Clinician Perspectives On Fistula Mental Health, Victoria K. Leonard

Doctoral Dissertations

Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and …

Fostering Interprofessional Collaboration In Community College Mental Health Centers: A Quality Improvement Project, Sara Jane Hamilton

Doctor of Nursing Practice (DNP) Projects

Background The worsening mental health rates among college students in the United States highlight the critical need for campuses to have high-quality comprehensive mental health centers (MHC). This necessity is particularly urgent in community college MHCs, which often lack these attributes. Local Problem An MHC within a large California community college recently introduced telepsychiatry services and is considering integrating a Psychiatric Mental Health Nurse Practitioner (PMHNP) into their team. However, knowledge gaps and limited interprofessional education (IPE) may hinder effective collaboration within the team. Methods A comprehensive literature review was conducted to assess current research on IPE, community college mental …

A Quality Improvement Project On Anxiety Management Before Ketamine-Assisted Psychotherapy, Kiera Paulo

Doctor of Nursing Practice (DNP) Projects

Background: This Quality Improvement project sought to determine if a brief progressive muscle relaxation (PMR) session could decrease patient anxiety before receiving intramuscular (IM) injections for ketamine-assisted therapy. Problem: The Kerstin Helgason, NP clinic does ketamine-assisted therapy, and many patients express anxiety beforehand, either due to a fear of needles or nerves surrounding the medication treatment. Intervention: This project implemented a brief progressive muscle relaxation therapy for patients with anxiety before receiving their IM injection. Measures: The patient’s anxiety levels were measured before and after the PMR therapy using a five-point Likert scale ranging from none to very severe. Results: …

Experiences Of Black American Millennials: A Qualitative Study Of Internalized And Externalized Coping In The Face Of Racial Trauma, Natalia Angelique Giles

Doctoral Dissertations

The experiences Black Americans have faced when standing against racial trauma have impacted the Black community for generations. Though previous generations faced overt styles of racism throughout the eras of slavery and Jim Crow, the invalidation and discrimination have remained consistent within the experiences of the Black American millennial (BAM) generation. Current experiences BAMs face are a combination of both overt and covert styles of racism, which increase mental exhaustion, reduce motivation, and leave the individual psychologically defenseless. The purpose of this qualitative study was to examine the experiences of BAMs in the face of racial trauma. This qualitative research …

The Impact Of High Temperatures On Child Anthropometric Outcomes Worldwide, Natalia A. Cancino Garcia

Master's Theses

High temperatures caused by climate change significantly impact society, including child nutrition. Our research focuses on the impact of high temperatures on the anthropometric outcomes of children aged 1 to 5 in 54 countries worldwide. We analyze the historical climate and anthropometric data to evaluate the effect of high temperature on weight-for-age (WAZ) and weight-for-height (WHZ) in children. Results indicate that high temperatures negatively affect child nutrition, particularly in areas above 20°C, and children in rural areas are more vulnerable. The impact of monthly temperature on child anthropometric outcomes varies across countries, regions, and cultural practices. Economic status alone is …

Community Health Worker Program: Chronic Non-Communicable Diseases In Children, Julia L. Newell

DNP Qualifying Manuscripts

Abstract

Background: Childhood obesity, asthma, and untreated mental health conditions, are three examples of chronic non-communicable diseases (CNDs) that pose a host of negative consequences later in life. Community health workers (CHWs) are in a unique position to address these negative health externalities by leveraging linguistic, cultural, and socioemotional connectedness within their communities.

Local Problem: Minority children in the Central Valley of California, face additional risk factors for the development of CNDs. CHWs working in this area require enhanced training on CNDs to improve their practice.

Methods: In partnership with Save the Children (STC), the University of San Francisco (USF) …

Mental Health And Experiences Of Pregnancy Among Black Women And Birthing People With Type 1 Diabetes (T1d), Madeleine E. Marcus

Doctoral Dissertations

This dissertation explored the potential effects of intersections of oppression (i.e., anti-Black racism, diabetes discrimination, and sexism) on mental health and pregnancy experiences among Black women and birthing people with Type 1 diabetes (T1D). Previous studies about pregnancy and T1D have included mainly white, cisgender women. Three participants qualified for inclusion in the present study and participated in semi-structured interviews, which the researcher analyzed using an interpretative phenomenological analysis (IPA) framework. Participants described feeling uncertain about whether aspects of their pregnancy experiences were related to obstetric and/or medical racism. Similarly, participants sometimes seemed uncertain about how racism may affect their …

Improving Minors' Access To Treatment For Opioid Use Disorder: A Policy Analysis, Sara Jane Hamilton

Master's Projects and Capstones

As the opioid epidemic continues to have devastating effects on our communities, medications to treat opioid use disorder (MOUDs) are severely underutilized especially for adolescents. Unlike adults, minors need parental approval before obtaining MOUDs presenting a key barrier to timely treatment. Being able to treat adolescents as soon as they are ready is critically important for people with OUD, and while cost and other barriers have been addressed in the literature, there is a paucity on how parental consent affects the accessibility of treatment. This paper aims to explore a potential policy in California that addresses the lack of access …

Meet Me In The Middle: A Scoping Review On Understanding Adolescent Needs In Climate Communication, Gwendolyn Monica Hoff Anderson

Master's Projects and Capstones

The greatest effects of climate change are likely to be felt by youth. Young people are disproportionately affected by climate change due to their critical developmental stage and lack of power, and they experience both higher severity and prevalence of mental health issues related to climate change. Strong emotions have long been recognized as potential catalysts for action, or they may lead to paralyzing feelings of being overwhelmed. Climate communication is a critical tool to spark climate concern and encourage action. Activism, in turn, may help youth manage their anxiety about climate change. This scoping review examines emerging evidence on …

Burnout: An Examination Of How Human Services’ Cultures Impact Person-Centered Care And Job Satisfaction, Ebony Webb

Master's Projects and Capstones

In a world that demands the constant requirement of adaptability and technology, the need for ‘hands on the ground’ continues to persist, and perhaps even grow. This research project explores burnout in the healthcare and nonprofit settings, as a pre-existing and ongoing issue, that was brought to centre-stage during the Covid-19 pandemic. The researcher explores the intersections of burnout with workplace culture, person-centered care (PCC), sweat equity and duty-of-care, through expert interviews and literature reviews. Data collected provides an immediate understanding of current workplace cultures and environments for human service providers, in both healthcare and nonprofit sectors. While the data …

Therapeutic Gardening For Addiction Recovery, Hugo A. Rivera Lopez

Master's Projects and Capstones

Problem: The use of evidence-based alternative forms of therapy like horticulture therapy and therapeutic gardening is underutilized in substance use recovery programs in the United States. As the country continues to struggle with addiction, it is important that recovery programs look to and incorporate these alternative therapies into official curricula. Currently, 46.3 million individuals living in the United States are living with a substance use disorder (U.S Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration, 2022).

Context: The intervention was implemented at an all-male substance use treatment facility in San Jose, CA that houses up …

Therapeutic Gardening For Mental Health In Substance Use Recovery, Stephanie E. Schafer

Master's Projects and Capstones

Abstract

As the clinical nurse leader (CNL) in this project, I used the “[CNL]

Essential 1: Background for Practice from Sciences and Humanities” (Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice, 2013) and its competencies to focus on designing nursing care for a clinical or community-focused population based on biopsychosocial, public health, nursing, and organizational sciences and to synthesize evidence for practice to determine appropriate application of interventions across diverse populations. With the help of the CNL competencies and collaboration with the healthcare team, we created and implemented a therapeutic garden for residents in a substance use …

Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson

Master's Projects and Capstones

First responders are at risk of developing mental health problems due to repeated exposure to traumatic incidents, increasing their chance of developing Post Traumatic Stress Disorder, substance abuse, suicidal ideation, and suicide. Unfortunately, first responders do not recognize that they may have a mental illness and are reluctant to seek help. This paper will discuss the prevalence of mental health problems among first responders and the barriers to their help-seeking. These barriers include the stigma around mental illness within the culture, the assessability of professional help, and the lack of mental health literacy regarding their well-being. Further discussion will focus …

Decreasing Restraint Use By Utilization Of Agitation Assessment And Verbal De-Escalation Strategies In An Inpatient Non-Psychiatric Hospital, Kiera Paulo

DNP Qualifying Manuscripts

Background: This paper reviews the literature on ways to decrease the use of restraints in hospitals – specifically the use of agitation assessments and verbal de-escalation to be implemented in healthcare facilities to decrease the number of restraints being used to manage undesirable patient behavior and workplace violence incidents. Problem: Restraints have been shown to impede the nurse-patient relationship and cause emotional and physical trauma to staff and patients. They are no longer considered preferred management and in some circumstances can be considered abuse. Intervention: Agitation assessments and verbal de-escalation have been shown to produce less aggressive behavior and decrease …

Clinicians' Perspectives On The Effectiveness Of Trauma - Focused Cognitive Behavioral Therapy With African American Children: A Qualitative Study, Jada Carter

Doctoral Dissertations

Literature exploring clinicians' perspectives on the effectiveness of trauma-focused cognitive behavioral therapy with African American children who suffer from trauma-related disorders is very limited. The current study examined clinicians' perspectives on the TF-CBT model when utilized with this population, including their experiences working with African American children and families with observable types of trauma-related disorders. This research study also explored the various facets of trauma that African Americans encounter in childhood and the barriers that prevent them from receiving adequate mental health care. Thematic analysis was utilized to explore themes that emerged when treating African American children with TF-CBT. Five …

Standardizing Perinatal Mental Health Interventions: A Guide For The U.S., Maile Lauren Robles

Master's Projects and Capstones

The term perinatal individual refers to women and other individuals who are pregnant or who have been pregnant within the last 12 months. Every year, in the United States there are 700 pregnancy-related deaths and 10% are due to mental health causes including death by suicide. Mental health conditions including but not limited to anxiety, depression, substance use disorders, and post-traumatic stress disorder affect one in five perinatal individuals throughout the United States. This increases perinatal morbidity, hospitalization costs, and economic burden nationwide.

After 43 days postpartum, mental health conditions are the second leading cause of death. The United States …

Illegal Homeless Encampments In California: Using The Com-B Framework To Transform A Public Health Nuisance Into A New Housing Development Model, Desiree E. Orozco

Master's Projects and Capstones

California has the highest homeless population, with over 161,000 people experiencing homelessness. Despite approving a billion dollars in grants for the 2018-2019 budget, The 2021 Annual Homeless Assessment Report (AHAR) to Congress revealed California had an increase of over 3,500 individuals staying in shelters between 2020-2021. The multi-faceted and multi-dimensional issues of homelessness and policies make it difficult to prevent individuals experiencing homelessness from living in illegal encampments. Therefore, the author proposes a multi-prong approach to homelessness in California grounded in theories of the Socio-Ecological Model (SEM) and COM-B model and informed by housing first and permanent supportive housing practices. …

The Child Care Crisis: Through The Social Ecological Lens, Jocelyne Saldana

Master's Projects and Capstones

Abstract

Objective - Working mothers face mental strain when returning to work due to the challenges of the current child care system. It is unclear how the instability of the child care sector impacts the mental health of working mothers.

Methods - The systematic review of literature was conducted to identify existing evidence to determine the influence access to quality, dependable, and affordable child care has on maternal mental health outcomes in working mothers. Multiple databases were used including PubMed and Scopus.

Results - Subsidized programs help reduce the cost of child care, however, income eligibility criteria makes it difficult …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Ask Your Doctor About: Prescribing Activism For Eco-Anxiety In Adolescents, Lexi Nutkiewicz

Master's Projects and Capstones

Climate change is an ongoing public health crisis. Efforts to protect future generations' physical and mental health are more urgent than ever. Youth, in particular, are experiencing eco-anxiety, a specific form of anxiety relating to stress or distress caused by environmental changes and one’s knowledge of them due to the climate crisis. This scoping review provides a better understanding of the value of youth climate change activism as a strategy to mitigate eco-anxiety. This review evaluates the current definitions of eco-anxiety, the risk factors for eco-anxiety among adolescents, and considers the benefits and drawbacks of youth activism. To identify relevant …

Using Machine Learning To Analyze Children’S Drawings As Indicators Of Mental Well-Being, Nicholas R. Lawrie

Master's Theses

Human figure drawings are a well-studied diagnostic tool for emotional distress in children. Cleft lip/palate is one of the most common birth defects in the world, and has been shown to negatively impact emotional well-being in childhood which can have negative economic consequences in adulthood. Utilizing a dataset of human figure drawings from children in India and survey data on mental health, this paper will assess the impact of corrective surgery on mental health outcomes, as well as assess the validity of the drawing emotional indicators themselves. The results indicate that while the emotional indicators may not be valid in …

Development And Implementation Of A Standardized Protocol For Nurse Practitioners Working In An Aud Treatment Telehealth Program, Cj Dea

Doctor of Nursing Practice (DNP) Projects

Background

Alcohol Use Disorder (AUD) is a major public health concern in the United States. Ria Health is a growing telehealth provider delivering AUD treatment through pharmacotherapy combined with behavioral health counseling.

Local Problem

Ria Health employs six California licensed nurse practitioners, but two of them have not yet met all the California provisions to practice independently without protocols. Ria Health has not put any standardized protocols in place.

Methods

This DNP project involved the creation of an evidence-based standardized protocol for AUD. The Student Satisfaction and Self-Confidence in Learning questionnaire was disseminated to participating nurse practitioners to measure student …

Implementation Of Community Health Workers To Improve Birth Outcomes, Emiko Maruri, Trinette Radasa, Jo Loomis

DNP Qualifying Manuscripts

Those who have ever been affected by an adverse childhood experience (ACE) have a greater likelihood of having poor birth outcomes. These include low infant birth weight, preterm delivery and can even lead to pregnancy loss. Black and Latina women have been identified by the Center’s for Disease Control (CDC) as those most affected by ACEs. The direct relationship is that Black and Latinas therefore have poor birth outcomes. With the implementation of nurse trained Community Health Workers (CHWs), the impacts within the community includes decreasing health care costs, adopting healthier choices for mother and child, and providing support and …

A New Narrative: Freeing Pediatricians From A Single Story, Tanya Scott, Tanya Scott

DNP Qualifying Manuscripts

An adolescent pediatric patient who presents with psychiatric and medical conditions is subject to a pediatrician's diagnostic acuity, experience with pediatric psych patients, and existing constraints on providing an appropriate course of care. Too often, the psychiatric DRG becomes the pediatrician's single story of the patient, accompanied by subtexts of aggressive behavior, and the pediatrician's own biases about psychiatric patients. The novelist Chimamanda Adichie warns of the dangers of a single story. As a child in Nigeria, Adiche devoured stories. The children were fair-skinned and blue-eyed in the books available to her. As Adiche began to write her own stories, …

Translatina Immigrant Mental Health Wellness: Suggestive Intervention Strategies The City Of San Francisco Should Consider Adopting, Valeria Vera

Master's Theses

Translatina immigrants in the United States often suffer from intersectional traumas due to their race, gender, sexual orientation, religion, and immigration status — putting them in a vulnerable position socially, psychologically, economically, and medically. Due to their positionality in the intersections of migration, criminalization, cissexism, and mental health, they are often more marginalized and have greater needs than communities with privileged sociocultural identities. As a particularly vulnerable group, they need guaranteed access to gender-affirming healthcare that is inclusive of mental health services. Despite Translatinas’ need for mental health services, there exist many barriers making services inaccessible and insufficient in San …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Implementation Of A Mental Health Environmental Risk Assessment Tool, Alan Le

Doctor of Nursing Practice (DNP) Projects

Background: Patient suicide is a serious safety issue, especially in mental health settings since suicides disproportionately affect psychiatric patients. Environmental hazards are a primary contributing factor in patient suicide cases.

Problem: Mental health staff may lack tools and training to perform proper environmental risk assessments, which is the case at a psychiatric crisis residential center in northern California that utilized no environmental risk assessment tool.

Methods: An environmental risk assessment tool was implemented at the site for four months to increase staff confidence, ability to identify hazards and decrease risk of patient suicides.

Interventions: The Suicide and …

Designing And Implementing A De-Escalation Toolkit To Improve Staff Education And Competency On De-Escalation Within A Mental Health Outpatient Setting, Balraj Bajwa

Doctor of Nursing Practice (DNP) Projects

Background: The purpose of this study is to develop and implement a de-escalation toolkit to help improve memory, retention, and utility of de-escalation techniques within an outpatient mental health crisis stabilization unit.

Problem: The aforementioned crisis stabilization unit has elevated rates of patient aggression/violence and staff present with difficulty recalling de-escalation techniques due to the lapse in memory and/or retention.

Methods: The project was introduced to the stakeholders of the crisis stabilization unit and input was obtained on the design and components of the toolkit. Various analyses were conducted to ensure the appropriate implementation of the project.

Intervention: A de-escalation …

Bullying In The C-Suite: A Nurse Leader Perspective, Kimberly Ann Colonnelli

Doctor of Nursing Practice (DNP) Projects

An estimated 35% of American workers have experienced bullying, and in 80% of those situations, the perpetrator was a supervisor or boss. 1 However, the reality is that bullying can come from anyone in the workplace, including subordinates. Victims are generally well liked and good performers, making them feel like threats to a bully’s power base. Bullying, unlike harassment, is not a legally defined behavior, so no laws currently exist to punish it. Victims are, therefore, at the mercy of their bosses, supervisors, co-workers, and human resource departments for protection or relief. Bullying is not a singular event, but rather …

Utilizing Digital Technology To Address Loneliness And Isolation In Older Adults Through A Community-Based Connection Model: Responding To A Pandemic, Melissa A. Nagel

Doctor of Nursing Practice (DNP) Projects

Problem: Loneliness and social isolation, both of which can have serious detrimental effects on health and well-being, have become more prevalent during the recent COVID-19 pandemic, particularly in the older adult population. During part of the past year, older adults were strongly encouraged to follow strict quarantine measures because of their vulnerability to the virus. This forced isolation exacerbated the already existing issue of loneliness and social isolation in this population.

Interventions: Older adults who are members of a local non-profit community organization, focused on increasing independence and social vitality, were invited to participate in a virtual, interactive social engagement …