Digital Commons Network^™

Risk Of Late Recurrence Of Colorectal And Breast Cancer Among Older Long-Term Cancer Survivors., Faiza Yasin, Sarah J. Westvold, Jessica B. Long, Terry Hyslop, Michael Cecchini, Ira Leeds, Andrea Silber, Shi-Yi Wang, Lisa Spees, Rebecca Forman, Tendai Kwaramba, Melissa Taylor, Cary P. Gross, Michaela A. Dinan

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

BACKGROUND: A growing population of older adult cancer survivors faces competing cancer and noncancer health risks. There are limited real-world data on recurrence patterns beyond 5 years post-treatment.

METHODS: This was a SEER-Medicare retrospective cohort study of patients aged ≥66 with stage I-III breast, colon, or rectal cancer who received definitive surgery and survived ≥5 years from diagnosis without recurrence or second primary malignancy. Late recurrence (5-10 years postdiagnosis) was identified using a validated algorithm to detect treated recurrence in Medicare claims. Demographic and clinical characteristics collected at cancer diagnosis were assessed as predictors of late treated recurrence using restricted …

Rooted In Dignity And Hope: Clinical Practice, Advocacy, And Compassionate Care, Holly Ann Harris

Graduate Student Portfolios, Professional Papers, and Capstone Projects

This MSW portfolio reflects my personal and professional journey toward becoming a social worker grounded in dignity, hope, and compassionate care. Inspired by early life experiences that shaped my understanding of the connection between dignity and hope, I entered the University of Montana’s MSW program with the goal of becoming a counselor supporting individuals and families experiencing grief, loss, and mental health challenges. Through coursework and the completion of my generalist and specialist practicums in hospice and the emergency department, along with ongoing critical self-reflection, my perspective has expanded to include a deeper understanding of systemic barriers, social justice, and …

Professional Portfolio: Becoming A Justice-Centered Practitioner, Akemi Nakagawa

Graduate Student Portfolios, Professional Papers, and Capstone Projects

This professional portfolio reflects my learning through this program, including the knowledge and skills I have developed, how my learning has been shaped by the people I have learned from and alongside, and what I will carry forward into future practice. I share my developing theoretical orientation that guides my thinking and practice, grounded predominantly in the Reproductive Justice framework, Critical Social Work, Janet Finn’s Just Practice framework, and by the work and wisdom of Paulo Freire–particularly his pedagogy of popular education.

This portfolio also reflects my ongoing development as a social worker who is committed to advancing intersectional justice …

Rooted, Emily Wortman-Wunder

Creative Nonfiction Magazine

No abstract provided.

Nudging Implementation Of Low Tidal Volume Ventilation: A Stepped Wedge, Cluster Randomized Trial, Meeta Prasad Kerlin, Michael O. Harhay, Fan Li, Dylan S. Small, Yingying Lu, Wei Wang, Barry D. Fuchs, Mark E. Mikkelsen, Teresa Tran, Aerielle Belk, Jasmine A. Silvestri, Tamar Klaiman, Stefania Scott, Elizabeth Levy, Michael W. Sjoding, Rachel Kohn, Karsten J. Roberts, Rinad S. Beidas, Scott D. Halpern

College of Health Professions Faculty Papers

BACKGROUND: "Nudges" embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. …

The Cost Of Compassion: Mixed Methods Insights Into Healthcare Chaplains’ Experiences Of Workplace Violence, Dana Fachner

Theses and Dissertations

Healthcare workers’ exposure to workplace violence has been well documented, with research emphasizing both its frequency and severity among clinical staff like physicians and nurses. Still, one group remains markedly overlooked: healthcare chaplains. Despite their frequent presence in high-stress, unpredictable, and emotionally charged situations, chaplains have never before been included in research regarding healthcare workers’ exposure to workplace violence. Healthcare chaplains provide spiritual and emotional care to patients, families, and staff by offering support that is culturally sensitive and appropriate to patients’ religious traditions. Chaplains collaborate with medical teams to deliver holistic care and are involved in a wide range …

Improving Adherence To Comprehensive Gynecological Assessments In Female Rectal Cancer Patients Prior To Rectal Cancer Treatment, Rachael Smith, Eleanor Williams, Emily Young

Rowan-Virtua Research Day

Background: A retrospective chart review of 139 female patients with Stage I-III rectal cancer treated at our institution (2017-2022) revealed only 32.6% (n=45) had documented age-appropriate gynecologic screenings prior to surgical intervention. These findings were disseminated to colorectal surgeons, medical oncologists, and radiation oncologists through departmental meetings and tumor boards. This follow-up study evaluates the impact of that educational initiative on gynecologic referral patterns. 

Hypothesis: Targeted education of colorectal surgeons, medical oncologists, and radiation oncologists would significantly increase gynecologic referral rates for female rectal cancer patients. 

Methods: This pre-post quality improvement study compared gynecologic referral rates among female patients with …

Cold Agglutinin Disease A Case On Diagnostic Pitfalls And Decision-Making Strategy, Portia Shaheed, Shefali Waghray Do, Te Du Md, Phd

Rowan-Virtua Research Day

Cold agglutinin disease is a rare subtype of autoimmune hemolytic anemia (AIHA) characterized by complement-mediated hemolysis triggered by cold temperatures. Because of its rarity and variable presentation, cold agglutinin disease is frequently underrecognized, often leading to extensive and sometimes unnecessary diagnostic evaluations. By recognizing cold agglutinin disease as a differential diagnosis in patients with recurrent admissions for hemolysis, clinicians can avoid unnecessary workups, consults, and distress for their patients.

Staff Education To Improve End-Of- Life Pain Management Confidence Among Long-Term Care Nurses, Andrea Osuji

Walden Dissertations and Doctoral Studies

No abstract provided.

Deathbed Dilemmas: A Proposal To Advance The Step Up In Basis To Address Tax Burdens On The Terminally Ill, Mary Leto Pareja

Journal of Health Care Law and Policy

No abstract provided.

Barriers To Palliative Care Access In Rural South Dakota: A Policy And System-Level Analysis, Harshavardhan Kadarkaraisamy

Honors Thesis

Palliative care improves the quality of life for people living with serious illness. It helps by addressing symptoms, improving communication, and providing mental, physical, and spiritual support. However, in South Dakota access to palliative care is limited in rural areas. These challenges include geographic isolation, workforce shortages, healthcare infrastructure, reimbursement, and misunderstandings about palliative care. This thesis examines the key policy barriers that limit access to palliative care in rural South Dakota. This work involves engaging with South Dakota-specific literature, rural health research, policy sources, community education, telehealth expansion, and policy reform. By focusing on the rural context of South …

A Quality Improvement Project To Strengthen Hospice Spiritual Care Delivery, Patricia Boudreau

Doctoral Projects

Spiritual care is an essential component of holistic end-of-life nursing, yet it is inconsistently provided in home hospice settings. For this Doctor of Nursing Practice (DNP) quality improvement project, we developed and implemented the Compassionate Spiritual Comfort Integration Program (CSCI), a brief, theory-based educational intervention to strengthen hospice nurses' spiritual care practices. Grounded in Kolcaba's Comfort Theory and Jinpa's Compassion Framework, the CSCI was delivered as a prerecorded webinar. A quasi-experimental single–group pretest–posttest design was used to evaluate changes in spiritual care behaviors, measured with the 17-item Nurse Spiritual Care Therapeutics Scale (NSCTS) and a single-item confidence measure. Twenty-two nurses …

Knowledge Of Advance Care Planning And Advance Directives Among Us Adults: Implications For Health Policy And Practice, Anisah Bagasra, Gretchen Agans

Faculty Articles

Background:

Objectives:

Returning To Play: Play-Centered Art Therapy With Parentified Adult Caregivers, Paola Andrea Mendez Carreno

Expressive Therapies Theses

This research investigates the impact of play-centered art therapy on parentified adult caregivers, focusing on how creative interventions utilizing elements of play can support identity development, self-compassion, and relational capacity. The literature indicates that childhood parentification leads to identity loss and burnout, but creative play can foster neuroplasticity and emotional processing by allowing adults to externalize harmful narratives that have been internalized. To explore these concepts, the author conducted four sessions over six weeks with an adult participant at a private outpatient practice in Massachusetts. Play-centered activities included free collaging, puppet-making, and clay modeling, often involving moments of parallel play …

Nurse-Driven Palliative Care Screening Tools In The Icu, Olivia Sarkis Bsn, Rn, Fiona Hill Bsn, Rn, Isak Madden Bsn, Rn

Nurse Residency

PICOT Question: In adult ICU patients, how does implementing a nurse-driven palliative care screening tool, compared to provider-discretion palliative care consultation, affect rates of palliative care consultation in the ICU?

Heaven In My Head: Finding Beauty, Interest, And Humor In Grief Through Essays On Death. Installment 1: Two Ceremonies And A Short Lesson In Physics, Katherine B. Thuma

Undergraduate Honors Thesis Collection

Death, loss, and grief are inherently difficult components of the human experience, but grappling with such emotions as an undergraduate student has been an especially unique journey. After my father passed from cancer at the end of my junior year, I chose to follow in the footsteps of many great authors by using writing as a tool for grieving. In writing a memoir collection of interconnected essays, I have created an outlet to process my emotions and think critically about my relationship with death. These essays focus on my recollection of the dying process and its aftermath while weaving in …

Unseen Magic, Tricia Goodman

The Prairie Light Review

No abstract provided.

Cathedral Of Golden Hope, - Spider

The Prairie Light Review

No abstract provided.

From Service To Support: Empowering Aging Veterans, Priscilla A. Mireles

Capstone Projects and Master's Theses

This capstone project was designed to assist aging veterans in Monterey County who face challenges staying safely in their homes long-term. It describes the Monterey County Military and Veterans Affairs Office, an agency dedicated to helping former service members and their families navigate the complexities of the federal benefits system to access essential support. The project focused on a small-scale community resource fair aimed at bridging the gap between aging veterans and local services including caregiving, healthcare, and transportation. By centralizing diverse organizations, the intervention aimed to increase awareness of available resources among this population. Most intended outcomes were met; …

Raising Awareness Of Senior Transportation Services In Monterey County, Daisy Prado

Capstone Projects and Master's Theses

Transportation barriers limit access to vital health and social services, especially for older adults. This capstone at Independent Transportation Network Monterey County (ITNMC) in Salinas focused on supporting older adults and those with visual impairments through volunteer-based rides, enabling independence and well-being. The project aimed to increase ITN awareness by sharing volunteer and rider stories on social media, building connections, and encouraging involvement. Social media presence grew, though limited time and structure hindered full implementation. Still, the foundation built is worth continuing to build. Intentional outreach can make a difference. With stronger planning, community support, and sustained effort, ITN can …

Choosing Death: The Moral Legitimacy Of Voluntary Active Euthanasia, Emma Rougeou

Honors Theses

During the last three decades, the issue of physician assisted suicide has captivated the interest of private citizens and state legislatures. Thinking about the matter of end-of-life concerns, particularly surrounding euthanasian (practices that hasten the deaths of suffering terminally ill people) have shifted. Views of private citizens and state-level legislation reflects a “slow shift to more permissive attitudes” (Cohen et al., 2012). Meanwhile, as recently as March 2026, state legislators in conjunction with the NY State Governor, passed a bill legalizing medical aid in dying for terminally ill patients. This thesis is intended to thoughtfully contribute to meaningful discourse on …

Gme As A Healthcare And Economic Driver In Southern Nevada, Tripp Umbach

Policy Briefs and Reports

In early 2025, the Nevada Health and Bioscience Corporation (NHBC) commissioned Tripp Umbach to conduct a comprehensive study examining the current state and future expansion of physician training and retention in Southern Nevada. The approach recommended in this report is rooted in strategic partnerships among medical institutions, proven funding approaches, and needed policy changes. Tripp Umbach, a nationally renowned private consultancy specializing in medical education expansion strategies, reviewed data, conducted interviews, and developed recommendations to expand GME, highlighting its profound economic impact in Southern Nevada.

Bridging The Accessibility And Communication Gap At Southern Illinois University Carbondale, Jay A. Reiss

OTD Capstone Projects

The purpose of this capstone project was to address the communication and accessibility gap at Southern Illinois University Carbondale (SIUC). The experience consisted of collaborating with the Office for Access & Accommodations (OAA) to develop a series of web pages that included information about event accessibility resources, communication accessibility, building-specific accessibility, and creating a sensory-friendly environment. The materials created were designed to support event planners and the community by increasing transparency around accommodations and encouraging their promotion at events. A total of six webpages were created, displaying useful resources for accommodation considerations and accessibility features at SIUC. Feedback from evaluators …

Red, White, And Broke: A Call For Accountability In Government, Mary A. Scott

Honors Theses

This study examines the scale of waste, fraud, and abuse in U.S. federal spending. The purpose of this research is to clarify how fiscal management in the federal government is intended to operate versus how it actually functions. Using a combination of conceptual analysis, existing literature, case-based evidence, and data analysis, findings suggest that the persistence of oversight failures arises from weak implementation, limited enforcement authority of oversight bodies, and an emphasis on recovery rather than prevention practices. This study contributes to the broader discussion of public finance by providing an accessible framework to understand why the foundational federal principle …

Heirloomed: An Italian-American Daughter Weaving Past And Present, Catherine Santino

Theses and Dissertations

Amid a string of family deaths, writer and journalist Catherine Santino found herself preoccupied by the idea of lineage and inheritance. As she digs into her Sicilian heritage, she explores how the traditions and values set forth by her family’s matriarchs have shaped the woman she’s still becoming. From grappling with the shame caused by the Roman Catholic Church’s teachings of purity to examining how Italian food customs impacted her body image, Santino interrogates the complicated truth that the belief systems she was raised with offer both comfort and torment.

Nature And Nurture: The Cognitive Image Of A Building And Its Site, Treyton Hardy

Architecture Theses

Current specialized care facilities often prioritize functionality over the emotional and psychological well-being of their residents. For individuals experiencing dementia, illegible architectural layouts hinder spatial problem-solving and cause severe disorientation. This thesis introduces "Nature & Nurture," a comprehensive dementia recovery and research community proposed for Duluth, Minnesota. By utilizing Kevin Lynch’s Five Elements of the cognitive image, this project establishes an evidence-based architectural framework designed to reduce cognitive load. The design integrates multi-sensory wayfinding cues, continuous circulation paths, and hyper-local landmarks to facilitate environmental recognition rather than demanding complex memory recall. Ultimately, this thesis demonstrates how legible spatial design can …

Implementation Of A Standardized Short Stay Pain Protocol To Reduce Pain In Short Term Care Facility, Maggie O'Brien, Kenzie Reuter, Holly Hansen, Elle Wichmann

Celebrating Scholarship and Creativity Day (2018-)

Pain is a common symptom across all areas of nursing care, yet it is often undertreated in skilled nursing facilities, particularly among residents receiving rehabilitation services. Pain in this population may result from a variety of causes, including musculoskeletal conditions, wounds and pressure injuries, neuropathic pain, and chronic illnesses. A review of Minimum Data Set (MDS) reports and resident pain reports from the short-term rehabilitation unit revealed a concern of disparity. Long-term care residents demonstrated strong quality indicator scores (9.21 out of 10), while short-term stay residents scored significantly lower (2.76 out of 10). This discrepancy raised concerns about pain …

Beyond The Court: Pickleball's Impact On Balance And Gait In Older Adults, Riley Scott Ahrndt, Abby Nicole Bertsch, Emma Florence Boris, Gabrielle Elizabeth Rheay, Isabella Cason Whiston

Physical Therapy Scholarly Projects

Background and Purpose: Older adults are at a greater risk for falls due to many variables that may include decreased balance, lower extremity strength, slower agility, and impaired gait mechanics. Daily physical activity has been shown to help combat age-related deficits. The popularity of pickleball is growing fast and may provide an option for exercise that incorporates strength, agility, balance, and aerobic effort. The goal of this study was to examine the effects of pickleball on the balance and agility of older adults participating in the National Senior Games organization.

Methods: The modified version of the Senior Athlete Fitness Exam …

An Examination Of Single Mothers' Psychological Capital In Seeking Higher Education, Jennifer L. Stuart

Theses & Dissertations

AN EXAMINATION OF SINGLE MOTHER’S PSYCHOLOGICAL CAPITAL IN SEEKING HIGHER EDUCATION

Jennifer Stuart

University of the Incarnate Word, 2025

Research Focus. In the United States, single mothers head nearly 80 percent of single-parent households, representing one of the most educationally vulnerable yet motivated populations. Despite increased visibility of single-parent families, limited research has examined the internal psychological factors that influence single mothers’ determination to pursue higher education. Much of the literature has emphasized external barriers—financial hardship, childcare demands, and social stigma—while overlooking internal strengths such as self-efficacy, resilience, optimism, and hope. These traits, conceptualized collectively as psychological capital (Luthans et …

Gaps In Therapeutic Services For Foster Youth In Short Term Residential Therapeutic Programs, Kaniqua Tainiaja Stewart, Maria Del Rosario Sanchez, Rachelle Hernandez

Electronic Theses, Projects, and Dissertations

This study examines rehabilitation outcomes among foster youth who are currently or were previously placed in Short-Term Residential Therapeutic Programs (STRTPs), also known as group homes. With more than 400,000 children are in foster care in the United States, and approximately 39,000–57,000 residing in group homes, limited research has explored why rehabilitation efforts in these settings often fall short. Existing literature emphasizes policy reforms, compliance, and placement outcomes under California’s Continuum of Care Reform, but gives less attention to youths lived therapeutic experiences and the consistency and quality of mental health services delivered within STRTPs. This study addresses this gap …