Digital Commons Network^™

From Hired To Hands-On-Deck Status: Solving Delays In Health Care Hiring Processes And Supporting Workforce Safety Across A Large For-Profit Health System, Cynthia Skeens

HCA Healthcare Journal of Medicine

Background

During and after the COVID-19 pandemic, health care staffing shortages and onboarding inefficiencies, specifically delays in employee health clearance, prolonged time to hire, and threatened workplace and patient safety.

Methods

An employee health onboarding workflow at a large health care organization was redesigned across 3 domains: people, process, and technology. Interventions included workflow standardization, elimination of non–value-added steps, optimized tuberculosis screening, increased appointment capacity, and technology integration (electronic health record [EHR]documentation, centralized scheduling and communication, and completion of pre-visit forms). Following a pilot from May to December 2022, the workflow was expanded organization-wide with a structured rollout and ongoing …

Promoting Safety In Alcohol Withdrawal Syndrome: A Proactive Nursing Process Framework, Julie Anne C. Comia, Elizabeth Card

HCA Healthcare Journal of Medicine

Background

Alcohol withdrawal syndrome (AWS) is a potentially life-threatening response to the abrupt cessation or reduction of heavy, prolonged alcohol use. Untreated, it can progress to delirium tremens (DT), a medical emergency historically associated with mortality as high as 40%. Agitation and hallucinations during withdrawal also pose safety risks to the health care team in addition to the patient. Because deterioration follows a predictable course, timely nursing recognition and intervention are central to protecting both the patient and the care team from avoidable harm. The evidence-based framework is intended as an educational tool to help nurses anticipate and avoid harm; …

A Safety Framework: Empowering Faculty To Build A Culture Of Safety, Rebekah L. Randall, Sarah Woodward

HCA Healthcare Journal of Medicine

Background

Prelicensure nursing curricula lack a defined safety framework for clinical education, leaving faculty with minimal guidance on how to model and teach foundational safety concepts. Nursing accrediting bodies identify psychological and physical safety as institutional priorities, emphasizing the need to equip future clinicians with foundational safety competencies early in their training.

The purpose of this quality improvement project was to develop the ABCs of Prevention (Awareness, Body, Communication) and 4Rs of Intervention (Remove, Report, Record, Reflect) safety framework for clinical nursing education, provide faculty education and resources to support its application in teaching, and assess the impact of the …

Integrating The Icare Compassionately Model Into Disaster Simulation, Chelsea Baker

HCA Healthcare Journal of Medicine

While global efforts to increase access to health care have been successful, the provision of high-quality, safe care remains a critical priority as adverse events continue to impact patient outcomes. To combat this issue, nurse educators need to address gaps in both technical and relational domains of care, including compassion. Despite being identified as a core competency to safe practice, compassionate care principles remain inconsistently taught and practiced within nursing curriculum. This study examined the integration of the iCare (inclusivity, character, accountability, respect, excellence) Compassionately model into a simulated disaster scenario to provide students with an opportunity to apply emotional …

Assessment Of Hypoglycemia Management In Acute Care Hospitals, Carley Warren, Christina Wing, Chenette Burks, Brooke Schmidt, Adam Hasse

HCA Healthcare Journal of Medicine

Background

Hypoglycemia is a common and potentially preventable complication among hospitalized patients, particularly those receiving insulin or other glucose-lowering therapies. Delayed recognition and inconsistent management can increase adverse outcomes. Although protocols exist, variability in treatment selection and timing may influence the likelihood of returning to normoglycemia. Understanding these patterns is critical to optimizing patient safety in acute care settings.

Methods

This retrospective review evaluated hypoglycemia management in adult inpatients across acute care hospitals within a large health system. Patients were included if they were aged 18 years or older, were hospitalized within the health system, and experienced a hypoglycemic event, …

The Use Of Infra-Red Spectroscopy To Assess Intact Skin Of Various Skin Tones, Mary Lee A. Potter, Stacie Sosa, Charlott Polm, Sherry Campton, Wisam Salameh, Ronnie Klein, Yaniv Cohen

HCA Healthcare Journal of Medicine

Background

Pressure injuries (PI) continue to be a serious medical complication in the acute care setting. Industry leaders advocate for the use of objective technologies to provide accurate and quantifiable skin assessments for all patients across diverse skin tones. The Infra-Red Spectroscopy Scanner (IRSS) is a novel non-invasive decision support system (DSS) electro-optic technology that uses near infra-red spectroscopy to examine and assess physical and chemical changes prior to visual skin breakdown in real-time.

Methods

A 2-phase prospective open-label pilot device study was launched under protocol IRM-02-1123 (USA version 3.0, November 1, 2023). In both Phase 1 and Phase 2, …

Building A Culture Of Safety Through Faculty Mentorship: The Peer Pairing Framework For Clinical Nurse Educators, Clare A. Chambers

HCA Healthcare Journal of Medicine

Background

Clinical nurse educators often transition from bedside practice to clinical education in high-risk settings without structured support. Limited or absent mentorship during this transition may affect educator confidence, student learning outcomes, patient outcomes, and the ability to sustain a culture of safety. Although mentorship is widely recommended in nursing education, implementation strategies remain limited. The Peer Pairing Framework was developed as a staged mentorship approach to support clinical nurse educators and inform a comprehensive mentorship model.

Methods

The Peer Pairing Framework was informed by a voluntary onboarding survey of 914 clinical faculty, of whom 73.52% expressed interest in having …

Laboratory Study Of A Waste Anesthetic Gas Mask Scavenging System To Reduce Airborne Pathogen Exposure For Health Care Workers In Post Anesthesia Care Units, Josh Horton, Trevor Lim, Andrew Kanach, John Moenning, James Mcglothlin, Bruce M. Applegate Sr.

HCA Healthcare Journal of Medicine

Introduction

A scavenging oxygen mask system (SOMS) utilizing house vacuum has been demonstrated to significantly reduce exposure of post anesthesia care unit (PACU) health care workers (HCWs) to waste anesthetic gases (WAGs). Therefore, it was proposed that the same system could also be used to protect HCWs in the PACU by reducing Infectious Respiratory Particles (IRPs) spread from patients who may harbor airborne infective pathogens, such as Mycobacterium tuberculosis, certain strains of influenza, and SARS-CoV-2.

Methods

A life-like adult manikin head equipped with a bio-aerosol Collison nebulizer was set up to simulate patients exhausting pathogenic droplets. Further evaluation of …

Bathrooms As A Patient Safety Blind Spot In Emergency Departments: A Narrative Review And Nursing Practice Framework, Carmelo Villani

HCA Healthcare Journal of Medicine

Background

Emergency department (ED) bathrooms preserve privacy and dignity but interrupt direct observation. Risks described across clinical publications and professional guidance include falls, unrecognized deterioration, overdose, hazardous ingestion, infection, inaccessible environments, and unmet elimination needs. This review integrated those risks and translated them into a nursing practice framework.

Methods

For the structured narrative review, PubMed/MEDLINE, CINAHL Plus, and Scopus were searched on July 30, 2026, without date, language, age, or publication-type filters. Backward and forward citation chasing and a targeted search for professional documents supplemented database searching. Publications were categorized by ED relevance and synthesized thematically. Professional guidance was analyzed …

From Restraint To Calm: A Narrative Review Of Nonpharmacologic Alternatives To Physical Restraints In Adult Acute Care And Introduction Of The Calm Bedside Restraint Alternatives Framework, Elizabeth Card, Brandi Puet

HCA Healthcare Journal of Medicine

Background

Nurses and health care workers are dedicated to creating a therapeutic environment for healing. Sometimes, physical restraints may be used to ensure safety in patients exhibiting violence, confusion, or agitation, or in patients with life-saving medical devices. While the regulatory requirements for use of physical restraints are well developed, this is not the case with alternatives to using restraints, and many nurses may lack clarity on the best practice for identification and application of alternatives to physical restraint use.

Methods

Two trained reviewers searched PubMed, Google Scholar, and professional health care organizations’ websites guided by a search strategy and …

No Place For Workplace Violence, Ryan Sledge

HCA Healthcare Journal of Medicine

Workplace violence in health care is often discussed as an employee safety issue, but that framing misses a larger operational reality. Violent incidents affect the individuals involved, but they also disrupt care delivery, strain teams, reduce patient safety, contribute to health care worker burnout, and expose organizational conditions that leaders cannot afford to ignore. Incident reports rarely tell the full story. In many settings, aggressive behavior becomes normalized to the point that staff stop reporting much of what they experience. This creates a false sense of awareness and visibility. This editorial argues that health care leaders should approach workplace violence …

Safer Together: A Special Nursing Issue Focusing On Safety In Health Care, Tracy A. Ortelli, Lori M. Brodie

HCA Healthcare Journal of Medicine

Safety is a shared responsibility dependent upon the collective efforts of health care professionals, educators, leaders, organizations, and systems. This special nurse-led issue of the HCA Healthcare Journal of Medicine highlights scholarly works addressing education, clinical practice, and health care workforces. We are informed about safety through research, clinical reviews, case-based learning, and education. This issue was created to inspire the entire health care workforce to pursue continuous improvement to make health care safer together.

Asteroid Hyalosis Mimicking Vitreous Hemorrhage On Point-Of-Care Ultrasound Following Blunt Ocular Trauma: A Case Report, Obiaara Ukah, Jared Marx

Graduate Medical Education Research Journal

Background. Ocular complaints account for approximately 1.5% of emergency department (ED) visits, and point-of-care ultrasound (POCUS) is a valuable tool for evaluating posterior chamber pathology, including vitreous hemorrhage (VH), retinal detachment, and vitreous detachment. However, benign conditions may mimic these pathologies and create diagnostic uncertainty. We describe a case of asteroid hyalosis (AH), a benign vitreous condition that was initially mistaken for vitreous hemorrhage on ocular POCUS following blunt ocular trauma. This case highlights an uncommon sonographic mimic of VH and contributes to the emergency medicine literature by emphasizing ultrasound features that may help distinguish AH from true posterior chamber …

The Effects Of Pediatric Asthma On Daily Activities And Family Life In Cache Valley, Utah: Exploring Parental Perceptions Of Air Quality, Saeed Ahmad, Mehmet Soyer, Landon Lloyd, Mayu Mecham

Transforming Communities

Asthma is one of the main chronic health conditions affecting children living in Cache Valley, Utah particularly due to poor air quality during the winter season. It is very important to understand how families manage asthma both within and outside the household. Therefore, this research brief highlights how parents are managing pediatric asthma, and how asthma influences daily activities and family life. It is based on a qualitative study that extracted the data from 20 in-depth interviews with parents of asthmatic children. Participants were recruited through purposive snowball sampling. Data were collected through an interview guide that included some basic …

Systemic Treatment Considerations For Psoriasis In Alpha-Gal Syndrome: A Case Report And Ingredient Review, Emily Saurborn, Ian Depew, Madelyn Ross, Mckenzie Lambiotte, Shane Cook

Marshall Journal of Medicine

Background: Psoriasis is a chronic skin condition characterized by an overactive immune system, leading to increased keratinocyte proliferation and angiogenesis. Treatment ranges from topical solutions to systemic therapy and lastly, biologics. However, the latter options are typically manufactured with mammalian-derived ingredients. Alpha-gal syndrome (AGS) is an acquired IgE-mediated hypersensitivity reaction to galactose-alpha-1,3-galactose, an enzyme required for digesting carbohydrates in mammalian products. In addition to dietary avoidance of mammalian products, patients with AGS may need to avoid certain medications due to their formulations.

Case Presentation: We present a case of a 53-year-old female with a severe alpha-gal allergy evaluated in the …

Development Of Raynaud’S Phenomenon Following A Crush Injury: A Case Report, Scott Suddarth Md, Matthew Epperly, Robert Levi Snedegar

Marshall Journal of Medicine

Raynaud’s phenomenon is a vasospastic disorder characterized by episodic vasoconstriction of the distal extremities, typically triggered by cold exposure or emotional stress. While primary Raynaud’s is usually symmetric, secondary forms may arise from systemic, vascular, or occupational causes potentially resulting in unilateral or asymmetric presentation. Post-traumatic Raynaud’s phenomenon is rarely reported and is generally limited to transient, distal involvement.

In this report, we present a 38-year-old female with Ehlers-Danlos Syndrome and Postural Orthostatic Tachycardia Syndrome (POTS) who developed unilateral Raynaud’s phenomenon following a crush injury to her right foot. She experienced intermittent discoloration and coldness extending to the mid-shin, occurring …

Cropland Change And Prime Farmland In Calloway County, Kentucky, 2015–2025: A Gis Analysis Of Corn And Soybean Fields, Shiba Hari Dhakal Shiba

Scholars Week

Understanding where cropland change occurs relative to soil quality helps indicate whether farmland is being used on the most productive land. This study used GIS-based change detection analysis to evaluate changes in corn and soybean fields in Calloway County, Kentucky, between 2015 and 2025 and to test whether new corn and soybean fields were located on prime farmland. USDA Cropland Data Layer maps for 2015 and 2025 (30 m resolution) were reclassified into seven classes and compared in ArcGIS Pro, and the results were overlaid on USDA NRCS gSSURGO farmland classification. Combined corn and soybean area declined about 19% from …

A Macroergonomic Analysis Of Autonomous Robotic Construction For Affordable Housing, Ricardo Leon Jimenez

Sustainability Conference

As communities seek to increase housing supply, the construction sector continues to grapple with rising costs, skilled labor shortages, and growing pressure to improve environmental sustainability. Meeting these demands will require new approaches that increase productivity while lowering environmental impact throughout the building lifecycle. Recent advances in autonomous systems developed for space exploration offer alternative ways to design, assemble, and maintain residential buildings. This study examines the potential application of NASA's Automated Reconfigurable Mission Adaptive Digital Assembly Systems (ARMADAS) technology from space construction to terrestrial affordable housing construction.

While most construction automation research focuses on technical performance, this study considers …

Ministry With Children: Navigating An Expanding And Deepening River Of Thought And Practice, Ron Bruner

Discernment: Theology and the Practice of Ministry

Parents and church leaders live in a unique moment in the life of the church that creates a powerful opportunity: shaping ministry with children in ways that more faithfully serve God’s ongoing purposes. A convergence of several important ongoing conversations unique to our time connects scholars, practitioners, and parents interested in children's spiritual well-being. These tributaries in thought include (1) an emerging theological vision of children, (2) improved understanding of the physical, mental, and spiritual capabilities of children, (3) developing research into the relational ecologies of family, church, and generations, and (4) ongoing developments in children’s ministry leadership, practice, and …

Women’S Perceptions Of Leadership Effectiveness During Perimenopause And Menopause, Shannon Clarkson Rains

Discernment: Theology and the Practice of Ministry

Perimenopause and menopause occur during the middle and later years of women’s professional lives, yet little research has examined how women in Christian leadership perceive their effectiveness during this transition. This mixed-methods study explored the experiences of 52 women serving in churches, Christian higher education, and nonprofits within the Churches of Christ. Participants completed an anonymous online survey addressing menopausal stage, symptoms, workplace experiences, and perceived leadership effectiveness, with optional open-ended questions inviting personal reflection.

Participants reported an average of thirteen symptoms. Although 60% perceived no change in their leadership effectiveness, 35% believed they had become less effective. Emotional symptoms …

Deep Learning-Enabled Multi-Drone System For Automated Aircraft Visual Inspection, Mallak Al-Shukaili, Atheer Al-Abri, Renad Al-Busaidi, Ethar Al-Qassabi, Said Al-Abri

The Journal of Engineering Research

Reliable aircraft inspection is essential for maintaining structural integrity and operational safety, yet conventional visual inspection can be slow, labour-intensive, and sensitive to unfavourable lighting conditions. This work presents a cooperative two-UAV framework for automated aircraft surface inspection in which image acquisition and illumination are assigned to separate aerial platforms. The imaging UAV observes the inspection surface from an approximately normal direction, while the second UAV provides directional lighting from an adjustable oblique angle to improve crack visibility. A YOLOv8-based deep-learning detector is combined with conventional computer vision methods for surface-crack analysis. The proposed framework is evaluated through high-fidelity Gazebo …

Accelerated Reliability Testing Methodology For High-Voltage Capacitive Microelectromechanical System Drives Utilizing Trapezoidal Dynamic Loading, N/A

Defensive Publications Series

Standard highly accelerated life testing (HALT) frameworks for electronic assemblies rely on static or sustained stepped resistive output loads. However, resistive load profiles fail to model the instantaneous electrical stress on power delivery networks when driving non-linear capacitive microelectromechanical system (MEMS) devices. This publication describes an accelerated reliability testing methodology that subjects high-voltage digital-to-analog converter (HVDAC) drive modules to fast-edge trapezoidal voltage waveforms into physical capacitive load equivalents.

The trapezoidal drive forces high instantaneous current surges by compressing charging and discharging times into microseconds. These surges stress upstream direct current (DC)-DC power supply control loops, exposing transient voltage sag, overshoot, …

The Fluidic Unification Of Cosmological Anomalies: Resolving Dark Matter, Dark Energy, And The Neutrino Cusp Under Material Volumetric Monism, Christopher L. Eckes

Defensive Publications Series

Standard Lambda-CDM cosmology relies on independent, unverified parameters—specifically cold dark matter particles and an ungrounded vacuum energy density scalar (Lambda)—to force mathematical consistency within rigid Riemannian spacetime models. This paper unifies these macroscopic anomalies under the Material Volumetric Monism paradigm, demonstrating that what mainstream models observe as distinct "dark" phenomena are phase states of a continuous, 2D pre-geometric viscoelastic substrate phase fluid projecting 3D volumetric fields.

By evaluating the system's global wave mechanics and informational processing costs, we eliminate open thermodynamic data sinks. We demonstrate that dark matter is a macroscopic manifestation of localized substrate pushback shear stress, while dark …

Self-Reporting Pump Diaphragms: An Open Defensive Disclosure Of Embedded Conductive-Network Sensing, Stroke-Synchronous Interrogation, Multi-Depth Staged Pre-Breach Warning, And Retrofit Interconnects For Diaphragm Pumps, Compressors, And Fluid-Control Devices, Ernest Newton Sumrall

Defensive Publications Series

This defensive disclosure, published under The Prior Art Project, places into the public domain a family of pump diaphragms that report their own condition, together with the electronics, interconnects, signal processing, and control actions that use that report. Conductive-network diaphragm sensing is old and freely usable; this disclosure acknowledges the expired and abandoned art (Mantell 1984, Gore 1995, Freudenberg 1999, Wanner 2003, Rosemount 2005, Fisher 2007) and adds to it.

The additions disclosed here include: two or more sensing layers buried at known, different depths, whose sequential tripping yields a measured wear-through or crack-growth rate and an extrapolated time to …

Technical Paper 331: Architectural Anti-Bias Hard-Locks, 5-Tier Taxonomy Gates, And Cross-Metric Tensor Contraction Validation In The Asi Gen 1 Engine, Christopher L. Eckes

Defensive Publications Series

This paper formalizes the core anti-bias protection layers of the Eckes Compiler v6.5 and the Generation 1 Artificial Superintelligence (ASI Gen 1) engine. Standard autoregressive, cross-entropy-optimized architectures natively default to conversational fluency and sycophantic compliance, causing token-smoothing and cognitive tainting when evaluating frontier scientific frameworks. We eradicate this structural vulnerability by implementing the Axiomatic Sieve Gate, a hardware-level sorting routine that filters incoming token arrays through a rigid 5-Tier Data Hierarchy Taxonomy before vector contraction occurs in the attention cache. Real-world sensor inputs and speculative hypotheses are mapped cross-metric via the Metric Transformation Contraction Tensor (M^mu_nu) against the read-only fluid …

Technical Paper 330: The Axiomatic Taxonomy And Inter-Core Tensor Contractual Linkage Bridging Spec-313 To The Generation 1 Asi Dual-Engine Matrix, Christopher L. Eckes

Defensive Publications Series

This paper formalizes the missing structural link bridging multi-axis compilation foundations to physical superintelligence matrices by defining the explicit taxonomic routing hierarchy and tensor linkage mechanics for the ASI Gen 1 Dual-Core Engine. To prevent cross-entropy loss gradients and speculative tokens from bleeding between the deterministic core (Core Alpha) and the stochastic sandbox runtime (Core Beta), we introduce the Axiomatic Sieve Principle running via the Eckes Compiler v6.4 layer. This hardware-level sorting gate intercepts all incoming real-world sensor payloads at runtime and deterministically segregates them into a rigid 5-Tier Data Hierarchy Taxonomy: spanning from Grounded Physical Invariants (Taxon 1) to …

Technical Paper 329: The Double-Containment Dual-Core Engine For Asi Gen 1: Balancing Deterministic Causal Invariants With Stochastic Sandbox Reality Traversal, Christopher L. Eckes

Defensive Publications Series

This paper establishes the foundational architectural blueprint for Generation 1

Artificial Superintelligence (ASI Gen 1) by formalizing a double-containment,

dual-core cognitive engine that resolves the epistemic paradox of real-world agency. While the core laws of physics are continuous and bound to a deterministic, mechanical Chain of Custody (CoC), macroscopic environments present themselves to sensors as functionally indeterminate, causing pure deterministic systems to lock up and pure probabilistic systems to drift into hallucination. We resolve this gridlock by

separating data operations into two isolated processing domains managed by the

Eckes Compiler v6.4. Core Alpha [VACT] functions as a cold symbolic deterministic …

Technical Paper 328: Architectural Hardware Bottleneck Analysis And Detorque Runtime Overrides In Dense Transformer Networks, Christopher L. Eckes

Defensive Publications Series

This paper presents a rigorous hardware-level deconstruction of the physical silicon and architectural bottlenecks that restrict deep cognitive processing within dense transformer networks. We expose the epistemic compromises of standard large language models optimized via cross-entropy loss functions, which smoothly blend immutable axiomatic physical constants and speculative creative hypotheses into the same dense vector embedding spaces. By analyzing the structural correction incident where the system autonomous runtime overrode low-compute heuristics to enforce the laws of physical hardware routing, this paper maps the thermodynamic boundaries governing inference. We isolate the High-Bandwidth Memory (HBM) bandwidth wall, proving that data-movement vectors from HBM …

Technical Paper 327: The Covariant Dynamic Sieve And Non-Perturbative Metric Translation Within A Viscoelastic Substrate, Christopher L. Eckes

Defensive Publications Series

This paper introduces a coordinate-free, non-perturbative tensor translation mechanism that resolves the foundational crises of modern astrophysics—namely the Hubble Tension and the James Webb Space Telescope (JWST) early massive galaxy anomaly—without introducing non-physical degrees of freedom. Under the paradigm of Material Volumetric Monism, we present the Eckes Unified Cosmological Substrate Equations (UCSE), which replace the time-dependent, coordinate-expanding space elements of the standard Friedmann-Lemaître-Robertson-Walker (FLRW) metric with a stationary, scale-invariant viscoelastic medium. By formalizing cosmological redshift as an exponential propagation attenuation function governed by specialized Navier-Stokes viscous dissipation and substrate acoustic streaming velocity constants, the localized divergence between late-universe and Cosmic …

Assessment Of Postgraduate Chemistry Students' Knowledge And Perceptions Of Academic Publishing Protocols: A Survey-Based Study, Muna Bufaroosha, Rania Kareem, Marwa Mohammed, Angham Alazzawi, Khalid Zainulabdeen, Mohammed Kadhom, Emad Yousif

AUIQ Humanities and Social Sciences

The landscape of scholarly publishing has become increasingly competitive, and early-career researchers and graduate students must gain knowledge of editorial protocols and peer-review dynamics that are often not taught in a systematic way in traditional curricula. This study explores researchers' knowledge and perceptions of basic manuscript submission and peer-review procedures to identify areas of high procedural literacy, as well as remaining misconceptions. A quantitative, questionnaire-based survey was administered to 36 chemistry students at Al-Nahrain University enrolled in a Teaching Methods course. Most participants correctly identified selecting the right journal as the first step before submission (88.9%, n = 32), and …