Digital Commons Network^™

Auravena, Isaac Kravatz, Bassem Fayek, Robert Pugliese, Pharmd

Phase 1

Introduction: Over 200 million peripheral IVs are placed annually, serving as critical access points for medications and therapies, yet up to 40% fail on the first attempt. While heat is often used to support IV placement, current methods are insufficient compared to what the literature suggests. Therefore, we asked: how might heat be applied more efficiently and sustainably to improve first-attempt success rates for patients with difficult IV access?

Methods: We began by interviewing nursing staff at an outpatient infusion center, uncovering a significant gap in care for patients with difficult IV access. These insights drove iterative design cycles focused …

Beyond Naloxone: A Human Centered Overdose Response And Education Kit To Destigmatize Opioid Use Disorder For First-Year Medical Students, Hope Friel, Justin Leggin, Madeleine Peele, Donya Zarrinnegar, Abigail Kay, Md

Phase 1

Introduction: Opioid related deaths are a leading cause of death in adults in the United States and Thomas Jefferson University equips each first year medical student (M1) with a box of Narcan at the White Coat Ceremony. Research has shown that there are knowledge and training gaps in M1s and harmful stigmas surrounding drug users. This project examines how we might provide an education-focused opioid overdose response kit and intervention for JeffMD M1s in order to reduce stigma and improve clinical readiness for drug-related emergencies.

Methods: Class of 2029 M1s will take a pre-post survey to capture the baseline level …

Beyond Naloxone: A Human-Centered Overdose Response And Education Kit To Destigmatize Opioid Use Disorder For First-Year Medical Students, Justin Leggin, Abigail Kay, Md, Madeleine Peel, Hope Friel, Donya Zarrinnegar

Phase 1

Introduction: Opioid overdose remains a leading cause of preventable mortality in the United States and is particularly prevalent in Philadelphia. While first-year medical students commonly receive brief training in overdose recognition and naloxone administration, such instruction often overlooks stigma toward people who use drugs(PWUD). Sidney Kimmel Medical College implemented a two-step model in which students received naloxone at their white coat ceremony and later completed a clinical skills–based overdose response session. This study assessed how this training influenced first-year students’ overdose knowledge and attitudes toward PWUD.

Methods: Students completed the Opioid Overdose Knowledge Scale (OOKS; 0–39)and Opioid Overdose Attitudes Scale …

Beyond Naloxone: A Human Centered Overdose Response And Education Kit To Destigmatize Opioid Use Disorder For First-Year Medical Students, Madeleine Peel, Justin Leggin, Hope Friel, Donya Zarrinnegar, Abigail Kay, Md

Phase 1

Introduction: Over 1,413 unintentional opioid-related deaths occurred in Philadelphia in 2022,indicating a public health crisis. Medical students can assist in overdose responses, driving our question: how might we provide an education-focused opioid-overdose response kit for first-year JeffMD students to reduce stigma and improve clinical readiness for opioid-related emergencies? We hypothesize that a naloxone kit with educational materials will improve preparedness and empathy and reduce stigma toward people who use drugs (PUD) compared with standard naloxone training.

Methods: A needs assessment was conducted among first-year JeffMD’s class of 2029 using pre- and post-surveys administered before and after a naloxone training. Surveys …

Beyond Naloxone: A Human Centered Overdose Response And Education Kit To Destigmatize Opioid Use Disorder For First-Year Medical Students, Donya Zarrinnegar, Justin Leggins, Madeleine Peel, Hope Friel, Abigail Kay, Md

Phase 1

Introduction: The opioid crisis remains a leading cause of accidental death among U.S. adults under 45. Yet, medical education often inadequately prepares trainees to recognize overdoses, administer naloxone, or provide stigma-free care for people who use drugs (PWUD). These gaps contribute to reduced treatment engagement and underutilization of lifesaving interventions. This project examined whether an education-focused opioid overdose response intervention for first-year JeffMD students (Class of 2029) reduces stigma and improves clinical preparedness for drug-related emergencies.

Methods: We administered a baseline survey prior to the White Coat Ceremony and a follow-up survey after a naloxone training. Surveys incorporated validated instruments, …

Chiefcomplaint: An Ai Based Application For Self Regulated Learning And Practicing Clinical Skills, Said Omer Sadat, Jeffrey Ratliff, Md

Phase 1

Introduction: As a constantly evolving field, medicine is prone to change with acquisition of new knowledge and information. As such, medical learners are obligated to practice Self-Regulated Learning (SRL); being behaviorally, metacognitively, and motivationally proactive in the learning process. With this project, we attempt to explore the use of AI as a tool to mimic clinical encounters and advance SRL.

Methods: Python was used to build an application that stimulates patient interactions under guidance of an instructor. Written case scenarios and AI instructions were parsed, chunked and stored into vectors using LangChain. To facilitate the clinician-patient interaction, OpenAI’s ChatGPT-4o-mini was …

Designing A Multilingual Instructional Language Tool For Patient Communication In Interventional Radiology, Samuel Almodóvar, Ahlam Houssein, Gregg Khodorov, Md, Mba, Sahib Sohal, Md, Robert Pugliese, Pharmd, David Dwyer, Md

Phase 1

Introduction: Current efforts to provide language-inclusive radiological care fall short, resulting in suboptimal imaging, increased procedural time, and greater radiation exposure. Inadequate language accessibility results in poor communication, suboptimal care, and increased patient dissatisfaction. A digital language tool was developed to provide patient instructions during interventional radiology (IR) procedures, addressing this gap and enhancing patient care.

Methods: Observations were carried out to better understand workflow during IR procedures and identify how to incorporate the tool. We conducted interviews with IR physicians, nurses, and technologists to gather common procedural phrases and patient instructions. Spanish and Mandarin were selected because they are …

Aura Vena, Bassem Fayek, Isaac Kravatz, Robert Pugliese, Pharmd

Phase 1

Introduction: Peripheral intravenous (IV) access remains a common problem faced across healthcare, leading to significant healthcare losses in terms of working hours, resources, as well as patient pain and discomfort. At Thomas Jefferson University Hospital’s (TJUH) infusion center, many healthcare workers utilize hot towels and disposable heat packs to warm patients’ arms if IV access is difficult- a wasteful solution that provides limited heating.

Methods: Nurses at TJUH’s infusion center were interviewed to define the problem and identify optimal product requirements for healthcare workers. In conjunction with market research, a heat-warming sleeve is designed and created. The design of the …

Patient Perceptions Of Medicare Annual Wellness Visits: Findings From A Pilot Survey, Payton Mccready, Amy Cunningham, Susan Parks

Phase 1

Purpose

Medicare Annual Wellness Visits (AWVs) were introduced in 2011 to promote preventive care among Medicare beneficiaries, yet patient satisfaction remains understudied. Participating in the  Age-Friendly Health Systems Initiative, Jefferson Health’s Center for Healthy Aging (CHA) is redesigning its AWVs to align with Age-Friendly principles. This study aimed to obtain baseline data on Medicare patients’ familiarity, experience, and satisfaction with AWVs in a geriatrics practice before implementing the redesigned model.

Methods

This cross-sectional survey was conducted in July 2025 at Jefferson Health’s CHA, a geriatrics practice serving about 2,000 Medicare patients. Eligible participants were Medicare-enrolled CHA patients. An eight-item survey …

The Effect Of Prior Work And Educational Experience On Medical School Small Group Case-Based Learning, Alexandra Kelleher, Alisa Losasso, Md

Phase 1

Purpose

Medical students have varied academic and professional backgrounds, many taking gap years in healthcare or research before matriculation. Prior studies suggest these experiences may reduce burnout, enhance patient skills, and improve teamwork capabilities, but their impact on early case-based learning (CBL) performance and perceived comfort level is unclear. This study explores how prior healthcare and research experience influence perceived preparedness and participation for first-year medical students in CBL at SKMC.

Methods

This mixed-methods study was conducted among 66 rising second-year JeffMD students. Participants completed an online 15-item survey assessing undergraduate background and self-reported confidence in CBL. Ten students were …

Understanding The Benefits Of Sustainable Ir Fellowship To A Large Public Hospital In Kenya, Abigael Gebremariam, Kevin Anton

Phase 1

In 2021, Kenya had 10 interventional radiologists for a population of about 54 million. RAD-AID, a non-profit organization improving global radiology, partnered with the University of Nairobi and Kenyatta National Hospital to establish the first IR fellowship program in Kenya in 2021. Through the program, the number of practicing IRs in Kenya has nearly doubled; however, their practice is limited by capital and supply resources. This study will demonstrate the benefit of the program to the hospital system and the patient population in Kenya.

The project employed a retrospective and comparative analysis of IR services at a large public hospital …

Patient Characteristics Associated With Telehealth Use In A Large Federally Qualified Health Center, Priyanka Gautom, Cara L. Eckhardt, Lisa K. Marriott, Cirila Estela Vasquez Guzman, Gloria D. Coronado

OHSU-PSU School of Public Health Faculty Publications and Presentations

The COVID-19 pandemic rapidly expanded telehealth services when in-person care was limited. Using primary care data from a large federally qualified health center in Washington state, this study aimed to: 1) describe trends in telehealth use among adult patients, and 2) provide disaggregated patient characteristic data associated with telehealth use, with a focus on patients speaking Asian Indian languages.

Association Between Environmental Exposures To Perfluoroalkyl And Polyfluoroalkyl Substances And Military Veterans Cancer Determination, Stephen A. Pereira Jr

Walden Dissertations and Doctoral Studies

This study involved evaluating whether cumulative exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) was associated with kidney cancer, bladder cancer, and adult leukemia among U.S. veterans. Pooled National Health and Nutrition Examination Survey (NHANES) data from 2005–2015 were analyzed for sample of 2,500 veterans with available serum PFAS measurements and physician-diagnosed cancer histories. This study employed a cross-sectional, correlational design grounded in a post-positivist paradigm. Inclusion required complete data for (a) serum PFAS concentrations, (b) kidney cancer, bladder cancer, and adult leukemia, and (c) covariates age, sex, race/ethnicity, smoking status, and body mass index. Cumulative PFAS was modeled as a …

Staff Education To Improve Antipsychotic Medication Adherence, Okikiola Oluwabunmi Ogunbunmi

Walden Dissertations and Doctoral Studies

Non-adherence to antipsychotic medication among patients with schizophrenia and other severe mental illnesses is a critical issue, contributing to high rates of relapse, rehospitalization, and increased healthcare costs. Despite the necessity of these treatments, patients often struggle with compliance due to lack of insight, side effects, or complex regimens. The project aimed to evaluate how structured staff education interventions increase knowledge and confidence among healthcare providers, regarding medication adherence strategies, including the use of Long Acting Injectable (LAI) antipsychotics and the “teach-back” methods. Staff education programs typically utilize evidence-based tools, pre-and post-intervention assessments, and training sessions to enhance knowledge on …

Survivors Of Sexual Trauma: Abortion Experiences Of Black Women In The Southern United States, Katie Grace Geter

Walden Dissertations and Doctoral Studies

Women who experience both sexual trauma and abortion within their lifetime are highly likely to struggle with serious mental health symptoms; however, social work students and practitioners lack education and knowledge on how to serve these women. Recent events, including the uprising of gender and race related movements, COVID-19, heightened political division, and increased governmental control on abortion rights also impact social-work practice. Acknowledging intersectionality, the purpose of this qualitative study was to explore the experiences of abortion for Black women in the Southern United States who have a history of sexual trauma. The experiences of 6 Black women with …

The Relationship Between Medical Mistakes, Organizational Culture, And Patient Safety In South Florida Hospitals, Tachaumbi Lamaya Williams

Walden Dissertations and Doctoral Studies

The present study investigated the relationship between safety-promoting management structures and medical errors in South Florida hospitals. The purpose of the study was to determine if safety-promoting management frameworks reduce medical errors. Using Donabedian’s model, the main research question focused on whether specific organizational management systems are significantly associated with the frequency and severity of medical mistakes in these hospitals. Using a quantitative, cross-sectional research design, the study analyzed secondary data, initially collected by Leapfrog group. Data analysis involved descriptive statistics to profile the sample’s demographics and baseline characteristics, followed by inferential statistical tests to assess the primary hypothesis. Findings …

Staff Education To Improve Knowledge On Early Recognition Of Staff Burnout In Nurses Working In Long-Term Care, Geraldine Ndeng Akonwah

Walden Dissertations and Doctoral Studies

This doctoral project was a practice-based staff education project aimed at educating nurses concerning early burnout recognition. The educational intervention was chosen to promote awareness and knowledge related to the concept of burnout and self-care among nurses employed in a long-term care facility. The practice problem addressed was the high prevalence of nurse burnout and the limited ability of nurses to recognize early signs of burnout. The problem is significant in nursing practice as burnout is detrimental to the clinical judgment, patient safety, job satisfaction and staff retention. The guiding question of the project was as follows: Does a staff …

Understanding Reporting Decisions: Qualitative Exploration Of Hate Crime Underreporting Among Minority Transgender Individuals, Shanise Anita Benitez

Walden Dissertations and Doctoral Studies

Minority transgender individuals experience disproportionately high rates of hate‑motivated violence, yet these incidents remain substantially underreported. This qualitative study examined the social, structural, and identity‑based factors that influence reporting decisions among minority transgender adults in the United States. Guided by Bandura’s social learning theory and Crenshaw’s intersectionality theory, the study examined how participants’ lived experiences, community-based observations, and intersecting marginalized identities influence their perceptions of safety, trust, and institutional legitimacy. Semi‑structured interviews with minority transgender participants were analyzed using thematic analysis to identify patterns related to reporting behaviors, community‑driven coping strategies, and barriers to formal engagement with law enforcement. Findings …

Faculty Perceptions About The Challenges Of Declining Enrollment In A Caribbean University, Courtney Palmer

Walden Dissertations and Doctoral Studies

The precipitous decline in enrollment is a concerning aspect of higher education. The problem addressed in this study was that faculty members at a local university on a Caribbean island have faced an approximate 44% reduction in student enrollment over the past six years. Guided by the new learning compact framework (NLC), the purpose of this basic qualitative study was to explore industrial technology lecturers' perceptions from one Caribbean Island university about the challenges they experience from declining enrollment and examine their suggestions to improve enrollment. Twelve lecturers with tertiary-level teaching experience at the institution were interviewed using semi-structured interviews. …

Emergency Nurses’ Perspectives On Workload, Stress, And Violence In The Context Of The U.S. Nursing Shortage, Wanda Marie Haynes

Walden Dissertations and Doctoral Studies

The nursing shortage is a critical global issue that significantly impacts emergency nurses (ER), leading to increased workloads, psychological stress, and heightened exposure to workplace violence (WPV). This phenomenon raises concerns among healthcare administrators and nurse leaders who seek strategies to improve retention and ensure quality patient care. The purpose of this qualitative study was to explore the meaning of workload, stress, and WPV among ER nurses during the U.S. nursing shortage. Guided by Herzberg’s two-factor theory, the study employed a phenomenological approach to capture nurses’ lived experiences. Data were collected through semi-structured interviews with eight ER nurses from diverse …

Understanding Interventions For Generational Trauma From The Experienced Counselors’ Perspective, Christina Ann Cartagena

Walden Dissertations and Doctoral Studies

Healing generational trauma involves counselors’ understanding and recognizing the symptoms of unhealthy coping mechanisms in adults who witnessed adverse emotional reactions as children. Generational trauma occurs when generations have trouble building healthy relationships and pass unhealthy coping mechanisms to future generations. There has been a reported increase in youth and adults seeking mental health services for generational trauma. The problem was that there was insufficient information about how counselors recognize and respond to the symptoms of generational trauma or what treatment methods or modalities to use to support patients. The purpose of this generic qualitative study was to explore the …

Group Antenatal Care Model As An Innovative And Sustainable Maternal And Child Health Service Delivery In A Northern Nigerian State, Pius I. Christopher-Izere, Abiola Ajibola, Abimbola Phillips, Dorcas Magbadelo, Ibidun Jolaoso, Obioma Azurunwa, Francis Ogirima, Collins Imarhiagbe, Anthony Onwuegbusi, David Udanwojo, Emmanuel Udeh, Victor Obagunlu, Adebola Adekogbe, Sunday Joseph, Hamza Abubakar, Neyu Iiyasu, Adetosoye Adebanjo, Barlarbe Gaya, Olayiwola Jaiyeola, Damilola Olaniyan, Bankole Olatosi Ph.D., Deborah Lynn Billings Ph.D., Et. Al.

Faculty Publications

The maternal and child health situation in developing countries remains critical and deeply concerning, These regions account for 99% of global maternal and under-five deaths. In Nigeria, uptake of critical life-saving maternal, neonatal and child health (MNCH) services, delivered through antenatal care (ANC), are sub-optimal, leading to poor outcomes. Group antenatal care (G-ANC) is an evolving antenatal care delivery model in low and medium-income countries. G-ANC models can improve quality and uptake of maternal health services.G-ANC model was implemented across 255 primary health facilities (PHFs) to ensure pregnant women receive components of a well-defined package of MNCH services at regular …

Sexual And Gender Minority Nurses’ Minority Stress In The Workplace: A Scoping Review, Justin Chavis, Robin Dawson Phd, Rn, Cpnp-Pc, Faan, Liam C. Hein

Faculty Publications

Background

Purpose

Methods

Final Repository Siting Study (Rss) Detailed Evaluation And Recommendations Report, Atlantic Richfield Company, Butte Silver Bow

Silver Bow Creek/Butte Area Superfund Site

No abstract provided.

The Politics Of Territorial Resistance To Federal Authority: Distinctiveness, Partisanship, And Outbidding In Texas And Alberta, André Lecours, Alexandre Couture Gagnon, Daniel Béland

School of Political Science, Public Affairs, Legal and Security Studies Faculty Publications

Federalism involves political struggles around the territorial division of powers. Typically, these struggles tend to occur when the federal government seeks to act in areas of constituent unit jurisdiction. Yet, recent political developments in Texas (Operation Lone Star) and Alberta (Alberta Sovereignty in a United Canada Act) have showcased state/provincial governments seeking to reject federal legislation within seemingly federal jurisdictions. This article develops an explanation for these initiatives that emphasizes regionalism as a form of territorial politics, the partisan dynamics between the state/provincial government and its federal counterpart, and the internal competition within the dominant political …

Human Capital And Labor Market Effects Of Elite Schooling In England, Scotland, And Wales: New Causal Evidence From Nonparametric Bounds, Zhanhan Yu, Vikesh Amin, Carlos A. Flores, Alfonso Flores-Lagunes, Giuseppe Germinario

Upjohn Institute Working Papers

We estimate the causal effect of attending elite schools in England, Scotland, and Wales on human capital and labor market outcomes for cohorts of children from the 1958 National Child Development Study and the 1970 British Cohort Study. For identification, we employ a nonparametric partial-identification approach that provides bounds on the causal effect by assuming that, on average, there is positive selection into elite school attendance, and that attending an elite school does not worsen average potential human capital or labor market outcomes. The bounds indicate that there could possibly be large education and labor market returns from attending an …

“My Heart Was In My Stomach”: Texas-Based Obstetricians’ And Gynecologists’ Experiences Post Anti-Abortion Legislation, Chelsey Kanipe, Precious Chiamaka Anunobi, Anupria D Davenport, Sheryl A Mccurdy, Marie A Brault

Faculty, Staff and Student Publications

Background

The purpose of this study is to investigate the downstream effects of anti-abortion legislation on the practice of obstetrics and gynecology in urban Texas.

Methods

We conducted semi-structured interviews until saturation with eleven obstetricians/gynecologists (OBGYNs) to explore the effects of Texas’s abortion laws. Analysis consisted of inductive and deductive approaches.

Results

We identified three main themes regarding the downstream effects of Texas abortion laws: the conflicting role of colleagues as a support system and a source of frustration and distrust for OBGYNs, the lowered standard of care for those with a desired pregnancy, and concerns that anti-abortion legislation will …

Mental Health Impacts Of Racism And Limited Diversity In Christiansburg, Virginia, Shuchi Sanyal

Selected Social Change Portfolios in Prevention, Intervention, and Consultation

Goal Statement

In this portfolio, I identify and address the prevention needs of racially and ethnically marginalized adolescents in Christiansburg, Virginia, examining how racism and limited diversity affect mental health and proposing culturally responsive, developmentally appropriate prevention strategies.

Significant Findings

Adolescents of color in predominantly White, semi-rural communities face racial isolation, microaggressions, and limited culturally responsive supports, increasing risk for anxiety, depression, and identity-related distress. Using a social-ecological framework, findings show that individual vulnerability is influenced by school climates, relationships, and community norms that may minimize racialized experiences. Protective factors include relational safety, identity affirmation, mentorship, and trauma-informed practices. Evidence-based …

The Evaluation Of Therapeutic Communication In Competency Based Nursing Education, Tracy J. Perron, Chelsea Lebo, Mary Louise Thomas, Romy Zemer

Creating Healthy Work Environments (CHWE)

Therapeutic communication is an essential part of nursing care. Therapeutic communication (TC) is the process of using verbal and nonverbal communication to connect with patients.TC is holistic, patient-centered and involves aspects of the physiological, psychological, environmental and spiritual care of the patient. Poor communication in the healthcare setting can lead to poor patient outcomes such as, decreased adherence to treatment, patient's dissatisfaction, inefficient use of resources and even death. Studies have shown that nurses lack communication skills due to a variety reasons from inadequate training, the lack of understanding of the importance of patient-centered communication, and the increased generational use …

What Is Your Preference? Creating A Healing Culture Through Employee Feedback, Julia W. Millspaugh, Mildred Ortu Kowalski, Sunnie A. Mortimer, Catherine C. Errico

Creating Healthy Work Environments (CHWE)

Stress levels are high for healthcare employees. The negative impact of employee burnout is well-documented within healthcare (Shanafelt et al., 2020; U.S. Department of Health and Human Services Office of the U.S. Surgeon General, 2022). A healthy work environment that optimizes the health and wellbeing of nurses is paramount to providing quality care to patients (Mabona et al., 2022). There is an immediate need for brief, feasible, and rapidly scalable interventions while at work to promote wellbeing for our healthcare workers (Putrino et al., 2020). There is no singular tool or one-size-fits-all approach that holds the answer to wellbeing. Wellbeing …