Digital Commons Network^™

Addressing Organizational Factors Contributing To The Underreporting Of Workplace Violence In Nursing, Jason K. Blomquist

Doctor of Nursing Practice Projects

Background: Nurses routinely face threats, verbal abuse, and physical violence, yet widespread underreporting obscures the full scale of the problem, hindering efforts to address workplace culture and protect nurses.

Aim: Through leadership engagement and targeted staff education, this quality improvement project sought to increase workplace violence reporting rates on a 35-bed medical/surgical unit.

Methods: Over eight weeks, a three-phase intervention was implemented. Phase one equipped charge nurses with uniquely designed training (DIVER framework) to strengthen leadership support. In phase two, staff received micro-education through established communication channels. Phase three reinforced learning via interactive staff meetings. Pre- and post-intervention surveys assessed …

Empowering Staff Wellbeing: A Team-Based Qi Initiative, Rebecca Lauren Smith, Elizabeth Morse, David Phillippi

SPARK Symposium Presentations

Project Title: Empowering Staff Wellbeing: A Team-Based QI Initiative

Keywords: Burnout, wellbeing, DNP, primary care, QI methodology

Background and Rationale: The consequences of burnout in healthcare are alarming: worse patient outcomes, lack of continuity of care, higher turnover, and increased cost to employers. Many studies of burnout and wellbeing of clinicians focus on larger institutions such as hospitals and Federally Qualified Health Centers. Over the past several years, burnout has been discussed among our small, eight-person clinician team working in a small, non-profit primary care clinic. Yet, there has been no formal assessment of the level of burnout among …

Provider Burnout Related To Patient Satisfaction, Sherita A. Lee

Doctor of Nursing Practice Projects

Provider burnout is a critical issue in healthcare, often intensified by increasing demands to meet patient satisfaction benchmarks. This quality improvement project aimed to examine whether a structured stress reduction program could reduce provider burnout and positively influence patient satisfaction scores in a small outpatient clinic. Guided by the PICOT question—In the clinic setting (P), does the implementation of a stress reduction program for providers (I), compared to no intervention (C), lead to improved patient satisfaction scores (O) over a six-week period (T)? —the project used a pre- and post-intervention design. The intervention included mandatory provider breaks, communication training, and …

Alumni Journal - Volume 96, Number 1, Loma Linda University School Of Medicine

Alumni Journal, School of Medicine

Editorials
2 | From the Editor
4 | From the President
6 | From the Dean

News
7 | This & That
10 | Alumni News
12 | School of Medicine News
14 | AIMS Report: Short-term Mission, Long-term Impact
16 | Student Appreciation
18 | Department Report: Preventative Medicine

APC 2025
20 | Annual Postgraduate Convention (APC) 2025 in Review

Features
34 | Building Connections
36 | Divine Connections
38 | Remembering Ath 'AT' Tuot
42 | Alumni Spotlight: Featuring Janet T. Strausbaugh '78-A
44 | Life After Medicine

In Memoriam
45 | Alumni Remembered: Featured Obituaries: David Tse …

Preeclampsia: Implementation Of The American College Of Obstetricians And Gynecologists Standardized Protocol, Sheila Ann Harwell

Electronic Theses and Dissertations

Preeclampsia is a significant medical condition that affects the perinatal population, posing risks to both the mother and fetus. Complications associated with preeclampsia include stroke, seizure, placental abruption (premature separation of the placenta from the uterus), fetal growth restriction (impaired growth due to reduced blood flow through the placenta), premature birth, and low-birth-weight infants with associated developmental issues. Because there is no cure for preeclampsia, the current management involves the timely administration of intravenous antihypertensives to reduce the risk of stroke and seizure. The gap in practice identified was the obstetrical department’s lacking a standardized protocol, compared to adopting the …

The Role Of Androgens On Experimental Pain Sensitivity: A Systemic Review And Meta-Analysis, Elizabeth Wu-Chen, Gourav Banerjee, Elise Requadt, Benjamin Hunter, Thomas J. Baranski, Whitney Trotter Ross, Hadas Nahman-Averbuch

2020-Current year OA Pubs

Animal studies have shown androgens, especially testosterone, may have an analgesic effect on nociceptive behavior. However, it is unclear if this effect is present in humans. This review and meta-analysis aim to summarize and synthesize the role of androgens on experimental pain sensitivity in humans. Studies were included if they examined the (1) relationships between androgens and experimental pain sensitivity, (2) group differences in androgen or pain levels, and (3) the effect of androgen interventions on experimental pain sensitivity. After a comprehensive search, 31 papers were identified. When possible, meta-analyses were performed. Most studies examined the impact of testosterone on …

Breaking Bias: How Implicit Bias Training Is Reshaping Healthcare Outcomes And Equity, Chloe C. Harris, Meyer Maddox, Anesu K. Murambadoro, Kevin Garcia Valdez, Blake Martin, Nina Mourao, Tirath Patel, Nikhilesh Anand, Kelsey Baker, Bharathi Gadad

Research Symposium

Background: The purpose of this systematic review is to evaluate the impact of implicit bias training as a component of health system science education on increasing awareness of biases, improving self-efficacy, and promoting organizational change. While such interventions are promising, their effects on provider behavior and patient outcomes over time remain open.

Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted using PubMed, Google Scholar, Scopus, and the New England Journal of Medicine database. Studies were selected based on relevance to the research question, with eligible studies including Randomized Controlled Trials …

Management Of Aggressive And Disruptive Behavior In The Emergency Department Using De-Escalation Techniques And Simulation: A Quality Improvement Project To Improve The Knowledge And Confidence Of Emergency Department Nurses And Clinical Staff, Ernestine Darby-Littlejohn

Electronic Theses and Dissertations

Abstract

Approximately 40% of all healthcare workers have reported episodes of violence by patients over the last 2 years. This Veteran’s Health Agency reported 824 disruptive events reported in the last 5 years, of which 56 occurred in the emergency department. Research shows that interventions are not always timely, resulting in the clinical staff requesting the Veteran’s Health Agency Police to intervene when a veteran’s level of stress is escalating. The gap in practice is shown to be related to a lack of knowledge in the clinical staff in managing high stress levels exhibited by some veterans, limited knowledge of …

The Clinical Impact Of A Standardized Pathway For Chest Pain Evaluation In The Urgent Care Setting, Tysheena L. Jones

Doctoral Dissertations and Projects

This study aimed to evaluate the deficiencies in the current chest pain evaluation practices compared to standard of practice at urgent care centers and to develop an evidence-based clinical workflow prioritizing the reduction of the door-to-EKG times utilizing the Marburg heart score assessment tool. Conducted in three urgent care centers within a larger not-for-profit healthcare system, the retrospective pretest-posttest design involved 44 patients presenting with chest pain. Utilizing t-tests, the study found a significant reduction in door-to-EKG times from 39 minutes pre-intervention to 14 minutes post-intervention (p < 0.05). The pre implementation chart reviews revealed that 7 (32%) of the charts had the required risk assessment tool used, and score documented in the EMR. The post implementation chart reviews revealed that 6 (27%) of the charts had the required risk assessment tool used and score for chest pain documented in the EMR. The Marburg Heart Score facilitated timely identification of high-risk patients while minimizing unnecessary EKGs for low-risk individuals, though protocol adherence and external workflow disruptions were noted limitations. The findings underscore the importance of standardized workflows in enhancing care efficiency and patient outcomes, suggesting that future research explore long-term sustainability and broader implementation in urgent care settings.

Building Capacity For Trauma-Informed Care: Enhancing Knowledge, Attitudes, And Practice Of Trauma-Informed Care Among Nurses, Kim G. Cudjoe

Doctoral Dissertations and Projects

Exposure to trauma is a global and pervasive phenomenon that is known to have negative consequences on the health, health outcomes, and well-being of individuals and at-risk populations to include Veterans. The implementation of trauma-informed care concepts and principles in the delivery of healthcare services among all staff and across the span of healthcare allows healthcare professionals to realize the impact of trauma on individuals, to recognize the signs and symptoms of trauma, to respond to trauma through improved practices, procedures, and policies; and to prevent re-traumatization while receiving care. The purpose of this evidence-based project is to develop and …

Counseling Students’ Perceptions Of Support During The Covid-19 Crisis: A Qualitative Study, Breahannah Hilaire, Galaxina G. Wright, Lea H, Laurie O. Campbell

Journal of Counselor Preparation and Supervision

The COVID-19 pandemic changed the counseling programs in clinical instruction, mentorship, and student’s perception of the university. The qualitative data presented in this paper identifies eight counseling students’ beliefs of support during their time in counseling program during the COVID-19 pandemic. Data was obtained through semi-structured interviews. An interpretive phenomenological analysis resulted in four themes: including higher education response, personal resources, emotions in crisis, and transitions in crisis.

Counseling Students’ Perceptions Of Support During The Covid-19 Crisis: A Qualitative Study., Breahannah Hilarie, Galaxina G. Wright, Lea H., Laurie O. Campbell

Faculty Publications

The COVID-19 pandemic changed the counseling programs in clinical instruction, mentorship, and student’s perception of the university. The qualitative data presented in this paper identifies eight counseling students’ beliefs of support during their time in counseling program during the COVID-19 pandemic. Data was obtained through semi-structured interviews. An interpretive phenomenological analysis resulted in four themes: including higher education response, personal resources, emotions in crisis, and transitions in crisis.

The Readiness For Integrated Primary Health Care (Ilp) At Puskesmas Pamulang In Tangerang Selatan City, Firda Safitri Rachmaningsih, Kurnia Sari

Journal of Indonesian Health Policy and Administration

. Integrated primary healthcare (ILP) is part of the transformation of primary healthcare aimed at improving access to quality healthcare. This study aims to analyze the readiness of Pusat Kesehatan Masyarakat (Puskesmas) and their networks to implement ILP. This research used a qualitative approach, focusing on a case study of a Puskesmas in an urban setting, specifically in the operational area of Puskesmas Pamulang in South Tangerang. Data collection methods include in-depth interviews, observations, and document reviews. This research adopts the conceptual framework of PHC monitoring based on WHO and Weiner's theory of organizational change readiness. The research findings indicate …

Benefits, Challenges, And Strategies For Increasing Women Coaches In Elite Sport: The Trail To Gold (T2g) Initiative In U.S. Cross-Country Skiing, Anika Anna Angriman, Lynda B. Ransdell, Shelley Lucas, Nicole Lavoi

International Journal of Physical Activity and Health

Despite tremendous growth in sport participation of girls and women following Title IX in 1972, women’s participation as sport coaches did not follow the same trajectory. In fact, women remain significantly underrepresented in sport coaching. Research highlights ongoing barriers within the sport industry's patriarchal structure, and although strategies have been proposed to improve women’s representation, the lack of progress over the past two decades indicates limited effectiveness. A better approach is essential to address this issue across individual, interpersonal, organizational, and societal levels. The purpose of this study is to interview participants within the U.S. cross-country skiing program, Trail to …

Autoethnographic Action Research As A Contemplative Practice: Awareness And Transformation Of Inner And Outer Selves, Jiju Varghese, Bal Chandra Luitel, Niroj Dahal

The Qualitative Report

Contemplation as a spiritual practice has taken various forms across different religious traditions and regions worldwide. Over the years, various contemplative practices have evolved and become popular even outside religious traditions to promote the well-being of all for inner and outer selves’ transformation. In education, many scholars worldwide have expounded on the benefits of contemplative practices in the classroom for students and teachers. Contemplative practices have penetrated research practices in the form of contemplative inquiry considering performative, philosophical, and artistic transformations, where researchers enter into a deep, thoughtful, and reflective introspective journey to see the connection between what is seen …

The Impact Of Standardized Leadership Rounding On Nursing Satisfaction, Amber N. Vaughn

Regis University Student Publications (comprehensive collection)

This quality improvement project aimed to address the lack of standardized communication between staff and management within the behavioral health service line, as this contributed to a negative culture. This project explored if implementing standardized leadership rounds would increase nursing staff satisfaction compared non-standardized rounds. This project utilized a pre- and post- intervention survey design, with a survey consisting of 15 questions. Eleven (N=11) nurses participated in the study, completing both the pre- and post- intervention surveys. There was an eight-week period of intervention between the pre- and post- intervention surveys. The pre-intervention survey mean score was 6.4848, while the …

Burnout In The Emergency Room: Corrective Measures Vs. The Absence Of Solutions, Zane Walters, Zachary Woodall

Theses, Dissertations and Capstones

Introduction: Physician burnout has become an increasingly prevalent and critical issue in healthcare systems worldwide, particularly among emergency room physicians who face high-stress, high-demand working conditions. Burnout manifests as emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, leading to negative outcomes for physicians’ mental health, job satisfaction, and overall career longevity. This phenomenon not only threatens the well-being of physicians but also compromises patient care quality and contributes to costly turnover within healthcare organizations.

Purpose of the Study: The aim of this study was to systematically investigate the impact of burnout interventions on emergency room physicians. …

Occupational Therapy Practitioner Perspectives On Leadership In Everyday Practice: A Descriptive Qualitative Study, Mary E. Spores

Occupational Therapy Doctorate Capstone Projects

Background: Leadership is a topic of interest for rapidly evolving healthcare professions and a cornerstone of the American Occupational Therapy Association (AOTA) Centennial Vision. The history of leadership in the profession has a robust foundation and yet calls to action for leadership in the profession remain focused on traits, behaviors and transformative processes. Occupational therapy practitioners (OTPs) are positioned to be leaders of change with the use of leadership influence however, practitioner views on their enactment of leadership in everyday practice are sparse in the literature.

Purpose: The purpose of this qualitative descriptive study was to capture the perspectives of …

Case Management For End-Stage Renal Disease Patients, Jamie L. Andrews

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Social determinants of health (SDOH) and health literacy directly impact adults with end-stage renal disease (ESRD) on hemodialysis (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2022; Ulrich, 2020). Adults with ESRD account for 1.5 million hospital admissions and 500,000 re-admissions within 30 days annually (NIDDK, 2022). Case management is essential in reducing re-admissions for adult ESRD patients, requiring abilities to identify factors affecting adult ESRD patients appropriately.

Methods: Therefore, an evidence-based practice (EBP) project using the IOWA Model framework was implemented to increase the knowledge base in identifying care and resources for ESRD patients for telephonic …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.

Safe Schedule Ii Stimulants Prescribing Bundle For Adults With Adhd, Etienne C. Poufong

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

The evidence-based practice (EBP) project aimed at improving the prescribing and monitoring of Schedule II stimulant medications for adults aged 18 and older diagnosed with ADHD in private practice settings. The project addresses the growing concerns of stimulant overprescription, shortages, abuse, and diversion, which have significant public health implications. Despite the increasing use of stimulants, there is no standardized protocol for prescribing these medications to adults. The proposed intervention includes a prescribing bundle consisting of provider education, mandatory in-person visits, periodic urine drug screens (UDS), access to the Prescription Drug Monitoring Program (PDMP), and the use of diagnostic tools, such …

The Impact Of Staff Education On Menopausal Care, Oluwatoyosi Olumide

Doctor of Nursing Practice Projects

Natural menopause typically occurs around the age of 51. During this transition, many women experience a variety of vasomotor symptoms, with hot flashes and night sweats being the most common. As women age, diminishing levels of estrogen, progesterone, and testosterone can lead to various health complications. Without proper assessment, diagnosis, and treatment, many may suffer in silence. This quality improvement project sought to evaluate the impact of staff education on menopausal care. The symptom checklist, or the Menopause Rating Scale (MRS), is a standardized, evidence-based tool for assessing menopause symptoms and serves as an essential component of the admission process …

Cus+E: Creating A Culture Of Safety Through Improved Communication Within Perioperative Services, Sunilka Thompson

West Chester University Doctoral Projects

The Department of Perioperative Services identified ongoing communication and cultural challenges that compromised team dynamics, psychological safety, and patient care. A culture of safety survey revealed a significant disconnect: while many staff felt comfortable raising safety concerns, nurses and ancillary support staff reported widespread experiences of disrespectful behavior—perceptions not shared by providers. In response, the department implemented the CUS+E (I’m concerned, I’m uncomfortable, this is a safety issue + Explanation) communication tool to enhance the real-time escalation of safety concerns. Project goals included increasing safety reporting, reducing adverse events, and improving staff confidence in raising concerns. Post-implementation surveys indicated that …

Using Educational Intervention To Impact Provider And Nurse Knowledge And Self-Efficacy In Contingency Management At An Sud Clinic, Chinwe Egwudo

Doctor of Nursing Practice Projects

The US opioid epidemic crisis led to 700,000 deaths in 2019 alone. Poor adherence to medications for opioid use disorder (MOUD) strains individuals, families, and the healthcare systems, with rising relapses at the project site highlighting the need for evidence-based intervention. Studies show that contingency management (CM), a behavioral intervention that incentivizes desired behaviors, improves adherence to MOUD. Despite its effectiveness, CM remains underutilized in clinical settings due to healthcare providers’ lack of knowledge and self-efficacy. This project aimed to bridge the knowledge gap by implementing an educational intervention to impact healthcare providers’ knowledge and self-efficacy in applying CM protocols …

Readiness To The Privatization Of The Health System In Saudi Arabia: Translation And Factor Analysis Of Readiness To Organizational Change (Roc) Scale, Ahmed Ali Alasiri, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

The Kingdom of Saudi Arabia (KSA) began a major transformation as a part of version 2030 for its health system. These reform initiatives aim to privatize health services and improve efficiency. Despite this meaningful change, there is a knowledge gap in how healthcare providers prepare for or perceive this shift. Specifically, there has been a lack of validation of Arabic instruments that gauge the individual readiness to this change. This study bridges the gap by localizing and validating the Readiness to Organizational Change scale (ROC) to provide empirical evidence and to understand adaptability for the KSA context.

Method

The …

Understanding The Challenges And Satisfaction Among The Medical Professional Preceptors, Cornelia Ko

West Chester University Doctoral Projects

This study evaluates the Penn Medicine Family Medicine Clerkship program through a mixed-methods approach, exploring the challenges and factors influencing the satisfaction of medical professional preceptors when precepting students. A quantitative survey with 54 preceptor participants reveals the top challenges preceptors face: workload, conflicts with patient care, and limited clinical space. Despite this, there is strong support for the program, with 89% of preceptors enjoying the role and 85% expressing willingness to continue to precept for the next three years. Finally, data analysis shows no statistical correlation between preceptor motivation with gender, ethnicity, age group, years of serving, or total …

Screening For Relative Energy Deficiency In Sport (Reds) And The Female Athlete Triad In Female Undergraduate Collegiate Athletes: A Quality Improvement Project, Maria A. Marziano

West Chester University Doctoral Projects

This quality improvement (QI) project investigated female collegiate athletes’ knowledge and prevalence of Relative Energy Deficiency in Sport (REDs) and the Female Athlete Triad (Triad). The increase in female athletics brings a growing concern for performance-related health risks, including low energy availability (LEA), menstrual dysfunction, and low bone mineral density (BMD). This study assessed the effectiveness of education and self-screening in identifying at-risk athletes and encouraging resource application for intervention. A mixed-methods design was employed, utilizing retrospective data along with pre- and post-intervention surveys. The study involved 33 female collegiate athletes from lean endurance sports, assessing knowledge, risk factors, and …

Distinguishing Symptoms Of Racial Trauma From Conventional Trauma, Michelle Yoong

West Chester University Doctoral Projects

Trauma research in psychology has traditionally been shaped by a White-centric framework, leading to the underrepresentation of racial and ethnic minority experiences. This study aims to establish racial discrimination as a distinct traumatic stressor with significant psychological consequences by exploring the distinction between racial and conventionally recognized traumatic stressors and posttraumatic stress symptoms (PTSS). It also aims to address inconsistent and exclusionary assessment methodology involving underrepresented racial minority (URM) populations, including the neglect of racial trauma and discrimination measures in trauma research. Participants consisted of URMs who sought enrollment in a clinical trial for opioid use disorder at a community …

Improvement Of Hpv Vaccination Rate In Pediatric Patients In A Clinic Through Implementation Of A Bundle, Macalah Jenschke

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction: Human papillomavirus (HPV) is a major cause of several cancers, and vaccination is a highly effective preventive measure. However, HPV vaccination rates remain suboptimal, particularly in rural pediatric populations. This quality improvement (QI) project aims to enhance HPV vaccination rates through the implementation of a comprehensive vaccination bundle targeting provider education, patient and parent education, appointment reminders, and the use of a vaccine waiver when needed.

Method: This QI project was conducted over twelve weeks in a rural pediatric clinic with approximately 130 patients seen daily. The intervention bundle included provider education on effective communication regarding HPV vaccination, educational …