Understanding Factors Influencing Multiple Tobacco Product Use Among Adolescents In Thailand: A Structural Equation Modeling Approach, Chaowalit Srisoem

Graduate Doctoral Dissertations

Tobacco use among Thai adolescents is shaped by personal, environmental, and product-related factors. However, the pathways linking these influences to actual behavior remain unclear. This study examined how personal, environmental, and product-related factors, along with intentions to use, relate to tobacco use among Thai adolescents. A cross-sectional secondary analysis was conducted using data from the 2022 Thailand Global Youth Tobacco Survey of 6,235 students aged 13–15 years. Survey weights methods were applied to produce nationally representative estimates. Confirmatory factor analysis and structural equation modeling assessed latent constructs, and multinomial logistic regression examined predictors of single, dual, and multiple product use. …

Integrating Matrescence Into Birth Worker Practice: A Practice Improvement Project, Kelsey B. Green

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal mood and anxiety disorders (PMADs) affect 20–25% of mothers worldwide and are a leading cause of maternal complications. Stigma, fragmented care, and limited provider training leave families vulnerable, while birth workers offer trusted, continuous support.

Problem: Birth workers' maternal mental health (MMH) training is minimal and often excludes matrescence, the developmental transition to motherhood, limiting their ability to distinguish normal adjustment from clinical PMADs and delaying intervention.

Methods: A single-group, pre-/post-test design evaluated a matrescence-informed workshop at Roots Community Health's 2nd Annual Symposium. Anonymous surveys measured knowledge, attitudes, and confidence, analyzed with Mann–Whitney U, Wilcoxon signed-rank tests, and …

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

Dissertations

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

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

Dissertations

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

Mindfulness To Reduce Psychotropic Prescriptions In Home-Based Elderly Patients, Mojisola Akinola Olusegun

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Home-based adults aged 65 years and older receiving care at a community behavioral health center exhibited high psychotropic polypharmacy, with over 80% prescribed two or more psychotropic medications, exceeding The Center for Medicare and Medicaid services (CMS) guidance for safe use. This pattern heightened risks for adverse drug events, functional decline, and avoidable healthcare utilization, while exposing a practice gap characterized by underuse of non-pharmacologic interventions.

Aim of the Project: The Doctor of Nursing Practice (DNP) project aimed to determine whether integrating a structured Mindful Breathing and Meditation (MBM) program into routine services could reduce psychotropic medication burden …

Enhancing Medication Timeliness Through Structured Handoff In A Mental Health Facility, Belinda Zinhu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Delayed medication administration in an adult inpatient mental health facility exceeded organizational benchmarks and posed risks to patient safety, treatment effectiveness, and continuity of care. Baseline electronic health record (EHR) audits showed that about 30% of scheduled medications were administered outside the organization's acceptable timeframe, and inconsistent nurse shift handoffs contributed to the delays.

Aim of the Project: The aim of the quality improvement project was to improve patient outcomes by implementing the I-PASS standardized handoff communication tool to reduce late medication administration from 30% to 15% within 12 weeks.

Review of the Evidence: Evidence supports structured handoff frameworks …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Empowering Healing And Recovery: Adverse Childhood Experiences Screening In A Cognitive Behavioral Therapy Intensive Outpatient Program, Serena C. Lee

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice project implemented Adverse Childhood Experiences (ACEs) screening in an adult Cognitive Behavioral Therapy Intensive Outpatient Program (COG IOP) at San Diego's largest behavioral health hospital to identify ACE exposure, deliver supportive interventions, and enhance clinician competency in trauma-informed care.

Background: ACEs are potentially traumatic experiences occurring before age 18 that are associated with toxic stress and worsening health outcomes. Despite evidence linking ACEs to adverse outcomes and substantial healthcare costs, routine ACE screening is not standardized in behavioral health settings.

Methods: Guided by the San Diego 8A's Evidence-Based Practice model, eligible patients were offered ACEs screening …

Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Implementing Cbt-I Coach App Education During Initial Psychiatric Evaluations At The Va Pec: A Provider-Facing Quality Improvement Initiative, Sarah J. Kang

Doctor of Nursing Practice Final Manuscripts

Objective: This evidence-based practice project aims to increase provider implementation of gold standard insomnia treatment, Cognitive Behavioral Therapy for Insomnia (CBT-I), by integrating CBT-I Coach app education into initial psychiatric evaluations within a VA psychiatric emergency clinic (PEC).

Background: Insomnia is highly prevalent among veterans and commonly co-occurs with PTSD, depression, and anxiety. National guidelines from the VA, DoD, and American Academy of Sleep Medicine endorse CBT-I as first-line treatment. Despite this, pharmacotherapy is the dominating intervention in psychiatric emergency settings. The CBT-I Coach app offers evidence-based CBT-I as a free, VA-developed digital tool, but it remains underutilized in acute …

Enhancing Primary Care Provider’S Knowledge And Use Of Long-Acting And Oral Naltrexone In The Management Of Opioid And Alcohol Use Disorder, Ariana Juarez-Moncada

Doctor of Nursing Practice Final Manuscripts

Abstract

Objective: This evidence-based project aimed to enhance primary care provider knowledge and prescription rates of naltrexone and long-acting injectable (LAI) naltrexone in a community healthcare setting.

Background: Naltrexone and LAI naltrexone pharmacotherapy is shown to reduce use of alcohol and opioids and improve client retention in patients with alcohol use disorder (AUD) and opioid use disorder (OUD) (Bahji et al., 2020; Morley et al., 2024; Murphy et al., 2022).

Methods: A 30-minute in-service was provided to 14 family practice providers at the clinic. The prescription rate of naltrexone and LAI naltrexone was evaluated for the baseline period of February …

Headset To Reset: Virtual Reality Therapy In Postoperative Heart And Lung Transplant Patients, Michaela Sanchez

Doctoral Projects

Postoperative heart, lung, and heart-lung transplant recipients are at increased risk for anxiety and depression, both of which have been associated with increased risk of complications and higher mortality rates. The purpose of this quality improvement project was to implement a mindfulness-based virtual reality (VR) therapy intervention for postoperative transplant recipients at a Northern California academic medical center and to evaluate its feasibility, tolerability, and acceptability during the index hospitalization. Over a 15-week period, five participants completed a total of eight VR sessions. Participants selected from immersive mindfulness-based environments, including guided meditation and other relaxation experiences. Anxiety and depression were …

Evaluating The Impact Of A Standardized Intimate Partner Violence Screening Tool In A Clinical Setting, Dylan Bogucki

Evidence-Based Practice Project Reports

Intimate partner violence (IPV) is defined as any act of violence, including physical, sexual, stalking, or psychological aggression by an intimate partner, former or current. Despite being preventable, IPV remains a leading nonobstetric cause of morbidity and mortality among women, which highlights the need for systematic screening in clinical settings. The purpose of this quality improvement project is to identify women who have previously experienced or are currently experiencing IPV and to connect them with appropriate resources. Twenty-one studies were identified, all demonstrating moderate to high methodological quality and supporting the need for routine IPV screening in women’s health settings. …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Silent Struggles: A Qualitative Study On Mental Health Stigma And Help- Seeking Among African Individuals In The U.S, Ololade Ekwere

Dissertations

Approximately one-third of African Americans and Caribbean Blacks who require mental health services seek and utilize them (Evans & Sheu, 2019). Research has shown that stigma surrounding mental health treatment contributes to lower rates of professional help-seeking among Black Americans (Pederson, 2023). Despite the growing diversity within the Black community, limited research exists on how stigma influences professional mental health help-seeking among Africans living in the United States.

The purpose of this qualitative descriptive study was to explore the effect of public stigma on the mental health help-seeking behaviors of Africans living in the United States. Demographic data were collected, …

Implementation Of A Process For Tracking Hgb A1cs In A Community Mental Health Organization, Devin Gill

Doctoral Dissertations & Projects

Background: Individuals with a serious mental illness (SMI) are 2 to 3 times more likely to develop type 2 diabetes, yet are less likely to receive routine screening of hemoglobin A1c (HbA1c) testing. The purpose of this quality improvement project is to implement a standardized workflow process to ensure consistent tracking of HbA1cs in adult consumers greater than 18 years of age with SMI receiving services at a rural community mental health (CMH) organization.

Methods: The primary intervention is a workflow process, with focus on the clinical information systems and organizational system. This quality improvement project was guided utilizing the …

Atypical Antipsychotic-Induced Weight Gain Preventive Bundle: A Quality Improvement Project, Jocelyn Urbano

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Antipsychotic-induced weight gain (AIWG) is a common, clinically significant adverse effect associated with second-generation antipsychotic medications and contributes to increased cardiometabolic risk among individuals with serious mental illness (SMI; Carolan et al., 2025; Hegde et al., 2024). Individuals experiencing homelessness or social instability often encounter additional barriers to maintaining healthy lifestyle behaviors and consistent engagement in healthcare, further increasing metabolic risks and treatment issues (Hamel et al., 2024; Kelly et al., 2025). This preventive care bundle, designed to reduce the risk of AIWG, was implemented in an outpatient behavioral health clinic serving an underserved urban Texas population.

As metformin may …

How Social Media And Cyberbullying Correlate To Eating Disorders In Adolescents, Nicoli A. Panelo

Nursing | Senior Theses

Background: Social media is very prevalent in today’s society, particularly in adolescents. This time period is crucial for this age group in terms of developing a sense of purpose and identity. Although social media may keep many of our children entertained, they also can create negative impacts on them and ultimately hinder their overall development both mentally and physically through negative body image and unrealistic self-expectations. Purpose: The purpose of this study is to find the correlation between social media use and the rise of eating disorders in adolescents. Doing so would allow us to find ways to lower the …

Bias In Nursing Students: How Student Exposure Impacts Patient Interactions, Claire Roy

Honors Theses and Capstones

Bias is a pervasive issue in healthcare. It affects all aspects of the healthcare system and affects patients primarily through their interactions with healthcare providers. This study aimed to identify if exposure to various patient populations reduced bias among participants and increased their understanding of the way bias impacts patients. Two participants were recruited from a baccalaureate nursing program course titled “Living with Mental Illness” to participate in a series of two-semi structured interviews to identify bias, perceptions of community-based care, and the growth from the beginning to the end of their clinical experiences. Results showed skill development, increased understanding …

Decreasing Work-Related Stress And Burnout In Advanced Practice Clinicians, Laura Vasquez

Doctor of Nursing Practice (DNP) Scholarly Projects

Background

Advanced practice clinicians (APCs) face ongoing job-related stress and career burnout. Work-related stress and burnout affect healthcare quality, safety, and patient satisfaction, yet evidence specific to job-related stress and career burnout from outpatient medical facilities in the South Texas region remains limited.

Purpose

A quality improvement (QI) project was implemented to decrease work-related stress and burnout among APCs working in an outpatient medical facility in the South Texas region.

Methods

Project participants included family nurse practitioners (FNPs) (n=7) and physician assistants (PAs) (n=4). Data was collected between January 2026 and March 2026. An intervention was implemented which included engagement …

Implementing An Electronic Referral System In A Community Mental Health Clinic To Streamline Patient Care: An Evidence-Based Quality Improvement Project, Judith Ngante

Master's Theses or Doctor of Nursing Practice

Inefficient referral processes in community mental health clinics contribute to delayed access to care, fragmented communication, and increased administrative burden. Traditional referral methods, including phone, fax, and paper-based systems, often result in prolonged wait times and documentation errors, negatively impacting patient outcomes. Evidence supports electronic referral (e-referral) systems as effective tools for improving care coordination, reducing delays, and enhancing provider satisfaction. This Doctor of Nursing Practice (DNP) quality improvement project aimed to implement an e-referral system in a community mental health clinic in metropolitan Texas to streamline patient care and reduce referral wait times by at least 30% over a …

Integrating Brief Cognitive Behavioral Therapy Into Telepsychiatry: A Professional Development Model For Pmhnps, Catherine A. Roberts

DNP Scholarly Projects

Background: Mental illnesses remain among the most prevalent health conditions in the United States, affecting approximately 23% or nearly one in five adults in 2025 (Centers for Disease Control and Prevention [CDC], 2025); National Institute of Mental Health [NIMH], 2024a). Despite this high prevalence, only 50.6% of adults living with mental health disorders receive treatment (NIMH, 2024a); although the expansion of telepsychiatry has improved access to mental healthcare, medication-management visits are frequently brief and primarily focused on pharmacotherapy thereby limiting opportunities for delivery of psychotherapeutic interventions. This limitation highlights the need for structured, evidence-based psychotherapeutic approaches that can be …

Guideline For A Burnout Bundle For Nurses In Psychiatric Mental Health Units, Festus Irabor

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Problem: Burnout among nurses, especially in psychiatric mental health units, significantly impacts both their well-being and the quality of patient care. Despite its severity, with approximately 30% of nurses worldwide affected and contributing to a 31.5% nurse turnover rate (Ge et al., 2023), there are limited formal guidelines specifically targeting nurse burnout prevention in the mental health setting. The issue is particularly acute in the United States, where 91.1% of psychiatric nurses report experiencing burnout, compared to 79.9% of other healthcare professionals (Anger et al., 2024). In the local unit 38.05% have experienced burnout.

Purpose: The PICOTS for this …

Introducing Education For Sensory Approaches In Mental Health-Related Emergency Department Visits: A Quality Improvement Project To Enhance Patient-Centered Care, Jesse O'Neill

Master's Theses and Capstones

Background: Barriers to specialty care access have resulted in emergency departments (ED) operating as temporary psychiatric hold facilities for their communities. Patients boarding in the ED are demonstrated to use a disproportionate percentage of facility resources with minimal benefit to the patient. The Institute for Healthcare Improvement identifies the impact of the healthcare environment on patient outcomes and suggests staff training to foster trauma-informed practice culture (Schall et al., 2020).

Local Problem: High-stress healthcare environments can escalate maladaptive patient behaviors and the use of restrictive interventions. Traditional use of restrictive interventions lacks supportive evidence and contradicts person-centered care goals (Molloy …

The Impact Of Night Shift On New Nurses: Effects On Mental Health And Work-Life Balance, Avery Windham, Abby Maruskin, Elizabeth Yoder

Williams Honors College, Honors Research Projects

This research examines the impact of night shift schedules on new nurses' mental health and work-life balance as they transition into professional practice. The transition from nursing school to the workforce presents challenges that are further compounded by shift work, which can disrupt circadian rhythms and contribute to stress, fatigue, and reduced job satisfaction. The purpose of this research is to evaluate how starting on night shift versus day shift influences nurses’ self-evaluation of work-life balance within their first year of practice. This systematic review synthesizes findings from peer-reviewed sources to assess the physical, emotional, and professional consequences of night …

Magnifying Mental Health In The Perinatal Population: A Systematic Review, Kasey E. Arnold, Alyssa M. Maki

Williams Honors College, Honors Research Projects

Pregnant individuals often experience significant anxiety, which can negatively affect both pregnancy and fetal outcomes. This systematic review evaluates the effectiveness of pharmacologic versus non-pharmacologic anxiety-relieving interventions, primarily focusing on the labor period. The PICOT question is: In perinatal patients, do non-pharmacologic anxiety-relieving measures, compared to pharmacologic anxiety-relieving measures, have a greater impact on ease of delivery and overall mental health during pregnancy and the perinatal period? PRISMA (2020) guidelines were used with inclusion criteria of human subjects, English language, and published within the last six years. Databases included PubMed, CINAHL, and Cochrane Library. Twenty-three studies were analyzed to examine …

Gratitude Journaling And Mindfulness To Mitigate Burnout In Mental Health Staff, Jennifer Davis

Doctor of Nursing Practice Projects

Burnout among mental health professionals in inpatient behavioral health settings negatively affects staff well-being, job satisfaction, and patient care quality. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the effectiveness of an 8-week mindfulness and gratitude journaling program implemented on a rural behavioral health unit in North Carolina. Guided by Jean Watson’s Theory of Human Caring, the intervention aimed to enhance resilience and workplace wellness through daily mindfulness and reflective journaling practices. A repeated cross-sectional design using anonymous pre- and post-intervention surveys was conducted with 30 staff participants. Thirty participants enrolled in the study, and 24 completed the …

Looking Beyond Traditional Therapy: The Promising Alternative Of Ketamine-Assisted Treatments In Improving The Quality Of Life Of Veterans, Noa Gutmann

Honors Undergraduate Theses

Posttraumatic stress disorder (PTSD) in United States veterans has a long history of treatment with standard care interventions and therapies. Unfortunately, many modern-day veterans experience treatment resistance and comorbid depressive symptoms that have yet to be resolved. This results in suicidal ideation, hospital readmission, and high treatment dropout rates of care plans. Recent evidence has shown a positive impact of ketamine, and esketamine, therapy on PTSD and depressive symptoms severity. Although, the outcomes and generalizability of this emerging therapy, compared to standard care, are not fully elucidated on. The purpose of this literary review was to further examine the current …

A Guideline To Address Barriers To Mental Health Treatment Experienced By Law Enforcement Officers, Jacqueline Estrella

Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Law enforcement officers are exposed to repeated trauma on the job that may negatively affect their mental health. Officers may avoid seeking mental health treatment due to police culture, stigma, and other barriers which may increase risks for suicide, absenteeism, and maladaptive coping.

Objectives: Develop an evidenced-based guideline to address barriers law enforcement officers face in seeking mental health treatment.

Methods: The National Quality Measures Clearinghouse (NQMC) Domain Framework was used to guide a literature review to identify best practices suitable for a guideline. Articles were graded for strength based on the John Hopkins Nursing Evidence Based Practice (JHNEBP) …

Musical Measures: Nurse Education On Music-Based Interventions To Reduce Patient Restraints, Crystal D. Tucker

Doctor of Nursing Practice Projects

The use of physical restraints in acute psychiatric settings poses significant risks to patient safety, including physical injury and psychological distress. Evidence supports the need for alternative, non-pharmacologic interventions to reduce reliance on restraints. This Doctor of Nursing Practice quality improvement project aimed to evaluate the impact of an educational intervention on nurses’ knowledge and confidence in implementing music-based interventions, specifically binaural beats, to manage patient anxiety and agitation.

The project was conducted on a medical observation and behavioral health holding unit and utilized a pre- and post-intervention design. Registered nurses participated in educational sessions on music-based interventions and were …