Medicine and Health Sciences Commons^™

Transforming Fall Prevention Using A Systems-Wide Approach, Jessica Pierce

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project proposal targets fall reduction and injury prevention in a Veteran Affairs Medical Center (VAMC). The initiative implements a non-restrictive, evidence-based fall prevention program that excludes side rails and bed alarms, emphasizing systematic patient safety and personalized care. Falls are a major safety concern at the VAMC due to ineffective traditional methods, inconsistent assessments, and reliance on restraints, contributing to high fall rates and increased healthcare costs. The project successfully achieved consensus from an interprofessional team on developing a comprehensive fall reduction program. Evidence indicates that removing restrictive devices enhances staff engagement and protocol …

Premenopausal And Postmenopausal Malignant Cervical Cancer Diagnosis Among Disaggregated Subethnic Groups Of Asian American Women In The United States, Nilofar Haider Mirza

Walden Dissertations and Doctoral Studies

Despite being the United States' fastest-growing and diverse population, Asian Americans are often aggregated with Native Hawaiian and Pacific Islanders in prior research, resulting in masking disparities in cervical cancer screening/diagnosis among Asian American subethnic groups. Guided by Bronfenbrenner's ecological model, the association between disaggregated subethnic groups and cervical cancer diagnosis among Asian American women aged 20+ in the United States was examined using binary logistic regression. How histology type/behavior and age at diagnosis moderate the relationship between disaggregated subethnic groups and cervical cancer diagnosis was also explored. A quantitative cross-sectional design was employed using cases (N=1014) from the U.S. …

Leveraging Artificial Intelligence (Ai) For Competency-Based Course Design: A Quality Improvement Project In Nursing Education, Lesslie Bull

Doctor of Nursing Practice Projects

This quality improvement project addressed inefficient, manual course design processes contributing to faculty workload and declining National Council Licensure Examination (NCLEX) pass rates at a rural Texas university’s baccalaureate nursing program. Guided by the Roy Adaptation Model and the Plan-Do-Study-Act framework, the project evaluated the effect of integrating artificial intelligence (AI) tools on faculty perceptions of technology adoption, specifically perceived usefulness (PU), perceived ease of use (PEOU), and behavioral intention (BI). Using a quasi-experimental pre-/post-intervention design, twelve faculty members completed a one-hour, evidence-based training using the Generative AI for Instructional Development and Education (GAIDE) framework, and eight faculty participated in …

An Anesthesia Informed Consent Checklist And Ahrq Share Decision-Making Model For Labor And Delivery Patients: A Quality Improvement Project, Katherine C. Burnett

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background and Significance: Informed consent is the disclosure of all benefits, risks, and alternatives to patients for a given intervention. Recalling all important details during the consenting process can prove difficult for providers. The process is further complicated for obstetric patients since healthcare decisions also have consequences for the fetus. The American College of Obstetricians and Gynecologists’ Committee (ACOGC) (2021) recommends shared decision-making models (SDMs) for the obstetric patient population. SDMs engage patients in healthcare decisions by reaching a decision through provider expertise, best evidence, and patient values. In addition, surgical informed consent checklists have emerged as useful …

Staff Education Focused On Screening Patients For Depression Using The Phq-9 Tool, Eveline Mankom Gwaabe

Walden Dissertations and Doctoral Studies

The doctor of nursing practice (DNP) project at a community health center (CHC) addressed a performance improvement measure related to the usability of the depression screening tool, Patient Health Questionnaire (PHQ-9), for patients 12 years and older. At CHC, the mental health providers underutilized this tool, leading to missed opportunities in identifying patients 12 years and older with depressive disorders. These missed opportunities may contribute to suboptimal patient treatment outcomes. The purpose of the staff educational program was to increase CHC staffs’ understanding of the PHQ-9 screening tool for routine depression screening. Ten mental health providers participated in the program, …

Staff Education To Nursing Leadership On Implementation Requirements Of A Nurse Residency Program, Sherri Ulfig

Walden Dissertations and Doctoral Studies

Nurse residency programs provide new graduate nurses with a solid foundation to support their transition into practice. The DNP students completed a staff education project to educate nurse leaders on the implementation requirements of a nurse residency program at a not-for-profit hospital in the Midwest. The identified practice problem was that the organization paused its nurse residency program during the COVID-19 pandemic due to critical staffing needs, and the leaders wanted to redesign the program to meet current practice standards. The educational project question addressed whether education for site leaders would increase their knowledge of the implementation requirements of a …

Staff Education On Using The Epworth Sleepiness Scale In Primary Care, Amanda Robyn Jones

Walden Dissertations and Doctoral Studies

Sleep disorders are prevalent in primary care settings and often remain underdiagnosed due to inconsistent assessment practices. This doctoral project was conducted to develop, implement, and evaluate whether an educational intervention for registered nurses would enhance their knowledge on using the Epworth Sleepiness Scale (ESS) for sleep assessment in primary care. Guided by adult learning theories and the analysis, design, development, implementation, and evaluation instructional design model, the aim of the project was to address the practice gap related to inadequate sleep evaluations, ultimately improving patient outcomes and promoting holistic care. Evidence was collected through pre and post intervention assessments, …

Relationship Of Provider-Patient Communication And Health Literacy To Self-Management In Black Adults With Type-2 Diabetes, Linda Walker

Walden Dissertations and Doctoral Studies

Black adults in the United States are nearly twice as likely to receive a diagnosis of type 2 diabetes mellitus (T2DM) and are more susceptible to severe diabetes-related complications. Health literacy and patient-provider communication (PPC) are extremely important for self-management in patients of all ethnicities however, 58% of non-Hispanic Blacks have basic or below-basic health literacy skills compared to 28% of non-Hispanic Whites. The purpose of this descriptive correlational study, with was guided by the interaction model of client behavior, was to determine (a) if there is relationship between PPC during the healthcare encounter to health literacy among Black adults …

Optimizing Workflow And Patient Outcomes: The Impact Of The Modified Adult Difficult Intravenous Access (A-Diva) Scale On Peripheral Iv Access: A Quality Improvement Project, Dakota S. Weaver, Ryan O'Sullivan

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Peripheral intravenous cannulation (PIVC) is one of the most performed invasive procedures in hospital settings, yet it is frequently associated with multiple attempts in patients with difficult intravenous access (DIVA). In obstetric (OB) triage settings, where time-sensitive care is critical, failed PIVC attempts can delay treatment and negatively affect patient experience. The Modified Adult Difficult Intravenous Access (A-DIVA) scale is a validated tool designed to identify patients at risk for DIVA and guide early use of advanced techniques such as ultrasound (US) guidance.

A QI initiative was implemented in the OB triage unit of a large academic hospital. The tool …

Change For The Use Of Phenobarbital In Severe Alcohol Withdrawal Syndrome, Rylee J. Studiner

Walden Dissertations and Doctoral Studies

Alcohol withdrawal syndrome (AWS) is a critical condition commonly encountered in hospital settings. If not properly treated, AWS can progress to seizures, delirium tremens, and death. Traditionally, benzodiazepines guided by the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar), have served as a mainstay of treatment. However, emerging evidence supports the use of phenobarbital as a pharmacologic alternative and the Severity of Ethanol Withdrawal Scale (SEWS) as a more objective and clinically practical assessment tool. This doctor of nursing practice (DNP) project aimed to develop an evidence-based clinical practice guideline (CPG) for the use of phenobarbital in managing severe …

Staff Education On Suicidal Screening In Young African American Male Adults With Bipolar Disorders, Tokunbo Ndidi Allen

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice education project aimed to enhance mental health providers’ preparedness in culturally competent suicide screening, specifically for African American males with bipolar disorder in a behavioral health department. The practice issue identified was a lack of documented training, leading to underdiagnosis, missed interventions, and health disparities driven by cultural stigma, provider discomfort, and the absence of standardized guidelines. This represents a serious patient safety concern for African American males with mood disorders, such as bipolar, who are significantly underserved in mental health care. The guiding question was: Does a suicide screening education program improve the knowledge …

Implementation Of Patient-Centered Approaches To Enhance Engagement And Satisfaction In Psychiatric Care Within A Family Mental Health Service, Nnenna Attah

Walden Dissertations and Doctoral Studies

Summary I conducted this evaluation of a quality improvement initiative at a family mental health service center aimed to enhance patient engagement and satisfaction in psychiatric care through patient-centered approaches. The practice problem addressed in this project was the lack of patient engagement and satisfaction. This issue is critical to address within the context of nursing practice because patient-centered care is fundamental to improving clinical outcomes, patient satisfaction, and overall quality of care. The practice-focused question was: How can patient-centered approaches enhance patient engagement and satisfaction in psychiatric care? In the project, I focused on evaluating the impact of patient-centered …

Tense And Agreement Measures In Young African American English-Speaking Children, Kwaku Nyantakyi

LSU Doctoral Dissertations

The Tense Marker Total (TMT) and the Tense and Agreement Productivity (TAP) score are two ways of measuring children’s tense and agreement systems, and studies have shown that both measures track developmental growth across different ages in General American English (GAE)-speaking children. This dissertation examined the feasibility and validity of using these measures for children learning African American English (AAE).

The data were cross-sectional archival language samples from 38 AAE-speaking children who ranged in age from three to five years (11 at 3 years, 12 at 4 years, 15 at 5 years). The language samples were coded and scored for …

A Religious Etiology Of Genito-Pelvic Pain And Pain With Penetration, Emily L. Carlson

Theses and Graduate Projects

Pelvic pain during penetration (PPDP) has been described using various diagnostic terms, including vaginismus, dyspareunia, and vulvodynia. The most recent and comprehensive classification is Genito-pelvic pain/penetration disorder (GPPPD) which is characterized by psychological distress associated with pain during or in anticipation of vaginal penetration (DSM-5-TR; American Psychiatric Association [APA], 2022). The etiology of PPDP is multifactorial, involving a complex interplay of biological, psychological, and relational factors. Religious and cultural influences may play a significant role in shaping individuals’ experiences of sexual pain. This study investigated the etiology of PPDP in relation to the religious influences among women raised in Judeo-Christian …

Antidepressant Medication Nonadherence In Adult Patients With A Major Depressive Disorder, Sandrine Djou Kaze

Walden Dissertations and Doctoral Studies

The chosen approach for the Doctor of Nursing Practice (DNP) project was a clinical practice guideline (CPG) on interventions to improve antidepressant medication adherence in adults diagnosed with depression in an outpatient setting. The consequences of medication nonadherence in patients with depression are devastating for individuals and the healthcare system. Therefore, addressing it within nursing practice is essential to improve treatment efficacy and patient outcomes. The practice question related to the DNP project was to determine whether the CPG could improve antidepressant medication compliance in adults diagnosed with a depressive disorder in an outpatient setting. I aimed to develop a …

Examining Multi-Level Support-Related Factors Influencing School-Based Mental Health Services Across Various Types Of U.S. Public High Schools, Wendy L. Wilson

LSU Doctoral Dissertations

Youth mental health is a global and national public health issue, with notable disparities in access to school-based mental health services (SBMHS; Kieling et al., 2024). This highlights the urgent need to identify supportive factors that can enhance service availability within educational settings. This cross-sectional, exploratory-descriptive study aimed to identify multi-level support-related factors (SRFs) at the student, school, and community levels that best predict SBMHS availability across different types of U.S. public high schools. The researcher conducted a secondary data analysis of a sample of 855 respondents who completed the 2017-18 School Survey on Crime and Safety. Various univariate, bivariate, …

An Educational Intervention Focused On Identifying Adverse Childhood Experiences, Laconia Bacon

Walden Dissertations and Doctoral Studies

Adverse childhood experiences (ACEs) refer to traumatic childhood experiences that individuals may have been exposed to during their youth, such as child maltreatment, domestic violence, or interparental violence. Research has demonstrated that experiencing ACEs in childhood may result in physical and mental illnesses that led to dangerous lifestyle patterns in adulthood. In the local organization, several patients with ACEs presented in the emergency department (ED). The nurses, unaware of ACEs, were unable to detect and respond to the consequences of ACEs. Thus, the purpose of this Doctor of Nursing Practice (DNP) project was to determine whether an educational intervention focused …

Addressing Psychosocial Barriers To Participation In People Experiencing Homelessness: An Occupational Therapy Workshop, Preston E. Bender

Student Capstone Papers

This capstone project addressed the critical gap in occupational therapy education and practice regarding the psychosocial needs of people experiencing homelessness. Despite the occupational therapy profession’s emphasis on holistic, person-centered care, many occupational therapy practitioners and occupational therapy students report feeling a lack of self-efficacy and preparedness to navigate the complex psychological, social, and systemic barriers that hinder occupational participation among this population. This capstone project aimed to address the perceived unpreparedness among clinicians through the creation of an 8-hour interactive educational workshop. The workshop is grounded in the Model of Human Occupation and informed by the Bridging the Transition …

Understanding Loss To Follow-Up: The Role Of Social Determinants Of Health In Infants Referred After A Positive Newborn Screening – A Quantitative Analysis, Betsy Graham-Moeller Graham-Moeller

Walden Dissertations and Doctoral Studies

Newborn screening (NBS) is a vital U.S. public health initiative that identifies medical conditions shortly after birth. Patients with positive screenings are referred for medical follow-up or evaluation. However, many patients do not receive the recommended long-term follow-up, posing concerns for healthcare providers and public health professionals working to ensure timely treatment and care continuity. Based on the Social Determinants of Health framework, this quantitative, retrospective cohort study aimed to examine demographic and clinical factors associated with follow-up adherence among 691 infants identified through NBS in Colorado and Wyoming. The purpose of the study was to determine whether race, ethnicity, …

Using Exercise To Treat Anxiety In Adult Patients With Addiction, Emmanuella N. Nnadozie

Walden Dissertations and Doctoral Studies

Summary In this Doctor of Nursing Practice (DNP) project, I selected a staff education as the best intervention to improve staff knowledge in using exercise to treat anxiety disorders in adult patients at a recovery clinic for addiction. Anxiety disorders are highly prevalent among individuals undergoing substance abuse treatment, often exacerbating withdrawal symptoms and increasing relapse risks; thus, integrating the use of exercise in addition to existing standard care for anxiety treatment in individuals with substance use disorder (SUD) will lead to decreased anxiety, decreased alcohol use and drug cravings, improved quality of life and affect, increased abstinence, and improve …

Enhancing Social Determinants Of Health Education In Home Health Care Including Social Determinants Of Health In Assessments And Care Plans For Home Health Clinicians, Emilia Mbanwite

Walden Dissertations and Doctoral Studies

This staff education-focused doctor of nursing practice (DNP) project addressed the critical practice problem of one southern health care facility staff’s knowledge on the integration of social determinants of health (SDOH) into home health care plans. Despite SDOH screening, clinicians lacked standardized training to effectively assess and intervene on factors such as housing, transportation, and food insecurity, contributing to preventable hospitalizations, particularly in vulnerable populations. The practice-focused question addressed whether an evidence-based education module could improve home health nurses’ knowledge and application of SDOH in assessments and care plans. The project’s purpose was to develop, implement, and evaluate this training …

Targeted Depression Screening For At-Risk High School Students: An Integrated Review, Joseph Calub

DNP Qualifying Manuscripts

Depression in high school students is underrecognized because symptoms can present not only as mood issues but also behavioral or academic problems. This integrated review examined literature from 2010-2015 using PsycInfo, ERIC, CINAHL, and PubMed to evaluate the effectiveness of targeted depression screening for students referred for behavioral, academic, or social concerns. Studies meeting inclusion criteria assessed targeted or clinically referred screening methods, with a focus on validated tools such as the Patient Health Questionnaire modified for Adolescents (PHQ-A). Findings indicate that targeted screening effectively identifies depressive symptoms in at-risk students and is more feasible in resource-limited schools than universal …

An Integrated Literature Review Examining Nurse Burnout Interventions, Wislande Joseph

DNP Qualifying Manuscripts

Nurse burnout has detrimental consequences for patients, nurses, and organizations and can negatively impact patient outcomes, nurse quality of life, and organizational costs. This integrated literature review aimed to examine interventions for nurse burnout in order to identify what characterizes effective interventions, whether evidence supports implementing such interventions, and how the most commonly-implemented intervention type (mindfulness-based) in particular impacts signs and symptoms of nurse burnout. A two-part search was conducted of CINAHL, PubMed, Google Scholar, and APA PsychInfo. Part one investigated burnout interventions broadly using the primary search terms nurse burnout and interventions; part two focused specifically on mindfulness-based interventions …

Effectiveness Of Leadership Rounding In Reducing Patient-Related Falls In A Medical-Surgical Unit, Elsie-Solange Mvoueng Nkoi-Mimba

Walden Dissertations and Doctoral Studies

Summary In this Doctor of Nursing Practice (DNP) project, I evaluated whether the project site organization’s implementation of leadership rounding reduced patient falls within a medical-surgical unit. Despite established fall prevention strategies, the unit continued to experience ongoing incidents, prompting the implementation of structured leadership rounding. The practice-focused question assessed changes in fall rates over a 3-month postintervention period compared to the preceding 3 months. A retrospective chart review was conducted from December 2023 to June 2024, excluding March 2024 due to partial implementation. I used descriptive statistics to analyze trends. The average monthly fall rate remained stable at 2.67 …

The Association Of Adult Medicaid Beneficiaries’ Characteristics And Their Experience During The Covid-19 Pandemic, Frank R. Tortorella

Dissertations and Theses (Open Access)

Background: The COVID-19 pandemic disrupted the United States’ safety net program, Medicaid, for low-income individuals affecting access to care, increasing enrollment, and requiring new approaches to care delivery. The literature shows that beneficiaries’ personal characteristics influence their healthcare experience. This study investigated the association between Medicaid beneficiary characteristics and experience with their Medicaid health plan, examined if COVID-19 negatively impacted experience, and tested if COVID-19 moderated the relationship between beneficiary characteristics and experience.

Methods: The research sample was 76,976 adult Medicaid beneficiaries who voluntarily completed the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) health plan surveys in 2018 …

Transcriptomic And Epigenomic Profiling Of Immune Cells Responses To Simian Immunodeficiency Virus Infection In The Brain, Xiaoke Xu

Theses & Dissertations

Human immunodeficiency virus type 1 (HIV-1) is an enveloped retrovirus that significantly impairs the human immune system. A common complication of HIV-1 infection is HIV-associated neurocognitive disorder (HAND), which, prior to the introduction of antiretroviral therapy (ART), led to considerable morbidity and mortality due to untreated neuropsychiatric manifestations. Although ART has substantially reduced the incidence of HIV-associated dementia (HAD), approximately 50% of people living with HIV (PLWH) continue to experience milder forms of HAND. The CNS is seeded by HIV during the acute phase of infection. Once in the brain, HIV targets and activates resident immune cells, primarily microglia and …

"Please Hold Space For Them": The Role Of Mental Health Professionals In Supporting Bipoc Female Survivors Of Campus Sexual Assault, Brianna Josefine Ortega

Doctoral Dissertations

Campus sexual assault (CSA) remains a pervasive issue in the United States, disproportionately affecting women. Despite this, the experiences of Black, Indigenous, and other Persons of Color (BIPOC) women are often underrepresented in the literature, limiting understanding of how best to support them. Based on intersectionality theory, this qualitative study explores how mental health professionals (MHPs) support BIPOC female survivors of CSA. Semi-structured interviews were conducted with six MHPs, and a thematic analysis framework uncovered seven key themes: disclosure (subtheme: barriers to disclosure), impacts of campus culture, fear and distrust, impact of campus sexual assault, coping, resources available for survivors, …

Effects Of Body Armor On Respiratory Muscle Fatigue And Muscle Blood Flow During Progressive Treadmill Marching, Kathryn Bell

UNLV Theses, Dissertations, Professional Papers, and Capstones

Introduction: Torso-borne loads such as body armor are essential for modern military operations but impose mechanical and metabolic strain. These physiological stressors can trigger the inspiratory metaboreflex, which redirects blood flow from locomotor to respiratory muscles, further reducing muscle oxygen and endurance. While aerobic fitness has been shown to alleviate these effects, the interaction between sex, aerobic capacity, and oxygenation under load is not well understood. This study examined the physiological effects of torso-borne load carriage on respiratory muscle fatigue, skeletal muscle oxygenation, and exercise performance to volitional exhaustion and the degree to which sex and aerobic capacity influence these …

Hot Spring Associated Infectious Diseases In The Great Basin And Southwest, Matthew Bentz

UNLV Theses, Dissertations, Professional Papers, and Capstones

Like all bodies of freshwater, natural hot springs can harbor pathogenic microorganisms that carry the threat of infectious disease. The unique chemistry, increased temperature, and popularity for bathing may alter the risk profile of hot springs compared to other natural bodies of water. Despite this risk, the role of hot springs as a reservoir for infectious diseases remains understudied, particularly within the context of regional public health. Nevada and the Great Basin/Southwest have increasingly promoted hot springs for the purposes of tourism, and they share a strong link to the cultural heritage of the region. The unknown risk profile and …

More Than A Feeling: A Mixed-Methods Examination Of Transgender Community Connectedness And Associations With Suicidality, Erin Rook

UNLV Theses, Dissertations, Professional Papers, and Capstones

Transgender adults experience significantly higher rates of suicidal ideation than the general population. A sense of transgender community connectedness (STCC) may reduce this risk, but predictors of STCC and its association with suicidal ideation are understudied. This cross-sectional mixed methods study examined STCC and past-year suicidal ideation in relation to dimensions of transgender community connectedness (TCC) at each level of the Social Ecological Model using data from a U.S. survey of transgender adults (n = 126). About half (52.4%) felt connected to the transgender community, and 27.0% reported past-year suicidal ideation. Hierarchical logistic regression models for both outcomes showed good …