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  Windows of Opportunity: Exploring How Home Practices Reframe Knowledge About High-Performance Retrofits

  Bean, Jonathan; Fink, Alyssa; Stoker, Philip; Wetherell, Meaghan (The University of Arizona., 2025)

  In hot, dry climates with older, uninsulated homes, high-performance windows can double or triple the effective insulation of the building enclosure and substantially reduce cooling loads from solar gain. Yet many households who choose to replace windows select lower-performing options, locking in higher energy use, reduced comfort, and greater carbon emissions. Previous work has sought to address this issue by developing a tool that quantifies personalized energy and non-energy benefits of high-performance window retrofits for consumers, based on the assumption that more information will shift consumer decisions. This study explores how different frameworks for understanding household window-replacement decisions can generate insights to inform the development of interventions that might effectively support higher-performance choices. Using interpretive analysis of fourteen semi-structured interviews with households in Tucson, Arizona considering window replacement, the study situates window replacement within the habitual, patterned performances of home improvement practices. A circuit-of-practice approach identifies three ways households integrate homes as material objects into daily life — domestication, configuration, and stewardship — and shows how each reconfigures the organizing principles through which consumers build knowledge about home projects. Analysis using concepts from Legitimation Code Theory reveals a code clash between these knowledge-building practices and the way the calculator frames its claims. The findings suggest pathways for resolving this clash and broadening the adoption of higher-performance window retrofits. The study contributes theoretical insight into how shifting social practices reshape knowledge practices and provides practical direction for developing interventions that more effectively support high-performance window retrofits and related home energy upgrades.
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  Procedures for the Characterization of Commercially-Available Volumetric Water Content Sensors to Augment Training Ensembles for Machine Learning Models with Synthetic Analog Datasets in Data-Sparse Regions

  Ferre, Ty P.A.; Wessner, David Paul; Troch, Peter; Guo, Bo (The University of Arizona., 2025)

  Machine Learning (ML) models are an increasingly popular method of producing predictions of real-world physical processes, such as forecasting stream stage heights after precipitation events, or the numerous meteorological models used in generating hurricane track forecasts. However, the development of ML models typically requires a significant amount of validated, real-world data inputs, which may be sparse or unavailable in specific regions due to a lack of instrumentation coverage. The limitation imposed by a lack of input data coverage or availability may be overcome by either augmenting, or replacing, input datasets with synthetic-analogs that are representative of the potential domain of actual in situ measurements. At a minimum, generating a synthetic-analog dataset requires an understanding of the real-world dynamics and properties governing the targeted physical process for the ML model, to create an adequate model ensemble from which representative data can be sampled. However, there is a greater need to measure and quantify any latent characteristics of instrumentation, such as sensor detection range, noise and bias, used in data collection intended to be used with the ML model post-development, to ensure that training data inputs match what may be seen in situ. This paper summarizes a method of characterizing commercially available soil volumetric water content (VWC) probes to use in the production of a large synthetic-analog datasets for the training and validation of deep-drainage flux and root-water uptake prediction ML models, derived from vadose (unsaturated) zone numerical model ensembles generated using Hydrus-1D.
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  Catastrophic Flooding in Osuga Valles, Mars: Implications For Its Paleoflood Hydrology and Formation

  Gulick, Virginia C.; Portillo, Dalia Flor Rueda; Baker, Victor R.; Ferre, Paul A. Ty (The University of Arizona., 2025)

  Satellite imagery of Mars has shown large flood-like features known as outflow channels across its surface. Previous studies have used a variety of techniques involving complex 1D equations and 2D models for outflow channels in Chryse and Elysium Planitia to estimate the magnitudes and depths of floods. In this study, we use both 1D and 2D flow equations and the 2D computer hydraulic model HEC-RAS version 6.6 to estimate stage-discharge relationships within Osuga Valles. Additionally, we use 1D groundwater and fracture flow equations, and the 2D thermal model HYDROTHERM to simulate pressure and temperature changes within the subsurface. The site of interest is Osuga Valles, an outflow channel that contains unique features suggesting pressure-dominated floods from groundwater that cover approximately 168 km of fluvially eroded channels. The varying depths along the channel suggest the floods are catastrophic, excavating between 250 to over 1,000 meters in depth. All channels appear to terminate into a relatively small collapsed basin, without indication of any surface flows beyond this terminus. High-resolution Digital Terrain Models (DTM) from HRSC, CTX and HiRISE are used to capture cross-sectional profiles and relative elevations of Paleo Stage Indicators (PSI’s) to provide supporting evidence for flood depths. From the HEC-RAS results, we find that the roughness of the channel bed in Osuga Valles does not greatly influence the depth for each flow rate, and the last flood that most likely filled the channel based on PSI is approximately 5 x 10^7 m3/s. However, our subsurface analysis counters this and suggests the last flood was several orders of magnitude smaller than simulated with HEC-RAS and short-lived. Permeabilities of the fractures within the aquifer for producing such large-scale flooding range from 1.4 x 10^-6 to 2.5 x 10^-6 m2, which converts to over ~1,400,000 darcies.
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  Love, Lust, or Liberation? Muslim Women through the Soviet and Russian Imagination

  Jens, Benjamin; Al-Thenayan, Mae; Leafgren, John; Lucey, Colleen (The University of Arizona., 2025)

  This thesis explores the representation of Muslim women through the lens of two literary works, Chingiz Aitmatov’s Jamilia (1958) and Guzel Yakhina’s Zuleikha (2015) with the goal of finding parallels between how the women are represented in Russian and Central Asian perspectives. By considering the religious, historical, and political landscapes in the texts, this thesis connects the construction of Muslim women within broader societal narratives, drawing upon theories of Orientalism, feminist scholarship, and postcolonial theory. It further explores artistic and visual modes of representation in order to find similar constructions and depictions akin to the literary texts. Additionally, this paper examines the difference between Russian Orientalism and Soviet Orientalism, tracing its evolution from the Imperial period to the Post-Soviet present.
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  Atomized Tears: A Comparative Analysis of the Collective Remembering of the Chernobyl Disaster in Ukraine and the Atomic Bombings of Hiroshima and Nagasaki in Japan

  Gordienko, Anastasia; West, Sterling; Leafgren, John; Jens, Benjamin (The University of Arizona., 2025)

  On more than one occasion, since the first atomic weapon test in 1945, mankind has only barely avoided Armageddon, and several of these nuclear near-disasters are particularly notable: the only nuclear weapons used in warfare were deployed by the United States in the Second World War against the Japanese cities of Hiroshima and Nagasaki. Another atomic first was the Chernobyl nuclear disaster of 1986; the Chernobyl disaster was, at the time, an unprecedented nuclear accident. These events are all unparalleled historical phenomena, and the collective remembering of these tragic events in both Japan and Ukraine provide a rich opportunity for comparative analysis. Besides performing a comparative analysis of the collective remembering of the respective atomic tragedies, it is necessary to compare how these tragedies are officially memorialized by the affected states. Officially-sanctioned memorials are a vital component in any nation’s collective remembering. This thesis explores the similarities of the collective remembering of the bombings of Hiroshima and Nagasaki and of the Chernobyl disaster, and it also comparatively analyzes the individual and collective psychological effects of these tragedies. While the bombings of Japan were a deliberate wartime decision and the Chernobyl disaster was an accident, this thesis additionally demonstrates that collective remembering of these nuclear events is centered around a struggle to come to terms with an invisible object with incomprehensible destructive potential: the atom.
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  Dietary Counseling in Primary Care: A Tool for Cardiac-Focused Mediterranean Diet Education

  Martin-Plank, Lorraine M.; Olson, Meg; Gorombei, Deborah A.; Skiba, Meghan B.; Samsam, Leila (The University of Arizona., 2025)

  Background: Cardiovascular disease (CVD) is the leading cause of death in the United States (US). The Mediterranean diet has been studied and shown to significantly improve cardiovascular outcomes. Providing dietary education, including the Mediterranean diet, in primary care is recommended by the American Heart Association (AHA) and U.S. Preventative Services Task Force (USPSTF) for patients with cardiovascular disease. However, primary care providers may lack the tools to provide effective dietary education. Purpose: The purpose of this project was to develop and implement an evidence-based patient handout to support providers in educating patients with CVD about the Mediterranean diet. Methods: This project was implemented at a primary care clinic in Bountiful, Utah. Participating providers received education on the Mediterranean diet and an accompanying patient handout to use during clinic visits. Providers completed pre- and post-education surveys assessing their confidence in providing dietary counseling. Survey results were analyzed to assess changes in provider confidence following the intervention. Results: Six providers participated. Average confidence scores increased across all survey domains, including educating patients on the Mediterranean diet (3.33 to 4.83), answering patient questions (4.00 to 5.00), tailoring education for CVD (3.83 to 4.83), and providing specific diet examples (3.33 to 5.00). Conclusions: A brief provider education session and patient handout improved provider confidence in delivering Mediterranean diet counseling in primary care. Integrating simple, evidence-based tools may help bridge gaps in dietary education for patients with cardiovascular disease.
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  Improving Asthma Management in Children: A QI Project at SACC

  Sparks, John; Diepenbrock, Tina; Bencs, Nicole; Boesch, Richard Paul (The University of Arizona., 2025)

  Purpose: The goal of this quality improvement project was to develop, implement, and evaluate a structured asthma education program in collaboration with a local school-age childcare program. Background: Asthma is a significant public health issue, affecting an estimated 262 million people worldwide (Global Asthma Network, 2022). According to the Centers for Disease Control (CDC), asthma affects 8.4% of children in the United States (US) (Lizzo & Cortes, 2023). It is the number one chronic medical reason children are absent from school (Lizzo & Cortes, 2023). Studies have shown that education is important in improving asthma management. Currently, staff at School Age Child Care (SACC) do not receive asthma-specific education. Methods: All SACC staff were invited to participate in a pre-questionnaire designed to measure awareness and existing knowledge levels. An in-person 30 minute educational session was subsequently conducted. Following this intervention, a post-survey was administered to evaluate the outcomes and assess the effectiveness of the educational session. Results: 48 staff members attended the presentation with 23 paired questionnaires used for data analysis. Nearly all participants showed improvement or maintained their scores from the pretest to the posttest. A Wilcoxon signed-rank test confirmed that this improvement in knowledge was statistically significant post-intervention, with a Z value of -2.7147 and a p-value of .00672. Wilcoxon signed-rank tests indicated significant gains in staff confidence in recognizing asthma exacerbation signs (Z = -2.301, p = 0.01072, r = 0.58), comfort with assisting children using inhalers (Z = 3.0594, p = 0.00111, r = 0.88), and staff comfort responding to asthma exacerbations at SACC (Z = 3.4078, p = 0.0032, r = 0.88). Conclusions: This project found that a nurse led structured asthma education presentation increased SACC staff confidence. However, the results are limited by the study being conducted in a single setting. The findings may not apply to other childcare environments with different cultures, resources, or staff. Further studies across multiple sites are needed to verify broader effectiveness.
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  Early Literacy Promotion: Increasing Parental Reading Frequency To Improve Developmental Outcomes

  Kenneally, Maria; Ramey, Abigail; Martin-Plank, Lorraine M.; Jastak, Holly (The University of Arizona., 2025)

  Background: Early childhood communication and language literacy are crucial aspects of children's communication development. Children who are read to regularly from a young age are more likely to meet their developmental milestones. Despite this, many parents do not read to their children frequently enough. Purpose: The purpose of this DNP quality improvement (QI) project was to increase the number of days parents are reading per week to their children aged two weeks to two years to improve communication development in children, as well as improve parent attitudes towards reading with their children. The results were intended to improve outcomes at Maricopa County Nurse Family Partnership only, with no intent to apply the findings more broadly. Methods: During home visits with Maricopa County Nurse Family Partnership nurses, parents with children aged 2 weeks to 2 years will be provided with an educational activity and an age-appropriate book. They will then complete a post/pretest that will evaluate shared reading frequency before the intervention and intended shared reading frequency, parent confidence, perceived benefit of educational activity, and knowledge regarding shared reading with their child. Results: Twenty-six of thirty-three parents, or 79%, participated in this quality improvement project. Data analysis identified a statistically significant improvement in shared reading frequency per week. Additionally, data support increased parents’ confidence and knowledge regarding shared reading with their child. Conclusions: The educational intervention improved shared reading time and increased parent confidence and knowledge regarding shared reading with their child.
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  Optimizing Treatment for Depression: Integrating TMS and Ketamine Through Provider and Clinical Staff Education

  Velo, Jamie; Grancorvitz, Gillian Rosemary; Velo, Jamie; Edmund, Sarah; Koening, Naomi (The University of Arizona., 2025)

  This Doctor of Nursing Practice (DNP) project aimed to evaluate the impact of an educational intervention created to improve mental health care providers, nurses, and other clinical staff's knowledge of the combined use of Transcranial Magnetic Stimulation (TMS) and ketamine for treating treatment-resistant depression (TRD). TRD affects a significant number of individuals who have Major Depressive Disorder (MDD) and often do not respond to traditional antidepressant therapies, thus leading to a need for other modalities. Novice treatments for TRD include ketamine, an NMDA receptor antagonist, and TMS, a non-invasive brain stimulation technique, both of which have demonstrated effectiveness. However, many of those who are involved in the care of those receiving ketamine, TMS, or both remain unaware of the synergistic benefits of combining the two treatments. This project utilized a quality improvement (QI) framework, specifically the Plan-Do-Study-Act (PDSA) model, to design and implement an educational intervention for mental health providers managing ketamine treatment in outpatient settings. Participants took a 10-question pre-quiz, then engaged in a 10-minute PowerPoint voice-over education session, followed by the same 10-question post-quiz to assess their knowledge of the mechanisms and clinical data supporting the combined use of ketamine and TMS. Data analysis involved comparing pre- and post-quiz results to evaluate a change in knowledge. This project aimed to enhance the clinical teams' knowledge, improve treatment outcomes for patients with TRD receiving ketamine and TMS, and contribute to the growing knowledge of integrating advanced treatment modalities in mental health care. This project aimed to address critical provider education and improve patient care in managing treatment-resistant depression.
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  Using Community Education To Increase Cervical Cancer Screening Rates in Ajo, AZ

  Locke, Sarah J.; Diaz, Gabrielle Maria; Newton, Tarnia; Kiser, Lisa H. (The University of Arizona., 2025)

  Background: Cervical cancer remains a pressing public health concern, particularly in rural and medically underserved communities where screening rates are significantly lower than national averages. According to the Centers for Disease Control and Prevention (CDC), routine Papanicolaou (Pap) tests and human papillomavirus (HPV) screenings are essential for early detection and prevention (2024). However, barriers such as lack of awareness, transportation difficulties, low health literacy, and cultural beliefs contribute to less-than-optimal screening rates in rural populations (Washington et al., 2024; Zhang et al., 2022). Community-based education has emerged as an effective, evidence-based strategy to address these gaps by promoting awareness, reducing stigma, and improving screening uptake, especially providing immediate access to services (Brecher et al., 2024; Wong et al., 2021).Purpose: This quality improvement (QI) project aimed to increase cervical cancer screening rates at Desert Senita Community Health Center (DSCHC) in Ajo, Arizona, by implementing a culturally considerate, community-based educational intervention during National Women’s Health Week. The intervention was adapted from the CDC’s widely validated AMIGAS program, an evidence-based initiative designed to improve screening uptake among Hispanic women (CDC, 2024). Specifically, this project assessed whether participation influences attendees’ intent to partake in cervical cancer screening. Methods: The educational session was promoted throughout the community and included information on the importance of routine cervical cancer screenings, HPV transmission risks, and available local healthcare services. Participants were encouraged to complete a survey capturing demographics, cervical cancer screening history, knowledge, and intent to screen. Clinic staff offered on-site screening appointment scheduling. Effectiveness was evaluated based on changes in knowledge and intent to screen and the number of participants who schedule cervical cancer screenings immediately following the session. Data was collected via paper surveys and the clinic’s scheduling system and analyzed using descriptive statistics to assess knowledge gains and behavior change. Results: Twelve individuals attended the session, ten of whom met inclusion criteria. Among these, the average understanding increased by 1.2 points on a 5-point Likert scale. Three participants scheduled same-day screenings. Conclusions: The findings supported the intervention’s effectiveness in increasing awareness and screening intent, highlighting the potential for broader community health impact.
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  Implementation of Standardized Debrief for Rapid Response Calls

  Bartlett, Courtney; Cochran, Claire; Carlisle, Heather L.; Kiley, Brigid A. (The University of Arizona., 2025)

  Background: Communication in healthcare is vital to providing patients with safe and effectivecare. Developing a strategy to enhance communication between bedside nurses and the rapid response nurse (RRN) is essential in providing patients with timely and effective care during critical situations. For bedside nurses, a structured debrief serves to enhance teamwork and communication during subsequent rapid responses. Purpose: To enhance communication between the bedside nurse and the rapid response nurse through structured debriefing following the conclusion of a rapid response. Recognizing effective communication and reinforcing positive interactions could reduce the hesitance when contacting rapid response, thereby improving patient care. Methods: This quality improvement project evaluated qualitative data collected during structured debriefs using the STOP5 debrief tool and also through a post-pre survey design distributed to the bedside nurses to determine the usefulness of maintaining debriefing. Results: The qualitative data revealed five themes that impacted the rapid response event, including communication and teamwork, SBAR & handoff protocols, advocacy & critical thinking, and resources, being the most frequently discussed topics in debriefs. Results of the post-pre survey demonstrated minimal to negative changes between pre- and post-intervention; the small sample size prevented the results from having adequate statistical significance. Conclusions: Debriefing encouraged bedside and rapid response nurses to identify areas for improvement following rapid response events. Negative results are due to multifactorial limitations. There is a need for ongoing follow-up after rapid response events, and further investigation is required to identify the most effective methods for conducting this follow-up.
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  Evaluating the Impact of Vaccine Education for Healthcare Providers on PCV Vaccination Rates

  Daly, Patricia; Marovich, Hollie; Thomas, Pamela; Pacheco, Christy (The University of Arizona., 2025)

  Background: Pneumococcal disease poses a significant health risk to adults aged 50 and older. In January 2025, the CDC updated its guidelines to recommend pneumococcal conjugate vaccines (PCVs) for adults beginning at age 50, expanding eligibility from the previous threshold of 65 years (Kobayashi, 2025). This recent change has contributed to a temporary lag in vaccination rates for the newly included age group. Persistent barriers such as vaccine hesitancy and limited provider engagement in proactive vaccine counseling continue to hinder uptake. Primary care providers play a critical role in patient education and vaccine advocacy, making provider-focused interventions a promising strategy to improve immunization rates. Methods: This quality improvement project utilized the Plan-Do-Study-Act (PDSA) model and was guided by the Theory of Planned Behavior. A brief, 20-minute educational session was delivered to healthcare providers and support staff at a primary care clinic in Peoria, Arizona. The session included CDC-based handouts and a PowerPoint presentation on PCV guidelines, risks of pneumococcal disease, and communication strategies for addressing vaccine hesitancy. Pre- and post-intervention surveys assessed changes in provider knowledge, confidence, and vaccine-related behaviors. A follow-up survey was administered three weeks later to evaluate sustained impact. Results: Three participants completed the initial surveys, and two completed the follow-up. Post-intervention scores showed improvements in familiarity with CDC guidelines (from 3.33 to 5.00), confidence in identifying eligible patients (from 3.00 to 5.00), and comfort initiating vaccine conversations. Follow-up responses indicated increased vaccine recommendations, more in-depth patient discussions, and sustained confidence in addressing hesitancy. Participants also reported barriers such as time constraints and EMR limitations and expressed interest in ongoing education. Conclusions: Targeted provider education significantly improved knowledge, confidence, and vaccine-related communication behaviors. These findings support the use of brief, evidencebased interventions to enhance provider engagement and address vaccine hesitancy in primary care settings. Future efforts should include chart audits and broader staff participation to assess long-term impact and scalability.
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  Active Classrooms, Focused Minds: Empowering School Staff to Support ADHD Through Movement

  Martin-Plank, Lori; Locke, Sarah J.; Fromm, Ashley Taryn; Keanneally, Maria; Gallagher, Shawn P. (The University of Arizona., 2025)

  Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that negatively impacts children’s behavior, executive function, and academic outcomes. Children in Title 1 schools, who often face compounded barriers such as physical inactivity and limited behavioral health support, are particularly vulnerable. Evidence supports physical activity as an effective non-pharmacologic strategy to improve attention, behavior, and executive functioning in children with ADHD. However, school staff frequently lack training and confidence in implementing these strategies. This quality improvement project aimed to enhance the knowledge and confidence of elementary school teachers in using movement-based interventions to support students with ADHD. Guided by the Iowa Model of Evidence-Based Practice, the project involves an educational session for school staff at Eagle Ridge Elementary School in Maricopa County, Arizona. Pre- and post-surveys were utilized to assess changes in teacher knowledge and confidence regarding the use of physical activity for ADHD symptom management. Data were analyzed using descriptive statistics and paired t-tests to evaluate the intervention’s effectiveness. Results were expected to demonstrate improvements in staff preparedness and willingness to integrate movement strategies into classroom routines. The long-term goal of this project was to reduce classroom disruptions, improve student engagement, and support educational equity for underserved children with ADHD. Findings will inform future efforts to scale physical activity interventions in school environments as part of a holistic, prevention-oriented approach to ADHD management in primary care.
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  Enhancing Pediatric Nurses' Competence in Infant Care and Parental Guidance Through Educational Interventions

  Williams, Deborah K.; Dill, Zoe; Bencs, Nicole D.; Shih, Sabrina J. (The University of Arizona., 2025)

  Background: Inpatient pediatric nurses often receive limited formal education on pediatric health promotion, as undergraduate curricula prioritize adult/geriatric content, and continuing education emphasizes acute care management. These gaps leave nurses underprepared to deliver developmentally appropriate guidance to parents, despite the importance of bedside education in improving pediatric outcomes. At Tucson Medical Center (TMC), the combined pediatric/pediatric intensive care unit (PICU) experienced high nurse turnover in 2024-2025, with most new hires during that time being recent graduates or transfers from adult care. Stakeholder feedback highlighted gaps in foundational knowledge and hesitancy in providing parent education, particularly for infants. Purpose: The purpose of this quality improvement project was to evaluate whether a structured, evidence-based educational session on newborn and infant care could enhance inpatient pediatric nurses’ self-perceived competence in infant health promotion and increase their intent to integrate education into bedside practice. Methods: A 55-minute educational session, titled “Diapers, Diet, and Development: Infant Care 101,” was delivered to nursing and support staff. Pre- and post-intervention surveys measured nurses’ self-perceived competency, knowledge, willingness to provide bedside education, perceived relevance of the content, and intent to implement the content in their practice. Quantitative data were analyzed with descriptive statistics and measures of central tendency, while qualitative data were reviewed for thematic insights. Results: 18 pre-survey answers and 11 post-survey answers were analyzed (n=11). Nurses demonstrated a 26% improvement in their self-perceived competency in infant care topics after the intervention. Most participants (91%) rated the content as highly relevant, and all expressed intent to apply the information in practice. Qualitative feedback highlighted the value of nonacute pediatric education and identified future topics of interest, including guidance on breastfeeding, pain management, and vaccine education. Conclusion: This intervention enhanced nurses’ self-perceived competence and motivation to provide health promotion education at the bedside. Findings support the incorporation of pediatric health promotion into unit-based continuing education and onboarding, with future research needed on the long-term impact, broader implementation, and parent perspectives.
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  Reduce Inappropriate Cardiac Stress Testing by Improving Adherence to Educational Guidelines

  Newton, Tarnia; Daley, Melinda; Daly, Patricia; Pradhan, Rajesh (The University of Arizona., 2025)

  Purpose: This quality improvement initiative aimed to educate primary care providers about theindications and contraindications for nuclear and non-nuclear cardiac stress testing to promote appropriate test selection and improve patient outcomes. Background: Cardiovascular disease is the leading cause of death in the United States, with coronary artery disease responsible for more than half of all cardiovascular events in adults under 75 (Chou, 2015). Although cardiac stress testing is essential for evaluating CAD, 5%–25% of imaging tests are performed inappropriately, resulting in unnecessary radiation exposure, increased costs, and potential patient harm (Chaudhuri et al., 2015). Selecting the correct test relies on following evidence-based guidelines and accurately assessing patient symptoms and clinical status. Methods: A pre-implementation chart audit revealed that 4–13% of stress tests required modification due to inappropriate orders, highlighting the need for provider education. Using a Plan-Do-Study-Act framework, a 30-minute educational intervention was delivered to four primary care providers. Content included types of stress tests, indications, contraindications, and a clinical flowchart tool to guide test selection. Pre- and post-intervention surveys assessed knowledge, confidence, and intent to apply the materials. A four-week post-implementation chart audit evaluated improvements in ordering accuracy. Results: Provider understanding of stress test types improved from 50% agreement before the intervention to 100% agreement or strong agreement afterward. Confidence in selecting appropriate tests rose from 25% to 75%. Knowledge of contraindications increased from 25% to 100%. Confidence in interpreting guidelines grew from 0% to 75%. All providers reported they would use the flowchart in practice. Post-implementation audit findings indicated that 87.5% (7 of 8) of stress test orders were appropriate. Conclusion: Targeted education and practical decision-support tools significantly improved provider knowledge, confidence, and accuracy when ordering cardiac stress tests. Using evidence-based guidance can lower unnecessary imaging, improve workflow efficiency, and reduce patient risk.
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  Diabetes Self-Management Education and Support (DSMES) For Underserved Group in Calexico, California

  Martin Plank, Lorraine M.; Gorombei, Deborah A.; Gonzalez, Carolina; Newton, Tarina; Loya, Julio C. (The University of Arizona., 2025)

  Purpose: This practice project seeks to explore the effects of a culturally tailored Diabetes Self-Management Education and Support (DSMES) program and its interventions on medication adherence and self-efficacy for a cohort of Hispanic adults 18 years and older who have been diagnosed with T2DM in Calexico. The aim is to establish DSMES as an effective intervention to increase knowledge and adherence. Background: Type 2 Diabetes mellitus (T2DM) continues to be a public health crisis in underserved communities such as Calexico, California. The communities’ lack of access to care, language barriers, and low health literacy has led to poor glycemic control and high prevalence of diabetes related complications. Methods: The quality improvement (QI) project will follow the Plan-Do-Study-Act (PDSA) framework. Recruitment will be done through an established diabetes education program. A 20-minute in-person, bilingual DSMES session will be conducted with health literacy-sensitive materials. Tools such as the Diabetes Self-Management Questionnaire (DSMQ) and the Medication Adherence Report Scale (MARS-5) will be used before the interventions. This study is consistent with Orem’s Self-Care Theory, and it facilitates the incorporation of DSMES into rural primary care. Results: Six patients were enrolled in a single session day; all provided consent, completed both surveys, and spoke Spanish. Median duration since T2DM diagnosis was 7.5 years. The average adherence increased from 4.08 during the pre-education phase to 5.00 after the education phase. The mean within-person shift was +0.92 points on the 1–5 scale, a statistically reliable gain (paired t(5) =8.88, p=0.00030). Conclusions: A single point-of-care, Spanish-only DSMES session integrated into the regular clinic flow was feasible and acceptable and led to an early clinically significant improvement in self-reported medication adherence among Hispanic adults with longstanding T2DM.
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  Improving Mental Health Provider Knowledge of Implicit Bias and Its Impact Through Trauma-Informed Learning

  Edmund, Sara J.; Elias, Omnia Hatim; Gallagher, Shawn P.; Young, Janay R. (The University of Arizona., 2025)

  Background: Implicit bias, unconscious, negative attitudes toward marginalized populations, significantly contributes to disparities in mental health care. Mental health providers (MHPs) are particularly vulnerable to these effects, as psychiatric diagnosis and treatment rely heavily on subjective judgment. Bias can result in misinterpretation of symptoms, misdiagnosis, and reduced access to care, particularly among people of color, veterans, immigrants, and the unhoused. Trauma-informed care (TIC) provides a supportive framework for addressing bias by fostering provider self-awareness and promoting culturally responsive, equitable treatment. Educational strategies that attend to providers’ cognitive and emotional needs can increase receptivity to learning and applying bias-mitigation techniques. Purpose: This Doctor of Nursing Practice (DNP) project aimed to enhance MHPs’ knowledge, awareness, and attitudes related to implicit bias through a TIC training at a Tucson outpatient psychiatric clinic. In a racially and culturally diverse state such as Arizona, implicit bias contributes to diagnostic disparities and poor therapeutic outcomes. This project implemented an evidence-based educational intervention to help MHPs recognize and mitigate unconscious bias, improve cultural responsiveness, and promote health equity. The project evaluated changes in MHPs’ understanding of implicit bias before and after the intervention, with the goal of informing future practice integration and advancing trauma-informed, bias-aware care. Methods: This quality improvement project utilized a pre-/post-survey design to evaluate the impact of an asynchronous, trauma-informed implicit bias training for MHPs. The intervention included an evidence-based presentation addressing implicit bias, its clinical implications, and trauma-informed strategies. Surveys administered via Qualtrics measured changes in knowledge, awareness, attitudes, and intent to apply TIC principles. Data were analyzed using descriptive statistics and paired t-tests within a Plan-Do-Study-Act (PDSA) framework. Results and Conclusions: Of six eligible providers, three psychiatric mental health nurse practitioners completed both surveys. While knowledge scores remained uniformly high, significant improvements (p < .001) were observed in awareness, attitudes, and intent, with the largest gains in awareness. Findings suggest that brief, trauma-informed implicit bias training can strengthen reflective practice and reinforce providers’ commitment to equitable psychiatric care.
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  Enhancing Psychiatric Providers' Knowledge and Screening Practices for Perinatal Depression

  Edmund, Sara J.; Rios, Ashli; Robinson, Kristen; Keenhold, Amanda (The University of Arizona., 2025)

  Background: Perinatal depression (PD) is a serious mental health condition that affects up to one in seven women during pregnancy or postpartum, yet it often goes undiagnosed and undertreated. If left untreated, PD can lead to significant health consequences for both mom and baby. Despite recommendations by various professional organizations, screening rates remain low. Although several screening tools exist, the Edinburgh Postnatal Depression Scale (EPDS) is specifically designed for perinatal populations and has demonstrated strong predictive validity for identifying PD. Providers may benefit from increased knowledge about PD and how to administer the EPDS to promote routine screening to improve early identification, intervention, and patient outcomes. Purpose: The purpose of this quality improvement (QI) project was to increase the knowledge, confidence, and comfort of psychiatric healthcare providers at Denova Collaborative Health regarding screening for perinatal depression. Further, this project evaluated the impact of the educational intervention on providers’ perceived benefit of the EPDS and intent to use the EPDS in practice. Methods: An asynchronous educational presentation with a pre- and posttest design was used. Psychiatric providers completed a pre-test survey to assess baseline knowledge and confidence about perinatal depression and the EPDS. The presentation provided healthcare providers with education about the significance of PD and the importance of using the EPDS among this patient population. A post-test survey evaluated changes in knowledge, confidence, perceived benefit, and intent to use the EPDS. Descriptive statistics were used to analyze survey responses, and free-text responses were summarized. Results: Six nurse practitioners (2%) completed all study activities and were included in the analysis. Participants demonstrated increased knowledge of PD, with mean scores rising from 52.4% to 85.7% after the intervention. Confidence in administering the EPDS increased from a median 5-point Likert score of 3.0 to 4.0, and the perceived benefit of the EPDS also increased from a median of 2.0 to 3.5. The intent to use the EPDS in future practice showed an overall positive trend, indicating plans for more consistent use among providers. Perceived barriers to consistent implementation of the EPDS included time constraints and tool complexity. Conclusions: This project suggests that a brief, asynchronous educational intervention may improve psychiatric providers’ knowledge, confidence, and attitudes toward using the EPDS for PD screening. Integrating targeted education and providing resources may help bridge existing gaps in screening and promote earlier identification and treatment of perinatal mental health conditions.
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  Proactive Prescribing Enhancing Hospice Care Through Anticipatory Pharmacy Practices

  Newton, Tarnia; Chrite, Adriana Lynne; Pacheco, Christy L.; Brownstein, Sandra (The University of Arizona., 2025)

  Purpose: This project aims to reduce avoidable hospitalizations, alleviate caregiver stress, improve patient comfort during the end-of-life phase through assessing RN case manager confidence in educating families about anticipatory medications and rolling out the educational pamphlet as a teaching tool. Background: Hospice care prioritizes comfort and quality of life for individuals with terminal illnesses. However, inadequate symptom management, caregiver burden, and frequent hospitalizations remain persistent barriers to effective hospice delivery (Virdun et al., 2015; O’Hara et al., 2010). Delays in medication access often lead to distress, emergency interventions, and unplanned hospitalizations, which undermine the goals of hospice care. Anticipatory prescribing, a proactive approach that ensures symptom management medications are available at the start of care, has been associated with improved comfort and reduced crisis events (Au, Baker, & Hindmarsh, 2022; Charlesworth, 2020). Methods: The project was conducted at a local hospice in Tucson, Arizona. A multidisciplinary team reviewed current prescribing practices and developed an anticipatory pharmacy protocol that included a standard set of medications for common end-of-life symptoms such as pain, dyspnea, agitation, and nausea. Educational sessions were conducted for hospice staff and caregivers to support medication administration. Data on symptom control, hospitalization rates, and RN case manager comfort with anticipatory prescribing and caregiver education were collected and compared pre- and post-implementation. RN comfort was assessed using a structured survey tool designed to measure confidence in initiating and educating on comfort medications. Results: Seven hospice nurses completed pre- and post-intervention confidence surveys, with average confidence scores increasing from 1–2 (not at all/slightly confident) to 4–5 (confident/very confident), representing an approximate 70% improvement across all domains. Among 20 patients who received the standardized education pamphlet, 12 (60%) effectively utilized comfort medications, and none required hospitalization for uncontrolled symptoms within 30 days. In comparison, the retrospective control group (n=20) experienced 4 hospitalizations (20%), including 2 related to uncontrolled pain despite medication availability. Pharmacy costs decreased to 3.3% of direct costs, the lowest in six months, accompanied by fewer on-call visits and improved home symptom control. Conclusions: Integrating anticipatory prescribing into hospice admission protocols may significantly enhance the quality of end-of-life care. While the upfront cost of early medication delivery may increase, it is outweighed by reductions in crisis interventions and hospital-related expenditures. These findings support the need for broader adoption of anticipatory pharmacy practices across hospice settings to promote patient-centered, cost-effective care.
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  An Oral Anticoagulant Patient Education Session to Improve Patient Safety

  Daly, Patricia; Lindstrom-Mette, Amber; Pizzini, Holly Anna; Dunlap, Deborah (The University of Arizona., 2025)

  Purpose: The purpose of this quality improvement (QI) project is to improve rural patients’ knowledge of oral anticoagulation therapy to increase safety at home and improve patient outcomes. Background: Older adults diagnosed with atrial fibrillation, venous thromboembolism, and who undergo post-heart valve replacement are frequently prescribed oral anticoagulant therapy (OAC) to prevent the devastating consequences of cerebral vascular accidents (CVAs) and myocardial infarction (MI). Rural older adults are at a higher risk of developing atrial fibrillation, have limited access to specialty care, and may experience higher mortality rates compared to their nonrural counterparts. Despite life-saving OAC benefits, these medications pose risks for major bleeding and significant harm if used inappropriately. Busy primary care clinics are challenged to achieve the standard of care for anticoagulation education, including provider-patient face-to-face interaction accompanied by written resources and utilization of the teach-back method. Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, this QI project in a rural primary care clinic will utilize a pre-test and post-test design to evaluate a ten-minute session of anticoagulant patient education (APE) created by the Project Manager, synthesizing evidence-based practice OAC guidelines. Participants completed a pre-test and post-test questionnaire to measure their medication safety knowledge and self-reported confidence of use with a Likert scale. The 10-minute APE session included an anticoagulant safety handout and verbal discussion of the risks, benefits, proper use, and precautions for the anticoagulant. Results: The average increase in knowledge gain reflected in the post-survey 7.92% (direct) and 7.5% (traditional). The survey question with the most amount of improvement (12.5%) was the direct OAC survey questions three and five. Conclusion: Findings from this QI project will be utilized to develop a ten-minute educational video to be shown in clinic lobbies, allowing patients to receive education while waiting for their appointments. Despite modest improvements, results support the value of ongoing patient education and highlight the strong baseline knowledge among participants.

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