Health Services Research Commons^™

Attrition Of The Midwifery Workforce: Understanding Factors Associated With Leaving The Profession, E. Brie Thumm, Amy H. Goh, Elizabeth G. Phillips, Zachary Giano

College of Health Professions Faculty Papers

OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce.

STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who …

Uncovering The Path To Diagnosis Among Adults With Attention-Deficit/Hyperactivity Disorder: A Constructivist Grounded Theory Mini-Study, Jeffrey D. Whitaker, Rick Zoucha, Melissa Kalarchian

Graduate Student Research Symposium

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, yet many adults are first diagnosed only after years of functional strain, compensation, and alternative explanations for their difficulties. Purpose: This study explored how adults first diagnosed with ADHD in adulthood described navigating the process of obtaining a formal diagnosis. Methods: A constructivist grounded theory mini-study was conducted with seven adults, ages 27 to 43, who reported receiving their first formal ADHD diagnosis at age 18 or later. Participants completed semi-structured Zoom interviews focused on early experiences, symptom interpretation, help-seeking, and formal assessment. Data were analyzed using initial, focused, and theoretical …

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 …

“There Was Nothing Left To Give”: Experiences Of Compassion Fatigue Among Former In-Patient Psychiatric Clinicians, Katie Ladner

Counseling and Psychology Dissertations

Compassion Fatigue (CF) is a state of emotional and physical exhaustion resulting from prolonged exposure to stressful or traumatic experiences, specifically among healthcare workers, and it negatively impacts their ability to provide care to their patients and perform their jobs effectively (Singh et al., 2020). The purpose of this qualitative study is to explore the lived experiences of compassion fatigue in mental health clinicians who previously worked in in-patient psychiatric hospitals and their subsequent resignations. This phenomenological research explored participants' understanding and descriptions of their CF experiences in their roles within psychiatric hospitals and how CF contributed to their leaving …

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Improving Identification And Referral Of Xylazine‑Associated Wounds In Homeless Healthcare, Ramon A. Gambino

Doctor of Nursing Practice Scholarly Projects

Background: Xylazine-adulterated fentanyl is linked to distinctive necrotic wounds and complex care needs in unsheltered populations. This quality improvement (QI) project implemented a brief survey and referral log at Albuquerque Health Care for the Homeless (AHCH) to track suspected xylazine-associated wounds and referrals to advanced care. Methods: Final data were exported from Qualtrics, cleaned to retain finished responses, standardized categories, and de-identified. The analytic sample included 18 encounters. Results: Results showed that 55.6% (n = 10) documented suspected xylazine-associated wounds; 5.6% (n = 1) reported no suspicion; 38.9% (n = 7) were uncertain. Referrals were rarely documented overall at AHCH …

M-O-M-S On The Bayou: Implementation Of An Intervention To Improve Mental Health After Disaster, E. W. Harville, Gloria Giarratano, M. Patterson, M. Schultheis, K. S. Dorans, S. Turner, S. Harris, S. Longo, K. Weis

School of Nursing Faculty Publications

Pregnant women are a vulnerable population after disaster. Their health may be improved through community-based support programs in addition to their standard prenatal care. We conducted a prenatal peer support program, Mentors Offering Maternal Support (M-O-M-S), focused on improving mental health in hurricane-affected areas in southern Louisiana. M-O-M-S consists of six biweekly sessions covering pregnancy acceptance, maternal role identification, family and partner relationships, preparation for labor/fears around labor, well-being/safety of self and baby, and post-delivery health and maternal-infant bonding. The program is led by a “mentor”, an experienced mother but not necessarily a clinician or social worker, who guides the …

Health Disparities In Cardiovascular Care: The Impact Of Diabetes Education And Post-Discharge Interventions For African American Adults At Risk For And After Myocardial Infarction, Trinity L. Billingsley

Nursing | Senior Theses

Background: Cardiovascular disease is the leading cause of death in the United States, affecting African American adults at higher rates compared to other racial and ethnic groups. Diabetes as a comorbidity is one of the risk factors of experiencing a myocardial infarction, remaining one of the leading causes of death among individuals with diabetes. Objective: To examine the effectiveness of structured diabetes education tailored to African American adults who are at risk for and after a myocardial infarction. Additionally assessing the complications of a myocardial infarction, the outcomes associated with structured education will be compared to the outcomes of …

Precision In Practice: Subject Matter Expert Integration To Support Excellence In Population-Specific Documentation, Sara Pump, Mary Hawes, Lauren Spain, Virginia Kasenic, Meagan Talent, Alivia Stewart, Carrin Shaw, Chad Gautreaux, Dori Cousin, Ponesea Allen, Jonathan Rowe

2026

This poster describes a quality improvement initiative that integrated psychiatric resource nurses as subject matter experts (SMEs) into clinical documentation workflows to improve documentation compliance for high-risk behavioral health patients. The intervention resulted in substantial improvements in charting accuracy and compliance, including an increase in emergency department documentation compliance from 28% to 95% over seven months, while enhancing staff education, collaboration, and patient safety.

No One Left Behind: Identification Of Healthcare Needs Through System-Wide Social Determinants Of Health Screenings, Rose Dela Cruz, Amanda Marquez, Madison Lemmons

2026

This poster describes a system-wide quality improvement initiative designed to increase completion rates of Social Determinants of Health (SDOH) screenings by addressing workflow barriers, educating staff, and implementing standardized processes across clinical teams. The project demonstrates how interdisciplinary collaboration, nursing engagement, and structured screening workflows can improve identification of social needs and connect pediatric patients and families with resources that support health equity and better health outcomes.

Improving Sdoh Screening Compliance In Pediatric Settings: Addressing Health Literacy In East Texas, Katie Bien, Shannon Blalock, Donna Procell

2026

This poster focuses on efforts to improve compliance with social determinants of health (SDOH) screening in pediatric healthcare settings, with a particular emphasis on addressing health literacy challenges in East Texas. The project examines how health literacy considerations may influence the effectiveness and consistency of SDOH screening practices among pediatric patient populations.

Scaling Up Health Literacy Practices Through A Champion Program, Cameron Stine, Kelli Williams, Diana Montoya, Leslie Moore, Carol Howe

2026

This poster describes the development and expansion of a Health Literacy Champion Program designed to improve the consistent use of health literacy best practices across a healthcare organization. The program successfully expanded from ambulatory nursing to 13 disciplines, using champion training, newsletters, clinical observations, and peer influence to promote plain language communication, information chunking, and teach-back techniques that support patient understanding and safety.

Examining The Barriers To Healthcare Among Native Hawaiian And Pacific Islander Populations Living In Hawaii, Gracie L. Kaye

Honors Undergraduate Theses

The state of Hawaii was annexed by the United States in 1898, and served as a starting point from which the U.S. influenced Hawaii's socioeconomic conditions and healthcare access. The literature review examines healthcare views and outcomes among Native Hawaiian and Pacific Islander residents, utilizing various tools and resources to investigate how these factors have impacted overall health statistics and the reasons behind these trends. Results found that the western colonization of the island and the disease outbreaks led to an initial mistrust of “western ideas.” Additionally, due to long-standing cultural beliefs, there is a natural preference for traditional cultural …

Healthcare Access And Community Nursing Outreach Effectiveness In Underserved Zip Codes In Central Florida, Miah Sanchez

Honors Undergraduate Theses

Access to healthcare depends on more than whether healthcare services are available. A person’s ZIP code, income, education, transportation options, health literacy, and neighborhood resources can all affect whether care is reached at the right time and in an appropriate setting. This literature review examines healthcare access and the role of community nursing outreach in underserved ZIP codes across Central Florida. The review synthesizes current literature on social determinants of health, geographic disparities, medically underserved populations, and community-based nursing interventions to better understand how these factors shape access to care. Across the literature, poverty, limited transportation, lower educational attainment, neighborhood …

Vitamin D Deficiency And Cardiovascular Health Disparities In High-Melanin Populations: A Scoping Review, Jalen K. Luter, Silver R. Kaylor, Michael S. Boyer

Doctoral Projects

Cardiovascular disease (CVD) remains a leading cause of mortality and disproportionately affect individuals with darker skin tones, partly due to vitamin D deficiency (Sabzmakan et al., 2014). This Doctor of Nursing Practice (DNP) project uses a scoping review methodology to examine the relationship between vitamin D deficiency and cardiovascular outcomes, with an emphasis on high-melanin populations. Guided by the Joanna Briggs Institute Framework, the review synthesizes existing evidence, identifies gaps in representation and biomarker use, and highlights social and biological contributors to disparity. Databases including PubMed, CINAHL, EMBASE, and Scopus were searched, and studies were screened using standardized inclusion criteria: …

The Science Of Sound: Studying The Cognitive, Emotional, And Physiological Effects Of Frequency, Genre, And Music, Jett Yarborough

Senior Honors Theses

Music influences emotion, physiology, and cognition, yet little is known about how the frequency it is tuned to affects these influences. Prior research has shown that music tuned to 432 Hz can reduce stress, lower blood pressure, and improve sleep. My colleagues and I conducted two studies to investigate this. Our research found that music tuned to 432 Hz promotes a significant increase in memory retention and induces a state of focus and relaxation. These results suggest that shifting from the standard tuning frequency of 440 Hz to 432 Hz could have a profoundly positive impact on our daily lives. …

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 …

Nursing Education Research In Sub-Saharan Africa: A Systematic Review And Bibliometric Analysis, Beth Waweru, Peter Gatiti, Serah Wachira

School of Nursing & Midwifery, East Africa

Nursing education is pivotal for ensuring competent healthcare professionals, and its improvement is essential for enhancing the quality of health care systems globally. This study focuses on nursing education research in Sub-Saharan Africa (SSA) over the last decade, employing both bibliometric analysis and systematic review methodologies. The bibliometric analysis reveals an evolving landscape of nursing education research in SSA, offering insights into trends, key countries, journals, and predominant research themes. Notably, the study identifies a scarcity of literature using bibliometric approaches in nursing research, addressing this gap by providing a comprehensive overview of the field.The systematic review, guided by the …

Improving Hospital Discharges Before Noon: Implementation Of A Vida (Very Important Discharge Appointment), Nadia Paul

Evidence-Based Practice Project Reports

Delays in hospital discharge can negatively affect hospital throughput and bed capacity, resulting in increased length of stay and boarding of patients in off-unit locations which causes concerns for patient safety and potential harm (Rutherford et al., 2017). The purpose of this DNP project was to determine if the implementation of a very important discharge appointment (VIDA) would increase the number of hospital discharges occurring before noon (DBN) each day. This project was implemented at a 350-bed academic medical center in East Central Indiana. A 25-bed, adult medical unit served as the pilot unit. In total, 538 patients were included …

Labour Companionship And Respectful Treatment Of Women During Childbirth: A Cross-Sectional Study Across 16 Hospitals In Benin, Malawi, Tanzania And Uganda, Soha El-Halabi, Kristi Sidney Annerstedt, Christian Agossou, Fadhlun Al-Beity, Andrea B. Pembe, Phillip Wanduru, Bianca Kandeya, Jean-Paul Dossou, Helle Molsted-Alvesson, Claudia Hanson

Centre of Excellence in Women and Child Health

Introduction: Evidence suggests that women value and benefit from having a labour companion during childbirth. However, the applicability of the evidence to low-income and lower-middle-income countries is limited and varies. Thus, we assessed the association between the presence of labour companions and mistreatment in 16 hospitals of Benin, Malawi, Tanzania and Uganda.

Methods: We conducted a cross-sectional survey using a validated questionnaire administered to women at discharge after birth between December 2021 and March 2024. The main outcomes were factor-weighted respectful treatment score and its subscores on maintained respect and dignity, privacy and maintained confidentiality and no physical and verbal …

Toward The Application Of Natural Language Processing In Electronic Health Record Analysis For Taxonomy Development, Latoya Mcdonald

All Dissertations

Electronic health records (EHRs) are pivotal resources for nurse practice because they increase the timeliness and reliability of patient information at the point of care and support access by multiple healthcare providers and the individual patients themselves. However, it is widely recognized that data extraction from EHRs is challenging due to the variability in the language used in clinical care notes and the lack of standardized terminology across healthcare systems. The broad objective of this dissertation is to develop taxonomy-based classification models for nursing care by applying feature engineering approaches to EHRs that include nursing care of ostomy patients following …

Health Literacy, Health Perception, And Influencing Factors Among Immigrants, Canan Birimoglu Okuyan, Ebru Deveci, Fatma Karasu

Makara Journal of Health Research

Background: Individuals living in rural areas face several healthcare disadvantages, including limited access to medical facilities and specialists during emergencies. This study examines healthy lifestyle behaviors, health perceptions, and influencing factors among immigrants in a rural region of southern Türkiye.

Methods: This cross-sectional study involved immigrants registered at a family health center. Data were collected using a sociodemographic questionnaire, the Perception of Health Scale, and the Health Literacy Scale.

Results: Statistically significant differences in THLS-32 scores were found based on participants’ occupation, marital status, and education level (p < 0.05). A moderately positive correlation was observed between health literacy and health perception scores (p < 0.05).

Conclusions: Research on the relationship between …

Impact Of Cde Referral On A1c Control In Adult Type 2 Dm Patients., Alivia Watts Bsn, Rn, Yesica Sanchez Bsn, Rn, Morgan Hilliard Bsn, Rn, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Type II Diabetes Mellitus is a chronic health condition impacting many adults in Tennessee. Certified Diabetic Educators (CDEs) are specifically trained in educating and addressing the health care needs of patients with diagnoses of Type I or Type II Diabetes. Research has shown that education conducted by CDEs leads to improved outcomes and self- care in those with diabetes (Bowen, et al., 2016, King et al., 2019). Not only are CDEs cost effective services leading to a decrease in healthcare costs, but they also aid in the improvement of hemoglobin A1C (Hgb A1C) levels and decrease complications associated with Type …

The Impact Of Hyperglycemia On Post-Reperfusion Outcomes In Patients With Hyperacute Ischemic Stroke, Nicole Schumacher

Theses and Dissertations (ETD)

Stroke is a major contributor to disability in the United States, with ischemic stroke accounting for approximately 87% of all cases. The use of approved reperfusion therapies, including intravenous thrombolysis with tissue plasminogen activator (tPA) and mechanical thrombectomy, has significantly improved functional outcomes for ischemic stroke patients. However, hyperglycemia at the time of hospital arrival is associated with worse outcomes, including increased infarct growth, higher rates of disability, and elevated mortality. Despite this, current stroke guidelines neither exclude hyperglycemic patients from receiving reperfusion therapy nor recommend glucose management during the hyperacute phase of care. While recent studies suggest that mild …

The Lived Experience Of Acute Stroke Advanced Practice Registered Nurses (Aprn) Working In Expanded Roles: A Mixed Methods Study, Terri-Ellen Kiernan

Theses and Dissertations (ETD)

Introduction. Nurse practitioners have made credible gains through the six decades since inception to cover the growing need for outpatient family care. Nurse practitioners are now working in all aspects of medicine by continuing to fill gaps with healthcare needs that persist due to physician shortages. Stroke neurology is a medical specialty plagued by a shortage of physician specialists in hospital acute care which can limit acute stroke diagnosis and treatment capabilities. Stroke nurse practitioners (SNP) are vascular neurology trained specialists who fill relatively new hospital roles to assume traditionally physician-based responsibilities in an expanded role. This study aims to …

Using Ehr Reminders To Control Hypertension, Umme Kulsoom Ghous, Logan Mcculley, Danielle C. Hall, Linda Katherine Lambert, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Hypertension is a significant risk factor for cardiovascular and kidney diseases but is often under-diagnosed and poorly managed. Electronic Health Records (EHR) can help by providing automated reminders to recheck elevated blood pressure (BP) readings, ensuring accurate measurements, and guiding clinical interventions. This study aims to determine if EHR-based reminders improve BP control in adult patients aged 21 and older, focusing on hypertension diagnosis accuracy and timely management.

Methods

After a literature review, the study took place in a primary care clinic and only included patients with an existing diagnosis of hypertension. Thirty patients were included in the study. …

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 …

The Impact Of Diabetes Education & Post Discharge Interventions For African American Adults At Risk For & After Myocardial Infarction, Trinity L. Billingsley

Nursing | Student Research Posters

Cardiovascular disease or CVD refers to a multitude of conditions that affect both the heart and blood vessels. Being the leading cause of death in the United States, heart disease claims 919,032 lives; the risk of death becomes more likely when accompanied with comorbidities like diabetes (CDC, 2024). While heart disease is a leading cause of death across all populations, it accounts for a larger proportion of deaths in African American, or AA, adults at 22.6% compared to White adults at 18.0% and Hispanic adults at 11.9%, highlighting persistent racial disparities in cardiovascular outcomes (CDC, 2024). Diabetes as a comorbidity …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

Financial Health Literacy Of Community-Dwelling Older Adults: A Qualitative Research Study, Kimberly Davis

Theses and Dissertations

Background: Financial health literacy (FHL) is an emerging concept with unique application to older adults. Multiple complexities converge in older age that create increased financial vulnerability (e.g., retirement, chronic disease). However, low financial and health literacy are common in older adults, impacting their ability to self-manage. The AWV’s focus on prevention offers an opportunity to incorporate a proactive approach to financial-related assessment. This study will explore the perceived value of assessing FHL in primary care settings and the financial-related barriers and facilitators to implementing the personalized prevention plan.

Methods: The conceptual framework was guided by the Individual and Family Self-Management …