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Implementation Of The Pressure Injury Prevention Care Bundle At A Home Based Hospice Program: A Quality Improvement Project, Adaeze U. Amechi-Fannin

Doctor of Nursing Practice Final Project Abstract

Purpose: This Doctor of Nursing Practice project was created to improve the prevention of pressure injuries in hospice patients receiving care through a Home-based Hospice and Palliative program. The project focused on introducing a standard set of care steps (a care bundle), enhancing caregiver education, and tailoring interventions to meet each patient’s unique needs, with the goal of improving overall patient outcomes.

Background: Pressure injuries remain a common and serious problem in hospice care, especially among patients who are immobile or confined to bed. Although effective prevention methods are known, inconsistent use of these methods, limited caregiver training, and poor …

Sporadic Creutzfeldt-Jakob Disease: A Case Report Of Rapidly Progressive Dementia, Diane Olski, Karissa Charles, Cristin Grant, Courtnee Harpine, Shannon Leonard, Sarah Puim

South Atlantic Division GME Research Day 2025

No abstract provided.

Taste Matters: Designing And Testing A Nurse-Led Intervention In Oncology, Sharon Kilbride, Abigail Dillon, Bree Aguilar, Mary Hook

Nursing

Problem/Research Question: Taste alteration affects up to 70% of oncology patients receiving chemotherapy, leading to decreased dietary intake, malnutrition, and poor quality of life. It is often under reported due to lack of taste assessments during toxicity screening and has no known treatment. Researchers have shown that breast cancer patients were able to assess and control alterations with a researcher-delivered intervention. Research is needed to translate this promising strategy for clinical use with populations beyond breast cancer.

Objectives: An oncology-certified infusion nurse observed that many chemotherapy patients experienced taste alterations that affected their quality of life. The observations sparked interest …

Facilitating Timely Hospice Referrals Using A Screening Toolkit In A Rural Hospital: A Quality Improvement Initiative, Jessica Muse

Doctoral Projects

End of life care is often a difficult time for patients, families, and caregivers. Hospice is a valuable resource for individuals who are considered terminally ill and have a life expectancy of six months or less. Many patients who are near the end present to acute care settings for treatment needs. While there are several clinical indicators that may suggest hospice care is the best plan of care for a patient, identifying hospice appropriate patients can be difficult in an acute care setting and there are currently no numerical assessment tools available in the literature that provides a quick reference …

Pharmacist-Led Initiative To Increase Naloxone Prescribing For Patients On High-Dose Opioids In A General Internal Medicine Clinic, Christine E. Leduc, Hyun J. Lee, Polly D. Fraga

The Lahey Journal

Abstract

Introduction:

Opioid overdose is a pressing public health concern in the United States. In 2022, prescription opioids were involved in 15% of all opioid deaths.1 Despite CDC recommendations for prescribing naloxone to high-risk patients, primary care physicians prescribe only 1.5 naloxone prescriptions per 100 prescriptions of high-dose opioids.2,3 Strategies are needed for healthcare institutions to expand naloxone access and mitigate opioid-related harm. This pilot study assesses the impact of a pharmacist-led quality improvement patient outreach initiative on increasing naloxone prescribing for adult patients taking ≥ 50 MME per day of prescription opioids as recommended by current CDC guidelines.

Methods: …

Innovative Teaching Strategies: Ai Chatbots To Prepare Nursing Students For Difficult Conversations, Lindsay Iverson, Tamara Oliver, Steven Fernandes, Mandy Kirkpatrick, Kara Morgan, Lauren Guthrie, Trisha Beiermann, Melissa Taylor

International Nursing Research Congress (INRC)

Background and Significance: Therapeutic communication is a core competency in nursing and a consistently prioritized workforce requirement (Broeckelman-Post et al., 2022; McGunagle & Zizka, 2020; AACN, 2021). As AI and digital learning technologies advance, nursing programs are exploring technology-enabled strategies to better prepare students for emotionally complex patient interactions. Although AI chatbots have shown value in clinical training and simulation (Chang et al., 2021; Srinivasan et al., 2024), limited evidence exists on their use to prepare students for difficult or sensitive conversations. Addressing this gap supports student resilience and prepares future nurses for communication-intensive roles.

Purpose and Aims: This study …

Cryptococcal Meningitis: A Retrospective Analysis Of Immunocompetent And Immunocompromised Cases, Daniel Kotas, Ho-Man Yeung

Journal of Community Hospital Internal Medicine Perspectives

Introduction. Cryptococcal meningitis (CM) primarily affects immunocompromised individuals, but up to 20% of cases occur in immunocompetent patients. However, there are limited clinical comparisons between immunocompromised and immunocompetent patients.

Methods. This is an IRB approved, single-centered retrospective chart review study. Patients aged >18 admitted between 2012 and 2022 with Cryptococcus neoformans meningitis were included. Demographic, associated conditions, clinical data, and clinical outcomes were obtained. Patients were categorized into immunocompromised and immunocompetent groups.

Results. 37 patients with CM were identified, with 32 (86.5%) immunocompromised patients and 5 (13.5%) immunocompetent patients. The median time to first lumbar puncture was …

Incidence And Risk Factors Of Pleural Effusion In Patients With Autoimmune Diseases: A Retrospective Cohort Study, Jacob Sutton, Marwah Muhammad, Muhammad Hashim Khan, Anastasia Slobodnick

Journal of Community Hospital Internal Medicine Perspectives

Background: Pleural effusion is a common manifestation of autoimmune and connective tissue disorders, but large-scale data on its incidence, risk factors, and outcomes are limited. This study aimed to assess the clinical characteristics, hospital course, and outcomes of patients with pleural effusion associated with autoimmune diseases compared to those without autoimmune conditions.

Methods: We conducted a single-center retrospective cohort study of adult patients admitted with pleural effusion. Patients were divided into two groups: those with autoimmune diseases (study group, n = 1,346) and those without autoimmune conditions (control group, n = 1,278). Data were extracted from electronic health records, and …

Palliative Care Consults In The Intensive Care Unit, Kyra Zimmer

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Intensive care unit (ICU) patients often face serious illness or terminal diagnoses requiring invasive monitoring and life-sustaining treatments. Palliative care (PC) supports patients and their families by focusing on improving quality of life, goals of care, and symptom management. It is estimated that 14-20% of ICU patients in the United States could benefit from palliative care consults (PCCs) with potential savings of $6 billion per year. Nurses caring for these patients face unique ethical challenges and may develop secondary post-traumatic stress, emotional strain, burnout, and compassion fatigue.

Review of Literature: The review of literature supported a structured …

Analyzing Mortality Trends In A Uk Pediatric Critical Care Long-Stay Patient Cohort, Trishul Kothari, Nicola Kelly, Hari Krishnan Kanthimathinathan

Journal of Pediatric Intensive Care

Objectives: Long-stay patients in PICU are at-risk of higher mortality. The long-stay PICU population is growing larger. Identification of indicators of adverse outcomes in this cohort may provide opportunities for timely counselling and support. We aim to analyse the factors associated with higher mortality in the long-stay PICU patient cohort. Methods: Retrospective single centre study of long-stay PICU admissions defined as a PICU length of stay of at least 28 days during a three-year study period (1st April 2017 to 31st March 2020). Outcomes analysed included in-PICU mortality, and mortality within 12 months of PICU discharge. Variables analysed for association …

Examining The Influence Of Cognitive Load And Self-Efficacy On The Development Of Clinical Reasoning In The First Clinical Education Experience Of First Year Physical Therapy Students, Andrew S. Bartlett, Brittney Gunterstockman

Internet Journal of Allied Health Sciences and Practice

Purpose: Clinical reasoning is critical for effective decision-making and patient outcomes in physical therapy. Although self-efficacy, cognitive load, and clinical reasoning have been studied individually, limited research has examined these constructs holistically. This study explored the influence of cognitive load and self-efficacy on the development of clinical reasoning during the first clinical education experience of first-year Doctor of Physical Therapy students using a think-aloud protocol. Methods: All participants completed measures of self-efficacy (New General Self-Efficacy [NGSE], Physical Therapist Self-Efficacy [PTSE]) and cognitive load (intrinsic, extraneous, germane) before and after their first clinical education experience. Think-aloud protocols were conducted at …

Practical Aspects Of Religious Social Work In Modern Ukraine, Inna Vladislavivna Kovalchuk

Occasional Papers on Religion in Eastern Europe

This work analyzes the current state and specifics of the activity of religious organizations in the social sphere of Ukraine. Special attention is paid to the transformation of religious social work in the conditions of a full-scale war, where religious communities have become key agents of humanitarian, psychological and spiritual assistance. The article examines the mechanisms of interaction between the church, the state and non-governmental organizations in solving social problems. The findings are based on the practical experiences of those working with internally displaced persons (IDPs), veterans, large families, and individuals facing difficult life circumstances. Unique methods of denominational assistance …

Loralee Clark, Loralee Clark, Loralee Clark

Virginia Poets Database: A Literary and Educational Resource

No abstract provided.

Developing Ethical Reasoning And Teamwork In Nursing Students Via Organ Donation Simulation, Miranda M. Smith, Melissa Miasek, Laura Dunaway, Joseph Chamness, Mary Deason, Shikha Modi

International Nursing Research Congress (INRC)

Background: Organ donation is a critical healthcare priority, with 140,964 transplants performed worldwide in 2018 (Lewis et al., 2021). Nursing students often report limited exposure to donor referral processes, brain death determination, and communication with organ procurement organizations. Low baseline knowledge and confidence highlight the need for structured educational interventions (Alwesmi et al., 2023; Bertocchi et al., 2025). Evidence shows teaching and simulation-based learning enhance knowledge, attitudes, and competence in end-of-life donation care (Lewis, 2023). Simulation provides psychological safety, supporting teamwork, communication, clinical judgment, and emotional readiness for ethically complex situations (Masgaard & Svellingen, 2025).

Purpose/Methods: This study examined senior …

The End-Of-Life Option Most People Don’T Know About: Is It Legal?, Pamela Bucy Pierson

Idaho Law Review

This article is about an end-of-life option that many people have not heard of: Voluntary Stopping Eating and Drinking (VSED). With VSED, a person deliberately ceases intake of food and fluid to hasten their death. VSED is a peaceful, pain-free end-of-life option chosen by an increasing number of individuals in their last chapter of life who are suffering from chronic, incurable, progressively debilitating diseases. While there is considerable scholarship on the lawfulness of VSED, there is confusion in the existing literature on whether VSED is suicide, and on the related question whether individuals who provide comfort and care to VSED …

The Impacts Of Emotions On Thirst Among Heart Failure Patients, Chieh-An Yang, Hsing-Mei Chen, Tsung-Neng Tsai, Chieh-Yu Liu, Hui-Ju Lu, Ting-Ti Lin

International Nursing Research Congress (INRC)

Purpose: Thirst, characterized by sensations of oral dryness and a craving to drink, is a ubiquitous experience among heart failure (HF) patients. Besides reduced cardiac output, the clinical treatments for HF patients (e.g., diuretics, fluid restriction) may activate the renin-angiotensin-aldosterone system (RAAS), exacerbating their thirst distress.

Negative emotions are commonly experienced among heart failure patients. Previous studies have suggested that emotions (e.g., anxiety, depression) may activate the sympathetic nervous system, reducing the secretion of saliva, which, in turn, may increase sensations of dry mouth among HF patients. However, the relationship between emotions and thirst distress remains unclear. Therefore, the aim …

The Impact Of Covid-19 On The Mental Health And Well-Being Of Black And Latinx Nurses In California, Jerry John Ouner, Patience Afulani, David A. Asakitogum, Nneka Umeh, Monica Getahun, Jaffer Okiring, Michael Denyu, Orlando Harris, Osamuedeme Odiase

International Nursing Research Congress (INRC)

On January 31, 2020, Santa Clara County reported California’s (CA) first COVID-19 case. As the pandemic unfolded, health systems were severely strained, and health care workers faced dual exposure risks from their communities and households alongside heightened occupational risk from direct patient care.1,2 For Black and Latinx nurses, COVID-19’s disproportionate impact on their communities intensified stress, fear, and uncertainty, and when combined with the demands of frontline work, greatly increased their risk of psychological distress and burnout. We examined COVID-19’s impact on the mental health and well-being of Black and Latinx nurses in CA.

Method: We conducted an explanatory sequential …

Msw Portfolio, Aunnika K. Woods

Graduate Student Portfolios, Professional Papers, and Capstone Projects

A professional portfolio displaying a collection of experiences and development throughout my time in the MSW program, documenting growth, challenges, and values.

Enhancing Nursing Narrative Interoperability: Omop-Cdm Representation Of Concern Features, Sujin Gan, Rae Woong Park, Youngjin Lee

International Nursing Research Congress (INRC)

Purpose: This study aims to standardize inpatient nursing narratives by mapping their semantic units to CONCERN features and implementing a structured, interoperable representation of nursing documentation within the OMOP-CDM.

Background: Nursing narratives capture nuanced assessments, clinical reasoning, and early signs of deterioration, yet remain unstructured and inconsistently represented across institutions, limiting interoperability and secondary use. The OMOP Common Data Model (CDM) provides a standardized framework for harmonizing clinical data, but nursing documentation has not been systematically incorporated. The CONCERN framework, developed to identify early deterioration signals from narrative nursing data, offers an appropriate conceptual basis. This study adopted CONCERN features …

Staff Education To Improve Confidence Of Triage Decision-Making In Hospice After-Hours Care, Kelly Hurst

Walden Dissertations and Doctoral Studies

A quality improvement project addressed variability in after-hours hospice telephone triage through implementation of structured communication and symptom-based decision-support tools. The practice-focused question examined hospice triage nurses’ perceived confidence following implementation of these tools. A descriptive quality improvement design was used. Five hospice triage nurses received education on the CALMER communication technique and symptom-specific decision-support guides for anxiety and dyspnea. Outcomes were evaluated through a postimplementation survey assessing confidence, tool utilization, intervention perceptions, and practice recommendations. Quantitative responses were summarized using descriptive statistics, and qualitative responses were reviewed for themes. All participants reported high baseline confidence in hospice telephone triage. …

Defining Quality Of Life: The Lived Experience Of Adults With Pulmonary Hypertension And The Impact Of Activity-Induced Respiratory Distress, Bethany Jean Adams

Walden Dissertations and Doctoral Studies

Pulmonary hypertension (PH) is a progressive, life-limiting disease that significantly affects quality-of-life (QoL). Limited research has explored lived experiences of individuals with PH. Guided by Parse’s human becoming theory, this qualitative descriptive phenomenological study explored the lived experiences of individuals affected by PH and examined how activity-induced respiratory distress affected QoL. The research Question was: How do individuals with PH describe the impact of activity-induced respiratory distress on their QoL. I conducted interviews with nine participants, including eight adults diagnosed with PH and one caregiver of an individual with PH. Data were analyzed using Saldaña's comparative coding framework to identify …

Strategies For Managing Change In Home Health Care Businesses, Halbert Brown

Walden Dissertations and Doctoral Studies

Home health care agencies may experience financial hardship when regulatory inspections result in deficiencies and administrative penalties. Home health company (HHC) leaders are concerned because ineffective change management strategies may contribute to ongoing regulatory deficiencies, penalties, and reduced business performance. Grounded in Lewin’s change management theory, the purpose of this qualitative pragmatic inquiry project was to explore change management strategies some HHC owners successfully implemented to reduce administrative deficiencies and penalties to augment business performance and profitability. The participants were six leaders from HHC firms in the southwestern region of the United States who had developed effective strategies to improve …

The Role Of Reassurance Messages In Pediatric Oncology, Isabelle Faller

Doctoral Dissertations

Despite decreasing mortality rates, the high prevalence and incidence of pediatric cancer necessitate the need for advancements in the treatment of psychological concerns, specifically the reduction of patient distress and anxiety. A more comprehensive understanding of current reassurance messages in clinical practice can aid in developing a standardized framework for providing reassurance in pediatric oncology. Qualitative Content Analysis was employed to examine the types of messages nurses use to reassure patients (to reduce their anxiety about a future health-related event) and how effective nurses perceive these messages to be in relieving patients' anxiety. The adult participants, located at hospitals throughout …

What Do We Do At The End Of A World?: Cultivating Emergent Leadership In A Time Of Collapse, Brent Godfrey

Journal of Legal Education

No abstract provided.

The Parkinson's Pathway: Enhancing Knowledge And Care Management In Skilled Nursing, Kaitlyn Chau

Master's Projects and Capstones

Parkinson’s disease (PD) is commonly diagnosed among the older population, contributing to high utilization of skilled nursing facility (SNF) services. Objective: SNF A’s current onboarding and training program for staff discussed general geriatric topics but failed to include structured PD-specific education. This may lead to gaps in competence, confidence, and workflow related to PD care and management, resulting in low quality of patient care, poor health outcomes, and decreased safety and satisfaction. Aim: The project aimed to establish and incorporate a structured PD-specialized education program within a SNF located in Northern California, to increase employees’ self-reported confidence, competence, …

Reducing Live Discharges Using A Tiered Protocol In A Rural Hospice: A Quality Improvement Project, Jemma Lowak

Doctor of Nursing Practice Final Project Abstract

Purpose: To reduce 30-day caregiver-driven hospice revocations by implementing a tiered post-admission nursing visit protocol based on caregiver preparedness. Background: Caregiver distress and inadequate support contribute to hospice revocations and interruptions in care. Increased nursing contact during the first week of enrollment may improve caregiver preparedness and reduce crisis-driven hospitalizations. Methodology: An eight-week quality improvement project using the Plan-Do-Study-Act framework was implemented at a rural hospice agency. Caregivers completed a Caregiver Preparedness Survey to assign preparedness tiers and guide additional nursing visits during the first week. Process measures included survey completion and protocol adherence. Outcome measures included caregiver preparedness and …

Knowledge Dilution And Tinted Pedagogical Dissemination: A Call For De-Colonizing Commercial Textbooks In Teacher Education For International Students, S. A. N. Zaidi, Cherian, F.V.

Journal of Comparative & International Higher Education

Abstract

This qualitative study examines how commercially produced textbooks mediate professor agency and shape the racialized and epistemic positioning of international students within a Canadian Teacher Education program. Situated within the internationalization of higher education, the study interrogates how textbook-driven curricular practices reproduce racial hierarchies, Eurocentric knowledge systems, and epistemic exclusion. The study responds to ongoing debates on race, racism, and racialization by examining how knowledge production and dissemination in classrooms may marginalize the lived experiences and intellectual contributions of international and racialized students. Data were collected through semi-structured interviews and document analysis in programs serving racialized and international students. …

Reducing Copd Readmissions Through An Evidenced-Based Clinical Practice Guideline, Courtney Rye

Walden Dissertations and Doctoral Studies

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and hospital readmissions, with rural critical access hospitals (CAHs) facing unique challenges in delivering consistent, evidence-based care. At the pilot CAH medical–surgical unit, local chart review and practice observation revealed an approximately 18% 30-day COPD readmission rate and significant variation in discharge education, written action plans, inhaler technique assessment, and structured post‑discharge follow‑up. The purpose of this Doctor of Nursing Practice project was to develop and appraise an evidence‑based, Appraisal of Guidelines Research and Evaluation II (AGREE II) and Institute of Medicine–compliant COPD clinical practice guideline (CPG) to …

Enhancing Patient Understanding: Standardizing Cardiac Medication Education Using Teach-Back For Heart Failure, Nicole Valerie Hediger

Master's Projects and Capstones

Problem: The transition from hospital to home places heart failure (HF) patients at risk for medication errors, nonadherence, deterioration, and rehospitalization. In a 28-bed medical-surgical telemetry microsystem, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores indicated an opportunity for improvement: “Communication About Medicines” composite score of 47.9%; 62.5% of patients reported being informed about the medication purpose, and 33.3% reported that staff described potential side effects.

Context: A cohort of HF patients was selected to test teach-back methodology and improve patient understanding. Nurse champions volunteered for a 5-month improvement project.

Interventions: Teach-back methods were implemented. Nurse leader rounding …

In Memoriam: Claudette Colvin, Luke Hunter

History in the Making

No abstract provided.