Digital Commons Network^™

``But What About Me?'': A Structural Redesign For Cascading Trust Into An Integrated Culture Of Care, Hazelin Hei Laam Ngan

Patient Experience Journal

In healthcare, patient experience (PX) and employee experience (EX) are often managed as separate priorities despite their interdependence. This article presents a case study from NYC Health + Hospitals/Community Care, a 250-person safety-net division providing home-based services across New York City. In response to frontline staff repeatedly asking, ``But what about me?'' when offered PX best practice suggestions, the organization integrated patient experience, staff engagement, and wellness into a unified Care Experience portfolio led by the Chief Experience Officer. From this structural redesign emerged a practical framework for trust-building organized around three pillars: Purpose, Presence, and Partnership. Purpose aligns staff …

Plan Of Day | Plan Of Stay: How Inter-Disciplinary Communication Improved Patient Experience And Hospital Throughput, Theresa Jean Dionne, Felicia Hurst, Danna Qunibi, Lauren Lazar, Sydney Mccurdy, Ashlyn Coenraad, Brittney Ward, Whitney Black, Ashley Nelson, Judd Salem, Luisa Restrepo

Patient Experience Journal

Background: Effective communication among healthcare team members is critical for delivering high-quality, patient- and family-centered care while optimizing hospital operations. This case study examines the implementation of a structured ``Plan of Day | Plan of Stay'' model, leveraging bedside whiteboards to enhance inter-disciplinary communication in a pediatric hospital setting. By providing a clear, visual summary of daily care plans, care team members, and discharge goals, whiteboards foster transparency, empower patients and families, and facilitate coordinated clinical decision-making. Purpose: This quality improvement initiative evaluated the implementation of a standardized Plan of Day | Plan of Stay communication model on a pediatric …

Patient Psychological Safety: A Qualitative Study Of Patient Experiences, Derick R. Simmons, Cheryl Rathert, Ryan Valayil, Maria Joseph, Ibraheem Jawadi

Patient Experience Journal

There is growing interest in understanding patients' experiences with psychological safety during healthcare encounters. Recent studies reveal that patients describe needing patient psychological safety (PPS) to form connections with their care providers, which are associated with better health outcomes. Therefore, it is critical to examine indicators of PPS. Using a phenomenological interpretive approach, this study utilized a patient narrative survey methodology to qualitatively explore how and why patients experience a lack of PPS during their healthcare encounters. We surveyed patients from across the U.S. and analyzed responses among a sub-sample of respondents to an open-ended question whose responses indicated they …

Self-Medication Experience And Healthcare Trust Among Youth: A Regionally Concentrated Digital Survey In Indonesia, Wahyudi Wahyudi, Azra Muzaiyana Nasution, Arini Dwi Rahmadani, Alysa Rahmadani Hasibuan

Patient Experience Journal

Self-medication has become a central experience for youth transitioning toward independent medical decision-making. In the digital era, young people must navigate a complex landscape of health information while seeking independent health solutions. This study investigates self-medication experiences and healthcare trust among youth, utilizing a regionally concentrated digital survey approach in Indonesia. Data were collected via a cross-sectional approach using digital platforms (Instagram, TikTok, and Twitter/X), facilitated by 76 trained enumerators. While respondents from all 38 provinces participated, the sample (N = 2,790) exhibits a major geographical concentration in the Sumatra region. The study employed a validated 16-item instrument to evaluate …

Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust In Their Inpatient Physicians—A Convergent Mixed-Methods Study, Marlise Jeanne Pierre-Wright, Ibrahim Badreldin Mokhtar, Uma Thachapuzha, Yashoswini Chakraborty, Revika Singh, Rachel O'Conor, Jing Song, Julia Lee, Maria E. Theodorou, Christine Schaeffer, Kimberly Collins, Muriel Jean-Jacques

Patient Experience Journal

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants …

From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus

Patient Experience Journal

After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

Caring But Still Hurting: Uninsured Patients' Illness And Healthcare Experiences At A U.S. Free Clinic, Danaya Amornnimit, Eda G. Christensen, Adelaida Salmeron, Kian Robison, Sofia Ampudia Arroyo, Jessica Benelli, Brenda Spearman, Akiko Kamimura

Patient Experience Journal

While free clinics provide essential healthcare to socioeconomically disadvantaged populations, patients' lived experiences in these settings remain underexplored. This qualitative study examined how uninsured patients at a U.S.-based free clinic perceive their illness experiences and interactions with healthcare providers. From October to December 2024, semi-structured interviews were conducted with 21 adult patients (ages 18–72; M = 49.14), most of whom were non–U.S.-born and primarily Spanish-speaking. Participants described illness as entangled with emotional distress, social isolation, stigma, and disruptions to identity and family roles—revealing a psychological burden that extends beyond physical symptoms. These findings highlight the need to integrate psychosocial and …

From Drifting To Anchored: How Online Health Communities Can Transform Care For Complex Chronic Illness, Mads Eggerding

Patient Experience Journal

This personal narrative recounts a 25-year diagnostic odyssey with Ehlers-Danlos syndrome, defined by medical fragmentation, dismissed symptoms, and profound isolation. It illustrates how Online Health Communities (OHCs) bridged the chasm between lived experience and a clinical system ill-equipped for complex chronic illness. For patients like me, these digital forums provide the peer validation, practical knowledge, and self-advocacy tools necessary to navigate a disjointed healthcare landscape. For providers, this story underscores a critical opportunity: proactive, non-judgmental engagement with OHCs is not a threat to expertise but a foundational strategy for patient-centered care. By acknowledging and constructively partnering with these patient-led spaces, …

Secondary Infertility: A Personal Story Of Loss And Grief, Ben Hughes

Patient Experience Journal

An increasing number of people worldwide are experiencing fertility and this trend is reflected in the data from the United Kingdom. However, most research focuses on the experiences of women and so the male perspective is largely missing from the literature. This narrative is an account of my personal journey of secondary infertility. Presenting a male perspective of infertility provides a point of view which is rarely explored and is about a topic which feels largely a societal taboo. I chart how infertility has changed me, what it has meant to me through my years of trying to come to …

When Hope Meets Harm: A Story Of Trust, Pain, And Consent In Intimate Care, Sharon I. Choe, Erin Foster

Patient Experience Journal

Transparent communication is key to building and maintaining strong patient-provider relationships. In this article, I interviewed a patient who shared her experience undergoing treatment for a chronic vulvar condition and the consequences that followed. She described a painful procedure for which she felt unprepared and later realized she had not been educated about the need for ongoing care. Years later, this gap in understanding contributed to irreversible disease progression. After re-establishing care with a dermatologist she felt comfortable confiding in, the patient expressed a desire for her story to be shared. This narrative presents her experience as she shared it …

Ai As A Physician Companion In Enhancing Trust In Healthcare, Saria Gouher

Patient Experience Journal

Trust remains a fundamental pillar of the physician–patient relationship, ensuring care that is safe, evidence-based, and grounded in shared decision-making; however, the increasing use of artificial intelligence tools such as ChatGPT has introduced a new dynamic in how patients interpret symptoms and seek medical advice. This narrative describes a clinical encounter involving an elderly patient with multiple myeloma whose caregiver used ChatGPT to evaluate new-onset slurred speech suggestive of stroke, resulting in an urgent recommendation driven by incomplete clinical information. Through comprehensive history-taking, physical examination, and careful review of the Artificial Intelligence (AI)-generated response, the physician reassured the caregiver, contextualized …

Rebuilding Trust After Bondi Beach: Healing Patients, Protecting Caregivers, And The Sacred Work Of Care, Anne Marie Hadley

Patient Experience Journal

The Bondi Beach tragedy of December 14, 2025 profoundly disrupted Australia's collective sense of safety, belonging, and trust. Beyond the immediate loss of life and injury, such events exert lasting impacts on healthcare systems and the people who work within them. This article explores how trust can be rebuilt not only for patients and communities, but also for caregivers themselves. Drawing on trauma-informed care, psychological safety, and human experience design, it examines the often-overlooked dimensions of staff safety, the essential role of pastoral care and chaplaincy, and the particular vulnerabilities experienced by faith-based caregivers during periods of social fracture and …

Co-Designing Trust: Patient Experience, Relationships, And The Design Of Care, Toni Land

Patient Experience Journal

Trust can have a positive or negative impact on patients, families, and community healthcare experience. Although important, it is often treated as something soft and intangible rather than something intentionally measured and designed. Currently, healthcare organizations collect and report patient experience data related to communication, courtesy, respect, and responsiveness. But these measures do not capture the specific behaviors that influence whether trust builds or whether it stalls. This commentary explores trust as a foundational behavioral and environmental element in healthcare and challenges that improving trust requires more than good intentions; it requires bringing voices to the table through co-design. Starting …

Healing The Social Covenant: Rebuilding Trust And Re-Humanizing Healthcare, Cynda Hylton Rushton

Patient Experience Journal

Violence against healthcare workers continues to escalate despite substantial investments in security measures, workplace violence prevention programs, and legislative protections. Although these interventions are necessary, they have not produced sustained improvements in workforce safety or retention, suggesting that workplace violence is more than a behavioral or security problem. This commentary argues that it also reflects a deeper erosion of trust within healthcare. Drawing on evidence linking workplace violence to burnout, moral injury, psychological distress, and turnover intention among nurses, we propose that repairing trust is essential to sustaining the workforce and healthcare.Building on our earlier work, Rebuilding a Foundation of …

The Registered Dietitian Nutritionist’S Implementation Of Dysphagia Screening In Clinical Practice: A Commentary, Nicole Wiksten, Holly Estes-Doetsch, Laura C. Boucher, Sarah Rusnak, Kristen M. Roberts

Journal of Dietetic Education

Background: The Accreditation Council for Education in Nutrition and Dietetics (ACEND) amended the competencies for the future education model (FEM) in dietetic education to include competency 3.6 stating that the Registered Dietitian Nutritionist (RDN) must be able to "Initiate and conduct bedside swallow screenings". There is no clear process for RDNs to implement dysphagia screening in practice or academia. The aim of this review is to inform clinicians and educators on current literature discussing current RDN and speech language pathology approaches to dysphagia screening and to provide a proposed curriculum for implementation of competency 3.6 in clinical practice and academia.

Assessing And Addressing Cultural Competence And Cultural Humility In Dietetic Education, Zoe Duran, Nicholas Slagel, Lisa Caldwell, Katie Kage

Journal of Dietetic Education

Limited theory-informed, dietetic-specific resources are available to guide the development, evaluation, and refinement of culturally competent (CC) curricula. This pilot study used a mixed-methods, theory-informed approach to evaluate CC integration within an undergraduate dietetics curriculum and examine the applicability of existing CC self-assessment tools for dietetic students. A senior-level undergraduate community nutrition curriculum was evaluated using the Tool for Assessing Cultural Competence Training (TACCT), guided by the Campinha-Bacote Model of Cultural Competence in Healthcare Delivery. James Banks’ Model of Multicultural Curriculum Reform was then applied to refine curricular content and learning activities. In addition, 74 students enrolled in a didactic …

Virtual Reality: The Future Of Didactic And Experiential Education For Nutrition And Dietetics, Michael Holik, Dexter Richardson

Journal of Dietetic Education

The integration of virtual reality (VR) into nutrition and dietetics education provides an innovative answer to challenges in accessing experiential learning. This study examined student perceptions of immersive VR experiences designed to simulate hospital foodservice operations and nutrition counseling sessions, guided by the Diffusion of Innovation Theory (DOI). A quasi-experimental design involved 55 participants who engaged with 360° VR modules featuring interactive elements, avatars representing key healthcare roles, and embedded critical-thinking questions. Results demonstrated strong support for VR’s educational value across DOI’s five key attributes: relative advantage, compatibility, complexity, trialability, and observability. Participants reported enhanced understanding of registered dietitian roles, …

How Philip K. Dick Used The Unreliable Narrator To Transport Unwitting Acolytes, Michael Barros, Jordi Smith

Dialogue: The Interdisciplinary Journal of Popular Culture and Pedagogy

This essay examines the use of the unreliable narrator to transport the reader into narrative worlds, specifically in Philip K. Dick's fiction. By exploring the phenomenon of narrative transportation and the role of emotions in engagement with fiction, we argue that Dick's use of the unreliable narrator significantly engages and transports readers into his narrative worlds. Subsequently, we contend that his belief in the fundamental reality of those worlds is effectively positioning himself as a gatekeeper and mediator between the narrative world and the real world, which sets him, in his mind, as a prophet, using fiction as a tool …

An Architecture Of Vanishing: Toward A Protocol Of Archival Disappearance, Edgardo Civallero

Journal of Contemporary Archival Studies

This article rethinks the preservationist reflex that equates archival care with permanence. Drawing on post- and decolonial theory, it provincializes endurance as a historically situated ideal and foregrounds global traditions where disappearance, opacity, and cyclical renewal structure memory. It reframes vanishing as custodianship rather than neglect, introducing a taxonomy of protocols of epistemic disappearance—temporal, spatial, relational, semantic, and material—and a grammar of vanishing that operationalizes them as design tools. Extending to institutions, it outlines seasonal, dismantling, shadow, and nomadic archives as forms that measure success by their capacity to end well. A concluding framework articulates five principles—vanishing as care, duration …

Wildfire Risk & Preparedness For Urban Rail Operators Supporting Large Stadium Events, Karl Kim, Eric Yamashita, Daniele Spirandeli, David Rother

Mineta Transportation Institute

The project team, in collaboration with partners and stakeholders, developed a four-hour training course designed to build a foundational understanding of how wildfire hazards affect rail systems infrastructure operations and how this knowledge can help equip urban rail operators with tools and best practices for proactive risk management. Led by the University of Hawaiʻi and the National Disaster Preparedness Training Center, in partnership with Haley & Aldrich, Inc., this technical report presents an overview of the four modules and scenario planning exercise that together make up the four-hour Wildfire Risk & Preparedness for Urban Rail Operators Supporting Large Stadium Events …

Enhancing Wildfire Resilience In The Rail Industry: Developing A Community Resilience Extreme Events Portal (Creep), Karl Kim, Eric Yamashita, Daniele Spirandeli, David Rother, Chris Chiesa, Greg Hampe, Michele Toner

Mineta Transportation Institute

The Community Resilience Extreme Events Portal (CREEP) provides a centralized platform for accessing wildfire danger indices, critical asset locations, and vulnerability scores for rail segments. The project team developed a data-driven, indicator-based vulnerability assessment framework that defines vulnerability as a function of exposure, sensitivity, and adaptive capacity. To build this framework, the team selected publicly available datasets, prioritizing national datasets whenever possible to ensure transparency, reproducibility, and scalability. The portal allows users to analyze and visualize vulnerability across 1-kilometer segments of Class I freight and passenger rail lines in California, supporting planning and mitigation prioritization to help reduce rail-related fatalities, …

Media Emotion Regulation And Executive Function In Childhood: Associations With Respiratory Sinus Arrhythmia, Lara M. Almeida

Theses and Dissertations

Media emotion regulation (MER), or the use of media to help children manage emotions, may influence children's development by shaping opportunities for practicing self-regulatory skills. Guided by the Dynamic, Relational, Ecological Approach to Media Effects Research (DREAMER) model, this study examined longitudinal associations between MER and executive functioning (EF) in early childhood and explored whether respiratory sinus arrhythmia (RSA), a physiological index of regulation, predicted developmental changes. Participants included 175 parent-child dyads assessed across two annual waves when children were approximately 4 and 5 years old. Structural equation modeling was used to test bidirectional associations between MER and EF while …

Integrating Matrescence Into Birth Worker Practice: A Practice Improvement Project, Kelsey B. Green

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal mood and anxiety disorders (PMADs) affect 20–25% of mothers worldwide and are a leading cause of maternal complications. Stigma, fragmented care, and limited provider training leave families vulnerable, while birth workers offer trusted, continuous support.

Problem: Birth workers' maternal mental health (MMH) training is minimal and often excludes matrescence, the developmental transition to motherhood, limiting their ability to distinguish normal adjustment from clinical PMADs and delaying intervention.

Methods: A single-group, pre-/post-test design evaluated a matrescence-informed workshop at Roots Community Health's 2nd Annual Symposium. Anonymous surveys measured knowledge, attitudes, and confidence, analyzed with Mann–Whitney U, Wilcoxon signed-rank tests, and …

When Everyone Is A Librarian: Examining Job Titles And Responsibilities In California School Libraries, Mary Ann Harlan, Jeffrey Mattison, Jodi Hwang

Learning Hub

School libraries in California are staffed by a wide range of personnel, including credentialed Teacher Librarians (TLs) and paraprofessional staff working under a variety of job titles. Analysis of responses from the California School Library Survey revealed substantial variation in self-reported library staff titles, raising questions about the relationship between job titles, job descriptions, and professional responsibilities. This study examined the titles used by individuals working in California school libraries as paraprofessionals and analyzed corresponding job descriptions to determine whether distinctions exist between professional standards and descriptions and paraprofessional duties. Using survey data from the 2022–2023 California School Library Survey, …

The Screening Tool Of Behavioral Self-Regulation “Head-Toes-Knees-Shoulders” Task: A Preliminary Adaptation To Greek Older Adults, Eleni Rachanioti, Dimitra Magkavila, Olga Fragkomichelaki, Magda Dinou, Effie Katsadima, Theodora Foti, Anastasia Tzalla, Anna Dougali, Christina Bourmpou, Maria Staikopoulou, Aphrodite Papantoniou, Fotini Varlami, Irene Dinaki, Maria Tsiountala, Konstantinos Staikopoulos, Tryfon Mavropalias, Efthymia Efthymiou, Demetra Tomprou, Maria Georgiadi, Dimitra Katsarou, Georgios Kougioumtzis, Ioanna Giannoula Katsouri, Harilaos Zaragas, Despina Moraitou, Maria Sofologi, Georgia Papantoniou

All Works

The aim of the present study was to examine the psychometric properties of the Head-Toes-Knees-Shoulders (HTKS) behavioral self-regulation (executive function) measure in a sample of Greek older population. Specifically, 88 cognitively healthy Greek older adults over the age of 65 participated in the study. The Greek version of HTKS was administered along with the Greek versions of the Mini-Mental State Examination (MMSE), the Raven's Educational CPM, the Number Series (NS) test, the Positive and Negative Affect Scale (PANAS), the Barratt Impulsiveness Scale (BIS-11) and the Impulsive Behavior Scale (UPPS-P). Exploratory factor analysis supported the unidimensional structure of the HTKS. The …

Fighting With Data: Design Implications For Ai-Enabled Mission-Command Systems, C. Anthony Pfaff

Books, Monographs & Collaborative Studies

Fighting with Data examines how artificial intelligence (AI) is reshaping military decision making by changing both the speed of command and the structure of cognition within mission-command systems. Rather than treating AI as a tool that merely accelerates existing staff processes, this monograph recognizes AI redistributes cognitive labor across a network of people, data, tools, and operational processes. In this new environment, commanders and staffs spend less time assembling information and more time interpreting meaning, judging uncertainty, and deciding how to act.

This shift in the human role requires a new way of thinking about trust in military AI. Traditional …

Physical Activity, Trauma, And Posttraumatic Stress: The Indirect Role Of Exercise Addiction, Anastasiia Rozumna

Theses and Dissertations

Exercise is often conceptualized as a protective factor for mental health, including for individuals exposed to trauma. However, less is known about whether exercise may relate to posttraumatic stress symptoms differently when it is accompanied by compulsive or addictive features. The present study examined whether volume and intensity of physical activity were associated with posttraumatic stress symptom severity indirectly through exercise addiction symptoms. This secondary cross-sectional analysis included 557 adults living in the United States who reported regular participation in sport or physical activity. Participants completed self-report measures of physical activity behavior, exercise addiction symptoms, trauma exposure, and posttraumatic stress …

A Systematic Review Of Posttraumatic Stress Disorder Among Hispanic Immigrants In The United States, Rashel Acireale

Theses and Dissertations

This study systematically reviews the literature on posttraumatic stress disorder (PTSD) among Hispanic immigrants in the United States, a population exposed to cumulative trauma across the migration process. Stressors may occur before, during, and after migration and include violence, family separation, dangerous travel conditions, discrimination, and fear of deportation. Despite these risks, findings on PTSD prevalence remain mixed, and Hispanic immigrants are underrepresented in clinical research and culturally informed interventions. This review examines sample representation, types and timing of trauma, PTSD measurement approaches, and the inclusion of cultural and contextual factors such as acculturation and immigration-related stress. It also evaluates …

Evaluating Gender Equity In The Berenstain Bears Picture Books, Christy Tisnawijaya, Geni Kurniati

Bahasa dan Seni: Jurnal Bahasa, Sastra, Seni, dan Pengajarannya

Picture books serve as a foundational medium in early childhood education, utilizing interrelated visual and verbal elements to foster linguistic, cognitive, and social development. Despite their pedagogical utility, certain literary works inadvertently perpetuate traditional gender roles, constraining children's conceptualizations of identity. This study evaluates gender representation within eleven selected titles of The Berenstain Bears series. Employing a qualitative multimodal content analysis, the study integrates Butler's gender performativity framework (1990), Callow's multimodal narrative approach (2020), and Adam and Harper's evaluative criteria (2021) to examine how domestic, social, and recreational roles are constructed. This study offers novelty by establishing a dual-lens multimodal …