Digital Commons Network^™

Enhanced Rehabilitation Program In Acute Care: New Program Development And Results In Response To Delayed Hospital Discharges, David L Smith, Morgan Hall, Mary E Mcnulty, Elizabeth Pontius, Cathy Peabody, Beth Burke, Julie Fox

Journal of Maine Medical Center

Problem: The objective of this project was to evaluate and describe the flow of patients who have delayed discharge after they have participated in an enhanced therapy program. Approach: In the current practice, which started in 2021, the care coordination team identifies patients medically ready for discharge but with barriers. Working with the rehabilitation team, the care coordination team determines if the patient is suitable for the enhanced therapy program. These patients go on to receive 1 hour of physical therapy and 1 hour of occupational therapy each day, Monday through Friday, with the goal of discharge to home. Outcomes: …

Impacting Competency In C-Ssrs Suicide Risk Screening On An Inpatient Psychiatric Unit, Fidelis Sangye

Doctor of Nursing Practice Projects

Suicide remains a leading public health concern, and inconsistent application of the Columbia-Suicide Severity Rating Scale (C-SSRS) may contribute to variability in suicide risk assessment and delayed intervention within inpatient psychiatric settings. The purpose of this quality improvement (QI) project was to evaluate the effectiveness of a standardized C-SSRS-guided educational intervention on staff competency in suicide risk screening. Guided by Lewin’s Change Theory and implemented using the Plan-Do-Study-Act (PDSA) framework, this quantitative pretest-posttest QI project was conducted on an adult inpatient psychiatric unit. The intervention consisted of a 25-minute instructor-led PowerPoint presentation on standardized C-SSRS administration and evidence-based suicide risk …

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 …

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 …

What Makes Implicit Bias Training Effective? An Examination Of Training Program Interventions And K-12 Educator Experiences, Kyleigh K. Mcaloon

McNair Summer Research Program

Differences in disciplinary referrals based on race have led many to argue that bias may influence disciplinary decisions. Implicit bias (IB) training is designed to address such disparities by raising awareness of biases that may impact assessment of behavior and disciplinary decisions. In recent years, many have questioned the validity of IB as a construct and also the potential impact of training. Some scholars argue that these programs fail to produce meaningful behavioral change and may unintentionally reinforce or increase bias. The aim of the present study was to investigate how individuals receive and respond to such training. Sixteen K-12 …

Effective Leadership Strategies To Retain For-Profit Education Employees After A Leadership Change, Kimberly Keene

Walden Dissertations and Doctoral Studies

Ineffective leadership transitions in for profit higher education erode employee morale, trust, and retention. Higher education business leaders recognize that ineffective leadership transitions can contribute to employee disengagement, reduced organizational commitment, and increased turnover, undermining institutional stability, workforce continuity, and organizational performance. Grounded in transformational leadership theory, the purpose of this qualitative pragmatic inquiry was to identify and explore the effective leadership strategies used by for-profit education institution leaders to retain key employees after a change in leadership. The participants were 10 leaders employed at for-profit higher education institutions in the southern United States who had successfully implemented leadership strategies …

Reducing No-Show Rates In An Outpatient Behavioral Health Clinic Through A Multimodal Patient Engagement Intervention, Gwendoline Osong

Walden Dissertations and Doctoral Studies

Reducing No-Show Rates in an Outpatient Behavioral Health Clinic Through a Multimodal Patient Engagement Intervention

C.S.A. Assessment - Tamp Family Health Center Portal, Delante Clark

Graduate Scholarship and Creative Works

This C.A.S. assessment evaluates how the Tampa Family Health Centers website influences userattention, cognitive processing, information accessibility, navigation efficiency, and digital user experience.The assessment examines whether the platform supports intentional engagement and informed decision-making while minimizing cognitive overload, distraction, confusion, and unnecessary attentional demands.

TFHC serves as a healthcare access portal providing appointment scheduling, patient resources, providerinformation, healthcare services, MyChart access, payment services, and community health resources.These functions make attention management and information clarity critical to successful user outcomes.

Zeus Network And The Commercialization Of Conflict: A Critical Analysis Of Exploitation, Representation, And Reality Television, Delante Clark

Graduate Scholarship and Creative Works

This study examines Zeus Network as a prominent example of the commercialization of conflict within contemporary digital media. Through reality based programming that frequently emphasizes confrontation, public humiliation, emotional volatility, and interpersonal disputes, the network has cultivated a profitable entertainment model built upon spectacle and controversy. Drawing upon conflict theory, critical race theory, and media sociology, this paper investigates whether Zeus functions as a platform for cultural representation and economic opportunity or as a system that monetizes dysfunction for audience consumption. Particular attention is given to the portrayal of Black women and Black communities, whose experiences often become central to …

Leveraging Innovation And Resilience: A Qualitative Project Of Mid-Level Managers Driving Business Performance In Multinational Corporations, Karla Karey Diaz

Walden Dissertations and Doctoral Studies

Employee underdevelopment in multinational corporations (MNCs) can weaken the organization’s agility and competitive advantage in the global market. Mid-level managers must be leveraged effectively, as this level of management holds primary adaptive responsibility for building, integrating, and reconfiguring resources during organizational change. Grounded in the dynamic capabilities theory, the purpose of this qualitative pragmatic inquiry project was to identify and explore effective strategies mid-level managers in MNCs use to improve dynamic capabilities. Participants were 10 U.S.-based MNC mid-level managers with experience using strategies to improve dynamic capabilities. Data were collected through semistructured interviews and publicly available documents, including strategic plans, …

Implementation Of A Standardized Columbia-Suicide Severity Rating Scale Screening Process In An Outpatient Psychiatric Practice, Dela Mensah Frimpong

Walden Dissertations and Doctoral Studies

This doctoral project was an organizational change initiative designed to implement a standardized suicide risk screening process in an outpatient psychiatric practice. The identified practice problem was inconsistent staff use and documentation of suicide risk screening, which could result in missed warning signs, delayed provider notification, incomplete documentation, and inconsistent follow-up care. Suicide risk identification is an essential nursing responsibility and a key component of patient safety (The Joint Commission, 2024; Zero Suicide, n.d.). The practice-focused question examined whether staff education and implementation of a standardized Columbia-Suicide Severity Rating Scale (C-SSRS) workflow would improve staff compliance, documentation completion, and knowledge …

Impact Of Emerging Technologies On Leadership Identity Of Behavioral Health Leaders, Jenah Habermehl

Walden Dissertations and Doctoral Studies

Emerging technologies are reshaping behavioral health leadership by changing documentation, communication, ethical responsibilities, and role expectations. Qualitative case study research methodology was used in this study. The problem addressed in this case study was the limited understanding of how emerging technologies influence the leadership identity and professional values of behavioral health leaders. The Baldrige Performance Excellence Framework guided this study of behavioral health leaders at a privately operated behavioral health organization in the South Atlantic region of the United States. Data were collected by conducting semistructured interviews with four behavioral health leaders at the organization and gathering internal archival and …

The Human Side Of Leadership: How Personality Assessments Build Self-Aware, Accountable, And Emotionally Intelligent Public Sector Leaders, Hillary Faulkner

Certified Public Manager® Applied Research

Public sector organizations face a persistent set of leadership challenges, including miscommunication, inconsistent accountability, and reactive decision-making, that are rarely resolved through technical training alone. This study examines how the intentional use of personality assessments can improve self-awareness, emotional intelligence, accountability, and communication among public sector leaders, and how those improvements contribute to more effective and cohesive leadership teams. Using a qualitative case study design, this research draws on Organization Analysis and Design (OAD) personality assessment data and in-depth interviews with two supervisors at a municipal government organization in Henderson, Texas, who participated in a structured six-month personality-based leadership development …

Implementation Of An Electronic Gad-7 Screening Tool To Improve Anxiety Screening Completion And Documentation, Obiageli L. Ukatu

Walden Dissertations and Doctoral Studies

Quality Improvement Initiative Implementation of an Electronic GAD-7 Screening Tool to Improve Anxiety Screening Completion and Documentation

Evaluating Mentorship, Professional Networking Participation, And Leadership Classifications For Women In Health Service Organizations, Marina Nagy Hanna

Walden Dissertations and Doctoral Studies

Despite women comprising a substantial portion of the U.S. health care workforce, they continue to be underrepresented in leadership across health service organizations. Mentorship and professional networking opportunities are commonly used to support women’s professional growth; however, inequities in leadership attainment remain prevalent, particularly among women from racial and ethnic minority backgrounds. The purpose of this quantitative archival comparative study was to examine associations across mentorship participation indicators, professional networking participation indicators, leadership classifications, and racial and ethnic classifications. The study was underpinned by intersectionality theory and social capital theory, which supported examination of how demographic identities and access to …

Organization Change Process Initiative Suicide Risk Assessment Screening Implementation, Dawn Marie Zaccardo

Walden Dissertations and Doctoral Studies

Suicide remains a leading cause of preventable death among individuals receiving psychiatric care, emphasizing the need for consistent suicide risk assessment practices in outpatient behavioral health settings. This Doctor of Nursing Practice (DNP) quality improvement project addressed inconsistent suicide risk screening and documentation by implementing a standardized evidence-based suicide risk assessment protocol in an outpatient psychiatric clinic. Guided by the Johns Hopkins Evidence-Based Practice Model, the project incorporated staff education, workflow standardization, leadership support, and stakeholder engagement to improve provider adherence to organizational policy requiring suicide risk screening during every patient encounter. Deidentified retrospective chart audits conducted before and after …

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 …

Longitudinal Behavioral Delta Detection System And Method For Passive Multi-Modal Audio Analysis, Eric Zavesky

Defensive Publications Series

A system and method for passive longitudinal behavioral delta detection through multi-modal audio analysis is disclosed. The system comprises an edge audio capture device for continuously capturing ambient audio, an on-device multi-modal feature extraction pipeline extracting acoustic features as semantic-level representations, topic-level natural language embeddings without retaining specific words, behavioral graph topology interaction data, and classified non-verbal sound event frequency vectors, and a longitudinal delta detection engine computing temporal deltas at multiple resolutions against a historical baseline. A privacy architecture ensures on-device processing with content obliteration and hashed entity identity. A model adaptation layer provides supervised, unsupervised membership testing, and …

Digital Leadership Patterns Of School Principals In Coding And Artificial Intelligence Learning, Ramadhanur Putra, Lia Yuliana

Jurnal Pendidikan: Teori, Penelitian, dan Pengembangan

Digital transformation in education requires school principals to integrate technology into learning processes and school management. This study aims to analyze principals' digital leadership patterns in supporting Coding and Artificial Intelligence learning at SMP Islam Al Azhar 26 Yogyakarta and SMP Islam Al Azhar 66 Bantul. This research employed a descriptive qualitative approach and the data were collected through interviews, observations, and documentation for data collection. The participants consisted of principals, vice principals for curriculum, and teachers. The findings reveal that both schools implement transformational digital leadership through establishing a digital vision, enhancing teacher competencies, providing technological infrastructure, and strengthening …

Institutional Support Environments In Higher Education: Rethinking The Role Of Military-Affiliated Student Centers, Coby W. Dillard

Human Resource Development Student Publications and Presentations

Military-affiliated student centers have become common features of higher education institutions serving veterans, active-duty service members, and military-connected students. Despite their growing presence, these centers are often institutionally positioned and evaluated primarily through administrative and compliance functions related to federal education programs. This framing risks overlooking the broader developmental and engagement functions these environments can provide for adult learners transitioning from military to academic contexts. Drawing on organizational support theory, social exchange theory, and belonging frameworks in higher education, this Perspectives essay proposes a conceptual reframing of military-affiliated student centers as institutional support environments rather than transactional service units. Institutional …

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 …

Standardized Metabolic Monitoring Protocol For Adult Outpatients Who Are Prescribed Antipsychotic Medications, Abel Bueno Gonzalez

Walden Dissertations and Doctoral Studies

This doctoral project was an organization change process evaluation of a quality improvement initiative in a masked outpatient mental health clinic. The practice challenge was poor metabolic monitoring and documentation among adult outpatients taking antipsychotics that were not in line with guidelines. This problem is relevant to nursing practice because use of antipsychotic medications raises risk for weight gain, dyslipidemia, hypertension, and glucose abnormalities, and not monitoring risks may delay referral or management. The practice-focused question was: According to evidence, among adult patients who are prescribed antipsychotic medications in an outpatient mental health clinic, what is the impact of implementing …

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 …

Padres Ayudando A Padres: Co-Constructing A Family-Centered Mental Health Intervention Of, By, And For Central American Immigrant Parents, Rachael Goodman, Colleen K. Vesely, Maribel Tohara Nakamatsu, Victoria Stone, Valeria Quintana, Bethany Letiecq, Amigas De La Comunidad

Trauma Counseling and Resilience

In the wake of the COVID-19 pandemic, our partners in a Central American immigrant enclave reported an increasing need to support parents and children whose mental health was negatively impacted by the confluence of underlying systemic stressors and traumatic experiences. Using our existing family-centered participatory action research (FCPAR; Letiecq, Vesely, et al., 2022) approach and guided by the transcreation model (Nápoles & Stewart, 2018), we co-constructed a mental health intervention in partnership with community members, via our community advisory board (CAB). Essential to this process was building the intervention with the community, ensuring that it was culturally and contextually grounded …

Quality Improvement Project: Advancing Personalized Depression Care In Outpatient Psychiatry, Jillian K. Benoit

Doctor of Nursing Practice Projects

Depression is a leading cause of disability worldwide, yet inconsistent use of evidence-based assessment and treatment strategies contributes to gaps in the quality of psychiatric care. A needs assessment at a community outpatient psychiatric clinic identified inconsistent documentation of measurement-based care (MBC), shared decision-making (SDM), and patient education during depression treatment. The purpose of this quality improvement project was to evaluate whether implementation of MBC and SDM improved depression treatment documentation among psychiatric providers over a 4-week period. Guided by Lewin’s Change Theory and implemented using the Iowa Model of Evidence-Based Practice as the implementation framework, this quantitative one-group pretest-posttest …

Improving Exam Scores: Alternative Next Generation Questions In Curriculum, April Morgan

Doctor of Nursing Practice Projects

Evidence identifies clinical judgment deficits among newly licensed nurses, supporting the integration of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) and Next Generation NCLEX (NGN) strategies. Inconsistent NGN implementation and Assessment Technologies Institute (ATI) Comprehensive Predictor performance established the local problem. This quality improvement project evaluated the impact of implementing NCJMM-aligned NGN instructional strategies, including unfolding case studies and bow-tie questions, on students’ first-attempt achievement of the ATI Comprehensive Predictor benchmark and faculty outcomes. The primary aim was to increase the percentage of students achieving the ATI Comprehensive Predictor benchmark of 76.2% on …

Standardizing Hypertension Care In An Occupational Medicine Clinic: A Quality Improvement Project, Carolyn Duncan

Doctor of Nursing Practice Projects

Hypertension remains a leading modifiable risk factor for cardiovascular disease, and inconsistent implementation of evidence-based hypertension management may contribute to variability in patient education, documentation, and follow-up care. This quality improvement project evaluated an evidence-based educational program and a standardized hypertension management workflow, based on the 2025 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines, in an occupational medicine clinic. Guided by the Iowa Model of Evidence-Based Practice, Kotter's 8-Step Change Model, and the Plan-Do-Study-Act framework, the intervention aimed to impact staff self-efficacy, documentation of lifestyle education, and follow-up appointment scheduling. A quantitative quasi-experimental pre-post design was used with …

Can Employees Report Stress-Related Problems Without Repercussions? Understanding The Determinants Of Stress Stigma, Kristieona L. Epting

All Theses

Few studies examine the stigma associated with reporting stress-related work concerns, or stress stigma. When employees refrain from communicating their experience of stressors due to the worry of negative repercussions, leaders become unable to gain full insight into the organizational factors causing stress. Learning more about employees’ reluctance to communicate stress concerns can help companies identify workplace stressors. Additionally, prior research has shown that an individual's core self-evaluation (i.e., fundamental evaluation of self) influences how they interpret and react to environmental situations. Individuals with higher levels of CSE may experience fewer adverse consequences from unfavorable job characteristics than a person …

Addressing Food Pantry Capacity To Offer Medically Tailored Groceries For Food Insecure Individuals With Chronic Disease In Rural South Carolina, Anna G. Taylor

All Theses

This study examines the feasibility of implementing medically tailored grocery (MTG) programs within rural food pantries in South Carolina to better serve food-insecure individuals living with chronic diseases. Using a mixed-methods design, the study aimed to assess current pantry capacity, identify barriers and facilitators to MTG implementation, and evaluate strategies to strengthen MTG delivery.

The intervention was guided by three implementation science frameworks: the Six-Step Knowledge Sharing Model, the Consolidated Framework for Implementation Research (CFIR), and the RE-AIM evaluation framework. Data collection occurred in two phases. In Phase 1, statewide focus groups, capacity surveys, and inventory assessments were conducted to …

Distributed Leadership Applied: The Role Of Professional Learning Communities In The Emergence And Development Of Teacher Leadership, Grace M. Bellamy

Electronic Theses and Dissertations

The purpose of this qualitative phenomenological study is to examine the processes through which teacher leadership is fostered and sustained among elementary and middle school educators who participate regularly in Professional Learning Communities (PLCs), with a focus upon schools implementing the DuFour and Eaker PLC model with fidelity during the winter and spring of 2026. This study looked for evidence of the presence of teacher leadership in a middle school and an elementary school. The theoretical frameworks of Distributed Leadership and the Teacher Leadership Standards created by the Teacher Leadership Exploratory Consortium were employed in this study, and observations of …