Digital Commons Network^™

Innovating Adhd Care: A Doctoral Capstone On A Pilot Adult Adhd Diagnostic Clinic Implementation, Fozia Aman

Doctor of Nursing Practice Final Manuscripts

Objective: To evaluate whether an APRN-led pilot Adult ADHD Diagnostic Clinic within a large academic healthcare system in the San Diego area improves timely access to diagnostic evaluation and optimizes care disposition for adults with suspected ADHD.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by inattention and/or hyperactivity-impulsivity that interferes with functioning in daily life. It often emerges in childhood and persists into adulthood, affecting approximately 360 million adults globally. Despite its prevalence and associated functional and psychiatric burden, adult ADHD remains underdiagnosed and undertreated due to limited primary care training, stigma, and reduced access to psychiatric services, resulting in delayed …

Sleep Tight: A Sleep Hygiene Bundle For Adults To Improve Sleep Quality In A Skilled Nursing Facility, Meaghan Corbin

Doctor of Nursing Practice Final Manuscripts

Abstract

Nearly two thirds of skilled nursing facility (SNF) residents report poor sleep. Negative consequences of poor sleep are depressed mood, anxiety, pain, cognitive impairment, increased risk for dementia, fatigue, decreased concentration, and lower activity participation. A review of literature has shown that implementation of non-pharmacological sleep interventions can significantly improve sleep quality. The aim to screen SNF residents on current self-reported sleep quality and provide non-pharmacological sleep interventions. The evidence-based project utilized the 8 A’s Model. Using the Pittsburg Sleep Quality Index (PSQI), a resident with a score above 0, received the non-pharmacological sleep hygiene bundle: eye mask, earplugs, …

Improving Transition To Adult Care: Assessing Health Insurance Literacy In Adolescent Patients With Congenital Heart Disease, Kaitlyn V. Mudge

Doctor of Nursing Practice Final Manuscripts

Background: With advances in surgery and medical management, 95% of children with congenital heart disease (CHD) survive into adulthood. Transition to adult care is an intricate process. Up to 60% of adolescents fail to follow through with cardiology care, facing three times the risk of needing emergency services. Only 25% of young adults with CHD knew of the need to change their care to an adult provider and to acquire health insurance as an adult. One barrier to successful transition is a lack of insurance coverage and limited insurance health literacy. Higher insurance literacy is associated with increased utilization …

Accessibility And Daily Cigarette Consumption Among Indonesian Adolescents: A Descriptive Study, Noviana Lathifah, Istiqomah Hanifah Rachman, Anisa Isnaini, Gloria Threesia Piliphinsa Simatupang

Journal of Indonesian Health Policy and Administration

Despite restrictive regulations, Indonesia faces a high prevalence of adolescent smoking, facilitated by easy access to tobacco products. This descriptive study aims to describe cigarette accessibility patterns and daily consumption trends among Indonesian adolescents. A cross-sectional study was conducted using secondary data from the 2019 Global Youth Tobacco Survey (GYTS) involving 9,208 respondents. Descriptive analysis was performed to examine the distribution of age at smoking initiation, daily cigarette consumption, and purchasing accessibility. The majority of respondents started smoking at ≥14 years of age. Daily cigarette consumption showed an increasing trend with age, with older adolescents more likely to consume more …

Deadline-Chasing In Digital Health: Forecasting Emr Adoption Dynamics And Regulatory Impact In Indonesian Primary Care, Suryo Satrio, Bukhori Muhammad Aqid

Journal of Indonesian Health Policy and Administration

Indonesia is accelerating digital health adoption under Minister of Health Regulation No. 24/2022, which mandates the use and integration of Electronic Medical Records (EMRs) with SATUSEHAT. However, evidence on how quickly primary health care facilities (Fasilitas Kesehatan Tingkat Pertama – FKTP) are adopting EMRs and what the adoption curve looks like remains limited. Survey findings also suggest key barriers and enablers, including security and data migration concerns, as well as human resource and infrastructure constraints. This observational study used provider-network data from a single EMR vendor. Key measures included cumulative registered facilities, monthly registrations, same-month activation (total_active/monthly inflow) as …

Optimizing Vitamin A Intervention: Strengthening Supplementation With Targeted Biscuit Fortification, Mayfa Yemima Simanjuntak, Nadia Amanda, Yuli Berliana Simanjuntak, Carissa Wityadarda, Lesta Livolina Simamora

Journal of Indonesian Health Policy and Administration

Vitamin A deficiency (VAD) remains a persistent public health challenge in Indonesia, particularly among children under five and breastfeeding mothers. This study aimed to analyze the distribution of vitamin A interventions and assess the potential of biscuit fortification as a complementary strategy. This study employs a literature review using the Health Policy Triangle (HPT) framework, examining policy context, content, key actors, and implementation processes related to vitamin A interventions. The analysis was conducted using secondary data from government reports, international agencies, and peer-reviewed literature published between 2018 and 2025, with comparative evidence from Vietnam, Bangladesh, and Ghana. The findings show …

Strength In Numbers: Six Nursing Faculty Embark On A Shared Journey To Doctorate Success, Melissa P. Arthur, Leigh Moore

Inquiry: The Journal of the Virginia Community Colleges

Pursuing a Doctor of Nursing Practice (DNP) is a demanding and transformative experience, one that can be both daunting and profoundly rewarding. This article chronicles the journey of six dedicated nursing faculty and administrators from Southside Virginia Community College (SVCC) who undertook this challenge together, turning an academic endeavor into a shared mission of growth, resilience, and collaboration. Originating from a spontaneous suggestion, this collective pursuit of doctoral education evolved into a powerful example of professional solidarity.

As seasoned educators and leaders, the group had previously collaborated on pivotal institutional milestones such as ACEN accreditation, Board of Nursing improvement initiatives, …

Intervention Levers For Stunting Reduction In Indonesia: Evidence From The 2023 Indonesian Health Survey Data, Iwan Ariawan, Hafizah Jusril, Zahra Izza Afifa, Azka Fitri, Elmarizha Sekar Utami, Mikail Hasan, Dwi Puspasari

Kesmas

Stunting remains the largest public health challenge among macro-nutrition problems in Indonesia, affecting almost a quarter of children under five in 2023. The prevalence is considered high according to the World Health Organization standard. This study analyzed 15 aggregated provincial variables from the 2023 Indonesian Health Survey using Structural Equation Modeling (SEM), focusing on determinants of stunting among children under two to identify primary intervention levers. Findings indicated that intervention urgency should focus on the first 1,000 days, particularly the steep increase in stunting prevalence observed in the 12–24-month age range. While the highest prevalence is in Eastern provinces (e.g., …

Narrative Roots - What We Inherit, What We Tell, What We Become: Intergenerational Storytelling, Meaning-Making, And Mental Health, Adam Sholder

Critical and Creative Thinking Capstones Collection

This capstone synthesis explores how the family stories we inherit and the stories we tell across generations shape who we become, with particular attention to their impact on identity and mental health. Drawing on narrative identity theory, reflective practice, and relational understandings of family life, it introduces the Recursive Narrative Integration Model, which positions intergenerational storytelling as both a method of inquiry and a mechanism of meaning-making. Informed by a recursive process of creative and reflective writing, this synthesis approaches storytelling not only as an object of study, but as a lived and generative practice through which experience and narrative …

Vergence Task-Based Neural Pathways With Binocularly Normal Vision And Comorbid Persistent Post-Concussive Symptoms -Convergence Insufficiency, Ayushi Sangoi

Dissertations

Binocular dysfunctions are more prevalent in the persistent post-concussive symptoms (PPCS) population than in the general population. The most prevalent binocular disorder is convergence insufficiency (CI), affecting 3-17% of the general population and up to 10 times as many people with PPCS. CI makes it difficult to fuse or maintain fusion on targets at near, and its symptoms include double or blurry vision and headaches when performing close-range tasks such as reading, which can exacerbate PPCS symptoms. Given controversy over the subjectivity and effectiveness of diagnostic tools and symptom surveys for both PPCS and CI, understanding why CI has high …

Parameter Density Estimation For Cardiac Electrophysiology Models Using Data Consistent Deep Learning, Michael Luo

Dissertations

Mathematical models of biological rhythms and excitable systems can provide insights into mechanisms underlying cardiac electrical dynamics. However, estimating the parameters of these models from experimental observations is often difficult due to noise, heterogeneity, and unobserved variables. For example, in an electrocardiogram (ECG) recording, information about the electrical properties of different regions of the heart is compressed into a single voltage trace. Additionally, variability within these signals may contain important information about population heterogeneity, regional differences in electrophysiology, and time-dependent modulation.

This dissertation develops, explores, and evaluates methods that perform feature-based distributional inference for complex nonlinear dynamical systems. The objective …

Transcranial Ac Modulation Of Cerebellar Nuclear Activity In Awake Animals, Nuran Kavakli

Dissertations

Entrainment of cerebellar nuclear (CN) cells via cerebellar transcranial alternating current stimulation (ctACS) has been reported in animals under ketamine/xylazine anesthesia. Our main objective was to demonstrate modulation of CN activity in unanesthetized, freely moving animals using ctACS. Multi-channel carbon-fiber electrodes were implanted into the interpositus nucleus for recording multi-unit (MU) activity, and thin-film electrodes were implanted subcutaneously over the posterior cerebellum for stimulation. A frequency-domain-based metric was developed to quantify modulation from MU signals. The results demonstrated modulation in a wide range of frequencies (4 Hz-300 Hz) as in anesthetized animals. In contrast, the amplitude of the peak in …

Enhancing Physiological Complexity Through Mindfulness: A Wearable-Based Intervention For First Responders And Their Partners, Thurmon Lockhart, Rahul Soangra, Christopher W. Frames, Sun-Kyung Lee, Amberlee Martin, Susanne Lee, Abigail H. Gewirtz

Physical Therapy Faculty Articles and Research

Background/Objectives: First responders frequently encounter high-stress environments that challenge physiological resilience and autonomic regulation. Heart rate variability (HRV) complexity is a critical marker of adaptive capacity and stress regulation. This study assessed the impact of a wearable-based mindfulness intervention on HRV complexity among first responders using a smartwatch. Methods: A total of 87 first responders participated in a one-month wearable-based intervention. Participants wore Garmin Vivosmart 5 devices to continuously collect PPG data (photoplethysmogram), focusing on beat-to-beat intervals (BBIs). The intervention involved daily Ecological Momentary Assessments (EMAs) and individual randomization to either a mindfulness message, a prompt to access an audio …

Trends Of Pediatric Psychotropic Polypharmacy In Massachusetts Before And During The Covid-19 Pandemic, Gianna D'Ambrozio

Graduate Doctoral Dissertations

Youth in the U.S. and internationally are increasingly being diagnosed with depression and related psychiatric conditions (Murthy, 2021) many of whom are being subjected to non-evidence-based, or what has been termed irrational, psychotropic polypharmacy (Barnett & Concepcion Zayas, 2019). Psychotropic polypharmacy can be defined as “the use of 2 or more psychiatric medications in the same patient,” (Zito et al., 2021) though definitions can vary. Using data from the Center for Health Information Analysis’ Massachusetts All-Payer Claims Database, this study examined the sociodemographic factors associated with high rates of polypharmacy, a hypothesized increase in pediatric psychotropic polypharmacy rates in Massachusetts …

Culturally Competent Nurse-Led Education To Reduce Delayed Diagnosis And Increase Awareness Of Polycystic Ovary Syndrome In Reproductive-Aged South Asian Women, Madeeha Syeda

Honors College Theses

Polycystic ovary syndrome (PCOS) is a common condition that affects hormones in women, especially in their 20s and 30s. Symptoms of PCOS include irregular periods, abnormal hair growth, acne, obesity, hyperpigmentation of the skin, cysts, skin tags, thinning hair, and infertility (Newin, 2023). While the exact cause of PCOS is unknown, it is linked to insulin resistance, higher levels of androgens, and low-grade inflammation (Newin, 2023). In regards to complications, PCOS can increase risk for gestational diabetes, preeclampsia, preterm term, and C-section deliveries. In terms of treatment, there is no cure but early diagnosis is key to reducing symptoms (Newin, …

The Effects Of Osha State Plans And State Gdp On Occupational Injuries And Illnesses In The United States, Ahmad Abdel Rahman Mohammad Amoorah

Theses

Workplace safety in the United States is governed by a system in which some states operate under federal OSHA oversight, while others administer their own OSHA-approved safety and health plans. This duality raises questions about whether state-level control leads to variation in safety and health outcomes. Economic conditions have also been shown to influence workplace injury rates, yet the interaction between safety and health regulations and local economies remains underexplored. Understanding these relationships is critical to protecting workers in occupational settings. The effects of OSHA state-plan status and state-level economic activity on occupational injury and illness rates across the United …

Improving Antihypertensive Medication Adherence Through Education And Follow- Up Phone Calls In A Primary Care Setting, Sarah Peterson

Doctor of Nursing Practice Final Manuscripts

Hypertension affects nearly half of adults and significantly increases the risk of stroke and cardiovascular disease; however, poor medication adherence remains a primary barrier to effective blood pressure management. The purpose of this evidence-based practice (EBP) project was to improve antihypertensive medication adherence among adult patients in a primary care setting. Guided by the Iowa Model of Evidence-Based Practice to Promote Quality Care, the project utilized a pre-test/post-test design at a private practice clinic. The sample included adults with a hypertensive diagnosis and active prescriptions. Medication adherence was defined as the Morisky Medication Adherence Scale (MMAS-8) scores, measured before and …

Closing The Gap: Integrating A Standardized Depression Screening In Primary Care, Cyndy Marie Oreas

Doctor of Nursing Practice Final Manuscripts

Objective: The purpose of this evidence-based practice (EBP) project is to implement the routine use of the Patient Health Questionnaire-9 (PHQ-9) screening instrument in the primary care setting to improve early diagnosis, treatment, and referrals to mental health.

Background: Depression is frequently underdiagnosed in primary care despite its significant impact on health outcomes. Inconsistent screening practices and a lack of standardized workflows contribute to missed opportunities for early identification and intervention. Routine PHQ-9 screening has been shown to improve detection and facilitate timely referral to behavioral health services.

Methods: A standardized PHQ-9 screening was implemented for adult patients aged 18 …

Reducing Preoperative Anxiety In Patients Undergoing Gynecologic-Oncology-Related Surgeries, Iman Sean Lavine-Richardson

Doctor of Nursing Practice Final Manuscripts

Elevated levels of preoperative anxiety are associated with adverse effects in the postoperative period. Evidence demonstrates the effectiveness of incorporating multimedia into preoperative education to alleviate preoperative anxiety. This project aims to decrease preoperative anxiety levels and increase satisfaction and feelings of preparedness in patients scheduled to undergo gynecologic-oncology-related procedures through the implementation of an evidence-based practice (EBP) informational video. The San Diego 8A’s EBP model was utilized to guide this project. Data was collected, anonymously, through online questionnaires which included the Anxiety Specific to Surgery Questionnaire (ASSQ) to assess anxiety levels and Likert-scale questions to assess satisfaction and feelings …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Enhancing Emergency Preparedness In California High Schools: A Policy Framework For Implementing Nata-Compliant Emergency Action Plans Through Multidisciplinary Task Forces, Jennifer Lu

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes, yet it is highly survival with proven measures: a structured emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and access to an automated external defibrillator (AED) within 3 minutes can raise survival rates to 90%. Despite this, high schools show inconsistent compliance, largely due to the lack of fragmented oversight and lack of standardized practices

Purpose of Project: This proposal advocates for multidisciplinary task forces to enforce venue-specific, National Athletic Trainers Association (NATA)-compliant EAPs across California high schools, with the goal of improving emergency response …

Text Message Delivery Of Pre-Procedural Recommendations Prior To Lip Augmentation With Hyaluronic Acid Filler: An Evidence-Based Pilot Project, Jenna De Jonge

Doctor of Nursing Practice Final Manuscripts

Patients seeking lip augmentation procedures commonly experience self-resolving soft-tissue complications such as swelling and bruising. There are many widely accepted pre-procedural recommendations available to help patients minimize the risk of these undesirable outcomes. At a Medical Aesthetics practice in Southern California, lip augmentation patients often arrived to their appointment non-adherent to pre-procedural recommendations that were available on the practice website. Text message delivery systems have been used to improve patient adherence to healthcare instructions across a variety of healthcare settings. To address this gap, I implemented text message delivery of pre-procedural recommendations to lip augmentation patients prior to their appointment. …

Optimizing Lactation Support: Enhancing Patient-Centered Care And Breastfeeding Self Efficacy Through Data-Driven Survey Analysis, Jessica L. Doshay

Doctor of Nursing Practice Final Manuscripts

Objective: The objective of this project was to implement evaluation of an integrated lactation support model within a multi‑site pediatric primary care organization to assess patient experience and breastfeeding confidence associated with a lactation consultation.

Background: Optimizing the patient experience is an indicator of healthcare quality. Improving breastfeeding outcomes remains a national priority. Structured lactation support delivered by International Board-Certified Lactation Consultants (IBCLCs) enhances breastfeeding outcomes, the impact of this is often undocumented in primary care settings.

Methods: This quality improvement project was conducted within the lactation department of a multicenter pediatric clinic in Southern California. Pediatric clinicians who were …

Implementation Of Comprehensive Checklist For Opioid Use Disorder Treatment In Primary Care, Sophia R. Madden

Doctor of Nursing Practice Final Manuscripts

Background: The escalating opioid crisis demands a comprehensive approach to Opioid Use Disorder (OUD) management. Patients often face comorbid mental illnesses, infectious diseases, concurrent substance use, and social determinants of health (SDOH)—all of which increase the risk of treatment attrition. Standardizing care through evidence-based clinical practice guidelines and tools is essential for improving treatment quality and consistency.

Purpose: This project aimed to increase comorbidity screenings and improve resource access for OUD patients at a San Diego Internal Medicine primary care office by implementing a comprehensive care checklist based on the American Society of Addiction Medicine (ASAM) guideline.

Methods: The ASAM …

Empowering Healing And Recovery: Adverse Childhood Experiences Screening In A Cognitive Behavioral Therapy Intensive Outpatient Program, Serena C. Lee

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice project implemented Adverse Childhood Experiences (ACEs) screening in an adult Cognitive Behavioral Therapy Intensive Outpatient Program (COG IOP) at San Diego's largest behavioral health hospital to identify ACE exposure, deliver supportive interventions, and enhance clinician competency in trauma-informed care.

Background: ACEs are potentially traumatic experiences occurring before age 18 that are associated with toxic stress and worsening health outcomes. Despite evidence linking ACEs to adverse outcomes and substantial healthcare costs, routine ACE screening is not standardized in behavioral health settings.

Methods: Guided by the San Diego 8A's Evidence-Based Practice model, eligible patients were offered ACEs screening …

Enhancing Tardive Dyskinesia Screening In An Outpatient Psychiatry Training Clinic: A Quality Improvement Initiative, Ariel Davalos

Doctor of Nursing Practice Final Manuscripts

Background: Tardive Dyskinesia (TD) is a debilitating, often irreversible movement disorder caused by prolonged exposure to dopamine receptor-blocking agents, affecting 15-30% of patients on long-term antipsychotic therapy. Despite endorsement of the Abnormal Involuntary Movement Scale (AIMS) as the gold standard for TD screening, the condition remains significantly under-diagnosed. Purpose: This quality improvement project evaluated whether a 45-minute educational intervention could improve PMHNP trainees’ confidence and competence in TD recognition and AIMS administration. Methods: Guided by the Iowa Model of Evidence-Based Practice, the project used a pre-post survey design with a planned one-month follow-up across two clinical training sessions. Ten PMHNP …

Perinatal Mental Health Screening And Care Among Those With Pregnancy Complications, Alison N Goulding, Terri L Fletcher, Emily S Miller

Faculty, Staff and Students Publications

Perinatal mental health conditions are common and, without effective treatment, can contribute to adverse maternal and child outcomes. In the United States, mental health conditions are a leading cause of maternal morbidity and mortality, contributing to over 20% of pregnancy-related deaths. This expert review aims to assess current literature and provide recommendations regarding mental health care in high-risk patients who experience pregnancy complications. Individuals experiencing pregnancy complications are at increased risk for perinatal mental health conditions, including depression, anxiety, and post-traumatic stress disorder, as compared to those with uncomplicated pregnancies. Despite this increased disease burden, there is limited research on …

Rethinking Flow: The Paradox Of Renoprotection Without Increased Renal Blood Flow In Cardiopulmonary Bypass, Shiksha Mohan, Ronald A Shaju, Sharan Misra, Titiksha Sharma, Veeraj K Sirivolu, Abhinav Rajkumar, Anthony Rodas-Camacho, Aizah Zaidi, Dhruv Dhingra, Ilma Khan, Rishav Bhattacharya, Vishal Pancholy, Shivam Banerjee, Shreyo Ghosh, Shiyi Li, Kenneth K Liao, Carl P Walther, Nandan K Mondal

Faculty, Staff and Students Publications

No abstract provided.

Referral Patterns From Primary Care To Referral Care By Icd-10 Codes In Indonesia: Cross-Sectional Analysis Of National Claims Data (2017–2024), Della Dwi Ayu, Syarif Rahman Hasibuan, Putu Erma Pradnyani, Nisrina Widyasanti

Journal of Indonesian Health Policy and Administration

Primary health care (PHC) facilities serve as gatekeepers within Indonesia’s tiered health system. However, PHC referral patterns to hospitals still show substantial variation and remain insufficiently characterized by disease groupings based on the International Classification of Diseases, 10th Revision (ICD-10). This study aimed to identify the most frequently referred diagnoses from PHC to secondary or tertiary care facilities and to determine the participant characteristics associated with referrals. This observational study employed a cross-sectional design using secondary data from the National Health Insurance (Jaminan Kesehatan Nasional – JKN) claims database for the period 2017–2024. The unit of analysis was each …

Factors Associated With The Performance Of Essential Public Health Efforts At Primary Health Centers In Jember Regency, Griselda Ardelia Hibatullah, Nuryadi Nuryadi, Yennike Tri Herawati

Journal of Indonesian Health Policy and Administration

Performance assessment of primary health centers is essential to ensure the quality of healthcare services, including the delivery of essential public health efforts. The performance target for essential public health efforts in Jember Regency is set at ≥82%. This study aimed to analyze factors associated with the performance of essential public health efforts. The study employed an analytical cross-sectional design conducted from April to May 2025, with a sample of 37 out of 50 units selected through simple random sampling. Primary data were collected using questionnaires, while secondary data were obtained from primary health center (Pusat Kesehatan Masyarakat – …