. This study examined the relationship between the number of concomitant medicines, as well as the approved therapeutic indication, and the outcomes of reported adverse events associated with medicines approved under the breakthrough therapy designation. The conceptual framework applied in this retrospective, cross-sectional, quantitative study is the process of pharmacovigilance, which …

Educating Emergency Department Nursing Staff: Early Identification Of Sepsis, Cynthia A. Chaney

Walden Dissertations and Doctoral Studies

Sepsis remains a life-threatening health challenge, contributing to significant morbidity and mortality within healthcare systems. This Doctor of Nursing Practice (DNP) project aimed to address knowledge deficits among emergency room nurses regarding the early identification and management of sepsis, mainly through the implementation of the 3-hour sepsis bundle. The practice-focused question guiding this project was whether educating nurses on the 3-hour sepsis bundle would increase their knowledge. This project aimed to educate nurses on how to identify sepsis early and implement the sepsis 3-hour bundle in a timely manner, with the overall goal of improving nursing knowledge. The sources of …

Improving Nurse Adherence To Medication Reconciliation During Patient Admissions To Reduce Medication Errors Through Targeted Education, Wendy J. Marlowe

Walden Dissertations and Doctoral Studies

Medication reconciliation errors are a significant clinical concern because they have the potential to result in serious or even life-threatening harm to patients. Implementing risk-reduction strategies through targeted education and systematic processes for medication reconciliation is crucial to enhancing patient safety and mitigating the risk of errors. Over 40% of medication errors occur during patient transitions, such as admissions, which are mainly due to inadequate medication reconciliation. The project addressed a practice-focused question to increase patient admission medication reconciliation by improving nurse knowledge by 20% and reducing medication errors by 60% within 2 months. I employed a pre-/posttest design in …

Implementation Of The Patient Health Questionnaire-9 As A Screening Tool For Depression, Nathalie Teboh Njofri Bih

Walden Dissertations and Doctoral Studies

Depression is a common mental health issue that is often misdiagnosed or underdiagnosed in primary care practice due to a lack of appropriate screening. The practice problem addressed by this project was the inconsistent use of standardized tools, like the Patient Health Questionnaire (PHQ-9), which hinders timely and accurate depression diagnosis. The practice-focused question was: Does educating staff impact their knowledge of the recommended use and interpretation of the PHQ-9 and their confidence in administering the tool? I aimed to enhance depression screening practices by educating nursing staff on administering, scoring, and integrating the PHQ-9 into routine patient care. For …

Improving Icu Nurses’ Knowledge Of Early Mobility Through An Educational Intervention, Mohini Chand

Walden Dissertations and Doctoral Studies

This doctoral project sought to close a critical knowledge gap in the implementation of early mobility (EM) practices among intensive care unit (ICU) nurses. Guided by the ADDIE instructional design model, the initiative centered on developing and delivering a six-week educational intervention aimed at enhancing nurses’ comprehension and application of EM strategies for critically ill patients. Despite robust evidence supporting EM’s role in mitigating ICU-acquired weakness, reducing delirium, and improving functional outcomes, its clinical adoption remained inconsistent prior to this intervention. The project was anchored by the practice-focused question: “To what extent does an educational intervention improve ICU nurses’ knowledge …