Digital Commons Network^™

Implementation Of A Cognitive Aide To Guide The Use Of Non-Invasive Hemodynamic Monitoring For Goal-Directed Fluid Therapy During Cesarean Deliveries, Ashley George, Ashley Walbert

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, with delayed recognition contributing to adverse outcomes during cesarean delivery. In cesarean deliveries, traditional intermittent non-invasive blood pressure monitoring may not detect early hemodynamic instability, creating a need for more structured interpretation of continuous hemodynamic data. This Doctor of Nurse Anesthesia Practice quality improvement project implemented a cognitive aid to support anesthesia providers using the Edwards EV1000/ClearSight platform during goal-directed fluid therapy. A pre–post implementation design using provider surveys evaluated feasibility, usability, confidence, and perceived impact. By organizing continuous values such as stroke volume, cardiac output, and systemic …

A Staff Nurse-Led Clinical Instructional Competency Program To Improve Clinical Judgement In Undergraduate Nursing Students: A Quality Improvement Initiative, Shana Skeffrey

Doctor of Nursing Practice (DNP) Manuscripts

There is increasing concern that new graduate nurses are leaving bedside roles early in favor of less stressful positions due to rising patient acuity and heightened organizational expectations, increasing the effects of the nursing shortage (McClosky et al., 2022; AACN, 2024). A standardized clinical experience, combined with fair and consistent access to skill application in the hospital setting can support a collaborative approach for undergraduate nursing students. This quality improvement project is aimed to implement a Staff Nurse-Led Clinical Instructional Competency Program that will provide a structured opportunity for clinical instructors to help fill the gap in preparing undergraduate nurses …

Feasibility And Acceptability Of A Home-Health Aide-Delivered Loneliness Reduction Program In A Small Home Care Agency: The Caring Connections Quality Improvement Project, Tontalayia L. Robinson

Doctor of Nursing Practice (DNP) Manuscripts

Loneliness is a significant public health concern that adversely affects mental, cognitive, and physical health, with consequences comparable to smoking 15 cigarettes per day. Home care recipients experience loneliness at rates of 15.9% to 24.2%, yet home-health aides (HHAs), who often have the most consistent contact with homebound clients, lack structured tools for recognizing and responding to loneliness. This gap highlights the need for practical, evidence-based strategies that can be integrated into routine home care practice. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate the feasibility, acceptability, and appropriateness of a home-health aide–delivered loneliness …

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

Improving Chlamydia Testing For Females Through Universal Screening In Outpatient Pediatric Primary Care: An Adolescent Quality Improvement Initiative, Christina Howard

Doctor of Nursing Practice (DNP) Manuscripts

Chlamydia is the most common sexually transmitted infection in the United States in adolescents and young adults (Dutra & Lazenby, 2023). Per Smith, Reirden, and Nyquist (2022), adolescents and young adults between the ages of 15 and 24 account for more than 60% of new chlamydia infections each year. Testing for chlamydia is not standardized, and it is estimated that only 50% of those who qualify receive a yearly screening American Sexual Health Association. (2021). If outpatient testing and treatment is not improved these asymptomatic cases will be missed, infections in general will increase, and reinfections may occur leading to …

Enhancing New Graduate Nurse Confidence And Patient Safety Through Clinical Development Coach Integration, Megan T. Kramer

Doctor of Nursing Practice (DNP) Manuscripts

The transition from student to professional nurse is a critical developmental stage often marked by heightened stress, emotional exhaustion, and uncertainty in clinical judgment. These challenges frequently contribute to lower confidence levels, increased anxiety, and higher risks for patient safety events among new graduate nurses. This program evaluation project aims to assess the effectiveness of integrating a Clinical Development Coach (CDC) role to enhance new graduate nurse’s confidence, comfort, and overall competence while reducing patient safety incidents on a trauma/surgical inpatient unit in a medical center on the East coast. The CDC role is a structured mentorship and resource position, …

Implementation Of A Deteriorating Patient Simulation For New Graduate Nurses To Improve Clinical Judgment: A Quality Improvement Project, Kasey Mundell

Doctor of Nursing Practice (DNP) Manuscripts

New graduate nurses (NGNs) often have trouble recognizing and responding to patient deterioration because of limited clinical judgment and confidence during the transition to practice. This quality improvement project evaluated the implementation of a high-fidelity deteriorating patient simulation within a new graduate nurse orientation program at a Level I trauma center. Guided by the Plan-Do-Study-Act framework and the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice, the simulation focused on the assessment and management of a patient experiencing pulmonary embolism. Eight NGNs participated in the simulation and completed the Attitudes Toward Recognizing Early and Noticeable …

Evaluating The Implementation And Progress Of A Bereavement Care Program In An Acute Care Adult Hospital, Nancy Abraham

Doctor of Nursing Practice (DNP) Manuscripts

Bereavement care is a significant component of patient and family centered care; however, it remains inconsistently addressed in acute adult hospital settings. Families of patients who die in hospitals frequently experience grief, anxiety, and emotional distress, which may be exacerbated by fragmented or inadequate bereavement support (Kustanti et al., 2021). Evidence supports the use of structured, interdisciplinary approaches to bereavement care to ensure timely, consistent, and compassionate support for families. To address this gap, a Bereavement Committee was established at a Level I trauma center in eastern Pennsylvania to implement a standardized Bereavement Care Program aimed at improving bereavement practices …

From Novice To Competent: Enhancing Orientation And Readiness For Post-Anesthesia Care Nurses, Gerri Y. Young

Doctor of Nursing Practice (DNP) Manuscripts

Post-anesthesia care unit (PACU) nurses are responsible for managing complex postoperative patients requiring advanced clinical judgment, airway management, hemodynamic monitoring, and rapid recognition of complications. Many nurses transition into the PACU without formal perianesthesia education, resulting in variability in orientation practices, competency validation, and preparedness for independent practice. At a military treatment facility (MTF) in Mississippi, 78% of newly assigned PACU nurses had only one to two years of medical-surgical experience, and a standardized orientation program was not available.

This quality improvement project aimed to implement and evaluate a standardized, evidence-based PACU orientation program designed to improve nurse knowledge, confidence, …

Sing Lustily And With Good Courage: Reinventing Methodist Hymns In The Context Of The Indonesian Methodist Church, Budi Taniwan

Doctor of Pastoral Music Projects and Theses

The majority of Methodist churches continue to uphold the legacy of hymn singing, a practice highly esteemed by early Methodists. John and Charles Wesley employed hymns alongside sermons as a means of teaching Methodist theology, shaping Christian discipleship, and forming Methodist identity. However, in contemporary times, Indonesian Methodist churches recite fewer doctrinal hymns. Inadequate early translations, the absence of authentically Indonesian Methodist hymns, and the emergence of contemporary Christian music have contributed to this decline. Changes in liturgy, worship culture, and technology have also transformed the way congregations learn and sing their faith. This study explores the historical and theological …

Fast Mr Imaging: Reducing Sedation And Improving Patient Experience, Hajir Aljumaily

Radiologic Sciences

Purpose To examine the impact of fast magnetic resonance (MR) protocols on sedation requirements, patient tolerance, workflow efficiency, and diagnostic accuracy in musculoskeletal and brain imaging.

Method An integrative literature review was conducted using PubMed, CINAHL, and Google Scholar to identify peer-reviewed, original research articles published between 2019 and 2026. Studies were selected for relevance, human subjects, and outcomes related to sedation, patient experience, or diagnostic effectiveness.

Results Fast MR protocols were consistently associated with reduced sedation use, improved patient comfort, and increased exam completion rates. Workflow efficiency improved due to shorter scan times. Although minor reductions in image quality …

Ai Integration In Radiotherapy Workflows: Emerging Trends And Best Practices, Vi T. Dinh

Radiologic Sciences

Purpose To synthesize current evidence on artificial intelligence (AI) integration in radiotherapy workflows, identify emerging application trends, and examine best practices for clinical implementation.

Method A structured literature review was conducted using PubMed, Scopus, and Google Scholar to identify peer-reviewed studies published between 2015 and 2025. Eligible studies evaluated AI applications in radiotherapy workflows, including segmentation, treatment planning, and clinical decision-making. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) AI-based segmentation improved contouring efficiency and reduced interobserver variability; (b) AI-assisted treatment planning enhanced dose prediction consistency and workflow reproducibility; and (c) workflow integration supported clinical decision-making …

Disengagement And Reconnection: Investigating The Role Of Purpose And Identity Seeking Across Career Stages In Healthcare, Charmel Renee Jeffery

Radiologic Sciences

Purpose To examine the generational purpose gap in healthcare by identifying the psychological and environmental factors underlying early-career disengagement and late-career reconnection.

Method An integrative literature review was conducted using four academic databases. An artificial intelligence (AI)-assisted thematic synthesis was applied to extract and organize findings within a standardized analytic matrix. To ensure accuracy and rigor, all AI-generated outputs were validated against the original source data.

Results Two primary themes emerged. Early-career healthcare workers commonly experienced disengagement associated with destiny beliefs, while later-career professionals demonstrated renewed purpose and resilience despite ongoing stressors.

Discussion The findings revealed a pronounced generational divide …

Ai-Driven Multi-Modal Mr For Precision Oncology, Maneet K. Marwaha

Radiologic Sciences

Purpose To examine the role of artificial intelligence (AI) in multiparametric magnetic resonance (MR) imaging for precision oncology, with a focus on automated tumor segmentation, treatment response prediction, and workflow efficiency.

Method A literature review was conducted to examine current evidence on AI applications in multiparametric MR imaging for oncology. Studies evaluating deep learning models for tumor segmentation, longitudinal imaging analysis, and treatment response prediction were synthesized using a thematic analysis approach.

Results Three primary themes emerged: (a) AI-driven tumor segmentation improved accuracy, reproducibility, and efficiency across multiparametric MR sequences; (b) deep learning models enhanced prediction of treatment response through …

Mr-Linac Technology, Katherine Orellana

Radiologic Sciences

Purpose To examine the clinical advantages of magnetic resonance-guided linear accelerator (MR-Linac) technology in radiation therapy, with a focus on treatment accuracy, adaptive planning, and patient outcomes.

Method A literature review was conducted using peer-reviewed articles identified through The University of Texas MD Anderson Cancer Center Research Medical Library. Studies published between 2022 and 2026 were included if they addressed the clinical advantages of MR-Linac technology. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) superior soft-tissue visualization improved tumor delineation and treatment accuracy; (b) daily adaptive treatment planning and real-time tumor tracking enhanced precision by accounting …

Impact Of Music On Patient Comfort During Mr Scans: A Literature Review, He Yan

Radiologic Sciences

Purpose To investigate the influence of auditory stimuli on patient comfort levels during magnetic resonance (MR) imaging, with particular emphasis on indicators of distress, duration of patient positioning, and utilization of emergency signaling devices.

Method An integrative literature review was undertaken utilizing peer-reviewed research articles sourced from journals within the fields of radiology, music therapy, and clinical practice. A comprehensive search was conducted across databases such as PubMed, ScienceDirect, SpringerLink, and Oxford Academic employing keywords including MR anxiety, music therapy, and patient comfort.

Results The body of literature consistently indicated that auditory stimuli significantly mitigate patient anxiety and distress in …

Quality Improvement Project From Novice-To-Expert: Training Nurse Faculty On Virtual Simulation, Dae'visha Kinniebrew

Doctor of Nursing Practice Projects

Virtual simulation is an evidence-based teaching strategy that enhances student learning; however, inconsistent faculty preparation limits its implementation in nursing education. A needs assessment identified a practice gap, with 70% of nursing faculty reporting no virtual simulation training within the previous 12 months. The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI) project was to evaluate the effectiveness of a structured non-immersive virtual simulation training program on nursing faculty confidence, perceived competence, and technology readiness in an Associate Degree Nursing (ADN) program. The aim was to improve faculty preparedness to implement non-immersive virtual simulation. A quantitative, quasi-experimental, …

The Impact Of A Structured Education Program On Artificial Intelligence Use For Nursing Faculty On Teaching Practices, Katy White

Doctor of Nursing Practice Projects

Artificial intelligence (AI) is increasingly integrated into nursing education; however, nursing faculty report inconsistent preparedness, including gaps in AI knowledge and self-efficacy for responsible AI integration. This quality improvement project addressed inconsistent faculty preparedness through an asynchronous AI educational program. The purpose was to address gaps in AI knowledge and self-efficacy, and the aim was to evaluate changes in AI self-efficacy and AI knowledge while supporting AI integration into nursing education. Rogers' Diffusion of Innovations Theory served as the change theory, the Technology Acceptance Model served as the theoretical framework, and the Plan-Do-Study-Act framework guided implementation. A quantitative one-group pretest-posttest …

Online Parent Group Intervention For Executive Function Skills For Autistic Children And Adolescents, Kathleen Clark

Theses and Dissertations

Executive functioning (EF) skills deficits are prevalent among children and adolescents with autism spectrum disorder (autism) that impacts their academic functioning, social relationships, and families' quality of life. This study aimed to explore an online parent group intervention, to test effectiveness of a 6-week parenting intervention on parenting stress and child's executive functioning (EF) among autism families in rural Utah with limited access to traditional intervention resources. The participants were eight parents from six families of children and adolescents (8-15 years) with clinical diagnosis of autism spectrum disorder and appropriate language abilities for their age. The parents participated in weekly …

Enhancing Cancer Diagnosis And Treatment Planning Through Multi-Modal Imaging Techniques: A Literature Review, Ngan Kim Le

Radiologic Sciences

Purpose To examine how combining magnetic resonance (MR), computed tomography (CT), and positron emission tomography (PET) enhances clinical outcomes in complex or metastatic cancers, focusing on diagnostic performance, staging accuracy, and effects on treatment decisions.

Method Data were extracted and analyzed using a thematic synthesis approach for this literature review. Key variables included study design, sample size, cancer type, imaging modalities used, and reported diagnostic outcomes such as sensitivity, specificity, and accuracy.

Results The integration of multiple imaging modalities enhanced diagnostic performance, improved differentiation between tumor recurrence and posttreatment changes, and increased detection of occult metastatic disease. Advanced imaging approaches, …

"Help Me Live It The Way You Do": Grounding Singaporean Responses To The Rorschach Situation, Casey Y. Lee

Electronic Theses and Dissertations

Contemporary research on the Rorschach and culture is striking for the latter’s disappearance as a variable of significance (Meyer et al., 2015; Meyer et al., 2007; Mihura et al., 2013; Viglione & Hilsenroth, 2001). This erasure is chronicled and reproduced in the narratives of universal objectivity, of extensive international meta-analyses, of replications, of standardized norms (Ritzler, 2004; Smith et al., 2018; Smith et al., 2020; Weiner, 2004). A different story emerges, however, when we ask, how has culture disappeared? The proposed study is a multimethod qualitative analysis of Singaporean responses to the Rorschach, aimed at generating sensitive yet critical discourses …

Bridging The Gap: Documenting The Effectiveness Of Counseling Education In A Speech-Language Pathology Graduate Program, Gianna Baker

Electronic Theses and Dissertations

This study aimed to examine the impact of a required counseling course through Duquesne University's Speech-Language Pathology program, particularly regarding student’s counseling self-efficacy and their ability to apply counseling skills within clinical practice. Nineteen first year Master’s students in Speech-Language Pathology at Duquesne University during 2025 participated in this study while enrolled in a counseling course and providing therapy to clients. Students completed the Counselor Activity Self-Efficacy Scales for SLPs (CASES) (Victorino & Hinkle, 2019) prior to beginning and after completion of the required counseling course. While observing video-recorded therapy sessions, the Counselor Competencies Scale-Revised (CCS-R) (Lambie & Swank, 2024) …

Ai-Enhanced Ct Reconstruction: Effects On Image Quality Across Dose Levels And Implications For Radiation Dose Optimization: A Systematic Review, Matthew R. Alberto

Radiologic Sciences

Purpose To evaluate how deep learning image reconstruction (DLIR) affects diagnostic image quality and noise characteristics at different radiation dose levels and how it influences dose optimization compared with conventional reconstruction methods.

Method A systematic review was conducted using major databases for studies published between 2020 and 2026. Eligible studies assessed DLIR across multiple dose levels, reported radiation dose, included quantitative image quality metrics, and compared DLIR with filtered back projection or iterative reconstruction.

Results Thirty‑seven studies met criteria, and 15 were synthesized. Three themes emerged: (a) DLIR reduced noise by 15–82% and often improved signal-to-noise and contrast-to-noise ratios while …

Reducing Mr Acquisition Times Using Artificial Intelligence: A Systematic Review, Fatin M. Arief

Radiologic Sciences

Purpose To synthesize existing evidence on artificial intelligence (AI) applications for reducing magnetic resonance (MR) imaging acquisition time, evaluate their impact on image quality, and identify challenges in clinical implementation.

Method A systematic literature review was conducted using PubMed, CINAHL, and Scopus including peer reviewed, English-language articles published between 2020 and 2026. Both qualitative and quantitative primary research were eligible and had to be on AI use in MR processes. Findings were analyzed through thematic synthesis, and the quality of each study was appraised using relevant critical appraisal tools.

Results Three major themes emerged: AI methods in MR procedures, perceived …

Impact Of Mr-Linac Technology On Prostate Cancer Treatment Outcomes, Anhdiep P. Tran

Radiologic Sciences

Purpose To evaluate the impact of magnetic resonance-guided linear accelerator (MR-Linac) technology on treatment precision, clinical outcomes, and operational challenges in prostate cancer radiotherapy.

Method A systematic literature review was conducted using PubMed, Scopus, and Google Scholar to identify peer-reviewed studies published between 2018 and 2026. Eligible studies evaluated MR-Linac technology for prostate cancer and reported outcomes related to treatment precision, toxicity, workflow, and clinical effectiveness.

Results Three primary themes emerged: (a) improved treatment precision through superior soft tissue visualization, real-time target tracking, and adaptive radiotherapy; (b) improved clinical outcomes characterized by reduced radiation exposure to organs at risk, decreased …

Gadolinium Deposition Concerns In Magnetic Resonance Imaging, Emily Tran

Radiologic Sciences

Purpose To examine how concerns about gadolinium deposition have influenced the use of macrocyclic versus linear contrast agents in magnetic resonance (MR) practice.

Method A structured literature review was conducted using AI-assisted research tools and academic databases to identify recent peer-reviewed original research articles related to gadolinium deposition and contrast agent use patterns in MR. Only studies published between 2020 and 2026 were included.

Results Recent research confirmed that gadolinium can accumulate in human tissues following contrast-enhanced MR examinations. Multiple studies demonstrated that linear gadolinium-based contrast agents are associated with greater levels of tissue retention compared with macrocyclic agents due …

Impact Of Artificial Intelligence On The Roles And Career Trajectories Of Radiologic Technologists, Carolina Esquivel

Radiologic Sciences

Purpose To examine how artificial intelligence (AI) is influencing the roles, responsibilities, and career trajectories of radiologic technologists by identifying emerging challenges and opportunities associated with AI integration in medical imaging.

Method A systematic literature review was conducted using PubMed and CINAHL to identify peer-reviewed studies published between 2016 and 2026. Eligible studies examined AI applications in medical imaging and their effects on workforce roles, education, collaboration, and professional practice. Findings were synthesized using thematic analysis.

Results Three primary themes emerged: (a) workflow efficiency and protocol optimization through AI-assisted imaging processes; (b) professional skill development and evolving responsibilities related to …

Work-Related Musculoskeletal Disorders In Sonography: Impact On Career Longevity And Evidence-Based Interventions For Workforce Retention, Aileen Gonzalez

Radiologic Sciences

Purpose To synthesize current evidence on work-related musculoskeletal disorders (WRMSDs) among sonographers, examine their impact on career longevity and job satisfaction, and identify leadership-driven interventions that support workforce retention.

Method A scoping review was conducted using PubMed, Google Scholar, and The University of Texas MD Anderson Cancer Center Research Medical Library to identify peer-reviewed studies published between 2020 and 2026. Eligible studies examined WRMSDs in sonographers and reported outcomes related to career longevity, job satisfaction, workplace retention, or injury prevention interventions. Findings were synthesized thematically.

Results Three primary themes emerged: (a) WRMSDs are highly prevalent across sonography specialties and represent …

High-Definition Healing: Investigating Ai-Driven Mr Reconstruction Methods, Jerell R. Jones

Radiologic Sciences

Purpose To analyze recent artificial intelligence (AI)-driven magnetic resonance (MR) reconstruction methods aimed at addressing long acquisition times, image artifacts, and workflow inefficiencies.

Method A systematic literature review was conducted using PubMed, Scopus, and Scopus AI, targeting peer‑reviewed studies published between 2015 and 2026. Search terms included “MRI,” “magnetic resonance imaging,” “artificial intelligence,” “deep learning,” and “machine learning.” Eligible studies included methodology, validation, and review papers. Extracted data included algorithm type, study design, key findings, and limitations. Themes were identified through content analysis and generative AI use.

Results Prominent themes identified were the emergence of generative adversarial networks, advanced neural …

Administrative And Clinical Impacts Of Theranostic Program Expansion In Nuclear Medicine, Karmela Kljajic Pascual

Radiologic Sciences

Purpose To synthesize current evidence on theranostic trials, nuclear medicine clinical workflow models, and organizational readiness, with a focus on how healthcare organizations and medical imaging leaders are adapting to the rapid expansion of theranostic services.

Method A comprehensive search was conducted across Scopus, PubMed, MEDLINE, and Google Scholar. Inclusion criteria required peer‑reviewed articles published between 2002 and 2026 addressing nuclear medicine leadership, theranostic implementation, workflow design, and organizational factors influencing theranostic program development. Exclusion criteria removed editorials, blog posts, and nonpeer‑reviewed sources.

Results Four major themes emerged: workforce and staffing demands, infrastructure and resource requirements, regulatory and administrative pressures, …