Digital Commons Network^™

Ethics Under Siege: The Conflict In Tigray Through The Lens Of Just War Theory, Daniela Widya Purba

Journal of Strategic and Global Studies

This research article explains the ethical principles of the conflict in Tigray based on the Just War Theory. By using the descriptive qualitative methodology, this research article draws data from secondary sources which includes; academic journals, news reports, as well as international legal instruments to analyze the moral trajectory of the conflict. This research begins with jus ad bellum, to assess Ethiopia’s government justification in declaring conflict within Tigray. While the government fulfilled the criteria of just cause and legitimate authority, the question stands on the ambiguous political intentions and the failure to enact peaceful alternatives before resulting in waging …

Evaluating Machine Learning Models On Classification Of Novel Cyber Attacks In The Healthcare Domain, Promise Ehimen

Dissertations, Theses, and Projects

The increasing adoption of the Internet of Medical Things (IoMT) has improved healthcare delivery through connected medical devices while simultaneously expanding the cybersecurity risks facing healthcare organizations. Although machine learning based intrusion detection systems have demonstrated high detection accuracy, their ability to respond reliably to previously unseen cyberattacks remains uncertain. This study investigated how a Neural Network model and a Logistic Regression model classified novel cyberattacks within the IoMT environment. The Neural Network and Logistic Regression models were both trained and tested using a subset of the CICIoMT2024 benchmark dataset. The Neural Network achieved 99.82% test accuracy and a 0.94 …

Systematic Review Of The Institutionalization Of Service Learning In Higher Education, Wilmer Hernan Cruz Gutierrez

ASEAN Journal of Community Engagement

An increasing number of universities are integrating service-learning (SL) to fulfill their social mission. However, sustainable institutionalization of SL remains a persistent challenge. This study identifies and analyzes the factors, actors, and strategies that drive and inhibit SL institutionalization in higher education. Using the PRISMA 2020 guidelines, a systematic literature review analyzed 52 documents from seven academic databases (including WoS, Scopus, and ERIC). The findings were grouped into three sections: cultural (integration into institutional values/missions), process (articulation within teaching, research, and outreach), and structural dimensions (dedicated support entities). The results obtained reveal a reciprocal relationship where cultural alignment enables processual …

Exploring Perceptions Of Self-Efficacy Among Newly Graduated Nurses In The Labor And Delivery Unit After The Use Of Rapid Cycle Deliberate Practice For Obstetric Emergencies, Amber L. Hulsey

Dissertations

Background: The average turnover rate among newly graduated nurses (NGNs) in the United States is 25-30% within their first year, with increased rates in high-stress units like obstetrics and critical care. Many risk factors contribute to the high turnover rate of NGNs, but one modifiable factor is feelings of self-efficacy. Studies have shown that simulation training can increase self-efficacy in obstetric emergencies. This study was conducted to explore feelings of self-efficacy among NGNs working in the labor and delivery unit after a rapid cycle deliberate practice (RCDP) simulation of an OB emergency.

Methods: The study used a descriptive …

The Use Of A Sepsis Escape Room Simulation To Enhance Undergraduate Nursing Student's Clinical Judgment, Alaina Peterson

Dissertations

Background: Less than 10% of new graduate registered nurses meet practice-ready expectations for clinical judgment competencies, and 52% of critical care nurses are unable to adequately define sepsis. Traditional clinical rotations offer inconsistent exposure to high-acuity, low-frequency events such as sepsis, leaving new graduates unprepared for independent practice. Escape room simulations use the proven effectiveness of high-fidelity simulations with gamification to develop clinical judgment through active learning, teamwork and problem-solving.

Objective: The purpose of this project was to determine the effectiveness of a sepsis escape room simulation to improve perceived clinical judgment skills of undergraduate nursing students. The intervention was …

Codesign And Implementation Of A Tai Chi Intervention For Managing The Fatigue, Sleep Disturbance And Depression Symptom Cluster In Breast Cancer Survivors In Regional Australia: A Feasibility Study Protocol, Suellen Skinner, Wai Hang Kwok, Jing Yu Benjamin Tan, Tao Wang, Daniel Bressington, Liqun Yao, Brona Nic Giolla Easpaig

Research outputs 2022 to 2026

Introduction: Breast cancer survivors (BCS) often experience side effects such as the fatigue, sleep disturbance and depression symptom cluster (FSDSC). Previous studies have demonstrated the potential efficacy of Tai Chi (TC) for improving FSDSC in BCS in a hospital setting in China. This study will explore the feasibility, acceptability and preliminary effects of the Easy 8 Form TC protocol as an adjuvant therapy in BC survivorship care, adapted to a regional Australian community setting.

Methods and analysis: The purpose of the present study is to provide a codesigned TC protocol. This multimethod study comprises a codesign study, followed by a …

The Legacy, Importance, & Impact Of Lend: Evidence And Personal Stories, Emily Zalimeni, Emma Stone, Alexa Fortier, Leia Getchell, Nataliya Kloyzner, Asha Abdullahi, Elizabeth Barkoudah, Meghan Chapman, Meredith Close, Heather Engholm, Melissa Levin, Aanchal Sharma, Sarah Sparks, Patricia Rissmiller, Amy Szarkowski, Jason M. Fogler

Developmental Disabilities Network Journal

Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs offer an interdisciplinary/interprofessional training opportunity for medical and allied health professionals, and individuals impacted by disability, including family members and self-advocates. Toward the aim of advocating for the enduring need of LEND and similar training programs, this article centers the voices of a subset of our alumni who have advanced the rights and improved the lives of persons with intellectual and developmental disabilities. These stories are intended to illustrate the key lessons and principles of LEND training, including attending to disability issues in education, growing skills within and between individuals working …

Full Issue: The International Undergraduate Journal Of Health Sciences, Volume 6, Issue 1, July 2026

International Undergraduate Journal of Health Sciences

Full Issue: The International Undergraduate Journal of Health Sciences, Volume 6, Issue 1, July 2026.

The Effects Of Jasmine And Champaca Aromatherapy Combined With Acupressure On Sleep Quality In Older Adults With Non-Communicable Diseases: A Quasi-Experimental Study In Rural Northern Thailand, Sriwan Chutithamniti, Katekaew Seangpraw, Prapaporn Tulwattanakul, Manuchet Manotham, Parichat Ong-Artborirak, Nestor Asiamah, Wannita Sakulwattana, Surangkana Chairinkam, Phatcharee Pimalram, Wichida Larsomsri

Journal of Health Research

Background: Poor sleep is common among older adults and negatively affects physical and mental health. This study evaluated the effects of jasmine and champaca essential oil aromatherapy combined with acupressure on sleep quality and cardiovascular parameters among older adults.

Methods: A quasi-experimental study was conducted in rural Phayao, Thailand. Older adults aged ≥60 years with non-communicable diseases and poor sleep quality (Pittsburgh Sleep Quality Index [PSQI] > 5) were assigned to either an intervention group (n = 54), receiving aromatherapy and acupressure for 6 weeks, or a control group (n = 54), receiving usual care. Sleep quality, blood pressure (BP), and …

Evaluation Of A Streamlined Insurance Advocacy And Pre-Authorization Process For Hormone Replacement Therapy, Ellison Edwards

Walden Dissertations and Doctoral Studies

This organizational process evaluation project addressed the high rate of insurance denials for hormone replacement therapy (HRT) for women with symptomatic menopause and "normal" laboratory values within a private primary care setting. The practice problem involved bureaucratic barriers in the front office and a lack of structured advocacy, which delayed patient access to evidence-based care. The purpose of this project was to evaluate the impact of a streamlined insurance advocacy and pre-authorization process on access to therapy. The project utilized a standardized "Insurance Advocacy Toolkit" and evidence-based templates aligned with the 2023 North American Menopause Society (NAMS) guidelines. Analytical strategies …

A Proposal For A Nurse-Led Continuity Of Care Program, Belinda Siri Mesape

Walden Dissertations and Doctoral Studies

At an outpatient primary care and behavioral health clinic, the practice problem is the high rate of patient no-shows and late appointment cancellations. Missed appointments are a problem, disrupting continuity of care and follow-up and potentially affecting patient outcomes. A comprehensive literature search was performed using PubMed/MEDLINE, CINAHL Complete, the Cochrane Library, PsycINFO, and Google Scholar. The search revealed 26 peer-reviewed studies. Literature consistently supports the use of multifaceted interventions to improve appointment adherence in outpatient settings. The project proposal consists of the development of an evidence-based practice (EBP) program proposal to address the gap in practice in improving appointment …

Alcohol Withdrawal Management Practices And Prevention Of Escalation Events In Hospitalized Adults, Danielle Logan

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project was an organizational process evaluation examining alcohol withdrawal management among hospitalized adults. Alcohol withdrawal can cause severe agitation, seizures, delirium, behavioral emergencies, transfers, and prolonged hospitalization, making early recognition and evidence-based management essential to patient safety. The practice-focused question examined whether hospitalized adults experiencing alcohol withdrawal were assessed and treated proactively based on risk factors and clinical presentation or reactively after symptom escalation, and whether management practices contributed to Code Green activation and higher-level-of-care transfers. The purpose was to identify practice gaps and develop evidence-based recommendations to improve safety and consistency of care. A …

Public Responses About Air Quality In The World’S Ten Most Populous Countries, Noah Lim, Alessandro Del Ponte, Lina Ang, Wei Jie Seow

Political Science Faculty Articles and Research

Understanding how people view and react to outdoor air quality is crucial to effectively managing and responding to air pollution, which is a major threat to global public health. Using a quota sample of 10,618 respondents from 1,372 localities across the world’s ten most populous countries (Bangladesh, Brazil, China, Indonesia, India, Mexico, Nigeria, Pakistan, Russia, and the United States), we assessed the association between exposure to fine particulate matter with diameter ≤ 2.5 micrometers (PM2.5) and people’s knowledge, attitudes, perceptions, practices, and concern about air quality. Overall, we find an inverse association between air pollution exposure and knowledge about air …

Evaluating Mobile Palliative End-Of-Life Advanced Care Enhancement (Mpeace) Usability And Technology Acceptance: Mixed-Methods Design, Ni Luh Putu Inca Buntari Agustini, I Gede Putu Darma Suyasa, Israfil Israfil

Jurnal Keperawatan Indonesia

Palliative End-of-Life Care (PEoLC) is a process requiring timely assessment, effective communication, and personcentered decision-making to support patients and families. Although the process can be strengthened through digital health innovations such as Mobile Palliative End-of-Life Advanced Care Enhancement (M-PEACE), its use in PEoLC remains limited. Therefore, this study aimed to evaluate M-PEACE usability and technology acceptance through an explanatory sequential mixed-methods design and explore user experiences in describing quantitative results. The quantitative phase was conducted to assess usability through an adapted System Usability Scale (SUS), and technology acceptance was measured using a modified Technology Acceptance Model (TAM) questionnaire. A total …

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Posters and Presentations

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Scholarly Projects

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

“It’S Not Just Cost”: Barriers To Mammography Screening Access Among Low-Income Women In The United States—A Scoping Review, Julia Messerman, Callia Nickels, Nigel C. James

Health Studies Faculty Publications

Despite the recognized importance of early detection, disparities in mammography access persist among low-income women in the United States. While financial barriers are often emphasized, less is known about how multiple barriers interact to shape access to screening. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to synthesize evidence on barriers to mammography access among low-income women in the United States. A systematic search of PubMed, CINAHL, and Google Scholar identified peer-reviewed studies published between 2010 and 2025, of which 47 met inclusion criteria. Extracted barriers were categorized into …

Loss Of Pleasure (Anhedonia): A Sex-Dependent, Cross-Species Consequence Of Unpredictable Signals To The Perinatal Brain, Anna M. Zhou, Madison R. Tetzlaff, Laura M. Glynn, Curt A. Sandman, Hal S. Stern, Tallie Z. Baram, Elysia Poggi Davis

Psychology Faculty Articles and Research

Reward seeking is an essential component of human behavior. Anhedonia (reduced motivation for and pleasure in reward) is a core feature of several mental illnesses. Early life adversity associates with later impairments in reward behaviors and related psychopathology; however, specific aspects of early adversity that lead to disrupted reward behaviors are unknown. Capitalizing on evidence that unpredictable signals to the developing brain constitute adversity and influence neurodevelopment, we examined whether exposure to perinatal unpredictable maternal signals associated with diminished reward responsivity, and probed causality using experiments in mice. We analyzed a longitudinal human study (N=158 mother/child dyads) and a …

Supportive And Palliative Care: Addressing The Unspoken Burden Of Cancer On Significant Others, Esmeraldo C. De Las Armas Iv

Jurnal Keperawatan Indonesia

A diagnosis such as cancer can cast a long-lasting gloom that affects not only the patient but also their loved ones. This concept analysis represents an effort to understand and explore the nuanced world of supportive and palliative care for significant others of cancer patients, a population that has often been overlooked. Rodgers’ evolutionary model of concept analysis was utilized to examine the concept of supportive and palliative care for significant others of cancer patients. Positive outcomes for both significant others and patients included improved coping mechanisms, reduced caregiver burden, enhanced communication, and better quality of life. However, several challenges …

Staff Education About Prescribing Glucagon-Like Peptide-1s (Glp1s), Deenis Garcia

Walden Dissertations and Doctoral Studies

Obesity is a growing health concern that affects many people. In recent years, the use of glucagon-like peptide-1 (GLP1s) has become increasingly popular to combat obesity. The use of GLP1s has shown successful outcomes, yet there are inconsistencies when prescribing the medication for weight loss. The practice problem identified at the organization was the lack of consistent and evidence-based guidance for providers to utilize when prescribing GLP1s for weight loss. The practice-focused question was to determine whether education on structured guidance tools for clinical staff who prescribe GLP1 medications improves their knowledge and intent to use these tools when prescribing …

Development Of A Proposal For An Occupational Safety And Wellness Program, Lodie Rogers

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) evidence-based practice project was a quality improvement initiative focused on developing and implementing an occupational safety and wellness program (OSWP) in an industrial organization. The practice problem was the absence of a formal, standardized program for injury prevention, near-miss reporting, hazard identification, employee wellness, safety education, and leadership accountability. Evidence from scholarly databases, Occupational Safety and Health Administration (OSHA) reports, organizational safety data, incident reports, near-miss documentation, and compliance measures supported the project. I examined how a 10-week OSWP can reduce employee incidents, improve safety culture, decrease injuries, increase engagement, and sustain wellness practices. …

Recognizing Appropriate General Inpatient Hospice Patients Time To Stop Normalizing Suffering, Oliver Charles Roth

Walden Dissertations and Doctoral Studies

Hospice patients experiencing uncontrolled pain, dyspnea, agitation, anxiety, delirium, or other severe symptoms may require General Inpatient (GIP) hospice care for intensive symptom management. However, inconsistent recognition of symptom crises can delay escalation to the appropriate level of care, contributing to unnecessary patient suffering, caregiver distress, and avoidable emergency department or hospital utilization. This Doctor of Nursing Practice executive leadership project evaluated the implementation of an educational framework designed to improve clinician recognition and timely escalation of patients who may be appropriate for GIP hospice care. Education emphasized early identification of uncontrolled symptoms, interdisciplinary communication, documentation, and escalation for clinical …

Demographic And Socioeconomic Factors Related To Visceral Leishmaniasis Infection In South Sudan, Duncan Ochieng Ochol

Walden Dissertations and Doctoral Studies

Visceral leishmaniasis, a severe parasitic disease that is invariably fatal, is characterized by frequent outbreaks, and is associated with poverty. South Sudan is among the countries with the highest burden of visceral leishmaniasis. However, few studies have investigated factors associated with visceral leishmaniasis in the country. This study investigated demographic (age, gender, marital status, education level and occupation) and socioeconomic factors (transport, access to health services and residence) that may be associated with visceral leishmaniasis infection in South Sudan. The study was anchored on the socioecological model conceptual framework, which describes the interaction between individual and their social environment and …

Development Of A Culturally Tailored Care Model For Chronic Disease Management In The Coastal Community: A Modified Delphi Study, Laode Saltar, Heltty Heltty, Sitti Mikarna Kaimuddin

Jurnal Keperawatan Indonesia

Chronic noncommunicable diseases (NCDs), particularly hypertension and type 2 diabetes mellitus, are increasing in Indonesia’s coastal communities including the Bajo population in Southeast Sulawesi. Limited healthcare access, cultural barriers, and low preventive health engagement exacerbate the disease burden in these communities. Culturally tailored interventions are needed to enhance self-awareness and improve chronic disease management. This study aimed to develop and validate a culturally sensitive care model for chronic disease management in the Bajo coastal community. A three-round modified Delphi method was used with 26 panelists representing health professionals, community leaders, policymakers, and family members recruited through community health centers and …

Early Post-Cesarean Anxiety, Nausea, Vomiting, And Pain Under Spinal Anesthesia: Trajectories And Modifiable Predictors, Indah Susanti, Eza Kemal Firdaus, Septian Mirova Sebayang, Amelia Andini, Alicia Dumes Berg, Margaret Atwood, Rantiningsih Sumarni, Mesya Mesya, Asmat Burhan

Jurnal Keperawatan Indonesia

Recovery after caesarean under spinal anesthesia remains a quality gap, with scarce evidence on modifiable anesthetic practices improving recovery. Data linking the neuraxial technique, nausea, anxiety, and pain remain limited. The objective of this study was to describe postoperative nausea and vomiting, anxiety, and pain at 6, 12, and 24 hours after caesarean section under spinal anesthesia and to examine whether intrathecal adjuvant use, sensory block level, fasting duration, and American Society of Anesthesiologists (ASA) physical status were associated with these outcomes. Cross-sectional study across five hospitals; 534 women undergoing caesarean under spinal anesthesia. Exposures: intrathecal adjuvant, sensory level (≤ …

Emotional Intelligence, Work Engagement, And Turnover Intention Among Hospital Nurses: A Hierarchical Component Analysis, Catrin Catrin, Christopher Wisnu, Pauline Henriette Pattyranie Tan

Jurnal Keperawatan Indonesia

High turnover intention among hospital nurses poses serious challenges to healthcare organizations, affecting service quality and workforce stability. Understanding the psychological and organizational factors associated with turnover intention is essential for developing effective retention strategies. This study aimed to examine the relationships among emotional intelligence, work engagement, and turnover intention among hospital nurses, including health-promoting leadership, workload, and burnout as contextual variables within the model. A cross-sectional study was conducted among 98 nurses working in inpatient units using validated questionnaires. The data were analyzed using partial least squares structural equation modeling (PLS-SEM) with hierarchical component analysis. Emotional intelligence significantly predicted …

Implementing A Research Best Practices Training For Community Health Workers And Promotoras At Multiple Sites: A Mixed Methods Evaluation, Alexandra E. Harper, Analay Perez, Gretchen Piatt, Gina M. Jay, Jasmine J. Opusunju, Lakeisha M. Batts, Giselle M. Garza, Tania Terezon, Candace Robledo, Loren Clark

School of Medicine Publications

Introduction: We previously developed and tested a peer-led research best practices training for community health workers and promotoras (CHW/Ps) to enhance the capacity of a workforce that is increasingly important for community-engaged research. This paper explores results of training implementation at 4 additional sites – 3 academic institutions and 1 community-based organization.

Methods: Forty-two CHW/Ps were trained over 6 trainings and 10 site staff participated. We used a mixed methods design consisting of surveys and interviews to assess site staff’s perceptions of the training and its implementation. Survey data were examined using basic statistics and thematic content analysis. Two coders …

Intermembrane Coupling Between Bcl-Xl And The Ip3 Receptor Supports Local Ca2+ Transfer At Er-Mitochondrial Contacts, Arijita Ghosh, David Weaver, Chi Li, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Bcl-xL, an anti-apoptotic Bcl-2 family protein, engages laterally with Bak/Bax in the outer mitochondrial membrane (OMM) to inhibit apoptosis and interacts with the IP₃ receptor Ca²⁺ channels (IP3Rs) in the endoplasmic reticulum (ER) membrane to control Ca²⁺ release. It is unknown if OMM-localized Bcl-xL can also interact in trans with IP3Rs at ER-mitochondrial contacts to form a tethering complex that supports IP3R-mediated local Ca²⁺ transfer from ER to mitochondria. We establish that IP3R-mitochondria Ca²⁺ signal propagation depends on Bcl-xL. By targeting Bcl-xL specifically to different subcellular compartments, we find that OMM-localized Bcl-xL increases the efficacy …

Client Usability And Student Perspectives Of A Novel Mobile Health App To Facilitate 3d-Printed Assistive Device Learning And Application, Sara Benham, Sarah Argumedo, Samantha Pifer, Tiras Williams, Jeffrey Bush, Monica Kaniamattam

Journal of Innovation in Health Sciences Education

Introduction: Locating, selecting, and printing appropriate 3D-printed assistive devices (AD) to meet specific health needs can be overwhelming. To address these challenges, the 3DAdapt app was developed. This study aimed to explore the app’s usability through an occupational therapy (OT) student project that involved delivering 3D-printed AD to older adults.

Methods: Over three sessions, OT students collaborated with older adults to provide customized 3D-printed AD. The app’s usability was assessed using a mixed-methods approach, including the System Usability Scale (SUS; scores ≥ 70 indicate usability). Focus groups with OT students further explored the usability of occupation-focused interventions with their …

Shaped By Experience: A Study Of Hybrid Professional Physical Therapist Education Patient Experiences And Experiential Learning., Teresa R. Bachman, Anne H. Boddy, Megan B. Flores, Elizabeth M. Ardolino

Journal of Innovation in Health Sciences Education

Introduction: Limited evidence exists on the use of patient experiences (PE) and experiential learning (EL) in hybrid entry-level physical therapist (PT) education programs. This study explored the impact of PE and EL within immersion labs on student self-confidence and self-efficacy in a hybrid entry-level PT education program. A total of 431 surveys were completed across 8 lab immersions for 6 courses. Nine total focus group discussions occurred, with a total of 50 participants, ranging from 2 to 10 per group.

Methods: A convenience sample from one entry-level hybrid PT education program participated in this mixed-method study with surveys and …