Medicine and Health Sciences Commons^™

Staff Education To Improve Fall Prevention Practices In The Home Health Setting, Chinemelum Okoye

Walden Dissertations and Doctoral Studies

Falls among adults aged 65 and older represent a significant public health concern, as they are the leading cause of injury and hospitalization within this demographic. According to the Centers for Disease Control and Prevention (CDC), nearly one in four older adults experiences a fall annually, leading to over 3 million emergency department visits. In home health settings, the risk of falls is heightened due to uncontrolled environments and insufficient staff training. This quality improvement project assessed the effectiveness of an educational intervention aimed at fall prevention strategies for home health staff, including registered nurses (RNs) and certified nursing assistants …

Genotoxicity Assessment Of Conventional And Cad/Cam Denture Base Materials, Alanood Aldubayan

Master's Theses (2009 -)

Aim: In prosthodontics, polymethyl methacrylate (PMMA) has been widely used. Their biocompatibility and potential genotoxicity remain a concern due to the residual monomer release. Computer-aided design and manufacturing (CAD/CAM) denture base materials have emerged and offered some improved mechanical and physical properties compared to the standard conventional heat-cured denture base material. However, their long-term biocompatibility remains unstudied. Therefore, this study evaluates the genotoxicity effects of conventional and CAD/CAM denture base materials on human gingival fibroblasts (HGFs). Methodology: Disk-shaped samples were fabricated of six denture base resins, including heat-cured PMMA, milled PMMA, and four 3D-printed resins. HGFs were exposed to the …

From Surviving To Thriving: The Oxygen Mask Approach For Middle Management, Lydia Marque

Master's Projects and Capstones

Problem: Middle managers in healthcare experience high levels of stress, heavy workloads, and burnout. At a large medical center in Northern California, middle managers reported low perceptions of organizational support for well-being despite an abundance of available resources.

Context: Baseline data indicated a perceived support score of 6.5 out of 10 on the Employee Interest Survey and a People Pulse Culture of Health score of 60 for assistant nurse managers (ANMs), both below regional benchmarks. These findings suggested inadequate engagement with organizational well-being resources.

Interventions: A six-month performance improvement initiative, guided by the ADKAR change model and …

Skin Care Excellence: Increasing Rn Skin Check Frequency To Prevent Hapis, Yu Jian Kwan

Master's Projects and Capstones

Background:
This quality improvement project was implemented in the Transitional Cardiac Unit (TCU), a 32-bed telemetry unit primarily serving older adults recovering from cardiac procedures. A microsystem assessment revealed a hospital-acquired pressure injury (HAPI) rate of 1.49 per 1,000 patient days, exceeding the regional target of 0.82. Key barriers included limited skin assessment frequency, inconsistent documentation, and gaps in staff training.

Problem:
From June to December 2024, six HAPIs occurred in the TCU. Despite existing protocols requiring two-RN skin assessments at admission, transfer, and discharge, early detection of skin breakdown remained insufficient. Contributing factors included inconsistent surveillance, varied assessment skills, …

The Influence Of Myocardin Effector Genes On The Tgf-Beta Smad3 Signaling Pathway In Human Pleural Mesothelial Cells, Hema Chandra Hrushi Dusharla

Biotechnology Theses

Pleural Fibrosis (PF) involves excessive extracellular matrix (ECM) deposition, mainly by myofibroblasts, leading to pleural thickening and impaired lung function. Pleural mesothelial cells (PMCs) contribute via mesothelial and mesenchymal transition (MesoMT), triggered by cytokines like TGF-β. Our lab identified Myocardin (MyoCD), a transcriptional co-activator of cardiac and smooth muscle, is a master regulator of pleural fibrosis through interactions with serum response factor (SRF) and Smad2/3 transcription factors which initiate fibrosis signaling. RNA sequencing and qPCR analysis revealed that silencing MyoCD decreased the expression of CTNNB1, MDFI, and Tspan2. MDFI emerged as a potent candidate, as this gene affecting the expression …

The Influence Of Sociodemographic Factors On Opioid Mortalities In The U.S. State Of Georgia, Theresa Highsmith

Walden Dissertations and Doctoral Studies

Since the late 1990s, the United States has been in the midst of an opioid epidemic that continues to present significant public health challenges. Opioid-related mortality, particularly involving fentanyl, has disproportionately affected vulnerable populations. The purpose of this quantitative study was to examine the associations between educational level, homelessness, and alcohol use with opioid-related overdose deaths involving fentanyl, while controlling for age, gender, and marital status, among Black and White populations in the U.S. state of Georgia. The theoretical framework was Bronfenbrenner’s socioecological model, which recognizes that individual behavior is influenced by multiple levels of factors, including interpersonal, community, and …

Comparing The Mechanical Properties Of Conventional, Milled, And 3d-Printed Occlusal Splint Materials: An In Vitro Study, Sadeem Alzaghran

Master's Theses (2009 -)

Aim: Evidence on the mechanical properties of digitally manufactured occlusal splint materials remains scarce. The aim of this study was to evaluate and compare the mechanical properties of CAD/CAM fabricated occlusal splint materials versus conventionally heat-cured acrylic resin materials. Materials and Methods: A total of 100 specimens were manufactured for the present study. One CAD-CAM milled (ProArt CAD Splint), one heat-polymerized (SR IVOcap Clear), and three 3D-Printed (KeySplint Hard, NightGuard Firm2 and RoDIN Splint 2.0) resin materials were evaluated. Flexural strength, flexural modulus and surface hardness were measured. The three-point flexure test was used for the determination of flexural strength …

Enhancing Onboarding And Role Transition For Advanced Practice Clinicians Through The Development Of A Structured Mentorship Program, Christina Sternesky

Walden Dissertations and Doctoral Studies

The assimilation of advanced practice clinicians (APCs), nurse practitioners, and physician assistants into healthcare systems is significantly dependent on the quality of their onboarding experience and the availability of a structured mentorship program. Without mentorship programs, APCs often experience job dissatisfaction, reduced confidence, undefined role clarity, and increased burnout. In this quality improvement Doctor of Nursing Practice project, I conducted a comprehensive assessment of the needs of APCs and subsequently developed a structured, evidence-based mentorship program. The program, approved by an expert panel, was designed to support the onboarding of APCS, their role transition, and ongoing professional development within a …

Association Between Homelessness And Maternal Health Outcomes Among Non-Hispanic Black Women In Georgia, Miranda Weaver

Walden Dissertations and Doctoral Studies

Maternal health disparities among homeless non-Hispanic Black women in Georgia represent a critical public health concern, driven by inequitable access to care and elevated risks of adverse pregnancy outcomes. This study examined how homelessness influences perinatal care utilization (timing and frequency of prenatal visits and postpartum checkups) and pregnancy complications (gestational diabetes, hypertension, and depression), and whether these associations differ by geographic context (urban versus rural). Grounded in the Social Determinants of Health framework, the study used a quantitative cross-sectional design, analyzing secondary data (n = 1,540; weighted ≈ 203,571) from Phase 8 (2017–2021) of the Pregnancy Risk Assessment Monitoring …

The Covid-19 Lockdown And Diabetes Self-Management In Esan Northeast Area Of Edo State, Esther Ehivbaun Rapu

Walden Dissertations and Doctoral Studies

The COVID-19 lockdown impacted chronic diseases care globally, but there is limited research on how individuals in rural Nigerian communities managed diabetes during this period. This qualitative phenomenological study explored the lived experiences of self-management with diabetes during the COVID-19 lockdown among adults in Esan Northeast. The socioecological model (SEM) served as the guiding conceptual framework, allowing for the exploration of the impact of individual, interpersonal, community, and institutional factors on self-care behaviors. The research explored how cultural, social and economic factors impacted how adults with diabetes in Esan Northeast managed their condition during the COVID-19 lockdown. Semi-structured interviews via …

Comparing Dosimetric Outcomes Of Static Imrt And Vmat In Accelerated Partial Breast Irradiation For Medially Located, Left-Sided Tumor Beds, Rani Jamil

Masters Projects

Abstract

Introduction: Accelerated partial breast irradiation (APBI) has emerged as a targeted alternative to whole-breast irradiation for early-stage breast cancer, particularly for patients with medially located, left-sided tumors. Static intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) offer advanced dose conformity, yet no direct comparisons between static IMRT and VMAT have been conducted specifically for medially located, left-sided APBI, a uniquely challenging anatomical subgroup. This study evaluates dosimetric differences between static IMRT and VMAT plans to determine which modality provides superior target coverage and organ-at-risk (OAR) sparing in left-sided APBI.

Methods: Ten patients with medially located left-sided breast …

Oncology Nurse Self-Assessment Of Caring Behaviors Following Telehealth And In-Person Visits, Maryann Connor

Walden Dissertations and Doctoral Studies

Oncology nurses coordinate care, ensure the safe administration of treatments, manage symptoms, and support those newly diagnosed with cancer. Traditionally, oncology care included in-person visits, but the COVID-19 pandemic accelerated the adoption of telehealth, transforming how oncology care is delivered. The purposes of this study, guided by Watson’ theory of human caring, were to determine (a) if there is a difference in oncology RNs’ self-assessments of applying caring behaviors during in-person visits compared to oncology RNs’ self-assessments of applying caring behaviors of telehealth visits with newly diagnosed cancer patients, and (b) if there is a difference in self-assessment of caring …

Predicting Dietary Behavior In Obese Adult Diabetics Using Social Cognitive Theory, Precious Mueller

Walden Dissertations and Doctoral Studies

Predicting Dietary Behavior in Obese Adult Diabetics Using Social Cognitive Theory by Precious Mueller MA, University of Phoenix, 2009 BS, University of Iowa, 2006 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2024 “ Diabetes mellitus Type II is a prevalent and serious condition affecting millions globally, particularly among obese adults. The association between dietary behaviors and diabetes management is critical, as it directly impacts health outcomes and quality of life for affected individuals. This study aims to identify the determinants of dietary behaviors that influence Type II …

Type Of Intimate Partner Violence And Association With Perpetrator Demographics, Katrisha Williams

Walden Dissertations and Doctoral Studies

Intimate partner violence (IPV) is a public health concern because of its long-term impact on health and well-being with 1 in 4 American women experiencing some form of IPV. To help understand how age, gender, and race of both, the perpetrator and victim, impact the type of IPV, multiple regression analysis was performed with secondary data from the National Intimate Partner and Sexual Violence survey (N=541). This study used Raewyn Connell’s Theory of Masculinity as a conceptual framework. This theory states that males have a need to show dominance, strength, and suppress emotion, which can inform patterns of violence in …

Policy Review Of The Aha Clinical Practice Guideline For Congestive Heart Failure: Evaluating Best Practices, Brenda E. Garcia

Student Scholarly Projects

Practice Problem: Congestive heart failure (CHF) is a significant public health challenge that impacts various populations and contributes to rising hospital admission rates.

PICOT: The PICOT question that guided this scholarly project was: For healthcare policymakers and interprofessional teams (P), how does a policy review of the American Heart Association’s Clinical Practice Guidelines for Heart Failure (I), guided by the CDC’s Polaris Framework (C), conducted over a 12-week period (T), evaluate alignment with evidence-based practices and potential for adoption in the care of patients with congestive heart failure (O)?

Evidence: This scholarly project focused on reviewing the current clinical guidelines …

Staff Education On Early Diagnosis And Management Of Hypertensive Crisis, Sharon Fairweather

Walden Dissertations and Doctoral Studies

Summary This project is a Doctor of Nursing Practice initiative to educate healthcare professionals at a primary healthcare clinic. The focus was on improving staff knowledge of hypertensive crises in African American patients aged 20 to 40. The project included face-to-face training sessions and educational resources to empower providers and enhance patient outcomes. Hypertensive crises are a significant health risk, especially in African Americans. This group has higher rates of hypertension, leading to serious health complications. Addressing this issue is crucial in nursing practice. Early diagnosis and timely interventions can significantly improve care. Equipping nurses with the necessary skills is …

Emergency Nurses’ Perceptions Of A Trauma-Informed Organizational Climate: A Cross-Sectional Study, Audrey Kobina

Nursing Theses and Dissertations

Healthcare leaders face numerous challenges in today’s complex healthcare environment. The most pressing issues are staffing shortages and burnout among healthcare workers. By 2025, the U.S. healthcare system could experience a shortfall of up to 450,000 nurses, or 20% fewer nurses than needed to provide adequate patient care. High job dissatisfaction and burnout levels are significant factors driving many nurses away from the profession. This three-paper dissertation portfolio addressed how trauma-informed approaches and practices can enhance the work environment by establishing trauma-informed organizational climates to mitigate burnout. Understanding the impact of trauma-informed practices within healthcare systems supports the nursing workforce. …

Improving Staff Knowledge Of Insulin Protocols, Farzana Dalal

Walden Dissertations and Doctoral Studies

A midwestern inpatient hospital experienced a rise in insulin-induced hypoglycemic events on an acute medical-surgical floor as evidenced by 6-23 incidences per month between September 2024 to February 2025. A gap in practice revealed deficiencies in knowledge on the use of insulin protocols, which led to the project question addressing if nursing education on the use of insulin protocols would improve nursing staff knowledge as measured by pre- and post-educational surveys, thus resulting in decreased hypoglycemic events. This educational project utilized the ADDIE pedagogy, the John Hopkins evidence-based practice (JHEBP) model, and the Walden University's DNP Project Process Guide. This …

Unintentional Drowning In Florida: An Analysis Of Demographic And Water Type Associations Among Youth And Young Adults, Michelle Sterling

Walden Dissertations and Doctoral Studies

Unintentional drowning is a leading cause of preventable injury fatalities among youth and young adults in the United States. Despite the preventability, drowning continues to affect specific populations disproportionately. Limited research has examined demographic and environmental factors that contribute to drowning fatalities among individuals aged 5 to 25 years old in Florida. Understanding these patterns is key to informing targeted prevention strategies. This quantitative, retrospective study explored the relationship between demographic characteristics (i.e., gender, race, and ethnicity), environmental context (i.e., water type), and drowning fatalities of 5- to 25-year-olds in Florida from 2018 to 2022. Data for this study, which …

Psychotropic Medication Nonadherence Among Psychiatric Patients Using Motivational Interviewing, Kate Ananga Pabai

Walden Dissertations and Doctoral Studies

This educational intervention involved enhancing knowledge and competency of nursing staff in terms of application of motivational interviewing (MI) techniques to improve adherence to prescribed psychotropic medications among patients with mental health conditions. The project met criteria for a staff education initiative, directly addressing the ongoing issue of psychotropic medication nonadherence, a prevalent and pressing challenge at the project site. Clinicians observed frequent missed doses and treatment discontinuation, leading to symptom relapse, emergency room visits, and avoidable hospital admissions. These outcomes emphasized the need for a targeted intervention to support frontline nursing staff. The practice-focused question guiding the project was: …

Dosimetric Comparisons For Determining Optimal Arc Geometry In Multi Target Thoracic Vmat Sbrt Treatment Plans For Patients With Locally Advanced Inoperable Nsclc, Alexandrea M. Reeves

Masters Projects

Non-coplanar beam arrangements have been used for many years in radiation treatment planning. Their use has been known to show an increase in target conformity and gradient index. However, by using non-coplanar beam arrangements, the treatment planning time as well as the treatment delivery time can increase. Despite the increase in treatment planning and delivery complexity and time, previous studies have shown a decrease in OAR doses resulting in a desire to use non-coplanar beams. Previous studies have looked at various body sites and target locations, though no research has been found specifically studying non-coplanar beam arrangement in multi-target treatment …

Enhancing Medication Communication In The Acute Care Setting To Strengthen Patient Comprehension And Retention, Ashleigh C. Christensen

Student Scholarly Projects

Practice Problem: Research has shown that breakdowns in communication, especially in the context of medication education, play a critical role in the delivery of safe and effective patient care. These findings underscore the need to prioritize effective communication in medication education. In the acute care setting, effective communication is essential for ensuring patient safety, adherence, and improved patient-centered outcomes.

PICOT: In clinical staff providing direct patient care in the acute care setting (P), does the implementation of the evidence-based teach-back method (I), as compared to current practice (C), improve patient knowledge, understanding, and self-management upon discharge (O), over ten weeks …

Implementation Of Artificial Intelligence For Scribing In An Outpatient Mental Health Clinic, Elissa A. Moore

Student Scholarly Projects

Practice Problem: Traditional documentation practices place a significant burden on psychiatric mental health nurse practitioners (PMHNP) in outpatient mental health clinics (MHC), contributing to provider burnout and negatively impacting the patient-provider relationship. Preserving practicing PMHNPs is essential across the United States, but imperative in medically underserved areas where mental health services are limited.

PICOT: In PMHNPs (Population), does the use of AI scribing software (Intervention) compared to traditional documentation methods (Comparison) reduce documentation time and increase provider satisfaction (Outcome) over a ten-week period (Time)?

Evidence: This Doctor of Nursing Practice (DNP) scholarly project was informed by evidence obtained from 15 …

Controlling Hypertension In The African American Population Through Dash Diet Education, Tanya K. Mccaskill

Doctor of Nursing Practice Projects

Hypertension disproportionately affects African Americans, contributing to elevated risks of stroke, cardiovascular disease, and kidney failure. Despite the well-established benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, its adoption remains limited due to cultural, socioeconomic, and health literacy barriers. This Quality Improvement (QI) project aimed to evaluate the effectiveness of a culturally tailored DASH diet education intervention in improving nutritional knowledge among African American adults with hypertension (HTN). Using a quasi-experimental pre-post intervention design, 50 participants received a structured educational session during a single clinic visit, which included counseling, printed materials, and sample menus. The intervention was guided …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Comparing And Evaluating Contralateral Breast Dose Relative To Median Ptv Tumor Bed Dose For Hypo-Fractionated Breast Treatments Using Import High Dose Constraints., Shannon J. Nordby

Masters Projects

This study is aimed to compare two different planning constraints for post-lumpectomy whole breast radiation treatments to evaluate whether or not the mean dose to the contralateral breast can be significantly reduced while maintaining plan quality for treatment. A total of 10 patients who had first undergone a lumpectomy were included into this study. Each patient’s initial treatment plan was created using a conventional approach with a mean dose constraint of < 600 cGy (Plan A) and then was replanned using the Import High protocol of a mean dose constraint, aiming to further push for a mean dose < 150 cGy (Plan B) to the contralateral breast. Both of these plans were analyzed for PTV coverage and dose to the surrounding critical structures. The results have shown that the contralateral mean dose was significantly reduced from an average of 216.32 in Plan A to 126.53 cGy in Plan B. All while meeting the target coverage of > 95% isodose line. Statistical testing showed a significant difference between the two planning techniques of lowering the contralateral dose (p < 0.0001), and normality testing supported the validity of the data analysis. In addition to a substantial dose reduction to the contralateral breast, Plan B maintained equal or improved dose constraint to other surrounding critical organs at risk, including the heart, lungs, spinal cord, and thyroid. The Import High protocol demonstrated consistent outcomes across diverse patient anatomies. These findings suggest that by using the Import High mean dose constraint, it is possible to maintain plan quality while reducing dose to the contralateral breast. This approach may help reduce the risk of long-term side effects and improve the patient’s overall outcomes in whole breast radiation treatments.

Staff Education To Improve Preceptors’ Knowledge Base To Adapt Teaching Methods Across Generations, Lucretia Dennise Sanders

Walden Dissertations and Doctoral Studies

Today’s nursing workforce consists of individuals from multiple generational cohorts, which creates a dynamic mix of nurses whose behavior and work reflect the cultural and historical events that shaped their generation. As the nursing workforce becomes increasingly multigenerational, nurse educators and leaders face growing challenges in ensuring that onboarding practices meet the needs of diverse learners. In the local organization, leaders and clinical educators observed inconsistencies in preceptorship practices and onboarding experiences, particularly for newly hired nurses. As a result, leaders determined that an educational intervention focused on generational teaching strategies was needed. Thus, the purpose of this Doctor of …

On The Use Of Wearable Continuous Glucose Monitors (Cgms), Jovita Ozonnadi

Walden Dissertations and Doctoral Studies

This DNP project implemented an educational module on the use of continuous glucose monitoring devices (CGM) to increase staff knowledge of diabetic care and glycemic control for the diabetic population in a community healthcare clinic. Diabetes mellitus is a significant health concern that poses a substantial challenge to the community and the American healthcare system with a higher burden of diabetes complications found among the low income, uninsured, and minority populations. Poor glycemic control is a major health issue that significantly increases the risk of developing diabetes-related complications such as heart and kidney diseases, and obesity. The adoption of CGM …

Allied Health Student's Attitudes And Beliefs On Health Literacy Issues Focused On The Non-Native English-Speaking Community, Amy I. Thompson

Graduate Theses, Dissertations, and Capstones

Today's allied health students and their professors are faced with many challenges, including the low level of health literacy among the United States population. Healthy People 2020 defined health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Healthy People 2030). This definition was expanded in Healthy People 2030, to include concepts related to personal and organizational health literacy. Social determinates, such as a language barrier, further complicates an already complex situation with health literacy levels. This focus group, interview-based qualitative …

Screening For Bullying In A Middle School Setting, Paige Bernau

Dissertations

Problem: Bullied youth are two and a half times more likely to experience depression and three times more likely to experience anxiety and suicidal ideation than their peers (Li et al., 2024). Schools represent a key access point for mental health support and treatment for youth (Duong et al., 2020). Despite this, schools typically do not have formal bullying screening integrated into student support services.

Methods: This program evaluation used a descriptive, observational design to evaluate a bullying screening program in a suburban middle-school. This program used the California Bullying Victimization Scale (CBVS) to assess for bullying victimization (BV) followed …