Background: Opioid use disorder (OUD) remains a critical public health challenge in Arizona and across the United States (US), disproportionately affecting unhoused populations who face barriers to consistent and effective treatment. Despite the efficacy of medication-assisted treatment (MAT) with buprenorphine (Suboxone), provider hesitancy—driven by stigma, limited confidence, and concerns about treatment adherence—continues to impede access to care. Purpose: The purpose of this quality improvement (QI) project was to decrease provider hesitancy to initiate Suboxone therapy for unhoused individuals through the delivery of a brief, targeted educational intervention and post-intervention survey. Methods: A short educational video was developed by the Project Lead to address common provider concerns, reduce stigma, and highlight evidence-based benefits of MAT for unhoused patients. Providers were invited to view the video and complete a post-survey immediately, assessing changes in their knowledge, attitudes, and willingness to initiate Suboxone therapy—the Plan-Do-Study-Act (PDSA) framework guided project design and implementation. Results: Survey responses indicated improvements in provider-reported knowledge and comfort levels regarding MAT initiation for unhoused populations. Respondents demonstrated increased willingness to consider prescribing Suboxone following the educational intervention. Although limited by a small sample size, single-site implementation, and reliance on self-reported data, the project's findings suggest that even brief, targeted education can have a positive influence on provider attitudes. Conclusions: This project supports the value of focused educational interventions in addressing provider hesitancy to initiate Suboxone therapy. Implications for future practice include expanding similar training across multiple sites, integrating content into continuing education programs, and conducting longitudinal assessments to evaluate the sustained changes in prescribing behaviors. By equipping providers with the confidence and knowledge to initiate MAT, healthcare systems can expand access to life-saving treatment and reduce disparities among unhoused individuals with OUD.

Background: Cardiac-specific anxiety (CSA) is often underrecognized and affects patients after events like myocardial infarction (MI), coronary artery bypass grafting (CABG), heart failure (HF), or implantable cardioverter defibrillator (ICD) placement. Higher CSA levels are associated with worse cardiac outcomes, lower quality of life, poor treatment adherence, and increased healthcare use (Schmitz et al., 2022; Van Beek et al., 2016). Although organizations like the American Heart Association (AHA) and the American Psychiatric Association (APA) recommend routine psychosocial screening, real-world adoption is inconsistent. Evidence shows that only about 60% of patients in cardiac rehab are screened for anxiety or depression, with significant variation in screening methods across different groups (Helmark et al., 2022). The Cardiac Anxiety Questionnaire (CAQ), a validated screening tool for CSA, is underused in clinical practice due to gaps in provider knowledge and workflow challenges. Purpose: This quality improvement (QI) project aimed to enhance advanced practice providers’ (APPs) knowledge, confidence, and intention to screen for cardiac-specific anxiety with the CAQ via a brief, self-paced educational module at HonorHealth. Methods: A 15-minute online module was created to educate APPs about CSA prevalence, risk factors, and CAQ administration and interpretation. Participants completed pre- and post-module surveys assessing knowledge, confidence, and screening intent, which were distributed through Qualtrics. Data were analyzed using descriptive statistics to evaluate participant knowledge and attitude changes, and open-ended responses offered qualitative feedback on the module's usability. Results: Six APPs completed the pre-survey, while four completed both pre- and post-surveys. The average knowledge quiz scores rose from 6.25 to 8.0, showing a positive trend in learning. Participants also reported increased familiarity with CSA and the CAQ after the intervention, higher confidence in recognizing CSA, and a stronger willingness to include screening in their clinical work. Conclusions: This project showed that a short, targeted educational intervention can improve provider awareness and preparedness to carry out CSA screening in a busy cardiology setting. Despite a small sample size, the findings indicate the practicality and clinical importance of integrating standardized anxiety screening into cardiac care to support holistic, patient-focused outcomes.

Background: CGM technology provides accurate, real-time glucose data, improving glycemic control, reducing glycosylated hemoglobin (HbA1c), and enhancing patient engagement. Despite evidence-based recommendations, CGM remains underutilized in primary care, often due to limited provider familiarity with prescribing and educating patients on device use. Barries include knowledge gaps, time constraints, and uncertainty regarding insurance coverage. Providers at this primary care clinic identified a knowledge gap but have interest in CGM utilization for their T2DM patients. Purpose: The purpose of this DNP quality improvement project was to increase healthcare provider (HCP) knowledge, confidence, and intended implementation of continuous glucose monitoring (CGM) in adults with type 2 diabetes mellitus (T2DM) and to identify additional learning needs at a Southwest, urban primary care clinic. Methods: Using the Chronic Care Model (CCM) and the Plan-Do-Study-Act (PDSA) framework, an approximately 15-minute asynchronous, online educational session was delivered via email to providers at a Southwest, urban primary care clinic. The presentation covered American Diabetes Association (ADA) aligned pharmacotherapy, CGM metrics, device selection, and patient education. An online, anonymous post-intervention survey was utilized to assess changes in knowledge, confidence, and intent to implement CGM, and identified future learning needs to facilitate utilization. Results: Of the five eligible providers, four (80%) completed the asynchronous, online presentation and post-intervention survey. All respondents had selected they had prior experience with CGM, and four (100%) respondents reported increased knowledge and confidence in educating patients about CGM use and prescribing CGM for appropriate adults T2DM patients. Three (75%) respondents selected that they intended to prescribe more CGM after viewing the presentation and one (25%) responded selected they were neutral. Barriers identified included insurance coverage, data interpretation, and time. Facilitators identified included the asynchronous nature of the presentation and information gained from the presentation. Conclusions: This quality improvement project effectively improved provider knowledge, confidence, and intent to prescribe CGM for appropriate T2DM patients at a Southwest urban primary care clinic. The findings of this QI project align with existing literature, especially the barriers and facilitators, investigating CGM use in the primary care setting. Recommendations for further projects include targeting education for insurance coverage and CGM data interpretation while keeping the asynchronous nature of the presentations.

Background: As the dangers of traditional tobacco cigarettes were publicly realized, rates of cigarette smoking declined; however, the use of electronic cigarettes (vape devices) has increased, especially among the minor population. An abundance of misinformation about the dangers and risks of vaping is present in the public arena, especially among children whom the producers of these devices are targeting. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate the impact of an educational intervention about vaping presented to children ages 13-18 years at a primary care health clinic in Queen Creek, Arizona. Changes in both knowledge and opinions about vaping were evaluated before and after the presentation of a PowerPoint presentation with an embedded instructional video. Methods: Over a three-week timespan, a convenience sample of 23 children at a primary care health clinic was assessed for pre- and post-intervention knowledge and intentions surrounding vaping following the presentation. Results: Paired t-tests revealed that changes to knowledge of electronic cigarette use were statistically significant following the presentation. 23% of the children also expressed a different opinion (against vaping) following the presentation of facts. Conclusions: This project and its findings presented stakeholders with the opportunity to consider effective educational interventions to address the vaping crisis affecting children. The dissemination of vaping prevention education, both in the community and within healthcare settings, may improve short- and long-term health outcomes for children.

The purpose of this study was to examine how teachers’ political orientation (PO) and years of teaching experience relate to their personal and professional diversity beliefs. By examining these demographic variables, this research can contribute to the field by highlighting the central role of political orientation in shaping teachers’ diversity beliefs, suggesting that future studies should further explore how underlying belief orientations interact with political ideology to influence classroom practice and professional practice. Using a mixed-methods design, data were collected through surveys from active educators (n = 92) that included items on beliefs about diversity and through semi-structured interviews (n = 15). Results indicated that political orientation, rather than years of teaching, was most consistently associated with both personal and professional diversity beliefs. Qualitative findings reinforced these patterns, illustrating that teachers’ political worldviews shaped how they conceptualized and enacted diversity, equity, and inclusion (DEI) practices. These results highlight the centrality of underlying belief orientations in shaping educators’ perspectives on diversity. Implications for practice, limitations of the study, and recommendations for future research are discussed.

Background: Prolonged use of mechanical ventilation (MV) has been shown to contribute to harmful complications, such as ventilator-associated pneumonia, delirium, and lasting cognitive and musculoskeletal impairment known as post-intensive syndrome (Olsen et al., 2023). Early liberation from MV has been shown to significantly reduce mortality, decrease the number of days spent on MV, and decrease overall length of stay (Balas et al., 2022). Despite sufficient evidence supporting the implementation or increased adherence to screening protocols, such as the SAT, several barriers have contributed to their limited utilization in ICUs. Purpose: This quality improvement project aimed to increase spontaneous awakening trial (SAT) compliance in an intensive care unit by utilizing evidence-based quality improvement methodologies. These methodologies involved enhancing the awareness of a pre-existing SAT bundle tool and protocol. Methods: This quality improvement initiative aimed to enhance SAT bundle compliance by increasing staff nurses’ awareness of a pre-existing protocol through the incorporation of teaching into daily nursing huddles, the use of run charts, posters, and unit-wide emails. Utilizing the Plan-Do-Study-Act model for improvement, this project aimed to identify and resolve existing barriers to increase compliance. Results: A total of 27 (n=27) participants completed the pre-intervention knowledge survey, with 15 (n=15) of the original participants having completed the post-intervention knowledge survey. Knowledge enhancement was observed across several response categories in the SAT protocol compared with the pre-intervention period. A statistically significant increase in SAT compliance and SAT included patient agitation, lack of physician direction, high patient acuity, and knowledge gaps related to SAT protocol items. Conclusions: Implementing education on SAT protocols during nursing huddles, combined with posters, educational emails, and bedside in-services, enhances nurses’ knowledge and correlates with increased compliance. This QI project offers a framework for the Scripps Mercy San Diego Intensive Care Unit to enhance compliance with the SAT protocol, a crucial first step in preventing ventilator- and delirium-associated complications. Further research is necessary to better understand the prevalence and impact of over-sedation, as well as its association with adverse outcomes.

Corpus linguistics has transformed language education by enabling teachers and learners to engage directly with authentic language data. Data-driven learning (DDL), also known as the direct use of corpora in language teaching (DDL; Johns, 1991), supports second language writing (SLW) instruction by fostering genre awareness and rhetorical decision-making (Boulton & Cobb, 2017). While research affirms the benefits of corpus-based instruction, most studies have centered on expert-driven models, limiting insights into how instructors without advanced corpus training learn to adopt these tools (Chambers, 2019). Moreover, many teachers receive little sustained support in integrating corpus methods into their instructional contexts (Farr, 2008; Poole, 2022). This dissertation investigates how teachers learn to design and implement corpus-based pedagogy in SLW instruction. Organized as a three-article study, it addresses gaps in teacher training, corpus-based materials design and implementation, and long-term engagement with DDL. Article 1 presents a systematic review of 33 empirical studies, identifying trends and gaps in DDL teacher education. Article 2 analyzes classroom data from 14 instructors implementing ready-made corpus-based materials, using the TPACK framework (Mishra & Koehler, 2006) to explore pedagogical decision-making. Article 3 examines a 10-week collaborative workshop in which 6 in-service SLW instructors engaged in co-design, peer feedback, and reflective dialogue around corpus pedagogy, highlighting how collaboration support teacher learning of corpus-based instruction. Together, these studies offer a multi-dimensional view of DDL integration and propose practical, collaborative, and context-responsive approaches to help teachers meaningfully incorporate corpus tools into SLW pedagogy. The opening chapter of the dissertation introduces the broader context of corpus linguistics, data-driven learning (DDL), and corpus-based instruction, while also presenting a summary of each article and my positionality as a researcher. This chapter is followed by three standalone articles (Chapters 2, 3, and 4). The dissertation concludes with a final chapter that synthesizes the insights across the three articles, highlights their collective contributions, and outlines implications and directions for future research.

This dissertation analyzes legal English as a special register of English employed across the legal domain, with specific emphasis on its use in wills, and develops an integrated foundation for transforming natural language wills into executable smart contracts through three interconnected contributions. The first contribution introduces an artificial intelligence-based system that interprets English language wills and computes their expected devolution outcomes. The system architecture and implementation are described in detail, and evaluation on manually annotated test sets shows that it surpasses a baseline model in both accuracy and accountability while maintaining interpretability and traceability. The second contribution extends this framework through a task aware prompt chaining approach for information extraction. The method divides extraction into an initial classification stage and a targeted extraction stage. The classification stage identifies the types of information present in the input and selects the most relevant examples for inclusion in the extraction prompt. Experiments with two different models show improved performance in few-shot settings and reduced token usage. Incorporating this method into the first system enables more detailed information extraction and provides a basis for adding functionality that relies on finer distinctions in the text. The third contribution presents a natural language inference dataset designed to assess the legal validity of will statements. Each validity judgment requires three inputs: a will statement, a law, and the conditions at the testator’s death, resulting in texts that are longer and more complex than those in standard NLI datasets. Eight neural models trained on this dataset achieve over 80 percent macro F1 and accuracy, although group accuracy, a stricter metric evaluating sets of related examples, remains in the mid 80s at best, indicating only superficial task understanding. Ablation and explanation analyses further show that models draw on all three text segments but sometimes rely on semantically irrelevant tokens. While presented as an independent resource, this study can be developed further to extend the first system by supporting automated evaluation of the legal validity of testamentary clauses. Taken together, these studies provide a unified foundation for transforming natural language wills into machine-interpretable smart wills. They also deepen our understanding of the linguistic and structural features of legal documents, including their intricate syntactic patterns, specialized terminology, and reliance on external contextual information such as legal rules and conditions. The findings from this work will support the development of accountable systems for the legal domain and contribute to broader progress toward smarter, more interpretable wills.

This quality improvement project aimed to increase early skin cancer detection by educating primary care nurse practitioners (PCNPs) providing care to an underserved patient population at a rural health care clinic in Arizona. Background: Skin cancer is the most common malignancy worldwide, with early detection significantly improving patient outcomes and survival rates. Skin cancer, including melanoma, basal cell carcinoma, and squamous cell carcinoma, is a growing public health concern, with over 5 million cases diagnosed annually in the United States (American Cancer Society, 2025). Despite its prevalence, routine screening for skin cancer in primary care remains underutilized, often due to provider knowledge gaps and the lack of practical tools for implementation. Research indicates that incorporating simple, evidence-based screening protocols into wellness visits can significantly enhance early detection and treatment outcomes. Rural and underserved communities encounter unique challenges, including limited access to specialty care and higher rates of late-stage diagnoses, underscoring the need for targeted interventions in these areas. Conceptual Framework: This project was guided by the Information-Motivation-Behavioral Skills (IMB) model and microlearning principles. The IMB model posits that behavior change requires access to accurate information, motivation to act, and the development of specific behavioral skills (Chang et al., 2014). These components provide PCNPs with targeted education on skin cancer detection, fostering motivation through awareness of its clinical importance and equipping them with practical skills for integrating screening into patient care. Microlearning is ”bite-sized” learning with specific content that promotes engaging in small but conscious steps (Hug & Friesen, 2010). Microlearning principles are employed to design brief, focused educational sessions that minimize disrupting busy clinical workflows while maximizing retention and applicability. Purpose: This quality improvement project aimed to educate PCNPs on early skin cancer detection and prevention through simple, evidence-based screening assessments that can be seamlessly integrated into physical wellness evaluations across the lifespan. A particular focus was placed on addressing the needs of underserved communities, tailoring interventions to reduce disparities in access and outcomes for adults and pediatric patients. Interventions included educational sharing with professionals working in primary care facilities within the Marana Health Center network in southern Arizona. Methods: A post-survey intervention design to assess the impact of a microlearning educational program on PCNP’s knowledge, confidence, and screening practices. The intervention consisted of an interactive PowerPoint workshop covering epidemiology, risk factors, lesion recognition (e.g., the ABCDE criteria) with hands-on screening techniques, supplemental microlearning modules delivered via email to reinforce key concepts with visual aids and clinical-decision-making scenarios, and vetted educational materials from reputable sources such as the Skin Cancer Foundation with access to clinical decision support tools. Descriptive statistics were employed to measure outcomes by post-intervention knowledge assessments, and self-reported confidence surveys were used to guide future integration of these tools into PCNPs practice.

Background: Hospital-acquired pressure injuries (HAPIs) result in patient morbidity, prolonged hospital stays, and increased healthcare costs. The organizational benchmark established by Banner Health is to maintain fewer than 2.95 HAPIs per 1,000 patient discharges. Banner Thunderbird Medical Center (BTMC) continues to report rates higher than the organizational average, with the highest rate being 6.3 HAPIs per 1,000 patient discharges, resulting in extended hospital stays and annual costs that exceed $2.8 million. Purpose: The aim of this project is to assess the success of Banner’s HAPI prevention program, which was implemented in March 2024. The goal of Banner’s HAPI prevention program is to increase staff compliance with HAPI interventions and proper documentation for high-risk patients to achieve the goal of fewer than 2.95 HAPI events per 1,000 patient discharges at BTMC by December 30, 2025. The purpose of this formative evaluation is to examine the progress of the performance initiative, including baseline data from January 1, 2023, through September 30, 2025. The goals include identifying current gaps, monitoring early implementation, and evaluating staff engagement. Methods: This formative evaluation utilized the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) in conjunction with the CDC Program Evaluation Framework. Participants included nursing staff—registered nurses (RNs) and patient care technicians (PCTs)—across intensive care units (ICUs), progressive care units (PCUs), and medical-surgical units (MS). Data was collected through monthly adherence audits, surveys, pre/post quiz scores and training evaluations following participation in the HAPI Bootcamp education sessions. A quantitative analysis was completed by analyzing trends in participation, knowledge gains, HAPI rates, and adherence. A qualitative analysis was conducted by analyzing the open-ended survey feedback. Then the project assessed progress toward HAPI rates of ≤2.95/1,000 discharges and if that goal was attained. Results: From 2023 to 2025, BTMC’s overall HAPI rate decreased from 4.26 to 3.02, reflecting a downward trend following implementation of the HAPI Bootcamp intervention. The Medical-Surgical Units achieved the greatest reduction of 35.4%, followed by the Progressive Care Units with 20.3%, and the Intensive Care Units demonstrated a 21.6% reduction but remained to have the highest rates compared to the other units at BTMC. Conclusions: The formative evaluation indicated BTMC’s HAPI prevention program was practical, sustainable, and adaptable for long-term use. Continued attention to documentation accuracy and data quality is necessary for maintaining progress toward the target of ≤ 2.95 HAPIs per 1,000 patient discharges by December 2025.