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Articles 211 - 240 of 13142
Full-Text Articles in Entire DC Network
Higher Education Instructors’ Perspectives On The Challenges Of Implementing Competency-Based Learning In Coursework, Sammie Leo Davis Jr
Higher Education Instructors’ Perspectives On The Challenges Of Implementing Competency-Based Learning In Coursework, Sammie Leo Davis Jr
Walden Dissertations and Doctoral Studies
Higher education instructors face challenges in implementing competency-based learning (CBL) in their coursework. Grounded in Vygotsky’s social constructivist theory, the purpose of this basic qualitative study was to explore the perspectives of higher education instructors on the challenges and their needs to implement CBL in coursework. For this basic qualitative design, semistructured interviews were conducted with 12 higher education instructors who had at least 2 years of experience teaching CBL courses. Data were analyzed using qualitative content analysis and inductive coding to identify codes and categories, with the following five themes emerging: CBL implementation depends on (a) aligned assessment, curriculum …
Improving Pcu Nurses’ Knowledge Of Evidence-Based Mindfulness Techniques Through Targeted Education, Dairia Moore Mohammed
Improving Pcu Nurses’ Knowledge Of Evidence-Based Mindfulness Techniques Through Targeted Education, Dairia Moore Mohammed
Walden Dissertations and Doctoral Studies
The progressive care unit (PCU) is a high-acuity setting in which nurses manage patients with complex health conditions, respond to rapid changes in clinical status, and navigate ongoing physical and emotional demands. The practice problem that I addressed was, presently, stress-management support is typically informal, optional, and reactive rather than systematic, evidence-based, and preventive. The purpose of this project was to implement and evaluate a structured educational intervention designed to increase nurses’ knowledge of evidence-based mindfulness breathing techniques that could be integrated into the daily PCU workflow. The practice-focused question was: In PCU nurses in an acute care setting, how …
Strategies Human Resource Leaders Use To Implement Holistic Wellness Programs To Reduce Absenteeism And Increase Profitability, Diane Hardy
Walden Dissertations and Doctoral Studies
Human resources (HR) leaders struggle to reduce employee absenteeism and increase organizational profitability due to a lack of effective strategies for implementing holistic wellness programs. Identifying effective strategies for implementing holistic wellness programs is essential for helping HR leaders address absenteeism and strengthen organizational profitability. Grounded in the Pender health promotion model, the purpose of this qualitative pragmatic inquiry was to identify and explore effective strategies for implementing holistic wellness programs to reduce employee absenteeism and increase organizational profitability. Participants were nine HR leaders from medium- to large-sized organizations across the United States who implemented holistic wellness programs to reduce …
Experiences With Microaggression Of African American Female Faculty Who Work In Predominantly White Institutions, Teffany Jonte Malone
Experiences With Microaggression Of African American Female Faculty Who Work In Predominantly White Institutions, Teffany Jonte Malone
Walden Dissertations and Doctoral Studies
The problem addressed through this study is the gap in the literature on the experiences of African American female faculty in higher education institutions with racial microaggressions while working in predominantly White institutions (PWIs). Grounded in Delgado and Stefancic’s critical race theory, the purpose of this basic qualitative study was to explore African American female faculty’s experiences with racial microaggressions and recommended support their institutions can put in place at PWIs in California. For this basic qualitative design, data were collected through semistructured interviews with 15 African American female faculty members employed at PWIs in California. Through qualitative content analysis, …
Adults’ Lived Experiences With Placement In Child Protective Services During Adolescence, Michaela First Haynes
Adults’ Lived Experiences With Placement In Child Protective Services During Adolescence, Michaela First Haynes
Walden Dissertations and Doctoral Studies
Perceptions of safety and emotional support during involvement with child protective services (CPS) during adolescence may play a significant role in shaping attachment experiences and relationships in adulthood. Although researchers have examined the effects of child maltreatment and foster care involvement, limited research has explored how adolescents perceive emotional support and safety during CPS involvement and how those experiences influence attachment in adulthood. The purpose of this qualitative study was to explore the lived experiences of adults who experienced CPS involvement during adolescence and to understand how perceptions of safety and emotional support are reflected in their adult attachment relationships. …
Exploring The Experiences Of Nigerian Army Personnel With Toxic Leadership, Shamsideen Toyin Shafaru
Exploring The Experiences Of Nigerian Army Personnel With Toxic Leadership, Shamsideen Toyin Shafaru
Walden Dissertations and Doctoral Studies
Toxic leadership has been shown to be present in Nigeria, promoting negative consequences for organizations and adverse effects on employee performance. However, how toxic leadership behaviors impact Nigerian Army operations and the performance of personnel have not been studied. Exploring toxic leadership in the Nigerian Army is important because the way in which leaders exercise influence determines the effects it has on followers. The purpose of this general qualitative study was to examine the lived experiences of Nigerian Army personnel who had worked as subordinates of individuals who exhibited toxic leadership traits and its impact on their performance. The theoretical …
The Lived Experiences Of Midlife Black Women In Atlanta Managing Hypertension Through Nonpharmacological Interventions, Beth Feagins
The Lived Experiences Of Midlife Black Women In Atlanta Managing Hypertension Through Nonpharmacological Interventions, Beth Feagins
Walden Dissertations and Doctoral Studies
In this qualitative phenomenological study, the beliefs and lived experiences of midlife, low-income Black women with hypertension were explored, concentrating on understanding how social determinants of health influence effects adherence to diet, physical activity and stress management. Social determinants of health and how health beliefs shape adherence to behaviors were examined. The study was guided by a dual theory approach of the social cognitive theory and theory of planned behavior. Six women, identified as Black, between the ages 40-60, diagnosed with hypertension and living in Atlanta, Georgia, participated in the study. Data was analyzed using Moustakas’ phenomenological analysis and revealed …
Staff Education To Improve Clinical Staff Knowledge, Confidence, And Use Of The Patient Health Questionnaire-9 (Phq-9) In Outpatient Depression Screening, Madjou Stella Ngantche
Staff Education To Improve Clinical Staff Knowledge, Confidence, And Use Of The Patient Health Questionnaire-9 (Phq-9) In Outpatient Depression Screening, Madjou Stella Ngantche
Walden Dissertations and Doctoral Studies
Depression is one of the most common mental health conditions encountered in outpatient practice, yet inconsistent use of standardized screening tools contributes to missed opportunities for early identification and intervention. In outpatient settings, nurses and other clinical staff are often responsible for administering depression screenings; however, many lack formal education on the standardized use of the Patient Health Questionnaire-9 (PHQ-9). To address this practice gap, this Doctor of Nursing Practice (DNP) staff education project was implemented in an outpatient setting to determine whether staff education on the use of the PHQ-9 would improve staff knowledge, confidence, and intent to use …
Workforce Solutions For Primary Care Physician Shortages In Veterans Health Administration Outpatient Clinics, Quintin Warner
Workforce Solutions For Primary Care Physician Shortages In Veterans Health Administration Outpatient Clinics, Quintin Warner
Walden Dissertations and Doctoral Studies
The shortage of primary care physicians (PCPs) in the Veterans Health Administration (VHA) hospital system highlights the need for strategies to effectively mitigate this issue. The purpose of this integrative review was to examine the literature on primary care physician shortages in VHA hospital-based outpatient clinics and determine evidence-based solutions. The review question centered on strategies and best practices that can be implemented to address PCP shortages in VHA outpatient clinics. The Donabedian Model provided the framework for analyzing structural factors, processes, and patient outcomes. A comprehensive review of the literature resulted in 40 articles being screened for quality and …
Probation Officers’ Experiences Supervising Domestic And Intimate Partner Violent Probationers, Megan Davis
Probation Officers’ Experiences Supervising Domestic And Intimate Partner Violent Probationers, Megan Davis
Walden Dissertations and Doctoral Studies
This study includes insights regarding potential supervision challenges that are faced by probation officers overseeing domestic and intimate partner violence (IPV) probationers, emphasizing the importance of effective management to enhance offender accountability and victim safety. The relationship dynamic between probation officers and domestic and IPV probationers influences recidivism rates, highlighting the importance of effective and empathetic supervision. The purpose of this study was to identify gaps in training, supervision strategies, and resources, with a focus on integrating attachment-based practices to improve outcomes. Guided by the attachment theory, the research included key questions about supervision effectiveness and relational dynamics. Employing a …
Effective Strategies Small Business Owners Use To Sustain Their Businesses During Periods Of Disruption, Tracey Starr Moon
Effective Strategies Small Business Owners Use To Sustain Their Businesses During Periods Of Disruption, Tracey Starr Moon
Walden Dissertations and Doctoral Studies
Small businesses experience significant challenges sustaining operations during periods of disruption, including economic uncertainty, natural disasters, supply chain interruptions, and other environmental changes. This is a concern for small business owners because disruptions can reduce revenue and strain limited financial and operational resources, putting their continued survival at risk. Grounded in the resilience theory, the purpose of this qualitative pragmatic inquiry project was to identify and explore effective strategies small business owners use to sustain their businesses during times of disruption. The participants were six small business owners in the southern United States. Data were collected through semistructured interviews and …
Strategies To Improve Communication Among Culturally Diverse International Manufacturing Teams, Bessem Enow Nchenge
Strategies To Improve Communication Among Culturally Diverse International Manufacturing Teams, Bessem Enow Nchenge
Walden Dissertations and Doctoral Studies
Inefficient communication and insufficient collaboration in multicultural organizations can result in suboptimal team performance and stifle employee creativity. Manufacturing firm leaders who struggle with communication issues are concerned about deterioration in team cohesion, worker productivity, and information flow. Grounded in the theory of planned behavior, this qualitative, pragmatic inquiry research project explored strategies that leaders of international manufacturing firms use to bridge cultural differences and improve communication among international team members to enhance team performance. The participants were six leaders from manufacturing firms in the southwestern United States with international manufacturing agreements who demonstrated measurable success in improving communication among …
Staff Education To Improve Skills In Detecting And Addressing Medication Nonadherence Among The Psychiatric Nursing Staff, Uchenna Owunna
Staff Education To Improve Skills In Detecting And Addressing Medication Nonadherence Among The Psychiatric Nursing Staff, Uchenna Owunna
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) project was a staff education project focused on addressing the knowledge gap of medication nonadherence patterns by the psychiatric nurses in outpatient settings. Nonadherence to psychiatric medications is a major health issue that leads to disruptions of care and symptom relapse, hospitalization, and suboptimal treatment outcomes as well as high healthcare costs. Thus, improving the capacity of the psychiatric nurses to enhance medication adherence through staff education is essential. The purpose of this DNP project was to determine if a comprehensive medication adherence education program would increase psychiatric nurses’ knowledge and skills in assessing …
Immigration Status And Lung Cancer Diagnosis In U.S. First-Generation Immigrants, Valeriya Lockwood
Immigration Status And Lung Cancer Diagnosis In U.S. First-Generation Immigrants, Valeriya Lockwood
Walden Dissertations and Doctoral Studies
The healthy immigrant effect (HIE) is an observed phenomenon in which immigrants exhibit better health outcomes than native-born residents, though relatively few studies have examined its role in chronic diseases in the United States. The purpose of this quantitative cross-sectional study was to assess the associations between immigration status, age, sex, race/ethnicity, median household income, and geographic location and lung cancer diagnosis in first-generation immigrant adults aged 18 or older. The subsequent health trajectory model provided the theoretical framework for the study. Data were obtained from the SEER*Stat Database 1975-2022 (N = 1,993). Binomial regression analysis showed that immigrants were …
Innovation And Control In Curriculum Reform: An Autobiographical Inquiry From A Seoul Future Innovation School, Sunyoung Kim
Innovation And Control In Curriculum Reform: An Autobiographical Inquiry From A Seoul Future Innovation School, Sunyoung Kim
Journal of Educational Research and Practice
This autobiographical inquiry examines the lived experience of a teacher–researcher navigating curriculum reform within a centralized education system during her first year at a Seoul Future Innovation School. The study explores how policy ideals of curriculum autonomy, innovation, and student-centered learning encounter institutional realities of documentation, compliance, and performative accountability. Drawing on reflective journals and narrative reconstruction, the analysis identifies four tensions shaping reform enactment: the gap between reform discourse and school culture, the symbolic labeling of innovation, technocentric expectations that narrow curricular legitimacy, and the emotional labor of navigating stakeholder demands. The study illustrates how institutional conditions both constrain …
From Reluctance To Resilience: The Link Between Attitude And Growth Mindset In Calculus Students, Olivia Valente, Kathryn E. Pedings-Behling, Amy N. Langville
From Reluctance To Resilience: The Link Between Attitude And Growth Mindset In Calculus Students, Olivia Valente, Kathryn E. Pedings-Behling, Amy N. Langville
Journal of Educational Research and Practice
Many postsecondary students enter general education mathematics courses with negative attitudes, shaping their willingness to engage with the content. This study explores the relationship between students’ attitudes towards mathematics and their growth mindset, revealing effective strategies to enhance learning experiences, particularly for students who are reluctant learners. The research investigates two questions: (1) How do students’ Attitude Toward Mathematics Inventory (ATMI) scores and Growth Mindset Scale (GMS) scores relate? and (2) Do gender or course modality affect this relationship? This study addresses a gap in literature by examining how enjoyment, motivation, self-confidence, and perceived value connect with growth mindset. The …
Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad
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 …
Emergency Nurses' Perceptions Of Interpersonal Empathy When Caring For Department Superusers, Makeba K. Cavette
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 …
Consistent Phq-9 Administration At Mental Health Watch Initiation And Discharge In A Correctional Setting, Gouni Aicha Bouraima
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, …
An Exploration Of Successful Cloud Database Migration Strategies Used By Small And Medium-Sized Enterprises Leaders In The United States, Ashli Jarrett
Walden Dissertations and Doctoral Studies
Cloud database migration can improve organizational performance in small and medium-sized enterprises (SMEs), but SME leaders are concerned about ineffective migration strategies, which can increase risks to data security, regulatory compliance, and operational continuity. Grounded in diffusion of innovation theory, the purpose of this qualitative pragmatic inquiry project was to explore the effective strategies SME leaders use to manage secure cloud database migrations, mitigate risks, enhance data security, ensure regulatory compliance, and improve organizational effectiveness. The participants were 10 SME leaders in the United States who had successfully adopted cloud-based database systems. Data were collected through semistructured interviews and publicly …
Staff Education To Improve Mindfulness Knowledge Among Rns, Nps, And Mas In A Behavioral Health Setting, Barbara Buxton
Staff Education To Improve Mindfulness Knowledge Among Rns, Nps, And Mas In A Behavioral Health Setting, Barbara Buxton
Walden Dissertations and Doctoral Studies
Burnout is a recurrent problem for healthcare workers and is associated with staff turnover, a decline in the quality of care, emotional fatigue, and risks to patient safety. This Doctor of Nursing Practice (DNP) staff education initiative created a mindfulness-based training program to expand the knowledge of registered nurses, nurse practitioners, and medical assistants on mindfulness practices in a behavioral health setting. Baseline assessment data identified a need for support to address emotional fatigue, absenteeism, and staff disengagement, with a mean pre‑education knowledge score of 66%. A structured, in‑person educational program addressing burnout awareness, stress reactivity, and helpful mindfulness methods …
Cultural Values, Norms, And Mental Health Service Utilization Among Young Adult Guyanese Immigrants, Rhonis Alfred
Cultural Values, Norms, And Mental Health Service Utilization Among Young Adult Guyanese Immigrants, Rhonis Alfred
Walden Dissertations and Doctoral Studies
Young adult Guyanese immigrants living in the United States often face cultural, familial, and social challenges that influence their perceptions of mental health and willingness to seek professional support. Despite growing attention to immigrant mental health, limited research has explored the experiences of this population. This qualitative study aimed to improve understanding of how cultural values, family dynamics, and acculturation stress influence mental health perceptions and help-seeking behaviors. The theoretical framework underpinning this study was acculturation theory. The research explored how participants navigated cultural identity, family expectations, and adaptation to life in the United States. A purposive sampling strategy was …
Phenomenological Exploration Of The Military Veterans' Experiences Transitioning Into Civilian Workplace In Central Florida, James Wesley Shelton
Phenomenological Exploration Of The Military Veterans' Experiences Transitioning Into Civilian Workplace In Central Florida, James Wesley Shelton
Walden Dissertations and Doctoral Studies
Military veterans transitioning from military service to civilian employment frequently encounter challenges related to workforce integration, translating military-acquired skills, adapting to civilian workplace cultures, and employer perceptions of their qualifications. Organizational leaders need to understand these challenges as a key indicator of the factors that influence successful workforce integration, organizational commitment, and employee retention. Grounded in person-environment fit theory, the purpose of this qualitative study using an interpretative phenomenological analysis (IPA) approach was to explore the lived experiences of military veterans and how they make meaning of their transition to the civilian workplace. The participants comprised seven U.S. military veterans …
Social Workers’ Lived Experiences Of Trauma-Informed Training, Ashley Ann Johnson
Social Workers’ Lived Experiences Of Trauma-Informed Training, Ashley Ann Johnson
Walden Dissertations and Doctoral Studies
Social workers report limited formal training in trauma-informed approaches, and implementation of trauma-informed care varies widely across settings, with inconsistent training uptake and organizational support for sustained practice change. The purpose of this qualitative phenomenological study was to explore the lived experiences of social workers in trauma-informed training. The study was guided by trauma-informed care principles and an experiential learning framework. The research question examined how social workers develop trauma-informed competence and how systemic factors influence practice. Data were collected through 11 semi structured interviews with social workers and analyzed using thematic analysis. Three key themes emerged: (a) trauma-informed competence …
A Mindfulness-Based Stop Technique Training To Improve Nurses’ Knowledge And Self-Efficacy In Stress And Burnout Prevention, Rukiat Abolanle Afinni
A Mindfulness-Based Stop Technique Training To Improve Nurses’ Knowledge And Self-Efficacy In Stress And Burnout Prevention, Rukiat Abolanle Afinni
Walden Dissertations and Doctoral Studies
Nurse burnout and stress are well-documented occupational concerns in outpatient clinical settings, where high patient acuity and chronic staffing shortages leave nurses with little structured support for proactive self-care. To address this gap, a mindfulness-based STOP (stop, take a breath, observe, proceed) training program was developed and evaluated for outpatient nurses. The evidence-based practice question was: Among nurses in an outpatient clinical setting, what is the impact of a mindfulness-based STOP technique training on nurses' knowledge of stress and burnout prevention and self-efficacy in applying the technique? A one-group pretest-posttest design was used with eight participants. A project-developed questionnaire measured …
How Psychological Capital Promotes Student Flourishing: Mediating Effects Of Career Adaptability And Study Engagement, Sana Nisar, Adnan Adil, Sultan Shujja, Samina Rashid
How Psychological Capital Promotes Student Flourishing: Mediating Effects Of Career Adaptability And Study Engagement, Sana Nisar, Adnan Adil, Sultan Shujja, Samina Rashid
Journal of Social, Behavioral, and Health Sciences
In today’s rapidly evolving academic and occupational landscape, understanding the psychological resources that support student well-being is critical. This study investigates the predictive role of academic psychological capital (PsyCap) in fostering flourishing among Pakistani university undergraduates, specifically identifying the mediating mechanisms of career adaptability and study engagement. Grounded in career construction theory and the JD-R model, the research contributes to theory by positioning PsyCap as a key personal resource that facilitates adaptive capacity and meaningful engagement. Data from 350 undergraduates in public-sector universities were analyzed using path analysis. Results revealed that PsyCap significantly predicted flourishing (β = .35, p …
Mental Health Professional Preparedness To Address Mental Health Stigma And Challenges In Military Populations, Scott Martin Katzka
Mental Health Professional Preparedness To Address Mental Health Stigma And Challenges In Military Populations, Scott Martin Katzka
Walden Dissertations and Doctoral Studies
Veterans and service members often delay or avoid engaging in mental health services because of stigma experienced during military service and after transitioning to civilian life, contributing to worsening mental health outcomes. Although mental health professionals (MHPs) with military cultural competence can reduce stigma and improve engagement in care, little is known about how newly trained MHPs perceive their preparedness to effectively serve this population. The purpose of this hermeneutic, phenomenological study was to answer the question of what the lived experiences of new MHPs regarding their preparedness were to support veterans and service members experiencing mental health stigma. Seven …
African American Mother Counselors' Lived Experiences During The Dual Pandemics Of Covid-19 And Structural Racism, Shanti Jones
African American Mother Counselors' Lived Experiences During The Dual Pandemics Of Covid-19 And Structural Racism, Shanti Jones
Walden Dissertations and Doctoral Studies
The problem addressed in this study was that the dual pandemics of COVID-19 and structural racism in 2020 created compounded personal and professional stressors for African American mothers who are professional counselors, yet little was known about how they appraised these stressors and selected coping strategies. The purpose of this hermeneutic phenomenological study was to describe what it means to be an African American mother and professional counselor making decisions about coping strategies to manage personal and professional stressors during the dual pandemics of COVID-19 and structural racism in 2020. Guided by Heideggerian hermeneutic phenomenology and informed by the Transactional …
Hiring Out-Of-Field Teachers In Urban Title I Schools In Georgia, Lakeshia Pruitt Dixon
Hiring Out-Of-Field Teachers In Urban Title I Schools In Georgia, Lakeshia Pruitt Dixon
Walden Dissertations and Doctoral Studies
Urban Title I schools commonly experience teacher shortages, prompting principals to hire teachers to teach content areas for which they are not certified. The problem addressed in this study was that 8% of the teachers within a large urban school district in Georgia were teaching out-of-field. Guided by Elmore’s conceptual framework of knowledge, skills, and dispositions, the purpose of this basic qualitative study was to explore the factors contributing to principals’ decisions to recommend hiring out-of-field teachers in urban Title I schools in Georgia and to examine the support available for those teachers to meet certification requirements. Semistructured interviews were …
Staff Education To Improve Geriatric Mental Health Screening And Pharmacotherapy, Andy Wu
Staff Education To Improve Geriatric Mental Health Screening And Pharmacotherapy, Andy Wu
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) quality improvement project addressed the lack of standardized workflows and clinical confidence regarding geriatric mental health screening and safe antidepressant initiation at a rural primary care clinic. Utilizing the FOCUS-PDSA framework, a 15-minute staff education module and a clinical pocket guide were implemented to train Medical Assistants (MAs) on integrating PHQ-9 and GAD-7 screenings during triage, and to equip providers with EHR SmartPhrases and 2023 AGS Beers Criteria prescribing guidelines. A pre- and post-intervention 5-point Likert scale survey evaluated the knowledge and clinical confidence of the clinic staff (n = 12). Results demonstrated a …