Medicine and Health Sciences Commons^™

Improving Provider Knowledge And Confidence In Hormone Replacement Therapy Through A Quality Improvement Educational Intervention, Caitlin Schmidt

DNP Projects

Background
Menopause is associated with symptoms that can significantly diminish quality of life. Hormone replacement therapy (HRT) remains the most effective intervention for moderate to severe menopausal symptoms. Despite evidence-based guidelines endorsing its use in appropriately selected patients, HRT utilization remains limited.

Local Problem
A gap in provider knowledge and confidence regarding HRT prescribing was identified in a rural primary care clinic in the Midwestern United States. The clinical needs assessment revealed an absence of standardized menopause-specific education and highlighted an opportunity to improve evidence-based menopause management.

Methods
This quality improvement project employed a pre-post educational design guided by the …

Registered Nurse Procedural Sedation In Operating Room: An Analysis Of Patient Safety And Nurse Confidence Efficacy Of 2 Years Post Implementation, Cassandra Fredrickson

DNP Projects

Background
A Midwest hospital implemented a registered nurse (RN) procedural sedation program to provide safe, cost-effective sedation for selected operating room procedures under physician supervision, improving patient access while optimizing anesthesia resources.

Methods
A retrospective descriptive program evaluation examined 1,117 patients who received RN-administered procedural sedation for vascular and neurovascular procedures during 2022 and 2024. Outcomes included anesthesia consultation, anesthesia takeover, reversal agent use, and adverse events. Patient demographics and procedure duration were analyzed. Six procedural sedation nurses completed a self-efficacy survey assessing confidence in sedation-related competencies. Descriptive statistics and qualitative review of adverse event narratives were performed.

Results
Among …

Elucidation Of Micro/Nanoplastic Signature Of Human And Murine Lung Tissue Utilizing Pyrolysis-Gas Chromatography/Mass Spectrometry, Aerlin D. Decker

Pharmaceutical Sciences ETDs

Micro-and Nanoplastics (MNPs) are ubiquitous biological pollutants that have been identified throughout a variety of biological samples. MNPs have been detected in several human tissues, such as the brain, kidneys, and liver. Lung tissue remains understudied for MNP accumulation despite the large surface area and clear path for exposure. Using Pyrolysis-Gas Chromatography Mass Spectrometry (Py-GC/MS), human lung tissue was evaluated for 12 different polymers, enabling quantification of total plastic per gram of tissue to be identified. Further analysis was performed with Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to investigate heavy metal accumulation in human lung samples and determine whether a …

Enhancing Nursing Self-Efficacy In Advance Care Planning Conversations Through Role-Play Education: A Quality Improvement Project, Rachel Williams

DNP Projects

Background:
Advance care planning (ACP) conversations are essential for ensuring that patient healthcare preferences are understood and respected; however, nurses often report limited confidence and self-efficacy when initiating these discussions. Educational interventions that emphasize communication skills may improve nurses' preparedness to engage in ACP conversations.

Methods:
A quality improvement project utilizing a pre-post intervention design was conducted on three adult inpatient medical units within a regional Midwestern hospital. Registered nurses participated in an educational intervention consisting of ACP education, role-playing case scenarios, guided discussion, and debriefing. A modified 22-item Advance Care Planning Self-Efficacy Questionnaire was administered before and after the …

Medical Recommendations And Bmi Among Black And Hispanic Adolescent Females, Dorothea Polk

Walden Dissertations and Doctoral Studies

Adolescent obesity persists as a critical public health challenge in the United States, with Black and Hispanic adolescent females experiencing elevated rates. Adolescent obesity contributes to serious long-term health risks, but provider counseling may support body mass index (BMI) management. Guided by the social-ecological model, this study examined whether receiving medical recommendations to control or lose weight was associated with BMI among Black and Hispanic adolescent females aged 16–19 years and whether meal preparation habits and food security status moderated this association, controlling for age, household income, and race/ethnicity. This quantitative, cross-sectional secondary analysis used multiple linear regression analyses to …

Enhancing Surgical Team Readiness: Simulation Training For Power Failure Response In Robotic Procedures, Heather Marie Sorton

Walden Dissertations and Doctoral Studies

In this Doctor of Nursing Practice (DNP) project, I used a quality improvement design to implement and evaluate a simulation-based education aimed at improving perioperative staff knowledge related to robotic power-loss events. A practice gap was identified in staff preparedness for robotic system failures due to limited education on emergency protocols, communication, team roles, and Association of PeriOperative Registered Nurses (AORN)-aligned response processes, impacting patient safety during robotic-assisted procedures. I examined whether implementation of a simulation-based educational intervention improved staff knowledge related to robotic power-loss management. The purpose of the project was to improve staff knowledge and standardize responses to …

Uv Damage Mapping Reveals Different Impacts Of Xpd Mutations On Global Genomic And Transcription-Coupled Dna Repair, Allyson Hoag

Biomedical Sciences ETDs

Nucleotide Excision Repair (NER) is a fundamental cellular process that removes bulky and helical distorting lesions from the genome through the separate responses of its two subpathways – global genomic (GG-NER) and transcription coupled (TC-NER) DNA repair. The pathways converge with the recruitment of the TFIIH complex, a key step that is mediated by the translocase and helicase activities of  its XPD subunit. Germline mutations in XPD result in the clinical disorders, Xeroderma Pigmentosum (XP) and XP combined with Cockayne Syndrome (XP/CS). The goal of this thesis was to understand if XPD XP and XP/CS mutations differentially impact GG-NER and …

Mapping And Modeling Threat-Evoked Brain States After Early Life Adversity, Taylor W. Uselman

Biomedical Sciences ETDs

Early life adversity (ELA) increases lifelong neuropsychiatric vulnerability. Yet how ELA reorganizes brain-wide activity and circuit coordination across later experience remains unclear. This dissertation tests the hypothesis that ELA alters adult brain-wide activity and responses to threat through disrupted coordination among neural systems that regulate emotional experience, including prefrontal-limbic and monoaminergic systems. Longitudinal manganese-enhanced MRI of adult mice exposed to standard or fragmented early care, combined with computational processing and statistical modeling, quantified brain states before, during, and long after innate predator threat. These studies established that acute threat evokes large-scale, distributed brain activity that evolves over time. ELA potentiates …

Prenatal Alcohol Exposure Induces Vulnerability To Mild Stress Through Heightened Limbic Glial Activation And Cytokine Release, Justine R. Zimmerly

Biomedical Sciences ETDs

Fetal alcohol spectrum disorder (FASD) results from prenatal alcohol exposure (PAE) and is linked to development of mood disorders, which in turn are driven by dysregulation of the sympathetic nervous system, the neuroendocrine hypothalamic-pituitary-adrenal (HPA) axis, and the central nervous system (CNS) neuroimmune response to stressors. PAE alters brain glial activation and proinflammatory cytokine expression through secondary challenges such as psychological stressors. The goals of the experiments presented in this dissertation were to 1) examine peripheral glucocorticoid receptor function following mild acute stress in adult PAE offspring, 2) characterize a sensitized cytokine stress response in the hippocampus, medial prefrontal cortex, …

Naturalistic Aided Language Intervention For Children Who Have Multiple Disabilities Including Visual Impairment, Naomi Nattress

Speech and Hearing Sciences ETDs

ABSTRACT

This dissertation examined aided AAC interventions for individuals with multiple disabilities, including visual impairment, across three original studies. Chapter 2, a meta-analysis, found limited rigorous research for this population while showing that individuals at early symbolic stages with diverse visual profiles can successfully engage with AAC when appropriate adaptations are provided. The pilot study in Chapter 3 indicated that caregivers and graduate student clinicians can learn and implement naturalistic AAC techniques and VI accommodations with high fidelity through structured coaching. The mixed methods study in Chapter 4 introduced the ImPAACT-VI program, showing strong outcomes in educator performance, students’ symbolic …

The Dental Hygienist Perspective On Laser Use For Nonsurgical Periodontal Therapy, Tammie A. Nyce Mrs.

Dental Hygiene ETDs

The purpose of this study was to assess the perceptions, attitudes, and experiences of dental hygienists regarding the use of lasers in the non-surgical treatment of periodontal disease.  A descriptive survey was distributed via email to current active and inactive members of the American Dental Hygienists’ Association. The sample consisted of practicing dental hygienists who had received training in laser use and lived in states that allowed laser use by dental hygienists.   Those dental hygienists who are not practicing clinically, who are not trained in the use of lasers, and who do not have experience using lasers in the treatment …

Study On The Accuracy Of Varian Eclipse Mlc Modeling When Mlcs Are Open Beyond The Jaw In Breast Cancer Patient Planning Using Aaa And Acuros With Both Dual-Isocentric Technique And Mono-Isocentric Technique., Amy Rogers

Masters Projects

Accurate dose delivery at the chest wall-supraclavicular (CW-SCV) junction remains an important challenge in breast irradiation, especially when multileaf collimator (MLC) leaves are intentionally opened beyond the collimator jaws to improve junction coverage. This study evaluated the dosimetric accuracy of the Varian Eclipse treatment planning system (TPS) at the CW-SCV junction using the Anisotropic Analytical Algorithm (AAA) and Acuros XB calculation algorithms with mono-isocentric and dual-isocentric treatment techniques. A prospective phantom-based study was performed using a solid water phantom and a Varian TrueBeam linear accelerator. Twenty-four unique three-dimensional conformal treatment plan configurations were created using combinations of beam energy (6 …

Exercise Self-Efficacy And Physical Wellness In A Worksite Wellness Program: Exploring Factor Structure And Perceptions, Micah B. Mcglathery

Dissertations

Exploring Perceptions of Exercise Self-Efficacy and Physical Wellness in a Worksite Wellness Program

Abstract

Worksite wellness programs are increasingly adopted to address insufficient exercise participation and other health-related behaviors that put employees at risk of chronic disease. Although quantitative outcomes are well-documented, there is limited research exploring how employees perceive these programs' impact on personal behavior change, particularly in relation to exercise self-efficacy. Guided by the Social Cognitive Theory and the Exercise is Medicine initiative, this study qualitatively investigates employee perceptions of a worksite wellness program’s influence on physical wellness and confidence to exercise. A phenomenological approach using semi-structured interviews …

Using Fecal Diagnostic Tests To Assess The Prevalence Of Fasciola Hepatica In The United States Sheep Population, Brooke A. Delcambre

LSU Master's Theses

Fasciola hepatica, the common liver fluke, is endemic in the Pacific Northwest and Gulf Coast of the United States. To provide updated information on F. hepatica prevalence, as part of the USDA National Animal Health Monitoring System Sheep 2024 study, sheep operations in the top 30 sheep-producing states were identified, and producers were invited to participate. For each operation, feces were collected from at least eight sheep and pooled to form a single composite sample. Two methods were used to identify sheep infected with F. hepatica: fecal sedimentation and indirect sandwich ELISA. At the national level, across 318 operations, 7.1 …

Improving Provider Adherence To Adolescent Depression Screening: Implementation Of A Standardized Phq-A Workflow In Pediatric Primary Care, Taylor P. H. Wamser

Student Scholarly Projects

Practice Problem: Adolescent depression is frequently under identified in pediatric primary care because of inconsistent implementation of routine depression screening despite national recommendations. This practice gap may delay diagnosis and treatment which may increase the risk of adverse mental health outcomes.

PICOT: The PICOT question that guided this project was: In pediatric primary care providers, how does the implementation of a standardized PHQ-A (Patient Health Questionnaire for Adolescents) workflow compared to informal screening practices affect provider adherence to depression screening guidelines over 12 weeks?

Evidence: Current evidence and national clinical practice guidelines support routine adolescent depression screening using validated tools …

Enhancing Chronic Kidney Disease Awareness And Early Identification Through Community Health Worker Education In Rural Arkansas, Samantha L.M. Smith

Walden Dissertations and Doctoral Studies

The doctoral project was focused on improving staff education and development to prevent chronic kidney disease (CKD) through community health worker (CHW) education. The practice problem was the delayed identification of CKD risk factors and late referral to nephrology services, particularly among rural and underserved populations. Because CKD often progresses without symptoms, early education and awareness are critical to improving outcomes and reducing disease progression. The purpose of the project was to develop and implement a structured CKD educational curriculum for CHWs to improve their confidence in kidney health, CKD risk factors, prevention strategies, early identification, and referral awareness. The …

Time Series Analysis Of Temperature And Pollen Exposure On Asthma Outcomes In Atlanta, Georgia, Victoria Okereke-Viktorsson

Walden Dissertations and Doctoral Studies

The effects of climate change contribute to volatile temperature changes, which coupled with pollen exposure pose a significant threat to asthmatic people, potentially impacting methods for asthma management. The purpose of this ecological time-series study was to use the carbon dioxide theory of climate change, Dutch hypothesis, and social ecological model to estimate the relationship between average temperature and average pollen concentrations on average asthma morbidity outcomes for adults living in metropolitan Atlanta from 2020 to 2022 (N = 37,913). Results varied in terms of years, socioeconomic status (SES) vulnerability, gender, and racial group. Overall, a linear regression model revealed …

Kras-Independent Factors Drive Pi3k Signaling And Circumvent The Necessity Of Kras-Driven Pi3k Activation In Pdac, Lucas Christopher Bialousow

MUSC Theses and Dissertations

Pancreatic ductal adenocarcinoma (PDAC) has one of the lowest five-year survival rates among cancers and is characterized by near-ubiquitous occurrence of oncogenic KRAS mutations. Oncogenic KRAS activates several downstream pathways, including ERK 1/2 MAPK and PI3K, which are critical for PDAC. However, accumulating evidence suggests that PI3K activity can be maintained independent of oncogenic KRAS. The high prevalence of KRAS^G12R in PDAC challenges the prevailing model of KRAS-driven PI3K activation, as this mutant is defective in direct engagement with PI3Kα. These observations raise important questions regarding how PI3K signaling is sustained in PDAC. Here, we investigated KRAS-independent mechanisms that …

Parental Enculturation And Child Well-Being In Immigrant Families: Examining Peer Relationship Difficulties And Emotional Symptoms In Asian American Youth, Yuxin Yu

LSU Master's Theses

Parents with immigration backgrounds face the dual challenges of maintaining their heritage culture while supporting their children’s adaptation to the mainstream culture. Although previous studies stressed both acculturation and enculturation, these two processes can compete and even conflict, leading to the important question for parents: Does parental enculturation influence children’s peer relationships and emotional functioning? This study examines the associations between parental enculturation and the social and emotional adaptation of Asian American youth by focusing on peer relationship difficulties and emotional symptoms. Participants included 75 Asian American parents of children aged 4 to 17, who completed measures of parental enculturation …

Risk Factors For Metabolic Syndrome Among U.S.-Born And Non-U.S.-Born Hispanics In The United States, Banessa Maldonado

Walden Dissertations and Doctoral Studies

Current knowledge regarding risk factors for metabolic syndrome (METS) among Hispanic individuals of Mexican descent remains limited. Using data from NHANES 2017–2020, this study compared factors contributing to METS and included U.S.-born and non-U.S.-born Hispanic adults of Mexican descent aged ≥ 18 years living in the USA (N = 949) with assessed METS. Grounded in the social ecological model and social determinants of health, this research evaluated dietary habits, lifestyle patterns, and acculturation processes using multivariate logistic regression and stratified analyses. Educational attainment was associated with METS, but the association was not statistically significant in adjusted models p = 0.528. …

Enhancing Staff Knowledge Of Prenatal Depression Screening And Follow-Up Protocols, Gladys Ajohmbu Esunji

Walden Dissertations and Doctoral Studies

This staff education project addressed inconsistent staff knowledge of prenatal depression screening and follow-up protocols in an outpatient behavioral health practice serving prenatal patients. Prenatal depression is a nursing practice concern because delayed identification and inconsistent follow-up may affect maternal well-being, infant outcomes, family functioning, and timely access to behavioral health support. The practice-focused question was: According to the evidence, among clinical staff in an outpatient maternal mental health setting, what is the impact of structured staff education on adherence to prenatal depression screening on follow-up protocol knowledge? The purpose was to improve clinical staff knowledge through a structured education …

Exploring Caregiving Choice In The Adult Cancer Population, Jennifer L. Huggins

MUSC Theses and Dissertations

ABSTRACT Purpose Although extensive research examines family caregivers (FCs) across populations, less attention has been paid to how lack of choice in assuming the role affects quality of life (QOL) among FCs of adults with cancer. Understanding choice could guide interventions protecting this invaluable, often invisible workforce. Aims (1) Synthesize what is known about perceived choice among informal caregivers of adults with serious illness; (2) assess relationships between caregiving choice and caregiver QOL, burden, sleep, depression, stress, and social determinants of health; (3) describe experiences of FCs of adults with cancer providing care with no, little, or some choice. Design …

Relationship Between Internet Use, Perceived Social Support, And Obesity Among African American Young Adults, Marketta Mccollough

Walden Dissertations and Doctoral Studies

The disproportionately high prevalence of obesity among African American young adults is a significant public health crisis rooted in systemic inequities. The purpose of this quantitative cross-sectional study was to examine the relationships between internet use for health information, perceived social support (online and offline), and obesity in this population. Grounded in the social cognitive theory (SCT), this study investigated how these behavioral and environmental factors interact to influence body mass index. Using secondary data from the 2021–2023 National Health and Nutrition Examination Survey, a complex samples logistic regression with a Bonferroni correction (α = .0125) was conducted on an …

Proposal For A Comprehensive Workplace Violence Program In An Acute Care Facility, Christin V. Timmons

Walden Dissertations and Doctoral Studies

Workplace violence (WPV) in healthcare is a growing threat to caregiver safety, workforce stability, and patient outcomes. At a newly opened acute care facility, the absence of a comprehensive WPV prevention program posed a gap in practice, creating safety risks and regulatory vulnerability. A literature search was conducted using CINAHL, PubMed/ MEDLINE, ProQuest Nursing & Allied Health collection, and Google Scholar. A total of 50 articles were identified with 11 articles meeting all inclusion criteria. Collectively, findings supported comprehensive, multicomponent WPV prevention programs to integrate leadership engagement, structured governance, staff education, environmental controls, and continuous data monitoring to improve safety …

Association Between Opioids And Leukemia/Lymphoma In Adults Living In The United States, Brenda Sue Newberry-Colasanti

Walden Dissertations and Doctoral Studies

Opioid prescribing rates and opioid misuse remain high throughout the United States. Exposure to opioids has been positively associated with various cancers; however, research evaluating associations between opioid exposure and hematologic cancers like leukemia and lymphoma is limited. Using the Socio- Ecological Model as a foundation, this quantitative cross-sectional study aimed to analyze the association between medicinal opioid use, opioid misuse, and leukemia/lymphoma while exploring how selected social determinants of health (SDOH) may modify that relationship. Secondary data were pooled from the 2015–20-year United States National Survey on Drug Use and Health (NSDUH). One thousand three hundred and twenty binary …

Association Between Resource Availability And Wellbeing Of Autism Patients In Ghana, Kwabena Aduse-Poku

Walden Dissertations and Doctoral Studies

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that presents significant challenges for children and families in Ghana, where resources remain limited. Grounded in the social ecological model, this quantitative cross-sectional study examined the associations between autism management programs and wellbeing, defined briefly as independent functioning in daily life and learning of autism patients enrolled in selected institutions in Accra and Kumasi, Ghana. Data were collected from N=122 autism patients using structured questionnaires that were completed by caregivers and program staff. Binary logistic regression analyses were conducted to assess relationships between program type, regional location, and years of enrollment and …

Health Literacy And Diabetes Self-Care Behavior, Eucharia Amaefule

Walden Dissertations and Doctoral Studies

Limited health literacy is a significant barrier to effective diabetes self-management among adults with type 2 diabetes mellitus (T2DM), yet nationally representative evidence using comprehensive health literacy measures remains limited. Guided by the health belief model, the purpose of this quantitative, secondary data analysis using cross-sectional data was to examine the relationship between health literacy and diabetes self-care behaviors among U.S. adults with T2DM and determine whether education level moderated this relationship. Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed for U.S. adults (N = 9, 535) with self-reported T2DM. Diabetes self-care behaviors included blood glucose monitoring, …

A Program Proposal For A Leadership-Driven, Evidence-Based, Intentional Rounding Playbook, Jacqueline Butler Brown

Walden Dissertations and Doctoral Studies

Patient experience is a key indicator of healthcare quality. In an acute care hospital in Northeast Georgia, intentional rounding is an established practice. Inconsistent communication, variable leadership engagement, and limited accountability are practice gaps that have reduced its effectiveness in improving patient experience outcomes. A comprehensive literature review using PubMed, CINAHL, MEDLINE, and the Cochrane Library yielded 15 peer-reviewed studies that consistently support intentional rounding as an evidence-based strategy for improving patient satisfaction. As the team leader for this Executive Leadership System Improvement Project, I proposed the development of an Evidence-Based, Leader-Driven Intentional Rounding Program Playbook to standardize enhanced rounding …

The Effects Of Anti-Gdnf On The Sensory And Autonomic Nervous System In The Heart, Tryphosa Konadu

Honors Theses

Heart disease is the number one leading cause of death; about 1 in every five deaths is due to heart disease. “Heart disease” is a catch-all phrase that encompasses a variety of conditions that affect the heart’s structure and function. Many of these symptoms can be attributed to dysfunction within the parasympathetic, sympathetic, and sensory nervous systems. Neurotrophic factors like GDNF (Glial cell line-derived neurotrophic factor), BDNF (Brain-derived neurotrophic factor), and NGF (Nerve growth factor) promotes neuronal survival, and regeneration of the nerve fibers of the heart, especially sensory and autonomic nerve fibers. Studies have suggested that increased expression of …

Understanding The Experience Of Separation On The Substance-Exposed Mother-Infant Dyad, Tamara Lee Depascale

Electronic Theses and Dissertations

Maternal-infant separation following birth is a profoundly distressing experience that may have significant emotional, relational, and health implications for mothers with substance use disorders (SUD). Guided by Caring Science and Swanson’s Theory of Caring, the purpose of this qualitative descriptive study was to explore the dimensions of the health challenge associated with maternal-infant separation among mothers with SUD following birth and the approaches mothers used to navigate and respond to that experience. Data were collected through semi structured interviews with mothers who had experienced separation from their infants following birth and analyzed using deductive and inductive thematic analysis. Findings revealed …