Health and Medical Administration Commons^™

Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

Post-Pandemic Telebehavioral Health: Sustaining And Regulating Remote Mental Health Care As A Core Modality, Weiqiao Dong

Dartmouth College Master’s Theses

The United States continues to face a persistent mental health crisis after the COVID-19 pandemic, raising a policy question about the long-term role and regulation of telebehavioral health as a core modality of care. This thesis examines that question through a case study of New York State, an early center of the pandemic and a leader in telehealth policy reform.

Guided by the Health Policy Triangle framework, this thesis integrates longitudinal data from all 62 New York counties for 2010-2025 with a 2025 cross-sectional dataset covering 61 counties. Seventeen standardized indicators are organized into four dimensions: geographic, economic, demographic, and …

Needlestick Injury Risk And Preventive Behaviors Among Nursing Students, Angga Wilandika, Riandi Alfin, Rosa Intan Khoerunnisa

Makara Journal of Health Research

Background: Needlestick injury (NSI) remains a persistent occupational safety risk for nursing students during clinical practice, with implications for worker safety, patient care, and healthcare safety systems. Understanding preventive safety behavior within clinical training environments is essential for improving workplace safety in healthcare settings.

Methods: A cross-sectional study was conducted among nursing students undertaking hospital-based clinical placements. Using a purposive sampling, participants completed a structured self-administered questionnaire assessing NSI exposure, preventive safety behaviors, clinical supervision, safety training, and perceived safety within the clinical learning environment. Data was analyzed to identify patterns of NSI risk and associated preventive behaviors. …

Dnp Final Report: Medication Errors: Decreasing From Day One Through Online Learning Module And Incident Reporting, Marsha Pohorelsky

DNP Final Reports

Medication administration errors remain a significant patient safety concern in healthcare and nursing education. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the implementation of a standardized medication safety learning module and incident reporting process to improve medication safety awareness, medication administration competency, and error reporting among second-semester Bachelor of Science in Nursing (BSN) students. Guided by the Johns Hopkins Nursing Evidence-Based Practice Model and Kotter's 8-Step Change Model, the project incorporated medication safety education, simulation-based learning, and near-miss reporting to promote a culture of safety. Although competency outcomes were similar to previous student cohorts, participants demonstrated increased …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Closing The Loop: Strengthening Cauti Prevention With Urinary Catheter Management, Erika N. Braun

Master's Projects and Capstones

Objective: Catheter-associated urinary tract infections (CAUTIs) are among the most common preventable healthcare-associated infections and are associated with significant patient harm and increased healthcare costs. Baseline assessment across five adult cardiovascular and critical care units within a community-based acute care hospital identified four CAUTI events during the first half of 2026 and revealed important nursing knowledge deficits related to bladder scanning protocols and urinary catheter management practices. Aim: This Quality Improvement (QI) Project aimed to improve nursing knowledge of evidence-based bladder scanning protocols and urinary catheter management practices through targeted educational interventions implemented over a 10-week period, with …

Shared Equity Leadership In An Offshore Medical School: Distributing Responsibility For Equity, Vishal B. Surender, Sreekrishna Penna, Oluwabusola Osimosu

Journal of Comparative & International Higher Education

This essay applies the Shared Equity Leadership (SEL) framework to an offshore MD program at a private Caribbean medical school where students complete basic sciences on an island and clinical clerkships across multiple international sites. Using SEL scholarship and de-identified institutional data, we ask how equity work is currently distributed, where gaps emerge in assessment, remediation, and mobility for historically underrepresented students in medicine, and how responsibility for equity might be more deliberately shared. The Woven model of SEL provides a lens to map existing structures like curriculum committees, CQI dashboards, advising systems, and clinical site partnerships. We propose a …

Enhancing Patient Understanding: Standardizing Cardiac Medication Education Using Teach-Back For Heart Failure, Nicole Valerie Hediger

Master's Projects and Capstones

Problem: The transition from hospital to home places heart failure (HF) patients at risk for medication errors, nonadherence, deterioration, and rehospitalization. In a 28-bed medical-surgical telemetry microsystem, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores indicated an opportunity for improvement: “Communication About Medicines” composite score of 47.9%; 62.5% of patients reported being informed about the medication purpose, and 33.3% reported that staff described potential side effects.

Context: A cohort of HF patients was selected to test teach-back methodology and improve patient understanding. Nurse champions volunteered for a 5-month improvement project.

Interventions: Teach-back methods were implemented. Nurse leader rounding …

Bridging Fiscal Sustainability And Health Equity: A Policy Analysis Of California’S Healthcare Coverage Safeguards, Guadalupe Castaneda Martinez

Master's Projects and Capstones

Without structural policy intervention, approximately 4.6 million Californians remain at risk of being uninsured by 2030, worsening racial and ethnic health disparities and hospital uncompensated care burdens. This policy analysis advocates for a hybrid universal coverage model combining sliding-scale subsidies (California Senate Bill 78) with full-scope Medi-Cal expansion for all income-eligible residents regardless of legal status (California Assembly Bill 133). The framework relies on existing funding mechanisms, including the Managed Care Organization tax and the Health Care Affordability Reserve Fund. Comparative analysis indicates that market-only subsidies leave severe equity gaps, whereas immediate single-payer transitions pose substantial fiscal and administrative risks. …

High-Flow Nasal Cannula Oxygen Therapy Versus Standard Oxygen Therapy On Perioperative Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement, Kirsten B. Whiteside, Jacqueline M. Case

Graduate Theses, Dissertations, and Capstones

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion …

Prevention Of Hypotensive Adverse Events Utilizing Structured Home Blood Pressure Monitoring In Patients On Glp-1 Agonists, Alexandrya M. Tran

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement intervention was to assess whether a structured home blood pressure (BP) monitoring program with weekly check-ins would help decrease hypotensive episodes and associated adverse events in patients who have lost weight after GLP-1 agonist initiation.

Background: This project was implemented in an outpatient multidisciplinary clinic in Houston Texas. 

Methodology: A total of 13 patients were ask to monitor their BP daily and keep a log. Weekly telephone calls were conducted to monitor the patients and collect the data for a period of eight weeks. Weekly BP logs, hypotensive symptoms, and any antihypertensive medication …

``But What About Me?'': A Structural Redesign For Cascading Trust Into An Integrated Culture Of Care, Hazelin Hei Laam Ngan

Patient Experience Journal

In healthcare, patient experience (PX) and employee experience (EX) are often managed as separate priorities despite their interdependence. This article presents a case study from NYC Health + Hospitals/Community Care, a 250-person safety-net division providing home-based services across New York City. In response to frontline staff repeatedly asking, ``But what about me?'' when offered PX best practice suggestions, the organization integrated patient experience, staff engagement, and wellness into a unified Care Experience portfolio led by the Chief Experience Officer. From this structural redesign emerged a practical framework for trust-building organized around three pillars: Purpose, Presence, and Partnership. Purpose aligns staff …

Building A Culture Of Trust: Engaging Teams With Targeted Tactics For Meaningful Improvement In Patient Experience, Anna Buckner, Kimberly Lewis

Patient Experience Journal

Rising financial pressures and the need to revitalize culture prompted a renewed emphasis on patient experience at Billings Clinic. This case study describes the impact of redefining patient experience as a measure of trust and a set of care processes. It presents an alternative to the more traditional view of patient experience as an outcome metric based on meeting patient expectations. Billings Clinic chose the patient survey question likelihood of recommending as an organizational goal or key performance indicator (KPI). Under the direction of executive leadership, the patient experience team developed a new strategic framework aimed at driving improvement for …

Plan Of Day | Plan Of Stay: How Inter-Disciplinary Communication Improved Patient Experience And Hospital Throughput, Theresa Jean Dionne, Felicia Hurst, Danna Qunibi, Lauren Lazar, Sydney Mccurdy, Ashlyn Coenraad, Brittney Ward, Whitney Black, Ashley Nelson, Judd Salem, Luisa Restrepo

Patient Experience Journal

Background: Effective communication among healthcare team members is critical for delivering high-quality, patient- and family-centered care while optimizing hospital operations. This case study examines the implementation of a structured ``Plan of Day | Plan of Stay'' model, leveraging bedside whiteboards to enhance inter-disciplinary communication in a pediatric hospital setting. By providing a clear, visual summary of daily care plans, care team members, and discharge goals, whiteboards foster transparency, empower patients and families, and facilitate coordinated clinical decision-making. Purpose: This quality improvement initiative evaluated the implementation of a standardized Plan of Day | Plan of Stay communication model on a pediatric …

Patient Psychological Safety: A Qualitative Study Of Patient Experiences, Derick R. Simmons, Cheryl Rathert, Ryan Valayil, Maria Joseph, Ibraheem Jawadi

Patient Experience Journal

There is growing interest in understanding patients' experiences with psychological safety during healthcare encounters. Recent studies reveal that patients describe needing patient psychological safety (PPS) to form connections with their care providers, which are associated with better health outcomes. Therefore, it is critical to examine indicators of PPS. Using a phenomenological interpretive approach, this study utilized a patient narrative survey methodology to qualitatively explore how and why patients experience a lack of PPS during their healthcare encounters. We surveyed patients from across the U.S. and analyzed responses among a sub-sample of respondents to an open-ended question whose responses indicated they …

Patient-Centred Care: An Integrated Bibliometric And Structural Equation Modelling Approach, Japheth Nuhu Ahmed

Patient Experience Journal

This study investigates how communication and service quality in Patient Relationship Management impact patient satisfaction through trust. The literature in this field is predominantly in developed countries, whereas it is scarce in sub-Saharan Africa. Combining bibliometric analysis and structural equation modelling, the study highlights emerging research trends and provides empirical evidence to guide healthcare practitioners, policymakers, and researchers in improving patient care. To strengthen its theoretical foundation, the study integrates the Social Exchange Theory and Expectancy–Disconfirmation Theory to explain the model. The study retrieved quantitative data from the Scopus database for bibliometric analysis. A questionnaire was used to collect data …

From Anticipation To Relief: Anxiety Reduction And Patient Experience As Indicators Of Trust During Dental Extractions In Orthodontic Treatment, Kanza Tahir, Mubassar Fida, Rashna Hoshang Sukhia

Patient Experience Journal

Trust is central to healthcare encounters involving fear and uncertainty. This quasi-experimental study evaluated changes in anxiety before and after dental extractions performed during orthodontic treatment planning and examined whether patient experience factors were associated with post-extraction anxiety. Fifty patients aged 11–40 years undergoing fixed orthodontic treatment requiring extraction were recruited consecutively at a tertiary care hospital from October 2023 to June 2024. Anxiety was measured immediately before and after extraction using the Beck Anxiety Inventory. Post-procedure patient experience was assessed with a structured questionnaire addressing reassurance, communication, privacy, shared decision-making, perceived understanding, and overall experience. Paired t-tests and simple …

Self-Medication Experience And Healthcare Trust Among Youth: A Regionally Concentrated Digital Survey In Indonesia, Wahyudi Wahyudi, Azra Muzaiyana Nasution, Arini Dwi Rahmadani, Alysa Rahmadani Hasibuan

Patient Experience Journal

Self-medication has become a central experience for youth transitioning toward independent medical decision-making. In the digital era, young people must navigate a complex landscape of health information while seeking independent health solutions. This study investigates self-medication experiences and healthcare trust among youth, utilizing a regionally concentrated digital survey approach in Indonesia. Data were collected via a cross-sectional approach using digital platforms (Instagram, TikTok, and Twitter/X), facilitated by 76 trained enumerators. While respondents from all 38 provinces participated, the sample (N = 2,790) exhibits a major geographical concentration in the Sumatra region. The study employed a validated 16-item instrument to evaluate …

Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust In Their Inpatient Physicians—A Convergent Mixed-Methods Study, Marlise Jeanne Pierre-Wright, Ibrahim Badreldin Mokhtar, Uma Thachapuzha, Yashoswini Chakraborty, Revika Singh, Rachel O'Conor, Jing Song, Julia Lee, Maria E. Theodorou, Christine Schaeffer, Kimberly Collins, Muriel Jean-Jacques

Patient Experience Journal

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants …

Navigating Uncertainty: Patient Experiences Of Birads 0 Mammogram Results, Petranea Smith, Jasmine Warren, Marina Demas, Roberta Goldman, Joanne E. Wilkinson

Patient Experience Journal

Objective: Describe experiences of patients receiving BIRADS 0 (inconclusive) mammogram results in electronic health portals. Methods: Recruited eighteen patients who had received BIRADS 0 results via the portal in the last 5 years.Semi-structured interviews yielded qualitative data, analyzed sequentially using the immersion crystallization method to identify content and then iterative coding both individually and in groups. A team of 4 researchers coded and analyzed the transcripts, using repeated meetings and a shared spreadsheet to organize codes and develop thematic elements via visual organization. Results: Themes included baseline comfort/trust with healthcare and how it interacted with anxiety about the uncertainty of …

From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus

Patient Experience Journal

After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed …

Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii

Patient Experience Journal

Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …

Pathways To Patient-Provider Conflict In Nigeria: A Structural Equation Model Of Expectations, Communication, Trust, And Organizational Constraints, Akaninyene O. Unaam, Christie Divine Akwaowo, Edidiong A. Unaam

Patient Experience Journal

Objective: This study empirically investigated the drivers of patient-provider conflict and tested a conceptual model linking treatment expectations, communication, trust, and organizational constraints to conflict intensity in Nigerian tertiary care. Methods: A cross-sectional survey of 400 patients (response rate 82.3%) and 150 healthcare providers (response rate 71.2%) from three Nigerian tertiary hospitals was conducted using stratified random sampling. Validated, culturally adapted scales measured unrealistic treatment expectations, communication barriers, organizational constraints, trust, and conflict intensity. Data were analyzed using Structural Equation Modeling (SEM) with maximum likelihood estimation and bootstrapping for mediation testing. Multi-group confirmatory factor analysis established measurement invariance across samples. …

Centering Community Voices To Address Healthcare Inequities In Underserved Utah Populations, Karishma Shah, Jazmine Abril, May Shaaban, Silvia Soule, Sonia Sehgal, Rawad Farhat, Jeannette Villalta, Oreta Tupola, Valentine Mukundente, Cathy Wolfsfeld, Ivana Holiday, Walter Watchman, Carrie Olvera, Lauren Gleave, Kamaile Tripp, Alexander Sperber, Rita Osborn

Patient Experience Journal

Persistent disparities in health outcomes across the United States are often driven by systemic inequities and social determinants of health. In Utah, these inequities are particularly pronounced among racially, ethnically, and geographically underserved populations. Community healthcare workers (CHWs) who share lived experiences with these communities are uniquely positioned to bridge the gap between patients and a fragmented healthcare system. This study aimed to explore how underserved communities in Utah perceive and interact with the healthcare system, centering their lived experiences to inform more equitable care models. We conducted eight focus groups with 73 participants from six medically underserved communities: African …

Caring But Still Hurting: Uninsured Patients' Illness And Healthcare Experiences At A U.S. Free Clinic, Danaya Amornnimit, Eda G. Christensen, Adelaida Salmeron, Kian Robison, Sofia Ampudia Arroyo, Jessica Benelli, Brenda Spearman, Akiko Kamimura

Patient Experience Journal

While free clinics provide essential healthcare to socioeconomically disadvantaged populations, patients' lived experiences in these settings remain underexplored. This qualitative study examined how uninsured patients at a U.S.-based free clinic perceive their illness experiences and interactions with healthcare providers. From October to December 2024, semi-structured interviews were conducted with 21 adult patients (ages 18–72; M = 49.14), most of whom were non–U.S.-born and primarily Spanish-speaking. Participants described illness as entangled with emotional distress, social isolation, stigma, and disruptions to identity and family roles—revealing a psychological burden that extends beyond physical symptoms. These findings highlight the need to integrate psychosocial and …

From Drifting To Anchored: How Online Health Communities Can Transform Care For Complex Chronic Illness, Mads Eggerding

Patient Experience Journal

This personal narrative recounts a 25-year diagnostic odyssey with Ehlers-Danlos syndrome, defined by medical fragmentation, dismissed symptoms, and profound isolation. It illustrates how Online Health Communities (OHCs) bridged the chasm between lived experience and a clinical system ill-equipped for complex chronic illness. For patients like me, these digital forums provide the peer validation, practical knowledge, and self-advocacy tools necessary to navigate a disjointed healthcare landscape. For providers, this story underscores a critical opportunity: proactive, non-judgmental engagement with OHCs is not a threat to expertise but a foundational strategy for patient-centered care. By acknowledging and constructively partnering with these patient-led spaces, …

Secondary Infertility: A Personal Story Of Loss And Grief, Ben Hughes

Patient Experience Journal

An increasing number of people worldwide are experiencing fertility and this trend is reflected in the data from the United Kingdom. However, most research focuses on the experiences of women and so the male perspective is largely missing from the literature. This narrative is an account of my personal journey of secondary infertility. Presenting a male perspective of infertility provides a point of view which is rarely explored and is about a topic which feels largely a societal taboo. I chart how infertility has changed me, what it has meant to me through my years of trying to come to …

When Hope Meets Harm: A Story Of Trust, Pain, And Consent In Intimate Care, Sharon I. Choe, Erin Foster

Patient Experience Journal

Transparent communication is key to building and maintaining strong patient-provider relationships. In this article, I interviewed a patient who shared her experience undergoing treatment for a chronic vulvar condition and the consequences that followed. She described a painful procedure for which she felt unprepared and later realized she had not been educated about the need for ongoing care. Years later, this gap in understanding contributed to irreversible disease progression. After re-establishing care with a dermatologist she felt comfortable confiding in, the patient expressed a desire for her story to be shared. This narrative presents her experience as she shared it …

Ai As A Physician Companion In Enhancing Trust In Healthcare, Saria Gouher

Patient Experience Journal

Trust remains a fundamental pillar of the physician–patient relationship, ensuring care that is safe, evidence-based, and grounded in shared decision-making; however, the increasing use of artificial intelligence tools such as ChatGPT has introduced a new dynamic in how patients interpret symptoms and seek medical advice. This narrative describes a clinical encounter involving an elderly patient with multiple myeloma whose caregiver used ChatGPT to evaluate new-onset slurred speech suggestive of stroke, resulting in an urgent recommendation driven by incomplete clinical information. Through comprehensive history-taking, physical examination, and careful review of the Artificial Intelligence (AI)-generated response, the physician reassured the caregiver, contextualized …

Building Trust In The Absence Of Certainty: Community As Trust In Action, Jennifer A. Owens

Patient Experience Journal

This personal narrative explores how trust is experienced and sustained in the context of serious illness, where uncertainty is persistent and control is limited. Drawing on the lived experience of caregiving for a child with an undiagnosed congenital diaphragmatic hernia (CDH), this personal narrative examines how trust emerges not as a matter of belief or individual choice, but as something recognized through the actions of others.