Nursing 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 …

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 …

Beyond Cough Drops And Band-Aids: An Interpretive Phenomenological Study Of Certified School Nurses’ Professional Scope And Enacted Roles In Pk–12 Settings, Brandy Gershon

Electronic Theses and Dissertations

This qualitative dissertation explored the underutilization of certified school nurses (CSNs) in PK–12 educational settings across urban, suburban, and rural school districts in western Pennsylvania. Despite their advanced preparation and wide-ranging scope of practice, school nurses are often limited to providing episodic care, including first aid, medication administration, and treatment of minor injuries. This limited use reflects a significant misalignment with their professional scope of practice, which encompasses chronic disease management, health education, mental health support, care coordination, and leadership in public health. Guided by role theory (Biddle, 1986), this study examined how school nurses perceived and interpreted their professional …

Reducing Humpty Dumpty Syndrome In Pediatric Inpatients, Jeanene Burns

Electronic Theses and Dissertations

The Doctor of Nursing Practice project examined pediatric inpatient falls. The healthcare agency involved in the project identified concerns regarding pediatric inpatient falls. Data were collected on pediatric inpatient falls that occurred on two nursing units at this agency based on the Generalized Risk Assessment for Pediatric Inpatient Falls and the Humpty Dumpty Falls Prevention Scale. Results from the project indicated marginal statistical significance, with approximately a 60% reduction in falls after the implementation of the Humpty Dumpty Falls Prevention Scale. A recommendation for future research is a comparison of the two pediatric fall risk assessment tools after the Humpty …

Implementing Hypertension Guidelines Into Clinical Practice, Misti Michele Mays

Electronic Theses and Dissertations

Hypertension is a complex chronic disease process, and it is essential to educate the patient on the disease process, as well as on all aspects of self-management. It is essential that providers choose an evidence-based guideline by which they will manage their hypertensive patients. In addition, providers must schedule regular follow-up appointments with their patients, along with a wide variety of other multifactorial components in regard to the management of patients diagnosed with hypertension. In addition, providers have a responsibility to stay informed on new approaches to blood pressure management by reviewing the professional literature on a regular basis. Much …

Leader Rounding For Outcomes To Improve Employee Retention, Laura R. Escobar

Electronic Theses and Dissertations

Intention to leave a nursing staff position, if not addressed, may lead to an increased rate of nursing turnover. High turnover rates can negatively affect staffing patterns, increase organizational costs, and disrupt the continuity of patient care. A quantitative quasi-experimental pre-/posttest design was used to evaluate the impact of the High Reliability Organization Leader Rounding for Outcomes tool to reduce the intent-to-leave scores, as measured by the Turnover Intention Scale (TIS-6), compared to current practice over 12 weeks. Implementation of the tool provided a structured leader rounding process designed to strengthen communication, recognize staff contributions, and proactively identify workplace concerns. …

Patient Wait Time And Throughput Interventions In The Cardiology Outpatient Setting, Chioma Ohiri Tawose

Electronic Theses and Dissertations

Healthcare collaboration and patient care require effective communication. Poor communication impacts wait time. Inadequate communication in the outpatient cardiology clinic can lead to disruptive patient throughput, or workflow, and extend patient length of visit. The purpose of this project was to implement a means of communication for clinicians and healthcare assistants to improve patient flow and cut down idleness, ultimately reducing patient wait time. The project established the incorporation of a built-in electronic health record communication notification system, the Event Button, for asynchronous communication between staff. A quantitative quality improvement design was used to conduct this project. Inferential and descriptive …

Integrating The Five As Framework To Enhance Person-Centered Care For Adults Living With Obesity, Alexandra Charles

Electronic Theses and Dissertations

Obesity has adverse effects on physical health, emotional well-being, and mental functioning. To effectively address this highly prevalent and multifaceted condition, the use of a structured, evidence-informed framework is essential to support providers in delivering consistent, person-centered care for individuals living with obesity. The Five As is a powerful yet not commonly implemented framework in many primary care practices. The Five As framework (Ask, Assess, Advise, Agree, Assist) offers a structured model to guide clinicians in delivering consistent, supportive, and transformative care for individuals with obesity.

The goal of the project was to implement a timely and cost-effective protocol/tool that …

From Awareness To Action: Improving Advanced Directives With The Five Wishes In College Aged Young Adults, Dina M. Giovanetti

Electronic Theses and Dissertations

This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of …

Congolese Mothers' Beliefs That Influence Health-Seeking Behaviors For Their Infants., Shawn Meiman

Electronic Theses and Dissertations

In 2024, approximately 100,000 refugees were admitted to the United States, with 20% coming from the DRC, while Kentucky continues to rank fourth in the country for refugee resettlement. The increasing number of Congolese refugee children in the United States and Kentucky necessitates a greater understanding of these beliefs and practices to ensure equitable, quality, and culturally informed health services. The purpose of this study was to explore Congolese refugee mothers’ culturally and socially situated beliefs, perceptions, practices, and resources related to health care that may influence their views and practices of preventive well-child health care for their infants in …

The Role Of Psychological Capital And Case Management Intensity In Patient Activation In Permanent Supportive Housing Residents., Sarah J. Carter

Electronic Theses and Dissertations

This dissertation explores patient engagement with health, or patient activation, in the formerly homeless population housed in Permanent Supportive Housing (PSH) and receiving case management support. Research is limited on patient activation in PSH residents; consequently, there is minimal understanding of factors contributing to one’s attitudes and behavior towards health care in this group. Psychological Capital refers to the components of hope, self-efficacy, resilience, and optimism. Research in other marginalized groups indicates increasing psychological capital may improve health behaviors. Case management provides support to PSH residents and forms of social support have been associated with improved health outcomes. Applying the …

Breaking The Silence With Routine Genitourinary Syndrome Of Menopause Screening: A Quality Improvement Project, Ashley R. Noel

Electronic Theses and Dissertations

Affecting upwards of 87% of women in post menopause, genitourinary syndrome of menopause is greatly under-diagnosed, and consequently, under-treated. Genitourinary syndrome of menopause refers to health conditions impacted by hypoestrogenic state experienced in menopause. Common symptoms of GSM include vaginal dryness, irritation, clitoral or labial atrophy, dyspareunia, decreased libido, anorgasmia, dysuria, recurrent UTI, urinary incontinence (Kaufman et al., 2025). Despite the burdensome consequences of GSM, women are unlikely to vocalize their symptoms and seek treatment. Additionally, societal beliefs of shame surrounding sexual health impede patients and clinicians from addressing GSM specifically (Mili et al., 2021). As a result, the North …

Safety In Stability: A Cdc-Guided Evaluation Of Hospital Fall Prevention Practices, Matthew C. Dougherty

Electronic Theses and Dissertations

Hospital falls remain a persistent and preventable cause of patient harm, emphasizing the need for continuous evaluation of fall prevention practices. This project assessed the effectiveness of AdventHealth Orlando’s fall prevention policy using the Centers for Disease Control and Prevention (CDC) Program Evaluation Framework. A mixed-methods design incorporated quantitative analysis of 12 months of fall data and qualitative feedback from frontline staff surveys and discussions. Results demonstrated a decrease in total falls from 549 in the previous year to 528 in the current year, indicating early progress despite the incomplete reporting period. Unit-level analysis showed a mean improvement of 16.9% …

Enhancing Provider Knowledge And Implementation Of Medication For Opioid Use Disorder (Moud) To Improve Treatment Outcomes: A Quality Improvement Project., Motunrayo Abigael Ibraheem

Electronic Theses and Dissertations

This quality improvement project sought to enhance healthcare providers' knowledge and attitudes toward Medication for Opioid Use Disorder (MOUD) at Galt Ocean Rehab Center to improve treatment outcomes for patients with opioid use disorder. Despite evidence supporting the efficacy of MOUD, significant knowledge gaps and stigmatizing attitudes among providers create barriers to optimal care. Sixteen healthcare providers participated in a comprehensive educational intervention grounded in Jean Watson's Theory of Transpersonal Caring and the Institute for Healthcare Improvement's Model for Improvement. The intervention consisted of a 4-hour workshop, six weekly reinforcement sessions, and the implementation of standardized buprenorphine management protocols. Pre- …

Effects Of Aromatherapy On Promoting Sleep In Patients With Neurological Deficits, Cherylle R. Reed

Electronic Theses and Dissertations

Reliance on sleep aids in neurological patient population can lead to negative side effects and compromise patient safety. The purpose of this doctoral nursing project was to determine if the implementation of McDonnell and Newcomb’s aromatherapy process will reduce the incidence of sleep-promoting medication administration as compared to the current practice in neurological deficit patients over 4 weeks. A quantitative, quasi-experimental design evaluated effects on sleep quality and pharmacological sleep aids by using McDonnell and Newcomb’s aromatherapy combination of lavender, bergamot, and ylang ylang essential oils placed on a cotton ball at the patient’s bedside each night. The sample included …

A Quality Improvement Project To Standardize Sexual Dysfunction Screening In Primary Care, Ashley M. D’Anna

Electronic Theses and Dissertations

Sexual health is an essential aspect of overall well-being but is often overlooked in primary care due to provider discomfort, time constraints, and lack of standardized screening protocols. This quality improvement (QI) project aimed to implement a consistent approach to screening for sexual dysfunction using the Arizona Sexual Experiences Scale (ASEX), a validated five-item tool assessing sex drive, arousal, orgasm, and satisfaction. Guided by Swanson’s Theory of Caring and Pender’s Health Promotion Model, the project emphasized compassionate, patient-centered care and the promotion of health-enhancing behaviors.

Using the Plan-Do-Study-Act (PDSA) framework, the ASEX tool was incorporated into annual wellness visits following …

Differences In Peer Social Connections Between Traditional And Online Nurse Residency Programs, Tatum Leonard

Electronic Theses and Dissertations

The anticipated retirement of baby boomer nurses by 2030 will intensify the global nursing shortage, a crisis that demands innovative strategies for onboarding and retaining new graduate nurses. Nurse residency programs (NRPs) are designed to ease the transition from student to practicing nurse, reduce turnover, and foster professional resilience. Amid the COVID-19 pandemic, many NRPs rapidly transitioned from traditional, in-person seminars to synchronous, online formats. This study explored differences in peer social connections between traditional and online NRPs, focusing on three constructs: sense of community, collaborative learning, and peer social support. Using a quasi-experimental, mixed methods approach, this secondary data …

Describing Latent Tuberculosis Infection And Treatment Completion In Virginia: A Social Determinants Of Health Approach, Amber N. Harmon

Electronic Theses and Dissertations

While the treatment of latent tuberculosis infection is a key strategy in tuberculosis elimination nationally and globally, there is a limited understanding of the general prevalence of latent tuberculosis as well as factors related to successful treatment. This dissertation describes the known landscape of latent tuberculosis in Virginia and explores possible factors related to latent tuberculosis infection treatment through three manuscripts. The first manuscript, Chapter 1, outlines the overall proposal for this dissertation research in the style of a National Institute of Health grant proposal. The second manuscript, Chapter 2, describes the current understanding of the factors related to latent …

Exploration Of The Cultural Beliefs, Values, And Practices Of African American/Black Women Or Birthing Persons Regarding Postpartum Depression: A Focused Ethnography, Stephanie Jacobs

Electronic Theses and Dissertations

Introduction: Postpartum depression (PPD) is the most prevalent perinatal mental health illness in women, affecting approximately 10% to 20% of all women in the United States, and a disproportionately higher number of African American women. The aim of this study was to explore the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression.

Research Question: What are the cultural beliefs, values, and practices of African American/Black women or birthing persons regarding postpartum depression?

Methodology: A focused ethnography was chosen for this study and consisted of semi-structured interviews. Data was transcribed and analyzed …

The Lived Experiences Of Navajo Nurses During The Covid-19 Pandemic, Stephnie Ann Leeson

Electronic Theses and Dissertations

When COVID-19 was diagnosed on the Navajo Nation, the impact on the people and the healthcare system was not understood. For almost three years, Navajo healthcare workers battled what was known to the Navajo as Dikos Nitsaaígíí Náhást’éíts’áadah, translated as The Big Cough. The Navajo Nation President, Jonathan Nez, referred to it as a Monster, as did many people in the Navajo Nation. Navajo nurses on the frontlines battled the monster daily as they saw friends and relatives succumb to the insidious disease. Much has been written about nurses off the reservations working on the frontline during the pandemic. However, …

The Impact Of Mindfulness Therapy To Reduce Disruptive Behavior In High School, Wendy Nell Peters

Electronic Theses and Dissertations

The aim of this project was to determine the impact and effectiveness of Gina Biegel’s mindfulness techniques for stressed teens method on adolescent anxiety and the disruptive symptoms that lead to high school adolescents being assigned to detention. This project described a quantitative correlational design research project that investigated a small adolescent sample size, with a goal of decreasing the number of local high school adolescent students who are repeat detention offenders, by implementing Gina Biegel’s mindfulness techniques for stressed teens method on those high school adolescents who were assigned to detention. This was achieved by collecting demographic data from …

Weight Recidivism Post-Bariatric Surgery: A Lifestyle Modifications Educational Intervention, Kimeshia N. Johnson

Electronic Theses and Dissertations

Weight recidivism after bariatric surgery is a frustrating phenomenon for bariatric surgery patients and healthcare professionals. A 90-day lifestyle modification intervention for patients at least 18 months postsurgery was performed in the primary care setting to determine if a structured program could promote or maintain weight loss. The intervention aimed to investigate if participation in a structured lifestyle modification program would impact the body mass index of bariatric patients at least 18 months postsurgical intervention. In coordination with a nutritionist specializing in addiction and obesity education, a booklet detailing the guidelines for a 12-week program was provided to 41 bariatric …

Hospital Organizations’ Obligation To Promote Spiritual Well-Being Among Nurses: Development Of A Normative Ethical Argument, Michael Jordan

Electronic Theses and Dissertations

This dissertation presents an innovative strategy to promote the support of nurses' spirituality within hospital organizations. By focusing on the spiritual well-being of nurses by hospital organizations, with a natural extension into nursing schools, the approach aims to enhance nurse’s ability to protect their own spirituality, provide comprehensive spiritual care to patients, and increase nurse moral resilience. By investing in nurses' spirituality and spiritual growth, hospitals can potentially increase job satisfaction among nursing staff, improve patient care outcomes, and create a more holistic healing environment for both nurses and patients. As the nursing shortage continues and the number of nurses …

A Theory-Based Intervention To Mitigate Weight Bias Among Nurses: A Pilot Study, Gregory S. Marler

Electronic Theses and Dissertations

Background: As obesity rates continue to rise, a growing number of individuals living with obesity will seek medical care, increasing their exposure to weight-biased healthcare providers. This bias presents a significant risk, as it can lead to compromised care, diminished trust in medical professionals, and ultimately poorer health outcomes. Nurses, as frontline caregivers, must recognize the harmful impact of weight bias and take proactive steps to mitigate its effects. Addressing this bias is essential to ensuring equitable, high-quality care and improving patient outcomes.

Aim: The study explored the acceptability, feasibility, and preliminary efficacy of an intervention for acute care …

The Lived Experience Of New Graduate Nurses Implementing Evidence-Based Practice In A Clinical Setting, Kimberly A. Mcfarland

Electronic Theses and Dissertations

The purpose of this qualitative interpretive phenomenological analysis study was to explore the perceptions and lived experiences of new graduate nurses (NGNs) as they implemented evidence-based practice (EBP) in clinical settings. This study addressed the problem that NGNs often lack the skills and confidence to effectively apply EBP, despite its critical role in improving patient outcomes. The research aimed to provide insight into the challenges, support systems, and strategies that influence EBP integration during the transition from student to practicing nurse. The study utilized the interpretive phenomenological analysis methodology to analyze data collected through semistructured interviews conducted via the Teams …

Implementation Of Houdini Guidelines Nurse-Driven Protocol To Lower Catheter-Associated Urinary Tract Infections And Foley Utilization Days, Tammie N. Collins

Electronic Theses and Dissertations

Catheter-associated urinary tract infections are a common issue in healthcare settings. These issues contribute to hospital-acquired infections and can lead to complications and increased healthcare costs. The quality project evaluated the impact of the HOUDINI guidelines nursedriven protocol to reduce infection rates and Foley utilization days. A structured guideline for Foley catheter safe removal was implemented using a quantitative method. Catheter-associated urinary tract infection rates and Foley utilization days pre- and postintervention were tracked. Data were collected using the electronic health records, infection control data sheets, and the HOUDINI checklists. A baseline assessment of catheter-associated urinary tract infections rates was …

Preeclampsia: Implementation Of The American College Of Obstetricians And Gynecologists Standardized Protocol, Sheila Ann Harwell

Electronic Theses and Dissertations

Preeclampsia is a significant medical condition that affects the perinatal population, posing risks to both the mother and fetus. Complications associated with preeclampsia include stroke, seizure, placental abruption (premature separation of the placenta from the uterus), fetal growth restriction (impaired growth due to reduced blood flow through the placenta), premature birth, and low-birth-weight infants with associated developmental issues. Because there is no cure for preeclampsia, the current management involves the timely administration of intravenous antihypertensives to reduce the risk of stroke and seizure. The gap in practice identified was the obstetrical department’s lacking a standardized protocol, compared to adopting the …

Impact Of A Transplant Nurse Navigator In The Dialysis Setting, Judith D. Pozzerle

Electronic Theses and Dissertations

Patients with kidney disease have better patient outcomes and quality of life with a kidney transplant. However, the transplant process is complicated with inherent inequalities and biases and patients frequently fail to initiate a referral for transplant evaluation. The Centers for Medicare and Medicaid have now placed financial incentives to improve the number of patients transplanted. The only way to increase the number of patients transplanted is to start with a referral for evaluation. Studies have been done highlighting the barriers, but there is a lack of studies implementing strategies to improve these numbers. Utilizing Kotter’s change theory and describing …

Management Of Aggressive And Disruptive Behavior In The Emergency Department Using De-Escalation Techniques And Simulation: A Quality Improvement Project To Improve The Knowledge And Confidence Of Emergency Department Nurses And Clinical Staff, Ernestine Darby-Littlejohn

Electronic Theses and Dissertations

Abstract

Approximately 40% of all healthcare workers have reported episodes of violence by patients over the last 2 years. This Veteran’s Health Agency reported 824 disruptive events reported in the last 5 years, of which 56 occurred in the emergency department. Research shows that interventions are not always timely, resulting in the clinical staff requesting the Veteran’s Health Agency Police to intervene when a veteran’s level of stress is escalating. The gap in practice is shown to be related to a lack of knowledge in the clinical staff in managing high stress levels exhibited by some veterans, limited knowledge of …

“But The Trauma Did Not Fade Away” Childhood Sexual Abuse, Adolescent Pregnancy, And Rurality, Cynthia H. Mcniss

Electronic Theses and Dissertations

Childhood sexual abuse (CSA) and adolescent pregnancy are critical public health issues that intersect in complex ways, particularly in rural areas. Adolescents who have experienced CSA are at a significantly higher risk of becoming pregnant before the age of 19 compared to their peers without such a history (Madigan et al., 2014). Rurality is also associated with elevated rates of adolescent pregnancy due to various socio-economic and healthcare access challenges ("Rural Health Information Hub," 2024). This study employed a grounded theory approach to develop a comprehensive understanding of the social and psychosocial processes influencing the choices, actions, and decisions of …