Medicine and Health Sciences Commons^™

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Posters and Presentations

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Scholarly Projects

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Dosimetric Impact Of Eclipse’S Entrance Avoidance Tool On Salivary Gland Sparing In Head And Neck Vmat Plans, Shannon Diederichs

Masters Projects

Medical dosimetry is constantly evolving as new techniques emerge to improve plan quality. The Eclipse treatment planning system (TPS) is equipped with the entrance and exit dose avoidance tool commonly used to prevent beam interaction with implanted metals or steer the beam away from anatomical regions. Current literature shows this tool has not been thoroughly investigated for more fundamental applications such as routine organ at risk (OAR) sparing. Xerostomia remains a lasting side effect for head-and-neck cancer (HNC) patients after the salivary glands receive substantial radiation. This study takes a more detailed look at the tool’s effectiveness when applied to …

A Perfect Storm In Advanced Aids: Severe Acute Respiratory Distress Syndrome From Pneumocystis Jirovecii And Mycobacterium Avium Complex Coinfection, Abdel Martinez, Abelardo Rodriguez, Conrad Chouinard, Fatimah Bello

School of Medicine Publications

Advanced HIV infection is associated with profound immunosuppression, predisposing patients to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP) and Mycobacterium avium complex (MAC). PJP can cause severe respiratory disease, including acute respiratory distress syndrome (ARDS), while disseminated MAC may contribute to systemic illness and pulmonary complications. Concurrent infection with both pathogens is uncommon but may precipitate severe pulmonary failure. A man in his 40s presented with unintentional weight loss, fatigue, oral thrush, and progressive dyspnea. On arrival, oxygen saturation was 86% on room air, requiring high-flow nasal cannula. Laboratory evaluation revealed profound immunosuppression (CD4 7 cells/mm3, HIV RNA 123,000 …

Cracking The Code: The Systematic Development Of A Coding Matrix For Qualitative Data Analysis, Greta Gray, Marie-Christine Potvin

Department of Occupational Therapy Faculty Papers

A systematic approach was used to develop a coding matrix for a qualitative study with the intent to strengthen the credibility and dependability of the findings. Coding matrixes are commonly used in qualitative studies to organize data into meaningful units of text to be interpreted by the researchers. Current methods of coding matrix development can be problematic as they may introduce biases in the results and have limited reproducibility. A novel approach was employed to address this need with the “a priori” development of a coding matrix using a multi-step deductive and inductive process with multi-coders (n=5).  The coders who …

Rehcardicare: A Digital Telerehabilitation Platform For Cardiac Recovery Following A Coronary Artery Bypass Graft, Elvipson Sinaga, Khairunnisa Batubara

Jurnal Keperawatan Indonesia

Post-coronary artery bypass graft (CABG) patients often experience decreased cardiac output, which slows recovery and increases the risk of cardiovascular complications. This research and development study evaluated the preliminary effectiveness of the REHCARDICARE application in increasing cardiac output, a key indicator of successful cardiac rehabilitation. The research also assessed user satisfaction to determine the feasibility of broader implementation. The findings can inform further development of the application. The application development used the (Analysis, Design, Development, Implementation, Evaluation) ADDIE model. The study subjects consisted of 30 post-CABG patients purposively selected at the North Sumatra Integrated Heart Center. An application-based resistance and …

Craniospinal Irradiation Volumetric Modulated Arc Therapy (Vmat) Planning: A Dosimetric Contrast Utilizing Anterior Avoidance Sectors, Ashleigh M. Sammataro

Masters Projects

Purpose: Craniospinal irradiation (CSI) is essential for treating pediatric and adult central nervous system malignancies, yet it exposes large volumes of normal tissue to low‑dose radiation, contributing to significant long‑term toxicity. This study evaluated whether incorporating anterior‑avoidance sectors (AVD) into volumetric modulated arc therapy (VMAT) planning would improve normal tissue sparing while maintaining target coverage and plan quality.

Materials and Methods: 8 previously treated CSI patients were retrospectively replanned using two VMAT techniques: Full Arc and AVD. All patients were simulated supine with standardized immobilization and planned in Eclipse. Identical target volumes, optimization structures, and planning objectives were used for …

Recognizing Appropriate General Inpatient Hospice Patients Time To Stop Normalizing Suffering, Oliver Charles Roth

Walden Dissertations and Doctoral Studies

Hospice patients experiencing uncontrolled pain, dyspnea, agitation, anxiety, delirium, or other severe symptoms may require General Inpatient (GIP) hospice care for intensive symptom management. However, inconsistent recognition of symptom crises can delay escalation to the appropriate level of care, contributing to unnecessary patient suffering, caregiver distress, and avoidable emergency department or hospital utilization. This Doctor of Nursing Practice executive leadership project evaluated the implementation of an educational framework designed to improve clinician recognition and timely escalation of patients who may be appropriate for GIP hospice care. Education emphasized early identification of uncontrolled symptoms, interdisciplinary communication, documentation, and escalation for clinical …

Demographic And Socioeconomic Factors Related To Visceral Leishmaniasis Infection In South Sudan, Duncan Ochieng Ochol

Walden Dissertations and Doctoral Studies

Visceral leishmaniasis, a severe parasitic disease that is invariably fatal, is characterized by frequent outbreaks, and is associated with poverty. South Sudan is among the countries with the highest burden of visceral leishmaniasis. However, few studies have investigated factors associated with visceral leishmaniasis in the country. This study investigated demographic (age, gender, marital status, education level and occupation) and socioeconomic factors (transport, access to health services and residence) that may be associated with visceral leishmaniasis infection in South Sudan. The study was anchored on the socioecological model conceptual framework, which describes the interaction between individual and their social environment and …

Staff Education To Improve Geriatric Mental Health Screening And Pharmacotherapy, Andy Wu

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) quality improvement project addressed the lack of standardized workflows and clinical confidence regarding geriatric mental health screening and safe antidepressant initiation at a rural primary care clinic. Utilizing the FOCUS-PDSA framework, a 15-minute staff education module and a clinical pocket guide were implemented to train Medical Assistants (MAs) on integrating PHQ-9 and GAD-7 screenings during triage, and to equip providers with EHR SmartPhrases and 2023 AGS Beers Criteria prescribing guidelines. A pre- and post-intervention 5-point Likert scale survey evaluated the knowledge and clinical confidence of the clinic staff (n = 12). Results demonstrated a …

Evaluation Of A Streamlined Insurance Advocacy And Pre-Authorization Process For Hormone Replacement Therapy, Ellison Edwards

Walden Dissertations and Doctoral Studies

This organizational process evaluation project addressed the high rate of insurance denials for hormone replacement therapy (HRT) for women with symptomatic menopause and "normal" laboratory values within a private primary care setting. The practice problem involved bureaucratic barriers in the front office and a lack of structured advocacy, which delayed patient access to evidence-based care. The purpose of this project was to evaluate the impact of a streamlined insurance advocacy and pre-authorization process on access to therapy. The project utilized a standardized "Insurance Advocacy Toolkit" and evidence-based templates aligned with the 2023 North American Menopause Society (NAMS) guidelines. Analytical strategies …

A Proposal For A Nurse-Led Continuity Of Care Program, Belinda Siri Mesape

Walden Dissertations and Doctoral Studies

At an outpatient primary care and behavioral health clinic, the practice problem is the high rate of patient no-shows and late appointment cancellations. Missed appointments are a problem, disrupting continuity of care and follow-up and potentially affecting patient outcomes. A comprehensive literature search was performed using PubMed/MEDLINE, CINAHL Complete, the Cochrane Library, PsycINFO, and Google Scholar. The search revealed 26 peer-reviewed studies. Literature consistently supports the use of multifaceted interventions to improve appointment adherence in outpatient settings. The project proposal consists of the development of an evidence-based practice (EBP) program proposal to address the gap in practice in improving appointment …

Alcohol Withdrawal Management Practices And Prevention Of Escalation Events In Hospitalized Adults, Danielle Logan

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was an organizational process evaluation examining alcohol withdrawal management among hospitalized adults. Alcohol withdrawal can cause severe agitation, seizures, delirium, behavioral emergencies, transfers, and prolonged hospitalization, making early recognition and evidence-based management essential to patient safety. The practice-focused question examined whether hospitalized adults experiencing alcohol withdrawal were assessed and treated proactively based on risk factors and clinical presentation or reactively after symptom escalation, and whether management practices contributed to Code Green activation and higher-level-of-care transfers. The purpose was to identify practice gaps and develop evidence-based recommendations to improve safety and consistency of care. A …

Development Of A Proposal For An Occupational Safety And Wellness Program, Lodie Rogers

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) evidence-based practice project was a quality improvement initiative focused on developing and implementing an occupational safety and wellness program (OSWP) in an industrial organization. The practice problem was the absence of a formal, standardized program for injury prevention, near-miss reporting, hazard identification, employee wellness, safety education, and leadership accountability. Evidence from scholarly databases, Occupational Safety and Health Administration (OSHA) reports, organizational safety data, incident reports, near-miss documentation, and compliance measures supported the project. I examined how a 10-week OSWP can reduce employee incidents, improve safety culture, decrease injuries, increase engagement, and sustain wellness practices. …

Staff Education About Prescribing Glucagon-Like Peptide-1s (Glp1s), Deenis Garcia

Walden Dissertations and Doctoral Studies

Obesity is a growing health concern that affects many people. In recent years, the use of glucagon-like peptide-1 (GLP1s) has become increasingly popular to combat obesity. The use of GLP1s has shown successful outcomes, yet there are inconsistencies when prescribing the medication for weight loss. The practice problem identified at the organization was the lack of consistent and evidence-based guidance for providers to utilize when prescribing GLP1s for weight loss. The practice-focused question was to determine whether education on structured guidance tools for clinical staff who prescribe GLP1 medications improves their knowledge and intent to use these tools when prescribing …

Early Post-Cesarean Anxiety, Nausea, Vomiting, And Pain Under Spinal Anesthesia: Trajectories And Modifiable Predictors, Indah Susanti, Eza Kemal Firdaus, Septian Mirova Sebayang, Amelia Andini, Alicia Dumes Berg, Margaret Atwood, Rantiningsih Sumarni, Mesya Mesya, Asmat Burhan

Jurnal Keperawatan Indonesia

Recovery after caesarean under spinal anesthesia remains a quality gap, with scarce evidence on modifiable anesthetic practices improving recovery. Data linking the neuraxial technique, nausea, anxiety, and pain remain limited. The objective of this study was to describe postoperative nausea and vomiting, anxiety, and pain at 6, 12, and 24 hours after caesarean section under spinal anesthesia and to examine whether intrathecal adjuvant use, sensory block level, fasting duration, and American Society of Anesthesiologists (ASA) physical status were associated with these outcomes. Cross-sectional study across five hospitals; 534 women undergoing caesarean under spinal anesthesia. Exposures: intrathecal adjuvant, sensory level (≤ …

Effects Of Montessori-Based Stimulation On Fine And Gross Motor Development Among Children With Stunting: A Quasi-Experimental Study, Indah Rahmadaniah, Tukimin Bin Sansuwito, Rini Anggeriani, Rinda Lamdayani, Ade Marlisa Rahmadayanti, Aris Citra Wisuda

Jurnal Keperawatan Indonesia

Stunting affects not only physical growth but also several aspects of child development, including gross and fine motor skills. Early stimulation interventions, such as Montessori-based activities, have been proposed to enhance developmental outcomes through structured sensorimotor experiences. This study aimed to evaluate the effects of Montessori-based stimulation on motor development among children with stunting and to compare its outcomes with those of conventional stimulation. A quasi-experimental study with intervention and control groups was conducted among 120 children with stunting aged 36–59 months. Participants were allocated to either a Montessori group (n = 60) or a conventional stimulation group (n = …

Emotional Intelligence, Work Engagement, And Turnover Intention Among Hospital Nurses: A Hierarchical Component Analysis, Catrin Catrin, Christopher Wisnu, Pauline Henriette Pattyranie Tan

Jurnal Keperawatan Indonesia

High turnover intention among hospital nurses poses serious challenges to healthcare organizations, affecting service quality and workforce stability. Understanding the psychological and organizational factors associated with turnover intention is essential for developing effective retention strategies. This study aimed to examine the relationships among emotional intelligence, work engagement, and turnover intention among hospital nurses, including health-promoting leadership, workload, and burnout as contextual variables within the model. A cross-sectional study was conducted among 98 nurses working in inpatient units using validated questionnaires. The data were analyzed using partial least squares structural equation modeling (PLS-SEM) with hierarchical component analysis. Emotional intelligence significantly predicted …

Evaluating Mobile Palliative End-Of-Life Advanced Care Enhancement (Mpeace) Usability And Technology Acceptance: Mixed-Methods Design, Ni Luh Putu Inca Buntari Agustini, I Gede Putu Darma Suyasa, Israfil Israfil

Jurnal Keperawatan Indonesia

Palliative End-of-Life Care (PEoLC) is a process requiring timely assessment, effective communication, and personcentered decision-making to support patients and families. Although the process can be strengthened through digital health innovations such as Mobile Palliative End-of-Life Advanced Care Enhancement (M-PEACE), its use in PEoLC remains limited. Therefore, this study aimed to evaluate M-PEACE usability and technology acceptance through an explanatory sequential mixed-methods design and explore user experiences in describing quantitative results. The quantitative phase was conducted to assess usability through an adapted System Usability Scale (SUS), and technology acceptance was measured using a modified Technology Acceptance Model (TAM) questionnaire. A total …

Knowledge, Attitudes, And Practices By Women In Cartagena Regarding Breast Self-Examination, Rafael Arnedo Martínez, Keidis Ruidiaz Gómez

Jurnal Keperawatan Indonesia

Breast self-examination (BSE), especially when adopted by vulnerable populations, serves as a vital mechanism for the timely detection of breast abnormalities indicative of cancer. As a result, this decreases the public health burden associated with treatment at advanced stages. Therefore, assessing knowledge, attitudes, and practices (KAP) regarding this simple early detection method is a priority. This study examines the relationship between KAP concerning BSE among women in Cartagena, Colombia. A cross-sectional correlational study was conducted with 322 women attending a healthcare facility. Data were gathered using two tools: a sociodemographic profile and a KAP questionnaire. Results showed that most participants …

Loss Of Pleasure (Anhedonia): A Sex-Dependent, Cross-Species Consequence Of Unpredictable Signals To The Perinatal Brain, Anna M. Zhou, Madison R. Tetzlaff, Laura M. Glynn, Curt A. Sandman, Hal S. Stern, Tallie Z. Baram, Elysia Poggi Davis

Psychology Faculty Articles and Research

Reward seeking is an essential component of human behavior. Anhedonia (reduced motivation for and pleasure in reward) is a core feature of several mental illnesses. Early life adversity associates with later impairments in reward behaviors and related psychopathology; however, specific aspects of early adversity that lead to disrupted reward behaviors are unknown. Capitalizing on evidence that unpredictable signals to the developing brain constitute adversity and influence neurodevelopment, we examined whether exposure to perinatal unpredictable maternal signals associated with diminished reward responsivity, and probed causality using experiments in mice. We analyzed a longitudinal human study (N=158 mother/child dyads) and a …

Development Of Perineal Electric Massager Experience (Pem-X) To Improve Perineal Elasticity, Suryani Manurung, Amalia Mely, Yetty Mariani Tambun

Jurnal Keperawatan Indonesia

Perineal injury remains a common concern in vaginal childbirth, with a prevalence of 30.6%. Low maternal perineal massage practice is a contributing factor to decreased perineal elasticity and an increased risk of perineal trauma. This pilot study aimed to develop the Perineal Electric Massager Experience (PEM-X) to support mothers in self-guided perineal massage. The research employed a level 4 Research and Development (R&D) method with a one-group pretestposttest design. The study sample consisted of two parts: the PEM-X prototype and postpartum mothers who had vaginal deliveries. A purposive sampling technique was used to recruit 10 postpartum mothers who had vaginal …

Supportive And Palliative Care: Addressing The Unspoken Burden Of Cancer On Significant Others, Esmeraldo C. De Las Armas Iv

Jurnal Keperawatan Indonesia

A diagnosis such as cancer can cast a long-lasting gloom that affects not only the patient but also their loved ones. This concept analysis represents an effort to understand and explore the nuanced world of supportive and palliative care for significant others of cancer patients, a population that has often been overlooked. Rodgers’ evolutionary model of concept analysis was utilized to examine the concept of supportive and palliative care for significant others of cancer patients. Positive outcomes for both significant others and patients included improved coping mechanisms, reduced caregiver burden, enhanced communication, and better quality of life. However, several challenges …

"It Doesn't Matter Where Ocd Comes From," Or Does It?, Caitlin M Pinciotti, Ryan J Mccarty, Gabriella T Ponzini

Faculty, Staff and Students Publications

Purpose of review: This review critically evaluates the claim that etiology is not relevant to cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD). Research on the clinical presentation and treatment outcomes associated with traumatic/stressor and biological etiologies is presented.

Recent findings: The extant literature demonstrates varying clinical utility across the reviewed etiologies. Traumatic/stressor etiologies show the most consistent and robust evidence of clinical utility, demonstrating compelling associations with clinical presentation and treatment outcomes, while also being amenable to existing evidence-based approaches. Medical conditions (e.g., Pediatric Acute onset Neuropsychiatric Syndrome) and neurobiological factors also demonstrate considerable associations with OCD presentation, yet …

Development Of A Culturally Tailored Care Model For Chronic Disease Management In The Coastal Community: A Modified Delphi Study, Laode Saltar, Heltty Heltty, Sitti Mikarna Kaimuddin

Jurnal Keperawatan Indonesia

Chronic noncommunicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, are increasing in Indonesia’s coastal communities including the Bajo population in Southeast Sulawesi. Limited healthcare access, cultural barriers, and low preventive health engagement exacerbate the disease burden in these communities. Culturally tailored interventions are needed to enhance self-awareness and improve chronic disease management. This study aimed to develop and validate a culturally sensitive care model for chronic disease management in the Bajo coastal community. A three-round modified Delphi method was used with 26 panelists representing health professionals, community leaders, policymakers, and family members recruited through community health centers and …

Intermembrane Coupling Between Bcl-Xl And The Ip3 Receptor Supports Local Ca2+ Transfer At Er-Mitochondrial Contacts, Arijita Ghosh, David Weaver, Chi Li, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Bcl-xL, an anti-apoptotic Bcl-2 family protein, engages laterally with Bak/Bax in the outer mitochondrial membrane (OMM) to inhibit apoptosis and interacts with the IP₃ receptor Ca²⁺ channels (IP3Rs) in the endoplasmic reticulum (ER) membrane to control Ca²⁺ release. It is unknown if OMM-localized Bcl-xL can also interact in trans with IP3Rs at ER-mitochondrial contacts to form a tethering complex that supports IP3R-mediated local Ca²⁺ transfer from ER to mitochondria. We establish that IP3R-mitochondria Ca²⁺ signal propagation depends on Bcl-xL. By targeting Bcl-xL specifically to different subcellular compartments, we find that OMM-localized Bcl-xL increases the efficacy …

Client Usability And Student Perspectives Of A Novel Mobile Health App To Facilitate 3d-Printed Assistive Device Learning And Application, Sara Benham, Sarah Argumedo, Samantha Pifer, Tiras Williams, Jeffrey Bush, Monica Kaniamattam

Journal of Innovation in Health Sciences Education

Introduction: Locating, selecting, and printing appropriate 3D-printed assistive devices (AD) to meet specific health needs can be overwhelming. To address these challenges, the 3DAdapt app was developed. This study aimed to explore the app’s usability through an occupational therapy (OT) student project that involved delivering 3D-printed AD to older adults.

Methods: Over three sessions, OT students collaborated with older adults to provide customized 3D-printed AD. The app’s usability was assessed using a mixed-methods approach, including the System Usability Scale (SUS; scores ≥ 70 indicate usability). Focus groups with OT students further explored the usability of occupation-focused interventions with their …

Shaped By Experience: A Study Of Hybrid Professional Physical Therapist Education Patient Experiences And Experiential Learning., Teresa R. Bachman, Anne H. Boddy, Megan B. Flores, Elizabeth M. Ardolino

Journal of Innovation in Health Sciences Education

Introduction: Limited evidence exists on the use of patient experiences (PE) and experiential learning (EL) in hybrid entry-level physical therapist (PT) education programs. This study explored the impact of PE and EL within immersion labs on student self-confidence and self-efficacy in a hybrid entry-level PT education program. A total of 431 surveys were completed across 8 lab immersions for 6 courses. Nine total focus group discussions occurred, with a total of 50 participants, ranging from 2 to 10 per group.

Methods: A convenience sample from one entry-level hybrid PT education program participated in this mixed-method study with surveys and …

When Robots Join The Care Team: A Pilot Study Of Social Robots In Inpatient Pediatric Occupational Therapy, Nora Mizell, Rebecca Ozelie

Student Journal of Occupational Therapy

Background: Children may experience anxiety while hospitalized. This may act as a barrier to participation in occupational therapy (OT) sessions and diminish the benefits of OT. Therefore, occupational therapy practitioners (OTPs) must provide interventions that support mental health and engagement during pediatric hospitalization. This study explored the feasibility of using social robots as OT intervention to reduce anxiety and support engagement in therapy in children admitted to an acute inpatient rehabilitation facility (AIR).

Methods: Participants included four children ages 5-10, admitted to an urban AIR facility. Each participant interacted with a social robot during three, 30-minute occupational therapy sessions. A …

Environmental Exposure Risk Education To Enhance Chronic Kidney Disease Prevention And Screening For Nurse Practitioners, Kelsea J. Carrier

Doctor of Nursing Practice Posters and Presentations

Chronic kidney disease (CKD) affects approximately 36 million adults in the United States, with nearly 90% of individuals unaware of their diagnosis until advanced stages. While diabetes and hypertension remain the primary causes, increasing evidence highlights environmental exposures as significant and underrecognized contributors to CKD onset and progression. Exposures such as heavy metals, per- and polyfluoroalkyl substances (PFAS), air and water pollution, microplastics, and heat exposure have been linked to impaired renal function. Despite this growing body of evidence, environmental health content remains limited in nursing education, resulting in gaps in environmental health literacy (EHL) among nurse practitioners (NPs) and …