Digital Commons Network^™

Understanding And Cultivating Algebraic Thinking: A Case Study Of Middle Grades Multilingual Learners, Damiale Johnson

Curriculum and Instruction (Ed.D.) Dissertations

Multilingual learners often encounter challenges in mathematics classrooms due to the linguistic and interpretive demands of mathematical discourse and problem-solving. This qualitative case study investigated how three seventh-grade multilingual learners developed and demonstrated algebraic thinking during collaborative mathematical problem-solving tasks. Specifically, the study examined students’ strategies and resources, the challenges they encountered, and how language, collaboration, and representation supported algebraic and functional reasoning.

Guided by situated learning theory, sociocultural developmental theory, and the Algebraic Habits of Mind framework, the study emphasized social interaction, language, and contextualized problem-solving. Participants were Spanish-speaking multilingual learners developing academic proficiency in English in a middle …

Patient Factors Influencing Caregiver Burden After Stroke, Madison Johnson, Catherine Vaughn, Elizabeth Byrd

Expo Student Presentations

2026 Summer Expo Poster Presentation

• Health Sciences & Health Professions

Adolescent Brain Activity During Associative Memory Encoding Is Related To Dietary Nutrient Intake, K S. Mohankumar, C T. Eickstead, A Bolaram, D K. Grey, C A. Orihuela, R Evans, S Mrug, D C. Knight

Expo Student Presentations

2026 Summer Expo Poster Presentation

• Social & Behavioral Sciences

Addressing Homelessness As A Key Risk Factor For Overdose Deaths In King County, Washington, Catherine Mutti-Driscoll

Selected Social Change Portfolios in Prevention, Intervention, and Consultation

Goal Statement:

In this portfolio, I identify prevention strategies that address the nested problems of overdose deaths and homelessness in King County, Washington. By examining how housing instability, substance abuse, structural racism, and gaps in coordinated care intersect, this paper advocates for a responsive prevention approach that combines evidence-based substance abuse strategies, phased housing approaches, and culturally responsive care.

Significant Findings:

While recent harm reduction measures have improved overdose death rates in King County, unhoused individuals continue to account for 50% of the county’s still concerning fatal overdose numbers. Data shows that historical racism in King County also shapes who …

The Impact Of Childhood Trauma On Parenting And Emotional Regulation In Charlotte, Nc], Raven Forrest

Selected Social Change Portfolios in Prevention, Intervention, and Consultation

Goal Statement:

The goal of this social change project is to increase awareness of how unresolved childhood trauma can affect parenting, emotional regulation, and family relationships among low-income families in Charlotte, North Carolina. This project focuses on prevention by promoting trauma-informed education, emotional regulation skills, and evidence-based parenting support programs that can help reduce intergenerational patterns of trauma.

Significant Findings: Unresolved childhood trauma may affect adults through emotional dysregulation, anxiety, depression, low self-esteem, unhealthy communication, harsh discipline, and difficulty forming healthy family relationships. These challenges may increase parenting stress and create emotionally unsafe home environments for children. In Charlotte, families …

Preventing Mental Health Issues In Children And Adolescents With Learning Disabilities, Laura Barrett

Selected Social Change Portfolios in Prevention, Intervention, and Consultation

Goal Statement: The goal of this social change portfolio is to prevent mental health issues in children and adolescents with learning disabilities in the state of Utah.

Significant Findings: Children and adolescents with learning disabilities (LDs) in Utah face elevated risks of anxiety, depression, low self-esteem, and related difficulties stemming from chronic academic frustration and social challenges, yet substantial service gaps for this vulnerable population exist. Approximately 58% of children needing mental health care in Utah do not receive any, and only about half of the estimated 58,000 students diagnosed with LDs have specialized educational supports such as individualized education …

Adolescent Social Disconnection And Social Media Overuse In San Jose, California, Gilmour Arufo

Selected Social Change Portfolios in Prevention, Intervention, and Consultation

The goal of this Social Change Portfolio is to support the implementation of a school-based prevention program for high school students in San Jose, California, that promotes healthy technology use, strengthens peer and adult connections, and increases participation in face-to-face social activities. The proposed program seeks to increase adolescents' awareness of their social media use patterns while strengthening protective factors associated with positive youth development, including school connectedness, supportive peer relationships, trusted adult relationships, and meaningful social engagement.

Reviewing The Perioperative Process For Gastrostomy Tube Care: A Qualitative Study, Douglas J. Fox Iii, Owen N. Ferriola, Allen J. Huang, Nicholas A. Long, Joan C. Bruce, Erin M. Morris, Jeannette M. Joly, Carleen V. Cuevas, Terry Fisher, Kuojen Tsao

Summer Research Program Abstracts

No abstract provided.

Tipping In The Digital Age: Comparing Group And Individual Tipping Behavior Across Cashless Payments, Akosua Sayer Koduah

Graduate Theses and Dissertations

Tipping has long been central to the U.S. hospitality industry, where it provides a substantial share of service workers’ income. What was once a cash-based practice is now increasingly mediated through digital platforms such as card readers, QR codes, and peer-to-peer apps. These systems introduce features such as visibility of the decision, preset defaults, and group payment options that reshape how customers decide whether and how much to tip. While traditional tipping has been widely studied, research on digital restaurant tipping remains limited. This study focuses on two underexplored mechanisms: visibility (whether staff can observe the decision) and group context …

Nuclear Factor Of Activated T Cells As A Driver Of Tumor Progression And A Target For Precision Therapy, Hira Khan, Khushbakhat Alia, Yusra Al Dhaheri, Muhammad Naseem, Rabah Iratni, Edgar Serfling, Khalid Muhammad

All Works

The Nuclear Factor of Activated T Cells (NFAT) family comprises closely related transcription factors. Numerous biological processes including angiogenesis, invasion, migration, proliferation, and cell survival are regulated by the NFAT family. NFATs are overexpressed and have increased transcriptional activity in a variety of human solid tumors and hematological cancers. Beyond tumor cell-intrinsic roles, NFAT has also emerged as an important regulator of the tumor microenvironment (TME), where it can influence immune cell behavior and contribute to mechanisms of immune evasion. The discovery of the multifaceted functions of NFATs has driven the need to further unveil their role in cancer and …

Cultural Diplomacy Through Museums: An Analysis Of The Role Of Sheikh Dr. Sultan Al Qasimi In Promoting Intercultural Dialogue Through History, Culture, And Tourism, Abdulla Almheiri, Fareed Awae, Muhammad Talhah Jima’Ain, Hamdan Chehdimae, Mohamad Azrien Mohamed Adnan, Fuad Trayek

All Works

This study aims to analyze the role of cultural diplomacy in the Emirate of Sharjah through museums. Particular emphasis is placed on the important contributions of His Highness Sheikh Dr. Sultan Al Qasimi in promoting intercultural communication and consolidating cultural identity through the support of history, archaeology, and tourism. The study uses a quantitative approach with a survey research design. The perspectives of 285 museum visitors have been analyzed based on arithmetic means and standard deviations to measure their level of awareness regarding the museum’s historical, cultural, and tourism dimensions. The findings indicate a high level of awareness concerning the …

Timing Matters: Safe And Timely Insulin Administration, Katlyn Lenox

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely insulin administration is essential for safe inpatient diabetes management and is strongly associated with improved glycemic control and fewer adverse events. Despite ADA recommendations to administer insulin within 30 minutes of point‑of‑care (POC) glucose testing, internal data showed only 44% compliance, with an average delay of 44 minutes. These delays increased the risk of hypo‑ and hyperglycemia and highlighted the need for workflow redesign and strengthened nursing processes.

Aim of the Project: To increase the percentage of insulin doses administered within 30 minutes of POC glucose testing, reduce adverse glycemic events, enhance patient safety, and align practice with …

Purposeful Rounds: A Structured Fall Prevention Plan: Final Report, Cincerlyn Lewis

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are the most frequently reported preventable events in hospitalized patients.  Falls in the project unit were increasing, and a gap analysis revealed variation in how nurses assessed fall risk and implemented interventions. Evidence indicated that inconsistent rounding undermined situational awareness and delayed identification of patient needs. This gap highlighted the need for a structured, evidence‑based rounding process to improve consistency and reliability.

Aim of the project: The Purposeful Rounds (PR) project aimed to implement a structured process to improve rounding consistency and staff responsiveness, while reducing fall rates over a 12‑week period.

Review of the Evidence: Evidence-based literature …

Increasing Referrals To The Lung Cancer Screening Program, Megan Randall

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Lung cancer is the leading cause of cancer-related deaths worldwide and is frequently diagnosed at advanced stages when treatment options are limited. A Veterans Administration (VA) primary care clinic demonstrated lower referral rates to the lung cancer screening (LCS) program than a comparable VA clinic despite having a higher prevalence of tobacco users. Existing electronic health record reminders focused on smoking cessation and did not systematically assess eligibility for LCS, contributing to underutilization of the screening program.

Aim of the Project: The aim of this quality improvement project was to increase referrals to the LCS program by improving identification …

Mindfulness To Reduce Psychotropic Prescriptions In Home-Based Elderly Patients, Mojisola Akinola Olusegun

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Home-based adults aged 65 years and older receiving care at a community behavioral health center exhibited high psychotropic polypharmacy, with over 80% prescribed two or more psychotropic medications, exceeding The Center for Medicare and Medicaid services (CMS) guidance for safe use. This pattern heightened risks for adverse drug events, functional decline, and avoidable healthcare utilization, while exposing a practice gap characterized by underuse of non-pharmacologic interventions.

Aim of the Project: The Doctor of Nursing Practice (DNP) project aimed to determine whether integrating a structured Mindful Breathing and Meditation (MBM) program into routine services could reduce psychotropic medication burden …

Optimizing Daily Central Line Review: A High-Reliability Qi Project, Heather Khan

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Prolonged central line use increases the risk of infection. At baseline, central line utilization in a 21-bed medical intensive care unit exceeded organizational goals and the national median. Gaps in the central line review process and variation in staff knowledge contributed to overutilization.

 Aim of the Project: The project team aimed to improve patient outcomes by reducing the central line standardized utilization ratio (SUR) from 0.93 to the national median of 0.79 over 12 weeks.

Review of the Evidence: Evidence supports standardization, use of decision-support tools, measurement, and auditing to reduce central line utilization. Leadership engagement, safety culture, and …

Poor Adherence To Established Clinical Guidelines In Outpatient Bladder Cancer Management, Melanie Boren

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The outpatient urology practice encountered challenges with adherence to Clinical Practice Guidelines (CPGs), primarily due to unfamiliarity and lack of operational accountability. This led to a low adherence rate of only 40% among patients with bladder cancer. Key issues included inadequate training and knowledge gaps regarding CPGs.

Aim of the Project: The project aimed to improve patient care and outcomes in bladder cancer treatment by enhancing patient retention and adherence to treatment protocols. Evidence-based interventions were implemented to optimize care delivery and support adherence to prescribed treatments.

Review of Evidence: A literature review highlights the effectiveness of nurse navigator …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

A Quality Improvement Approach To Reducing Chronic Obstructive Pulmonary Disease Readmissions, Florwisse Rubio

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

The problem identified at the project site is that care transitions for patients with COPD lack standardized discharge processes, leading to inconsistent education, limited follow-up, and poor coordination of care.

Aim of the Project:

The primary aim was to improve patient outcomes by reducing the 19.6% 30-day readmissions among older adults diagnosed with COPD at the selected project site by implementing a standardized discharge intervention over 12 weeks, measuring progress, and ensuring appropriate workflow. The initiative of this project sought to foster a sense of proper continuity of care through timely follow-up, interprofessional communication among patients and providers, and …

Improving Timely Hospice Pain Reassessments Through A Quality Improvement Initiative, Brianna Strong-Mosley

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In a hospice care organization, a practice gap was observed in prompt pain reassessment with an onset or increase of pain, as mandated within a 48-hour timeframe by the Centers for Medicare and Medicaid Services (CMS). Baseline data showed that only 40% of eligible patients with a pain score of ≥ 6 received a documented pain reassessment within 48 hours. Overall patient satisfaction with hospice services was 45%.

Aim of the Project: The quality improvement project aimed to enhance pain management by increasing the percentage of eligible hospice patients with a documented pain score of ≥ 6 from a …

Reducing Emergency Department Boarding Using Pull-Based Throughput Intervention: Quality Improvement Project, Eunice Dundu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Emergency department (ED) boarding increases overcrowding and delays care. A 200-bed acute care hospital in the southeastern United States has a median time from inpatient bed readiness to ED departure that exceeds its hospital benchmarks, resulting in prolonged boarding and delays. Hospital data showed a median bed-ready-to-departure time of 76 minutes, exceeding the target of less than 45 minutes. Workflow analysis identified delays in transport activation, communication, and accountability as major contributors to inefficiency.

Aim of the Project: ED throughput quality improvement project aimed to reduce the median time from when an inpatient bed is marked ready to …

Improving Medication Reconciliation Compliance In Home Health Admissions, Paula A. Petrie-Rivas

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Clinician compliance with medication reconciliation at a home health agency was below regulatory expectations, with agency performance significantly lower than state and national averages. Workflow inefficiencies, inconsistent clinician practices, and limited training contributed to noncompliance, increasing the risk of medication discrepancies, preventable rehospitalizations, and Medicare reimbursement penalties.

Aim: This quality improvement project implemented a standardized medication reconciliation workflow using the Agency for Healthcare Research and Quality’s MATCH toolkit to improve clinician compliance during admission to home health.

Evidence: Literature supports structured medication reconciliation as an effective strategy to improve safety during transitions of care. The MATCH toolkit provides a …

Utilizing A Multidisciplinary Team Approach To Opioid Stewardship In A Long-Term Acute Care Hospital, Lesley Moore

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

The opioid crisis continues to negatively affect patient safety and healthcare outcomes across the United States. Long-term acute care hospitals (LTACHs) care for medically complex patients who often require prolonged pain management and are at increased risk for opioid-related adverse events. At the project site, a 32-bed LTACH, 72% of reviewed patient charts included an opioid prescription upon admission, exceeding recommended prescribing benchmarks and identifying a gap in opioid stewardship practices. The absence of a standardized opioid stewardship program (OSP) and opioid risk screening process increased the risk of opioid misuse, dependency, and adverse patient outcomes.

Aim of the …

Implementing The Walking Impairment Questionnaire For Peripheral Artery Disease Screening And Referral, Lisa Doyle

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity, mortality, and lower extremity amputation. At a Level 1 veterans medical center, the absence of a standardized screening and referral process contributed to delayed identification of symptomatic PAD and underutilization of supervised exercise therapy (SET). Between August 2024 and July 2025, only four veterans completed SET despite a large high-risk population, demonstrating a significant gap in evidence-based recommendations and clinical practice.

Aim of the Project: The aim of this project was to improve patient outcomes by standardizing screening for symptomatic PAD using the Walking Impairment Questionnaire (WIQ) to …

Identifying Palliative Care Needs In The Emergency Department, James Sullivan

All Doctor of Nursing Practice (DNP) Scholarly Projects

This quality improvement project evaluated the implementation of the Palliative Care and Rapid Emergency Screening (P‑CaRES) tool to improve early identification of unmet palliative care (PC) needs among adults with advanced, life‑limiting illnesses presenting to a community emergency department (ED). The problem addressed was the absence of a standardized PC screening process, resulting in delayed recognition, missed referral opportunities, fragmented care, and repeated ED utilization. Guided by Plan‑Do‑Study‑Act cycles and the OhioHealth Change Management Model, the project integrated P‑CaRES into ED workflows, provided staff education, and established structured referral pathways. Over 12 weeks, clinicians completed 65 screenings; 57 patients met …

Enhancing Medication Timeliness Through Structured Handoff In A Mental Health Facility, Belinda Zinhu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Delayed medication administration in an adult inpatient mental health facility exceeded organizational benchmarks and posed risks to patient safety, treatment effectiveness, and continuity of care. Baseline electronic health record (EHR) audits showed that about 30% of scheduled medications were administered outside the organization's acceptable timeframe, and inconsistent nurse shift handoffs contributed to the delays.

Aim of the Project: The aim of the quality improvement project was to improve patient outcomes by implementing the I-PASS standardized handoff communication tool to reduce late medication administration from 30% to 15% within 12 weeks.

Review of the Evidence: Evidence supports structured handoff frameworks …

Tailoring Interventions For Patient Safety Protocol: A Strategy To Prevent Inpatient Falls, Yashu Adhikari

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Inpatient falls were a significant safety issue at the project site, substantially affecting patient outcomes and organizational resources. The identified gap was the lack of individualized, patient-centered fall-prevention strategies despite the presence of standard fall-prevention bundles. The baseline fall rate of 6.04 was 20% higher than the national benchmark of three to five falls per 1,000 patient days, indicating a clear need for improvement.

Aim of the Project: The quality improvement (QI) project aimed to improve patient safety by reducing inpatient falls through implementation of the AHRQ Fall Tailoring Interventions for Patient Safety (TIPS) protocol on a …

Standardized Infection Prevention Protocol To Reduce Surgical Site Infections In Pediatric Neurosurgery, Pisey Kareth

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Surgical site infections (SSIs) are a significant concern in the pediatric neurosurgical patient population and are associated with increased morbidity, longer hospital stays, and increased medical expenses. The absence of a standardized preoperative infection prevention process led to variability in perioperative care practices and infections at the practicum site.

Aim of the Project: The aim of the project was to reduce the incidence of SSIs among pediatric patients undergoing neurosurgical procedures who were initially evaluated in an ambulatory setting.

Review of the Evidence: Evidence supports the implementation of bundled infection prevention strategies as a more effective approach to reducing …

Pressure Injury Prevention Bundle Implementation In An Acute Care Unit, Hannah K. Pobi

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Pressure Injuries are quality indicators that reflect the quality of care delivered to patients. With a hospital-acquired pressure injury rate above 12%, the project site exceeded the national benchmark average of 5-8% for acute inpatient settings. The cost of managing hospital acquired pressure injury ranges from $20,900 to $151,700 per patient, compounded by complications in a patient’s treatment plan.

Aim of the Project: To reduce the prevalence of HAPIs in a step-down unit to below 8% by implementing the Pressure Injury Prevention bundle. The PIP bundle, an evidence-based intervention, primarily aimed to educate the nursing team on its …

Fall Tailoring Interventions For Patient Safety: A Program Evaluation, Shirley Morrison

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls with injury rates had increased for over two years at the project hospital until nurse leaders implemented a new fall-prevention intervention. Patient falls are the most common preventable adverse event in acute care hospitals, with approximately 700,000 to 1 million occurring annually in the United States. Before implementing the Fall Tailoring Interventions for Patient Safety (TIPS) toolkit, the hospital’s program lacked an evidence-based approach and a fall communication board to alert staff, patients, and families about the individual fall risk status, leaving a significant gap in patient-centered care.

Aim of the Project: The aim of the project was …