Medicine and Health Sciences Commons^™

Examining Nurses’ Perspectives Of Organizational Strategies Designed To Enhance Job Satisfaction, Kerine J. Moodie-Brown

Walden Dissertations and Doctoral Studies

Nurse job satisfaction remains a critical issue in healthcare, as it directly impacts patient care quality, nurse retention, and organizational performance. Despite numerous organizational efforts, there is limited qualitative insight into how nurses perceive strategies aimed at improving their satisfaction. The purpose of my study, guided by Maslow’s hierarchy of needs theory, was to explore nurses’ perceptions of organizational strategies designed to enhance job satisfaction, with a particular focus on interventions such as pay incentives, workplace safety, career development opportunities, nurse residency programs, and initiatives promoting well-being. Semi-structured interviews were conducted with 10 RNs having at least 1 year of …

Use Of Perioperative Scores In Predicting Postoperative Event And Selection For Discharge After Elective Laparoscopic Cholecystectomy: A Retrospective Cohort Study, Brian Nyamweya Bundi

Master of Medicine in General Surgery

Background: While daycare laparoscopic cholecystectomy is gaining momentum in developed countries, a majority of patients in low and middle-income countries are admitted overnight. This safety precaution offers prompt access to emergency services should need arise. This precautional overnight stay has implications on cost, healthcare utilization and patient satisfaction. Daycare procedures routinely utilize scoring systems for assessing discharge readiness. We explored the utility of the modified Surgical APGAR Score (mSAS) and the White Fast Track Score (WFTS) as predictors for postoperative events and their role in identifying patients who can have a safe daycare discharge after laparoscopic cholecystectomy in this retrospective …

Identifying The Barriers And Facilitators To Guideline-Concordant Breast Cancer Surgical Care In Kenya: A Sequential Mixed Method Study, Emmanuel Marsuk Lomole

Master of Medicine in General Surgery

Introduction 

Breast cancer represents the most commonly diagnosed cancer in women. In Kenya, it constitutes 20% of all cancer diagnoses as well as the second most common cause of cancer related death in the country, with a 5-year survival between 40.1% and 64%. There exists heterogeneity in the delivery of breast cancer care despite the presence of guidelines that can standardize care and that have been contextualized for Sub-Saharan Africa. There is paucity of data on barriers and facilitators of guideline-concordant breast cancer surgical care.

Setting 

The Aga Khan University Hospital Nairobi.

Aim 

The purpose of this study was to …

Racial Moderation Of Infant Mortality Risk And Protective Factors In The United States, Temitope Oluwaseun Akinsola

Walden Dissertations and Doctoral Studies

The rate of infant mortality is a pressing health issue in the United States, as ethnic minorities are disproportionately affected. This study addressed how race controls the predictive power of demographic, socioeconomic, and geographic factors on infant mortality. Using a quantitative correlational design, secondary data from 181 individuals listed in the CDC-National Vital Statistics System database were used, which contains nationally aggregated data related to infant mortality rates. Bronfenbrenner’s social ecological model guided the study, and multiple regression and moderation models were used to examine socioeconomic status and access to healthcare on infant mortality outcomes. Results indicated that race significantly …

Medication Adherence Among Partnered, Sexual Minority Men Living With Hiv: What’S Love, Interdependence And Comorbidities Got To Do With It?, Kendell M. Doyle

Dissertations, Theses, and Capstone Projects

Sexual minority men (SMM) report higher incidence and prevalence rates of HIV infection relative to their heterosexual counterparts. The burden of HIV infection has garnered research attention focused on HIV risk reduction and HIV disease management (such as medication adherence). More recently, attention has been paid to the association of comorbid chronic health conditions and ART adherence among people living with HIV (PLWH) more broadly. Yet, limited attention has been paid to the association of comorbidities among SMM living with HIV specifically, despite the high rates of HIV among this population and various other risk factors that put SMM at …

Enhancing Preparedness: A Genetic Study Of Sar-Cov-2 And Other Microbial Public Health Threats In Wastewater From A College Town, Christian N. Hutchinson

Master's Theses

Problem

The SARS-CoV-2 (COVID-19) pandemic revealed both the systemic vulnerabilities of our healthcare system as well as the importance of timely, localized data for informing public health responses. Traditional testing approaches were essential but often failed to capture the full extent of viral spread, especially in those with mild or asymptomatic conditions that relied on at home testing. This underreporting hindered effective allocation of resources and made developing effective intervention strategies difficult. We also realized the potential for wastewater surveillance to be applied to tracking antimicrobial resistance gene markers. Taken together, this approach should have important implications for improving public …

Curing The Peasant's Disease : Frank Oldt’S Work And Research On Hookworm Disease In South China, 1905-1926, Jiaying Fu

Lingnan Theses (MPhil & PhD)

While current scholarship on “hygienic modernity” in China focuses on the construction of urban health systems and institutional infrastructures, this study proposes an alternative analytical lens by foregrounding the domain of agricultural health. It aims to investigate how early twentieth-century medical researchers uncovered public health models grounded in China’s agrarian conditions. Taking the case of Frank Oldt (1879–1976), a medical missionary living in Guangdong between 1905 and 1926, this research examines how he identified, interpreted, and sought to mitigate the problem of hookworm disease—a parasitic condition intricately linked to China’s farming practices and rural environmental conditions.

Specifically, this thesis aims …

The Blacker The Berry: Food Environments And Intake Associated With Perinatal Depression And Secondary Breastfeeding Outcomes Among Black Americans In The St. Louis Metropolitan Area, Najjuwah S. Walden

Brown School Graduate Student Theses and Dissertations

The relationship between the food environment, intake, and health is complex. The purpose of this study was to evaluate if food environments in proximity to Black pregnant women in the St. Louis Metropolitan Area were associated with prenatal eating habits and if these eating habits were associated with the risk of developing depressive symptoms in pregnancy and postpartum. The study also aimed to understand if there was a relationship between prenatal eating habits and the decision to breastfeed and if the onset of postpartum depressive symptoms has any effect on this relationship. Due to the importance of nutrient-dense, anti-inflammatory foods …

Appearance Over Function - The Impact Of Long-Term Oral Contraceptive Use On Brain Development, Breast Tissue Composition, And Future Lactation Outcomes, Fiona M. Wang

Dissertations

This integrative review examines the long-term effects of combined oral contraceptive (COC) use beginning in puberty on brain development, breast tissue composition, and future breastfeeding outcomes. Puberty is a critical developmental stage during which hormonal changes significantly impact the neurological and reproductive systems. The introduction of synthetic estrogen and progestin through COC use during this time may disrupt natural hormonal pathways, potentially altering neuroendocrine signaling and breast tissue maturation. Such changes may have lasting consequences, including impaired milk production, a weakened milk ejection reflex, disrupted maternal-infant bonding, and reduced overall breastfeeding success. The review synthesizes findings from endocrinology, neuroscience, and …

Nanoparticle Iron Based Catalysts For Clean Water And Other Applications, Shelby Lynn Foster

Graduate Theses and Dissertations

This dissertation explores the development, characterization, and application of iron-based catalysts for environmental remediation and energy generation. The research focuses on Fe-based nanomaterials for water purification, electrochemical ammonia production, and ethanol oxidation enhancement. The first section of the dissertation investigates the removal of water contaminants using nickel-iron (NiFe) bimetallic nanoparticles. Various NiFe ratios were synthesized and tested for their efficiency in degrading the azo dye (Orange G), with lower Ni content formulations achieving 80–99% dye removal within 60 minutes. Results show that changing the molar ratio of nickel to iron caused different removal rates, as well as the extent of …

Differences In Peer Social Connections Between Traditional And Online Nurse Residency Programs, Tatum Leonard

Electronic Theses and Dissertations

The anticipated retirement of baby boomer nurses by 2030 will intensify the global nursing shortage, a crisis that demands innovative strategies for onboarding and retaining new graduate nurses. Nurse residency programs (NRPs) are designed to ease the transition from student to practicing nurse, reduce turnover, and foster professional resilience. Amid the COVID-19 pandemic, many NRPs rapidly transitioned from traditional, in-person seminars to synchronous, online formats. This study explored differences in peer social connections between traditional and online NRPs, focusing on three constructs: sense of community, collaborative learning, and peer social support. Using a quasi-experimental, mixed methods approach, this secondary data …

Impostor Phenomenon, Psychological Safety, And The Intent To Leave Of Novice Pa Faculty, Barbara J. Quillin

Electronic Theses and Dissertations

The growing healthcare demands of the aging population in the United States, along with the growth of physician assistant (PA) educational programs, has created a pressing need for qualified PA educators. This study examined the role of impostor phenomenon and psychological safety in shaping PA faculty members’ intent to leave. Grounded in the job demands-resources framework, the research explored how individual psychological experiences and perceptions of the organizational climate relate to faculty turnover intentions in PA education. This study aimed to provide PA program administrators with information that may reduce faculty attrition and improve the overall well-being of novice faculty. …

Patient Education On Conversion From Oral Art/Prep To Long-Acting Injectable (Lai) To Improve Patient Treatment Adherence, Marnel Reina Mae M. Hernandez

Doctor of Nursing Practice Final Manuscripts

Patient Education on conversion from oral ART/PrEP to Long-Acting Injectable (LAI) improves patient adherence.

Marnel Reina Mae Hernandez, MSN, RN

Joseph, F. Burkard, DNSc, CRNA, EBP-C

Background: Long-acting injectables (LAI) have been shown to be equally effective in viral load suppression. Implementing nurse led educational interventions in the use of oral treatment to LAI will address if LAI prescriptions can improve adherence and patient retention. Despite the availability of LAI for ART (antiretroviral treatment) and PrEP (pre-exposure prophylaxis for HIV) patients continue to have a low appointment adherence which can impact adherence and overall viral detectability. LAIs will continue to …

Raising Provider Awareness Of Fluid Status In Women Undergoing Elective Cesarean Section Through The Use Of A Preoperative Checklist To Assess Fluid Status: A Quality Improvement Project, Marcus Miller, Michael Sorge

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Abstract

Maternal hypotension following neuraxial anesthesia during cesarean section is a common and potentially harmful complication. While vasopressors are often used for this issue, they carry risks to fetal well-being. Goal-directed fluid therapy (GDFT) provides an individualized approach that may improve outcomes by optimizing fluid status perioperatively. This quality improvement project aimed to increase provider awareness of fluid status through the implementation of a preoperative checklist that assessed fluid status in women undergoing cesarean section. A preoperative fluid assessment checklist was developed using evidence-based predictors of fluid status and integrated into anesthesia workflow. The project followed the Plan-Do-Study-Act cycle and …

Identifying Novel Fibrotic Mechanisms Underlying Treatment-Resistant Lower Urinary Tract Dysfunction, Quentin Darcy

Graduate Doctoral Dissertations

ABSTRACT

IDENTIFYING NOVEL FIBROTIC MECHANISMS UNDERLYING TREATMENT-RESISTANT LOWER URINARY TRACT DYSFUNCTION

August 2025

Quentin D’Arcy, B.S., University of Massachusetts Amherst

Ph.D., University of Massachusetts Boston

Directed by Dr. Jill Macoska

Lower urinary tract dysfunction (LUTD) is a common, age-related disease that affects millions of men over the age of 50. Current treatment for this and other related prostate diseases concentrate on decreasing benign prostate growth and relaxing smooth muscle contractions to alleviate urinary voiding symptoms. However, up to 45% of patients with LUTD are treatment-resistant and require surgical intervention to resolve prostate issues. By focusing on the contribution of inflammation-derived …

Implementation Of An Epidural Catheter Assessment Tool To Reduce The Risk Of Racial And Ethnic Disparities Associated With The Conversion To General Anesthesia In Cesarean Deliveries: A Quality Improvement Project, Marjani A. Saunders, Tyler-Nicole Pannell

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Neuraxial anesthesia has significantly reduced anesthesia-related maternal morbidity during the peri-partum period. Despite these advancements, racial disparities persist in obstetric anesthesia care and Black women continue to experience disproportionately higher rates of general anesthesia (GA) for cesarean delivery when compared to non-Hispanic White patients. This quality improvement (QI) project sought to decrease the conversion from epidural anesthesia to GA for cesarean sections in laboring women by creating an epidural catheter assessment tool. The epidural catheter assessment tool provided uniform assessment and documentation of labor epidurals by anesthesia providers to reduce the use of general anesthesia for unplanned cesarean section deliveries. …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

"Improved Obstetric Hemorrhage Care Through Toolkit Revision: A Quality Improvement Project", Amber M. Woodring, Samantha Kalkstein

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric hemorrhage (OBH) remains a leading cause of preventable maternal morbidity and mortality in the United States. Accurate risk identification is critical for initiating timely interventions; however, current risk assessment practices vary significantly. This quality improvement (QI) project aimed to implement the California Maternal Quality Care Collaborative (CMQCC) OBH Risk Assessment Tool on the labor and delivery (L&D) unit of a community-based hospital to standardize risk stratification and improve interdisciplinary communication. Guided by the Johns Hopkins Nursing Evidence-Based Practice model, the project involved a gap analysis, staff education, and the introduction of a paper-based CMQCC tool formatted for visibility and …

Quality Improvement Initiative For Emergency Cesarean Delivery: Implementation Of Rapid Sequence Spinal Anesthesia, Hunter L. Baselj, Joseph A. Gabster

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Abstract

Background: General anesthesia (GA) for emergency cesarean sections (EmCS) poses potential risks Rapid Sequence Spinal Anesthesia (RSSA) offers a promising alternative that preserves benefits of neuraxial anesthesia while accommodating the urgency of EmCS. This quality improvement (QI) project aimed to implement and evaluate the use of RSSA at a teaching hospital, utilizing a decision-tree tool to enhance clinical efficiency and assess provider perceptions regarding its impact on airway complications and post-operative pain outcomes. Methods: A RSSA decision-making chart was developed and introduced to anesthesia providers at a teaching hospital. A total of 16 providers, including CRNAs, SRNAs, and anesthesiologists, …

Utilizing Simulation Training To Understand Maternal Cardiac Arrest Precipitated By Amniotic Fluid Embolism: A Quality Improvement Project, Erica L. Wright, Megan L. Tiernan, Michael W. Neft, Paige Spagiare, Erica Coffin

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Background and Problem: Maternal cardiac arrest precipitated by amniotic fluid embolism is among the leading direct causes of death among laboring women (Enomoto et al., 2022). Because it presents suddenly without any immediate apparent cause and lacks specific diagnostic tests, frontline obstetric caregivers must be vigilant, competent, and prepared to handle this potentially catastrophic emergency. Coordination among multiple disciplines is paramount since two lives, not just one, are at risk. Unfortunately, the rarity of maternal cardiac arrest significantly limits opportunities for staff to learn how to identify and manage these events successfully. Method: This quality improvement project established a simulation-based …

Improved Obstetric Hemorrhage Care Through Toolkit Revision: A Quality Improvement Project, Samantha Kalkstein, Amber Woodring

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric hemorrhage (OBH) remains a leading cause of preventable maternal morbidity and mortality in the United States. Accurate risk identification is critical for initiating timely interventions; however, current risk assessment practices vary significantly. This quality improvement (QI) project aimed to implement the California Maternal Quality Care Collaborative (CMQCC) OBH Risk Assessment Tool on the labor and delivery (L&D) unit of a community-based hospital to standardize risk stratification and improve interdisciplinary communication. Guided by the Johns Hopkins Nursing Evidence-Based Practice model, the project involved a gap analysis, staff education, and the introduction of a paper-based CMQCC tool formatted for visibility and …

Towards A New Health Politics In Kenya: Labor Organizing And Strikes By Health Workers In The Public Health Sector, Michael Scanlon

Graduate Doctoral Dissertations

There has been insufficient attention by global health scholars to labor organizing by health workers, including when and why organizing occurs, what forms and strategies it takes and its implications for governance and policy. These questions are critical but largely absent in research on what has been called the “global health workforce crisis.” Kenya represents an important case study. A new constitution in 2010 expanded institutional spaces for labor organizing and decentralized governance of the health system. Both reforms had significant implications for the health workforce and strikes by health workers have been pervasive. In 2017, nationwide strikes by public …

Improving Perioperative Nursing Residency Student Retention: Identifying And Mitigating Factors Causing Attrition In A Nursing Residency Program, Bridgette D. Mangan

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: The nursing workforce decreased by 100,000 nurses from 2021 to 2022. Such a drop has not been seen in the last 40 years of the nursing profession. The frequency of job turnover among newly hired nurse graduates is troublesome. Research reveals 30% to 69% of new graduate nurses voluntarily leave their positions within a year of employment. Nurse residency programs help new graduate nurses’ transition from advanced beginners to competent professionals and focus on areas critical to new graduate success. The cost of training a new graduate nurse to be a competent perioperative nurse may be upwards of …

Biofluid Biomarkers Aid In Diagnosing And Developing Improved Treatments For People With Alzheimer's Disease, Jonatan A. Lopez

University Honors Theses

Dementia is a disease in which daily life is disrupted by a loss of cognitive function. Late-onset Alzheimer's disease (AD) is the most common dementia that largely begins to affect individuals in their mid 60s or older. AD was selected as the focus of this paper because it is the most common form of dementia, accounting for 50-70% of dementia cases. A typical diagnostic approach used by physicians starts with a simple clinical test, the Mini-Mental State Examination (MMSE), when cognitive decline is suspected in a patient. Then if there is enough evidence to suggest AD, a physician would order …

Staff Education To Reduce Alarm Fatigue And Enhance Patient Safety Through Nurse Education On Telemetry Optimization, Casey Alan Metcalf

Walden Dissertations and Doctoral Studies

Summary This project was an evidence-based staff education initiative to reduce alarm fatigue and enhance patient safety through telemetry optimization in an acute care setting. The core issue involved the overuse of continuous cardiac monitoring, which contributed to nonactionable alarms, alarm fatigue, workflow inefficiencies, delayed throughput, and increased costs. The project was a structured intervention delivered to 171 telemetry nurses across three inpatient units. Pretests and posttests measured changes in knowledge, intent, and practice. Results showed a 22.9% increase in knowledge, a 92% agreement regarding intention to follow discontinuation protocols, and a 10% overall reduction in practice of telemetry use …

Staff Education On The Abbreviated Teachers’ Rating Scale (Atrs) Tool As A Screening Tool For Attention Deficit Hyperactivity Disorder (Adhd)., Tena E. Currie

Walden Dissertations and Doctoral Studies

This doctoral project is a staff education program to enhance the treatment and diagnosis of attention-deficit hyperactivity disorder (ADHD) at a mental healthcare facility. The identified practice problem was the lack of knowledge about the Abbreviated Teacher Rating Scale (ATRS) used in ADHD testing, which may result in inaccuracies and underutilization of the tool. To bridge this gap is essential in nursing practice as clinicians should be competent in performing standard assessment, which is indispensable for patient with ADHD. Staff education with the ATRS was the practice-directed question for the project: Does staff education with the ATRS increase knowledge for …

Blood Culture Contamination Rates, Jackqueline R. Easley

Walden Dissertations and Doctoral Studies

The timely and accurate collection of blood culture specimens is essential for improving patient outcomes and minimizing complications. Contaminated specimens can lead to unnecessary antibiotic use, prolonged hospital stays, and delays in appropriate treatment. At one eastern healthcare facility, monthly blood culture contamination rates reached an average of 4.5%, prompting the need for a targeted intervention. The objective of this project was to determine whether a structured process and trained team could reduce contamination rates to below 1%. De-identified data were reviewed using descriptive statistics to observe contamination trends over time, by department, and by month. Using the t-test, contamination …

Staff Education On Perinatal Opioid Use Disorder, Mukisha Livingston Gunter

Walden Dissertations and Doctoral Studies

Perinatal Opioid Use Disorder (POUD) constitutes a significant public health issue with important ramifications for both mothers and their newborns. The gap in practice identified for this Doctor of Nursing Practice staff education project was the perinatal nurses’ lack of knowledge regarding POUD. The problem was the need for POUD education for the nurses. The practice focus questions were: Will there be a change in knowledge by perinatal nurses following the delivery of the education as shown by a pretest/posttest? Will the participants evaluate the education as having met the program objectives related to the curriculum presented? Guided by the …

Staff Education On Discharge Planning For A County Crisis Stabilization Unit, Eric Rowshaun Luster

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education initiative developed to address insufficient staff knowledge related to discharge planning for homeless individuals experiencing mental health crises. The purpose of the project was to examine whether enhanced staff training could improve knowledge of transitional care planning, thereby supporting equitable, safe, and inclusive discharge processes. By improving staff proficiency, the project sought to reduce gaps in care coordination and promote continuity of treatment for a highly vulnerable patient population. The project was implemented at a Crisis Stabilization Unit (CSU) in the southern United States that serves individuals experiencing homelessness, …

Staff Education Project For Enhancing Medication Adherence In Mental Health: An Evidence-Based Education Program For Healthcare Practitioners In Outpatient Clinics, Rita Erina Pyuzza

Walden Dissertations and Doctoral Studies

The staff education project was designed to address medication non-adherence among mental health patients in an outpatient psychiatric clinic by enhancing the knowledge and skills of mental health nurses and nurse practitioners. The lack of structured, evidence-based training on medication adherence strategies has contributed to poor patient outcomes, increased hospitalizations, and higher healthcare costs. Clinic patient reports indicated 50% medication non-adherence, highlighting the need to address non-adherence through effective nursing-led education, medication management, and adherence monitoring. The project assessed whether enhancing the outpatient healthcare providers’ skills and knowledge through a structured, evidence-based program would improve the providers’ medication adherence strategies. …