Digital Commons Network^™

Clinicians’ Reflections On Explainable Ai (Xai) In Counselor Education And Diagnostic Training: An Exploratory Qualitative Study, Kuo Deng, Xiaomeng Ye, Yi Li-Brown, Cara Miles, Angelina F. Pennino

Journal of Technology in Counselor Education and Supervision

Current approaches to teaching clinical diagnosis in counselor education and supervision often

rely on self-reports, brief vignettes, and supervisors’ recollections—methods that can be resource- intensive and prone to bias, contributing to diagnostic inaccuracy among trainees. While artificial

intelligence (AI) has gained traction in healthcare, many machine learning (ML) models function as “black boxes,” limiting transparency and educator trust. Explainable AI (XAI), which focuses on making AI processes interpretable, offers a potential solution for counselor training. This exploratory qualitative study examined eight licensed psychologists’ reflections after viewing a live demonstration of an original XAI model trained to predict depression. Using Reflexive …

Toward A Triadic Therapeutic Alliance: Understanding Client, Therapist, And Ai Relational Processes In Counseling, Jennifer Young

Journal of Technology in Counselor Education and Supervision

Artificial intelligence (AI) is integrated into counseling through chatbots, digital companions, and clinical decision-support tools. This integration challenges traditional models of the therapeutic alliance, which have historically centered on the dyadic relationship between client and therapist. To address this gap, the Triadic Therapeutic Alliance (TTA) Model of Client-Therapist-AI Relational Dynamics offers a new framework for understanding how relational processes unfold when AI becomes an active participant in therapy. The model extends alliance theory into a triadic structure that includes the client-AI and therapist-AI relationships alongside the traditional human alliance. Drawing on research in human-computer interaction and ethical frameworks of trust …

Exploring Chatgpt As A Simulated Client: A Feasibility Study In Undergraduate Counselor Training, Kayla E. Hayes, Rebecca L. Wilson, Joshua Wilson

Journal of Technology in Counselor Education and Supervision

Generative artificial intelligence (AI) offers new possibilities for simulation-based counselor training by enabling scalable, text-based interactions that mimic human dialogue. This exploratory feasibility study examined whether ChatGPT can serve as a simulated counseling client and feedback provider for undergraduate students learning counseling skills. Five upperclassmen completed a 45–60-minute text-based session with ChatGPT portraying “Sarah,” a college student experiencing depression and loneliness, followed by AI feedback and a semi-structured interview. Trained raters judged ChatGPT’s client portrayal and feedback as generally accurate, particularly for tone, empathy, and identification of students’ strengths. Accuracy was lower for rapport, summarizing, and pacing characteristic of an …

The Digital Tightrope: Navigating Social Media Ethics In Counseling, Kaitlynn Cornell-Mullane

Journal of Technology in Counselor Education and Supervision

Social media has become deeply integrated into both personal and professional lives, yet the use by counseling professionals remains underexplored. This study investigated how various roles within the counseling field experience and utilize social media in their professional development, identity formation, and ethical practice. A qualitative online survey was utilized to collect data from counseling professionals (N = 20). Findings revealed six themes: (1) Conflicting Perspectives on Client Social Media Use and Engagement, (2) Personal Discomfort and Ethical Ambiguity, (3) Counselors’ Varied Approaches of Social Media Use, (4) Social Media Use for Professional Development, (5) Mixed Perspectives on Social Media …

Generative Artificial Intelligence In Counselor Development: Examining Systemic Influences On Training, Lauren Dollarhide, Leo Gonzalez Jr., Rachel M. Smith

Journal of Technology in Counselor Education and Supervision

The use of large language models (LLMs) and generative artificial intelligence (AI) tools (e.g., ChatGPT, AI-assisted supervision platforms, and AI-powered role-play simulations) in counselor education is changing the way counselors-in-training (CITs) are trained and has both risks and benefits for the field. This conceptual article applied Bronfenbrenner’s ecological systems theory to evaluate the impact of these technologies at multiple levels within the counseling training environment. The microsystem is described as the interactions between CITs and the AI they use to support their training experiences (e.g., AI-based learning tools, role-playing simulations). The mesosystem refers to the movement of AI across different …

Simulation-Based Education In A Counseling Skills Course: A Mixed-Methods Pilot Study, Alexandra Gantt-Howrey, Hana Shewamoltot Meshesha, Renyi Huang, Elizabeth A. Doughty Horn, Renee Howells, Adenike Ololade Adedapo

Journal of Technology in Counselor Education and Supervision

Simulation-based education (SBE) is a technique that introduces students to real-world experiences (Gaba, 2004) in a safe way (Holmes et al., 2023). Scholars have suggested that SBE may be a promising means of enhancing counselor education (e.g., Pope & Hilliard, 2024). We recruited a sample of N = 12 counseling skills students who completed up to 12 simulation-based education (SBE) activities using Simucase (2025) across one semester. We conducted an embedded, qualitatively-driven mixed methods pilot study (Creswell & Plano Clark, 2017) to understand participants’ perspectives on and impacts of the SBE activities on their perceived counseling self-efficacy and multicultural competence. …

Conceptual Framework Of Professional Learning Communities For Cambodian Upper Secondary School Teachers, Ousa Chao, Mam Chansean, Vira Neau

Jurnal Pendidikan: Teori, Penelitian, dan Pengembangan

This paper explores the challenges of teacher professional development within Cambodian public upper secondary schools, driven by low teacher qualifications, resource gaps, and cultural barriers. Using an integrative literature review and qualitative document analysis, this paper synthesizes 58 sources, including official Cambodian regulatory frameworks, global evaluations, and empirical studies. By synthesizing local policy with international PLC models from Japan, South Korea, and Singapore, this study reveals a substantial gap between national policy goals and local school conditions. To bridge this divide, the article presents a contextually adapted four-pillar conceptual framework alongside actionable strategies to support effective PLC implementation across Cambodian …

Reducing Primary Cesarean Births Among Nulliparous, Term, Singleton, Vertex (Ntsv) Patients Through Structured Multidisciplinary Communication, Toyin Ajani

Master's Projects and Capstones

Background: Primary cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients remained a persistent quality and safety concern in obstetric care. Unnecessary cesarean birth was associated with increased maternal morbidity, neonatal complications, prolonged recovery, higher healthcare costs, and adverse outcomes in subsequent pregnancies. Problem: A Northern California labor and delivery unit identified an elevated NTSV cesarean birth rate of 26.8%, exceeding the national benchmark of approximately 23%. Variability in provider communication, inconsistent labor management practices, and lack of standardized interdisciplinary collaboration contributed to this quality gap. Context: The project was conducted in a high-volume labor and delivery microsystem serving a …

Decreasing Icu Clabsi Through Improved Central Line Dressing Integrity, Sharmila Reyes Moreno

Master's Projects and Capstones

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant source of preventable patient harm, increased healthcare costs, and prolonged hospital stays. In a 20-bed medical-surgical ICU, CLABSI events increased from one case in 2024 to four cases in 2025, resulting in a standardized infection ratio (SIR) of 1.21, exceeding the organizational target of ≤ 0.87.

Context: Audits of central line dressings identified frequent edge lifting and dressing disruption despite staff awareness of CLABSI prevention practices. These findings suggested a gap between evidence-based recommendations and consistent clinical practice. The project was conducted in a 20-bed adult medical-surgical ICU serving a diverse …

Improving Peer Feedback Participation Through Psychological Safety Interventions In Labor & Delivery Nurses, Lindsey C. Hora

Master's Projects and Capstones

Abstract 

Background: Labor and Delivery (L&D) units require effective communication, speaking up, and team learning to support safe care. Psychological safety informed this quality improvement project as a contextual strategy to strengthen peer feedback engagement.  

Problem: Peer feedback participation among eligible L&D registered nurses at a large acute care hospital in Santa Clara, California, was 14.29% (N = 112) below the 30% project target and 80% organizational target. Low participation limited routine feedback for professional development, recognition, and team learning.

Interventions: Interventions included psychological safety education, peer feedback reinforcement, workflow integration, platform navigation support, dedicated completion time, and unit champions. …

Optimizing Life Care Planning For Palliative Home Health Care Patients, Lilian Muraya

Master's Projects and Capstones

Problem: In this home health palliative microsystem, many seriously ill patients begin care without timely goals‑of‑care conversations or documented advance directives, leading to fragmented communication and potentially avoidable emergency visits and rehospitalizations.

Context: This quality improvement project took place in a hospital-based home health palliative care program in Northern California, where an interdisciplinary team identified inconsistent Life Care Planning (LCP) practices and variable staff comfort with conducting goals‑of‑care discussions.

Intervention: A structured LCP workflow was developed so that newly admitted palliative home health patients receive a goals‑of‑care discussion and advance directive review within 7 days of start …

Same-Day Cancellation Reduction In An Ambulatory Surgery Unit, Anthone Dalit Vengersammy

Master's Projects and Capstones

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, …

The Sonam Times Newsletter Vol 01 Issue 01, School Of Nursing And Midwifery

The Aga Khan School of Nursing and Midwifery Archives

• Message from the Dean
• Collaborations & Outreach
• Key Events and Engagements
• Capacity Building Initiatives
• Accomplishments
• Stories of our People
• Promotions & Appointments

Betting On Gambling Diversion Courts To Handle The Risks Of Online Gambling For Problem Gamblers, Stephen Fajvan

Seton Hall Journal of Legislation and Public Policy

No abstract provided.

Addressing Obesity In Rural Health Clinics, Morgan P. Trusley

Student Scholarly Projects

Practice Problem: According to the Centers for Disease Control and Prevention (CDC), more than 2 in 5 adults in the United States are obese (CDC, 2024a). In a rural primary care clinic in South Carolina, approximately 70% of patients are obese and there is no current intervention in place to help educate and guide these patients in weight loss strategies.

PICOT: In obese adults over the age of 18 at a rural health clinic with a Body Mass Index (BMI) greater than or equal to 30, does implementing weekly virtual and in person multicomponent behavioral intervention educational sessions compared to …

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

The Method And The Machinery: Gloria Steinem, India, And The Cold War Making Of American Second Wave Feminsim, 1956-1972, Rashida Shafiq

History Theses and Dissertations

This dissertation argues that Gloria Steinem became one of the most visible feminists of her generation because two political inheritances — postcolonial India and the Cold War liberal United States — converged in a single career. In 1957 and 1958, on a Chester Bowles Asian Fellowship, Steinem spent eighteen months in India, where she moved from elite intellectual circles in Delhi to Gandhian and Sarvodaya peace work in the villages of Ramnad. Walking with Bhoodan fieldworkers through caste-riot-stricken communities, she absorbed a repertoire of organizing practices — listening across difference, lateral and leaderless structure, decision by consensus, and the conversion …

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

Human Resource Development Student Publications and Presentations

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

Opioid Overdose Education For Outpatient Settings And Simulation Development, Nancy S. Goldstein, Tyler Langley, Brook Van Buskirk

International Nursing Research Congress (INRC)

In 2023, the National Institute of Health reported 79,358 U.S. overdose deaths caused by opioids. This value is 166% higher than data from 2017, with an opioid-induced death toll of 47,600.¹ The rising rates of overdose require clinics to be prepared to respond to overdose emergencies.² Literature analysis revealed gaps in provider response capability for opioid overdose in healthcare outpatient settings.^{3, 4, 5, 6} Thus, there is a need to address the gaps in emergency preparedness for an opioid overdose through simulation training of outpatient staff. The purpose of the pilot study is to develop a simulation …

Exploring Positive Deviance In Forensic Nursing Literature, Jodie C. Gary, Laurie Charles, Jaeda Onyemobi

International Nursing Research Congress (INRC)

Positive deviance (PD) is an intentional act of breaking rules in order to serve the greater good.¹ PD in nursing is intentional and honorable behavior that departs or differs from an established norm and contains elements of innovation, creativity, and/or adaptability; it also involves risk for the nurse.¹ Nurses who use PD practice differently and more effectively to provide patient-centered care.² Although professional standards guide patient care and lay the groundwork for best practices, they are not enough to guide many nursing decisions that involve multiple levels of uncertainty and risk in their practice; therefore, nurses may …

Driving Innovation: Transforming Adult Health Nursing Curricula Through Educational Advances, Suja P. Davis, Kunta Devi Punn

International Nursing Research Congress (INRC)

Background and Purpose: Traditional lectures while effective in delivering large amounts of information systematically fail to engage students actively, leading to disengagement and limited critical thinking.[1] Research indicates that active learning methods using educational innovations increase student participation, enhance their critical thinking and problem-solving skills. [2 ]The purpose of this project was to evaluate the learning outcomes of educational innovations implemented in an adult health course for nursing at Department of Nursing, Kathmandu University School of Medical Sciences (KUSMS), Nepal.

Methods: Several educational innovations such as flipped classroom, concept mapping, problem based learning, case study analysis, 2D illustrations and animations, …

Aligning The Rn-Bsn Program To The Un-Sdgs: An Evidence-Based Teaching Practice, Tess B. Bernardo

International Nursing Research Congress (INRC)

Background/Introduction: The UN SDGs provide a globally recognized framework for addressing health equity, environmental sustainability, and social justice. Despite their relevance, integration of the SDGs into RN-BSN curricula remains limited and often lacks pedagogical coherence.

Purpose: This initiative aims to enhance learners’ capacity to critically engage with global health priorities and apply sustainability principles in clinical, community, and leadership contexts.

Methods or Processes/Procedures: A curriculum review was conducted to identify intersections between existing course objectives and SDGs, with emphasis on Goal 3 (Good Health and Well-being), Goal 4 (Quality Education), and Goal 10 (Reduced Inequalities). Faculty explored how a higher …

Empowering Nursing Students Through Equity, Diversity, & Inclusion Resources – An Rnao Initiative, Christina Oleynikov, Krussny Arunanthy, Hugo Tam

International Nursing Research Congress (INRC)

In the past, nursing programs have made concerted efforts to include comprehensive Equity, Diversity, & Inclusion (EDI) education [3,6]. Despite these attempts, there is an evident lack of support for accessible, peer-led resources to improve the uptake and application of such concepts in educational and practice settings [2]. Current literature also reflects a gap in research focusing on how EDI resources impact nursing students [1]. With promising past results from peer-driven engagement to increase self-efficacy in EDI [4,5], a similar approach should be used to encourage student-led knowledge translation and leadership initiatives. The purpose of this project was to identify …

Simulation Experiences Of Eal Prelicensure Nursing Students: An Integrative Review, Megan Ross

International Nursing Research Congress (INRC)

Background: Globalization has increased the use of English as a common language in healthcare settings (Cheng et al., 2025). Additionally, nursing programs have increased the number of students who speak English as an additional language (EAL; Henry, 2023). EAL students often encounter unique challenges in nursing programs, including struggles with communication and cultural norms that can impact success (Henry, 2023). Simulation-based learning is an effective method to develop nursing students’ knowledge and skills (Alharbi et al., 2024). Despite its growing use, there was no comprehensive synthesis of research exploring EAL nursing students’ experiences with simulation-based learning at the time of …

Minority Stress As Mediator Of Ace-Substance Use Pathways: Sem Analysis Of Sexual Minorities, Meghna Shukla, Marvin Schilt-Solberg

International Nursing Research Congress (INRC)

Background: Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual minority (SM) individuals have higher ACE scores than non-SM individuals, and as a result also have worse health outcomes.According to the WHO, ACEs such as abuse & neglect are among the most severe forms of stress an individual may face, with extant literature identifying SM status and ACEs as predictors of substance use. There is a paucity of evidence examining the pathways between ACEs and substance use in SMs. Burgeoning evidence indicates minority stress is a strong predictor of substance use in SMs.

Purpose: To examine the …

Transforming Telehealth With Thrive: An Online Intervention For Nps Caring For Young Adults, Lisa V. Duffy

International Nursing Research Congress (INRC)

AIM: To develop an online, video-based intervention for nurse practitioners (NPs) that illustrates best practices to establish therapeutic relational connection (TRC) during telehealth visits.

BACKGROUND: Telehealth offers many benefits for chronically ill young adults. Despite the potential benefits of virtual visits, little attention has been given to the quality of the virtual provider-patient relationship and its consequences. Relationships with healthcare providers that are characterized by a sense of TRC have the potential to increase self-management skills which are associated with improved physical, mental, and behavioral health outcomes. Although there are known benefits to TRC, what is not known are the …

Public Perceptions Regarding Surveillance Of Lyme Disease In Tennessee, Shaheena Yasmin Asad

Walden Dissertations and Doctoral Studies

Lyme disease (LD), a tick-borne illness, has been a growing concern in the state of Tennessee. Studies have established environmental concerns regarding a growing tick population and identified a gap between reported cases and disease burden in Tennessee. Despite this information, it remains classified as a low-incidence reporting state, raising concerns about underreporting that indicate an ineffective current surveillance system. Because the public perception regarding surveillance of LD is unknown, the purpose of this qualitative study was to explore how adults in Tennessee perceived LD as a credible public health threat within the context of the current surveillance system. Guided …

A Multifaceted Surgical Suite Quality Improvement Initiative, George Tazvitya Mhosira

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice project focuses on modernizing an acute care hospital’s surgical suite, enhancing environmental safety, and supporting the growing complexity of surgical care. As surgical procedures become more advanced, the physical environment must evolve to maintain sterile technique and reduce microbial presence. Current operating room configuration, characterized by overcrowding and outdated ventilation systems, introduces environmental risks that compromise patient safety and limit perioperative efficiency. Modernization is essential to align the surgical environment with contemporary safety expectations and organizational performance goals. The proposed initiative includes a comprehensive renovation and expansion of surgical spaces, integrating advanced air decontamination technologies, …

The Relationship Between Employees’ Involvement, Process Improvement, And Customer Satisfaction In Manufacturing Industries, Nawres Fouad

Walden Dissertations and Doctoral Studies

Customer satisfaction remains a challenge for some manufacturing organizations despite the widespread implementation of TQM practices. Manufacturing leaders must improve customer satisfaction because it enhances customer retention, organizational competitiveness, and long-term business performance. The purpose of this quantitative correlational study was to examine the relationships between employees' involvement, process improvement, and customer satisfaction. The expectancy-disconfirmation theory grounded the research project. Participants were 68 middle managers employed in manufacturing organizations in Ontario, Canada. Data were collected through an anonymous online survey using the Utrecht Work Engagement Scale (UWES-9) and the TQM Practices Scale. The data were analyzed using descriptive statistics, Cronbach’s …

Staff Education To Improve Depression Screening And Management Using Phq-9, Elizabeth Aja

Walden Dissertations and Doctoral Studies

This doctoral project was a staff education initiative. It was motivated by the realization that depression is often under-recognized when standardized screening practices are not consistently implemented. The identified practice gap was inconsistent administration, interpretation, and documentation of the PHQ-9 by the nursing staff. The practice-focused question examined whether a staff education intervention would improve nurses’ knowledge and confidence in using the PHQ-9 for depression screening. The purpose of the project was to implement and evaluate an evidence-based educational program on PHQ-9 administration, scoring, interpretation, and documentation. Data analysis included descriptive statistics on pretest and posttest scores from 14 participating …