Digital Commons Network^™

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

Consistent Phq-9 Administration At Mental Health Watch Initiation And Discharge In A Correctional Setting, Gouni Aicha Bouraima

Walden Dissertations and Doctoral Studies

This staff education project addressed inconsistent Patient Health Questionnaire-9 (PHQ-9) administration and documentation at mental health watch initiation and discharge in a correctional setting. A baseline audit showed 42.1% PHQ-9 documentation compliance (8 of 19 charts), below the 90% organizational benchmark, limiting objective depression severity data needed for clinical decision-making and safe transitions. The practice-focused question was: Among nurses working with incarcerated individuals at mental health watch initiation and discharge, what is the impact of staff education on nurses’ knowledge of PHQ-9 screening protocols? The purpose was to implement structured staff education to improve nurses’ knowledge of PHQ-9 trigger points, …

Emergency Nurses' Perceptions Of Interpersonal Empathy When Caring For Department Superusers, Makeba K. Cavette

Walden Dissertations and Doctoral Studies

Compassion fatigue syndrome (CFS) is a significant challenge for healthcare professionals, particularly nurses in the emergency department (ED), due to the demanding, high-pressure nature of their work environment and their increased exposure to human suffering. The purpose of this qualitative phenomenological descriptive study, guided by Nursing Theory of Personal Empathy, was to describe the meaning of ED nurses' interactions with superuser patients and how these interactions affect ED nurses' empathy and susceptibility to developing CFS. A purposive sample of 8 ED nurses with at least 3 years of experience as ED staff nurses working with superuser patients participated in semistructured …

Implementation Of Visual Bed Indicator Lights To Improve Fall Prevention Processes, Andrea Leffew

Master's Projects and Capstones

Problem: Inpatient falls remain a significant patient safety concern associated with preventable patient harm, prolonged hospitalization, and increased healthcare costs. Routine fall bundle validations identified inconsistent adherence to safe bed configuration practices, such as beds left raised and bed alarms turned off.

Context: A 3-month quality improvement project was implemented on a 20-bed medical-surgical telemetry unit within an integrated healthcare delivery system at a 130-bed community hospital in Northern California, which was experiencing an increase in inpatient falls and fall-related sentinel events.

Interventions: Implementation of bed-monitoring technology with visual indicator lights that provided real-time feedback on bed configuration.

Measures: The …

Reducing Primary Cesarean Births Among Nulliparous, Term, Singleton, Vertex (Ntsv) Patients Through Structured Multidisciplinary Communication, Toyin Ajani

Master's Projects and Capstones

Background: Primary cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients remained a persistent quality and safety concern in obstetric care. Unnecessary cesarean birth was associated with increased maternal morbidity, neonatal complications, prolonged recovery, higher healthcare costs, and adverse outcomes in subsequent pregnancies. Problem: A Northern California labor and delivery unit identified an elevated NTSV cesarean birth rate of 26.8%, exceeding the national benchmark of approximately 23%. Variability in provider communication, inconsistent labor management practices, and lack of standardized interdisciplinary collaboration contributed to this quality gap. Context: The project was conducted in a high-volume labor and delivery microsystem serving a …

Improving Peer Feedback Participation Through Psychological Safety Interventions In Labor & Delivery Nurses, Lindsey C. Hora

Master's Projects and Capstones

Abstract 

Background: Labor and Delivery (L&D) units require effective communication, speaking up, and team learning to support safe care. Psychological safety informed this quality improvement project as a contextual strategy to strengthen peer feedback engagement.  

Problem: Peer feedback participation among eligible L&D registered nurses at a large acute care hospital in Santa Clara, California, was 14.29% (N = 112) below the 30% project target and 80% organizational target. Low participation limited routine feedback for professional development, recognition, and team learning.

Interventions: Interventions included psychological safety education, peer feedback reinforcement, workflow integration, platform navigation support, dedicated completion time, and unit champions. …

Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy

Master's Projects and Capstones

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …

Sense Of Purpose As The Guiding Light In Nursing Practice: A Grounded Theory Study, Kathleen Casler

Theses & Dissertations

Problem: As a prosocial profession, individuals may enter the practice of nursing because of an interest in helping and caring for others. However, over time, nurses may be challenged with experiences of burnout that can impact both their relationship with the profession and patient outcomes.

Background/Significance: A sense of purpose has been associated with positive physical, behavioral, and psychological outcomes. In a professional context, a sense of purpose may provide support for navigating complex work environments. It is currently not known what nurses’ experience of sense of purpose may be in relation to nursing practice and how their sense of …

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Quality Improvement Project Simulating Ethics: Improving Ethical Decision-Making In Nursing Undergraduates Through Simulation And Faculty Training, Shannon Brown

Doctor of Nursing Practice Projects

Nursing faculty often report limited confidence in teaching ethical principles, despite the essential role ethics plays in preparing students for complex clinical decision-making. This quantitative, quasi-experimental pre/post quality improvement project evaluated whether a structured ethics education module incorporating simulation could impact faculty confidence in teaching ethical principles. Guided by Lewin’s Change Theory and the Jeffries Simulation Framework, the project examined how organizational readiness for change and structured simulation design influence faculty development outcomes. Nursing faculty in a baccalaureate program participated in a single simulation-enhanced ethics session. Data were collected through anonymous pre/post Qualtrics surveys, and faculty confidence was measured using …

Hypothermia Management In Adult Trauma Patients: Enhancing Nursing Knowledge And Self-Efficacy In The Emergency Department, Shannon M. Rapert

Doctor of Nursing Practice Projects

Trauma-induced hypothermia is a significant, preventable condition that contributes to increased mortality. Evidence suggests that inconsistent recognition and management of hypothermia persist in the emergency department (ED), highlighting the need to strengthen ED nurses’ knowledge and self-efficacy in evidence-based warming strategies. The purpose of this quality improvement project was to evaluate the impact of an educational intervention on ED nurses’ knowledge and self-efficacy in managing trauma-induced hypothermia. Guided by the Iowa Model of Evidence-Based Practice, the ADKAR Change Model, and the Plan-Do-Study-Act framework, this quantitative, quasi-experimental, pretest–posttest project evaluated the effect of an instructor-led educational intervention in ED nurses at …

Responsivity Education Reflection Packet For Multigenerational Caregivers, Natalie Holsky

Honors Projects

Caregivers play an essential role in supporting their child’s language development. Through everyday routines, caregivers have countless opportunities to foster strong language skills. Extensive research has examined the influence of caregiver input on language development. Comparatively little research has explored how historical trends in parenting advice across generations may shape caregivers’ use of language facilitation practices. The purpose of my honors project was to examine how generational parenting trends could inform the development of a clinic-to-home language facilitation resource. This resource was designed to help caregivers incorporate language facilitation strategies into everyday routines to increase language-rich interactions at home. A …

Integrating Oncology Into Entry-Level Physical Therapist Curricula, Shana Harrington, Christopher M. Wilson, Morgan Zaranec, Lori Boright

Oncology Rehabilitation in Practice

Print issue available for $25.

Background: Cancer and its treatments commonly result in adverse effects that impair function, well-being, and quality of life, necessitating access to skilled physical therapists (PTs). Although oncology is an essential component of physical therapist practice, entry-level education in cancer rehabilitation has historically been limited. In 2025, the Essential Competencies for Physical Therapy Entry-Level Education in Oncology were developed through a mixed-methods, modified Delphi process, establishing 19 competencies across six domains and defining minimum expectations for new graduates. To support translation of these competencies into academic curricula, a practical implementation resource was needed.

Purpose: To …

A Poetic Call For And A Reflection And Commentary On Clarity, Understanding, Hope, Courage, And Compassion, Carroy U. Ferguson

Psychology Faculty Publication Series

Finding a published poem I had written as a teenager, titled “The Heavens Weep.” this article uses that poem as the basis for a commentary that reflects on the state of the world today (2026),  As a commentary, the article uses the poetic and metaphoric words in the poem as a relevant "reality check" for what is still going on today.  In essence, the commentary is about a call for Clarity, Understanding, Hope, Courage, and Compassion, or what I call Archetypal Energies, Higher Vibrational Energies that operate deep within our individual and collective psyches to creatively urge us to "see" …

“Caring Makes Students Learn English More Easily And Enthusiastically”: Exploring The Emotional And Academic Outcomes Of Experiencing Teacher Care In Medical Sciences University Efl Classes In Iran, Kiyana Zhaleh, Shima Azizbeigi

The Qualitative Report

Previous research on teacher care in university second/foreign language (L2) classes have primarily concentrated on non-medical sciences students, resulting in a lack of insights into its effects in medical sciences education. This is surprising considering the field-specific challenges of medical sciences education, potentially influencing teacher caring behaviors in this context. Addressing this gap, this qualitative study employed the emotional response theory (ERT) and positive psychology to explore how Iranian medical sciences undergraduates perceive teacher care in university EFL classes, how they emotionally respond to it, and how their experiences of care impacted their academic outcomes. In this descriptive qualitative research …

Standardized Training Methodologies For Medical Laboratory Science Students And Their Importance For Student Success, Maria Simpson

Medical Laboratory Science Independent Study Projects

Clinical education is a critical component of Medical Laboratory Science (MLS) programs, serving as the primary bridge between academic instruction and professional practice. However, traditional clinical rotation training models often struggle to keep pace with rapid advancements in laboratory technology, expanding professional responsibilities, workforce shortages, and heightened patient safety expectations. The purpose of this capstone project is to examine the key factors driving the need to update training methodologies in MLS clinical rotations and to evaluate contemporary educational approaches that better prepare students for entry-level practice. This project addresses systemic challenges faced by clinical laboratories, such as staffing constraints, heavy …

Nurse Manager Perceptions Of Strategies To Overcome The Underutilization Of Nonpharmacological Pain Control Methods In Adult Acute Care, Landen M. Bonnell

Undergraduate Honors Theses

A basic patient right is to have pain adequately managed. However, research consistently indicates that many adult patients in acute care experience inadequately managed pain, which may contribute to adverse patient outcomes. Studies have shown that nonpharmacological pain management can lead to increased patient satisfaction, shorter hospital stays, and better patient outcomes. However, many barriers exist to nurses providing effective nonpharmacological pain control therapy, primarily including heavy workload and a lack of education and support. Currently, there is insufficient research on how to overcome these barriers. Four nurse managers with experience in nursing leadership were interviewed using a qualitative descriptive …

Online Group Neurobehavioral Therapy (Nbt) For Veterans With Epilepsy And Major Depressive Disorder (Mdd), Melissa F. Fadipe

Dissertations and Theses (Open Access)

Background: Veterans with epilepsy experience high rates of psychiatric comorbidity, most commonly major depressive disorder (MDD). Barriers to accessing mental health care—including geographic distance, transportation limitations related to seizure-related driving restrictions, and fragmented care between neurology and psychiatry, contribute to the underdiagnosis and undertreatment of MDD in this population. Neurobehavioral Therapy (NBT), a Cognitive Behavioral Therapy (CBT)-informed psychotherapy developed for individuals with seizures, has demonstrated benefits for psychological distress and quality of life. Internet-based interventions and short message service (SMS) text messaging offer promising strategies to address access barriers; however, limited research has examined the feasibility and acceptability of delivering …

Baseline Nutrition Knowledge And Feasibility Of A Whatsapp-Delivered Nutrition Education Intervention Among California Wildland-Urban Interface Firefighters, Lauren E. Anderson

Master's Theses

Wildland firefighters perform physically demanding work under challenging environmental conditions that place substantial demands on nutritional health and occupational performance. Despite the importance of nutrition in supporting physical performance, recovery, and long-term health, limited research has examined nutrition knowledge and dietary behaviors among California wildland firefighters or evaluated the feasibility of remotely delivered nutrition education interventions within this occupational population. Therefore, the purpose of this pilot study was to assess baseline nutrition knowledge, nutrition self-efficacy, and dietary behaviors while evaluating the feasibility of a 12-week WhatsApp-delivered nutrition education intervention among California wildland firefighters.

Twenty-four firefighters completed the baseline assessment and …

From Birth To Better Health: Educating Mothers With Gestational Diabetes On Breastfeeding Benefits And Glucose Management, Jesse A. Soria Jr, Sarah Smith, Audrey Nolan Smith, Keeley Kosier

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Gestational diabetes mellitus (GDM) increases a mother's risk of developing type 2 diabetes mellitus (T2DM) later in life and can affect an infant's future health. Breastfeeding can help improve a mother's blood sugar control and may lower her future risk of diabetes, but many mothers with GDM do not know about these benefits. This quality improvement (QI) project evaluated a standardized education program on breastfeeding and diabetes prevention for postpartum mothers with GDM at the Family Birthing Center at St. Joseph's Medical Center (SJMC) in Stockton, California. The intervention included a 10- to 15-minute education session and an evidence-based educational …

Mind Over Scrubs – A Peer-Led Anxiety Reduction Program, Nhi T. Tran, Angelica Dirige, Adeleke Fashola

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Nursing students experience elevated anxiety during the transition into accelerated programs, which can negatively affect academic performance, well-being, and retention. This quality improvement project evaluated Mind Over Scrubs, a peer-led anxiety reduction program for incoming Entry-Level Master of Science in Nursing students at the University of the Pacific, consisting of four 45-minute sessions on evidence-based coping strategies. Generalized Anxiety Disorder-7 surveys were administered at baseline, before and after each session, and at two- and four-week follow-ups; Wilcoxon signed-rank tests evaluated matched changes. Thirty-one of 62 enrolled students (50%) attended at least one session. Post-session scores fell below individual baselines for …

Predictors Of The Mother-Infant Bond: The Role Of Maternal Attachment Style, Parity, Race, And Motherhood Expectations, Samia Qadri

Theses, Dissertations and Culminating Projects

This study examined how maternal attachment style, parity, race, and motherhood expectations, individually and in interaction, predicted the quality of the mother-infant bond during the postpartum period. Grounded in a maternal feminist framework, the study used a quantitative, cross-sectional correlational design. Postpartum mothers aged 20–39 (N = 87) completed validated measures of maternal attachment style, motherhood expectations, mother-infant bonding, and depressive symptoms. Multiple regression compared a Primary Model containing the four focal predictors and planned interaction terms with a Secondary Model that added maternal depressive symptoms as a covariate. Depressive symptoms emerged as the strongest single predictor of bonding, and …

Experiential Learning In Child Life Education, Amanda L. Lockett

All Dissertations

Child life specialists support children and families during healthcare experiences and other stressful life events, making it important for child life students to develop both knowledge and practical skills before entering the profession. This study explored how current child life students and recent graduate experienced hands-on learning activities in their child life education. Through interviews, a survey, and follow-up reflection, participants described how activities like role play, case studies, realistic scenarios, activity play plans, and teaching plans influenced their learning and professional development. Participants shared these experiences helped them learn to apply what they learned in the classroom into real …

J Mich Dent Assoc August 2026

The Journal of the Michigan Dental Association

Each month, the Journal of the Michigan Dental Association delivers news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200-plus members. It remains the main publication reaching Michigan dentists and is available worldwide through ADA Commons.

The August 2026 (Volume 108, No. 8) issue of the Journal is published in print format to provide updates and insights for Michigan's oral health community and MDA members. Print editions occur every other month beginning with January.

The August 2026 issue of the Journal of the Michigan Dental Association explores clinical, professional, legal, leadership, and public …

An Update On The Role Of Multimodal Analgesia In Perioperative Pain Management, Whitney N. Kuwamoto, Grace C. Eddy, Edward R. Mariano, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

Multimodal analgesia has become a foundational principle of acute perioperative pain management and enhanced recovery and involves the application of nonpharmacologic, pharmacologic, and/or interventional techniques. The overall goal of this approach is to apply a combination of different modalities that target discrete points along the pain pathway and thereby avoid the overreliance on opioids and associated side effects. Since our review in 2018, there have been significant developments that have prompted an updated review of multimodal analgesia. In this article, we identify and summarize important trends that influence the current approach to acute perioperative pain management as well as provide …

The Resilient Women's Collective: Empowering Women To Recognize Their Worth, Mary Campbell Johnstone

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2026

Mothers experiencing homelessness face challenges related to chronic stress, trauma, disrupted routines, and limited access to supportive resources, all of which negatively impact health, well-being, and occupational participation (Anderson et al., 2024). Occupational therapy is uniquely positioned to address these challenges through occupation-based, trauma-informed interventions that promote resilience, empowerment, and engagement in meaningful activities. This doctoral capstone addressed these complex needs through a multifaceted approach that included a scoping review, program development, advocacy, and educational initiatives. A scoping review examined stress-management interventions supporting single mothers experiencing homelessness in the United States. Although positive outcomes were reported, the literature revealed limited …

The Acute Effect Of A Single Dose Of Berberine On Blood Glucose Response Following A Standardized Meal And 2-Mile Walk Performance In Healthy Adults, Victor Emmanuel Obaro

Master's Theses

It is clear that exercise improves overall health status, and it is possible that berberine (BR) may work through some similar mechanisms to improve health status as well.  Purpose: The purpose of this study was to explore the acute effects of a single dose of BR on health status following a standardized meal and a 2 mile walk treadmill protocol with outcomes including blood glucose (BG), blood pressure (BP), heart rate (HR), rate of perceived exertion (RPE), and a two-mile walk time trial performance. Methods: This study used a cross-over design where 14 healthy, young adults were given berberine (BBR) …

Supporting Mental Health Through Occupation: Education For Women Living With And Beyond Breast Cancer, Rebekah Nicole Trammell, Lakeisa Boykin, Rebekah Jarrar

Summer 2026 OTD Capstone Symposium

Breast cancer is the most commonly diagnosed cancer among women in the United States, and these women experience high rates of anxiety, depression, and disruption to daily routines and meaningful occupations. Evidence shows that education on self-management strategies, mindfulness-based interventions, and targeted occupational therapy interventions can support the mental health of women experiencing breast cancer. Furthermore, remaining engaged in meaningful occupations is essential to improving overall well-being and quality of life. The purpose of this capstone project was to develop and deliver accessible, evidence-based education in digital and print formats that specifically target identifying mental health challenges, self-management strategies, and …

Attrition Of The Midwifery Workforce: Understanding Factors Associated With Leaving The Profession, E. Brie Thumm, Amy H. Goh, Elizabeth G. Phillips, Zachary Giano

College of Health Professions Faculty Papers

OBJECTIVE: To understand why advanced practice midwives (certified nurse-midwives and certified midwives) leave the workforce.

STUDY SETTING AND DESIGN: A multi-method, multi-source investigation included secondary analysis of certification data of advanced practice midwives and a cross-sectional online survey with closed- and open-ended items. Advanced practice midwives' active certification data were used to compare self-reported demographic characteristics of advanced practice midwives who reported working in the discipline of midwifery to those who did not (n = 9704). A survey was conducted in 2022 with individuals who allowed their certification to lapse between 2017 and 2021 (n = 303) and individuals who …