Medicine and Health Sciences Commons^™

Creating An Unconscious: Toward A New Ethic Of Residential Treatment, Daniel Garcia

Middle Voices

What is currently nominated “residential treatment” for serious mental illness (SMI) has a long and varied history. From its earliest version as houses for the unproductive, to confinement of and with the unruly and criminally dangerous, to asylumdom, residential treatment has always sought to protect society from those it perceives as actively trying to revoke it. Consequently, the remedies prescribed in defense of civilization have also ranged from the gruesome to the utopian and the seat of responsibility for maintenance of the social order has vacillated between the family and the church, the local community and the state, the psychiatric …

What Are Elementary Phenomena? An Introduction To A Lacanian Conceptualization, Derek Hook Ph.D.

Middle Voices

What do Lacanians mean when they refer to the notion of elementary phenomena? This idea, crucial to Lacan’s (1993) theorizations of psychosis in Seminar III, refers back to the psychiatric conceptualizations of the late 19th and early 20th century. However, even while citing the influence of others when utilizing the concept, Lacan—characteristically enough— described the concept in his own distinctively psychoanalytic way. The term is particularly important to Lacan in terms of how he thinks about the development of delusions and related psychotic symptoms in relation to the initial onset of psychosis. In this short paper, I aim simply to …

Working With Schizophrenia: Adaptive Work & The Threat Of Despair, Pavan S. Brar

Middle Voices

Commentary

A League Of Her Own: The Comeback After Collison, Ashley Otto, Do, Mbs, Carly Day, Md

Jefferson Hospital Staff Papers and Presentations

Initial History

During a college softball game, the left fielder (patient A) and center fielder (Patient B) collide while attempting to catch a fly ball. Patient A immediately lost consciousness and Patient B screamed in pain grabbing her right leg. The athletic trainer (AT) and student athletic trainer access and triage the players. Upon the AT's arrival, Patient A became conscious, appeared confused, denied distress, and complained of jaw pain. Patient B continued to have upper right leg pain. Both athletes are helped off the field and the on-call physician is asked to come to the field.

Home-Based Vs Clinic-Based Stool Testing For Detecting Early Cancer Markers: A Scoping Review, S. Elizabeth Brock, Jacqueline Giles, Sydney James, Cha'landria Mccall, Bobby Bellflower Dnsc, Nnp-Bc-Faanp, Fnap, Faan

Doctor of Nursing Practice Projects

Purpose/Background 

Colorectal cancer (CRC) remains a significant public health concern in the United States, with screening rates below national targets due to persistent socioeconomic and structural barriers, particularly among underserved populations. Stool-based screening modalities offer accessible alternatives to colonoscopy, and emerging evidence suggests that home-based delivery models may improve screening uptake; however, implementation strategies vary and comparisons between home-based and clinic-based approaches remain limited. This scoping review examines current evidence on strategies that support CRC screening uptake, with a focus on stool-based modalities, including fecal immunochemical testing (FIT), fecal occult blood testing (FOBT), and multitarget stool DNA testing (mDNA), and …

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 …

Methionine Restriction Enhances Platinum-Based Chemotherapy-Induced Immunogenic Cell Death In Triple Negative Breast Cancer Cells, Mallory Thompson, Laura Sipe Ph.D.

Departmental Honors & Graduate Capstone Projects

When cancer cells are treated with chemotherapy, they can release Damage-Associated Molecular Patterns (DAMPs) as they die that can alert and engage the immune system, a process known as an immunogenic cell death (ICD). The dying cancer cell can release certain molecules, including ATP or calreticulin, that immune cells first recognize as abnormal before initiating an anti-tumor response. However, not all chemotherapies cause the release of these beneficial signals as they kill the cell. This study aims to determine whether a specific deprivation technique, called methionine restriction, enhances the ICD process and DAMP expression when used in conjunction with chemotherapy …

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, …

The Wager Of Speech, And The Maneuver Of The Dream In The Clinic Of Psychosis, Christopher Meyer

Middle Voices

Psychoanalysis, especially in the clinic of psychosis and extreme states, requires a wager on the part of the analyst. This wager welcomes the speech of the analysand regarding a censored unconscious. In the clinic of psychosis, the analyst’s reference to the dream in the establishment of the frame of the treatment is a maneuver that creates a working space that reveals the subjective history of the analysand. This history concerns key moments of trauma in which the speaking being found themselves without resort or resource to speech or language to represent their experience. The discourse of the delusion arises in …

Psycho-Pathology And Links Between Neurosis And Psychosis, B. Mason Judy, John Dall'aglio

Middle Voices

Commentary

The Secretary Of Alienation: Metaphor And Metapsychology, Anna Kreienberg

Middle Voices

Commentary

An Interview With Stijn Vanheule, Phd Following His Talk: “The Clinic Of Psychoanalysis In Times Of Capitalism”, Stijn Vanheule

Middle Voices

An interview with Stijn Vanheule

Moving Toward Standardization Of Breast Cancer Screening: A Scoping Review Comparing Uspstf And Acs Recommendations For Women Aged 40–74, Gerita F. Perry, Krystal D. Hester-Smith, Bobby Bellflower Dnsc, Nnp-Bc, Faan, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose 

To compare U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) breast cancer screening guidelines for women aged 40–74, and to recommend adopting one consistent, standardized guideline in practice. Standardization can improve care continuity, patient adherence, reduce anxiety, support early detection, and lower mortality.

Background 

Breast cancer is the second leading cause of cancer-related death amongst women. The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. The ACS recommends an annual mammogram. Differences between the two organizations for screening emphasize the need for a common alignment to reduce breast cancer mortality. As breast …

Staff Educational Impact On School-Based Mental Health Services: A Scoping Review, Daniel J. Kim, Di'yana Fisher, Laura Reed Dnp, Aprn, Fnp-Bc, Cne, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

            Trends are consistently increasing among adolescents in regard to mental health diagnoses and suicide risks, which emphasizes the necessity for early identification via school-based psychiatric screenings. The Patient Health Questionnaire-9 (PHQ-9) has proven effective in uncovering symptoms of depression; variable application and limited staff knowledge continue to be substantial hurdles. This scoping review examined the influence of staff education and training on the efficacy of school-based psychiatric screening.

Methods

            PubMed, CINAHL, Medline, Elsevier, Google Scholar, and JAMA were utilized to conduct this scoping review. Peer-reviewed studies published between 2020 and 2025 were included if they involved adolescents aged 13-18, …

Score Data 2026, M. Barnard, T. Johnson, A. Ford-Wade, M. Godfrey, C. Compretta, E. Dehon, B. Wade

Faculty and Student Publications

This data file includes data for four years of Project SCORE implementation.

Transesophageal Echocardiogram Training For Student Registered Nurse Anesthetists, Sophie Hesse, Annie Krippene, Christian Shelton

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Transesophageal echocardiography (TEE) is a vital diagnostic tool in perioperative care. At Barnes-Jewish College Goldfarb School of Nursing (GSON), Student Registered Nurse Anesthetists (SRNAs) formerly received limited TEE instruction, consisting primarily of didactic content. This quality improvement project aimed to enhance SRNA proficiency in TEE by integrating online and simulation-based training.

Review of Literature Findings: Simulation-based education has been shown to improve knowledge, skill, and confidence compared to lecture-only methods (Bloch et al., 2017; Chenkin et al., 2023; Pezel et al., 2023; Weber et al., 2019; Zhao et al., 2021).

Methods: Guided by the Iowa Model and …

Preventing Information Loss During Icu To Or Handoff, Jenna Alfeldt, Kristen Hoffer, Ashley Miles, Amanda Schwarztrauber

Doctor of Nursing Practice (DNP) Student Projects

Background and Significance: Inconsistent ICU to OR handoff practices create conditions for information loss, threatening patient safety and continuity of care. Communication errors contribute to an estimated 250,000 fatalities and $20 billion in annual U.S. healthcare costs.

Review of Literature Findings: A thorough literature review revealed that standardized handoff procedures are shown to improve communication and team dynamics.

Methods: This quality improvement (QI) project implemented a standardized handoff process using the Handoff Reference Tool when transferring patients from the Intensive Care Unit (ICU) to the Operating Room (OR) in a large academic medical center. Pre- and post-implementation …

Do-Not-Resuscitate Orders In The Perioperative Period: A Quality Improvement Project, Brooke Popejoy, Connor Lebsack, Rena Bish

Doctor of Nursing Practice (DNP) Student Projects

Background & Significance: Management of do-not-resuscitate (DNR) orders during the perioperative period presents ongoing ethical and clinical challenges. Variability in provider knowledge and documentation can compromise patient autonomy and safety. Despite institutional policies, such as Barnes-Jewish Hospital’s “Goals of Care Directive,” inconsistent adherence remains common.

Review of Literature Findings: Evidence reveals that limited provider education contributes to uncertainty in managing perioperative DNRs. Studies by Baumann et al. (2017), Chappell et al. (2023), and Crowe and Marsh (2023) support targeted educational interventions to improve provider competence and consistency with national guidelines regarding required reconsideration.

Methods: Preintervention and postintervention surveys will be …

Riding The End-Tidal Wave: Enhancing Nurse Confidence And Clinical Competence On Capnography Waveform Interpretation, Megan Monda, Kirk Wallis, Rachel Zehner

Doctor of Nursing Practice (DNP) Student Projects

This quality improvement project addressed inconsistent use of end-tidal carbon dioxide (ETCO2) monitoring among nurses in the Cardiac Procedure Center (CPC) at Barnes-Jewish Hospital. Although capnography detects respiratory compromise earlier than pulse oximetry, limited staff education contributed to variability in waveform interpretation and clinical response. Guided by Kurt Lewin’s Change Model and the Plan-Do-Study-Act cycle, four structured one-hour educational sessions were delivered to CPC nurses and supplemented with hands-on practice and visual cognitive aids. Pre-, immediate post-, and two-week post-education surveys evaluated changes in knowledge, confidence, and clinical skill. Mean knowledge scores improved from 65% at baseline to 75% immediately …

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 …

Quality Improvement Project: Evaluating The Effectiveness Of Chlorhexidine Gluconate Bathing Education On Staff Perceived Knowledge, Kaonta Spencer

Doctor of Nursing Practice Projects

A community hospital set strategic goals to achieve Vizient top-decile performance and drive continuous improvement by reducing surgical site infection (SSI) rates. The purpose of this quality improvement project was to support this goal by implementing an evidence-based educational intervention to improve nurses' perceived knowledge and self-reported ability with the chlorhexidine gluconate (CHG) bathing protocol for hysterectomy patients. Guided by Lewin's Change Theory, the Iowa Model Revised, and the Iowa Implementation Framework, the educational intervention applied a structured approach to address behavioral and organizational barriers contributing to protocol noncompliance. A quantitative, quasi-experimental pre- and post-intervention design was used to evaluate …

Quality Improvement Project: Improving Interdisciplinary Care In Nursing Education Through Simulation, Anna Williams

Doctor of Nursing Practice Projects

Interprofessional education (IPE) is essential in preparing nursing students for effective teamwork and communication in clinical practice and is supported by the literature as improving these outcomes. However, limited faculty training in interprofessional simulation design contributes to reduced IPE opportunities within nursing curricula. A needs assessment at the project site identified a lack of structured, hands-on training for simulation faculty, resulting in decreased faculty confidence and limited implementation of IPE simulations. The purpose of this quality improvement project was to evaluate whether a structured training intervention improved simulation faculty self-efficacy in developing and implementing IPE simulations. Bandura’s Self-Efficacy Theory guided …

Implementation Of A Nurse-Led Discharge Protocol To Impact Nurse Confidence And Optimize Transitional Care Management, Jessi-Ann Elrod

Doctor of Nursing Practice Projects

Heart failure (HF) remains a leading cause of hospitalization and readmission, with the transition from hospital to home representing a vulnerable period for patients. Variability in discharge education and follow-up scheduling contributes to poor self-management and adverse outcomes. This quality improvement (QI) project evaluated whether implementing a standardized nurse-led HF discharge protocol impacted nurses' confidence and the rate of 7–14-day transitional care management (TCM) follow-up appointments. Guided by Meleis’ Transitions Theory and Lewin’s Change Theory, a one–group pretest–posttest QI design was implemented on a cardiac step-down unit. Twelve discharge nurses participated. The intervention included a structured education session and the …

Quality Improvement Project Reducing Attrition Rates In Nursing Students: Evaluating The Enhanced Student Success Program, Jason Grigg

Doctor of Nursing Practice Projects

The high attrition rate in the Associate of Applied Science in Nursing (AASN) program created an opportunity to develop the enhanced Student Success Program (eSSP). This is a faculty-based quality improvement project designed to increase support for students at risk of withdrawal from the AASN program. The aim of eSSP is to reduce attrition rates, however, this project evaluated only short-term changes in faculty confidence. Using Lewin's Change Model and the Theory of Planned Behavior as a guide, this QI implemented a one-group pre-post experimental design to determine whether a short eSSP training program, combined with a 5-week implementation period, …

Quality Improvement Project : Educating Critical Care Nurses On Braden Scale And Sskin Care Bundle To Impact Pressure Injuries, Andrea Garrett

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries (HAPIs) increase patients' risk of infection, prolonged hospitalization, death, and healthcare costs. The Agency for Health Research and Quality (AHRQ) has shown that implementing a standardized skin assessment process and a care bundle helps prevent skin injuries. A critical care unit (CCU) at an acute care 339-bed hospital in Southaven, MS, has seen an increase in HAPIs. This quality improvement project aimed to educate CCU nurses about the Braden Scale and the SSKIN care bundle to impact pressure injuries in the CCU within 8 weeks. Education on the Braden Scale and the Skin, Sensory, Keep Moving, Incontinence, …

Quality Improvement Project: Gpt Prompts As Tools For Cultural Competence In Undergraduate Nursing Education, Elizabeth K. Hobbs

Doctor of Nursing Practice Projects

In rural nursing programs, student exposure to diverse cultures is limited, which can hinder development of cultural competence. Artificial intelligence (AI) simulation is an evidence-based strategy to improve cultural competence and clinical decision-making, a practice gap exists due to lack of structured, accessible tools. This quality improvement project evaluated whether Generative Pre-trained Transformer (GPT)–based structured prompts would increase culturally inclusive simulation activities and improve faculty perceptions of usefulness and ease of use at a rural community college. The guiding PICOT asked: Among nursing faculty, how does the use of GPT-based structured prompts, compared to an unstructured approach, impact perceived usefulness, …

Quality Improvement Project: Faculty Development For Understanding And Utilization Of Exam Data, Deanne Hutchens

Doctor of Nursing Practice Projects

This quality improvement project focused on inconsistent use and understanding of exam data among Associate Degree in Nursing (ADN) faculty, which can influence teaching decisions and student success. Many nursing faculty enter education with strong clinical backgrounds but limited experience working with exam statistics such as item difficulty, discrimination values, and Kuder-Richardson 20 (KR-20) reliability. Without a consistent approach, exam results may not be fully used to guide remediation or adjust instruction. This Doctor of Nursing Practice (DNP) project examined whether a structured faculty development session could improve faculty confidence and ability to interpret and apply exam data. A pre- …

Quality Improvement Project: Evaluating The Impact Of Provider Education On Sbirt On Screening For Suds, Faith Ogala

Doctor of Nursing Practice Projects

Substance use disorder (SUD) is a serious public health issue in people with psychiatric disorders. However, diagnosis and treatment are often delayed, leading to poor treatment outcomes and increased social and economic costs. The purpose and aim of this Doctor of Nursing Practice (DNP) project was to educate providers on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model to facilitate the timely diagnosis of SUDs in patients with dual diagnoses. The key outcomes were provider knowledge and SBIRT implementation rates. The Donabedian Model of Healthcare Quality assessed the outcomes, whereas Lewin’s Change Model guided implementation. The project employed …

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 …