Medicine and Health Sciences Commons^™

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 …

Food And Drug Administration Audit Outcomes And Their Association With Class I And Class Ii Food Recalls, Mark Baker

Walden Dissertations and Doctoral Studies

Foodborne illness and food recalls remain major public health concerns in the United States. Guided by the Theory of Planned Behavior, the purpose of this quantitative secondary analysis was to examine whether Food and Drug Administration (FDA) inspection classifications, warning letters, and prior 24-month inspection frequency were associated with facility involvement in a subsequent Class I or Class II food recall. Question-specific analytic files were created from publicly available FDA administrative records. Eligible records included FDA-regulated food facilities with qualifying inspection or warning letter events and sufficient data to assess recall involvement within a 12-month follow-up period. The final analytic …

Continuous 1:1 Sitter Observation Versus Standard Safety Interventions To Reduce Falls In Hospitalized Adults At Risk, Zainab Williams

Student Scholarly Projects

Practice Problem: Patient falls remain a significant patient safety concern among hospitalized adults, particularly those at high risk. Traditional fall-prevention strategies, including continuous 1:1 sitter observation, require evaluation to determine their effectiveness in reducing falls and fall-related injuries.

PICOT: In hospitalized adult patients at high risk for falls (P), does continuous 1:1 sitter observation (I), compared to standard safety interventions (C), reduce fall rates (O) as measured by reported falls per 1,000 patient days during hospitalization over 12 weeks (T)?

Evidence: Current evidence supports multifactorial fall-prevention programs that combine patient assessment, staff engagement, and proactive nursing interventions through intentional rounding. …

Climate Anxiety And Nurses’ Awareness, Motivation, And Behaviors In Addressing Climate-Related Health Risks, Sarah Kaplan

Theses and Dissertations

Background: Climate anxiety, the emotional distress associated with awareness of climate change and its consequences, is an emerging mental health concern that may influence how nurses perceive and respond to climate-related health risks. Climate change is largely driven by emissions of greenhouse gases which radiate and absorb heat. Human-caused climate change is leading to higher average global temperatures and increasing risk to health through poor air quality, changes in vector borne diseases, extreme weather events, and exacerbation and development of physical and mental illnesses. This study contributes to nursing science by examining climate anxiety and climate related health practices among …

Palatal Expansion Using The Invisalign Palatal Expander, Hassan Chihab

ETDs from 2020-2029

Palatal expansion has been used in orthodontics to treat a narrow maxilla and to primarily correct posterior dental crossbites. In younger patients, palatal expansion can readily be achieved through opening of the mid-palatal suture, as it is not fused at that age. As the mid-palatal suture matures, expansion will gradually be difficult to achieve, and more dental expansion is obtained rather than skeletal. In addition, there is a tendency to get more dental tipping. Palatal expansion has been recommended not only to correct crossbites but also to improve breathing in patients with sleep disorders such as obstructive sleep apnea (OSA). …

The Effect Of Part-Time Vs Full-Time Integrated Clinical Education On Student Physical Therapists’ Self-Efficacy And Clinical Reasoning, William J. Buchala

Student Dissertations

Integrated clinical education (ICE) varies across Doctor of Physical Therapy (DPT) programs, particularly in the use of part-time and full-time clinical experiences. Limited research has examined relationships between ICE structure, self-efficacy, and clinical reasoning. The purpose of this quantitative ex post facto study was to examine relationships between part-time and full-time ICE models and self-efficacy and self-assessed clinical reasoning in DPT students. Survey responses were collected from DPT students who had participated in ICE experiences. Self-efficacy was measured using the Physical Therapist Self-Efficacy Scale, and self-assessed clinical reasoning was measured using the Self-Assessment of Clinical Reflection and Reasoning Scale. Independent-samples …

Examination Of Maternal Mortality, Mental Health Conditions, And Co-Occurring Factors, Laura Eileen Skaarer

Walden Dissertations and Doctoral Studies

Maternal mortality (MM) continues to be a public health concern in the state of Arizona. There is little to no research investigating the relationship between MM and mental health conditions co-occurring with contributing factors among women who have died in Arizona while pregnant or within 1 year of the end of a pregnancy. The purposes of this quantitative study, guided by the three delays model (3DM), were to examine (a) MM and mental health conditions as the primary underlying cause of death; (b) MM and mental health conditions surrounding death; and (c) significant contributing factors (i.e., discrimination, knowledge, lack of …

Clinical Practice Guideline To Improve Medication Adherence In Adults With Chronic Conditions In Outpatient Settings, Mulumbwa Chishimba

Walden Dissertations and Doctoral Studies

The Doctor of Nursing Practice project was conducted to develop and assess a clinical practice guideline (CPG) to enhance medication adherence among adult patients with chronic illnesses in an outpatient setting. Adverse health-related outcomes include worsening chronic illness and developing complications, frequent hospital admissions, and rising costs of healthcare services. While some interventions are recommended based on the available literature, most outpatient facilities do not have systematic practices for monitoring and enhancing medication adherence among patients with chronic conditions. The evidence-based question was: What evidence, based on content expert review using the Appraisal of Guidelines for Research and Evaluation II …

Staff Education To Decrease Workplace Violence Through De-Escalation Training In The Emergency Department, Tyrani Anderson

Walden Dissertations and Doctoral Studies

Workplace violence remains a significant issue in healthcare settings, particularly in emergency departments where psychiatric patients may present with aggressive behaviors. Nurses and healthcare staff are frequently exposed to verbal threats, intimidation, and physical aggression, which negatively impact staff safety, job satisfaction, and patient care quality. Despite workplace violence prevention policies, gaps remain in staff preparedness when managing escalating patient behaviors. The purpose of this Doctor of Nursing Practice project was to implement an evidence-based de-escalation training program to improve staff knowledge about managing aggressive psychiatric patients in the emergency department. The practice- focused question was: Can staff education on …

Community Health Workers’ Experiences Distributing Harm Reduction Supplies During Covid-19 In The Barren River Area Development District, Angel Nichole Shoemake

Walden Dissertations and Doctoral Studies

Community health workers (CHWs) distributing sterile injecting equipment help reduce infectious disease transmission among people who inject drugs; however, limited research exists regarding their experiences delivering harm reduction services during public health emergencies in rural areas. The purpose of this qualitative study was to explore CHWs’ experiences and perceptions of health risks, operational barriers, and social influences affecting harm reduction service delivery during the COVID-19 pandemic in the Barren River Area Development District. The health belief model guided this study, emphasizing perceived susceptibility, severity, barriers, benefits, and self-efficacy. Data were collected through semistructured Zoom interviews with eight purposively sampled CHWs …

Examining Hiv Testing In Black Americans In The Southern United States: Association Between Sexual Orientation, Gender Identity, Healthcare Access, And Hiv High-Risk Behaviors, Shavon Wolfe

Walden Dissertations and Doctoral Studies

Examining factors that affect HIV testing in the Black/African American population is important because socioeconomic hardship, stigma, and restricted access to healthcare all lead to gaps in early diagnosis and prevention treatment to prevent further spread of infection. However, most studies have focused on these factors separately, leaving less understanding of how they work together to influence HIV testing behavior. Guided by the health belief model, this study examined the relationship between sexual orientation, gender identity, healthcare access, and HIV high-risk behaviors. The study examined the relationship between sexual orientation, gender identity, healthcare access, and HIV testing, and the influence …

Nurse Staffing Variation Viewed Through The Lens Of Institutional Isomorphism, Mara Raggi

Electronic Theses and Dissertations

Nurse staffing is strongly associated with organizational and patient quality outcomes. Existing studies have not adequately explained why nurse staffing levels vary across hospitals operating under similar external institutional isomorphic pressures. Secondary and administrative datasets, along with random-effects regression models, were used to analyze 6 years of data (2014-2019) and examine the relationship between institutional factors and hospital nurse staffing in the general acute care setting. The results indicate that coercive factors of state laws were significantly associated with nurse staffing. Staffing mandates and staffing committees were significantly associated with increases in nurse staffing, while public reporting was significantly associated …

The Primary Care Brief Intervention Competency Assessment Tool (Bi-Cat): Examining Reliability And Validity, Arielle Guillod

Dissertations

Within primary care, the Primary Care Behavioral Health (PCBH) model integrates behavioral health services into medical settings through brief, population‑based interventions delivered by behavioral health consultants (BHCs). Although effective performance in this role requires competencies distinct from traditional mental health practice, few psychometrically sound tools exist to assess clinical skills in primary care. The Brief Intervention Competency Assessment Tool (BICAT) is commonly used for this purpose but lacks published evidence supporting its reliability and validity. This dissertation examined the psychometric properties of the BICAT across two studies. Study 1 evaluated factor structure, internal consistency, and construct validity in a heterogeneous …

Enhancing Nursing Competency In The Ambulatory Surgery Center, Rachael Owokole

Walden Dissertations and Doctoral Studies

In this project, I addressed a persistent practice problem among agency nurses working in an ambulatory surgery center (ASC) in Southern California, who often enter the facility with varying familiarity with its policies and procedures. I designed this staff education, evidence-based practice (EBP), quality-improvement initiative to strengthen nursing knowledge and competency among agency nurses at the facility. The practice question was designed to assess on whether their knowledge and self-perceived competency improved after participating in the education program. I obtained evidence for the project from peer‑reviewed research, clinical guidelines, and national competency frameworks. I identified sources through systematic searches of …

Staff Education To Instruct Nurses On How To Use The Braden Scale To Increase Their Knowledge, Anna Shedrick

Walden Dissertations and Doctoral Studies

No abstract provided.

Fall Prevention Education Among Older Adults At Townson Assisted Living Facility (Talf), Yolana Farrell-Williams

Walden Dissertations and Doctoral Studies

Falls in the elderly are a significant cause of injury, disability, and preventable medical expenditure; thus, fall prevention is an issue to assisted living homes like Townson Assisted Living Facility (TALF). The internal incident reports showed that persistent fall incidents were associated with inconsistent knowledge among the staff and unequal observed compliance with fall-prevention guidelines, indicating a practice gap in the systematized education of nurses. Educational interventions are effective in achieving high-quality staff, adherence to protocols, and outcomes concerning falls. Consequently, the current project was conducted to determine whether a specialized falls-prevention education program would enhance the knowledge and competency …

Exploring Lifestyle Transitions And Perceptions Of Weight And Health Among College Students In Huntsville, Texas, Keyonna Nicole Thomas

Walden Dissertations and Doctoral Studies

College students aged 18–25 transitioning to independent living often experience changes in diet, physical activity, stress, and time management that increase health risks. These challenges may be amplified in semi-urban communities by limited access to healthy food, transportation barriers, and scheduling constraints. This qualitative phenomenological study explored how college students in Huntsville, Texas, perceived and interpreted these lifestyle changes and their influence on perceptions of health and weight. Guided by the social ecological model, the study included 12 participants who were 18–25 years old, enrolled in college, living independently in Huntsville, Texas, and able to describe their experiences with lifestyle …

Dosimetric Impact Of Replacing An Anterior Field With A 3d Conformal Anterior Partial Arc In Thoracic Spine Palliative Radiotherapy, Camri Garretson

Masters Projects

Purpose: Palliative radiotherapy is commonly used for the treatment of thoracic spine metastases; however, conventional beam arrangements can expose nearby organs at risk (OAR), including the heart, to unnecessary radiation dose. This study evaluated whether replacing a static anterior beam with a conformal anterior arc could reduce cardiac dose while maintaining adequate target coverage.

Methods: Fifteen thoracic spine treatment plans were retrospectively replanned using an experimental technique in which the static anterior beam from the original plans was replaced with a 3D anterior conformal arc. All other planning parameters, including beam geometry, wedges, and multi-leaf collimator margins (MLC), were kept …

The Association Between Food Insecurity, Housing Insecurity, Self-Care Practice And Depression Among Black Immigrants In The United States, Beatrice Ngozi Mbaocha

Walden Dissertations and Doctoral Studies

The prevalence and poor prognosis of depressive symptoms remain significant among adult Black immigrants in the United States. This study examined the complex interplay between food insecurity, housing insecurity, self-care practices, and depression among adult Black immigrants in the United States. Grounded in the socioecological model, this quantitative cross-sectional study analyzed data from N = 469 noninstitutionalized Black immigrant adults (54.2% female, 45.8% male) using the 2023 National Health Interview Survey. Binary logistic regression was employed to assess the probability of depressive symptoms as a function of food insecurity, housing insecurity, and self-care practices, controlling for age, gender, and employment …

Effect Of Virtual Reality Intervention Of Postoperative Pain In Pediatric Surgical Patients, Tara L. Kempker

Dissertations

Problem: Pediatric surgical procedures are associated with preoperative anxiety. Preoperative anxiety is associated with higher postoperative pain. Multiple studies have found that decreasing preoperative anxiety using Virtual Reality (VR) Intervention also decreases postoperative pain scores and use of rescue analgesics in postoperative care units (PACU). However, there is no standardized protocol for use of VR interventions and in our institution, VR was not utilized at all.

Methods: This quality improvement (QI) initiative utilized a quasi-experimental design and convenience sampling. Quantitative data was collected during visits for scheduled operative visits for pediatric surgical patients ages seven to 18 years …

Sleep Disturbances Affect Sleep Quality Of Hospitalized Adults, Tonjia Hardesty

Dissertations

Abstract

Background: Sleep disturbances affect the quality of sleep hospitalized adults experience, possibly extending patient recovery time. Treatment of insomnia frequently includes pharmacological interventions exposing patients to potential side effects, leading to negative patient outcomes.  The purpose of this project was to determine if a sleep hygiene toolkit including eye masks, earplugs, advocacy cards, and removal of nicotine patches at bedtime would improve patient sleep quality without use of pharmacological interventions.

Methods: A descriptive observational design was used in this quality improvement (QI) project. A convenience sample of 37 (N =37) participants over the age of 18 years and …

Psychotropic Medication Use In Older Adults In A Long-Term Care Facility: Implications For Screening Tool, Callie M. Johnson

Dissertations

Psychotropic medication use in older adults aged 65 years and older residing in the long-term care facility has a complex issue in the high use of psychotropic medications. Older adults residing  in long-term care (LTC) facilities are affected and prescribed at least one psychotropic or antidepressant medication.

Enhancing Well-Being: Implementing Weekly Social Interventions For Older Adults In Independent Living, Rosa Huang

Dissertations

Loneliness and social isolation significantly impact the physical and mental well-being of older adults. This quality improvement project implemented an eight-week social intervention designed to reduce loneliness and enhance well-being through weekly sessions incorporating mindfulness exercises, gratitude journaling, and structured socialization activities. The intervention was delivered by nursing students to a sample of residents in a Midwestern independent living community. While most standardized measures of loneliness and mood did not show statistically significant changes, the project resulted in a statistically significant increase in social network engagement as measured by the Lubben Social Network Scale-6 (LSNS-6). The findings suggest that group-based …

Educating School Nurses On Trauma-Informed Care, Na-Keisha Allene White

Walden Dissertations and Doctoral Studies

Trauma-informed care is a critical component of supporting students' overall wellness, and school nurses are central to this work. They are often the first professionals to recognize when a student is exhibiting a trauma response or experiencing a mental health concern during the school day. Although evidence-based school health organizations have advanced efforts to ensure that academic environments are prepared to support students’ mental health needs, school nurses are too often left out of these strategic planning processes. Their exclusion not only overlooks their clinical expertise but also weakens the school’s ability to respond effectively and holistically to student needs. …

Fecal Fatty Acids And Other Risk Factors Associated With Multiple Sclerosis Score, Progression And Diagnosis Among Hispanic Adults, Juliana Ayala-Viqueira

Walden Dissertations and Doctoral Studies

Multiple sclerosis (MS) is a chronic neurological condition with insufficient research regarding risk factors influencing MS severity score (MSSS), progression and diagnosis among Hispanic adults living in the United States. This cross-sectional study assessed factors associated with MS score, progression and diagnosis using secondary data from the International Multiple Sclerosis Microbiome Study (iMSMS). Guided by the ecological model, the study included N = 576 participants with MS. Manuscript 1 explored the association between body mass index (BMI), sodium consumption, and the MS severity score in a Hispanic adult population. A multiple linear regression was conducted to examine whether age and …

The Impact Of Social Determinants Of Health On Alcoholism Among African American Communities Aged 65 And Older, Kymberly Williams

Walden Dissertations and Doctoral Studies

Alcohol use disorder among African American older adults (aged ≥65) remains an underrecognized contributor to preventable morbidity and diminished quality of life. Although previous research has identified individual risk factors for alcohol misuse, little is known about how social determinants of health shape alcohol use among this population. The purpose of this descriptive phenomenological study was to explore how family support, experiences of racial discrimination, religious engagement, and economic stability influence late-life alcohol use. Cultural Resilience Theory guided the exploration of how cultural resources and structural stressors influence alcohol use. Five African American adults aged 65 years and older were …

Cytoskeletal Protein Expression In Autism Spectrum Disorder: A Psychoneuroimmunological Perspective On Sars-Cov-2, James Birch

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic heightened concerns about health disparities among individuals with autism spectrum disorder (ASD). Limited understanding of the biological factors underlying health variability may hinder efforts to reduce disparities and improve care for neurodivergent populations. Guided by the psychoneuroimmunology framework, this quantitative study investigated whether cytoskeletal gene expression was associated with neuroimmune variability in ASD and SARS-CoV-2 populations. Three genes –Nck-associated protein 1 (NCKAP1), WAS/WASL-interacting protein family member 1 (WIPF1), and actin-related protein 2/3 complex subunit 1B (ARPC1B)—were evaluated using two publicly available Gene Expression Omnibus datasets GSE212645 (ASD vs. sibling-matched controls, N = 40) and GSE152641 (SARS-CoV-2-positive vs. …

Clinical Practice Guideline For Evidence-Based Management Of Chronic Prostatitis, Sandra Castro

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project involved the development, expert appraisal, and implementation of an evidence-based Clinical Practice Guideline (CPG) for chronic prostatitis management in adult male patients at a private outpatient clinic. The practice problem was persistent symptom burden from reliance on antibiotic monotherapy without adjunctive therapies, contributing to recurrent symptoms and decreased quality of life. The purpose was to develop and implement a standardized CPG to improve symptom outcomes and support antimicrobial stewardship. The project question was: In adult male patients with chronic prostatitis, how does a standardized CPG incorporating adjunctive ozone therapy and structured symptom monitoring, …

Spatiotemporal Patterns Of Vaccine Uptake For Measles Outbreaks In Katsina State, Nigeria, Zeenat Kabir Asma'i

Walden Dissertations and Doctoral Studies

Measles remains a public health concern in Nigeria despite the availability of effective vaccines, yet limited research has comprehensively examined spatiotemporal patterns and contextual determinants of vaccination coverage and measles incidence in Katsina State. Guided by the socioecological model, this quantitative ecological study examined spatiotemporal patterns of measles incidence among children aged 9–59 months of age across 183 wards in 34 local government areas of Katsina State, Nigeria, from 2018 to 2022. Confirmed cases (n = 376) were analyzed using negative binomial regression and spatial methods, including Moran’s I, SaTScan, and geographically weighted regression (GWR). Urban wards had higher incidence …

Impact Of Wet Vs. Dry Hair And Varying Hair Changes On Surface Dose And Setup Consistency In Whole Brain Radiation Therapy, Dyanira Salinas

Masters Projects

Purpose: The purpose of this research was to quantify how varying hair conditions—dry hair versus wet hair, complete hair loss, and the use of hair extensions—influence surface dose during WBRT. The study evaluated mask fit differences between the varying hair parameters and the potential implications for immobilization accuracy.

Methods: Four CT scans were acquired with a water phantom and varying hair parameters. A whole brain radiation therapy (WBRT) plan was created on a dry wig human hair scan using 6MV photos. Thermoluminescent dosimeters (TLDs) were used to measure surface dose for each hair condition. Gap between the water phantom and …