Digital Commons Network^™

Quality Improvement Project: Gpt Prompts As Tools For Cultural Competence In Undergraduate Nursing Education, Elizabeth K. Hobbs

Doctor of Nursing Practice Projects

In rural nursing programs, student exposure to diverse cultures is limited, which can hinder development of cultural competence. Artificial intelligence (AI) simulation is an evidence-based strategy to improve cultural competence and clinical decision-making, a practice gap exists due to lack of structured, accessible tools. This quality improvement project evaluated whether Generative Pre-trained Transformer (GPT)–based structured prompts would increase culturally inclusive simulation activities and improve faculty perceptions of usefulness and ease of use at a rural community college. The guiding PICOT asked: Among nursing faculty, how does the use of GPT-based structured prompts, compared to an unstructured approach, impact perceived usefulness, …

Transesophageal Echocardiogram Training For Student Registered Nurse Anesthetists, Sophie Hesse, Annie Krippene, Christian Shelton

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Transesophageal echocardiography (TEE) is a vital diagnostic tool in perioperative care. At Barnes-Jewish College Goldfarb School of Nursing (GSON), Student Registered Nurse Anesthetists (SRNAs) formerly received limited TEE instruction, consisting primarily of didactic content. This quality improvement project aimed to enhance SRNA proficiency in TEE by integrating online and simulation-based training.

Review of Literature Findings: Simulation-based education has been shown to improve knowledge, skill, and confidence compared to lecture-only methods (Bloch et al., 2017; Chenkin et al., 2023; Pezel et al., 2023; Weber et al., 2019; Zhao et al., 2021).

Methods: Guided by the Iowa Model and …

Enhancing Anesthesia Clinicians’ Knowledge And Confidence In Prophylactic Antibiotic Selection For Patients Receiving Concomitant Therapeutic Antimicrobials, Nicholas Rangel, Michela Williams, Amber Theisen

Doctor of Nursing Practice (DNP) Student Projects

: Background and Review of Literature: Antibiotics are essential for preventing surgical site infections (SSIs), but improper selection can contribute to antimicrobial resistance, increased costs, and patient harm. Studies show that clinical decision support (CDS) tools can improve antibiotic prescribing practices using evidence-based guidelines.  Purpose: This project aimed to integrate a revised CDS tool into the workflow of a anesthesia clinicians at a midwestern academic medical center, incorporating allergy-specific guidelines and antimicrobial substitution recommendations for patients on concomitant therapeutic antimicrobials (CTA) to improve decision-making. Methods: This project used pre- and post-surveys to assess clinicians’ knowledge, confidence, and satisfaction in selecting …

Associations Between Smoking Habits And Weight-Related Behaviors Among People Who Smoke In The United Arab Emirates: A Cross-Sectional Study, Sharifa Alblooshi, Maryam Hassan Dawood, Dana N. Abdelrahim, Marika Lo Monaco, Falak Zeb

All Works

Background: Smoking is one of the leading global public health problems, and is complicated by multiple reasons for its prevalence and associated health problems. An understanding of the influence of smoking activity on weight management is essential to formulate successful health programs. Aim: The objective of the present study was the investigation of the association between smoking habits and weight management among adult people who smoke in the UAE. Methods: A cross-sectional study was conducted with 232 participants who completed a 36-item questionnaire assessing their smoking habits and weight management practices. Results: The sample consisted mostly of males (75.4%) aged …

Executive Summary: Executive Leadership System Improvement Improving Depression Screening And Follow Up Processes, Rebecca Geneiveve Hidalgo Salomon

Walden Dissertations and Doctoral Studies

Depression remains a significant public health burden in the United States, contributing to disability, healthcare utilization, and economic cost. Internal 2024 audits at the project site identified variability in Patient Health Questionnaire 9 PHQ 9 screening and follow up processes, with 68% of screenings completed, 55% of follow ups timely, and disparities among patients with limited English proficiency. These findings indicate a systems level reliability and equity gap. This executive leadership system improvement project focused on developing a standardized, nurse led, electronic health record supported workflow to improve PHQ 9 completion and timely follow up. The practice focused question asked …

Contemplating Race In Clinical Algorithms: Educating The Physicians Of Tomorrow, Adam Gaetz

North American Conference to End Race-Based Medicine

No abstract provided.

Use Of Resistive Exercise Snacks To Improve Upper Body Fitness In Undergraduate And Graduate Students, Zachary Abouelkawaam, Kevin Vaughan, Alexander Rothstein, Abdelmohsen Mossolem, Jean-Paul Dodier, Carlos Africa, Freddie Leong, John Handrakis

International Journal of Exercise Science: Conference Proceedings

Graduate/undergraduate students lack time for consistent physical activity, leading to declines in fitness. Exercise snacks (ExSnck), short bouts of submaximal exercise performed throughout the day, may offer a solution. PURPOSE: To evaluate the effects of a 6-week upper body ExSnck program on endurance, strength, power, and enjoyment compared to a 1-set maximal exercise (MaxEx) protocol and a control group. METHODS: 43 participants were randomly assigned to ExSnck (n=15), MaxEx (n=16), or Control (n=12) groups. The ExSnck group performed 33% of their maximal push-ups and plank time for 3 sessions/day (sessions ≥2hrs apart). The MaxEx group performed the same …

Pediatric Cardiac Imaging With Second- And Third-Generation Dual Source Ct Scanners: Radiation Dose, And Diagnostic Accuracy In Comparison With Echocardiography And Mri—A Systematic Review And Meta-Analysis, Lamia Ghazi Jamjoom, Razan Kamal Daghistani

Journal of the Saudi Heart Association

Objectives: The purpose of this study was to evaluate the diagnostic accuracy, imaging speed, radiation dose, and clinical utility of second- and third-generation dual source computed tomography scanners, in comparison with echocardiography and magnetic resonance imaging in diagnosing congenital heart disease in paediatric patients.

Material and Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 1 January 2006 to 30 April 2025.  Eligible studies included pediatric populations undergoing cardiac imaging with modern computed tomography scanners and compared outcomes against echocardiography or magnetic resonance imaging. Study selection followed PRISMA guidelines. …

Examining Nurse Burnout During The Covid-19 Pandemic: Causes And Mitigation Strategies, Melanie Sena

Honors Projects

Nurse burnout is a multidimensional occupational syndrome that predates the COVID-19 pandemic, yet the pandemic served as a catalyst that intensified its scope and severity in ways that the healthcare system was profoundly ill-equipped to manage. Characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, burnout among nurses accelerated dramatically between 2020 and 2022 as clinical workloads surged, personal protective equipment remained scarce, and moral distress became a near-universal experience across care settings. This review examines the primary systemic and individual contributors to nurse burnout during COVID-19, explores the consequences of burnout for both nurses and patients, …

Marching Health From Music To Injury: The Implications Of Marching Band Athletic Training Accessibility, Madelyn Liebhardt

Honors Projects

The following study explores the importance and need of athletic trainers (ATs) in marching band settings. Athletic Training is an essential backbone to many sports programs worldwide. Athletic Trainers are commonly seen as active staff members for many high school, collegiate, professional teams as well as in clinical office sites. Athletic Trainers are also staffed in non-traditional settings such as corporate settings, performing arts, military branches. Marching bands are categorized under non-traditional sports settings and ATs are becoming more highly preferred in this area. This study follows the Bowling Green State University (BGSU) Falcon Marching Band (FMB) during the 2025 …

Implementing A Self-Administered Crafft Screening Tool In A Pediatric Mental Health Setting, Michael Nguyen

Doctoral Dissertations & Projects

Background: Adolescent substance use disorders (SUDs) require early identification in inpatient psychiatric settings, but inconsistent screening workflows limit systematic detection.

Aims: This quality improvement project evaluated implementation of the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) 2.1 screening tool to improve identification of adolescents at risk for SUDs and support multidisciplinary communication.

Methods: CRAFFT 2.1 screening was embedded into admission workflows for adolescents admitted to two inpatient psychiatric units. Admission nurses distributed self-administered forms during admission. Completed screenings were scored and entered into the electronic medical record. Scores were categorized as low (0), medium (1), or high (≥2). High-risk results …

Quality Improvement Project: Integrating Depression Screening Into Adult Wellness Visits In A Primary Care Clinic, Nina Denchukwu

Doctor of Nursing Practice Projects

Depression is a prevalent and debilitating mental health condition that remains significantly underdiagnosed in primary care, despite national recommendations for universal adult screening. At the project site, less than 40% of adults completing annual wellness visits had documented depression screening. The purpose of this quality improvement project was to evaluate whether integrating the evidence-based Patient Health Questionnaire (PHQ)-2 and PHQ-9 into the electronic health record (EHR) would improve completion of depression screening, documentation, and referrals to treatment. The project was guided by Rogers' Diffusion of Innovations Theory and the Plan-Do-Study-Act (PDSA) framework. A quantitative pre–post intervention design linked with the …

Quality Improvement Project: Improving Provider Workflow And Documentation For Routine Mental Health Screening In An Outpatient Psychiatric Clinic, Sharon Uchechi Joshua

Doctor of Nursing Practice Projects

Depression and anxiety are leading causes of disability and are frequently underdiagnosed in outpatient psychiatric settings due to inconsistent screening and documentation practices. Evidence supports the use of standardized tools, such as the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), to improve early detection and clinical outcomes. This quality improvement (QI) project evaluated whether implementing standardized electronic health record (EHR) templates and provider education would improve documentation of PHQ-9 and GAD-7 screenings. The aim was to increase the consistency of screening and documentation among psychiatric providers. The project was guided by the Plan-Do-Study-Act (PDSA) framework and Lewin’s Change …

Understanding Adult Patients’ Experiences Of Trauma-Informed Care In Outpatient Healthcare, Jayme Aguero

Dissertations (1934 -)

Trauma is recognized as a universal human experience. Well-established evidence demonstrates the negative impact of trauma on health outcomes. In 2014, following a recommendation from SAMHSA, trauma-informed care (TIC) was implemented across human service sectors, including healthcare. While TIC has been in use for the past decade, adults’ experiences of receiving TIC in outpatient healthcare remain largely unknown. The purposes of this study were (a) to explore and describe how adults’ healthcare experiences aligned with the principles of TIC being implemented in outpatient healthcare settings and (b) to understand the perceived usefulness and meaning of TIC for adult patients. A …

Association Between The Combined Herbal Medicines And Risk Of Dental Diseases In Patients With Rheumatoid Arthritis: Insight From A Nationwide Database, Chiu-Hui Ling, Wei-Jen Chen, Ying-To Hsu, Hanoch Livneh, Ming-Chi Lu, Tzung-Yi Tsai

Leadership, Learning and Counseling Faculty Publications and Presentations

Background and Objectives:

Patients with rheumatoid arthritis (RA) are found to have a higher risk of dental diseases. Although herbal medicines (HMs) have long been used to treat various conditions, few studies focus on its impact on dental diseases. In this longitudinal cohort study, we assessed the correlation between HM use and risk of dental diseases in RA groups.

Materials and Methods:

A total of 2359 persons with RA aged 20–80 who were free of dental diseases between 2001 and 2010 were retrospectively enrolled from nationwide register-based data. They were then classified into HMs and non-HMs groups based on whether …

The Accuracy Of Occlusal Splint Fabricated By The Different Materials With Different 3d Printers., Supisara Thamrongsak

Master's Theses (2009 -)

Aim: The purpose of this study is to evaluate the accuracy of occlusal splints fabricated by the different materials with different 3D printers in four different orientations (0°, 15°, 25°, 40°) using surface matching software. Materials and Methods: Occlusal splints were printed in 4 different orientations including 0°, 15°, 25°, and 40° based on the STL file of the designed occlusal splint with 3 different printers (Carbon® M3Max, SprintRay Pro S, Asiga Pro4K). A total of 120 occlusal splints were printed for the present study, 10 occlusal splints were printed for each group. Then all occlusal splints were scanned using …

Response Of Reticulocyte And Red Blood Cell Indices To Single-Dose Intravenous Iron In Pregnant Women With Moderate Iron Deficiency Anemia: Secondary Analysis Of The Rapidiron Trial, Manjunath S. Somannavar, Sudhir Mehta, Dharmesh Kumar Sharma, Seema Mehta, Yogeshkumar S, Umesh Charantimath, Benjamin E. Leiby, Michael K. Georgieff, Zubair H. Aghai, Ashalata Mallapur, Umesh Ramadurg, Radha Sangavi, Praveen Patil, J. P. Akshaykirthan, Rupsa C. Boelig, Mrutyunjaya B. Bellad, Richard J. Derman

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Iron deficiency anemia in pregnancy is a significant health concern. Reticulocyte hemoglobin equivalent (Ret-He) and immature reticulocyte fraction (IRF) are emerging as early markers, yet their response to different iron therapies in pregnancy is underexplored.

OBJECTIVE: To determine whether intravenous single-dose iron administration produces a more favorable effect on reticulocyte indices than oral iron therapy in anemic pregnant women.

METHODS: This is a secondary analysis of the RAPIDIRON Trial, a multicenter, three-arm randomized controlled trial comparing ferric carboxymaltose (FCM), ferric derisomaltose (FDM) and standard oral ferrous sulfate. Reticulocyte hemoglobin equivalent (Ret-He), Immature Reticulocyte Fraction (IRF) and other red blood …

Autoantibody Reactivity In Hidradenitis Suppurativa: Characterizing Keratinocyte And Apocrine Gland Targets Across Disease Progression And Anti-Tnf-Α Treatment, Talla Hamouche

Student Theses and Dissertations

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease associated with impaired quality of life, representing one of the highest burdens among dermatological conditions. This debilitating disorder primarily affects apocrine-gland-bearing and flexural skin areas, most commonly the axillae, breast, buttocks, and groin. As lesions recur and new sites emerge, surgical excision does not guarantee prevention of disease reestablishment. Despite its substantial burden, HS remains among the least understood and most treatment-resistant inflammatory diseases. The mechanisms underlying this chronicity and the frequent failure of conventional anti-inflammatory therapies remain unresolved. An underappreciated autoimmune dimension may contribute to HS pathogenesis: the clonal …

Improving Monitoring And Documentation Of Long-Acting Injectable Antipsychotic Adherence In Patients With Schizophrenia Through Staff Education And Refill History Review, Stacy Ann Bruce

Doctor of Nursing Practice Projects

Schizophrenia is a chronic psychiatric disorder associated with relapse, hospitalization, and poor outcomes when medication adherence is suboptimal. Nonadherence increases morbidity and healthcare utilization (World Health Organization, 2022; Zhao et al., 2025). Long-acting injectable (LAI) antipsychotics improve adherence and reduce hospitalization, but inconsistent monitoring and documentation in outpatient settings hinder early identification of missed doses (Lieslehto et al., 2022). This Doctor of Nursing Practice (DNP) quality improvement project aimed to evaluate whether staff education and structured refill-monitoring processes improve identification and documentation of nonadherence to LAI antipsychotics. Using Kotter’s Change Management Model and the Plan-Do-Study-Act framework, the project focused on …

Quality Improvement Project: Emergency Preparedness In Urgent Care: Impacting Competency Among Medical Assistants, Sarah Pettyjohn

Doctor of Nursing Practice Projects

Urgent care settings present significant challenges, including limited staffing and resources, unpredictable patient acuity, and training deficiencies. These factors contribute to a competency gap among medical assistants, limiting their ability to recognize and respond to medical emergencies. The purpose of this quality improvement project is to impact emergency medical preparedness through a formal educational intervention. Grounded in Lewin’s Change Model and the Kirkpatrick Model, the project aims to improve emergency medical competency, consistent with evidence supporting structured training approaches. Using American Heart Association guidelines, medical assistants participated in a six-week educational program implemented through the Plan-Do-Study-Act framework, with assessments administered …

A Novel Guide‑Free Internal Device Fixation For Transverse Tri‑Planar Distal Metatarsal Osteotomy: A Retrospective Review​, Maya D. Kaafarani, Brittney White, Graham A. Hamilton, Shannon M. Rush

School of Podiatric Medicine - Student Research

Introduction: Minimally invasive surgery (MIS) for bunion correction has gained popularity due to favorable outcomes and reduced recovery times. However, most MIS techniques rely on commercial instrumentation for osteotomy, reduction, and fixation. This retrospective study evaluates patients treated with a novel tri-planar distal metatarsal osteotomy performed without specialized MIS guides, using only standard surgical tools and a novel device.

Methods: A retrospective review was conducted on 28 patients (31 procedures, including 3 bilateral cases) who underwent MIS bunion correction from 2021 to 2024. The technique involved a 2–3 cm medial incision, transverse osteotomy at the distal surgical neck of the …

Nurses’ Attitudes Toward Physical Examination, Nazan Çaylı, Cansu Nirgiz, Merve Kıymaç Sarı

Makara Journal of Health Research

Background: This descriptive, cross-sectional study was conducted to determine the attitudes of nurses working in clinical settings toward conducting physical examinations.

Methods: The sample surveyed consisted of 364 nurses currently working at 14 branches of a private hospital with facilities in seven cities, who participated voluntarily. Data was collected online via a survey created through Google Forms, applying descriptive characteristics form and the Physical Examination Attitude and Practice Scale in Nursing. The data were analyzed using the Mann–Whitney U test, Kruskal–Wallis test, Spearman’s rank-order correlation coefficient, and multiple regression analysis.

Results: It was found that nurses had …

Knowledge Of Parents And Guardians Of Computed Tomography Examinations And Radiation Risks In Children In Malaysia, Nur Maisarah Ali Wahab, Nur Hamizah Mohd Zainudin

Makara Journal of Health Research

Background: Early exposure to computed tomography (CT) imaging during childhood increases cancer risk, emphasizing the critical need to minimize unnecessary imaging in pediatric patients. This study aimed to assess parents and guardians’ knowledge about CT examinations and their associated risk following pediatric CT.

Methods: A cross-sectional survey was conducted among parents and guardians who accompanied their children to a private hospital radiology department for CT examinations. The survey enquired about their socio-demographic, knowledge of CT examinations, and their radiation risks. Data were analyzed using descriptive analysis and the Kruskal-Wallis test.

Results: A total of 144 responses were …

Questionnaire For Eudaimonic Well-Being: Psychometric Validation Among Malaysian Youth, Mohd Ahsani A. Malek, Nurulwahida Saad, Suzana Mohd. Hoesni, Muhamad Ariff Ibrahim, Nurul Shafira Adi, Mohd Nazir Mohd Nazori

Makara Journal of Health Research

Background: The rising prevalence of mental illness underscores the need to understand how individuals can live and flourish under such conditions. In Malaysia, research has largely emphasized diagnosis and treatment, with limited focus on positive psychology and few validated instruments. This study aimed to translate and validate the questionnaire for eudaimonic well-being (QEWB) among Malaysian youth.

Methods: The QEWB was translated into Malay using back-to-back translation and administered to undergraduates from four public universities through a cross-sectional survey design. Convenience quota sampling was used, resulting in 229 respondents completing the online form to measure sociodemographic characteristics, eudaimonic well-being, …

The Mediating Role Of The Care Factor In The Effect Of Nomophobia On Nurses’ Job Satisfaction, Uğur Öner, Sinan Aslan, Erhan Ekingen

Makara Journal of Health Research

Background: This study aimed to examine the mediating role of the Care Factor in the relationship between nomophobia and job satisfaction among nurses.

Methods: A descriptive, cross-sectional study was conducted with 1,083 nurses working in a province in Turkey between May and September 2024. Data were collected using a Descriptive Form, the Fırat Nomophobia Scale (FNS), the Care Factor Scale (CFS), and the Job Satisfaction Scale for Nurses (JSSN). All analyses were performed using SPSS 25, including descriptive statistics, Pearson correlation, and regression. Mediation was tested using PROCESS Macro version 4.0 (Model 4).

Results: The CFS-CS and …

Food Reintroduction After Negative Ofcs In Pediatrics: Dietary Frequency And Caregiver Attitudes, Olivia Pietrantozzi

Honors Projects

Food allergies in pediatric populations have been gradually increasing in prevalence and present significant nutritional risks requiring strict dietary management and psychosocial challenges. Oral food challenges (OFCs) serve as a gold standard in diagnosing food allergies and determining whether allergenic foods can be safely reintroduced to an individual's diet. However, caregivers of children may still experience anxiety and barriers that delay the reintroduction of foods, which can limit diet diversity and increase the child's risk of future allergy development. This study looked to evaluate the dietary frequency of allergenic food reintroduction following negative OFCs, as well as to assess changes …

Eeg Studies Of Pre-Stimulus Activity During Turn-Taking In Naturalistic Conversation, Seyedmohamadreza Manzourolajdad

Student Works (2020-2029)

This study integrates conversational analysis principles and neural activity to investigate natural cognition and examine event-related brain changes. A wireless electroencephalography (EEG) device was used in an ecological validity setting to analyse pre-stimulus brain activity preceding conversational turns. This study aims to identify aspects of the conversation that reflect its naturalness in the aspect of listening and the corresponding brain activity by analysing the signals before and after a turn in a conversation. This research contributes to an ecologically valid understanding of natural conversation as a social action that enables seamless communication. Seven Malaysian participants (aged 19–22, M=20.46) engaged in …

Quality Improvement Project: Reimplementation Of Bedside Reporting, Veronicah Banga

Doctor of Nursing Practice Projects

Communication breakdown during nursing shift handoffs is a major patient safety challenge in healthcare today. At the project site, 85% of handovers occurred at the central nursing station, and most staff nurses expressed dissatisfaction with the quality of the bedside reporting. In psychiatric nursing, unique barriers exist that make bedside reporting challenging, including patient confidentiality and an individual's diagnosis. Such barriers eroded bedside reporting (BSR) over time, leading to measurable safety risks and nursing dissatisfaction. The purpose of this quality improvement project was to reintroduce bedside handoffs using the Situation, Background, Assessment, and Recommendation (SBAR) framework and to maintain BSR …

Breathing-Controlled Electrical Stimulation (Breestim) Selectively Modulates Affective And Cognitive Components Of Pain-An Eeg Study, Ahmad Z Rao, Michael Houston, Hao Meng, Shengai Li, Yingchun Zhang, Sheng Li

Faculty, Staff and Student Publications

Breathing-controlled electrical stimulation (BreEStim) is an innovative neuromodulation intervention that synchronizes deep voluntary breathing with peripheral electrical stimulation. Prior studies have shown its analgesic effects in healthy adults and spinal cord injury patients with neuropathic pain. The present study used EEG to examine BreEStim's neural effects on sensory, affective, and cognitive components of pain. Fourteen healthy participants (7 M, 7 F) completed 30 min of BreEStim and conventional electrical stimulation (EStim) interventions in a randomized, crossover within-subject design. Electrical pain thresholds (EPT) and EEG were recorded pre- and post-intervention. Event-related potentials (ERPs) at pre-EPT-level stimuli before and immediately after each …

Abstract Book (Pdf), Lsu Health School Of Medicine

Medicine Research Day

No abstract provided.