Public Health and Community Nursing Commons^™

Dnp Final Report: Improving Diabetes Self-Efficacy Through Nutrition Education: A Quality Improvement Project, Lakimberely S. Wooten

DNP Final Reports

Diabetes affects 12.7% of residents in Northeast Texas and is the 7th leading cause of death. Internal evidence indicates low health literacy and a heavy disease burden in the service area, underscoring the need for a standardized, low-cost, and feasible approach to nutrition education. This quality improvement project evaluated the feasibility of implementing an instructor-led nutrition education session. Guided by the Johns Hopkins Evidence-Based Practice Framework and the ADKAR behavioral change model, adult participants with Type 2 diabetes received instruction on the Plate Method. Participants enrolled in a 4-week, instructor-led diabetes education class completed a 1-hour, nutrition education session using …

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 …

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 …

Getting To The Heart Of The Problem: Blood Pressure Management Through Medication Adherence, Mallory G. Livengood

Evidence-Based Practice Project Reports

Clinical hypertension affects one in four adults globally, making it the most common chronic condition. Despite its widespread impact, hypertension can be prevented, as it represents the most modifiable risk factor in preventing cardiovascular disease. The primary purpose of this evidence-based project was to determine whether a one-month follow-up with a healthcare provider improved medication adherence through enhanced hypertension management. Twelve eligible participants were selected from a primary clinic located in Northwest Indiana, based on their newly initiated anti-hypertensive medications or who required a medication adjustment due to poor hypertension management. Each participant’s preferred method of communication was noted, and …

Breastfeeding Promotion For Infants With Neonatal Abstinence Syndrome (Nas), Olivia Czerwonka

Evidence-Based Practice Project Reports

Neonatal abstinence syndrome (NAS) is the exposure in utero to drugs with the incidence in the United States increasing from 4 to 6.3 per 1000 births (Wei et al., 2023). The purpose of this quality improvement project was to implement a breastfeeding support intervention to increase breastfeeding frequency and reduce hospital length of stay of newborns with NAS. A tailored multicomponent guideline based upon the current Ten Steps to Successful Breastfeeding as established by WHO and UNICEF (2017) was implemented. Mothers of infants diagnosed with NAS were recruited using convenience sampling from a Northwest Indiana Hospital. Key stakeholders within the …

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. …

Comparison Of Ecg Features, Cardiac Biomarkers, And Clinical Outcomes In Three Waves Of Hospitalized Covid-19 Pneumonia Patients With Cardiovascular Events, Yuchen Han, Jahnavi Sunkara, Tshura S Ali, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C. Huang, Justin J. Huang, Maiying Kong, Jiapeng Huang

The University of Louisville Journal of Respiratory Infections

Background

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a rapidly evolving virus that can severely impact the cardiovascular system. With new variants, it is important to characterize wave-specific (defined by dominant circulating variants) clinical changes.

Methods

A multi-center retrospective cohort study of patients hospitalized with SARS-CoV-2 community acquired pneumonia at eight adult acute-care hospitals in the city of Louisville, KY was conducted. Patients hospitalized with Coronavirus Disease 2019 (COVID-19) community acquired pneumonia who experienced a cardiovascular event between March 2020 and July 2022 were included in this analysis. Variant assignment was based on temporal prevalence rather than genomic confirmation, and …

Navigating The Nicu Without Words: A Case Study Of A Spanish-Speaking Mother’S Healthcare Experience, Emma Norris

Poster Presentations

Research on NICU experiences largely focuses on majority-language families; non-English-speaking families are understudied (Cleveland, 2008). The Family Integrated Care model promotes parent-infant connection and shared decision-making to improve outcomes (Wreesmann et al., 2020). Language barriers impede parent-provider communication, increasing miscommunication and parental anxiety (Kynoe et al., 2020; Ardal et al., 2011). The purpose of this research is to explore communication experiences and barriers between English-speaking and bilingual NICU nurses and a Spanish-speaking NICU mother.

Impact Of Innovative Interprofessional Practice And Education Intervention Led By Graduate Medical Education Resident Physicians With School-Based Nursing In 32 School Districts, Christoffer A. Amdahl, Hans Drawbert, Sadra Forati, Tyler Fields, James Mantil, Afsha Rais Kaisani, Marci Ayers, Michele L. Mccarroll Phd

HCA Healthcare Journal of Medicine

Background

School nurses play a critical role in student well-being, underscoring their growing importance in both education and health care systems. Research consistently demonstrates their contributions to individual student care and broader population health.

Methods

This resident-led project explored community-based partnerships to facilitate mutual learning between school nurses and graduate medical education (GME) physicians. Conducted during the 2023–2024 academic year, this quality initiative (QI) involved the Medical City Healthcare (HCA Healthcare) GME programs and North Texas school districts. Educational resources were delivered through in-person teaching sessions led by resident physicians and hands-on medical simulations. School nurses who attended the Continuing …

Improving Colorectal Cancer Screening Adherence, Albin Abraham

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background

As the second leading cause of cancer-related deaths in the United States, colorectal cancer (CRC) is a prevalent but highly preventable form of cancer (American Cancer Society National Colorectal Cancer Roundtable [ACSNCCR], 2026; Maratt et al., 2024). Screening for CRC is fundamental to prevention and early detection. Despite advances in screening measures, CRC screenings remain suboptimal (Tonini & Zanni, 2024). In the US, more than one in three adults 45 years or older are not screened as recommended (ACSNCCR, 2026).

Purpose

As a safety-net county health network primarily serving the under-resourced population, the organization is uniquely positioned to impact …

Early Pressure Injury Identification And Intervention In Emergency Department Older Adults Who Are Admitted Into A Community Hospital Intensive Care Unit, Lisa M. Britt

Doctor of Nursing Practice (DNP) Scholarly Projects

A clinical gap was identified when reviewing a hospital acquired pressure injury (HAPI) dashboard from a 369- bed, acute care community hospital located in North Texas. Fifty percent of HAPIs acquired occurred in older adults, aged 60 or higher, who were admitted into the intensive care unit (ICU) from the emergency department (ED). A retrospective review of the electronic health records (EHR) demonstrated that none of the patients had received HAPI prevention interventions while they were in the ED and the inconsistent document of skin assessments resulted in identification of few HAPIs present on admission (POA). The purpose of this …

Mental Health And Art Adherence In A Multisite International Study: The Mediating Roles Of Social Support And Substance Use In People With Hiv, Joseph Awad, Wenxiu Sun, Diane Santa Maria, Rebecca Schnall, Panta Apiruknapanond, Tongyao Wang, Claudia Patricia Valencia, Christine Horvat Davey, Solymar Solis Baez, Sheila Shaibu

School of Nursing & Midwifery, East Africa

ART adherence, essential to preventing disease progression for people living with HIV (PLHIV), remains challenged by factors like poor mental health condition, insufficient social support, and substance use. This study investigates the roles of social support and substance use as mediators in the relationship between mental health and antiretroviral therapy (ART) adherence among PLHIV in a multisite, international context. Cross-sectional data from N = 1598 PLHIV across eight countries were analyzed using parallel mediation analyses in R. Results indicated that both social support and substance use independently mediated the relationship between mental health and ART adherence. Hallucinogens mediated the mental …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

Empowering Dietary Change: A Culturally Competent Nutrition Intervention For Hispanic Patients At The Agape Clinic, Ariana N. Smith

DNP Research Projects

Abstract 

Type 2 diabetes disproportionately affects Hispanic adults and may be more difficult to manage among uninsured and underserved populations experiencing barriers to healthcare, nutrition education, and culturally appropriate resources. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate a brief, culturally tailored nutrition education intervention for Hispanic adults with elevated A1C receiving care at The Agape Clinic in Dallas, Texas. A quantitative, quasi-experimental, within-subject design was used. The intervention provided bilingual, low-literacy education focused on A1C, portion control, added sugars, and culturally familiar foods. Thirty-eight participants enrolled in the project, and 11 …

Improving Clinic Workflow To Enhance Rubeola Immunity Screening In Pregnant Patients, Courtney Mcduffie

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to improve provider adherence to Rubeola IgG serum order entry for prenatal care visits by implementing a standardized workflow and an electronic medical record (EMR)-based order-entry process in a high-risk maternal outpatient clinic.

Background: Rubeola infection during pregnancy is associated with significant maternal and fetal complications. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) to use serologic testing to determine immunity status, inconsistent provider ordering practices and workflow gaps contribute to missed opportunities for identifying non-immune patients and planning post-partum vaccination.

Methodology: A ten-week intervention period utilized …

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

The Implementation Of A Pilot Program On Puberty And Menstruation Education For Adolescent Females And Youth Development Specialists For A Gender-Specific Community Organization: A Quality Improvement Project, Cassandra Tavares

Doctor of Nursing Practice (DNP) Manuscripts

Background & Significance: Adolescent girls in the United States (U.S.) often lack adequate education and support regarding puberty and menstruation, despite the importance of this knowledge for healthy development (Schmitt et al., 2022). Only 21% of school systems serving ages 8–12 provide puberty education, and many educators feel unprepared to teach it (Schmitt et al., 2022). Purpose: This quality improvement project aimed to equip youth development specialists (YDS) at a community organization with a structured curriculum and educational tools to confidently educate adolescent females (ages 8–13) on the physical, emotional, and social aspects of puberty and menstruation. Intervention: A four-day …

Resonant Disruptions: Understanding Canadian Nurses’ Practice With Youth Survivors Of Sexual Exploitation, Danielle E. Giebelhaus, Andrew Estefan Phd, Rpn

Dignity: A Journal of Analysis of Exploitation and Violence

The sexual exploitation of youth is a global concern. Youth survivors of sexual exploitation present to and require healthcare services, but most nurses do not feel effectively equipped to care for this population. There is currently little nursing literature to guide nurses in their practice with youth survivors. In this article, we report on a qualitative, hermeneutic study undertaken to explore nursing practice with youth survivors of sexual exploitation. Hermeneutics is concerned with understanding, and is a helpful way to conduct research when little is known about a topic. In this study, we asked the research question, “How might we …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

A Retrospective Study Of Pulmonary Function Tests In Bronchiectasis: An Infectious Disease Of The Respiratory System, Vinod Mutkule, Mahesh Shinde, Vidya Bapmare, Sangramsingh Dixit, Atharva Sharma, Kshitij Sarwey, Yogeshwari Patil, Sanket Jethlia, Aayushi Dwivedi, Disha Pardeshi, Anmol Rai, Kunal Shah, Vidhi Kalwar

The University of Louisville Journal of Respiratory Infections

Introduction: Bronchiectasis, currently being recognized worldwide, is an abnormal dilatation of the bronchi and bronchioles brought on by recurrent cycles of inflammation and airway infection. Impaired pulmonary function has a predictive significance in bronchiectasis. When treating patients with suspected or confirmed respiratory diseases, pulmonary function tests (PFT) are useful examinations. Very few studies have been done on PFTs in bronchiectasis. The main aim of this study is to study PFTs in bronchiectasis.

Method: This is a retrospective observational study done on 50 patients over two years at the tertiary care center. The previous records of patients were collected from the …

Preserving What Matters: A Multimodal Approach To Maintaining Fat-Free Mass During Anti-Obesity Medication Based Weight Loss, Sarah Gore

Evidence-Based Practice Project Reports

Weight loss is often associated with reductions in fat-free mass (FFM), which can negatively impact metabolic rate, thermoregulation, bone density, functional capacity, and overall quality of life (Roth et al., 2022; Sedlmeier et al., 2021). This Evidence-Based Practice project aimed to reduce FFM loss in adults prescribed anti-obesity medications (AOMs) for weight management through a targeted, multimodal intervention. Twenty-two patients beginning AOM treatment at a family practice in northwest Indiana were invited to participate, with 19 consenting to enroll. Each participant received personalized guidance, including tailored calorie and protein intake goals to support a hypocaloric, high-protein diet, alongside evidence-based aerobic …

Association Of Plant-Based Dietary Patterns With Female Reproductive Cancer Incidence And Mortality: A Systematic Review, Esther L. Farley, Scott Moore, Gary A. Giovino, Darryl Somayaji

Campus Research Month

Healthy plant-based eating, a health-related behavior that nurses may promote, has been associated with a decrease in multiple types of cancer. However, the association of a healthy plant-based dietary pattern with decreased female reproductive cancers has not yet been established.

This review of the literature followed PRISMA guidelines to search for the relationship between a healthy plant-based dietary pattern and incidence of and mortality from a breast or gynecological cancer diagnosis. Databases searched for this review included PubMed, EMBASE, CINAHL, and Web of Science.

We identified 27 publications that met the qualifications for inclusion. Twelve studies covered mortality from breast, …

The Effectiveness Of Gad-7 Screening In High School Students, Tamara L. Smith, Allison Darnell, Margaret Harvey, Phd, Acnp-Bc, Chfn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Adolescent mental health is a growing concern, with anxiety disorders being particularly prevalent among high school students. Left untreated, anxiety can significantly impact academic performance, social functioning, and long-term mental health. The COVID-19 pandemic exacerbated these challenges, highlighting the critical need for effective screening and intervention strategies. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated tool for identifying anxiety disorders, yet its application in high school settings is limited. This scoping review explores the effectiveness of GAD-7 in increasing mental health referrals and improving anxiety outcomes in high school students.

Methods

A comprehensive search was conducted across …

Perceived Risk And Hpv Vaccination Awareness Among Women In Rural And Underserved Communities In The State Of Louisiana, Deborah Gurgel Smith, Emily M. Dantes, Robbie Beyl, Yanna X. De Koter, Margaret Bourg, Corey D. Smith, Gelinia Jackson, Justin Brown, Jerry W. Mclarty

School of Nursing Faculty Publications

Despite the availability of effective preventive measures, women in rural and underserved communities of Louisiana face health disparities regarding human papillomavirus infections. This study explores how perceived risk and socioeconomic factors, such as income, influence HPV vaccine awareness and attitudes toward HPV risk. A cross-sectional study was conducted among women in rural and underserved areas of Louisiana from November 2022 to December 2023. Participants were eligible to be included in the study if they were adult females aged 25 to 64 with no history of hysterectomy and no history of cervical cancer. We used convenience sampling through a mobile health …

Colorectal Cancer Screening And Correlating Gender Disparities, Kara Marr, Megan Janssen, Margaret Payne, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

In 2023, colorectal cancer (CRC) was the second leading cause of cancer-related deaths in the US, equating to approximately 50,000 total deaths (National Cancer Institute, 2024). Further, it is estimated that an additional 1.4 million Americans are living with CRC (National Cancer Institute, 2024). Early detection screening modalities remain imperative since the NIH has released a combined survival rate of 70% when utilized (National Cancer Institute, 2024). Different derivatives of CRC develop from pre-cancerous polyps and are often without signs or symptoms of disease progression; this asymptomatic period emphasizes the importance of early detection and prevention of colorectal cancer …

Decolonizing Global Health Research: Experiences From The Women In Health And Their Economic, Equity And Livelihood Statuses During Emergency Preparedness And Response (Wheeler) Study, Ahmed Adam, Lisa Lazarus, Bernadette Kina, Robert Lorway, Bilali Mazoya, Michaela Mantel, Marleen Temmerman, Lisa Avery, Evaline Chepchirchir Langat

Centre of Excellence in Women and Child Health

Decolonizing global health research involves rethinking power structures and research collaboration to prioritize the voices and experiences of communities that have been historically marginalized. Cross-sectoral and cross-regional partnerships based on reciprocity, trust, and transparency can be facilitated by decolonized research frameworks. To address global health issues in a way that is inclusive, context-specific, and genuinely advantageous to all parties involved, especially communities most impacted by health disparities, the ethics behind this change is imperative. We applied a decolonizing health research approach to the Women in Health and their Economic, Equity, and Livelihood Statuses During Emergency Preparedness and Response (WHEELER) study …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Prepared To Protect: Improving Cardiac Emergency Response Through Education And Action Planning In Youth Club Sports, Melissa Garcia

Nursing | Senior Theses

Sudden cardiac arrest (SCA) is the leading cause of death in youth sports, illuminating the essential demand for adequate emergency response, including cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and comprehensive emergency action plans (EAPs). Research shows that despite the importance of prompt intervention, the majority of youth club sports programs outside of the school setting lack the training and resources needed to respond effectively to SCA incidents. This study will evaluate the effectiveness of an educational seminar that includes CPR/AED training and EAP simulation exercises in improving participants’ knowledge, skills, and confidence in managing cardiac emergencies. A quasi-experimental …

Nursing Students’ Attitudes And Preparedness For Maid, Kristal Candray

Nursing | Senior Theses

Medical assistance in dying (MAiD) also known as physician-assisted suicide in addition to euthanasia is on the rise with an increase in decriminalization of the practice(s) and enactment of practice-protected policies in many countries. Ethics and morals on the subject continue to be controversial in healthcare. As student nurses enter the field as clinicians, they may encounter a patient requesting MAiD. Studies from students in other countries where MAiD and/or euthanasia is practiced found that student nurses do not feel adequately prepared to navigate such situations. However, although MAiD has been legalized in a handful of states within the United …