Medicine and Health Sciences Commons^™

Intersectionality Gaps Among Multiple Social Determinants In U.S. Infant And Maternal Mortality Rates, Mary D. Kirkley

Walden Dissertations and Doctoral Studies

The purpose of this quantitative, cross-sectional study was to examine whether social determinants interactively influence U.S. maternal and infant mortality rates. Grounded in the Social Ecological Model, this study analyzed secondary data from the Centers for Disease Control and Prevention’s National Vital Statistics System were analyzed using multivariable logistic regression. The final sample included 110,402 maternal deaths and 55,839 infant deaths, with inclusion criteria requiring complete data on race, education, age, marital status, gender (for infants), residency, and year of death. Exclusion criteria included non-U.S. resident deaths or missing demographic data. Results revealed statistically significant interaction effects: race/ethnicity with education …

Evaluating Nutrition, Exercise, And Education, On Mental Health And Quality Of Life In Menopause, Jill R. Stone

Walden Dissertations and Doctoral Studies

Physical inactivity, poor nutrition, and a lack of understanding of menopause adversely affect mental health and quality of life in women entering menopause. Metabolic changes during this period can lead to an increase in visceral fat, loss of muscle mass, depression, and anxiety. These metabolic changes are linked to a higher risk for cardiovascular disease, type two diabetes, and metabolic syndrome. This cross-sectional quantitative study, guided by the health belief model, explored the contribution of adopting specific nutrition strategies, exercise, and education in women during menopause transition to help manage mental health (as measured by depression and tension), and quality …

Predictive Indicators For Graduation Upon Acceptance Into A Naacls-Approved Medical Laboratory Science Program, Warren Hovis

LSU Doctoral Dissertations

The primary purpose of this study was to determine the influence of selected academic and personal demographic characteristics on student success at a NAACLS-accredited medical laboratory science program in the southern portion of the United States.

Both academic and demographic categories were selected on students who entered the medical laboratory science program from 2014 to 2019 (pre-COVID). The sanitized, archived data set was provided by the MLS department and the registrar and student affairs office at the participating school. The extant data set contained academic and demographic variables, collected over a five-year period, of initially over 170 accepted MLS students. …

Staff Education Project An Educational Project To Educating Mental Health Staffs On Stress Management To Improve Knowledge And Staff Retention, Lilian Eneude

Walden Dissertations and Doctoral Studies

This evidence-based educational project addressed the knowledge gap in stress management techniques among mental health nursing staff at an acute psychiatric facility. Mental health professionals experience substantially higher rates of workplace stress and burnout compared to other healthcare workers, affecting staff wellbeing, patient care quality, and organizational outcomes. The practice-focused question was: Does educating mental health nurses on stress management improve knowledge as evidenced by pre- and post-intervention? A comprehensive literature search was done at the Walden University Library using CINAHL, PubMed, and PsycINFO databases that yielded 200 potential articles, with 45 full-text articles reviewed and 20 high-quality studies included …

Improving Compliance With Safe Sleep Bundles In The Neonatal Intensive Care Unit., Lindsey Davenport Shepherd

Doctor of Nursing Practice Papers

Abstract

Sudden Unexpected Infant Death Syndrome (SUIDS) is the leading cause of infant death. There is literature stating nursing compliance with safe sleep modeling in the hospital is a concern. In 2022, the American Academy of Pediatrics (AAP) updated their safe sleep guidelines which include the Neonatal Intensive Care Unit (NICU). The national average rate of SUIDS is 94.8 deaths per 100,000 live births (CDC, 2024). In Kentucky the rate is higher than that at a rate of 128.4 deaths due to SUID per 100,000 live births (CDC, 2024). The purpose of this project was to educate nursing staff, with …

Implementation Of A Cpr And Aed Training Program At A Local Martial Arts School: A Quality Improvement Project., Kaymie Johnston

Doctor of Nursing Practice Papers

Abstract

Background: Sudden cardiac arrest (SCA) is a leading cause of death in the United States with 356,000 out of hospital cases annually. SCA in athletes is a rare but serious event; affecting 15.4% of those engaged in martial arts. Community-based training programs which promote prompt intervention with cardiopulmonary resuscitation (CPR) and Automated External Defibrillation (AED) significantly improve survival outcomes.

Purpose: This project aimed to implement a CPR and AED training program at a local martial arts school to improve the knowledge, self-efficacy, and emergency response capabilities of staff, instructors, and adult learners.

Methods: A Plan Do Study Act (PDSA) …

Machine Learning For Digital Biomarker-Based Detection Of Cognitive Decline, Seng Khoon The

Dissertations and Theses Collection (Open Access)

Dementia is a neurodegenerative disease with a prevalence rate expected to triple by 2050, posing a significant challenge for health services. To impede the increasing prevalence, medical professionals and scientists are actively investigating technology to detect cognitive decline at a reversible stage known as Mild Cognitive Impairment (MCI). Digital biomarker technology is an emerging pragmatic approach to permit objective, ecologically valid, and long-term continuous measurement of cognitive health status, rendering it as one of the promising technologies for early MCI detection. Despite its potential, it is nontrivial to encode, extract and combine predictive information from these digital biomarker technologies; advanced …

Modification Of Epic System’S Simple Visit Coding (Svc) Evaluation Rule To Reduce Medical Claim Denials, Edith Ballard

Translational Projects (Open Access)

Background: The recruitment, development, and retention of skilled medical coding staff has become increasingly challenging for healthcare providers. To alleviate staffing burdens, Epic Systems’ electronic health record (EHR) introduced the Simple Visit Coding (SVC) work queue, designed to evaluate hospital patient encounters and automatically assign International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. However, the current SVC work queue evaluation rule at a prominent academic Oncology Care Organization (OCO) in the South does not utilize autonomous, generative, or computer-assisted coding (CAC) technologies. The work queue evaluation rule uses a simple rule-based program logic that relies on …

Enhancing Coagulase-Negative Staphylococcus Interpretation: Leveraging Data Visualization To Improve Diagnostic Accuracy And Patient Outcomes, Miriam Booker Barrett

Translational Projects (Open Access)

When implemented effectively, data displays can enhance interpretive decisions by helping physicians recognize patterns and relationships within various datasets. Data visualization has been widely studied for its role in converting raw data into actionable insights and supporting data-driven decision-making. However, few studies have been published that specifically explored using data displays to aid in interpreting coagulasenegative Staphylococcus (CoNS) in blood cultures.

One of the primary challenges infectious disease physicians face when interpreting CoNS in blood cultures is the disorganized nature of clinical data within electronic health records. The information necessary for accurate interpretation is often scattered across various sections of …

Evaluating The Predictive Value Of Basc-3 Anxiety Scale And Working Memory Index Scores For Clinically Significant Test Anxiety: A Comprehensive Analysis Of Non-Classifiable Cases, Des'tiana S. Williams

Electronic Theses and Dissertations

This dissertation will explore how test anxiety (TA) affects working memory (WM) and whether certain factors can help predict higher levels of test anxiety. Anxiety has been defined as a common experience that can show up in various forms—like general worry, social fears, panic attacks, and specific phobias (APA, 2022). It was described as often triggering our natural “fight-or-flight” response, which can impact our ability to focus, think clearly, and remember things. For students, test anxiety has been especially challenging, affecting how they perform in high-stakes academic settings. Using data from a university based psychological assessment center, this study will …

Evaluating The Predictive Value Of Basc-3 Anxiety Scale And Working Memory Index Scores For Clinically Significant Test Anxiety: A Comprehensive Analysis Of Non-Classifiable Cases, Des'tiana S. Williams

Electronic Theses and Dissertations

This dissertation will explore how test anxiety (TA) affects working memory (WM) and whether certain factors can help predict higher levels of test anxiety. Anxiety has been defined as a common experience that can show up in various forms—like general worry, social fears, panic attacks, and specific phobias (APA, 2022). It was described as often triggering our natural “fight-or-flight” response, which can impact our ability to focus, think clearly, and remember things. For students, test anxiety has been especially challenging, affecting how they perform in high-stakes academic settings. Using data from a university based psychological assessment center, this study will …

Oxytocin's Role In Feelings Of Social Connection And Loneliness, Cecile Sunahara

Psychology Theses and Dissertations

This study investigated the role of oxytocin (OT) in feelings of social connectedness. Healthy male and female participants (N=138) were exposed to a task designed to elicit feelings of social connectedness to close others (i.e., the Social Connection Task); participants’ salivary OT levels were measured in response to this task. Using ecological momentary assessment (EMA), data were collected on participants’ feelings of social connectedness in daily life. Results from the current study showed that, among male participants, OT levels decreased in response to the Social Connection Task, while no change in OT was observed among female participants. OT reactivity to …

A Tailored Approach To Prep Screening For Awareness And Readiness, Keionda Crumblin Caldwell

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Human immunodeficiency virus (HIV) is a serious health concern in the United States (U.S). Pre-Exposure Prophylaxis (PrEP) is a vital intervention in the prevention of HIV, yet its uptake and adherence are suboptimal due to barriers in identifying individuals who are most at risk and would benefit most from this preventive measure.

Purpose: This evidence-based project aimed to evaluate whether implementing a PrEP readiness tool at a walk-in clinic would identify at-risk adults and adolescents and lead to an increase in referrals for PrEP initiation.

Method: A PrEP Questionnaire from the Department of Wisconsin Public Health was given …

Improving Depression Screening Of Correctional Institution Inmates, Thelma Chidimma Ozigbu

Doctor of Nursing Practice Scholarly Projects

Problem: Depression significantly impacted on the quality of life of incarcerated individuals within correctional facilities, where rates of the disorder far exceed those in the broader community, increasing self-harm and suicide risks.

Purpose: This quality improvement project aimed to improve early identification of depressive symptoms and facilitate timely mental health referrals by implementing the Patient Health Questionnaire (PHQ-9) as a screening tool upon admission.

Method: Using the Iowa Model of Evidence-Based Practice (Iowa Model) as a guiding framework, this project involved training nursing staff to administer the PHQ-9 during initial health assessments. PHQ-9 is a nine-item questionnaire that assesses depression …

Improving Completion Of Diabetes Management Measures In Primary Care, Ashley Tyner Divers

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Adults with type 2 diabetes are at a risk of multiple comorbidities that can be prevented with proper screenings performed as recommended by the American Diabetes Association.

Purpose: Determine if using a checklist on the patient router will improve completion of urine microalbumin, diabetic eye exam, and diabetic foot exam.

Methods: The MA/LPN asked the patient about the last eye exam performed and requested a record from the previous provider if performed within the last year. If the microalbumin was not current, the MA/LPN obtained a urine specimen and placed the order into EPIC. If a diabetic foot …

Enhancing Glycemic Control, Patient Knowledge, And Self-Care Through Structured Diabetes Education, Amanda Suzanne Clark

Doctor of Nursing Practice Scholarly Projects

The rising prevalence of diabetes, particularly in South Carolina, revealed a significant gap in structured diabetes education programs, contributing to poor glycemic control and elevated A1C levels. In response, this project aimed to assess the integration of a comprehensive diabetes education program into standard care, potentially reducing A1C levels while improving patient knowledge and self-care behaviors in adults with diabetes over four months. The study used a pretest-posttest design to evaluate the effectiveness of this innovative intervention by comparing participants' outcomes before and after the program. Purpose: To determine if a comprehensive diabetes education program could reduce Hemoglobin A1C levels …

Assessing The Risk Of Adverse Obstetric Outcomes And Determinants Among Mothers With Gestational Diabetes Mellitus At Aga Khan University Hospital, Nairobi, Justus Wambugu

Master of Medicine in Obstetrics and Gynecology

Background: Gestational diabetes (GDM) is recognized as a major concern in obstetric care. It is associated with adverse obstetric outcomes including the risk of cesarean delivery, pregnancy-induced hypertension, obstetric hemorrhage, induction of labour, large for gestational age fetus, preterm delivery, and admission to neonatal critical care units. However, there is limited evidence on the magnitude of risk conferred by GDM for various adverse pregnancy outcomes

Objectives: The primary objective of our study was to assess the relative risk for adverse obstetric outcomes associated with GDM in women diagnosed using the WHO-recommended 75g 2-hour oral glucose tolerance test (OGTT), compared to …

Exploring Veteran And Non-Veteran Nursing Student Satisfaction Utilizing Marginality And Financial Stress, Juanita Nickols

Nursing Theses and Dissertations

It is widely recognized that there is a nursing shortage in the U.S. due to a growing aging population, nurses retiring, and a low nursing school capacity. Nursing schools can ameliorate part of this shortage by devising ways to increase nursing student success and graduation rates. This three-manuscript paper aims to present various ideas to help nursing schools in this endeavor. A relatively unstudied population is the veteran nursing student (VNS), the focus of this paper. The first chapter, Chapter 2: A Concept Analysis of Overload: Implications for Undergraduate Nursing Students Success, discusses the concept of overload so the …

The Evaluation Of Anti-Factor Xa Levels In Hospitalised Patients Receiving Low Molecular Weight Heparin (Lmwh): A Prospective Study, Tandzile Thandwayinkosi Simelane

Master of Medicine in Clinical Pathology

Background 

Patients admitted to the hospital have been reported to have coagulation abnormalities due to various factors including immobilisation, preexisting disease, and current illness. The overall incidence of venous thromboembolism (VTE) in critically ill patients varies from 15% to well over 50%, even with the use of prophylactic measures in most patients. Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are the recommended drugs for VTE prophylaxis in inpatient care. Although not standardly recommended, the laboratory can offer monitoring of anti-Factor Xa using the gold standard method of chromogenic anti-Factor X assay. The anti-Factor Xa levels are notably affected …

Implementing A Team-Based Approach To Reduce Blood Culture Contamination Rates In The Emergency Department: A Quality Improvement Initiative, Melissa Lockhart

Doctor of Nursing Practice Projects

Background: Blood culture contaminations (BCC) present significant risks to patients, including adverse drug reactions and the exacerbation of antibiotic resistance. BCC can also result in millions of dollars in financial burdens for hospitals due to the need for follow-up testing, treatment complications, and antibiotic stewardship efforts. At this facility, the contamination rate in the emergency department (ED) consistently exceeds the national benchmark of 3%. Contributing factors include high patient turnover and increased nursing workloads, which can lead to shortcuts in essential practices such as hand hygiene and skin disinfection before collection.

Purpose: This project aimed to evaluate whether implementing a …

National Patient Safety Goals: Reducing Health Care Disparities In Adult Patients With Alcohol Misuse, Jolie M. Carpenter

Doctor of Nursing Practice Projects

Background: An estimated 76 million people worldwide suffer from alcohol use disorder, accounting for almost two million deaths annually. The Joint Commission has made it a requirement to screen all patients admitted to an inpatient facility for health-related social needs, including alcohol use. By doing so, outpatient resources can be provided appropriately.

Purpose: The facility of interest does not currently have a discharge follow-up protocol. The purpose of this project was to implement an evidence-based protocol to follow-up one week after discharge to determine if patients accessed the community resources provided for alcohol use disorder and to determine whether the …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Implementing A Screening Tool To Increase Palliative Care Referrals For Patients With Metastatic Cancer, Rebecca N. Hegwood

Doctor of Nursing Practice Projects

Background: Palliative care (PC), when prescribed early for patients with metastatic cancer, has proven beneficial to the oncology patient and family by improving quality of life, decreasing stressors, and preventing premature discontinuation of therapy.

Purpose: This Doctor of Nursing quality improvement project aimed to determine if implementing a screening tool for patients newly diagnosed with metastatic cancer would increase PC referrals.

Project Design: The Five Item Palliative Care Screening Tool evaluated patients with a new metastatic cancer diagnosis. Secondary data was used to initiate a PC referral if the patient scored a five or greater on the screening tool. Project …

Implementation Of A Triage Assessment Area To Decrease Left Without Being Seen Rates In The Emergency Department, Margaret Mary T. Steed

Doctor of Nursing Practice Projects

Background: Left without being seen (LWBS) is a concern for emergency departments (EDs) nationwide. LWBS involves patients who sign into the ED and leave prior to being seen by a medical provider. LWBS has been linked to increased wait times in the ED.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project is to aid with decreasing LWBS rates in a local ED. Many tools aid with decreasing LWBS rates, including nurse-initiated protocols and standardized order sets. Despite available tools, LWBS rates remain elevated at 0.95% for the local ED.

Project Design: The evidence-based DNP quality improvement project …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Improving The Detection Of Refractive Errors In First And Third Graders, Tameka J. Bolden

Doctor of Nursing Practice Projects

Background: Vision is a crucial component of the learning process, with academic tasks being heavily dependent on visual acuity. Undetected or diagnosed visual impairments can significantly alter a student’s educational performance and overall development. Currently, in Alabama, kindergarten, second, and fourth grade students are the only students to receive routine vision screenings; therefore, regular screening for visual acuity and eye issues is critical for school health programs. Early screening, diagnosis, and correction of refractive errors prevent permanent visual impairment and support academic success by reducing educational barriers and delayed cognitive impairment.

Purpose: This project aims to improve the early detection …

Influenza And Chronic Obstructive Pulmonary Disease: Correlating Adult Immunization With Exacerbation Reduction After Implementation Of The Global Initiative For Obstructive Lung Disease Recommendations In A Rural Clinic, Jessica Semyonova

Doctor of Nursing Practice Projects

Background: Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations of the disease, leading to disease progression, decreased lung function, increased mortality, and decreased quality of life. However, one of the clinician’s best tools in preventing exacerbations may be the distribution of annual influenza immunizations.

Purpose: This project aimed to determine whether implementing an influenza vaccination protocol would increase influenza vaccination uptake and decrease COPD exacerbation rates.

Project Design: An influenza vaccination protocol was implemented over an eight-week period. During that time, data was gathered and compared to data from the previous year when a vaccination …

Enhancing Patient Outcomes: The Sepsis Navigator Approach, Temeka L. Parker

Doctor of Nursing Practice Projects

Background: Sepsis is the leading cause of hospital mortality, accounting for over $20 billion dollars in total healthcare costs and more than 5 million deaths annually worldwide. The increased burden of sepsis led the Centers for Medicare and Medicaid (CMS) to institute a quality core measure known as the Severe Sepsis and Septic Shock Management Bundle (SEP-1) as a protocol for sepsis treatment. CMS reports national SEP-1 compliance at 62% and 61% for Alabama. The undisclosed project site reports a much lower SEP-1 compliance average of 49% over six months. Compliance with the SEP-1 bundle improves overall patient outcomes and …

Commit To Sit: Does Purposefully Sitting With Adult Medical-Surgical Patients At A Rural Hospital Impact Patient Satisfaction?, Jolie A. Puckett

Doctor of Nursing Practice Projects

Background: Patient satisfaction surveys encourage patients to provide feedback about their experiences with healthcare organizations, and the surveys also play a critical role in identifying gaps in care that may contribute to patient harm. Effective communication between nurses and patients is crucial for delivering high-quality healthcare; therefore, initiatives to enhance this communication should be explored and implemented.

Purpose: This quality improvement project aimed to evaluate whether sitting with patients improved patient satisfaction scores for a medical-surgical unit within a Northwest Georgia inpatient facility.

Project Design: A pre- and post-design method was utilized to compare patient satisfaction scores before and after …

Utilizing Text Messaging To Increase Annual Mammogram Screening Compliance, Lacey B. Santa Cruz

Doctor of Nursing Practice Projects

Background: Routine mammography can lessen breast cancer deaths, but many patients do not follow the current screening guidelines. Limited access to mammography and insufficient awareness lead to missed screening appointments.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to improve annual mammogram adherence among women aged 40-74 by implementing an electronic medical record (EMR)-based text reminder system.

Project Design: Secondary patient data was collected from a privately owned, rural family practice clinic. Using the Mobilize-Assess-Plan-Implement-Track (MAP-IT) quality improvement framework, the project implemented a text message reminder intervention through the EMR. Eligible patients received a text reminder …