Digital Commons Network^™

Frequency And Outcome Of Peg Tube Implantations In Hospitalized Parkinson's Disease Patients, Rachael M. Burke, Ruina He, Hikaru Kamo, Tejas R. Mehta, Anne Brooks, Adrianne Smiley, Michael S. Okun, Christopher W. Hess, Matthew A. Remz

Department of Neurology Faculty Papers

BACKGROUND: Dysphagia is a known complication of Parkinson's Disease (PD). Percutaneous endoscopic gastrostomy (PEG) tube placement is a therapy for select patients with dysphagia. There is a paucity of information on the role of PEG in PD management.

OBJECTIVES: To investigate the frequency and outcomes of PEG tube implantations in hospitalized patients with PD.

METHODS: We performed a retrospective review of the PINC AI™ Healthcare Database of hospitalized PD patients between 2017 and 2023. PEG implantation, discharge status, and aspiration pneumonia (AP) diagnoses were collected and analyzed. The relationships between AP and PEG were evaluated using logistic regression. Generalized estimating …

Jewvell Bradley

African American Funeral Programs

No abstract provided.

Facilitating Palliative Care In The Intensive Care Unit, Crystal Sanchez

Master's Projects and Capstones

Abstract

Problem: Critically ill patients in the intensive care unit (ICU) frequently experience unmet palliative care needs due to inconsistent identification processes and delayed goals‑of‑care (GOC) discussions. Prior to this project, palliative care consultation practices were highly variable and lacked standardized criteria, resulting in missed opportunities for early communication and symptom management. This gap underscored the need for a structured, nurse‑driven approach to improve timely palliative care integration.

Context: This quality improvement project was conducted in a 20‑bed adult ICU within a large community‑based hospital system where palliative care integration was inconsistent and not systematically monitored.

Interventions: A nurse‑driven palliative …

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

The Shorthorn: April 24, 1986

The Shorthorn Newspaper Collection: 1980s

No abstract provided.

The Shorthorn: April 23, 1986

The Shorthorn Newspaper Collection: 1980s

No abstract provided.

Assessing And Addressing Financial Risk In Capitated Primary Care Contracts, Michael R. Wieck Dba, Laurence Smith, Steven R. Stout Dba

Engaged Management ReView

We employ multivariate statistical modeling and Monte Carlo simulation to study systematic and unsystematic financial risk faced by physician groups under capitated contracts with Medicare Advantage Organizations (MAOs). We use mixed methods and a standard reimbursement formula for risk-sharing contracts with primary care physicians (PCPs). We find that diversifying risk simply by increasing the size of a practice is insufficient to mitigate risks of large negative cash flows from capitation contracts and can result in financial failure. However, if use of costly medical services by patients is reduced from levels typically experienced under traditional Medicare to the levels of patients …

Using Simulation To Translate Theory Into Practice: Lessons Learned & Next Steps, Margarett Alexandre, Fern Baudo, Vanessa Carew

International Nursing Research Congress (INRC)

NIH notes adverse events can be avoided (Patient Safety, 2023). Simulations using high-fidelity mannequins offer an interactive environment for students to learn critical thinking skills. Simulations allow students to practice skills in a safe environment before working with real patients (Zenani, 2023; Durham & Alden, 2008). Saylor, Graber, and Trinkaus (2024) note that simulation-based learning experiences can increase confidence in undergraduate nursing students.

Purpose: To explore the impact of increase simulation with senior nursing students in an upper-level med/Surg course, incorporating guided reflective journaling to address students’ assessment of knowledge, understanding of theoretical and practical skills learned, and reflect on …

Strategies For Integrating Death Education Into Asynchronous Online Counselor Training, Kara E. Wolff

Journal of Technology in Counselor Education and Supervision

Online counselor education has grown exponentially, with a greater number of courses being offered in an asynchronous format. This presents challenges and opportunities for counseling training in death education, a subset of grief counseling. Death anxiety and death avoidance can result in counselors-in-training's disengagement with strictly didactic materials in this area. Instead, death education must offer opportunities for experiential processing and personal reflection to be effective. Specific teaching strategies that foster the development of death acceptance and death competence within asynchronous online counselor education courses are offered.

Sense Of Purpose As The Guiding Light In Nursing Practice: A Grounded Theory Study, Kathleen Casler

Theses & Dissertations

Problem: As a prosocial profession, individuals may enter the practice of nursing because of an interest in helping and caring for others. However, over time, nurses may be challenged with experiences of burnout that can impact both their relationship with the profession and patient outcomes.

Background/Significance: A sense of purpose has been associated with positive physical, behavioral, and psychological outcomes. In a professional context, a sense of purpose may provide support for navigating complex work environments. It is currently not known what nurses’ experience of sense of purpose may be in relation to nursing practice and how their sense of …

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 …

Impact Of Debriefing Methods On Psychological Outcomes In End-Of-Life Simulation, Jennifer A. Wentzel, Julie Steele, Desireé Hensel

International Nursing Research Congress (INRC)

Introduction: Nursing students do not feel adequately prepared to care for patients at the end of life (EOL) (Yoong et al., 2023). Current EOL education focuses on students’ learning outcomes instead of their psychological needs (Harder & Harwood, 2019). This is the first study to compare the impact of debriefing methods on psychological outcomes in EOL nursing education.

Purpose: Guided by the Transactional Model of Stress and Coping and Kolcaba’s Comfort Theory, this study examined the impact of the Trauma-informed, Psychologically Safe (TiPS) debriefing method on coping with death, attitudes toward care of the dying, and debriefing experience in undergraduate …

Integrating Oncology Into Entry-Level Physical Therapist Curricula, Shana Harrington, Christopher M. Wilson, Morgan Zaranec, Lori Boright

Oncology Rehabilitation in Practice

Print issue available for $25.

Background: Cancer and its treatments commonly result in adverse effects that impair function, well-being, and quality of life, necessitating access to skilled physical therapists (PTs). Although oncology is an essential component of physical therapist practice, entry-level education in cancer rehabilitation has historically been limited. In 2025, the Essential Competencies for Physical Therapy Entry-Level Education in Oncology were developed through a mixed-methods, modified Delphi process, establishing 19 competencies across six domains and defining minimum expectations for new graduates. To support translation of these competencies into academic curricula, a practical implementation resource was needed.

Purpose: To …

Isolated Lesser Trochanter Fractures In Adults: A Systematic Review Of Malignant, Infectious, And Benign Etiologies, Max Deneroff, Ethan J. Sack, Austin Khau, Zubair Mohammed, Chadi Ellaham, Jared W. Nichols

Student Publications

Isolated lesser trochanter (LT) fractures are uncommon in adults and may be the first clue to an underlying pathologic process. In contrast to adolescent apophyseal avulsions, the same finding in a skeletally mature patient has been linked to metastatic disease, primary bone tumors, hematologic malignancy, infection, and, less often, benign traumatic, stress-related, osteoporotic, or metabolic causes. This review examined the malignant, infectious, and benign etiologies, diagnostic pathways, treatments, and outcomes that have been reported in adults aged 18 years or older presenting with a radiographically isolated LT fracture or avulsion fracture. PubMed, Embase, and Scopus were searched for English-language case …

More Than A Profession: A Calling In Social Work, Paulette Lingle

Graduate Student Portfolios, Professional Papers, and Capstone Projects

No abstract provided.

Feasibility And Acceptability Of An Occupation‑Based Telehealth Intervention For Cancer Survivors: A Pilot Randomized Controlled Trial, Bernard A. Muriithi, Milan Bimali, Mario Schootman

Occupational Therapy Faculty Scholarship

Introduction

Cancer survivors frequently experience occupational performance challenges during early survivorship, and telehealth may offer a feasible approach to deliver interventions during this period.

Methods

This pilot randomized controlled trial included 17 adults in the first year following breast or prostate cancer diagnosis, assigned to the ActiveHeal Cancer Program (ACP) or a control group. ACP consisted of six 75‑minute occupation‑focused virtual group sessions and weekly follow‑up telephone calls delivered by occupational therapists over 12 weeks. Control participants attended three brief virtual meetings without therapeutic intervention. Feasibility and acceptability were assessed using validated measures, attendance, and completion rates. The exploratory outcomes …

A Mixed-Methods Study Of The Lived Experiences Of Patients And Caregivers Receiving Home Health Occupational Therapy Services, Peyton A. Mendias

Student Capstone Papers

Home health occupational therapy (OT) supports individuals’ safety, independence, and participation in their natural environments; however, patients and caregivers may face barriers that affect the implementation of therapy recommendations. This capstone project explored patient and caregiver experiences with home health OT and identified factors influencing implementation of OT recommendations. We used a sequential explanatory mixed-methods design guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model. Eight participants, including three patients and five caregivers, completed an electronic survey, and one caregiver participated in a follow-up semi-structured interview. We analyzed quantitative data using descriptive statistics and qualitative data using reflexive thematic analysis. Findings …

Mission Parkinson Possible: Building Confidence In Parkinson’S Disease Care In Skilled Nursing, Theresa Tran

Master's Projects and Capstones

Objective: Parkinson’s disease (PD) is a progressive neurological disease that requires specialized, interdisciplinary care. Despite this, staff in the skilled nursing setting often receive limited PD-specific education. This contributes to inconsistencies in care, improper medication administration, and reduced confidence in disease management. Aim: This project aimed to improve staff self-reported confidence, competence, and workflow in Parkinson’s disease care and disease management by 15%, from a baseline of 60% to 75%. Methods: The project implemented a PD-specific educational program that consists of an hour-long PowerPoint presentation and distribution of physical brochures to staff, residents, and their families. Pre- and post-surveys were …

Increasing Postpartum Appointment Attendance Rates, Tanya Lister

Doctor of Nursing Practice Scholarly Projects

Background: Postpartum visits provide an opportunity to detect and address potential complications, monitor healing and recovery, and offer guidance and support during the transition into motherhood. Current research shows that appointment reminders increase healthcare appointment attendance rates, whether delivered via text messages or phone calls.

Purpose: The purpose of this academic project was to plan, implement, and evaluate a process change within a single health facility to increase postpartum visit attendance rates.

Methods: This evidence-based scholarly project used telephone calls to remind patients scheduled for postpartum visits of their appointment dates and times. Appointment reminder phone calls were completed the …

Recognizing Appropriate General Inpatient Hospice Patients Time To Stop Normalizing Suffering, Oliver Charles Roth

Walden Dissertations and Doctoral Studies

Hospice patients experiencing uncontrolled pain, dyspnea, agitation, anxiety, delirium, or other severe symptoms may require General Inpatient (GIP) hospice care for intensive symptom management. However, inconsistent recognition of symptom crises can delay escalation to the appropriate level of care, contributing to unnecessary patient suffering, caregiver distress, and avoidable emergency department or hospital utilization. This Doctor of Nursing Practice executive leadership project evaluated the implementation of an educational framework designed to improve clinician recognition and timely escalation of patients who may be appropriate for GIP hospice care. Education emphasized early identification of uncontrolled symptoms, interdisciplinary communication, documentation, and escalation for clinical …

Factors Influencing Pediatric Palliative Care Utilization: A 12-Year Retrospective Study In Taiwan, Tzu-Ying Yang, Wei-Wen Wu, Frank Leigh Lu, Shao-Yi Cheng, Tsung-Hsien Yu, Kristin Berg

International Nursing Research Congress (INRC)

Background and objective: Pediatric palliative care (PPC) improves the quality of life for children with life-limiting conditions and their families by addressing physical, psychological, and spiritual needs. Despite increasing recognition of its benefits, PPC remains underutilized, particularly in Asian contexts where early integration and service accessibility are still limited. This study aimed to examine trends and factors influencing PPC utilization among deceased children in a tertiary children’s hospital in Taiwan from 2012 to 2023, to provide evidence on predictors for more equitable access to PPC.

Methods: A retrospective study was conducted using medical records of children aged 1–18 years who …

Supportive And Palliative Care: Addressing The Unspoken Burden Of Cancer On Significant Others, Esmeraldo C. De Las Armas Iv

Jurnal Keperawatan Indonesia

A diagnosis such as cancer can cast a long-lasting gloom that affects not only the patient but also their loved ones. This concept analysis represents an effort to understand and explore the nuanced world of supportive and palliative care for significant others of cancer patients, a population that has often been overlooked. Rodgers’ evolutionary model of concept analysis was utilized to examine the concept of supportive and palliative care for significant others of cancer patients. Positive outcomes for both significant others and patients included improved coping mechanisms, reduced caregiver burden, enhanced communication, and better quality of life. However, several challenges …

More Than A Voice: Interpreters As Cultural Brokers In Serious Illness Conversations, Katherine Doyon, Sadia Abdulkadir, Sarah Darney, Sunny Smart, Hannya Ornelas, Alice Mwamba, Adebusola Oluwatoba-Adeyemi

International Nursing Research Congress (INRC)

Background: In serious illness and end-of-life care, effective communication is critical to honoring patients’ values and goals. For patients with refugee backgrounds, healthcare encounters may also evoke distress or (re)traumatization due to past experiences of displacement, persecution, or medical mistrust. Interpreters are essential in facilitating understanding and emotional safety. Yet, their role often extends beyond that of neutral language conduits, they act as cultural brokers, bridging cultural and religious divides, buffering emotions, and fostering trust between refugees and the healthcare team.

Objective: To explore how medical interpreters experience their role as cultural brokers in serious illness conversations.

Methods: A 126-minute …

Targeted Nursing Bootcamps For Critical Access Hospital Nurses: A Program Evaluation., Nicholas Popp

DNP Projects

Background: Registered Nurses employed in critical access hospital settings are required to care for patients across the lifespan with varying levels of acuity. The registered nurse (RN) must be competent in providing medical, surgical, pediatric, obstetric, and intensive care-level services. However, the additional training they receive to care for their patients may be minimal or nonexistent, leading them to seek employment at other facilities due to safety concerns. Leadership within the organization believed that implementing targeted monthly nursing skills boot camps could increase nurses’ competence, confidence, and retention in critical access hospital settings.

Aims: This program evaluation project aimed to …

Enhancing Nursing Self-Efficacy In Advance Care Planning Conversations Through Role-Play Education: A Quality Improvement Project, Rachel Williams

DNP Projects

Background:
Advance care planning (ACP) conversations are essential for ensuring that patient healthcare preferences are understood and respected; however, nurses often report limited confidence and self-efficacy when initiating these discussions. Educational interventions that emphasize communication skills may improve nurses' preparedness to engage in ACP conversations.

Methods:
A quality improvement project utilizing a pre-post intervention design was conducted on three adult inpatient medical units within a regional Midwestern hospital. Registered nurses participated in an educational intervention consisting of ACP education, role-playing case scenarios, guided discussion, and debriefing. A modified 22-item Advance Care Planning Self-Efficacy Questionnaire was administered before and after the …

Assessing Nursing Students’ Palliative Care Competence To Inform Course And Curriculum Design, Wen-Wen Li, Jung Eun Kim, Derrick Huang

International Nursing Research Congress (INRC)

Purpose: This project evaluated undergraduate nursing students’ competency and knowledge in palliative care (PC) before a semester-long course. Findings informed curriculum design to strengthen students’ understanding and application of PC concepts in clinical practice.

Background/Significance: Palliative care is vital in nursing education, yet integration into undergraduate curricula remains inconsistent (Lippe & Becker, 2021). Developing PC competence enhances patients’ and families’ quality of life (Alhaddar et al., 2025). Assessing students’ baseline knowledge helps identify learning gaps and align curricula with the American Association of Colleges of Nursing [AACN] CARES Competencies (AACN, 2021) in PC education.

Methods: A cross-sectional study was conducted …

Dnp Final Report: Improving Rehospitalization Rates And Caregiver Quality Of Life In Outpatient Hospice, Carrie M. Judd

DNP Final Reports

Background: Hospital readmissions among home hospice patients disrupt continuity of care, increase healthcare costs, and may compromise end-of-life preferences.

Purpose: This quality improvement project evaluated the feasibility of implementing a telehealth communication intervention in an outpatient hospice organization. Project aims were to reduce Type I live hospice discharges by at least 2.5% and improve caregiver quality of life (QOL).

Methods: Zoom for Healthcare® video visits and three-way telephone communication supplemented standard nurse practitioner hospice visits during a three-month implementation period. Type I live discharge rates were compared with the organization's baseline quality metrics. Caregiver QOL was measured pre- and post-intervention …

Virtual Reality Simulation For End-Of-Life Communication: Case Development And Pilot Implementation, Kathryn M. Ledwin, Kylene Abraham, Karen Parker

International Nursing Research Congress (INRC)

Background: Registered nurses have reported feeling unprepared and lacking proper skills for critical end-of-life discussions with patients and their families (Kerr et al., 2020). Virtual reality (VR) simulation presents a novel approach to providing immersive opportunities to support learning and skill development (Liu et al, 2023; Sinurat et al.,2025). VR has been successfully integrated into nursing education to support clinical skill development (Foronda et al. 20220; Liu et al, 2023), however less research has focused on specific applications for complex medical discussions.

Purpose: This project aimed to develop and examine the feasibility of using VR simulation as an educational intervention …

From Prevention To Intervention: Delirium Order Set Utilization At Pennsylvania's First American College Of Surgeons (Acs) Geriatric Surgery Verified (Gsv) Hospital, Emma Dela Cruz, Rovinder Sandhu Md, Lauren Curcio Msn, Rn, Gero-Bc, Tcrn, Christina Holub Msn, Crnp, Fnp-C, Gs-C

Research Scholars

No abstract provided.

Sepsis Not Present On Admission Mortality Analysis: Insights From Squad Virtual Nurse Monitoring, Adelaide Weir, Courtney Moore Md, Lorraine Valeriano Bsn, Rn, Cnrn, Michael Blawn Bsn, Rn, Deborah Santos Bsn, Rn, Jessica Maher Adn, Rn, Ccrn, Timothy J. Friel Md, Matthew Mccambridge Md, Dana Peluso Lpn, Bs

Research Scholars

No abstract provided.