Digital Commons Network^™

Strategies For Integrated Primary Care Clinics To Improve Administrative Costs Due To Medication Nonadherence, Michael A. Watkins

Walden Dissertations and Doctoral Studies

Medication non-adherence is a pervasive issue that drives up administrative costs for integrated primary care clinics. Total administrative costs for medication non-adherence account for one-quarter of U.S. healthcare expenditures. The purpose of this integrative review was to identify cost-reduction strategies that integrated primary care clinic administrators can implement to offset costs associated with medication nonadherence. The theoretical framework for this integrative review was Bertalanffy’s general systems theory. The review question was to identify strategies that primary care clinics could implement to reduce administrative costs associated with patient medication nonadherence. A comprehensive literature search yielded 1,892 potential articles. A quality analysis …

The Integration Of Mental Health Services Within The Black Church: A Literature Review Of Systematic Inequalities, Stigma, And Culturally Responsive Approaches, Grace N. Wingate

Honors College Theses

Black American Christians in predominantly Black churches often face limited access to adequate mental health resources due to historical mistrust, systemic inequalities, and cultural stigma. These barriers are rooted in longstanding distrust of psychological services, the underrepresentation of Black mental health care professionals, and the high cost and inaccessibility of care. Additionally, stigma within Black Christian communities may discourage individuals from seeking help from mental health professionals, particularly when such care is perceived as conflicting with religious beliefs. Despite these challenges, Black churches remain central and trusted institutions within their communities, positioning them as crucial sites for mental health support. …

Charlotte Ku, Charlotte Ku

Faculty CVs

No abstract provided.

Cultivating The Dream In African American Men Through Black Excellence And Success, Sylvia Lawan Branch

LMU Theses and Dissertations

Achieving Black Excellence has been a goal for African American men for several decades; yet this movement has been hindered by social, emotional, and discriminatory life experiences from early childhood through adulthood. Black Excellence has been a phrase used in recent years to highlight achievements for African American men in wealth, mental health, well-being, fatherhood, and academic achievement. The main objective of this dissertation was to define and examine dimensions of Black Excellence among African American men, including elements that contributed to personal fulfillment and broader social impact. To determine recommendations to achieve Black Excellence (Scott, 2017), 10 semistructured interviews …

Wavetable Modification In Frequency Domain: Fourier Analysis With Matlab Implementation, Caleb Kortens

Senior Honors Theses

One of the challenges in creating computer generated music is producing life-like sounds. Music produced through computer synthesis can often sound thin and synthetic rather than vibrant and energetic. Wavetable synthesis is a method of waveform generation that uses a wavetable, which is a set of single period waves, or frames, that have varying characteristics. This method allows a synthesizer to transition between waveforms to produce a sound with time varying tone and harmonic characteristics. This adds life and movement to computer generated sounds. Wavetable synthesis is often used to imitate actual instruments, but unique wavetables can be created that …

Establishing A Standardized Suicide Risk Screening Policy For Psychiatric Providers: Closing Gaps In Provider Accountability And Clinical Documentation, Fadekemi Olude

Doctor of Nursing Practice Projects

Psychiatric providers in outpatient settings often experience inconsistent confidence and incomplete documentation when conducting suicide risk screening, contributing to missed opportunities for early identification of at-risk patients. This quality improvement project addressed the need for standardized suicide risk screening at an urban outpatient psychiatric clinic. The purpose was to evaluate documentation using the Columbia-Suicide Severity Rating Scale (C-SSRS). Using a pre-post intervention design guided by Lewin's Change Theory and the Donabedian Model of Quality Improvement, a 60-minute training session was delivered to 31 psychiatric providers. Participants completed pre- and post-intervention General Self-Efficacy Scale (GSES) surveys. Chart audits (N = 1,970) …

A Functional Nutrition Literature Review For Brain Fog And Adhd-Like Symptoms In Adults, Natalie Elisani Aldahondo-Matos

Department of Nutrition Student Projects

Attention-deficit/hyperactivity disorder (ADHD) and ADHD-like symptoms, such as difficulty concentrating, mental fatigue, and problems with executive functioning, are increasingly recognized in adults. Although medication is commonly used to manage ADHD, there is growing interest in whether nutrition may also play a role in supporting brain function and attention. Several nutrients involved in brain health including omega-3 fatty acids, vitamin B12, magnesium, iron, and choline  have been suggested as potential contributors to cognitive performance and attention. However, the research examining the connection between diet and ADHD symptoms is still limited and sometimes shows mixed results.

The purpose of this project was …

New Nurse Faculty Mentorship: A Quality Improvement Project, Kimberly B. Porter

Doctor of Nursing Practice Projects

The ongoing nursing faculty shortage limits program capacity and makes it harder to retain novice nurse educators transitioning from clinical practice to academia. The literature highlights issues such as insufficient mentorship, role confusion, and a lack of structured support as key factors contributing to early faculty attrition. This quality improvement (QI) project aimed to implement and evaluate an evidence-based mentorship program to improve perceptions of mentorship effectiveness among new-to-academia nurse faculty in a School of Nursing in Arkansas. The purpose was to implement and evaluate a mentorship program designed to improve perceptions of mentorship among new-to-academia nurse faculty. The project …

Supporting Advanced Practice Providers (Apps) Through Second Victim Experiences (Sves), Al-Zada Aguilar

Creating Healthy Work Environments (CHWE)

Background/Significance: SVEs describe the physiological, psychological, and professional impact experienced by providers involved in near misses, adverse events, and unanticipated patient outcomes.^1-3 Studies estimate that more than half of providers have SVEs and their sequelae at least once in their lifetime, further exacerbated by a lack of institutional support, potentially contributing to burnout, compassion fatigue, and attrition.^1-4 Existing literature addresses SVE in physicians and nurses; even so, the literature is sparse when it comes to APPs, providers positioned between nursing and medical models, often navigating clinical spaces without structured support systems.

Purpose: To develop an evidence-supported, system-level framework …

Resilience, Social Support, And Burnout: Building Healthy Work Environments For Emergency Nurses, Timothy R. Burns

Creating Healthy Work Environments (CHWE)

Background: Emergency department (ED) nurses work in high-stakes environments that increase exposure to stress, trauma, and burnout. Identifying protective factors that strengthen well-being is essential to building and sustaining healthy work environments.

Purpose: This study examined how years of experience, social support, and resilience influence burnout, secondary traumatic stress, and compassion satisfaction among ED nurses across the United States.

Methods: A cross-sectional design was used. Participants completed a demographic form, the Professional Quality of Life Scale (ProQOL), the Connor–Davidson Resilience Scale (CD-RISC), and the Lubben Social Network Scale. Data were analyzed using multiple and hierarchical regression to identify predictive relationships …

Assessing The Feasibility Of Integrating Occupational Therapy Services Within A Pediatric Primary Care Setting For Children 0-3 Years Old., Amanda L. Wilbert, Cristina Dumitrescu, Kim Karr

Post Professional Occupational Therapy Doctoral (PPOTD) Student Capstone Projects

The objective of this capstone project was to assess the feasibility of implementing occupational therapy (OT) services within a pediatric primary care office using a manualized service delivery approach. Occupational therapy is inherently grounded in parent coaching and education, positioning the profession to play a critical role in supporting families and promoting early identification of developmental risk. This project aimed to address a documented gap in the inclusion of OT within pediatric primary care by exploring how OT services can support parenting skills and monitor children identified as at risk for developmental, behavioral, or psychosocial concerns. The project was conducted …

Spartan Daily, April 28, 2026, San Jose State University, School Of Journalism And Mass Communications

Spartan Daily, 2026

Volume 166, Issue 38

Impact Of Provider Confidence And Psychiatric Referrals Through Education And Implementation Of The Gad-7 Anxiety Screening Tool In An Outpatient Family Clinic, Maceline E. Check

Doctor of Nursing Practice Projects

Gaps in provider and nurse confidence in identifying and managing anxiety disorders in outpatient family clinic settings contribute to underdiagnosis, delayed intervention, and reduced psychiatric referrals. This quality improvement project evaluated the impact of provider education and implementation of the Generalized Anxiety Disorder-7 (GAD-7) screening tool on provider and nurse confidence and appropriate psychiatric referral rates, with the goal of improving clinical decision-making and standardizing anxiety screening practices. The project was guided by Lewin’s Change Theory and the Iowa Model of Evidence-Based Practice. Using a quasi-experimental pre- and post-intervention design, providers and nurses in an outpatient family clinic received structured, …

Quality Improvement Project: Impacting Staff Confidence In Recognizing Hiv Medication Adherence, Joy Nwansi-Iro

Doctor of Nursing Practice Projects

Medication adherence to antiretroviral therapy is essential for viral suppression and improved outcomes among individuals living with human immunodeficiency virus (HIV). Despite advances in treatment, healthcare providers lack confidence in recognizing medication adherence challenges and implementing appropriate interventions. Evidence suggests that provider education using standardized adherence assessment tools improves adherence monitoring and clinical decision-making. The purpose of this quality improvement project is to evaluate whether an educational intervention and a standardized workflow using the CASE Adherence Index would impact healthcare staff confidence in recognizing HIV medication adherence. Lewin’s Change Theory guided the project through the stages of unfreezing, change, and …

Facilitators And Barriers To Engagement In A Virtual Mindfulness Program Among Healthcare Workers, Yu-Ping Chang, Tess Bernardo, Allie Nickel, Linda Steeg

Creating Healthy Work Environments (CHWE)

Purpose: Healthcare professionals experience ongoing stress and burnout from heavy workloads and emotional demands. Mindfulness-Based Stress Reduction (MBSR) has strong evidence for enhancing emotional regulation, resilience, and well-being. Despite its proven benefits, adoption remains limited across individuals and organizations. Identifying key facilitators and barriers is essential for sustainable integration into healthcare practice. This presentation explores healthcare workers’ perceived barriers and facilitators to participating in an eight-week virtual MBSR program.

Methods: We conducted a qualitative study using individual interviews with healthcare workers who completed the virtual MBSR program delivered by certified trainers aimed at improving workplace resilience. Four trained research staff …

Enhancing Anesthesia Clinicians’ Knowledge And Confidence In Prophylactic Antibiotic Selection For Patients Receiving Concomitant Therapeutic Antimicrobials, Nicholas Rangel, Michela Williams, Amber Theisen

Doctor of Nursing Practice (DNP) Student Projects

: Background and Review of Literature: Antibiotics are essential for preventing surgical site infections (SSIs), but improper selection can contribute to antimicrobial resistance, increased costs, and patient harm. Studies show that clinical decision support (CDS) tools can improve antibiotic prescribing practices using evidence-based guidelines.  Purpose: This project aimed to integrate a revised CDS tool into the workflow of a anesthesia clinicians at a midwestern academic medical center, incorporating allergy-specific guidelines and antimicrobial substitution recommendations for patients on concomitant therapeutic antimicrobials (CTA) to improve decision-making. Methods: This project used pre- and post-surveys to assess clinicians’ knowledge, confidence, and satisfaction in selecting …

Clinical Implications Of Circulating Mirna-200a And Mucin 16 In Late-Stage Colorectal Cancer: A Study In Iraqi Patients, Eman Sh. Ali, Ali W. Al-Ani

Baghdad Science Journal

Background: Colorectal cancer, the most common gastrointestinal cancer, is a significant health issue globally. Mucin 16 plays a critical role in cancer signal transduction pathways and is a potential glycoprotein target for cancer therapy. The miRNA-200 family also regulates the expression of numerous genes that play vital roles in cancer cells. This study aimed to investigate the changes in mucin 16 and miRNA-200a in patients with colorectal cancer (CRC). Subjects and Methods: Fifty-six patients with CRC, including 26 in stage 3 and 30 in stage 4, were included in this study, along with 38 healthy volunteers as a control group. …

Docking-Based Virtual Screening Of Bisbenzylisoquinoline Derivatives From Stephania Genus Against Hepatocellular Carcinoma, Aulia Syahfitri, Denny Satria, Poppy Anjelisa Zaitun Hasibuan, Jane Melita Keliat, Syukur Berkat Waruwu, Choo Yeun-Mun

Baghdad Science Journal

Hepatocellular carcinoma (HCC) is one of the most common and aggressive subtypes of liver cancer. It has a poor prognosis, a high rate of recurrence and shows limited response to current therapies. In order to combat this condition, the use of natural products as multitarget anticancer agents is gaining momentum. In this study, we investigated the medicinal value of bisbenzylisoquinoline (BBI) alkaloids from the Stephania genus via an integrative in silico approach. Due to their improved pharmacokinetic profiles and expected low toxicity, we chose 11 BBI derivatives. Network pharmacology analysis revealed 334 overlapped targets between the compounds and HCC. Functional …

Probing Composition Effects On The Intrinsic Energetics Of Proton Transfer In Binary (Hcl)M(H2o)N Clusters, Max R. Tucker, Sarah N. Arradondo, Olivia M. Longsworth, George C. Shields, Gregory S. Tschumper

Chemistry Faculty Research & Creative Works

This work examines the effects on intrinsic energetics as the composition of finite (HCl)_m(H₂O)n cluster families containing at least one water molecule is changed at the molecular level, where m ≥ 2 and m + n = 4 − 6, and the associated (Cl⁻)_x(H₃O⁺)_x(HCl)_m−x(H₂O)_n−x clusters resulting from the dissociation of x HCl fragments via proton transfer (PT). They are collectively labeled m:n, and xPT indicates the degree of dissociation, from 0PT (no dissociation) up to 3PT. More than 1000 unique minima …

Associations Between Smoking Habits And Weight-Related Behaviors Among People Who Smoke In The United Arab Emirates: A Cross-Sectional Study, Sharifa Alblooshi, Maryam Hassan Dawood, Dana N. Abdelrahim, Marika Lo Monaco, Falak Zeb

All Works

Background: Smoking is one of the leading global public health problems, and is complicated by multiple reasons for its prevalence and associated health problems. An understanding of the influence of smoking activity on weight management is essential to formulate successful health programs. Aim: The objective of the present study was the investigation of the association between smoking habits and weight management among adult people who smoke in the UAE. Methods: A cross-sectional study was conducted with 232 participants who completed a 36-item questionnaire assessing their smoking habits and weight management practices. Results: The sample consisted mostly of males (75.4%) aged …

Weakening Of Social Protection In Vietnam: Labour Legislation, Cicada Capital And Civil Society, Angie Ngọc Trần

SSGS Faculty Publications and Presentations

Using findings from a 2023 case study on Vietnamese workers in the wood-processing industry and critical content analysis of changes in the labour codes, social insurance laws and annual minimum wage increase policy, I demonstrate how the state’s rhetoric of ‘universal social coverage’ for workers has facilitated the recommodification phase, an authoritarian turn, in the ‘cycle of commodification’ ( Lin and Nguyen, 2021 ). I argue that the expansion of informal labour and unchecked prevalence of ‘cicada capitalism’ are enabled by weakening labour legislation, even weaker state enforcement of social protection laws, and suppression of civil society’s labour advocacy …

A Case For Mtor Pathway Screening In Early Epilepsy Diagnosis, David Seamons

Student Works

Mutations in the mTOR pathway can give rise to epileptic seizures in patients. While a variety of antiepileptic drugs are available to treat epilepsy, a large proportion of patients will experience refractory seizures (Chen et al., 2018). Additionally, patients with mTOR-related epilepsy may experience reduced efficacy in traditional therapeutic options to treat seizures (French et al., 2016; Hadzsiev et al., 2023; Kato et al., 2022; Moloney et al., 2023). Mutations resulting in mTOR-related epilepsy are genetically inherited; however, some variability in family histories of epilepsy may be due to second-hit somatic mutations in focal areas of the brain (Dawson et …

Key Issues For Speed Safety Cameras: Results From A Semi-Structured Interview Of Agencies In The United States, Sophia Semensky, Miguel Figliozzi

Civil and Environmental Engineering Faculty Publications and Presentations

Speed safety cameras (SSCs) are a recognized countermeasure for targeting speeding-related crashes, injuries, and fatalities. SSCs have been introduced in various cities and are steadily expanding in use both in the U.S. and internationally. The extensive literature review of domestic and international documents and research papers reveals that the U.S. has been comparatively slow to adopt SSCs, with some other countries implementing these systems more extensively and earlier. Many local agencies are eager to learn SSC best practices and implementation lessons within the U.S. context. In this research, key issues related to SSC implementation are explored through semi-structured interviews with …

Bridging The Gap: Empowering First-Generation Nursing Students To Transform Workforce Diversity, Kimberly L. Walsh

Creating Healthy Work Environments (CHWE)

Background/Significance: The U.S. nursing workforce remains insufficiently diverse, limiting culturally responsive care for minority and underserved communities. Nursing education is pivotal to diversifying the pipeline. First-generation nursing students (FGNS)—often from underrepresented backgrounds—can help close this gap, yet they face barriers such as financial strain, limited support networks, and unfamiliarity with academic expectations. Evidence is limited regarding which demographic and academic factors most strongly differentiate FGNS success from that of non-first-generation nursing students (NFGNS) in pre-licensure programs.

Purpose: To examine and compare demographic and academic success factors for FGNS and NFGNS in U.S. pre-licensure RN programs to inform targeted retention and …

Improving Undergraduate Nursing Student Self-Care Agency With The Moodfit App, Sarah C. Young, Susan Patton

Creating Healthy Work Environments (CHWE)

The prevalence of nursing burnout syndrome is estimated to range from 14 to 38% (Ge et al., 2023); North America has the highest rate at 38%. Two systematic reviews and meta-analyses found the global prevalence of burnout syndrome in nursing students ranging from 23 to 35% (Kong et al., 2023, Hernandez-Mariano et al., 2024). Arian and colleagues (2023) found student nurse burnout positively correlates with academic semester. As students progress through each term, burnout risk increases.

The American Association of Colleges of Nursing (2021) includes the demonstration of “…healthy, self-care behaviors that promote wellness and resiliency” (p.53) as an essential …

Exploring The Perspectives Of Nurse Leaders On Motivational Interviewing For Workplace Well-Being, Quinais S. Yu

Creating Healthy Work Environments (CHWE)

Background: Nurse leaders face challenges in supporting staff well-being while managing their own, and effective communication is crucial.

Aim: This study explored nurse leaders' perceptions of factors influencing well-being, challenges they face, the impact of Motivational Interviewing skills, and their training needs in MI.

Methodology: Employing a qualitative, exploratory design, the study gathered insights from nurse leaders in Hong Kong clinical settings through individual semi-structured interviews, analyzed using thematic analysis.

Key Findings: Nurse leaders perceive MI as a valuable tool for effective communication and addressing staff ambivalence towards self-care. They emphasized the need for improved work environments, work-life balance, career …

Factors Influencing Healthy Work Environments For Hospital-Based Nurse Practitioners In The U.S., Hyunmin Yu, Kathryn A. Connell, Sarah Delgado, Heather Brom, J. Margo Brooks Carthon, Amanda Bettencourt, Corinna Sicoutris, Deena Kelly Costa, Vicki Good, Matthew D. Mchugh

Creating Healthy Work Environments (CHWE)

Background: Nurse practitioners (NPs) are a rapidly growing segment of the U.S. healthcare workforce^1,2 and are increasingly integral to patient care in hospital settings.^3,4 Despite their expanding roles,⁵ little is known about the work environment factors that affect their well-being in hospital settings.⁶ This study aims to explore the factors that influence hospital-based NPs’ healthy work environments (HWEs) and identify strategies to enhance their well-being and support retention.

Methods: This qualitative descriptive study used directed content analysis⁷ to examine responses from 493 NPs across 264 hospitals in 10 U.S. states with varying scope-of-practice laws. …

Creating A Safe And Welcoming Environment For New Nurses Through Effective Preceptor Training, Heidi Keeler, Jodie Boswell

Creating Healthy Work Environments (CHWE)

The purpose of this presentation is to emphasize the critical role of nurse preceptors in supporting new nurses as they transition into clinical practice. It aims to highlight the importance of structured preceptor training to foster a safe, welcoming, and inclusive work environment. This presentation explores the essential role of preceptors in facilitating that transition with the use of the Ulrich Precepting Model. By focusing on the roles of Facilitator, Protector, and Socialization Agent, the presentation seeks to equip preceptors, educators and leadership with the tools and strategies necessary to promote psychological and physical safety, cultural assimilation, and professional growth …

The Use Of Cognitive Biases In Russian Cyber Operations, Emma Manning

Honors Theses

This thesis examines how Russia has employed reflexive control through cyber operations to influence decision-making in foreign states, focusing on disinformation campaigns during the 2014 annexation of Crimea and the 2016 U.S. presidential election. Reflexive control, a concept rooted in Russian military doctrine, seeks to shape an adversary's perceptions and decision-making by providing carefully crafted information that leads targets to make choices favorable to the initiator. This research argues that while the fundamental objectives of reflexive control have remained consistent, technological advances have significantly expanded Russia's ability to conduct operations in developing cyber domains.

Using qualitative analysis of open-source intelligence, …

How Does Cognitive Behavioral Therapy (Cbt) And Antipsychotics Compare To Antipsychotics Alone Impact Inpatient Length Of Stay: A Scoping Review, Morgan E. Johnson, Hailey M. Wade, Y'Esha V. Williams-Click, Rocquell Duncan, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Background

Psychosis in adults is a serious psychiatric condition that often necessitates inpatient hospitalization for stabilization and the initiation of medication. Untreated psychosis can lead to poor outcomes, including longer hospital stays, loss of occupational functioning, and a decreased quality of life. While antipsychotic medications are typically the first line of treatment, they can have severe side effects, which may lead to patients discontinuing their use. Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based intervention that targets maladaptive behaviors associated with the condition. CBT may improve treatment responses when used alongside antipsychotic medication. However, there is limited research on …