Improving Health Literacy And Self-Management In Adults With Heart Failure: A Nurse-Led Virtual Intervention In Outpatient Support Groups, Vivian Efosa Osunde

Doctoral Projects

Heart failure is a leading cause of morbidity and hospital readmissions, with limited health literacy contributing to poor self‑management and adherence challenges. The purpose of this Doctor of Nursing Practice project was to evaluate the feasibility and preliminary outcomes of a nurse‑led, virtual education-intervention designed to improve health literacy, self‑care behaviors, and medication adherence among adults with chronic heart failure who participate in an outpatient support group. A quality improvement design was used. Convenience sampling yielded nine adult participants with a documented diagnosis of chronic heart failure who attended at least one virtual support group session. The intervention consisted of …

Building A Road To Mitigate Ambulance Patient Offload Time (Apot), William J. Manguil

Doctoral Projects

Emergency departments (EDs) worldwide are experiencing increased utilization resulting in care delays for patients seeking urgent treatment. Despite critical circumstances that warrant emergency medical services (EMS) response, patients arriving to the ED via ambulance remain vulnerable to delays in care due to prolonged ambulance patient offload times (APOTs). The amount of health care providers and treatment space necessary to initiate care are both limited and often strained resources which dictate the need for innovative interventions to prevent patient harm. The following project outlines the interventions implemented at the project site to improve APOT as a means to enhance patient safety …

Evaluating The Effectiveness Of A Nurse-Initiated Post-Discharge Phone Call In The Prevention Of Hospital Readmissions For Type 2 Diabetes Mellitus, Sierra Kane

Doctoral Projects

Background: Hospital readmissions are widely recognized as a key metric of quality care, reinforced by Centers for Medicare and Medicaid (CMS) incentive programs (U.S. Centers for Medicare & Medicaid Services, 2025). Despite these incentives, achieving a meaningful reduction of readmissions remains a challenge, especially for chronic conditions such as type 2 diabetes mellitus (T2DM), where readmission is fueled by gaps in medication management, patient confidence in symptom management, and access to timely follow-up care. Purpose: Evaluate the impact of a nurse-initiated post-discharge telephone outreach, conducted at 48 hours, by the outpatient endocrinology clinic, on 7- and 30-day readmission rates for …

A Quality Improvement Project To Strengthen Hospice Spiritual Care Delivery, Patricia Boudreau

Doctoral Projects

Spiritual care is an essential component of holistic end-of-life nursing, yet it is inconsistently provided in home hospice settings. For this Doctor of Nursing Practice (DNP) quality improvement project, we developed and implemented the Compassionate Spiritual Comfort Integration Program (CSCI), a brief, theory-based educational intervention to strengthen hospice nurses' spiritual care practices. Grounded in Kolcaba's Comfort Theory and Jinpa's Compassion Framework, the CSCI was delivered as a prerecorded webinar. A quasi-experimental single–group pretest–posttest design was used to evaluate changes in spiritual care behaviors, measured with the 17-item Nurse Spiritual Care Therapeutics Scale (NSCTS) and a single-item confidence measure. Twenty-two nurses …

Perceptions Of Perinatal Depression Among Immigrant Mothers: Screening Practices In Nurse Home Visitation, Silvia E. Arabia

Doctoral Projects

Screening for perinatal depression is a recommended strategy aimed at prevention and timely management of mood disruption in pregnancy and the postpartum (ACOG, 2024). Screening for perinatal depression is often integrated in evidence-based home visitation curriculums. The aim of this qualitative descriptive quality improvement project was to explore perceptions of perinatal depression among immigrant mothers engaged in nurse home visitation to identify barriers, if any, to disclosure and treatment of perinatal depression among a group at increased risk of developing perinatal depression (Gennaro, S., et al, 2016). Immigrant mothers residing in a large urban county in the San Francisco Bay …

What Is The Impact Of An Education Program Designed To Remove The Healthcare Professional As A Barrier To Care For The Transgender And Gender Diverse Community?, Richard D. Dansereau

Doctoral Projects

Healthcare disparities disproportionately affect transgender and gender-diverse (TGD) individuals, often due to implicit biases among healthcare providers. This study examines the impact of an educational intervention designed to address these biases and improve care for TGD patients. Using the Biased Care Model as a guiding framework, the intervention targeted three critical phases of bias: pre-visit assumptions, in-visit interactions, and post-visit decisions. Conducted in the intensive care unit of a mid-sized hospital in Northern California, the study employed a pretest-posttest quasi-experimental design involving multidisciplinary healthcare workers. Participants completed a modified Jefferson Scale of Empathy survey to assess changes in cognitive and …

Patient Perception Of Nurse Practitioner Care, Nurse Practitioner Scope Of Practice And How That Influences Provider Choice, Naomi Hemp

Doctoral Projects

This project investigates patients' perceptions of nurse practitioner (NP) care versus physician (MD) care, the factors influencing these perceptions, and patients' understanding of NP scope of practice. A cross-sectional design was used, gathering quantitative data through an anonymous one-time survey distributed via Qualtrics, open for three months. Questions were based on The Watson Caritas Patient Score (WCPS) and the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). Data were analyzed using Intellectus Statistics software™, with descriptive statistics summarizing the findings. A two-tailed paired samples t-test revealed statistically significant differences in favor of patients' perceptions of NP care versus …

Primary Care Access In San Luis Obispo County- Primary Care Practitioner’S Perspectives, Jessica Peckham

Doctoral Projects

This study investigates healthcare access and utilization among Primary Care Providers (PCPs) in SLO County, utilizing a mixed-methods approach. Survey responses from PCPs when applied to Levesque’s Theoretical Framework reveal variations in provider approachability and acceptability, alongside significant wait times for both new and established patients, indicating barriers in healthcare reaching. Qualitative interviews further illuminated dimensions of healthcare access, including socioeconomic disparities and provider burnout. These underscore the complexities of ensuring equitable access to primary care services. The relationship between provider and consumer dimensions, such as work-life balance, workload, and the role of advanced practice providers, highlight the intricate dynamics …

Utilization Of The Reproductive Justice Framework In Contraceptive Counseling With Black And African American Women: A Comparison Of Patient Satisfaction And Provider Knowledge, Simranjeet K. Tagore

Doctoral Projects

Current practice in contraceptive counseling is characterized by great variation in both content and implementation. The literature indicates that African American women desire contraceptive counseling based in respect, trust, and equity. Conducted over 8 weeks, this quality improvement project compared satisfaction in African American and Black patients receiving contraceptive counseling by a provider trained in the Reproductive Justice Framework (RJF) versus those receiving contraceptive counseling by a provider not trained in the Reproductive Justice Framework. This project also evaluated the effects of Reproductive Justice Framework training on clinician knowledge. Inclusion criteria for the patients included identifying as Black and/or African …

Implementation Of A Peer Support Program To Increase Resilience In Nurse Managers In Acute Care Hospitals: A Pilot Study, Juana Castillo

Doctoral Projects

Background: Nurse managers are at risk for experiencing stress and burnout. The peer support program was implemented to increase resilience among nurse managers.
Methods: A one-group pretest and posttest design was employed to examine the impact of peer support on nurse manager resilience. The nurse managers participated in bi-weekly 30-minute peer sessions over 12 weeks. The Connor-Davidson Resilience Scale was utilized prior to and following the intervention along with demographic and satisfaction surveys.
Results: There were six nurse managers who participated in the peer support program; however, only four completed both the pre- and post-survey. The peer support program intervention …

Nurse Practitioner-Led Hepatitis C Virus Education In A Central Valley Opioid Treatment Program, Nikiesha Thomas Redus

Doctoral Projects

Introduction Viral hepatitis has been classified as a worldwide public health threat and it is estimated that 130-150 million people worldwide are infected with viral hepatitis. In the United States, increases in hepatitis C infections can be attributed to intravenous drug use and associated behaviors. Many people who inject drugs are unaware of their serostatus and access to accurate hepatitis C virus (HCV) information and education is limited. However, opioid treatment programs are well positioned to fill hepatitis C services gap among people who inject drugs by providing education, to raise hepatitis C awareness and lead to services and treatment …

Health Promotion Module For Migrant Youth Adults In Obesity Prevention: A Pilot Project, James Chongsu Wong

Doctoral Projects

The obesity epidemic continues to worsen. It is estimated there are over one half billion adults worldwide struggling with obesity. In the United States of America, 42% of the adults and over 15 million children are obese. Obesity leads to a myriad of other chronic diseases such as diabetes mellitus, hypertension, and hyperlipidemia. With an annual spending exceeding 173 billion dollars, obesity not only has a negative impact on quality of life but also a huge economic impact on the health care system.
This quality improvement project utilized 4 educational modules as intervention and measured the mean changes using a …

Implementing High-Intensity Trauma-Informed Sexual Behavior Risk Reduction In Justice-Involved Women, Lakisha M. Holton

Doctoral Projects

Sexually transmitted infections continue to be a source of significant morbidity in people with a history of incarceration, particularly women. Justice-involved women are at exceptionally high risk of long-lasting and severe health consequences of contracting an STI. This evidence-based practice implementation project used a repeated measures design to compare sexually transmitted infection knowledge acquisition and condom use self-efficacy in a group of incarcerated women before, immediately after, and three weeks following participation in the Safer Sex Self-Efficacy Workshop. Of the participants (N= 21), 100% demonstrated a significant increase in sexually transmitted infection knowledge and condom use self-efficacy between pre- and …

Asthma Care By Unlicensed Personnel In The Elementary School Setting: A Training Program, Teresa Eligio

Doctoral Projects

This Quality Improvement project (QI) aims to improve the competence and confidence of unlicensed school health staff in identifying asthma symptoms, reading an asthma action plan, asthma care, emergency response, medication delivery tools, and trigger reduction in the school setting. The QI project transpired in an Elementary School District in Los Angeles County, CA. The Project Manager, an asthma instructor trained by the American Lung Association, provided evidence-based Asthma-Basics training for health clerks (HCs), substitute health clerks (SHCs), licensed vocational nurse health clerks (LVN HCs), school office coordinators (SOCs), school office attendance clerks (SOAs), and substitute school office staff (SDO). …

By Utilizing Technology Can Nursing Students Gain More Confidence And Decrease Anxiety When Communicating With Chronically Ill Patients About Their Sexual Relationship?, Sheri Rickman Patrick, Alice Butzlaff

Faculty Research, Scholarly, and Creative Activity

Introduction
Effective communication is an essential part of nursing care. Nurses need to effectively communicate with patients, families, providers and staff. The purpose of this study was to show how the use of technology (i.e., video conferencing on an electronic device) could assist nursing students to gain more confidence and reduce anxiety when discussing difficult topics such as sexual intimacy.
Methods
Pre-licensure nursing students were recruited to participate as part of regular class activities. A pre- and post-survey asking about their confidence and anxiety in communicating with patients was completed; then subjects were randomly placed into groups of 4 to …

Mindful Matters: Addressing Barriers To Classroom-Based Mindfulness, Kirsten Munk

Doctoral Projects

A growing body of research suggests that incorporating classroom-based mindfulness interventions in elementary schools is associated with improvements in student behavior, self-regulation, and measures of mental health. However, the adoption of teacher-led mindfulness programs in California’s public schools has not been widely embraced. This doctoral project explored the impact of an educational intervention on pre-service teachers’ perceptions, attitudes, and intentions to implement mindfulness interventions in their classrooms. A brief educational intervention and website resource were provided to multidisciplinary teaching credential students in a 2-year graduate credential program. Participants completed a pre- and post-intervention survey to evaluate their intentions to implement …

An Appraisal Of Nursing Informatics Research And The Influence Of The Unified Theory Of Acceptance And Use Of Technology, Diodemise Ovwasa

Library Philosophy and Practice (e-journal)

Abstract

The study recognized the importance of healthcare informatics in today’s dynamic health systems, and narrows down to how nursing informatics, a component of healthcare informatics, can provide efficient and effective healthcare delivery. Hence, underpinned by the unified theory of acceptance and use of technology (UTAUT), the study aimed at situating research activities on nursing informatics within existing studies that have applied the theory to investigate healthcare informatics in general. The study adopted a systematic review of literature to explored online databases: Google Scholar and Ebscohost from 2014 to 2019. The search returned a total of 205 articles for the …

Willingess To Use Telehealth For Diabetes Management In The Rural Healthcare Setting, Andrew Kim

Doctoral Projects

Diabetes is a disease that has far reaching physically and financially consequences. This disease has shown to increase morbidity and mortality, along with increasing overall healthcare costs. Optimal management of diabetes may require a multidisciplinary approach across the span of multiple encounters with the diabetic patient. Considering the nature of diabetes, integration of telehealth has the opportunity to improve diabetes management by improving healthcare outcomes, along with potential cost savings. However, the use of novel technology like telehealth is only as useful if patients are willing to use it. Thus, this survey aimed to determining whether patients within a rural …

Nurse Practitioners’ Perceptions Of Telehealth Behaviors, Michelle Austin

Doctoral Projects

Problem: NP’s must be proficient in the behaviors that are required for a successful patient encounter to provide the full benefit of nurse practitioner (NP) telehealth. Consequently, it is imperative for NPs to understand telehealth etiquette behaviors which include the technical and non-technical skills that are necessary for an effective NP-patient patient telehealth encounter (Haney, Kott & Fowler, 2015). Telehealth has been incorporated into healthcare delivery and its use is expanding. In the United States, it is predicted to be used by seven million patients in 2020 (US Department of Health and Human Services, 2018). Appropriate access to health care …

The Mental Health Experience Among Parents Of Children With Autism, Thao Tran

Doctoral Projects

Parents of children diagnosed with autism spectrum disorder (ASD) face challenges, stress, and mental health issues than parents of children without autism. Mental health experience of parents in underserved communities are not adequately studied. This qualitative study used a phenomenological approach to understand the mental health experience of eight parent caregivers residing in San Joaquin Valley, California. All parents reported the journey was stressful but not all parents described the point when they received the diagnosis as being more stressful than before and after the ASD diagnosis. Parents’ responses to the semi-structured interview that assesses for the degree of ambiguous …

Exploring Ways To Improve Healthcare Access For The Homeless Population In Merced County, Stella Nwasoka Adesokan

Doctoral Projects

Homelessness is a societal dilemma that affects people in the United States and around the globe. Homelessness relates to poor health conditions that affect the living conditions of individuals (Institute for Urban Initiatives, 2018). Chronic and acute illnesses are rampant in this group, most of these illnesses are treatable but accessing healthcare poses a challenge for this vulnerable population. Homeless persons are often unable to access healthcare due to fear and denial of ill health, difficulty in communicating health needs, and low self-esteem (Lamb & Joels, 2014).

In the study, questionnaires were administered to 25 homeless individuals through random sampling. …

Barriers In Health Care In Hmong Men And Women With Cardiac Diseases, Ying Thao

Doctoral Projects

Lauver’s theory of care seeking behaviors is applied to identify perceived barriers to accessing healthcare in Hmong men and women that may influence care seeking behaviors. The purpose of this study is to identify barriers in accessing health care among Hmong men and women ages 50 to 80 with cardiovascular heart disease (CHD) and risk factors for CHD (e.g., diabetes, hyperlipidemia, and hypertension). A quantitative descriptive analysis was used to look at demographic characteristics while a multiple regression analysis was used to statistically compare correlations between barriers to care, risk factors for CHD, sex, and access to health care. The …

Follow-Up Among Homeless Patients At San Francisco General Hospital: Examining The Social Determinants Of Health, Robert Gnat

Doctoral Projects

The San Francisco General Hospital emergency department has a high occurrence of homeless patients that are lost to follow-up after discharge. This Doctor of Nursing Practice project conducted a survey to evaluate the social determinants of health among this population and how they influence the participant’s ability to follow-up. This is the first phase of a three-phase project involving assessment and evaluation. The second and third phases of this project will center on intervention and re-evaluation after intervention. The survey was administered to eligible participants who presented to the emergency department at San Francisco General Hospital. Fifty participants were surveyed …

Is There A Relationship Between Limited English Proficiency (Lep), Medication Adherence Behaviors, And Adverse Asthma Outcomes In Hispanic Adults With Moderate To Severe Persistent Asthma?, Archana Kartik Chandra

Doctoral Projects

The effects of LEP are well documented in the literature. LEP decreases medication adherence, causes ineffective communication between patients and providers, and reduces health outcomes. Asthma is known to be misdiagnosed and under-treated in Hispanic adults. There are discrepancies in the literature about the effects of LEP in Hispanic adults with persistent asthma.

The purpose of this study was to determine if the presence of LEP is associated with medication adherence behaviors and adverse asthma outcomes in Hispanic adults with moderate to severe persistent asthma. Hispanic adults with LEP were assessed for asthma outcomes and medication adherence behaviors.

The results …

Evidence-Based Study Of Medication Compliance Project In Hiv Prevention Using Pre-Exposure Prophylaxis (Prep) Antivirals For Hiv-Negative Males, Ming-Chun Ho

Doctoral Projects

In 2012, emtricitabine/tenofovir was the only Food and Drug Administration-approved medication for pre-exposure prophylaxis (PrEP) used in human immunodeficiency virus (HIV) prevention. To date, there is little research on open-label and mixed-payer characteristics supporting medication compliance of men who have sex with men (MSM). The purpose of this research was to describe individual demographic variables associated with PrEP medication adherence and to examine the effect of a follow-up phone call from a nurse once a month for 3 months. A total of 30 MSM were recruited and data were collected using a demographic questionnaire, medication adherence tool and follow-up phone …

Sexually Transmitted Infection Risk Reduction For College Students, Mary Kathryn Dowling

Doctoral Projects

University students have been assessed through many sexual health lenses, but there is a paucity of research on the sexual health of community college students. This population may provide good access to at-risk youth, and opportunity to reverse steep climbs in sexually transmitted infection (STI) rates. This research project pilot tests a theory-based intervention employing social facilitation to reduce STI risk among college students. Fifty students were recruited from Human Sexuality courses to participate in a 60-minute workshop. Pre- and post-testing measured for change in STI knowledge, attitude towards safer sex, and self-efficacy for engaging in safer sex practices.

A …

Adolescent Sexual Health: Provider Evaluation Of A Sexual History Tool At A School-Based Health Clinic, Gillian Marie Williams

Doctoral Projects

There is a growing concern within the United States in regard to sexual behavior within our adolescent population. Sexually transmitted infections (STIs) have always been a concern, however, there has been a steady increase since 2014 in the three nationally reportable diseases of chlamydia, gonorrhea, and syphilis. According to the CDC (2017), 15-24 years old account for half of all the new STI s. There is a need to provide more sexual health to adolescents during their health visits. It is also imperative to understand the beliefs and attitudes of providers with providing these types of exams and asking questions …

Can Using A Smartphone Application Improve The Ability Of Law Enforcement Officers To Recognize Commercially Sexually Exploited Children And Report Them To Child Welfare Authorities?, Sheree Goldman

Doctoral Projects

The commercial sexual exploitation of children (CSEC) is a crime of abuse that is frequently unrecognized because mandated reporters may be unfamiliar with the indicators. Commercially sexually exploited minors participate in sex acts in exchange for money, goods, or services. At least 200,000 American children are believed to be victims of this crime each year (County Welfare Director Association of California, 2015). Victims often go undiscovered and experience significant health issues. A public health model is used to explain the context of victimization and the need for interdisciplinary collaboration to discover victims and connect them with needed services. A randomized …

School Nurses’ Experience Of Barriers To Care In Children With Type 1 Diabetes, Eden Joseph Donahue

Doctoral Projects

Purpose: The purpose of the study was to gather data on the lived-experience of providing and coordinating type 1 diabetes care in the school setting from school nurses who practice in California. Methodology: A descriptive phenomenological qualitative study design was used to collect data through structured interviews with 13 school nurses. Descriptive coding was used to analyze the interview data. Findings: School nurses face multiple barriers to care when providing type 1 diabetes care in the school setting. The three major themes school nurses encountered were difficulty with care coordination, communication, and parents.

Prevalence And Prevention Of Diabetes In School Age Children: A Parent Education Module, Christine Mary Whitmyer

Doctoral Projects

The Center for Disease Control reports that there continues to be an increasing number of children being diagnosed with childhood-onset Type Two Diabetes Mellitus (T2DM). The recommendation is to provide education to parents regarding the risks and possible risk factors of T2DM, and strategies to prevent and treat these risk factors (Center for Disease Control [CDC], 2014). Educating parents of school age children on T2DM risk factors, and prevention practices may help to slow down this rising number of new cases. The Aim is to provide educational modules that may increase knowledge, which could in-turn change behavior, that may prevent …