A Quality Improvement Project: Enhancing Nursing Knowledge And Patient Safety In The Prevention Of Hospital-Acquired Pressure Injuries (Hapis) In A Medical-Surgical Unit, Kristen Vartabedian

Master's Theses and Capstones

Background: Hospital-acquired pressure injuries (HAPIs) are a significant quality indicator within the hospital system. HAPIs increase hospitalization, morbidity, and associated healthcare costs. The current evidence suggests that ongoing nursing education can improve pressure injury prevention and help in the early identification.

Local Problem: Nurses within a medical-surgical unit demonstrated a gap in knowledge in the identification of hospital acquired pressure injuries and lack of accuracy when charting skin findings. Thus, contributing to a delay in recognition and treatment of HAPIs.

Methods: This quality improvement project utilized the Plan-Do-Study-Act (PDSA) framework to guide implementation of educational flipbooks. Materials contained standardized wound …

Reducing Readmissions For Copd Through Improved Education: A Gap Analysis, Raphael Gaughan

Master's Theses and Capstones

No abstract provided.

Enhancing Patient Safety And Team Communication Via Standardized Unit Handoff Tools In Inpatient Rehabilitation, Julia Rae Before

Master's Theses and Capstones

Abstract

Background: Interdisciplinary safety huddles in healthcare are used to facilitate staff communication, voice patient safety concerns and identify high acuity patients, as well as identify current unit issues that need resolution. Using characteristics of safety huddles, revising patient report sheets to include pertinent safety information often shared during huddles may lead to an increase in staff perception of communication as well as awareness to patient safety concerns. Within an in-patient rehabilitation hospital, anonymous staff reports indicated dissatisfaction with interprofessional communication and microsystem data revealed increased events of adverse patient outcomes and safety concerns. Baseline data indicated inconsistent patient handoff …

A Patient-Centered Approach To Improving Patient And Family Education On Perioperative Processes To Reduce Anxiety: A Quality Improvement Initiative, Ashley Lauren Doherty

Master's Theses and Capstones

Background: Perioperative anxiety is common among surgical patients and their family members. Anxiety may be increased by uncertainty and limited understanding of the surgical experience. Improving perioperative education may enhance understanding, reduce anxiety, and support a more patient and family centered surgical experience.

Local Problem: A Post-Anesthesia Care Unit (PACU) identified knowledge gaps in patient and family education about the perioperative process. The existing waiting room bulletin board was outdated and provided limited information. PACU nurses observed anxiety-related behaviors and confusion among patients and family members about the perioperative process. Patient satisfaction surveys routinely collected by the hospital also demonstrated …

Improving Operating Room First-Case On-Time Starts And Reducing Turnover Times: A Quality Improvement Project, Ashley Cote

Master's Theses and Capstones

Abstract

Background: Delays in first case on-time starts (FCOTS) contribute to decreased operating room (OR) efficiency, increased healthcare costs, workflow disruptions, and reduced staff and patient satisfaction. Evidence suggests that standardized workflows, improved communication, and Lean Six Sigma methodologies can improve perioperative efficiency and reduce delays.

Local Problem: Baseline data from a local OR microsystem demonstrated an FCOTS rate of 77%, below the organizational benchmark of 80%. Root cause analysis identified inconsistent preoperative workflows, communication gaps, and variable staff adherence to standardized processes as primary contributors to delayed first-case starts.

Methods: A quality improvement project utilizing the Define, Measure, Analyze, …

Improving Early Ambulation After Cardiac Surgery Using Nurse Education And Workflow Cues: A Quality Improvement Project, Nathan Seeley

Master's Theses and Capstones

Background: Early ambulation following cardiac surgery is an evidence-based practice that promotes postoperative recovery, reduces complications, and supports earlier discharge (Cook et al., 2024; Engelman et al., 2019; Kanejima et al., 2020). Despite its recognized benefits, consistent implementation remains challenging in busy inpatient settings due to workflow demands, competing priorities, and patient-related barriers.

Local Problem: Inconsistent early ambulation practices were identified on the Cardiac Surgical Step-Down Unit, creating an opportunity to improve adherence to evidence-based postoperative mobility practices.

Methods: This quality improvement project used the Plan-Do-Study-Act (PDSA) model to evaluate the impact of a brief nurse-focused educational intervention on early …

Advancing Safe Medication Administration During Pediatric Emergency Care Through Nurse Education: A Quality Improvement Project, Ciera Hunter

Master's Theses and Capstones

Background: Due to the increased complexities of pediatric medication administration, preventable errors occur at a higher rate than in general adult populations. Rural emergency departments (EDs) often see fewer pediatric patients and have less specialized support available on-site. Nurse continuing education is an evidence-based intervention to reduce medication administration errors making it vital to supporting patient safety and maintaining pediatric readiness.

Local Problem: The microsystem is a rural, critical access hospital in northern New England. In 2021, the microsystem scored 66/81 on the National Pediatric Readiness Project’s (NPRP’s) ED Assessment. In 2026, the score dropped 11 points to 55/81. Contributing …

Improving Effective Completion Of Catheter Care Using A Reminder System To Minimize Incidence Of Catheter-Associated Urinary Tract Infections: A Quality Improvement Project, Morgan K. Leonard

Master's Theses and Capstones

BACKGROUND: CAUTI rates can be decreased by implementing a care cluster for RNs for CAUTI care into morning assessments and medication administration to ensure it is being done regularly with reminders through cards at the computers in patient rooms. LOCAL PROBLEM: The local problem in the microsystem were the catheter-associated urinary tract infection (CAUTI) rates at 1.199, while the national benchmark is 1.000 (Medicare, n.d.).

METHODS: Reminder cards were placed in patient rooms on the computers which are highly utilized by staY while providing patient care to serve as a reminder to complete catheter care in a high task burden …

Improving Efficiency In The Intensive Care Unit Through Reduction Of Nurse Burnout: A Quality Improvement Initiative, Johanna Grace Koroma

Master's Theses and Capstones

Abstract

Background: Intensive care unit (ICU) nursing is prone to high levels of burnout, which poses concern for staff wellbeing, patient safety, and microsystem strain (Kerlin et al., 2020). Educational interventions may serve as a means of increasing awareness on the issue and reducing the effects of burnout, through promotion of evidence-based management strategies.

Local Problem: One ICU microsystem identified several key contributing factors to nurse burnout, including staffing shortages, limited resources, competing responsibilities within the macrosystem, and insufficient organizational support (Zhang et al., 2025). Baseline survey data of the population observed a prevalence of 50% “high” burnout profiles among …

Increasing Patient Feedback Survey Completions Through Patient-Centered Nursing Communication: A Quality Improvement Project, Lindsey E. Pawlowski

Master's Theses and Capstones

Background: Patient feedback is essential to providing the best possible nursing care. Positive patient experiences can impact overall patient satisfaction, loyalty, and trust.

Local Problem: On a pediatric unit at a New England hospital, an assessment of the microsystem revealed that there was a low number of monthly patient feedback survey completions, which limited insight into patient experiences.

Aim Statement: The primary aim of this project was to increase the number of monthly National Research Corporation (NRC) surveys to ten by June 30, 2026.

Methods: This quality improvement project was guided by the Plan-Do-Study-Act (PDSA) model. The first stage of …

Incorporating Structured Safety Huddles To Improve Nursing Communication And Reduce Medical-Surgical Inpatient Fall Rates: A Quality Improvement Project, Alexia K. Leonard

Master's Theses and Capstones

BACKGROUND: Patient falls are a significant concern for patient safety in the acute care setting and are typically connected to inadequate communication during shift transitions. Bedside shift report is considered the standard of care, however, barriers are still present when shifting patient care responsibilities among nursing staff. A literature review identified standardized safety huddles as an evidence-based practice to improve areas of communication, teamwork, situational awareness, and patient safety. This quality improvement (QI) project concentrated on the implementation of a standardized evening safety huddle in order to improve nursing communication and reduce patient falls on an inpatient medical-surgical/telemetry unit. METHODS: …

Improving Telemetry Alarm Fatigue By Reducing Perception Of Noise Through Education: A Quality Improvement Project, Emma Bergeron

Master's Theses and Capstones

Background: The perception of excess telemetry noise has a negative impact on nursing staff workflow, emotional stress, physical stress, and alarm fatigue. This can create a distressing workplace, interrupt the ability to answer telemetry alarms in an appropriate amount of time, and further worsen alarm fatigue in nursing staff.

Local Problem: The local problem identified was the perception of telemetry noise and alarm fatigue. The purpose of this study was to assess the extent of alarm fatigue and perception of telemetry noise on the unit.

Methods: The study consisted of an assessment of the microsystem itself and the observed impact …

Enhancing Safety And Efficiency In Cardiac Admission Handoffs Through Implementation Of An I-Pass Checklist: A Quality Improvement Project, Soraia D. Barros

Master's Theses and Capstones

Abstract

Background: Effective care handoff is a necessary step for maintaining patient safety during hospitalizations. The goal of this quality improvement project was to improve the completeness of information, particularly cardiac-related, provided by the ED staff to the CSSU nurses. The implementation involved the creation of a cardiac checklist and applying it to the pre-existing I-PASS forms used during asynchronous handoff.

Local Problem: The macrosystem implemented an updated system for handoffs between the ED and CSSU by substituting an over-the-phone report with a faxed I-PASS sheet. The result, as identified by the CSSU staff, is that reports contain undetailed patient …

Promoting Safe And Effective Ciwa-Ar Protocol Adherence On An Inpatient Psychiatric Unit Through An Educational Reference Poster: A Quality Improvement Project, Kenan J. Gray

Master's Theses and Capstones

Abstract

Background: Alcohol withdrawal syndrome (AWS) can progress to seizures, delirium tremens, and autonomic instability. The Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) supports symptom-triggered AWS management, but safe use depends on timely nursing assessment, reassessment, and documentation.

Local Problem: On an adult inpatient psychiatric unit, chart audits identified CIWA-Ar protocol adherence gaps, including missed four-hour assessments and one-hour reassessments after lorazepam.

Methods: This quality improvement project used the Plan-Do-Study-Act model. Three educational reference posters were placed in high-visibility staff areas with QR-linked access to the facility’s AWS protocol and CIWA-Ar scoring guidelines. Outcomes were evaluated using pre- and post-intervention …

A Quality Improvement Initiative: Implementing An Effective Massive Transfusion Protocol Cognitive Aid Tool Within An Operating Room & Post-Anesthesia Care Unit Setting, Jenna L. Farrell

Master's Theses and Capstones

Abstract

Background: Massive Transfusion Protocol (MTP) activations are low-frequency, high-acuity events in the post-anesthesia care unit (PACU) setting.  These events necessitate the rapid formation of codes teams, interdisciplinary communication amongst unfamiliar providers, critical decision-making, high-volume rapid blood transfusions, and critical laboratory marker monitoring.

Local Problem: Due to the infrequent nature of hemorrhagic events in the PACU, nurses may have limited experience participating in these protocols at their institutions, resulting in potential for documentation errors from retrospective back charting, decreased confidence regarding blood product sequencing and laboratory draw timing, and increased cognitive workload overall.  This quality improvement (QI) project implemented …

Improving Nurse Well-Being And Patient Safety Through A Structured Break Buddy System: A Quality Improvement Project, Elizabeth Harrington

Master's Theses and Capstones

Abstract

Background: Nursing burnout has become an increasing concern due to heavy workloads, staffing shortages, and the inability of nurses to consistently take uninterrupted rest breaks during their shifts. Missed breaks contribute to fatigue, emotional exhaustion, decreased job satisfaction, and an increased risk of patient safety events. Evidence suggests that structured break interventions may improve opportunities for recovery during the workday.

Methods: A quality improvement (QI) project was conducted on a respiratory care unit at a midsized hospital in central New Hampshire using the Plan-Do-Study-Act (PDSA) framework. A microsystem assessment identified inconsistent break-taking as a significant gap. A five-question anonymous …

Increasing Nursing Education On Effective Therapeutic Communication For Postpartum Depression: A Quality Improvement Project, Kayley Jade Couture

Master's Theses and Capstones

Introduction
At a nonprofit hospital located in New Hampshire, a 5P assessment was completed to determine a gap in the nursing staff's education on postpartum depression on a labor and delivery unit. Through the use of instructional design, persistent education on postpartum depression shows an overall increase in knowledge resulting in better patient-centered care (Takei, 2023). An important aspect of this quality improvement project was the participation of the nursing staff.

Methods
Using the PDSA framework (Plan-Do-Study Act), registered nurses on a labor and delivery unit participated in a three week quality improvement project to test their knowledge on postpartum …

Overview Of The Ergonomic Model Of Soccer And The Training Process, James J. Collins, Shane Malone, Kieran D. Collins

Research Outputs: 2025-Present

Soccer is a complex sport with significant physical, physiological, psychological, technical, and tactical demands on players. This review presents an ergonomics-based model of soccer performance, emphasizing that no single component operates in isolation. Building on the foundational ergonomic framework, this review integrates contemporary evidence on training load monitoring, ecological dynamics, and cognitive-perceptual performance dimensions not systematically addressed in prior frameworks. Elite outfield players cover 9–14 km·h⁻¹ per match, with high-speed running (19.8–24.8 km·h⁻¹) making up about 20% of total distance and sprinting (>25 km·h⁻¹) around 2%. These outputs vary by playing position, tactical formation, …

Lease Capitalization And Financial Flexibility: An Empirical Investigation Of Asc 842’S Impact On Liquidity In The Us Telecommunications Industry, Caleb J. Martin

Doctor of Business Administration Dissertations

Measures of liquidity are some of the most important financial ratios to analyze when measuring a firm’s overall financial health and its ability to pay both creditors and dividends. The US telecommunications industry is an industry that has become synonymous with dividends, mergers, and acquisitions, all of which are possible due to industry wide and firm specific liquidity. With the implementation of ASC 842 and the new standard of placing operational leases on the balance sheet, additional research may be warranted to determine the effect ASC 842 may have on firm liquidity. This study investigated whether there was evidence to …

Qui Tam Legislation And Article Ii: State Constitutional Precursors To The “Take Care” Clause, Randy Beck

Scholarly Works

Anglo-American legislation since the fourteenth century has often authorized “popular” or “qui tam” enforcement, in which an uninjured “common informer” litigates to collect a forfeiture for violation of a statute. Popular enforcement has become considerably less common than in earlier centuries, but remains important because of the qui tam provisions of the federal False Claims Act (FCA). In Vermont Agency of Natural Resources v. United States ex rel. Stevens, the Supreme Court rejected an Article III standing challenge to qui tam litigation, concluding that the long history of popular enforcement means qui tam suits present cognizable “cases and controversies of …

Workers’ Empowerment As U.S. Trade Policy, Desiree Leclercq

Scholarly Works

U.S. trade policy stands at an inflection point. The Biden administration’s “worker-centered” trade policy promised to empower foreign workers to improve employment and living standards globally, but it linked its trade assistance to political allies. The Trump administration’s “America First” trade policy promises to use tariffs and isolationism to protect and empower U.S. workers, but it is fostering antagonism rather than cooperation in trade. Both policies, while sharply diverging at the edges, recognize that U.S. trade policy affects employment opportunities in the United States. Both policies also critically overlook the relationship between the treatment of workers in trade partner countries, …

Impact Of Social Determinants Of Health On Perioperative And Interstage Outcomes In Congenital Heart Surgery A Systematic Review, Sara Sakowitz, Jennifer S. Nelson, Justin Robinson, Camilla S. Rossi, David M. Shahian, David T. Cooke, Jeffrey P. Jacobs, Shelby Aughtman, Megan Schultz, Meena Nathan, Claude Beaty, Michal Shafer, Deborah Kozik, Glenn J. Pelletier

Department Surgery Faculty Publications

Importance: Social determinants of health (SDoH)- conditions in which patients live, grow, and age, - are increasingly recognized to influence the health of patients with congenital heart disease (CHD).

Objective: To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery.

Evidence Review: A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria …

The Trial Of Socrates, Jonathan K. Van Patten

South Dakota Law Review

In many important ways, the trial of Socrates was not just the trial of the century, nor even the trial of the millennium. It predated the trial of Jesus, which is important for many other reasons, but Socrates’ contribution to how we think about justice and the rule of law is without equal. This Article explores the ways that this fifth-century B.C. trial, located geographically on the margin of what came to be known as the West, is at the center of what makes us a civilization. It is not simply about the drama, nor the politics of free inquiry, …

Protecting Democracy Through Servant Leadership Actions On The Jury Trial System, Laura Anne Rose

South Dakota Law Review

In the face of the declining use of the right to trial by jury, this article argues for more action by members of the legal profession, and specifically action grounded in the principles of servant leadership. The article covers the historic roots of the right to trial by jury before turning to its importance in the areas of civic education, continuing legal education, legislative efforts, and innovative interdisciplinary courses in legal education. The article posits that members of the legal profession in all stages of their careers must defend the right to trial by jury through servant-leader based action in …

Filling The Tribal Court Attorney Need Through Tribes Licensing Their Own Attorneys, Nicholas James Stamates

South Dakota Law Review

The need for attorneys in Indian country to fill the positions of tribal prosecutors and tribal public defenders in criminal cases is dire. There are many postings on jobs sites such as Indeed and Zip Recruiter for tribal prosecutor and tribal public defender jobs in the $60,000 to $90,0000 a year salary range constantly being reposted for months—even years. Simply put, the Tribes cannot fill these positions at the salaries they are willing to pay or can afford due to their rural locations. 2024 data from Bryce Drapeaux & Hannah Haksgaard published in the South Dakota Law Review showcased how …

Deborah Morton Reviews Her Star Pupils, Deborah Morton

Westbrook College Alumni Reminiscences

Notes regarding several  former students collected by Deborah Morton.

A Critical Review Of The Theory Of Planned Behaviour In Tourism Research, Kourosh Esfandiar, Arghavan Hadinejad

Research outputs 2022 to 2026

The Theory of Planned Behaviour (TPB) has received considerable attention across various academic disciplines and remains one of the most widely applied–yet increasingly critiqued–theoretical frameworks in tourism research. Despite its widespread use, there is a notable lack of critical reflection on its adequacy in capturing the complexity of tourist behaviour and a limited exploration of alternative theoretical pathways. This paper addresses this gap by critically evaluating the appropriateness and limitations of the TPB in tourism research. Special attention is given to the Theory of Reasoned Goal Pursuit (TRGP), a recent extension of the TPB, alongside complementary frameworks from parent disciplines …

Strengthening Social Structures To Improve Informal Care For Older People With Chronic Life-Limiting Illnesses In Rural Ghana, Barbara Adonteng-Kissi, Obed Adonteng-Kissi

Research outputs 2022 to 2026

Traditional family-based care for older people in Ghana is declining as globalization and social change weaken historical support systems. This analysis is informed by a review of scholarly literature concerning the implications of globalization for the provision of caregiving for older people managing chronic life-limiting illnesses. We aimed to explore ways of strengthening social structures to enhancing the quality of lives of older people with chronic life-limiting illnesses in rural Ghana amongst 15 older people; 15 family caregivers; 10 healthcare professionals. Critical Social Theory (CST) functions as the primary theoretical framework for conducting an interrogation of the systemic structures that …

Trial Tribulations: Lessons Learned From An Unsuccessful Pilot Trial Of Behavioural Activation In Young People With Early Or Emerging Psychosis At A Regional Mental Health Service, Janina Catalao Dionisio Murta, Bróna Nic Giolla Easpaig, Mitchell K. Byrne, Richard Gray, Martin Jones, David Mitchell, Rebecca Creek, Ellie Brown, Jing Yu Tan, Shaun Dennis, Daniel Bressington

Research outputs 2022 to 2026

AimThe experience of conducting an unsuccessful pilot trial of behavioural activation (BA) to improve depressive symptoms in young clients with early or emerging psychosis is reported on. We aimed to identify barriers and enablers to inform the conduct of future trials with this client group.MethodsClinicians completed BA training with the aim of delivering this to suitable clients. Feasibility outcomes were calculated as proportions of feasibility targets. The various stages of the pilot randomised trial were examined, informed by interviews with five young people with early or emerging psychosis and four clinicians. Interviews were content analysed.ResultsClient recruitment and retention targets were …

Cecil Maxwell Deason Collection, University Of Alabama School Of Law

Manuscript Collections

This collection contains personal papers and photographs from Alabama state trial court judge and assistant solicitor Cecil Maxwell Deason from his times serving in the Pacific theatre of WWII, on the bench in Jefferson county, and in the solicitor's office.