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Lived Experience Of Secondary School Teachers During The Covid-19 Pandemic, Diane R. Lovett
Lived Experience Of Secondary School Teachers During The Covid-19 Pandemic, Diane R. Lovett
Walden Dissertations and Doctoral Studies
The study emphasizes the need for a deeper understanding of secondary school teachers' experiences during the COVID-19 pandemic, particularly focusing on their challenges during the transition back to in-person instruction after teaching online. The purpose of this phenomenological study explored the experiences of U.S. secondary teachers during the onset of COVID-19, the shift to virtual teaching, and the return to in-person instruction. The study was grounded in Bandura’s (1986) social cognitive theory, specifically the concept of observational learning and self-efficacy, to understand how teachers learned from peer successes and challenges during the transition to virtual learning and when returning to …
Executive Summary On Prolonged Emergency Department Waiting Period, Peace Adaugo Ezirim
Executive Summary On Prolonged Emergency Department Waiting Period, Peace Adaugo Ezirim
Walden Dissertations and Doctoral Studies
Emergency departments (EDs) are essential access points to healthcare for patients with urgent and emergent conditions. Yet, many EDs face persistent challenges, including overcrowding, prolonged wait times, and delays in care. These challenges can significantly affect patient safety, quality of care, and overall healthcare outcomes. Patients presenting with symptoms, such as cardiac, pulmonary, or abdominal discomfort, may initially appear clinically stable, but their conditions can deteriorate rapidly while awaiting evaluation by a provider. Without structured reassessment processes and efficient communication systems, early warning signs of clinical decline may be missed. ED crowding has become a widespread operational and patient safety …
Staff Education On Evidence-Based Weight Management Strategies For Adults With Mental Health Disorders And Type Ii Diabetes Mellitus, Abimbola Oluwafunmilayo Somoye
Staff Education On Evidence-Based Weight Management Strategies For Adults With Mental Health Disorders And Type Ii Diabetes Mellitus, Abimbola Oluwafunmilayo Somoye
Walden Dissertations and Doctoral Studies
Summary The type of project is a staff education project, specifically on evidence-based weight loss strategies that the facility can use to manage adults with type 2 diabetes mellitus (T2DM) and co-morbid mental health disorder(s). The evidence-based practice (EBP) question is: Does educating staff on weight loss strategies for T2DM with mental health disorder(s) improve staff knowledge and confidence within one month of staff education program implementation? The facility’s staff managed these patients using standardized diabetes management practices and have no formal staff education program that focuses on evidence-based weight loss strategies for this population. The staff has a vast …
The Impact Of Sexual Harassment Policy Strictness And Supervisory Support On Reporting Behavior In Local, County, And State Female Law Enforcement Officers In Northeastern Kansas, Cleora Maxine Tousey
The Impact Of Sexual Harassment Policy Strictness And Supervisory Support On Reporting Behavior In Local, County, And State Female Law Enforcement Officers In Northeastern Kansas, Cleora Maxine Tousey
Walden Dissertations and Doctoral Studies
This quantitative study examined the impact of stricter sexual harassment policies with protections against retaliation and stronger supervisory support on the likelihood that female law enforcement officers would report incidents of sexual harassment by male colleagues. The problem addressed was the underreporting of sexual harassment in policing, a critical issue given the negative impact on victims and workplace culture. Connell’s theory of masculinity served as the theoretical framework, indicating how traditional power dynamics may negatively influence the likelihood of reporting. Using a correlational design, this study surveyed municipal, county, and state female officers in Northeastern Kansas to measure their perceptions …
Staff Education To Increase Knowledge And Shape Attitudes Among Staff To Improve Control Of Hypertension In Primary Care, Doris Marie Mosby-Peterson
Staff Education To Increase Knowledge And Shape Attitudes Among Staff To Improve Control Of Hypertension In Primary Care, Doris Marie Mosby-Peterson
Walden Dissertations and Doctoral Studies
This doctoral project was an evidence-based staff education intervention designed to improve healthcare team knowledge, attitudes, and clinical practices related to the management of uncontrolled hypertension within a federally qualified health center (FQHC). The practice problem addressed was the persistent challenge of uncontrolled hypertension among patients receiving primary care services, which contributes to increased risk for cardiovascular disease, stroke, and preventable health disparities. Thus, the practice-focused question that guided the project asked whether a multidisciplinary staff education program at a rural FQHC improve healthcare staff’s knowledge, skills, attitudes, and workflow related to the management of uncontrolled hypertension? Findings demonstrated statistically …
The Relative Strength Of Justice-Related Satisfaction, Posttraumatic Maladaptive Beliefs, And Self-Compassion In Predicting Perceived Control Over Stressful Events, Katherine Mooney
Walden Dissertations and Doctoral Studies
Coercive control and domestic violence perpetrated by men against women are global social problems sustained by patriarchal norms that normalize gender-based violence. These norms often contribute to victims' maladaptive self-beliefs, leading women to believe they provoked the abuse. When survivors seek legal protection, they may experience revictimization through legal processes that minimize their claims and enable perpetrators to continue exerting power and control through the justice system. As a result, dissatisfaction with the legal system may reinforce self-blame, while low self-compassion may further undermine women's perceived control over stressful events in both the short and long term. While previous research …
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, …
Effective Leadership Strategies For Sustaining Radiology Departments During And After The Covid-19 Pandemic, Tameron Shanay Reed
Effective Leadership Strategies For Sustaining Radiology Departments During And After The Covid-19 Pandemic, Tameron Shanay Reed
Walden Dissertations and Doctoral Studies
Pandemic-driven workforce challenges highlighted the urgent need for radiology leaders to retain skilled staff and sustain service delivery. The COVID-19 pandemic raised considerable concerns for radiology leaders regarding future preparedness for patient safety, care outcomes, hospital expenses, and hospital profitability. Grounded in the Vroom expectancy theory, the purpose of this qualitative pragmatic inquiry was to explore successful strategies radiology department leaders used to retain employees, improve supply inventory management, and develop ambulatory and virtual services during and after the COVID-19 pandemic. Data were gathered through semistructured interviews with six successful radiology leaders and publicly accessible documents in northern Louisiana. The …
A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans
A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans
Walden Dissertations and Doctoral Studies
This doctor of nursing practice (DNP) executive leadership project is a practice-focused quality improvement initiative to reduce avoidable 30-day hospital readmissions in a skilled nursing facility by implementing the INTERACT communication tools, SBAR and STOP & WATCH. The practice problem is the lack of a standardized communication process for recognizing changes in resident conditions, contributing to preventable hospitalizations. The project's purpose was to develop an evidence-based communication process that promotes early recognition and timely provider intervention. The practice-focused question asked whether implementing INTERACT communication tools would improve communication and reduce avoidable acute care transfers. A focused literature search was conducted. …
Improving Chronic Disease Monitoring In Patients With Diabetes And Hypertension Through Guideline-Adherent Care, Olukemi Ogunmakinwa
Improving Chronic Disease Monitoring In Patients With Diabetes And Hypertension Through Guideline-Adherent Care, Olukemi Ogunmakinwa
Walden Dissertations and Doctoral Studies
Evidence-based chronic disease monitoring is essential for improving outcomes among adults with diabetes and hypertension; however, inconsistent application of clinical practice guidelines may result from gaps in healthcare providers' knowledge, confidence, and competency. Staff education is an effective strategy for strengthening evidence-based practice and promoting consistent guideline implementation. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to develop, implement, and evaluate a structured educational program to improve healthcare providers' understanding, knowledge, confidence, self-efficacy, and competency in applying evidence-based chronic disease monitoring guidelines in a primary care clinic. Methods: The educational intervention was developed using …
How Texas Early Childhood Teachers Collaborate To Support Students With Disabilities, Anna Weathers
How Texas Early Childhood Teachers Collaborate To Support Students With Disabilities, Anna Weathers
Walden Dissertations and Doctoral Studies
The problem addressed in this study was it was not known how Texas early childhood special education (EGSE) teachers and early childhood general education (ECGE) teachers use collaboration to identify, place, and support students with disabilities (SWDs). Framed by Colby’s collaboration theory, the purpose of this basic qualitative study was to explore the experiences of Texas ECSE and ECGE teachers when collaborating regarding identification, placement, and support for SWDs. Data were collected in semstructured interviews with 11 ECSE and 11 ECGE teachers who taught in Texas early childhood settings. Data were analyzed using thematic analysis with open coding, leading to …
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 …
Sidama Women's Perceptions Of Female Genital Mutilation/Cutting And Marital Fidelity, Mekonnen Doyamo
Sidama Women's Perceptions Of Female Genital Mutilation/Cutting And Marital Fidelity, Mekonnen Doyamo
Walden Dissertations and Doctoral Studies
Female Genital Mutilation/Cutting (FGM/C) affects women from the Sidama region of Ethiopia differently from women in other parts of Ethiopia, which results in different physical and psychological consequences. The purpose of this qualitative case study was to explore why the Sidama people’s FGM/C custom differs from that of other parts of Ethiopia. A case study methodology was used to answer the following research question: How does the practice of FGM/C among the Sidama people in Ethiopia differ from that in other regions regarding its cultural significance and rituals? Moreover, how do community attitudes and beliefs surrounding FGM/C among the Sidama …
Implementation Of A Fall-Prevention Clinical Practice Guideline In A Neurological Rehabilitation Center, Ron L. Adolph
Implementation Of A Fall-Prevention Clinical Practice Guideline In A Neurological Rehabilitation Center, Ron L. Adolph
Walden Dissertations and Doctoral Studies
This executive summary presents the final plan for implementation of an evidence-based fall-prevention clinical practice guideline on an open neurological rehabilitation unit. It does not propose a new device, a new electronic platform, or a separate education-only initiative. The practice change is the implementation and evaluation of a structured interdisciplinary clinical practice guideline designed to reduce inpatient falls and improve the reliability of daily prevention practices. The unit reports a baseline fall rate of 6.3 falls per 1,000 patient days. Thirty-five staff members from nursing, therapy, and support roles completed the survey, and 57% reported that patients had experienced falls …
English As A Second Language Students’ Perceptions On Their Reasons To Persist In An Adult Learning Program In Connecticut, Laurie Anne Winek
English As A Second Language Students’ Perceptions On Their Reasons To Persist In An Adult Learning Program In Connecticut, Laurie Anne Winek
Walden Dissertations and Doctoral Studies
The problem that was addressed through this study is that 30% of the English as a second language (ESL) students drop out of classes after the first 2 weeks in an adult education program in Connecticut. Grounded in Tinto’s model of student departure, the purpose of this study was to explore ESL students’ perceptions on reasons they persisted in an adult education program in Connecticut. For this basic qualitative design, semistructured interviews were conducted with five students. The data analysis procedures used open coding and categories, with eight themes emerging: ESL students persisted when their instructors cultivated lifelong learning; included …
Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould
Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice (DNP) project evaluated the impact of a structured staff educational intervention on ambulatory surgery center (ASC) staff knowledge of Universal Protocol and SOAP (Surgeon, Operating Room, Anesthesia, and Preprocedure Ready) documentation. A practice gap was identified in staff knowledge of perioperative safety processes that are essential for preventing surgical safety events. The purpose of this doctoral project was to improve ASC staff knowledge of Universal Protocol and SOAP readiness documentation through an evidence-based educational intervention designed to strengthen perioperative safety practices. The practice-focused question was: According to the evidence, in multi-specialty ASC staff, what is …
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. …
Training Strategies For Employees To Use Electronic Human Resource Management Systems, Anita Wright
Training Strategies For Employees To Use Electronic Human Resource Management Systems, Anita Wright
Walden Dissertations and Doctoral Studies
Ineffective electronic human resource management (e-HRM) training can weaken HR employees’ ability to use digital human resource (HR) systems that support HR operations, employee services, and workplace efficiency. HR managers in small to medium-sized enterprises (SMEs) recognize that poor e-HRM training undermines employees’ confidence, consistency, and accuracy in HR tasks. Grounded in the technology acceptance model (TAM), the purpose of this qualitative pragmatic inquiry project was to identify and explore the effective strategies some SME HR managers use to train HR employees to use e-HRM systems. The participants were eight SME HR managers in the southeastern United States with experience …
Reducing Urinary Tract Infections In Long-Term Care Residents, Felicity Antwi
Reducing Urinary Tract Infections In Long-Term Care Residents, Felicity Antwi
Walden Dissertations and Doctoral Studies
This quality improvement (QI) project addressed delays in diagnosing urinary tract infections (UTIs) at a skilled nursing facility (SNF), where reliance on urine culture testing and patient monitoring resulted in an average diagnostic period of 72 hours. A high UTI incidence and UTI-involved hospitalization rate are both nurse-sensitive indicators that are important to address in the nursing practice context because they portend negatively for nursing quality and safety. This quality improvement (QI) project addressed the practice-focused question: among long term care (LTC) residents with suspected UTIs in a nursing home (NH), how does reducing the diagnostic period from 72 hours …
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 …
A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira
A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira
Walden Dissertations and Doctoral Studies
This Doctor of Nursing Practice project focuses on modernizing an acute care hospital’s surgical suite, enhancing environmental safety, and supporting the growing complexity of surgical care. As surgical procedures become more advanced, the physical environment must evolve to maintain sterile technique and reduce microbial presence. Current operating room configuration, characterized by overcrowding and outdated ventilation systems, introduces environmental risks that compromise patient safety and limit perioperative efficiency. Modernization is essential to align the surgical environment with contemporary safety expectations and organizational performance goals. The proposed initiative includes a comprehensive renovation and expansion of surgical spaces, integrating advanced air decontamination technologies, …
Improving Adolescent Antidepressant Medication Adherence In An Outpatient Psychiatric Clinic Through Teach-Back And Motivational Interviewing, Sandra Ajao
Walden Dissertations and Doctoral Studies
Antidepressant medication adherence among adolescents is a significant concern in outpatient psychiatric care. Adolescents may miss doses because of stigma, forgetfulness, side effects, limited understanding of medication instructions, or inconsistent caregiver support. The purpose of this Doctor of Nursing Practice project was to improve antidepressant medication adherence and adherence-focused communication among adolescents in an outpatient psychiatric clinic through staff education on teach-back and motivational interviewing. The practice-focused question examined how teach-back combined with motivational interviewing, compared with usual care, affected medication adherence and depressive symptoms during the implementation period. Staff education included use of a previsit questionnaire, structured visit script, …
Staff Education To Improve Whiteboard Utilization To Focus On Nurse Communication And Patient Experience On A Medical-Surgical Unit, Charline J. Bethea
Staff Education To Improve Whiteboard Utilization To Focus On Nurse Communication And Patient Experience On A Medical-Surgical Unit, Charline J. Bethea
Walden Dissertations and Doctoral Studies
Inconsistent use of standardized whiteboards in patient rooms may contribute to ineffective nurse communication and lower patient experience scores. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether an evidence-based staff education program improved nursing knowledge, intent to use standardized whiteboards, and whiteboard utilization on a medical-surgical unit. Guided by the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design model, the intervention included a standardized educational presentation, pre- and post-education knowledge assessments, a workflow integration guide, competency validation, and weekly compliance audits. Thirty-five staff members, including registered nurses and patient care technicians, participated in the project. Following …
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 …
Early Childhood Teachers’ Perceptions Of Early Childhood Teacher Leadership, Their Leadership Experiences, And Teacher Leadership Skill Development, Danyle Watkins
Walden Dissertations and Doctoral Studies
The problem that was addressed in this study is that research into early childhood leadership has focused on early childhood directors and programs for leadership, but little research has been conducted on early childhood teachers’ (ECTs’) perceptions of the ECT leadership. Guided by the McCormick Center Whole Leadership Framework, the purpose of this basic qualitative study was to explore ECTs’ perceptions on characteristics of teachers as leaders, their leadership experiences, and their leadership skill development in a Midwestern U.S. state. Data were collected through semistructured interviews with 10 ECTs employed in licensed early childhood centers serving children from birth through …
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 …
The Relationship Between Employees’ Involvement, Process Improvement, And Customer Satisfaction In Manufacturing Industries, Nawres Fouad
The Relationship Between Employees’ Involvement, Process Improvement, And Customer Satisfaction In Manufacturing Industries, Nawres Fouad
Walden Dissertations and Doctoral Studies
Customer satisfaction remains a challenge for some manufacturing organizations despite the widespread implementation of TQM practices. Manufacturing leaders must improve customer satisfaction because it enhances customer retention, organizational competitiveness, and long-term business performance. The purpose of this quantitative correlational study was to examine the relationships between employees' involvement, process improvement, and customer satisfaction. The expectancy-disconfirmation theory grounded the research project. Participants were 68 middle managers employed in manufacturing organizations in Ontario, Canada. Data were collected through an anonymous online survey using the Utrecht Work Engagement Scale (UWES-9) and the TQM Practices Scale. The data were analyzed using descriptive statistics, Cronbach’s …
Staff Education To Improve Depression Screening And Management Using Phq-9, Elizabeth Aja
Staff Education To Improve Depression Screening And Management Using Phq-9, Elizabeth Aja
Walden Dissertations and Doctoral Studies
This doctoral project was a staff education initiative. It was motivated by the realization that depression is often under-recognized when standardized screening practices are not consistently implemented. The identified practice gap was inconsistent administration, interpretation, and documentation of the PHQ-9 by the nursing staff. The practice-focused question examined whether a staff education intervention would improve nurses’ knowledge and confidence in using the PHQ-9 for depression screening. The purpose of the project was to implement and evaluate an evidence-based educational program on PHQ-9 administration, scoring, interpretation, and documentation. Data analysis included descriptive statistics on pretest and posttest scores from 14 participating …
Predictive Analytics For Nurse Staffing Optimization And Patient Outcomes, Rhonda Lynn Fisher
Predictive Analytics For Nurse Staffing Optimization And Patient Outcomes, Rhonda Lynn Fisher
Walden Dissertations and Doctoral Studies
This evidence-based quality improvement project assessed the use of a Predictive Analytics Staffing Decision-Support Tool (PASDST) to enhance nurse staffing alignment, workforce planning, and patient outcomes in an acute care setting. Traditional staffing relied mainly on historical census data and fixed nurse-to-patient ratios, with limited real-time information on admissions, discharges, census, and patient acuity. Guided by the Johns Hopkins Evidence-Based Practice Model, a 12-week pilot of PASDST was conducted on one acute care unit. Baseline data from 30 stakeholders—five nurse managers and 25 bedside nurses—were collected. Quantitative responses were analyzed via frequencies and percentages, while open-ended responses underwent thematic analysis. …
Improving Suicide Risk Identification Through Standardized Implementation Of The Columbia–Suicide Severity Rating Scale (C-Ssrs) In An Adult Outpatient Behavioral Health Setting, Mirabel Ngwe Boma
Walden Dissertations and Doctoral Studies
Suicide risk may fluctuate throughout treatment, making ongoing assessment essential for timely identification and intervention. At the project site, an adult outpatient behavioral health practice, the Columbia–Suicide Severity Rating Scale (C-SSRS) was administered consistently at intake but inconsistently at follow-up visits, creating gaps in suicide risk reassessment and documentation. The purpose of this quality improvement project was to evaluate the effect of standardized implementation of the C-SSRS during intake and follow-up visits on suicide risk screening compliance over a 9-week period. The practice-focused question asked how standardized implementation of the C-SSRS, compared with current practice, affected suicide risk screening compliance …