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The Impact of Structured Education on Stress Reduction Among SWAT Nurses
No full textBackground: SWAT RNs are at the epicenter of critical situations that occur at BDMC. It is an expectation to respond to high-stress situations such as rapid responses and code blues in adults, pediatric, and obstetric patients. While SWAT RNs are known to manage high-intensity situations effectively, they are also expected to provide leadership and mentorship when the time arises. The constant exposure to critical situations and being the go-to person for both RNs and medical providers make the SWAT RN role one that is under constant pressure, leading to increased stress. Purpose: This project aims to educate the critical care Specialized Workforce for Acute Transport (SWAT) nurses (SWAT RNs) at Banner Desert Medical Center (BDMC) on Mindfulness-Based Stress Reduction and Headspace. Methods: This quality improvement project utilizes the Plan-Do-Study-Act (PDSA) cycle. On-demand education is provided on stress reduction interventions to reduce symptoms. A pretest and posttest survey was conducted to measure changes in knowledge, familiarity, and intent to use stress reduction interventions among SWAT RNs. Results: Nine of the SWAT RNs in the Clinical Care Operations (CCO) department participated in the project, with nine completing the pretest and nine completing the posttest. Conclusions: The on-demand, evidence-based intervention significantly enhanced SWAT nurses’ familiarity with and perceived benefits of Mindfulness-Based Stress Reduction, as well as their intention to use Headspace. These findings show that brief, accessible education can boost nurse resilience, support well-being, and potentially improve patient care outcomes
Education On Pulmonary Artery Catheters and the Impact on Nurse Self-Efficacy
No full textPurpose. The purpose of this Quality Improvement project was to develop, implement, and evaluate a skills validation module on pulmonary artery catheters (PACs) for critical care nurses. The project goals were to assess whether this intervention positively affected their self-efficacy with PACs and to evaluate their satisfaction with the content and format of the training via a post-training survey. Background. Self-efficacy, an individual’s belief in their ability to master the required functions of their professional role, facilitates the development of nursing competency and the delivery of quality nursing care. Proficiency in task performance can be developed through participation in educational activities, which, in addition to furthering knowledge, can increase an individual's self-efficacy. Therefore, education on PACs may enhance nursing self-efficacy and proficiency in managing these devices. Methods. This Quality Improvement (QI) project employed a retrospective pretest-posttest design to assess the impact of an educational program on nursing self-efficacy related to the management of PACs.Results. Six out of 202 eligible participants completed the post-training survey. Self-efficacy mean scores were higher after training than before. Four sub-dimensions of PAC management – identifying the correct placement of a PAC on chest x-ray, correctly identifying waveforms, obtaining a cardiac output using thermodilution, and obtaining a pulmonary capillary wedge pressure – demonstrated the most significant increases in self-efficacy ratings. Conclusions. Annual training on pulmonary artery catheters may enhance nursing self-efficacy in managing this device. In addition, self-efficacy scores obtained before designing a training program may facilitate the development of a more effective and efficient curriculum by identifying topics that are most in need of review and those in which nurses have already established proficiency
Equity in School-Based Mental Health and Academic Achievement for Elementary Students in Pima County, Arizona: A Comparative Study
No full textIn Arizona, students with disabilities who receive special education services perform below national averages on state standardized assessments. Research shows that school-based mental health (SBMH) services can improve academic achievement for students with disabilities as well as their peers. Scholars have called for more evidence on student level academic outcomes related to SBMH provision and research that explores SBMH provision as a contextual factor that can be leveraged to improve educational gains. The purpose of this research was to explore if SBMH provider staffing was associated with academic outcomes for 4th – 6th grade students on the state assessment for English language arts (ELA) and math. Students with disabilities receiving special education services, historically marginalized students, and general education students were the focus of this cross-sectional observational study of Pima County public elementary schools. Regression analyses were conducted using average growth scores collected from school report cards from the 2022-2023 school year and the employment status of SBMH providers at each school site. The regression models adjusted for grade range, free and reduced lunch eligibility, ratio of providers to students, teacher to student ratio, and race. Results suggest that the number of SBMH professionals is positively associated with improved math academic achievement for all students (B = 2.94, SE = 1.32, β = .34, p = .03). For students receiving special education services, the ratio of SBMH providers to students was associated with improved outcomes on the ELA assessment (B = 4.50, SE = 1.31, β = .36, p =.001). For students identified as economically disadvantaged, SBMH providers were positively associated with improved outcomes on the ELA assessment (B = 2.79, SE = 1.22, β= .26, p = .025) and the ratio of providers to students was also statistically significant (B = 2.41, SE = .93, β = .28, p = .012) and positively associated with improved outcomes. Interaction effects based on historically marginalized status are further discussed with noticeable effects for schools with a high percentage of American Indian or Alaska Native students, Black or African American students, and students eligible for free and reduced lunch. This study analyzed the relationship between academic growth scores on the state assessment and SBMH provider staffing as well as ratio of providers to students and associations with academic achievement. Policy makers can promote academic success for youth in southern Arizona by prioritizing and supporting their mental health needs and ensuring they receive timely care
Controlled Environment Agriculture Effluent Use in Specialty Crop Production
No full textThe escalating demand for sustainable crop production necessitates innovations within Controlled Environment Agriculture (CEA) that address resource scarcity, waste valorization, and economic viability. This body of work investigates the strategic utilization of aquaponic and hydroponic effluents in CEA, focusing on their impact on strawberry and lemongrass transplant production, and oyster mushroom cultivation. Using data collected, further analysis of comparative nutrient dynamics across plant species and development of an engineering based economic model for mushroom operations is evaluated. Experimental results demonstrate that pure aquaponic effluents require supplementation for optimal plant performance (as seen in strawberries and lemongrass) and blended solutions yield comparable results to conventional hydroponic solution. Aquaponic solution with supplemented nutrients to match the Yamazaki solution formulation can be used to grow strawberry and lemongrass transplants. Comparative nutrient analyses revealed crop-specific uptake patterns and complex ionic interactions, as well as common patterns and trends across the two species. This highlights the need for tailored nutrient management that may incorporate generalized components that are not crop specific, easing the burden of crop specific formulation. Agricultural effluents used for hydrating mushroom substrates demonstrated comparable yields to the water control and enhanced the nutritional profiles of fruiting bodies in certain metrics such as crude protein. This presents a pathway for food production with the potential for added functional nutrition. Further using effluents allows for waste valorization and remediation. Economic modeling identified bio-efficiency and substrate cost as dominant profitability drivers in addition to design parameters such as insulation and equipment efficiency. This emphasizes the necessity of robust engineering-economic models to guide investment and operational strategies in CEA. The different studies demonstrated the potential of integrating agricultural effluents for improved resource use efficiency and reduced operational costs in production. The diverse specialty crops studied can be complimentary to existing or planned CEA and aquaculture operations providing a diverse set of products. With presently small markets compared to other common CEA crops, the potential for effectual market entry is higher, however there is still risk. In addition to growing demand, some potential opportunity is capturing imports of crops like lemongrass and oyster mushrooms for domestic growth. This research in CEA can be applied to further serve the need of year-round strawberry transplant production, introduce a dynamically valuable crop like lemongrass, improve nutrient solution formulations, affect yield and nutrition of oyster mushrooms, and create economically sound production facilities through the suggested production model. This dissertation collectively offers a thought process to analyze production which can be implemented at small and medium scales
Increasing Clinicians’ Perceived Knowledge and Confidence of Intranasal and Intramuscular Ketamine for Acute Suicidality
No full textBackground: Suicide remains among the top ten causes of death in the United States and continues to rise in Maricopa County, where rates increased 17.5% from 2022 to 2023 (Arizona Suicide Prevention Coalition, 2024; Mann et al., 2021). Ketamine demonstrates rapid anti-suicidal effects within hours when administered intranasally or intramuscularly, making it a promising crisis intervention (Fountoulakis et al., 2025; Kumari et al., 2024). Despite its efficacy, many clinicians lack familiarity with safe dosing and monitoring protocols, limiting its integration into behavioral health practice (Ilg et al., 2024; Strayer, 2024).Purpose: This project aimed to increase outpatient behavioral health clinicians’ perceived knowledge and confidence in using intranasal (IN) and intramuscular (IM) ketamine therapy for the treatment of acute suicidality in adults in outpatient and crisis settings (Bell et al., 2024; Ilg et al., 2024). Methods: Two clinicians participated in this quality improvement project. Participant demographics were collected in REDCap, followed by completion of a pre-survey. A concise, evidence-based educational handout was then reviewed at the participant’s own pace, immediately followed by a post-survey. Pre- and post-survey results were compared descriptively, and mean scores were summarized and displayed in a grouped bar chart. Results: There was an overall increase in mean scores for both perceived knowledge and confidence from the pre-survey to the post-survey. Both clinicians correctly identified the monitoring schedule and demonstrated accurate knowledge of the C-SSRS item on both surveys, consistent with their prior familiarity and clinical experience. Conclusions: Findings suggest that a brief, targeted educational intervention improved clinicians’ perceived knowledge and confidence regarding IN/IM ketamine protocols. Although limited by a small sample size, the results support the use of concise, evidence-based education as a practical strategy to enhance clinical preparedness in crisis settings. Future quality-improvement projects should expand participation, include follow-up assessments, and examine operational readiness for implementation
An Oral Anticoagulant Patient Education Session to Improve Patient Safety
No full textPurpose: 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
Evaluating the Impact of Vaccine Education for Healthcare Providers on PCV Vaccination Rates
No full textBackground: 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
Using Community Education To Increase Cervical Cancer Screening Rates in Ajo, AZ
No full textBackground: 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
The Chinese Business Community in Morocco: Informality at the Global Margins
No full textThis dissertation examines how transnational migration, informality, and globalization coalesce in the everyday socioeconomic practices of Chinese businesspeople in Morocco. Against the backdrop of expanding Sino-African relations and shifting global economic hierarchies, it investigates why some Chinese migrants turn to informal practices, what sustains their participation in informality, and how they navigate the opportunities and constraints of operating outside formal institutional frameworks. Drawing on eighteen months of ethnographic fieldwork in Casablanca and Tangier (2022–2024), the study explores how informality is deeply embedded in transcultural interactions, transnational aspirations, social networks, and contradictory moral economies. Three interrelated case studies anchor the analysis. The first investigates Chinese informal entrepreneurs in Morocco’s tourism sector, showing how they rely on digital platforms and interethnic cooperation to operate in regulatory gray zones while maintaining a strategic relationship with the state. The second focuses on Chinese informal tourism laborers—especially self-employed guides—whose pursuit of mobility and freedom abroad (“quest for elsewhereness”) is often in tension with their struggles to achieve social legitimacy and material stability (“struggle for hereness”). The third examines huan qian, a community-based informal financial practice within the Chinese community in Casablanca and between the Chinese and local Moroccans, revealing how money transfers are entangled with trust-building, moral obligation, and the social reproduction of migrant networks. The dissertation advances an actor-centered, relational, and institutional approach to informality, challenging conventional binaries between formal and informal, legitimate and illegitimate, or survival and strategy. It contends that informality among Chinese migrants is less a mere reaction to marginalization than a hyper-dynamic arena of negotiation, aspiration, and constraint. By bridging economic anthropology, migration studies, and global political economy, this research contributes both theoretically and practically to a more nuanced understanding of informal economies. It also calls for a more engaged and policy-relevant anthropology—one attentive to the grounded realities of economic life at the global margins and capable of speaking across disciplinary and institutional boundaries.Release after 12/08/202
Expanding Triazabutadiene Applications Beyond Tyrosine and Histidine Reactivity
No full textThis thesis aims to expand the applications of diazonium ion chemistry beyond its traditional use in modifying tyrosine and histidine residues. Central to this work is the use of triazabutadienes (TBD), which serve as latent diazonium ion precursors capable of controlled activation under mild conditions.A major outcome of this work is a proof of concept for a pro-fluorogenic triazabutadiene. The design of this novel class of probes combines three key features relevant to advancing tools in chemical biology: logic gated systems, biological activation, and fluorescence-based reporting. In parallel, a new class of triazabutadienes was synthesized to generate alkyl diazonium ions – an underexplored but highly reactive species. These were shown to covalently label proteins, highlighting their potential for proximity labeling and other applications where short-lived, spatially restricted reactivity is desired. Finally, a series of exploratory studies support ongoing research efforts and point toward several key opportunities for expanding the capabilities of diazonium ion-based chemistry.Release after 05/25/202