Medicine and Health Sciences Commons^™

Depression Screening And Education For Immigrants To Increase Access To Care, Viktoriya Ivantsova

Dissertations

Abstract

Problem: Immigrants are at risk for developing mental health disorders due to multiple factors including social, cultural, or economic factors. This can result in a lower quality of life and an increased chance of further disabilities. Although immigrants are at increased risk for the development of mental health disorders, studies show that utilization of available services and resources are low. Additionally, organizations that provide services to immigrants may not be implementing screening and psychoeducation.

Methods: This quality improvement (QI) project followed a descriptive, observational design along with an educational intervention. Using convenience sampling for recruitment, Russian and/or Ukrainian adults …

Addressing Daily Compliance Of Central Line Discussions In A Pediatric Cardiac Intensive Care Unit, Caitlin Sherwood

Dissertations

Purpose: The purpose of this project was to determine the impact of targeted education on the consistency of central line discussions during daily, multidisciplinary rounds in a pediatric cardiac intensive care unit.

Method: The Kellogg Logic Model was utilized to guide this project. Education was created and presented to bedside nurses working within the unit regarding the importance of daily central line discussion and the impacts of central line associated blood stream infection on patients. The rate of central line discussion was collected pre- and post-intervention to assess effectiveness of the education.

Findings: This project failed to …

A Guideline-Based Approach To Increase Early Mobilization In The Pediatric Patient Following Cardiothoracic Surgery, Kayla Keeven

Dissertations

A Guideline-Based Approach to Increase Early Mobilization in the Pediatric Patient Following Cardiothoracic Surgery

Problem: Prolonged bedrest during the post-operative period contributes to complications that lengthen hospital stay and increase mortality and medical costs. Early mobilization is recognized as safe and feasible in critically ill children. However, there is no standardized procedure nor method of identifying patients who are safe to mobilize in a pediatric cardiac intensive care unit (ICU).

Method: The quality improvement (QI) project employed a descriptive observational design utilizing a retrospective-prospective method to assess the effects of implementing an early mobilization guideline in a pediatric cardiac ICU. …

Management Of Post-Extubation Dysphagia Using The Yale Swallow Protocol, Nicole West

Dissertations

Abstract

Problem: Post extubation dysphagia (PED) increases the patient’s risk for long term complications contributing to increased healthcare cost. Intensive care settings rarely use standardized swallow screening assessments for patients post extubation leading to variation in the evaluation of PED. Variation in the assessment of swallowing post extubation can lead to the missed diagnosis of patients with dysphagia.

Methods: This quality improvement (QI) project was a prospective cohort study implementing an evidence-based swallow screening protocol, the Yale Swallow Protocol (YSP), in an intensive care unit. This study was conducted over four months, which included a pre survey, education, implementation, and …

Neonatal Hyperbilirubinemia And Phototherapy: The Implementation Of Seminal Clinical Practice Guidelines, Christina Coleman

Dissertations

Problem: On a postpartum care and pediatric unit from February 2022 to December 2023, the average monthly percentage of neonatal patients greater than 35 weeks gestation with hyperbilirubinemia who were treated with phototherapy before it was medically supported by the current guidelines was 42.855% (N=668). The department’s goal was to decrease this number to 10%. Initiation of phototherapy with a subthreshold bilirubin level exposes many infants to an unnecessary treatment modality which can prolong the infant’s length of stay in the hospital and can be associated with adverse effects, such as maternal-infant bonding and breastfeeding rates.

Methods: The …

Implementing A Brief Intervention For Smoking Cessation In An Inpatient Psychiatric Facility, Erika Gotway

Dissertations

Abstract

Problem: Smoking is a leading cause of various preventable diseases, and those who experience mental illness smoke cigarettes at a higher rate than the general population. Brief intervention is a type counseling that has proven successful in encouraging smokers to quit. The “5 A’s” is a type of brief intervention which stands for: Ask, Advise, Assess, Assist, Arrange. Addressing the smoking epidemic among individuals with mental illness is not only essential for improving their overall well-being, but also for reducing health disparities and enhancing the effectiveness of existing mental health interventions.

Methods: The approach to this project was a …

360 Degree Clinical Competence Evaluation For Pediatric Hospitalist Advance Practice Provders, Elizabeth A. Schickler

Dissertations

Problem: Advanced practice provider (APP) peer reviewed clinical competencies is an expected part of professional, organizational, and The Joint Commission (Joint Commission) requirements, however, is not well defined and subject to organizational application and interpretation. Providers favor peer review as a means to improve professional practice. There is a lack of data to support frequency of feedback and method of feedback to support readiness to change practice and comfort giving and receiving feedback.

Methods: The quality improvement project utilized an analytical experimental design.

The Cardin Hospitalist Advanced Practice Provider - Readiness Assessment (CHAPP-RA) tool was implemented to a convenience sample …

Conserved Mechanisms Of Drug Induced Lifespan Extension In S. Cerevisiae And C. Elegans, Christine E. Robbins

Biomedical Sciences ETDs

Aging is a phenomenon that brings aches, pains and a risk of developing diseases. Many researchers have discovered pathways that regulate aging by altering gene expression. Understanding genetic regulation of aging is key but identifying drugs that target aging will result in translatable treatments. Additionally, understanding how drugs are interacting with our cells allows us to create targeted therapies. I study two types of drugs. First, tRNA synthetase inhibitors are a class of drugs that inhibit charging of tRNAs. I identified a mechanism of lifespan extension by upregulation of the conserved transcription factor, Gcn4 / Atf-4. Second, I found that …

Perceived Stress, Social Media Usage, And Sleep Quality In United States Adults, Justine P. Scott

Walden Dissertations and Doctoral Studies

The purpose of this quantitative study was to explore the intricate connections among perceived stress, sleep quality, and social media usage metrics, challenging prior assumptions by highlighting social media as a noteworthy stress coping mechanism. The research aimed to understand the relationship between sleep quality, perceived stress, and the frequency and quality of social media use, guided by the biopsychosocial model as the theoretical framework.The study involved adults aged 20-65. A questionnaire incorporated four validated instruments to assess these variables: the Epworth Sleepiness Scale (ESS), Internet Addiction Diagnostic Questionnaire (IADQ), Perceived Stress Scale (PSS), and Social Media Quality Measure (SMQM). …

Implementation Of The Process Improvement Toolkit For Hospital Acquired Pressure Injuries, Christina Bearden

Dissertations

Problem: Approximately 2.5 million people within the United States receiving inpatient medical care will develop a pressure injury each year (Padula & Demarmente, 2018). Pressure injuries (PI) are a multifactorial complication that can often be avoided with general prophylactic measures. Despite this, inpatient settings around the United States continue to see a rise in PIs.

Method: The quality improvement initiative utilized a descriptive, observational design. The turn team toolkit was implemented and monitored over a two-month period. Patient descriptors and quantitative data were collected through a retrospective chart review. The primary data collected was on pressure injury rates and staff …

Evaluation Of A Smoking Cessation Program In Primary Care, Yolanda Duncan-Watt

Dissertations

Abstract

Problem: The adult tobacco smoking rate exceeds 12.5%. The problem is the insufficient attention given to smoking cessation education in low socioeconomic status(SES) communities. There is a lack of access to and awareness of smoking cessation programs for low-income populations.

Methods: This quality improvement (QI) study will use a descriptive, observational approach. A retrospective medical record review will be conducted to determine the rate of individuals who got the smoking cessation intervention and the rate of those who successfully quit one month after the intervention. Data was collected throughout the spring of 2024, during primary care visits and phone …

Improving Nurse Response To Seizure Events In A Pediatric Epilepsy Monitoring Unit With Use Of A Standardized Process, Stacey Obst Paule

Dissertations

Problem: Nurses responding to seizure events in the pediatric epilepsy monitoring unit (EMU) should initiate a neurological exam in addition to managing seizure activity. When nurses respond to these events, however, there can be significant variability, which can result in diagnostic inaccuracy and adverse patient outcomes. The purpose of this project is to implement a nursing response checklist and neurological assessment guide to standardize the process of response to seizure events in the pediatric EMU.

Methods: This quality improvement (QI) project utilized a cohort study design. Standardized tools were placed in an accessible area outside patient rooms. Education was provided …

Implementation Of Skin-To-Skin Immediately Post C-Section: A Pilot Study, Miah Vernor

Dissertations

Skin-to-skin contact during the golden hour is a practice that has numerous health benefits following the delivery of a newborn. These benefits include a healthy transition to extrauterine state, initiation of breastfeeding, thermoregulation, and more. However, the mode of delivery affects how often this practice is done. Parents who deliver vaginally are routinely offered the opportunity to perform skin-to-skin immediately after delivery whereas birth parents who deliver by cesarean section are not always offered this same benefit due to various reasons. A quality improvement project was conducted on an 18-bed labor and delivery unit at a Midwest hospital. This project …

Implementation Of Skin-To-Skin Contact Immediately Post Cesarean Birth: A Quality Improvement Project, Sophia Cooke

Dissertations

Problem: Skin-to-skin contact implemented within the first hour of a newborn’s life improves health outcomes for both mother and infant. One of these health outcomes includes exclusive breastfeeding. The purpose of this quality improve project was to implement an infant securement device within the operating room after cesarean section births to decrease the time to initiate skin-to-skin contact and increase exclusive breastmilk feeding rates at discharge.

Methods: This study utilized a descriptive, observational design and was guided by the Plan-Do-Study-Act framework. A pre-test, post-test design was utilized to compared retrospective and prospective data. The retrospective data was collected to assess …

Evaluation Of The Grief Of Mothers Affected By Perinatal And Traumatic Loss, Landry Crabtree

Dissertations

Problem: The experience of a perinatal loss can be traumatic for mothers, and complicated grief reactions are common for those who have experienced a perinatal loss. An increase in perinatal loss resources is needed in the United States. The purpose of this program evaluation was to assess outcomes of a pilot perinatal loss support program on the grief of women who have experienced a perinatal loss.

Methods: This project was an evaluation of a perinatal loss support program that employed evidence-based strategies in both individual and group therapy sessions. A retrospective design was used, and data on perinatal …

Implementation Of Postnatal Depression Screening: A Pilot Study, Mollie Gulino

Dissertations

Abstract

Background: Postpartum depression (PPD) is a prevalent problem among women during their childbearing years, affecting approximately 1 in 7 women. Alarmingly, about 50% of PPD cases go undiagnosed and untreated, contributing to poor maternal outcomes, including suicide, which is a leading cause of maternal mortality in the United States.

Issue: Despite its prevalence and severe consequences, PPD often goes unrecognized due to inconsistent screening practices. Current guidelines vary by organization and lack consistent, evidence-based criteria.

Objective: This pilot program aimed to implement universal PPD screening with a validated tool at the six-week postpartum follow-up visit. The goal was to …

Implementation Of The Edinburgh Postpartum Depression Screening Tool For Postpartum Depression In A Midwest Primary Care Clinic, Makenzie Garrison

Dissertations

Problem: Postpartum depression is a prevalent health concern in postpartum women. Screening practices to identify postpartum depression are inconsistent. The purpose of this quality initiative is to determine if the implementation of the Edinburgh Postpartum Depression Screening Tool (EPDS) to screen for postpartum depression in the primary care setting increases the detection of postpartum depression in postpartum women from delivery to one year postpartum.

Methods: This quality improvement project utilizes a descriptive, observational design. A retrospective medical record review was utilized as well as a 12-week data collection period. Retrospective medical record reviews were conducted to assess the rate of …

Implementation Of Quantitative Blood Loss Following Cesarean Section Birth, Layna Victoria Schultz

Dissertations

Problems: Postpartum hemorrhage (PPH) is a significant problem due to potential harm and is a main contributor to maternal morbidity (ACOG, 2019). According to ACOG, of maternal deaths in the United States, 11% are caused by PPH and 54-93% of the deaths related to PPH could be prevented (ACOG, 2019). When institutions adopt quantitative blood loss (QBL) protocols for improved accuracy in blood measurement, PPH can be identified sooner, allowing for earlier intervention. Inaccurate estimation of obstetric blood loss by health care providers is a primary cause of delayed staff response to PPH (ACOG, 2019).

Methods: This quality improvement (QI) …

Socioeconomic Status On The Management Of Type-2 Diabetes Among African Americans (Aged 26–64) In Rural Pennsylvania, Mariejo Joyce Constant

Walden Dissertations and Doctoral Studies

There is a lack of knowledge on hardly-reached patients’ socioeconomic status (SES). This quantitative study examined the extent to which SES moderated or impacted the relationships of African American status, rural status, or insurance status with type-2 diabetes mellitus (T2DM) management outcomes (testing for elevated glucose levels, patient education, and regular doctor visits) for African American individuals of low SES living in rural areas. The theoretical foundation for this study was the ecological systems theory (EST). Secondary data were from the publicly available Behavioral Risk Factor Surveillance System (BRFSS) 2021 dataset. Binary and linear regression analyses showed insufficient results to …

The Effectiveness Of Technology And Smart-Home Based Teaching Modules For Direct Care Workers, Emily Demers, Andrea Mesbergen, Elise Kuiper, Jenna Prohaska, Lauren Czajka

Masters Projects

Little research has investigated the benefits of implementing technological devices in at-home environments for those with intellectual or developmental disabilities (IDD). Assistive technology has the capability to increase resident’s self-determination, communication, and overall independence in completing everyday tasks. This study explored the effects of training/education on the ongoing use of technology within the living space of those with IDD. The methodology for this study included a 2-part series of modules to teach direct care workers how to use and support their residents in using Amazon Alexa Show devices, Amazon Alexa Dot Devices, smart lights, and smart doorbells. The series included …

Nursing Staff Education On Enhanced Recovery After Surgery Related To Nurse-Patient Pain Communication, Kathleen Ranne

Walden Dissertations and Doctoral Studies

Perioperative pain is a significant challenge in terms of care of surgical patients which requires effective communication by nurses to improve patient outcomes and satisfaction. The communication component of the Enhanced Recovery after Surgery protocol is a foundation for improved patient outcomes and pain management. The problem that was identified in this Doctor of Nursing Practice project was lack of staff education during the perioperative period related to nurse-patient communications regarding pain management. Using the analysis, design, development, implementation, and evaluation model of instructional design, the purpose of this DNP project was to plan, implement, and evaluate a staff education …

Canine Hepatocellular Carcinoma: Evaluating Pgam5 And Heterobilharzia Americana, Priscilla Devora

LSU Doctoral Dissertations

Hepatocellular carcinoma (HCC) is the most common primary liver cancer in humans and domestic dogs. Despite extensive research, the mechanisms that drive HCC carcinogenesis and perpetuate cancer survival are incompletely understood in both species. The work described herein focused on finding similarities between canine and human HCC, which could be harnessed to benefit humans and dogs with cancer. The first aim was to investigate the expression of phosphoglycerate mutase 5 (PGAM5) in canine HCC. Upregulation of PGAM5 is a negative prognostic indicator in human HCC. Using archival formalin-fixed paraffin-embedded samples, we found that PGAM5 was overexpressed in canine HCC ( …

Cell And Molecular Mechanisms Of Plasticity And Injury Associated With Spreading Depolarization, Jordan E. Weisend

Biomedical Sciences ETDs

Spreading depolarization (SD) is now established as a critical event contributing to the expansion of acute brain injuries. In areas with insufficient access to metabolites, SD results in episodic glutamate accumulation and NMDA receptor over-activation. Intriguingly, in areas with sufficient access to metabolites SD can result in synaptic strengthening, together suggesting SD consequences may vary widely based on metabolic context. Utilizing acute murine brain slices, this dissertation sought to interrogate the cell and molecular mechanisms of SD induced detriment and revitalization. We describe evidence that the primary NMDAR subtype involved in SD is GluN2A-containing NMDARs, and when targeted during SD …

Deep Sequence-Coupled Biopanning And Vaccine Development, Julianne Peabody

Biomedical Sciences ETDs

Virus-like particles (VLPs) are nanoparticles comprised of viral structural proteins. They physically resemble the virus from which they are derived but lack genomic material. They are non-infectious, non-replicating, and have a favorable safety profile. VLPs are highly immunogenic with a dense, repetitive structure that is strongly activating for B cells. VLPs can be utilized to develop vaccines and can be used either as direct immunogens or platforms for the display of heterologous antigens. The display of foreign peptides on VLPs can be used to elicit high-titer antibodies against the displayed peptide. A virus-like particle based on the RNA bacteriophage MS2 …

Prelicensure Baccalaureate Nursing Faculty’S Experiences Of Providing Incivility Awareness Education To Students, Emily Vanessa Pappa

Walden Dissertations and Doctoral Studies

This study investigated prelicensure baccalaureate nursing faculty’s lived experiences of providing incivility awareness education to students. The problem was that previous research regarding incivility awareness education to prelicensure baccalaureate nursing students focused on pilot studies to find effective strategies and students’ receptiveness to educational approaches, but it lacked the nurse educators’ experiences of delivering the education. The purpose was to explore the lived experiences of nurse educators providing incivility awareness education to prelicensure baccalaureate nursing students. with at least 1 year of teaching experience in prelicensure baccalaureate nursing programs and had taught the topic of incivility awareness. Using the qualitative …

Evaluation Of An Advanced Practice Provider Residency Program, Amber Juetten

DNP Projects

The primary care physician shortage can be mitigated by effective preparation and placement of qualified advanced practice providers (APPs) (Zhang et al., 2020). APP residency programs have shown to increase confidence and competency, which leads to an increase in productivity, job satisfaction, retention, and has a positive financial impact on the organization (Minichiello et al., 2020; Nutting et al., 2022; & Han et al., 2018). Potential concerns around the skills and confidence of new APPs has been the impetus for this DNP project, which aimed to provide an APP residency program that provided the support needed for an effective transition …

Increasing Stroke Symptom Awareness In The Hispanic Community, Karina Barabash

DNP Projects

Ethnic and racial minorities are at higher risk for many health conditions including coronary artery disease and stroke (Mital et al., 2021). The Hispanic population specifically faces more risk factors, less knowledge of stroke symptoms, and higher probability of death and disability post stroke (Eisenstein et al., 2018). Unless this gap is addressed, ethnic and racial minority patients will continue to experience higher rates of death and disability from stroke, compared to non-Hispanic White patients. Therefore, the purpose of this project was to provide clinic-based stroke education in Spanish to Hispanic community members. The goal was to increase awareness of …

Intersectional Analysis Of Vaccination Inequity Among Individuals With Disabilities In The United States During Covid-19 Pandemic, Philip Ndoki Ndoki

Walden Dissertations and Doctoral Studies

This study was an investigation of how disability status, types, sociodemographic indicators, and reasons for not receiving vaccinations influenced COVID-19 vaccination rates among individuals with disabilities in the United States. Despite efforts, vaccination disparities persisted, necessitating an understanding of barriers to uptake. Using intersectionality theory and the social determinants of health framework, this study examined the impact of marginalized identities and structural inequalities. Key questions included the association between disability status and vaccination uptake, differences among disability types moderated by sociodemographic factors, and the interaction between disability status and reasons for not vaccinating. Household Pulse Survey data from the US …

Comorbidity Of Disordered Eating And Depression: Examining Intersectional Inequities And Cardiometabolic Health Consequences Across The Life Course, Franklin Hunter Mcguire

Brown School Graduate Student Theses and Dissertations

Traditional epidemiologic research has often neglected the degree to which interlocking systems of oppression may (1) describe the distribution of population health inequities and (2) moderate health exposure-outcome associations. Grounded in an intersectional framework, this three-aim dissertation used an intersectional multilevel modeling approach (i.e., intersectional MAIHDA) and US nationally representative data to answer a series of intersectionality-informed research questions relevant to disordered eating, depression, and cardiometabolic health. With data from the National Health and Nutrition Examination Survey, Aim 1 quantified the population distribution of weight loss-oriented disordered eating behaviors (DEBs) among US adults across intersectional groups defined by race/ethnicity, sex/gender, …

Rectal Cancer Treatment: Sexual Function Is Not The Sole Determinant Of Quality Of Life, Sarah M. Popek

Biomedical Sciences ETDs

Colorectal cancer is the third most common cancer. Rectal cancer patients face genitourinary dysfunction, impacting physical, psychological, and social well-being. This study examined the prevalence of sexual dysfunction in rectal cancer patients to assess the impact of sexual dysfunction on quality of life (QoL).

This mixed method study included 19 completing the survey portion and 10 completing an interview, evenly split between men and women, and those with and

without a stoma. Most experienced significant sexual dysfunction, and discussion of sexual function was rare. Quality of life scores were high. Themes from the interviews included (1) the relationship between the …