Digital Commons Network^™

Improving Palliative Care Knowledge And Intentions Among Great Plains American Indians: Efficacy Results From A Randomized Clinical Trial Testing A Culture-Centric Palliative Care Message, Mary J. Isaacson, Kah Meng (Charlie) Soh, Christopher S. Wichman, Gina Johnson, Kelly Le Beaux, Semhar Michael, Lisa Sparks, Karla M. Hunter

Communication Faculty Articles and Research

Background

Methods

Results

Pacific Rxtracts - December 2025, Pacific Rxtracts

Pacific RxTracts

Articles:

• FDA Approves Nerandomilast: A New Era in Idiopathic Pulmonary Fibrosis Treatment
• Brand New Approach to Addressing the Unmet Need of Cholestatic Pruritus
• Prep for Success with Lactulose
• Caution with Reported Allergies: Increased Risk of Surgical Site Infection with Non-β-Lactam Antibiotics
• Eltrombopag Redefines Treatment for Newly Diagnosed Pediatric ITP Combination for Extensive-Stage Small Cell
• Advancing Treatment for HER2-Positive Breast Cancer: Trastuzumab Deruxtecan plus Pertuzumab
• Comparison in Efficacy of Abiraterone and Enzalutamide in US Veterans with mHSPC
• Revumenib: A First-in-Class Menin Inhibitor for Relapsed or Refractory Acute Myeloid Leukemia
• Ziftomenib: A Menin Inhibitor Redefining Precision Therapy in NPM1-Mutated AML
• The Future …

Alzheimer's Medications And Polypharmacy Management In Advanced Dementia And Hospice Care, Rana Senlik, Robert Martin

Advocate GME

No abstract provided.

Medicaid Funding And Health-Related Social Needs: A Policy Analysis, Passion Ilea

Dissertations and Theses

The U.S. has disproportionately high health care spending compared to other high-income nations and comparatively poor health outcomes. The Centers for Medicare and Medicaid Services (CMS) have recently increased emphasis on addressing Medicaid member social needs. CMS believes addressing health-related social needs (HRSN) may reduce costs and improve health outcomes for Medicaid members. CMS has begun to test theories regarding the impact of member HRSN on health care by designing federal mechanisms to address HRSN, such as in lieu of services and settings-funded services, and by encouraging state Medicaid programs to develop their own approaches, such as Flexible Services. Information …

Reimagining Death And Rituals Through Design: Memorial Diamond Jewellery As A Speculative Probe, Yiwen Cheng, Jie Sun

IASDR Conference Series

Death remains one of the most enduring cultural taboos, often met with silence and avoidance across both Western and Eastern societies. Although design research has increasingly engaged with death through the lens of thanatosensitive design, it has largely focused on supporting the bereaved, leaving the perspectives and agency of the dying themselves under explored. This study explores the memorial diamond as a speculative medium for reimagining death rituals and the relationships between the deceased and the bereaved. Using a research through design approach, we engaged speculative design as both a future-oriented lens and a creative method to examine these phenomena. …

A Study On Supporting Administrative Procedures Related To Death And Inheritance -Focusing On Entry Items In Ending Notes, Ryoichi Tamura, Shintaro Yamada

IASDR Conference Series

This study aims to reduce the burden of administrative procedures related to death and inheritance by focusing on entry items in ending notes and identifying related challenges in terms of understanding and information sharing. Thirty-four ending notes were analyzed, and their entry items were organized into 25 categories. Using Hayashi’s Quantification Theory Type III and cluster analysis, the notes were classified into three groups to clarify their characteristics. Questionnaire surveys of older and middle- aged adults revealed levels of awareness, willingness to communicate, and desire to understand each item, leading to the classification of entry items into six types with …

Quality Improvement Project: Reducing Hospitalizations In The Long-Term Care Setting, Nenna Nzeocha

Doctor of Nursing Practice Projects

Hospitalizations in the long-term care setting can lead to higher costs incurred by skilled nursing home residents and a poorer quality of life. This quality improvement (QI) project evaluated whether an educational intervention on the Reducing Avoidable Facility Transfers (RAFT) model impacted hospitalization rates in the skilled nursing facility (SNF), while also assessing the confidence level of facility staff on the intervention. The project utilized Lewin’s change theory and the Donabedian model framework and was aimed at developing interventions that impact hospitalizations in the SNF using the RAFT model. A quasi-experimental design was used and consisted of a pre-and-post implementation …

Culturally Diverse End-Of-Life Simulation And Perceptions In Undergraduate Nursing Students, Jodi Kay Olson, Mary Pesch, Julie Keller-Dornbusch

Biennial Convention (CONV)

End-of-life (EOL) patient care is a challenging reality that nearly all nurses will face during their careers. Preparing nursing students for these situations can alleviate anxieties related to patient death (Venkatasalu et al., 2015). Simulation-based learning is an effective approach for teaching complex scenarios like EOL care (Cannity et al., 2021), with numerous studies highlighting improved confidence and competence in students who participate in EOL simulations (Gillan et al., 2014; Tamaki et al., 2019; Venkatasalu et al., 2015; Lewis et al., 2016; Jablonski et al., 2020). However, the lack of cross-cultural variations in death and dying highlights the need for …

Quality Of Life And Mental Health: A Qualitative Exploration Of Perceived Factors That Impact Older Adults, Chasiti Herring

All-Inclusive List of Electronic Theses and Dissertations

Enhancing quality of life and well-being is a universal phenomenon across the lifespan. As the population ages, older adults are in great need of supportive services to enhance quality of life and their ability to manage their mental health. The purpose of this study is to examine the quality of life (QoL) of older adults. This study aimed to provide valuable research in the area of QoL through the exploration of perceived factors that impact the older adult population. This exploratory qualitative research study consisted of 10 older adult participants between the ages of 65 and 95. Research recruitment prioritized …

Engage, Assess, Intervene, Evaluate: Barriers Facing The Elderly Population, Isabel Anderson, Gracie Brown, Mari Langton

Student Projects

This study examined barriers faced by older adults in Orange City, Iowa, through a mixed-methods community practice project incorporating assessment, implementation, and evaluation. During the assessment phase, researchers conducted interviews with elderly residents and professionals, gathered observational data, and facilitated community dialogue using the Nominal Group Technique. Key themes included social isolation, transportation challenges, financial strain, limited health literacy, and difficulty transitioning from independence to assisted living. A strong cultural emphasis on independence often discouraged help-seeking, while fragmented agency communication and rural limitations in specialized care further complicated service navigation. Asset mapping and power analysis highlighted community cohesion, faith-based support, …

Post-Discharge Transitions Of Care Pharmacists Follow-Up Impact On Patient Care, Lesly Rapado, Sara Panella, Elaina Rosario, Emilie Collongette, Faaria Quadri, Beatriz Jimenez-Cadilla, Amanda Gronniger

Nursing & Health Sciences Research Journal

Introduction: This quality improvement project assessed the impact of a newly implemented transitions of care (TOC) pharmacist service at a large health system. The service involves a comprehensive review of recently discharged value-based care individuals, including chart review and, when necessary, telephonic follow-up by the pharmacist 3-6 days post-discharge.

Methods: This retrospective evaluation compared two groups: pre-implementation (September 1st, 2023 - January 30th, 2024) and post- implementation (March 1st, 2024 - July 30th, 2024) of TOC pharmacist service, focused on patient evaluations 3-6 days post-discharge. The primary outcome was a composite of 30-day re-hospitalization rates including urgent care, emergency department, …

From Awareness To Action: Improving Advanced Directives With The Five Wishes In College Aged Young Adults, Dina M. Giovanetti

Electronic Theses and Dissertations

This quality improvement project aimed to increase early education, initiation, documentation, and completion rates of advance directives (ADs), specifically the Five Wishes, among college-aged young adults (18–24 years old) in a concierge primary care setting. The project addressed the low engagement and completion rates of ADs in this population, which can result in inadequate end-of-life care planning. The initiative involved training all staff members through collaborative instruction, informational sessions, and personalized provider-patient discussions. A convenience sample of eligible patients was identified via chart review. Inclusion criteria included English-speaking young adults aged 18–24, regardless of comorbid conditions who were members of …

Implementing Primary Care Fall Prevention With The Steadi Algorithm Toolkit, Roslyn Pechet

Electronic Theses and Dissertations

Falls among older adults remain a leading cause of morbidity and mortality, especially in underserved populations. The Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) toolkit to help providers systematically identify and address fall risks. The purpose of this Doctor of Nursing Practice (DNP) project was to implement and evaluate integration of the CDC STEADI toolkit within primary care at Palm Beach Program of All-Inclusive Care for the Elderly (PACE) Greenacres. The aim was to train the interprofessional leadership team to use the STEADI program to enhance knowledge, confidence, screening, and implementation …

Retrospectively Examining The Probability Of Acute Skin Failure Among Hospitalized Patients With Hospital-Acquired Pressure Injuries, Tori C. Hatch, Jeanine M. Salamone, Pierna F. Vaughner, Natalie Bermudez

Nursing & Health Sciences Research Journal

Introduction: Acute skin failure (ASF) in hospitalized patients is a growing concern and a product of multisystem organ failure. Unlike hospital-acquired pressure injuries (HAPIs), ASF is not preventable despite prevention measures. The Skin Failure Clinical Indicator Scale (SFCIS) was recently developed to assess the probability of ASF. The purpose of this study was to retrospectively examine the probability of and factors associated with ASF in hospitalized individuals with HAPIs.

Methods: Data were collected from the electronic health records of in-patients with stage 3 or greater HAPIs over two years. Collection included demographics, comorbidities, COVID status, wound staging, injury location, SFCIS, …

Assessment Of Stroke Priority Status On Door-To-Reversal Time And Outcomes In Anticoagulant Associated Intracranial Hemorrhage, Kayla Mitzel, Jonathan Kline, Thomas J. Wolfel, Erika Dittmar, Nina Cruz, Felipe De Los Rios La Rosa, Heidi Clarke

Nursing & Health Sciences Research Journal

Background: The emergent reversal of anticoagulation in the setting of intracranial hemorrhage (ICH) is critical, and it is essential that comprehensive stroke centers adhere to the American Heart Association (AHA) metrics for door-to-reversal within the designated 90 minutes. The objective of this review is to evaluate individuals classified as stroke alert priority 1 and non-stroke alert and compare AHA metrics for door-to-reversal times and clinical outcomes when diagnosed with ICH.

Methods: Single-center observational, retrospective review that compared stroke alert priority 1 individuals to non-stroke alert individuals who were diagnosed with an ICH and taking an anticoagulant prior to admission. The …

Bias And Disparities In Neonatal End-Of-Life Care, Tamiko Younge, Daria Murosko, Simranjeet S Sran, Terri Major-Kincade

Faculty, Staff and Student Publications

No abstract provided.

The Spiritual Care Of Hospice Patients With Cognitive Deficits, Shane Sullivan

Doctor of Ministry Theses and Dissertations

ABSTRACT How can a hospice chaplain know whether their presence and ministry make a meaningful difference when visiting patients with dementia or other serious cognitive impairments? This project thesis seeks to answer that question conclusively. The theological foundation of this project centers on the doctrine of the imago Dei—the image of God—as it relates to individuals who are dying with cognitive deficits. Specifically, it explores how a person who is helpless and near death continues to reflect the image of God. The project intervention described here is the creation of a specialized training guide for hospice chaplains at Bridge Hospice …

Enhancing End-Of-Life Quality In Hospice Care, Gerson Orellana Prudencio

Capstone Projects and Master's Theses

The‍‌‍‍‌ increasing demand for hospice care in Monterey County is a clear indicator of the rapid growth in the need for end-of-life services driven by the aging population. The project was developed at the Department of Hospice of the Central Coast, which is under the Montage Health Foundation, a non-profit organization. The community served consists of elderly people receiving hospice and end-of-life care, as well as volunteers who provide administrative and indirect support. The Volunteer Handbook aims to create a comprehensive procedural manual for hospice volunteers to improve administrative efficiency and ensure the quality of care. Interviews were conducted with …

Barriers To Hospice Access For The Latino Community, Guadalupe Rivera

Capstone Projects and Master's Theses

The Latino community in Monterey County faces significant obstacles to accessing hospice care, including language barriers and cultural misunderstandings. Many community members are unfamiliar with available hospice services or hold common misconceptions, such as equating hospice only with dying or abandonment. This capstone project, in partnership with the Central Coast Visiting Nurse Association (VNA), investigated these barriers through interviews conducted at a local senior event. An important outcome of the project was the creation of a bilingual (Spanish and English) resource guide for new Social workers which helps social workers efficiently connect Latino families to appropriate services in their preferred …

Bridging The Gap: Culturally Responsive Bereavement Support In Latino Families, Maria I. Hernandez

Capstone Projects and Master's Theses

Hospice of the Central Coast (HCC), a division of Montage Health, delivers high-quality end-of-life care and bereavement support to adults and families in Monterey and select areas of San Benito County. This capstone project sought to address the disparities by developing and implementing an eight-week bereavement support group curriculum translated and adapted for Spanish-Speaking Latino families. Despite the organization’s longstanding commitment to compassionate and inclusive healthcare, internal data reveal substantial gaps in service for the latino population: of 628 patients served in 2023, only 47 patients were of Hispanic or Latino origin. This discrepancy stems from ingrained barriers such as: …

Environmental Sanitation In Long-Term Care Facilities: A Focus On Regulations And Implementations, Ruwan Dissanayake Dissanayake Mudiyanselage

All Theses

Environmental sanitation is a fundamental component of infection prevention in long-term care facilities (LTCFs), where residents are at increased risk due to advanced age, underlying health conditions, and communal living arrangements. Despite its critical role, significant gaps remain in implementing environmental sanitation procedures and the regulatory frameworks that guide them.

This study combines two components: (1) an across-state regulatory review of environmental sanitation in LTCF regulations and (2) a cross-sectional survey assessing environmental sanitation characteristics of nursing homes (NHs) and assisted living facilities (ALFs) and Rural and Urban LTCF observation study in South Carolina (SC) . For the regulatory review …

Determining Timeframes To Death For Imminently Dying Patients: A Retrospective Cohort Study, Tricia O’Connor, Wai Man Liu, Juliane Samara, Joanne Lewis, Karen Strickland, Catherine Paterson

Research outputs 2022 to 2026

Background: Clinicians are frequently asked ‘how long’ questions at end-of-life by patients and those important to them, yet predicting timeframes to death remains uncertain, even in the last weeks and days of life. Patients and families wish to know so they can ask questions, plan, make decisions, have time to visit and say their goodbyes, and have holistic care needs met. Consequently, this necessitates a more accurate assessment of empirical data to better inform prognostication and reduce uncertainty around time until death. The aims of this study were to determine the timeframes for palliative care patients (a) between becoming comatose …

The First Year Of Assisted Dying In New Zealand Through The Lens Of Healthcare Professionals Not Directly Involved In The Process, Waqas Arshad, Aida Dehkhoda, Melissa Carey, David B. Menkes, Nicholas Hoeh, Frederick Sundram, Rosemary Frey, Gary Cheung

Research outputs 2022 to 2026

Background: New Zealand’s End of Life Choice Act 2019 was enacted in 2021, allowing terminally ill people experiencing unbearable suffering to request assisted dying if they are expected to die within six months. Healthcare professionals not directly involved in assisted dying provision may have unique perspectives on implementation, yet this remains under-explored. Methods: This qualitative study was conducted between June and November 2022. We used purposive and snowball sampling to recruit potential participants through various sources, including the Ministry of Health’s assisted dying training and communication email list. A multidisciplinary research team developed a semi-structured interview guide. The individual interviews …

The Effect Of Simulation On Nurses’ Confidence With Providing Post-Fetal Death Support To Bereaved Parents, Monique Scholine, Shannon Zalewski, Erin M. Franklin, Sandria Jamieson, Janelle Diaz, Donna Davis, Kristi Vargo, Nicole Adokou, Kettia Antoine, Natalie Bermudez

Nursing & Health Sciences Research Journal

Introduction: Fetal death (FD) affects one in 10 women worldwide and is associated with negative sequelae such as complicated grief. The negative effects of FD may potentially be mitigated through provision of bereavement support (BS) by trained healthcare workers.

Purpose: The purpose of this study was to explore the effect of simulation on registered nurses’ (RN) confidence in providing BS following FD.

Methods: This was a quasi-experimental study conducted within a South Florida community hospital. Nurses were recruited via email/flyers. Participation in the study entailed attending a post-FD simulation session, and completion of the Perinatal Bereavement Care Confidence Scale (PBCCS) …

High-Risk Medications In Pediatric Dentistry: Patterns, Outcomes, And Clinical Implications, Yilei Liu, Kawtar Zouaidi, Colin C Hubbard, Muhammad F Walji, Matthew R Cooke, Donald B Rindal, Kristin N Ray, Elsbeth Kalenderian, Katie J Suda

Faculty, Staff and Student Publications

Background: High-risk medications such as opioids and benzodiazepines are frequently prescribed in pediatric dental care, yet their prescribing patterns and associated adverse outcomes remain poorly understood. The aim of this study was to determine the extent of such prescribing to pediatric patients and factors associated with adverse outcomes.

Methods: MarketScan data for patients younger than 18 years with a dental visit from 2014 through 2019 were analyzed. High-risk medications included benzodiazepines, barbiturates, and opioids. Composite outcomes included hospitalization, emergency department visit, or urgent care visit within 7 days after the dental visit. Opioid-attributable outcomes included opioid-related overdose within 7 days …

Being A Caregiver For A Friend Or Family Member, Nancy Morrow-Howell, Michele Dinman

Harvey A. Friedman Center for Aging

Informal caregivers give assistance to family and friends who have functional limitations that challenge self-care. Most often, caregivers assist younger adults living with a disability and older people with age- associated chronic conditions. Family caregivers are the backbone of our long-term care system in this country, delivering 80% of care. Caregiving is increasing as people live longer with more chronic conditions. Indeed, caregiving is the new norm in our older society. As Roselyn Carter said: "There are only four kinds of people in the world. Those who have been caregivers, those who are currently caregivers, those who will be caregivers, …

A Model For Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 20, Satheesh Gunaga, Christopher R Carpenter, Maura Kennedy, Lauren T Southerland, Alexander X Lo, Sangil Lee, Kirby Swan, Fabrice Mowbray, Rachel M Skains, Teresita M Hogan, Martin F Casey, Kei Ouchi, Naomi R George, Kerstin De Wit, Cameron J Gettel, Katherine Selman, Luna C Ragsdale, Anita N Chary, James D Van Oppen, Glenn Arendts, Charles L Maddow, Katherine M Hunold, Katren R Tyler, Danya Khoujah, Ula Hwang, Shan Liu

Faculty, Staff and Students Publications

The original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, …

A Multilevel Analysis To Evaluate Variability In Sdoh Clusters Within Rurality And Its Effects On Cancer-Specific And All-Cause Mortality In The Us., Stephie Ann Abraham

Electronic Theses and Dissertations

Social determinants of health (SDOH) factors have consistently been shown to impact all-cause and cancer-specific mortality. Area-level SDOH factors that coexist to form “high-risk” clusters are more prevalent in rural than urban areas. However, heterogeneity within rural and urban areas may contribute to variations in SDOH factors that could influence higher mortality rates and is not considered in other studies. The primary objective of this study was to utilize ecological and individual-level data to determine if the composition of SDOH clusters within counties in the rural-urban continuum contributes to differences in all-cause (AC) and cancer-specific mortality rates of lung and …

Palliative Ventilator Withdrawal Algorithm: A Feasibility Quality Improvement (Qi) Project, Al-Zada Aguilar, Olivia Nicastro

Biennial Convention (CONV)

Managing respiratory distress during end-of-life (EOL) ventilator withdrawal poses significant challenges, particularly without structured algorithms or validated, reliable tools. This quality improvement (QI) project addressed these challenges by implementing Campbell’s ventilator withdrawal algorithm and the Respiratory Distress Observation Scale (RDOS), a validated, reliable tool for objective dyspnea assessment. This project sought to enhance care quality by evaluating process feasibility while addressing implementation barriers.

Dyspnea is a complex, subjective symptom frequently encountered during EOL ventilator withdrawal. Campbell’s algorithm provides a structured, individualized approach emphasizing prevention, early intervention, reassessment, and treatment while considering patient-specific factors such as illness severity and level of …

Clinical Phenotypes Of Motor Neurone Disease In A Kenyan Hospital-Based Population, Effie Nailah Kamadi, Jasmit Shah, Juzar Hooker, Thomas Jenkins, Dilraj Sokhi

Internal Medicine, East Africa

Background: Motor neurone disease (MND) presentation is globally heterogenous and data on the clinical phenotype in Sub-Saharan Africa (SSA) is scarce. We sought to address this by describing the profile of MND patients in a Kenyan hospital-based population.

Methods: The medical charts of all adult MND patients assessed in the facility between January 2010 and December 2023 were retrospectively reviewed. The biographical data and clinical features of these patients were captured from their electronic and manual health records and statistical analysis performed.

Results: In total, 160 patients had their data analyzed. The male to female ratio was 1.76:1. The median …