Medicine and Health Sciences Commons^™

Beyond Symptoms: Examining Perinatal Mental Health Care Among Black, Indigenous And People Of Color With Polyendocrine Metabolic Ovarian Syndrome, Vinaya Thomas

Electronic Theses and Dissertations

Perinatal mood and anxiety disorders (PMADs) are as a public health concern in the United States. Individuals from minoritized racial/ethnic groups face a significantly elevated risk of maternal morbidity, mortality, mental health disorders, and associated adverse outcomes. Emerging studies also reveal a higher likelihood of experiencing perinatal mental health concerns in individuals with polycystic ovarian syndrome (PCOS), currently known as polyendocrine metabolic ovarian syndrome (PMOS). People who identify as Black, Indigenous, or a person of color (BIPOC) face unique healthcare challenges given the added structural and social burdens. This online survey study aimed to 1) understand the relationship between PMOS …

An Assessment Of Accessibility And Affordability Of Inpatient Psychiatric Care In Tennessee, Kailee Havrda

Electronic Theses and Dissertations

Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.

Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive …

Phytochemical And In-Vitro Cytotoxic Analyses Of Flavonoid Species Isolated From Chromolaena Leivensis, Luke A. Bryant

Electronic Theses and Dissertations

As a leading cause of death worldwide, cancer and its treatments remain a primary source of interest among researchers. Modern studies are looking into bioselective cytotoxicity to create new chemotherapies that do not have the same harsh side effects as those we use today. Natural product research has a promising future for the development of such treatments. Specifically, polar flavonoids may be the key to a bioselective treatment. Such flavonoid species are native to plants, often within flower petals or within the body. A natural antioxidant, they are designed not to harm healthy cells. This study focuses on the plant …

Correctional Officer Suicide: A Theory-Driven Investigation Of Acquired Capability And Suicide Behavior, Abigail R. Andersen

All-Inclusive List of Electronic Theses and Dissertations

A growing body of research suggests that correctional officers (COs) die by suicide at a significantly higher rate compared to the general population and some other public safety personnel. Despite what is known about this phenomenon, an understanding of the risk factors driving the high rate of suicide among this population remains unclear. Specifically, little attention has been paid to specific risk factors for suicide among this population and there is an overall absence of theory-driven research investigating CO suicide. The present study sought to address the gap in this area of research by investigating potential risk factors for suicide …

Characterization Of Regulation Of Ace2 And Morphogenesis (Ram) Pathway Components In Aspergillus Fumigatus, Devi Naga Jyothi Bale

Theses and Dissertations (ETD)

Aspergillus fumigatus CotA is a conserved protein kinase and predicted orthologue of Cbk1, a terminal kinase of the Regulation of Ace2 and Morphogenesis (RAM) network. In our previous study, disruption of CotA resulted in carbon source dependent invasive growth with the mutant exhibiting preferential growth on glucose but severely impaired growth on alternate carbon sources. This pathway in other fungi has been implicated in the regulation of morphogenesis, stress responses, and virulence, but this study is the first one to characterize it in the pathogenic filamentous fungus.  In yeast, the RAM network includes the CotA ortholog, Cbk1, and associated proteins, …

Comparative Performance Of Physiological Vital-Sign Forecasting Under Random And Patient-Wise Splitting Using Deep Learning, Lavanya Vasavi Chittem Reddy

Theses and Dissertations

Physiological vital-sign forecasting estimates future measurements based on recent temporal patterns and can support analysis of continuously recorded monitoring data. This study comparatively evaluated deep feedforward, recurrent, bidirectional recurrent, long short-term memory, and bidirectional long short-term memory architectures for one-step-ahead forecasting of peripheral oxygen saturation, heart rate, and pulse rate. Each model received consecutive observations of peripheral oxygen saturation, heart rate, pulse rate, respiratory rate, and age, while separate single-output models predicted the next value of the selected target.

Random and patient-wise data splitting were compared using identical input definitions, preprocessing procedures, model architectures, and training hyperparameters. The strongest architecture …

The Benefits And Barriers To Expanding Crna Programs In Michigan, Grace Van Zweden

Honors Theses

The demand for Certified Registered Nurse Anesthetists (CRNAs) and their delivery of safe, high-quality anesthesia care has increased significantly due to nationwide anesthesia provider shortages and the growing reliance on CRNAs to meet healthcare system needs. This demand underscores the importance of expanding nurse anesthesia programs in Michigan and across the United States to support nurses pursuing advanced education and to improve patient access to essential care within their communities. The CRNA profession has evolved over time to meet the changing needs of the healthcare system, and current CRNA programs require applicants to satisfy rigorous and highly specific admission criteria. …

Foundation Models In Healthcare: Pre-Training, Alignment, And Clinical Applications, Arvind Pillai

Dartmouth College Ph.D Dissertations

Foundation models offer an impactful paradigm for healthcare by learning generalizable representations from vast amounts of unlabeled data that can efficiently adapt to a wide range of clinical tasks. This thesis presents five studies organized around three pillars crucial to advance foundation models in healthcare. Pillar I: Pre-training: Chapter I introduces PaPaGei, an open foundation model designed for photoplethysmography (PPG) signals. PaPaGei is pre-trained on large-scale continuous optical data using a morphology-aware self-supervised objective, outperforming general time-series models across diverse clinical tasks while remaining parameter-efficient and robust across skin tones. Pillar II: Alignment: To bridge continuous sensor data and language …

Implementation Of A Standardized Social Determinants Of Health Screening And Documentation Workflow In Primary Care, Callistus Eze Okereh

Walden Dissertations and Doctoral Studies

The completed quality-improvement project addressed inconsistent screening and incomplete electronic health record (EHR) documentation of low-income, limited family support, and transportation barriers in a primary care clinic. The nursing practice problem can disrupt access, adherence, chronic disease management, and continuity of care. The practice-focused question examined whether an ADDIE-based education program would improve social determinants of health (SDOH) screening, EHR documentation, staff knowledge and confidence, and referral or follow-up documentation during a 6- to 8-week period. The project purpose was to develop, implement, and evaluate a role-based education program and standardized workflow for clinic staff. Evidence sources were drawn from …

Implementation Of A Standardized Protocol To Improve Provider Documentation And Initiation Of Guideline-Concordant Hypertension Follow-Up Within 14 Days In Primary Care, Stella Williams

Doctor of Nursing Practice Projects

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality, yet timely follow-up after elevated blood pressure (BP) readings is not consistently documented in primary care. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a standardized hypertension screening follow-up protocol improved provider initiation or documentation of guideline-concordant follow-up within 14 days. The faculty-approved PICOT population was primary care providers in a primary care clinic; we used eligible electronic health record (EHR) encounters as the analytic records to observe provider performance. We used a quantitative pre/post design and retrospectively reviewed 30 eligible EHR encounters: 15 pre-implementation …

Facilitating Timely Hospice Referrals Using A Screening Toolkit In A Rural Hospital: A Quality Improvement Initiative, Jessica Muse

Doctoral Projects

End of life care is often a difficult time for patients, families, and caregivers. Hospice is a valuable resource for individuals who are considered terminally ill and have a life expectancy of six months or less. Many patients who are near the end present to acute care settings for treatment needs. While there are several clinical indicators that may suggest hospice care is the best plan of care for a patient, identifying hospice appropriate patients can be difficult in an acute care setting and there are currently no numerical assessment tools available in the literature that provides a quick reference …

Ai-Driven Biomarker Discovery & Progression Modeling For Precision Diagnosis Of Glaucoma, Cheng Huang

Computer Science and Engineering Theses and Dissertations

This dissertation presents a comprehensive study on the integration of artificial intelligence (AI) for glaucoma diagnosis and retinal image analysis. Leveraging multimodal imaging data including fundus photography, Optical Coherence Tomography Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA), the research develops a suite of deep learning frameworks designed to detect early glaucomatous changes with high precision, robustness, and interpretability. A series of novel architectures are introduced, spanning vessel segmentation networks, biomarker discovery pipelines, and multimodal fusion models, all designed to enhance diagnostic accuracy and generalizability across diverse populations. To facilitate reproducible and scalable ophthalmic AI research, this work …

Enhancing Care Coordination: Nurse-Physician Bedside Communication To Improve Outcomes, Harriet Chinakwe

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Inconsistent nurse-physician bedside communication on a 28-bed hybrid intermediate stepdown unit contributed to gaps in care coordination, patient engagement, and discharge readiness. Baseline Centers for Medicare & Medicaid Services (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (2026), Press Ganey (2022) communication scores were below the national 90th-percentile benchmark; nurse communication at 58% and doctor communication at 46%, indicating the need for a structured communication process.

Aim of the Project: The quality improvement project aimed to improve nurse-physician communication during daily bedside rounds by implementing a TeamSTEPPS-informed, structured bedside rounding process using the PATIENT tool over 12 …

Cdc’S Steadi Fall Toolkit To Decrease Adult Inpatient Medical-Surgical Fall Rates, Kevin Graham

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Adult inpatient falls are a persistent patient safety concern that can result in injury, prolonged hospitalization, and increased healthcare utilization. The identified medical-surgical unit had a baseline fall rate of 4.88 falls per 1,000 patient days, exceeding the organizational goal of fewer than 3.0 falls per 1,000 patient days. An organizational assessment identified inconsistent fall-risk assessment, documentation, patient education, and individualized prevention strategies as practice gaps.

Aim of the Project: The aim was to reduce the inpatient fall rate to fewer than 3.0 falls per 1,000 patient days through implementation of the CDC’s Stopping Elderly Accidents, Deaths & Injuries …

Fall Prevention In The Inpatient Oncology Unit Using Fall Boards And Visual Cues, Rachel Miller

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls remain a significant patient safety concern in hospitals. In an inpatient oncology unit at a large academic medical center, falls increased from 33 in 2024 to 46 in 2025, while the fall rate increased from 2.86 to 3.95 falls per 1,000 patient days. A gap analysis revealed that only 5% of high fall-risk patients had fall boards and visual cues in place.

Aim of the Project: The aim of this quality improvement (QI) project was to increase the utilization of fall boards and visual cues for high fall-risk patients through implementation of a standardized fall prevention education bundle …

Implementing An Evidence-Based Checklist To Improve Hypertension Clinical Performance, Angelica Wilson

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hypertension is a significant chronic disease management challenge at an urban Federally Qualified Health Center (FQHC), where about 26% of adults aged 18 to 85 years have uncontrolled blood pressure (BP). Despite the organization achieving a hypertension control rate of 74%, which exceeds the national FQHC average of 57.6% and approaches the goal of 80%, there remains inconsistent implementation of evidence-based hypertension management. The lack of standardized workflow has led to variances in BP reassessment, treatment management, lifestyle counseling, documentation, and follow-up, resulting in missed opportunities for guideline-directed care.

Aim of the Project: The quality improvement (QI) project aimed …

Strengthening Post-Fall Huddle Practices In Long-Term Care, Janette Perry

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: High resident fall rates and repeat falls caused by an unreliable nurse-only post-fall huddle (PFH) process that lacked structure, interdisciplinary participation, and timely root-cause analysis.

Aim of the Project: To reduce falls and fall-related injuries in long-term care units by implementing a standardized, evidence-based PFH workflow that strengthens root-cause analysis, improves interdisciplinary communication, and increases PFH reliability.

Review of the Evidence: Evidence from fourteen high-quality, peer-reviewed studies demonstrates that structured, interdisciplinary post-fall huddles are more effective than informal, nurse-only approaches in improving fall analysis and reducing repeat falls in long-term care settings. Structured PFHs strengthen root-cause analysis; interdisciplinary participation …

A Policy Analysis Of Nurse Practitioner Requirements In California Children’S Services Programs, Erna Josiah-Davis

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

California Children’s Services (CCS) is a state and federally funded program administered by the Department of Health Care Services that provides care coordination, therapy services and referrals for residents under the age of 22 years. CCS Numbered Letter 07-0123 outlines the requirements for nurse practitioner (NP) practice in CCS’ Special Care Centers. The Numbered Letter (NL) policy may have workforce and operational impacts that have not been assessed.

Aim of the Project:

The policy analysis’ aims were to describe policy impacts of the Numbered Letter on CCS programs, clients and providers, communicate impacts with stakeholders, and share policy recommendations …

Improving Abnormal Involuntary Movement Scale Screening Consistency In Outpatient Psychiatric Practice, Jeriece Lovelace

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) are potential adverse effects of long-term antipsychotic use that require ongoing monitoring. At the project site, inconsistent staff education, a lack of a standardized screening process, and the absence of electronic health record (EHR) reminders contributed to missed Abnormal Involuntary Movement Scale (AIMS) screenings. Baseline screening compliance was 54.7% (106/194).

Aim of the Project: The aim of this quality improvement project was to increase AIMS screening compliance among adult patients receiving long-term antipsychotic therapy from a baseline of 54.7% to 90.7% within 12 weeks.

Review of the Evidence: Literature review has shown …

Analysis Of The Deborah Sampson Act Of 2020: Improving Women Veterans’ Care, Jessica N. Shipp

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Women Veterans are one of the fastest-growing populations served by the Veterans Health Administration (VHA), yet gaps persist in access to gender-responsive, trauma-informed care. Despite requirements established by the Deborah Sampson Act (DSA) of 2020, implementation remains inconsistent in Women's Health Primary Care Provider (WH-PCP) access, women's mental health (MH) services, military sexual trauma (MST) care, workforce capacity, care coordination, and accountability.

Aim of the Project: The aim was to evaluate the effectiveness, feasibility, equity, and implementation fidelity of the DSA using the Centers for Disease Control and Prevention (CDC) Policy Analytical Framework (POLARIS) and identify evidence-based recommendations to …

Program Evaluation: Effectiveness Of Case Management Carehub For Skilled Nursing Facility Transitions, Rachel Choudhury

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Ineffective communication during transitions from acute care hospitals to skilled nursing facilities (SNFs) contributes to avoidable bed days (ABDs), prolonged length of stay (LOS), and discharge delays. Although evidence-based tools such as InterQual and Milliman Care Guidelines supported clinical decision-making, a standardized communication process among case managers, social workers, payers, and SNF partners was lacking. This program evaluation examined the effectiveness of a standardized CareHub communication workflow designed to improve discharge coordination and transitions to SNFs.

Methods: Guided by the Centers for Disease Control and Prevention Program Evaluation Framework, a 90-day program evaluation (February-April 2026) was conducted in a …

Improving Outcomes Through Early Management Of Pre-Eclampsia Risk Factors, Ada Licin-Odnez

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Pre-eclampsia is a serious pregnancy condition characterized by high blood pressure and proteinuria, typically occurring after 20 weeks. Pre-eclampsia affects 2–8% of pregnancies globally. Early detection and proper care are essential. The OBGYN clinic reports a 20% rate among high-risk patients, significantly higher than the national 5–8%, attributed to limited education, poor care coordination, and inadequate postpartum support. A medication-only approach without proper education has not effectively reduced the rates.

Aim of the Project: The overarching aim of the Quality Improvement project was to improve maternal and infant outcomes by managing pre-eclampsia risk factors. The QI project reduced the …

Improving Guideline-Directed Sodium–Glucose Cotransporter-2 Inhibitor Use In Reducing Proteinuria In Chronic Kidney Disease, Tamara Martin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Chronic kidney disease (CKD) is a progressive condition associated with increased risk for end-stage kidney disease, cardiovascular complications, hospitalization, and substantial healthcare costs. Proteinuria is an important marker of kidney damage and contributes to CKD progression. Although evidence-based guidelines support sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy in eligible patients with CKD, an outpatient nephrology clinic identified underutilization of SGLT2i therapy among patients with proteinuric kidney disease. Pre-implementation practice relied primarily on renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, with inconsistent use of adjunct SGLT2i therapy.

Aim of the Project: The purpose of this quality improvement (QI) project was to increase guideline-concordant SGLT2i …

Implementing A Fall-Prevention Bundle To Reduce Falls In A Skilled Nursing Facility, Ginette Lubin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a persistent patient-safety concern in skilled nursing facilities (SNFs), contributing to injury, functional decline, reduced quality of life, healthcare utilization, and costs. At the project site, a short-term rehabilitation unit in an urban SNF, 13 resident falls occurred during the baseline period, with 23% resulting in injury, and prevention relied on routine risk assessments, environmental checks, and post-fall reporting rather than proactive strategies.

Aim: To decrease the overall fall rate by 20%, reduce fall-associated injuries from 23% to 15% or less, and raise staff adherence to evidence-based fall-prevention interventions to 90% or higher within 12 weeks.

Evidence: …

Lowering A1c In Haitian Creole Adults With Type 2 Diabetes, Tammy W. Russell

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Haitian Creole–speaking adults with type 2 diabetes receiving care in a federally funded primary care clinic experienced gaps in glycemic control, follow-up attendance, preventive kidney screening, and access to linguistically appropriate diabetes care. The organizational baseline urine albumin-to-creatinine ratio (UACR) screening rate was 41.8%, demonstrating an opportunity to improve preventive diabetes management.

Aim of the Project: The aim was to implement a Chronic Care Model (CCM)-based interdisciplinary intervention over 12 weeks to improve diabetes outcomes, follow-up care, and UACR screening among Haitian Creole–speaking adults with type 2 diabetes.

Review of the Evidence: Current evidence supports structured chronic disease management, …

Implementing A Risk-Stratified Fall Prevention Bundle To Reduce Inpatient Falls,, Nana A. Tabiri

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Step-Down Unit (SDU) had a high fall rate of 4.8 falls/ 1,000 patient days, falling short of the 3.0 falls/1,000 patient days organizational target. Despite the high fall rate, the unit used a one-size-fits-all approach, which was ineffective. Also, nursing practices in the unit were unevenly adopted.

Project Objective: The project aimed to lower the fall rate in SDU by 10% and increase compliance with risk-stratified documentation to at least 90%.

Evidence Review: A huge pool of evidence supported the adoption of a multifactorial, person-centered fall prevention approach as opposed to universal precautions. The AHRQ …

Enhancing Suicide Risk Assessment Using The Columbia-Suicide Severity Rating Scale, Elizabeth Gyang

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Suicide risk assessment is a critical component of mental health care; however, inconsistent use of standardized assessment methods can lead to variability in risk identification and clinical decision-making. At the outpatient mental health project site, standardized use of the Columbia-Suicide Severity Rating Scale (C-SSRS) had not been established, indicating a practice gap.

Aim of the Project: The goal of the 12-week Quality Improvement (QI) project was to improve nursing staff knowledge, skills, competence and organizational readiness for standardized suicide risk assessment through structured C-SSRS education and implementation support.

Review of the Evidence: The C-SSRS is a standardized tool with …

Implementing Medication-Focused Fall Risk Assessment To Reduce Falls In Acute Care, Jill Shultz

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a significant patient safety concern among hospitalized older adults. The existing fall risk assessment did not evaluate medications, creating a gap in identifying fall-risk-increasing drugs (FRIDS).

Aim of the Project: The aim was to improve FRID identification by implementing a medication-focused fall risk assessment tool (MFRAT) for older adults admitted to an orthopedic and neurological medical-surgical unit. The American Society of Consultant Pharmacists & National Council on Aging Falls Risk Checklist was the chosen tool.

Review of the Evidence: Evidence identified three recurring themes: standardized MFRAT use, FRID identification, and healthcare worker education on FRIDs. Findings supported …

Improving Screening And Referral Of Adolescent Depression In Pediatric Primary Care, Eleanor Shaw

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: A practice gap existed in a rural primary care clinic where adolescents aged 12–18 years were not routinely screened for depression during annual well-child visits. A retrospective review of 22 adolescent charts identified no routine PHQ-9 screenings during well-child visits, establishing a baseline routine screening rate of 0%.

Aim of the Project: The aim was to implement a standardized Patient Health Questionnaire-9 (PHQ-9) screening process and increase routine depression screening to at least 90% of eligible adolescents while achieving documented follow-up within 14 days for at least 85% of adolescents with positive screens.

Review of the Evidence: Evidence supports …

Improving Patient Safety Through Daily Evaluation Of Central Line Necessity, Lakeesha Cunningham

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: At the project site, central line-associated bloodstream infection (CLABSI) rates and central line utilization exceeded national benchmarks. Between July 2025 and March 2026, 32 CLABSIs occurred hospital-wide, with a standardized infection ratio (SIR) of 1.35, more than seven times the national target of 0.19. The standardized utilization ratio (SUR) was 0.72 (target: 0.57), while the surgical intensive care unit (SICU) baseline SUR was higher at 1.06.

Aim of the Project: This Doctor of Nursing Practice (DNP) quality improvement (QI) project used an evidence-based central line checklist from the Agency for Healthcare Research and Quality (AHRQ) to improve the timely …