Digital Commons Network^™

Implementing A Standardized Counting Process, Paula M. Mbye

Master's Projects and Capstones

Abstract

Background: In a Northern California medical center with 11 operating rooms, two retained foreign object (RFO) events occurred following surgical procedures in 2025.

Problem: Surgical teams rely on manual counting processes to prevent retained foreign objects. Variability in counting practices among registered nurses and surgical technologists, combined with workflow interruptions and environmental distractions, can increase the risk of counting discrepancies and missed items. Standardizing the counting process may improve count accuracy and reduce the risk of RFOs.

Interventions: This quality improvement project implemented a standardized surgical counting process based on Association of periOperative Registered Nurses (AORN) guidelines within …

Evaluation And Continuation Of Oncology Nurse Mentorship Program, Gurpreet K. Kang

Master's Projects and Capstones

Problem: Newly hired nurses on a busy inpatient leukemia and lymphoma subspeciality unit experienced challenges after transitioning into specialty oncology practice. This resulted in decreased confidence, increased risk of medication errors, and a 40% unit-based annual turnover rate. The cost of replacing one staff nurse is $61,000.  Exit interviews determined root causes of turnover rates, nurse confidence.

Context: A quality improvement program was envisioned to optimize patient and organizational outcomes on a 25-bed inpatient unit to evaluate and sustain an oncology nurse mentorship program.

Interventions: Over one year, cohort 1 (n=8) and follow up 2^nd cohort (n=7) was implemented …

Enhancing Patient Understanding: Standardizing Cardiac Medication Education Using Teach-Back For Heart Failure, Nicole Valerie Hediger

Master's Projects and Capstones

Problem: The transition from hospital to home places heart failure (HF) patients at risk for medication errors, nonadherence, deterioration, and rehospitalization. In a 28-bed medical-surgical telemetry microsystem, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores indicated an opportunity for improvement: “Communication About Medicines” composite score of 47.9%; 62.5% of patients reported being informed about the medication purpose, and 33.3% reported that staff described potential side effects.

Context: A cohort of HF patients was selected to test teach-back methodology and improve patient understanding. Nurse champions volunteered for a 5-month improvement project.

Interventions: Teach-back methods were implemented. Nurse leader rounding …

Improving Pain Reassessment Within One Hour Of Pain Medication Administration, Geraldine B. Macalma

Master's Projects and Capstones

Abstract

Problem: Timely reassessment of pain is often missed or inconsistently documented, creating a gap between evidence-based standards and actual nursing practice. This inconsistency prevents evaluation of intervention effectiveness and contributes to unmanaged pain, reduced patient satisfaction, and safety concerns.

Context:  Pain reassessment is a critical component of evidence-based pain management, ensuring that nurses evaluate the effectiveness of interventions and adjust care accordingly.  Competing priorities and documentation challenges often lead to inconsistent reassessment, affecting patient comfort, safety, and overall quality of care.

Interventions: Guided by a Plan-Do-Study-Act framework, the intervention included documentation of a safety round, purposeful hourly rounding, …

Improving Documentation Of Skin Assessment In The Med-Surg Overflow Microsystem, Min Kim, Mikeal A. Swift

Master's Projects and Capstones

Abstract

Problem

Hospital-acquired pressure injuries (HAPIs) remain a costly patient safety concern with increased morbidity and prolonged hospitalization. Inconsistent admission skin assessment documentation in a 24-bed overflow medical–surgical microsystem led to delayed wound identification and misclassification.

Context

A baseline needs assessment (n = 15) identified key barriers, including low nurse confidence utilizing Rover (mobile software application) and linking photos to the LDA (lines-drains-airway) in the electronic health record.

Intervention

A bundle of 6 components was tested over 12 weeks: standardization of the two-RN skin assessments within 8 hours of admission or transfer; optimization of Rover photo capture and LDA linkage; …

Belonging And Whole Person Formation In Graduate Education: A Conceptual Framework For Student Flourishing, Cynthia Hickman

Papers

Graduate students experience substantial academic, personal, and professional demands that can negatively affect well-being and persistence. For students enrolled in professional programs, belonging may develop within two overlapping communities: the academic institution and the emerging profession. Institutional and professional belonging can provide connection, support, engagement, and opportunities for identity and professional development. This paper synthesizes literature on these two forms of belonging and proposes a conceptual framework describing their potential relationship with whole-person formation and flourishing. Whole-person formation extends graduate education beyond knowledge acquisition and professional competence to include development across interconnected dimensions of the person. Within the proposed framework, …

Comparison Of Training Background And Characteristics Between Osteopathic And Allopathic Team Physicians In Professional Sports Leagues., Brandon D Rust, Ambika Singh, Matthew T Mckinley, Joseph Imler, Mackenzie Elting, Ryan Callahan, Christopher L Rennie, Leighann C Krasney

Orthopedic Surgery Resident Research

CONTEXT: Team physicians (TPs) play a critical role in professional sports, providing medical care for athletes under high-pressure conditions. These positions are highly competitive, influenced by previous affiliations, training pedigree, and institutional connections, with fellowship training increasingly essential. Although the number of osteopathic (Doctor of Osteopathic Medicine [DO]) physicians in the United States has grown substantially, TPs in professional sports remain predominantly filled by allopathic (Doctor of Medicine [MD]) physicians, and the training pathways of DO TPs are not well characterized.

OBJECTIVES: The objective of this study is to compare the training and demographic characteristics of DO and MD TPs …

What Do Children Think About Bouncy Bands: A Mixed Methods Examination Of Bouncy Bands' Influence On Attention And Physical Activity, Ken Murfay, Sarah Collins

International Journal of Physical Activity and Health

Purpose: To examine how bouncy bands put onto elementary students’ classroom desks influenced students’ physical activity and attention/concentration, in addition to exploring students’/teachers’ opinions of the bands. Methods: Students within both experimental and control groups wore pedometers to assess movement during instruction and completed the d2 test for attention. Results: The group with bouncy bands on the desks had significantly more movement compared to the control group. For d2 scores, there was no significant difference between the two groups, nor was there a significant linear relationship between movement and d2 scores. Interviews were conducted with the students in the experimental …

Staff Education To Improve Knowledge On Accurate Administration Of Medication, Deepu Pudasaini

Walden Dissertations and Doctoral Studies

Medication errors have been a significant problem, primarily due to a lack of continuous monitoring and inadequate training for personnel involved in managing or administering medications in non-healthcare settings. These errors often go undetected or unreported. This Doctor of Nursing Practice (DNP) project was a staff education project to improve staff knowledge of accurate medication administration of medication in a group home. The practice-focused question was: Will a staff education program on the accurate administration of medication improve certified medication technicians’ (CMTs) knowledge about the association between the medication administration process and medication error? The purpose of this DNP staff …

Staff Education To Improve C-Ssrs Suicide Risk Screening Competency, Pearl Binka

Walden Dissertations and Doctoral Studies

This staff education doctoral project addressed inconsistent administration and documentation of the Columbia-Suicide Severity Rating Scale (C-SSRS) in an acute care mental health setting. The practice problem was important because inconsistent standardized screening could delay identification of patients who required timely safety interventions. The practice-focused question examined whether structured C-SSRS education improved nursing staff competency, screening consistency, and documentation compliance. The project was developed and implemented to strengthen nurses’ knowledge, confidence, and skill in applying the C-SSRS as part of routine suicide risk screening. Evaluation strategies included comparisons of pre- and posteducation knowledge scores, competency checklist completion, chart audit findings, …

Staff Education On Psychoeducation Delivery To Enhance Medication-Adherence Education For Adults With Bipolar Disorder In An Outpatient Psychiatric Mental Health Facility, Bibiana Chinwe Ndula

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) staff education project addressed inconsistent delivery of evidence-based medication-adherence psychoeducation for adults with bipolar disorder (BD) in an outpatient psychiatric mental health facility. The project question was whether an 8-week structured module, in relation to existing staff education practices, would increase staff knowledge and confidence. The intervention was guided by the Johns Hopkins evidence-based practice (JHEBP) model and comprised a PowerPoint presentation, a facilitator guide, a handout, a checklist, a toolkit, and anonymous pre- and post-training assessments. Eight out of ten invited staff completed the project. The mean knowledge rose from 6.1 to 8.9 …

Prenatal Health Factors Of Pregnant People Associated With Second Degree Postpartum Hemorrhage Across The United States, Elizabeth Simpler

Walden Dissertations and Doctoral Studies

Secondary postpartum hemorrhage (SPPH) is a significant contributor to maternal morbidity in the United States and occurs after hospital discharge during the postpartum period. Persistent disparities in terms of maternal outcomes suggest access to prenatal care alone may not adequately address clinical and social factors associated with SPPH. Guided by the Social Ecological Model, which recognizes that health outcomes are influenced by a collective approach to examining health. The purpose of this study was to examine associations between SPPH, prenatal care access, and social determinants of health from 2019 to 2022 while controlling for maternal age, race, and delivery type. …

08-19-26 Bor Hsc Committee Notice Of Meeting Revised, Patricia Serna

HSC Committee (A subcommittee of the UNM Board of Regents)

08-19-26 BOR HSC Committee Notice of Meeting Revised

Staff Education To Address Verbal De-Escalation Skills In Correctional Mental Healthcare, Mary L. Goodman

Walden Dissertations and Doctoral Studies

This staff education project evaluated the effects of a structured verbal de-escalation training program on self-efficacy among staff in a federal correctional mental health unit. Staff at the site often reported uncertainty managing escalating behaviors, leading to frequent use of restrictive interventions like restraints and seclusion—practices that can compromise safety, quality of care, and raise ethical concerns. To address this gap, an evidence-based curriculum was implemented for 41 multidisciplinary staff, including nurses, certified nursing assistants, and correctional officers. The curriculum included a PowerPoint presentation, role play, and group discussion. A pre–post design measured changes in staff confidence using a modified …

Staff Education Project To Increase Nursing Staff Knowledge Of Falls Prevention In Long-Term Care Facility, Oludele Olagoke

Walden Dissertations and Doctoral Studies

Falls among residents in long-term care facilities are a concern for families and facility management. Falls inflict pain, discomfort, and head trauma, causing fractures. In nursing practice, falls are nursing-sensitive indicators that reflect the quality of nursing care and patient safety. There is a need to bridge the gap and increase staff knowledge on how to prevent falls in the facility. The Doctor of Nursing Practice (DNP) project focused on increased nursing staff knowledge through an evidence-based education program and the implementation of an evidence-based practice education program. The DNP project practice question was about nursing staff in long-term care …

Miconazole As A Repurposed Anticancer Candidate For Prostate Cancer, Eswara Naga Hanuma Kumar Ghali, Lindsey Shim, Rajasekhar Baru, Anupam Dhasmana, Ryan Chang, Sung Yun Jung, Rahul Tiwari, Neeraj Chauhan, Vivek K. Kashyap, Sheema Khan, Diane Nguyen, Subhash C. Chauhan, Murali Mohan Yallapu

School of Medicine Publications

Prostate cancer is one of the major health concerns, with increasing incidence and persistent therapeutic resistance worldwide. Despite various available treatments (radiation therapy, chemotherapy, hormone therapy, cryotherapy, biological therapy, and high-intensity focused ultrasound), patients still show treatment-related side effects over many years. These challenges highlight the urgent need for novel and safe therapeutic strategies. In the present study, we repurposed five FDA-approved antifungal agents, namely natamycin (NM), terbinafine hydrochloride (TH), ketoconazole (KZ), miconazole (MZ), and clotrimazole (CZ), as they can modulate conserved cellular processes, including sterol metabolism and mitochondrial function, which are increasingly recognized as critical determinants of cancer cell …

Staff Education To Reduce Stress In Assisted Living Nursing Staff, Cherechi Onyenso

Walden Dissertations and Doctoral Studies

In this staff education doctor of nursing practice (DNP) project, I addressed a practice gap associated with inadequate staff knowledge of workplace stress-management strategies in an assisted living facility. Workplace stress in nursing practice is a contributing factor to burnout, reduced job satisfaction, poor teamwork, and a decline in the quality of resident care. The practice-focused question for this project was about whether staff knowledge would be enhanced over an 8-week period in comparison to baseline knowledge as a result of their participation in a structured staff education program on workplace stress management. The purpose of the project was to …

Staff Education To Improve Staff Knowledge, Confidence, And Intent To Consistently Implement Medication-Assisted Treatment, Matilda Boachie

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice staff education project addressed inconsistent medication-assisted treatment (MAT) implementation in a masked crisis stabilization unit. MAT was available, but staff education was informal and inconsistent, contributing to variation in knowledge, confidence, patient education, documentation, and discharge planning. The practice-focused question that was answered through this project was whether structured staff education would improve knowledge, confidence, and intent to consistently implement MAT. The purpose was to develop, implement, and evaluate structured education for interdisciplinary staff. De-identified pre- and post-education surveys were analyzed with descriptive statistics, and aggregate averages were compared because individual surveys were not matched. …

Improving Glycemic Control And Self-Care Among Adult Patients With Type 2 Diabetes Mellitus At A Community Health Center, Lydia Asabea Lartey

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus (T2DM) is a significant practice concern in community health settings, where adults often encounter barriers to effective self-management, including low health literacy, socioeconomic challenges, and limited access to Diabetes Self-Management Education and Support (DSMES). At the project site, inconsistent staff preparation, high patient volume, and limited standardized teaching resources contributed to gaps between evidence-based standards and routine diabetes education. To address these gaps, the project implemented a standardized, culturally responsive diabetes-education workflow to strengthen care quality, patient safety, and responsible resource use. The practice question guiding the project was: How does implementing a standardized, culturally responsive …

Gender Disparities In Sheltered Status And Systemic Drivers Of Homelessness In Johnson City, Tennessee, Preet Patel, Dr. Opal Frye-Clark

Journal of Appalachian Health

The article examines the homelessness crisis in Johnson City, Tennessee, a mid-sized Appalachian city. First, analysis of Point-in-Time (PIT) counts from 2023 to 2025, conducted in 2025, showed persistently high unsheltered rates (35.88% – 47.17%), with men comprising 60 – 65% of the unhoused population. Men experiencing homelessness also had approximately half the odds of being counted as sheltered compared with women, indicating a gender disparity in sheltered status. Second, an interview with an experienced public health practitioner from the Appalachian Region contextualized these findings by identifying systemic drivers, including the regional housing crisis and policy restrictions, and supporting equitable …

Improving Diabetes Self-Management Through A Partnership Between Clinical Providers And Community Educators In Appalachian Communities, Soghra Jarvandi, Lydia Hoskins, Karen Carver, Andrew May

Journal of Appalachian Health

Introduction: The burden of diabetes is an increasing public health challenge, especially in the Appalachian Region.

Purpose: This study assessed the impact of a community-based diabetes education program on glycemic control.

Methods: Health Extension for Diabetes (HED) is a 4-month diabetes education program offered by Extension educators in collaboration with clinical providers. Participants’ data were collected via phone interviews at baseline and after completing the program. Assessments included self-reported HbA1c, socio-demographics, diabetes knowledge, self-efficacy, and self-management behaviors. Data were analyzed by SAS software using paired analyses.

Results: Of the 105 participants in the program, 87 (83%) completed the post-assessment. Among …

School-Centered Tobacco Retailer Exposure And Neighborhood Opportunity Across Urban And Rural Tennessee, Sima Namin Dr, Jacob Black, Jennifer Ferris, Robert E. Heidel Dr

Journal of Appalachian Health

Introduction: Tobacco retailer availability contributes to youth tobacco use, and retailers are concentrated in socioeconomically disadvantaged communities. However, few studies have examined how school-centered retailer exposure intersects with neighborhood opportunity in a predominantly rural Appalachian state.

Purpose: The purpose of this study is to assess the association between neighborhood opportunity and school-centered tobacco retailer exposure across Tennessee (TN), including differences by rurality and Appalachian status.

Methods: We constructed a tract-level, school-centered youth tobacco exposure index for TN using tobacco retailer locations and public and private K-12 school data. The index incorporated retailer proximity, density, and distance-decay accessibility measures. Child Opportunity …

Deaths Of Despair Among Cancer Survivors In Rural/Urban Appalachia (2000-2022), Jason Semprini, Anders Erickson, Nosa Osazuwa-Peters

Journal of Appalachian Health

Introduction: Rising deaths of despair (premature deaths from suicide, overdose, alcohol, and violence) in adults under age 65 persist across the United States, especially in Appalachia. People diagnosed with cancer may face elevated risks of such deaths due to pain, psychosocial distress, and financial hardship.

Purpose: Deaths of despair trends were compared among adults with cancer across Appalachian and non-Appalachian regions, stratified by sex and rurality.

Methods: Analyzing SEER-21 Incidence-Based Mortality data (2000–2022), deaths caused by suicide, cirrhosis of the liver, or accidents (includes overdose) were identified among adults aged 20–64 years. Annual mortality rates per 100,000 total population were …

Disparities In Access To Medicare-Approved Medical Specialists In Rural Kentucky, Logan Hurm, Jacob A. Welch, James Adkins

Journal of Appalachian Health

Introduction: Approximately 20% of the United States population resides in a rural community; however, only 10% of all healthcare resources and physicians are dedicated to these areas. Appalachia, and Kentucky (KY) in particular, have higher populations living in rural areas which leads to a greater number of individuals affected by medical access disparities. As of 2026, 21% of KY’s population is eligible for Medicare, making access to Medicare-accepting specialty physicians crucial for the state’s population.

Purpose: This research aims to quantify healthcare disparities among rural communities in KY through quantification of the potential distance required to travel to access specialty …

Numerical Analysis Of The Sir Model For Predicting Disease Spread, Victoria Gaibor, Isabel Tejada, Kate Moore

Discovery Day - Daytona Beach

This project, Numerical Solutions of the SIR Model for Predicting Disease Spread, investigates the application of numerical methods to analyze the dynamics of infectious diseases using the classical Susceptible–Infected–Recovered (SIR) model. The SIR model, a system of nonlinear ordinary differential equations, is widely used to describe how diseases such as COVID-19 propagate through a population. The primary objective of this study is to solve the SIR initial value problem using multiple numerical techniques, including Euler’s method, Runge–Kutta methods, and multistep methods, and to compare their accuracy and efficiency. The model is implemented using given initial conditions and parameters, and additional …

Fieldwork Educators' Perspectives On Occupational Therapy Students Addressing Sexuality And Intimacy: Expectations, Supports, And Barriers, Elizabeth Deluca-Berg

Student Dissertations

Sexuality and intimacy are recognized as meaningful occupations within occupational therapy practice; however, they remain inconsistently addressed in clinical care. Previous research has identified limited educational preparation as a contributing factor to occupational therapists' discomfort and lack of confidence in addressing these occupations. Although classroom instruction provides foundational knowledge, Level II fieldwork serves as the primary setting in which students apply knowledge within authentic clinical environments. Despite the central role of FW educators in facilitating students' professional development, little research has explored how they prepare OT students to address sexuality and intimacy during fieldwork. The purpose of this basic qualitative …

Recalibrating Risk: A Call For South Asian-Focused Heart Failure Prediction Models, Nandini Nair, Dongping Du, Aiswarya J. Pillai, Swarna Mahesh, Mrudula R. Munagala, Howard J. Eisen, Balakrishnan Mahesh

Division of Cardiology Faculty Papers

Background: Heart failure (HF) represents the final common pathway of diverse cardiovascular disorders, including coronary artery disease, primary myocardial pathology, and abnormalities of cardiac conduction. These conditions arise from an interplay of genetic, environmental, and psychosocial influences, making it essential to understand these determinants to improve risk prediction and prevention. Multiple biological pathways of inflammation, fibrosis, coagulation, oxidative stress, lipid dysregulation, endothelial dysfunction, and metabolic disturbances are shaped by inherited susceptibility and modifiable exposures. Together, these mechanisms drive HF development and progression, though their relative contributions vary across populations. Methods: PubMed and Google Scholar were searched for clinical, biomedical, and …

Enhancing Cultural Competency Through Training In A Primary Care Clinic, Rogelio Perez Iii

Doctor of Nursing Practice Projects

Cultural competence remains essential in primary care settings serving diverse populations, yet staff at a small Southern Texas primary care clinic reported no previous formal cultural competency training in workplace orientation or school. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate whether a brief, evidence-based cultural competency intervention improved clinician cultural competency scores. Madeleine Leininger’s Culture Care Theory provided the theoretical framework, Lewin’s Change Theory guided the change process, and the Plan-Do-Study-Act cycle directed implementation and evaluation. The problem addressed was the lack of structured training to support culturally responsive communication, patient trust, and …

Impacting Competency In C-Ssrs Suicide Risk Screening On An Inpatient Psychiatric Unit, Fidelis Sangye

Doctor of Nursing Practice Projects

Suicide remains a leading public health concern, and inconsistent application of the Columbia-Suicide Severity Rating Scale (C-SSRS) may contribute to variability in suicide risk assessment and delayed intervention within inpatient psychiatric settings. The purpose of this quality improvement (QI) project was to evaluate the effectiveness of a standardized C-SSRS-guided educational intervention on staff competency in suicide risk screening. Guided by Lewin’s Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, this quantitative pretest-posttest QI project was conducted on an adult inpatient psychiatric unit. The intervention consisted of a 25-minute instructor-led PowerPoint presentation on standardized C-SSRS administration and evidence-based suicide risk …

Malt1 Protease Inhibition Restrains Glioblastoma Progression By Reversing Tumor-Associated Macrophage-Dependent Immunosuppression In Mice, Juliana Hofstätter Azambuja, Saigopalakrishna Yerneni, Lisa Maurer, Hannah Crentsil, Gabriela Debom, Linda Klei, Mei Smyers, Chaim Sneiderman, Kristina Schwab, Rajesh Acharya, Aivi Nguyen, Josie Emery, John Little, Jeffrey Meridew, Yijen Lin Wu, Prasanna Ekambaram, Dong Hu, Pete Gough, John Bertin, Ari Melnick, Gary Kohanbash, Riyue Bao, Peter Lucas, Linda Mcallister-Lucas

College of Life Sciences Faculty Papers

MALT1 protease is an intracellular signaling molecule that promotes tumor progression via cancer cell-intrinsic and cancer cell-extrinsic mechanisms. MALT1 has been mostly studied in lymphocytes, and little is known about its role in tumor-associated macrophages. We show that MALT1 is expressed in glioblastoma (GBM)-associated macrophages. Mechanistically, GBM tumor cells induce a MALT1-NF-κB signaling axis in macrophages, leading to enhanced macrophage migration and polarization toward an immunosuppressive ('M2-like') phenotype. Inactivation of MALT1 protease promotes transcriptional reprogramming that reduces migration and restores a macrophage anti-tumor 'M1-like' phenotype. Preclinical in vivo analysis shows that MALT1 inhibitor treatment results in immuno-reactivity of GBM-associated macrophages …