Implementation Of Electronic Triggers To Identify Diagnostic Errors In Emergency Departments, Viralkumar Vaghani, Ashish Gupta, Usman Mir, Li Wei, Daniel R Murphy, Umair Mushtaq, Dean F Sittig, Andrew J Zimolzak, Hardeep Singh

Faculty, Staff and Students Publications

Importance: Missed diagnosis can lead to preventable patient harm.

Objective: To develop and implement a portfolio of electronic triggers (e-triggers) and examine their performance for identifying missed opportunities in diagnosis (MODs) in emergency departments (EDs).

Design, setting, and participants: In this retrospective medical record review study of ED visits at 1321 Veterans Affairs health care sites, rules-based e-triggers were developed and implemented using a national electronic health record repository. These e-triggers targeted 6 high-risk presentations for MODs in treat-and-release ED visits. A high-risk stroke e-trigger was applied to treat-and-release ED visits from January 1, 2016, to December 31, 2020. A …

Exploring Medical Assistance In Dying: A Review Article, David Pfrimmer

Consensus

No abstract provided.

Enhancing End Of Life Care Through Recognition & Flagging Of Imminence To Increase Visits, Ali Ahmed, Guru Chinnaraj, Ana Goncalves, Ahad Ahmed, Ezekiel Ijaopo, Joseph Shega, Diana Tren

North Florida Division GME Research Day 2025

No abstract provided.

The Integrated Support Plan For End-Of-Life Care (Isp-Eolc), Kaitlin R. Sugarman

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

The Integrated Support Plan for End-of-Life Care (ISP-EoLC) workbook was developed to address the growing need for structured, occupation-based resources for occupational therapy practitioners (OTPs) working in end-of-life care. Rooted in evidence-informed practice, this workbook guides OTPs in supporting patients and caregivers through one of life’s most complex transitions. Each chapter of the workbook focuses on a key topic, including early recognition of OT needs, meaningful role participation, iterative interventions, caregiver support, and interdisciplinary collaboration. Designed to be both educational and interactive, the workbook includes patient and caregiver-directed activities that promote communication, reflection, and emotional connection. It also offers practical …

Death And Dying Across The Lifespan, Paige Sala

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

Death and Dying Across The Lifespan centers on the creation of three interdisciplinary educational courses focused on end-of-life care for three distinct age groups: geriatrics, adults, and pediatrics. The courses aim to improve undergraduate students’ competence in addressing death and dying with patients, caregivers, and other healthcare professionals within the team. The courses were developed in response to growing evidence that supports the need for education on death, dying, and caring for individuals at the end of life. Many students are not adequately exposed to these topics in current curricula, despite the importance of interdisciplinary collaboration in this area of …

Implementation Of A Pediatric Skills And Simulation Workshop Among Rural Nurses, Cassandra Grabiel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

No abstract provided.

Has The Elimination Of Mandatory Buprenorphine X-Waiver Increased Presciptions Of This Medication Upon Discharge From The Hospital?, Kendall Moore, Robyn Meadows, Robyn Hoelle, Matthew Calestino

North Florida Division GME Research Day 2025

No abstract provided.

Comparing Chatgpt And Deepseek For Deprescription Support In Geriatric And Palliative Care: An Exploratory Study Using Clinical Vignettes, Gokhan Demir, Angel Sanchez, Sanaz Kashan

East Florida Division GME Research Day 2025

Background: Polypharmacy is common in older adults and increases risks of adverse drug events, falls, and hospitalizations. Deprescription can mitigate these harms but is often hindered by time constraints, fragmented guidelines, and complex comorbidities. Artificial intelligence (AI) large language models (LLMs) may provide decision-support for deprescription in geriatric and palliative care.

Objective: To compare ChatGPT and DeepSeek in their deprescription recommendations across standardized polypharmacy vignettes.

Methods: Three validated clinical vignettes, varied by activities of daily living (ADL) status and cardiovascular disease (CVD) history, were presented to ChatGPT (GPT-4/5) and DeepSeek (2024 version). Each vignette was tested in three replicates per …

Death, End-Of-Life Doulas, And Art:
Exploring Connections Between Death Competency And Art Making, Jill K. Hoefgen

Art Therapy | Master's Theses

Death in the United States is often viewed as a medical event rather than the natural course of life, which results in avoidance of planning for the inevitable. The emergence of Hospice in the 1970s, Medical Aid in Dying (MAID) laws in several states, and the positive death movement have demonstrated a shift in attitudes and priorities about death and dying. Since the early 2000s, end of life doulas (EOLDs) have emerged as practitioners who help people plan for and transition to death. Emotional and existential coping skills are components that emerge from death work, and these elements can be …

A Nurse-Driven Protocol To Increase Music Therapy Referrals To Manage Patient Pain And Anxiety In The Medicine Intensive Care Unit, Ashley Fox

DNP Projects

Background: Critically ill patients often suffer from pain and anxiety. Music therapy is a safe and effective treatment option. However, most nurses never receive education or training on it, resulting in a lack of awareness of its value and its actual usage in care.

Purpose: The purpose of this project was to increase the number of music therapy referrals to manage pain and anxiety in eligible medicine intensive care unit (MICU) patients via a music therapy protocol that increased nurses’ knowledge, attitudes, and skills related to the use of music as an alternative treatment option for pain and anxiety in …

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 …

"You Sure Feel Like You're Alone, Kind Of Flailing Away Out There": Family Caregiver Perspectives Of Caring For An Individual With Glioblastoma Multiforme, Christy Muasher-Kerwin, Abby Baumbach, Yujun Liu, M. Courtney Hughes

Faculty Articles, Papers, and Other Scholarship

Objectives

Glioblastoma multiforme (GBM) is the most common and aggressive form of brain cancer. Family caregivers of individuals with GBM must navigate a wide range of their care recipients’ physical, cognitive, and psychosocial deficits to provide effective care, which is both mentally and physically demanding. This study aimed to investigate the perspectives of family caregivers of GBM patients about the barriers and challenges they encounter when providing care to their care recipients. Methods

Nineteen current and former family caregivers for individuals with GBM participated in semi-structured interviews from October 2023 through January 2024. We conducted interviews virtually and used applied …

Transdisciplinary Collaboration Of Healthcare Professionals And The Emotional Connectedness With Working With Patients Coping With Death And Dying, Princess Nguyen, Lindsay Gietzen

Pacific Journal of Health

Abstract

Purpose: This study explores how an integrated approach to care for patients and families by transdisciplinary healthcare teams provides opportunities for a patient-centered care approach to support quality of life throughout one's chronic illness and at the end-of-life. Discussions and conversations about impending death or dying are often challenging and a complex task for healthcare professionals in whatever settings. While there is an understanding of aspects of collaborative care and transitions and processes to support patients and families about how to cope and communicate about death and dying, it is essential to recognize how best to support end-of-life care …

Exploring Disparities In Palliative Care Utilization For Patients With End-Stage Liver Failure: A Nationwide Cohort Analysis (2016-2020), Sheza Malik, Hajra Khan, Amatul Mueed Taqiyyah Fatima Syeda, Mohammed Faisaluddin, Babu Mohan Md, Asim Mushtaq, Karin Dunnigan

Advances in Clinical Medical Research and Healthcare Delivery

Background: Despite the very high symptom burden, palliative care (PC) services are underutilized in patients with End-stage liver disease (ESLD). Herein, we investigated the disparities in the utilization of PC services among patients with ESLD hospitalized in the United States.

Method: We conducted a retrospective cohort analysis by utilizing the Nationwide Inpatient Sample from 2016 to 2020. All patients greater than 18 years old admitted with ESLD were included in the analysis. A multivariate logistic regression model predicting referral to PC was created.

Results: In our analysis, significant racial disparities were observed in the utilization of palliative care services among …

Measures Of Success: Making The Case For Advanced Practice-Sensitive Quality Indicators, Ruth Kleinpell, April Kapu, Cynthia Borum

HCA Healthcare Journal of Medicine

Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that …

Examining The Relationship Between Ethnocentrism, Perspective-Taking And Cultural Competence In Medical-Surgical Nurses, Lori Ann Palmieri

Seton Hall University Dissertations and Theses (ETDs)

This descriptive correlational study explored the relationships between cultural competence, ethnocentrism, and perspective-taking in practicing medical-surgical nurses living in the United States (US). Participants (N=111) were recruited from the New Jersey Board of Nursing (NJBON) and from the Academy of Medical-Surgical Nurses (AMSN). The survey consisted of three validated instruments a) the cultural competence assessment instrument (CCA-I); b) the generalized ethnocentrism scale (GENE); c) the perspective-taking (PT) subscale of the interpersonal reactivity index (IRI), and d) demographic profile questions. Data were collected via Qualtrics and analyzed with IBM SPSS Statistics (Version 28/29). Ethnocentrism and perspective-taking explained 30.2% of the variance …

Undergraduate Nursing Students’ Simulation Experiences With End-Of-Life Care In A Rural Setting: A Scoping Review, Christopher Norman Msn, Aprn, Gnp-Bc, Jodi Sutherland Phd, Rn, Acrn, Cne, Lori Marie Sprague Phd, Rn, Chse, Deborah Palmer Ms, Rn, Alma Rood Msn, Rn, Laura Lipke Ms, Mlis, Ahip

Nursing Faculty Scholarship

Objective: The purpose of this scoping review is to provide nurse educators and nurse leaders in practice with the findings on the state of the science surrounding undergraduate nursing education simulation-based experiences focused on end-of-life (EOL) care in rural settings. This scoping review aims to identify undergraduate nursing student experiences with EOL care in the rural setting and identify key simulation-based educational strategies utilized in undergraduate nursing programs to inform educational programs about simulation practices. The outcome of this review is intended to advance nursing education to better prepare future nurses for practice and to develop competence in providing EOL …

How Do Older Adults Define A Good Death? A Scoping Review, Ellen L. Csikai, Quentin R. Maynard

Midwest Social Sciences Journal

A scoping literature review of the concepts of ‘good death’ and ‘dying well’ among older adults was conducted. The purpose was to identify aspects that older adults specifically considered important in defining a ‘good death’. The search revealed five articles published between 2005 and 2019 that met inclusionary criteria for the review. Primary among the views of the older adults in these studies of a ‘good death’ was the desire to avoid being a burden to families; done so by dying pain-free/peacefully (preferably in sleep) and preparing in advance by involving family in decisions and funeral/estate planning. Family support throughout …

Barriers Primary Care Physician Assistants Face In Referring Patients To Palliative Care Services Early In The Disease Process, Claire Petersen

Theses and Graduate Projects

Background: Medical specialties such as hospice and palliative care have been proven to improve quality of life for patients facing end-of-life and chronic illness. Though increasing awareness of these specialties has resulted in greater availability, it is essential to investigate the barriers clinicians, such as Physician Assistants, face in making these referrals in order to provide quality healthcare to those who need it. Physician Assistants specifically are an essential clinician group to evaluate, as they continue to become more prevalent in the healthcare system.

Purpose: To determine barriers primary care Physician Assistants face when identifying candidates for and referring to …

2024-2025 Pediatric Subspecialty Trainees, Children's Mercy Kansas City

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in advanced non-invasive imaging, adolescent medicine, allergy/immunology, child abuse pediatrics, child neurology, clinical neuro-psychology, clinical child psychology, clinical child psychology internship, developmental-behavioral, epilepsy, headache medicine, hospice & palliative care, laboratory genetics & genomics, pediatric anesthesiology, pediatric bioethics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric cardiology, pediatric clinical pharmacology, pediatric critical care medicine, pediatric dentistry, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric EM/child abuse, pediatric infectious diseases, pediatric nephrology, pediatric ophthalmology; pediatric optometry, pediatric orthopedic surgery, pediatric otolaryngology, pediatric pathology, pediatric pulmonology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, …

The Pause: Impacting Moral Distress In Our Caregivers, An Integrative Review, Bethany Corinne Furman

Doctoral Dissertations and Projects

Moral distress is endemic to healthcare in the emerging post-covid era. Moral distress is defined as the knowledge of the correct or ethical action but the repeated inability to act in that manner. First studied in nursing, it has been found in nearly every facet of healthcare and is strongly associated with clinician burnout, intent to leave position, and behaviors that can in turn compromise patient safety. Intensive care unit (ICU) nurses experience moral distress at higher rates than other subspecialties. Prevention of and recovery from moral distress is complex, but various forms of debriefing have long been suggested to …

End Of Life, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Undergraduate Baccalaureate Nursing Student Knowledge And Attitudes Towards Neonatal And Pediatric Pain Management Practices, Jordan Lee Slowik

Doctoral Dissertations and Projects

Research has indicated that pain management practices amongst registered nurses is inadequate across all age groups; however, it is frequently noted that children receive less analgesia in comparable situations than adult clients leading to harmful and costly consequences. There is a distinct gap in nursing educational research understanding nursing student knowledge and attitudes towards neonatal and pediatric pain management practices. Using a convenience sample from a private, Christian-based university in the southeastern United States, this study used a quasi-experimental, one-group pretest/posttest design to understand the impact of elective nursing courses on undergraduate baccalaureate nursing student knowledge and attitudes towards neonatal …

Eye Care For Corneal Transplant Donors In The Icu: What We Didn’T See Coming, Ashton Lackey, Joey Royea, Alexandra Hartman, Aaron Worthley, Abbi Mason, Bryan Howington, Bharat Meenavalli, George Helmrich, Stephen M. Meyer

South Atlantic Division GME Research Day 2024

No abstract provided.

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

Establishing A Protocol For Hospice Compassionate Withdrawal Of Ventilatory Support In The Home Setting, Georganna Rosel, Ana Sanchez, Reuben Smith

South Atlantic Division GME Research Day 2024

No abstract provided.

Understanding Hospital-Based Nurse End-Of-Life Care, Knowledge, And Comfort: A Quality Improvement Project, Emma Doran

Honors Theses and Capstones

Providing physical, emotional, and spiritual care to patients at the end of life (EOL) can relieve their suffering and the pain experienced by loved ones in their presence. As death approaches, patients’ symptoms may require increased comfort measures, and it is imperative that all nurses be properly trained and prepared to provide this care. In this quality improvement (QI) project, the End-of-Life Professional Caregiver Survey (EPCS) and demographic and experiential questions were administered in the form of a Qualtrics survey to nurses working on an acute care inpatient unit at a healthcare organization in New England. 18 survey responses were …

Relationships Of Secondary Traumatic Stress, Compassion Fatigue, And Compassion Satisfaction Among Maternity Nurses Caring For Patients Who Succumbed To Maternal Mortality, Debra Joy Mendelson

Theses & Dissertations

Background:

Maternity nurses work where positive outcomes are the norm, leaving them more vulnerable to the adverse effects of dealing with death. Limited data indicate that caring for a maternity patient who dies may result in nurses developing secondary traumatic stress and associated compassion fatigue, which may affect their job performance. Research is warranted to promote a better understanding of nurses’ experiences, especially since the increase in maternal mortality has resulted in more nurses being exposed to maternal death.

Purpose:

The purpose of this study was to explore relationships between secondary traumatic stress, compassion fatigue, and compassion satisfaction of maternity …

Palliative Care Integration Into Critical Care In People With Terminal Conditions, Arielle Westfall

Honors Undergraduate Theses

Palliative care is of value to the quality of life in people with terminal conditions when initiated early. The purpose of this literature review was to identify barriers to early initiation of palliative care consultation. The secondary purpose was to examine characteristics that prompt palliative care consultation. The TLC model of palliative care was used to explore palliative care in the critical care setting in people with terminal conditions. The concepts of the model support optimal palliative care as collaborative and comprehensive, with shared decisions made by the patient, practitioners, and loved ones. A literature review was conducted to identify …