Digital Commons Network^™

Utilizing The Patient Health Questionnaire In A Family Practice Clinic To Enhance Clinical Benchmarks, Dorothy Akaeze

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: About one-third of the 129 million chronically ill patients in the United States experience persistent depressive symptoms. Approximately 300 of 500 (60%) chronically ill patients treated at the project site each month show signs of depression, indicating a higher prevalence than the national rate of 33.33%. Despite the critical role of family practice in identifying and managing depression, many patients are not adequately screened, leading to missed opportunities for early diagnosis and treatment. The project site does not use the digitized PHQ screening tool to screen patients for depression. An analysis of patient charts revealed that, out of about …

The Impact Of A Nurse Navigator On The Completion Of Medicare Annual Wellness Visits, Nanette L. Snyder

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Despite being a covered service designed to support individualized prevention planning, the Medicare Annual Wellness Visit (MAWV) remains underutilized at a rural Federally Qualified Health Center (FQHC). Barriers include low patient awareness, inconsistent outreach, and a reactive scheduling process that excludes patients without upcoming appointments. These issues limit the FQHC’s ability to meet preventive care goals and sustain performance in value-based reimbursement models.

Aim of the Project: This quality improvement project evaluates the impact of implementing a nurse navigator on MAWV completion. The intervention incorporates proactive scheduling and cohort engagement to address barriers related to awareness, access, and outreach. …

Evidence-Based Pain Management Bundle For Pediatric Postoperative Orthopedic Patients, Samantha Firmstone

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Postoperative pain management in pediatric orthopedic patients is often inconsistent due to variability in provider practices and a lack of standardized protocols. At a Central Texas pediatric orthopedic clinic, all patients received opioid prescriptions post-knee surgery regardless of procedure severity, leading to frequent caregiver calls for clarification. This practice revealed a critical gap in preoperative education and multimodal pain management strategies, contributing to patient safety concerns and increased clinic workload.

Aim of the Project: The primary aim of the project was to improve pain control, reduce opioid reliance, and decrease postoperative pain-related follow-up calls by implementing a standardized, evidence-based …

Improving Hospital Throughput Through Flash Rounds And Standardized Discharge Readiness Assessments, Erin D. Dobda

All Doctor of Nursing Practice (DNP) Scholarly Projects

• Problem: The target hospital faced serious throughput challenges, with emergency department overcrowding and discharge inefficiencies impacting patient outcomes and organizational performance. Discharge order to depart times exceeded the 90-minute benchmark, averaging 154 minutes, while 41.2% of patients exceeded the geometric mean length of stay (GMLOS) target of 40.17%. Gaps included inconsistent discharge planning, poor communication, and limited follow-through on barriers.
• Aim of the Project: The project aimed to improve hospital throughput by reducing GMLOS and discharge order to depart times on Unit A. This was achieved through implementation of proactive, evidence-based interventions to streamline discharges, reduce delays, and support safe …

Implementing The Patient Health Questionnaire-2 To Improve Referral Rates To Mental Healthcare Through Routine Depression Screening, Kelly Murakata

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Primary care settings often encounter patients with depression symptoms, characterized by feelings of sadness, lack of interest in activities, and functional impairment, impacting quality of life. At the project site, the PHQ-9 was only used during annual or new patient visits, resulting in low screening rates of 12% and a 33% referral rate. The lack of routine screening led to missed opportunities for mental health referrals and detection of depression.

Aim of the Project: The aim of the project was to increase mental health referral rates through early identification of depression symptoms by implementing routine PHQ-2 screens.

Review of …

Improving Depression Screening For Young Adults In Outpatient Settings, Addie Smith

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Depression among young adults aged 25 to 35 years in the United States has been among the second highest at 19.9%. Depression underdiagnosis stems from many patient-level causes, including a lack of standardized screening, inadequate provider education, and stigma of mental illness. Untreated depression results in low quality of life, comorbidities, suicidality, and socioeconomic issues.

Aim of the Project: The aim of this project was to address the gap in practice by implementing a standardized screening process for young adults to enhance diagnoses and increase screening rates.

Review of the Evidence: A comprehensive review of the evidence …

Improving Colorectal Cancer Screening Referrals In A Rural Health Clinic, Kysha Mcbee

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Colorectal cancer is the second leading cause of cancer death in the United States. Preventive screening for colorectal cancer has been associated with early detection and improved 5-year survival rates. The referral rates for colorectal cancer screening at the practicum site were 17.7%, well below the national benchmarks of 71.8%.

Aim of the Project: The aim of this project was to increase the screening referral rates in adults aged 45 to 75 years by 50% over a ten-week period by implementing an evidence-based toolkit.

Review of the Evidence: Literature review highlighted barriers to colorectal cancer screening, such as knowledge …

Optimizing Pressure Injury Prevention: Implementation Of The Sskin Bundle In Acute Care, Joycelyn Mccall

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Hospital-acquired pressure injuries (HAPIs) contribute to increased morbidity, extended hospitals stay, and significant healthcare costs. At the project site in northwest, Indiana, HAPI rates averaged 6.29%, which significantly higher than the national benchmark of 2.24%. Inconsistencies in documentation, a lack of standardized preventive practices, and variable staff engagement contributed to these increased rates. Despite the use of the Braden Scale, staff inconsistently implemented preventive interventions.

Aim of the Project: The aim of the project is to reduce HAPI incidence by 30% over 10 weeks by implementing the surface, skin inspection, keep moving, incontinence/moisture management, and nutrition (SSKIN) bundle and …

Reducing Emergency Department Length Of Stay, Chelsea Zigan

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Rising Emergency Department (ED) volumes and Registered Nurse (RN) shortages have led to overcrowding, delayed care, and inefficiencies. In 2023, patient visits exceeded budget projections by 14% for six months. From July to December 2024, discharged patients’ average ED length of stay (LOS) exceeded the three-hour target by over one hour, left without being seen (LWOBS) rates surpassed the 1% benchmark for five months, and diversion hours increased, restricting ambulance admissions. These issues strained nursing resources, reduced care quality, and heightened risks of complications and financial losses, emphasizing the need for a redesigned care model to optimize staff roles …

Improving Medication Nonadherence In Clients With Attention Deficit Hyperactivity Disorder Using Medication Reminder Applications, Christian Durand

All Doctor of Nursing Practice (DNP) Scholarly Projects

At an outpatient clinic in Southern California, a 77% medication adherence rate was observed in August 2024 among clients with ADHD. Medication nonadherence in ADHD clients may result in difficulty reaching therapeutic levels, leading to adverse outcomes, such as family disruptions, substance addiction, injuries, criminal occurrences, and even suicide. The project aims to reduce the number of ADHD clients who are noncompliant with their medications and surpass the national benchmark of 80% medication adherence. Evidence has suggested that MRAs may improve medication nonadherence among ADHD clients. Current research has supported the use of MRAs for various chronic diseases including diabetes …

Implementing An Evidence-Based Transitional Care Toolkit To Reduce Postpartum Readmissions In Women With Chronic Conditions, Cassidy La Fleur

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Postpartum women with preexisting chronic conditions are at increased risk of hospital readmissions due to fragmented care transitions and poor follow-up adherence. At the project site, the 30-day postpartum readmission rate was 10%, exceeding the national benchmark of 7.15%. Gaps in standardized discharge planning and limited patient engagement were identified as contributing factors.

Aim of the Project: The aim of this quality improvement (QI) project was to reduce 30-day postpartum readmissions in women with chronic health conditions by implementing an evidence-based transitional care toolkit within a women’s outpatient clinic.

Review of the Evidence: Evidence supports the use of structured, …

Improving Provider Documentation For Procedure Authorizations: A Nursing Perspective On Enhancing Outcomes And Compliance, Juli Legg

All Doctor of Nursing Practice (DNP) Scholarly Projects

Insurance denials resulting from non-standardized documentation and communication gaps in the prior authorization process adversely impacted financial performance and patient care within the electrophysiology (EP) department of a large Midwest academic medical center. High denial rates for costly procedures revealed a need for improved alignment with payer medical necessity criteria. This quality improvement (QI) project aimed to enhance provider documentation, reduce denials, improve care delivery, and increase revenue by implementing standardized documentation templates. A review of the literature supports that standardized documentation and clinical decision support tools enhance consistency, reduce errors, and improve prior authorization success rates. Guided by the …

Integrating Kangaroo Care Into Cesarean Delivery Practices: A Pathway To Enhanced Health Outcomes, Julia Swords

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Cesarean deliveries often interrupt early mother-infant bonding, delaying the initiation of breastfeeding and limiting opportunities for skin-to-skin contact. Despite national guidelines promoting immediate postpartum contact, cesarean-born infants receive kangaroo care (KC) at significantly lower rates than those born vaginally. Prior to this project, only 2% of cesarean births at the project site received KC, highlighting a significant gap in care delivery.

Aim of the Project: The aim was to evaluate the feasibility and impact of implementing kangaroo care during cesarean deliveries in a community hospital to improve neonatal outcomes and adherence to evidence-based postpartum practices.

Review of the Evidence: …

Preventing 30-Day Rehospitalization In Congestive Heart Failure Utilizing Transitional Care Teams, Esther Baminrin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Congestive Heart Failure (CHF) continues to be a prevalent and challenging health issue, contributing significantly to hospital readmissions within the first 30 days of patients transitioning to home health care. Rehospitalization affects the patient's quality of life and the agency's revenue, as reimbursements are paused when patients are hospitalized during the first 30 days of admission to a home health agency. The agency experienced a 22% rehospitalization rate within a year, slightly higher than the national average of 10%.

Aim of the Project: The primary objective of this project was to decrease rehospitalization of patients with CHF within the …

Fall Prevention In Long-Term Care, Steven Zissler

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls among older adults residing in long-term care facilities continue to rise, resulting in injuries that contribute to adverse outcomes, a reduced quality of life, and increased healthcare costs. Despite existing safety interventions, falls persist, indicating a gap in effective, sustainable fall prevention strategies. Repeated failures to reduce falls among adults aged 65 years and older highlight the need for a structured, evidence-based approach aimed at addressing this critical patient safety issue.

Aim of the Project: The aim of this project was to reduce falls and fall-related injuries by 25% for older adults residing in a long-term care facility …

Reducing Catheter-Associated Urinary Tract Infections In The Intensive Care Unit, Rosa Shiffman

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections in intensive care units (ICUs), contributing to increased morbidity, prolonged hospital stays, and elevated healthcare costs. Despite established prevention guidelines, inconsistent practices in catheter removal and gaps in daily necessity reviews persist. At the project site’s 24-bed ICU, the CAUTI rate was 1.9 per 1000 catheter days, which exceeds the national benchmark of 1.0. Gaps in consistent assessment of necessity and delays in removal contributed to an elevated infection risk.

Aim of the Project: This project aimed to reduce CAUTI rates in the ICU through evidence-based interventions …

Effect Of Standardized Phone Call Protocol On The Achievement Of Target Hba1c Levels, Felicia Choyce

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem:

Type 2 Diabetes Mellitus is a common chronic illness with far-reaching health and financial consequences. At the project’s primary care clinic, the average hemoglobin A1c among adults with Type 2 Diabetes Mellitus was 9.6%, exceeding the recommended clinical goal of less than 7% (American Diabetes Association, 2023). The absence of a standardized follow-up protocol and inconsistent use of health literacy-based communication contributed to persistent hyperglycemia and failure to reach target HbA1c levels. These factors indicated an urgent need for an evidence-based intervention.

Aim of the Project:
The aim of this project was to reduce HbA1c levels among adults with …

Celebrity Politics: Construction And Validation Of A Scale To Measure The Political Influence Of Celebrities, Azmat Rasul, Donghee Shin

All Works

This study develops and validates the Political Influence of Celebrities Scale (PICS), designed to assess how entertainment celebrities influence young adults’ political attitudes and behaviors. Drawing on survey data collected from 498 university students in the United States, we applied exploratory and confirmatory factor analysis to test the scale’s structure and psychometric validity. The results support a three-factor model consisting of general attitudes toward celebrities, enjoyment of celebrity-centered political content, and behavioral outcomes such as political discussion and participation. Each subscale demonstrated strong internal reliability (Cronbach’s α ≥ .79). The PICS provides a theoretically grounded and empirically supported measure to …

The Indian Pharmacopoeia: Enabling Open Access And Crafting A ‘Sovereign Function Exception’ For Government Works, Aparajita Lath

National Law School Journal

Standardisation of drugs and access to such standards are important levers for effective drug regulation. The Indian Pharmacopoeia, the official book of standards for drugs in the country prescribed by the Union government under the Drugs and Cosmetics Act 1940, are legally binding and enforceable. Not only do the standards have the force of law but are also government-created. The Indian Pharmacopoeia Commission (IPC), a division of the Union Department of Health and Family Welfare, has a legal monopoly over creating and publishing this compendium. Though it is legally binding, the Indian Pharmacopoeia is neither in the public domain …

The Procedural Architecture Of Climate Justice: Comparative Lessons From Regional Human Rights Courts, Indira Boutier

National Law School Journal

Climate change, once narrated through scientific data and economic costs, is now unavoidably framed as a question of rights and justice. This article examines how litigation before the African, European, and Inter-American human rights courts makes the procedural dimensions of climate justice visible. Procedural justice here is understood capaciously and includes not only rules of access, standing, and evidence, but also the recognition of corporations as duty bearers in transnational accountability regimes. A comparison of the three regions shows how colonial legacies, institutional architectures, and political economies shape the channels through which communities can contest climate harm. Litigation emerges less …

Operationalising The Social Licence To Operate Along The Belt And Road: The Case For A Mediation-Focused Approach, Mark Mclaughlin

Research Collection Yong Pung How School Of Law

This article examines the intricate dynamics of community representation and stakeholder influence in the realm of international investment law. More specifically, it considers the most effective method by which to operationalise the concept of the ‘social licence to operate’ when attempting to resolve investor-state disputes. By utilising disputes relating to China’s Belt and Road Initiative as a case study, it is shown that the social impact of foreign investment projects is often a catalyst for arbitration claims. Community interests are insufficiently represented at the stage of procurement or admission of investment, which has led to violent clashes between investors and …

The Answer To Perimenstrual Distress Is Not Automatically Prescription: Review Of Allopathic And Integrative Approaches To Mental Health Care For Pms & Pmdd Symptoms, Grace Oja

University Honors Theses

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) affect a notable percentage of people who menstruate. PMS/PMDD have a wide range of symptoms that negatively impact mental well-being and quality of life. This review is the culmination of a database search to review current allopathic treatments for PMS/PMDD, which often include oral contraceptives and antidepressants, and explore evidence-based methods for integrative and alternative treatments to address some of the limitations of standard allopathic care, including limitations on which symptoms they address and side effects. This paper aims to examine how integrative medicine may expand existing treatments for PMS and PMDD …

Level Of Awareness About Diabetic Retinopathy And Eye Checkup Practice Among Type 2 Diabetic Patients Attending Baghdad Teaching Hospital 2023., Ali Olaiwei, Mohammed Ibrahim

Iraqi Postgraduate Medical Journal

Background: Diabetic retinopathy is a common and serious complication of diabetes that can lead to vision loss or even blindness if not detected and treated early. However, some people may not have any symptoms until the condition is advanced. Therefore, regular eye exams with dilated pupils are recommended for people with diabetes to check for signs of diabetic retinopathy and other eye problems regardless of the symptoms.Objectives of the study: To measure patients’ awareness and practices regarding diabetic retinopathy, to detect the barriers for eye screening and receiving eye check-up, and to find if there is any association between level …

Intracerebral Hemorrhage In Covid-19: A Case Series Study, Naqa'a Al-Zubaidi, Hasan Al-Hamadani

Iraqi Postgraduate Medical Journal

Background:SARS-CoV can cause dysfunction of multiple organs and systems. Cardiovascular complications after COVID-19 have now been reported very often but the knowledge of neurovascular complications especially Intracerebral hemorrhage is undetermined. Aim of the study: To describe the natural history of acute Intracranial Hemorrhage (ICH) in COVID-19 patients.Patients and Methods:A case series study was performed at Al-Imamain Al-Kadhimain medical city and Saad Alwitry Hospital for Neuroscience in 2021.Result: Twenty patients with ICH were included in this study, 12 (60%) participants were males while females were 8 (40%) participants with mean age of 54.38±10.51 years; 10 (50%) patients had high systolic & …

Persistent Imbalance: Women’S Representation In North American Pediatric Cardiology Leadership Roles.Persistent Imbalance: Women’S Representation In North American Pediatric Cardiology Leadership Roles, Alaina K. Kipps, Audrey C. Marshall, Neha Bansal, Holly Bauser-Heaton, Nadine Choueiter, Devyani Chowdhury, Aarti Dalal, Molly Ehrlich, Lindsay R. Freud, Supriya S. Jain, Pei-Ni Jone, Kristin Laraja, Dalia Lopez-Colon, Sonal T. Owens, Christina Ronai, Ritu Sachdeva, Corey Stiver, Nicole Sutton, Terrie Vasilopoulos, Jennifer Co-Vu

Department of Pediatrics Faculty Papers

BACKGROUND: Despite recent gender parity of physicians entering pediatric cardiology, representation of women leaders lags their male colleagues.

OBJECTIVES: We sought to better understand the variation in women in leadership roles in pediatric cardiology.

METHODS: The gender of physicians in 16 prespecified leadership positions was collected by survey between July 2022 and January 2023 from pediatric cardiology programs with >5 cardiologists in North America. We analyzed the association of women leaders with center size (based on surgical volume), geographic region, presence of categorical fellowship program, and gender of division chief and department chair.

RESULTS: Across 99 centers, a median of …

Multiple Subcortical And Subcortico-Cortico Dynamic Network Reconfigurations Characterize Focal-To-Bilateral Tonic-Clonic Seizures, Shilpi Modi, A. Ankeeta, Walter Hinds, Michael R. Sperling, Xiaosong He, Joseph I. Tracy

Department of Neurology Faculty Papers

Temporal lobe epilepsy (TLE) is the most common focal epilepsy, with focal to bilateral tonic-clonic seizures (FBTCS+) a more severe form of the disorder. Evidence has underscored the critical role of the thalamus, mesial temporal region, basal ganglia and cerebellum, along with the cortex, in the propagation, termination, and modulation of seizure activity. We examined time variant patterns of interaction within and between 7 cortical and 4 subcortical systems in 55 healthy controls and 56 patients with TLE (n = 40 with FBTCS+ and 15 without), isolating those patterns most distinctive of FBTCS+ utilizing tools from dynamic network neuroscience on …

Characterization Of Lactobacilli-Containing Catheter Segments Developed By Using Selective Laser Sintered Mold., Caden Maners

Master of Engineering Theses

Catheter-associated urinary tract infections (CAUTIs) are a major healthcare burden with current prevention strategies offering limited success. This study presents a novel, self-coating biomaterial approach using a silicone-based bioink embedded with thermally sensitive probiotic strains (L. crispatus, L. rhamnosus, and L. reuteri). Catheter segments were fabricated via bio-injection molding using 3D-printed CAD molds. These Lactobacilli, selected for their probiotic and antimicrobial potential, serve as a non- antibiotic strategy to reduce infection risk. These segments were evaluated for mechanical strength (Shore A hardness), thermal stability (TGA/DSC), porosity and bacterial presence (SEM), biofilm formation (crystal-violet assay), as well as mass retention in …

Gender Differences In The Associations Between Developmental Disabilities And Anxiety And Depression Symptoms Among U.S. Children: Insights From The 2021 National Health Interview Survey, Gloria Wang, Muyiwa Ategbole, Xingguang Luo, Kesheng Wang, Chun Xu

Health & Biomedical Sciences Faculty Publications

Background: Limited research has explored the associations between developmental disabilities and symptoms of anxiety and depression among U.S. children during the COVID-19 pandemic.

Objective: This study investigates the associations between developmental disabilities and symptoms of anxiety and depression among U.S. children and examines whether these associations differ by gender.

Methods: The analysis included 6092 children aged 5-17 from the 2021 National Health Interview Survey (NHIS). Key risk factors for anxiety and depression symptoms included attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability (ID), learning disability (LD), and developmental delay (DD). Weighted multivariable logistic regression (MLR) was conducted to evaluate …

Summer Semester 2025, Georgia Southern University

Academic Calendars

No abstract provided.

The Collision Course Between Outdated State Laws And Automated Vehicles, Wililam Hubbard, Colin Starger

Cardozo Law Review

America stands at the precipice of a vehicular revolution. Myriads of self-driving vehicles—often referred to as “automated vehicles” or “AVs”—are already rolling out across the nation, and innovators assert that AVs will make our roads safer, less congested, and more economically productive. However, reaching these dreams of self-driving utopias will require more than just technological progress. The uses of traditional vehicles are heavily regulated by hundreds of thousands of state laws that ensure public safety, health, and order. Will these traditional laws still make sense when AVs shift the paradigm? Despite the hype and optimism of many AV advocates, this …