Medicine and Health Sciences Commons^™

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 …

Navigating Insulin Access For Pediatric Type 1 Diabetes: Caregivers' Experiences And Challenges, Ella Anderson

Doctoral Dissertations

Between 2012 and 2018, the annual 14% increase in insulin prices made Type 1 Diabetes (T1D) the most expensive chronic health condition, significantly raising out-of-pocket costs for uninsured or underinsured individuals in the United States (Hayes & Farmer, 2020; Willner et al., 2020). This study utilized a qualitative content analysis methodology to explore the challenges and experiences of parents with children diagnosed with T1D with accessing insulin for their child. Five participants from various areas of the United States responded to open-ended questions both in person and via Zoom. The analysis revealed three main themes: pragmatics of managing diabetic care, …

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 …

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 …

The Grindr Complex: The Behavioral Health Impact Of Sexual Racism On Latinx Men Who Have Sex With Men, Luisalfredo Plascencia

Doctoral Dissertations

Given the social history surrounding the issue of HIV/AIDS in the LGBTQ+ community and the unique and intersectional experiences that Latinx Men who have Sex Men (MSM) have in their community, this dissertation’s research will contribute to the growing work on sexual racism and how it correlates with various elements of behavioral health. The study investigated the moderation impact of Latinx cultural values of caballerismo and familismo on the relationship between experiences sexual racism to mental health symptoms. The study also examined the moderation of caballerismo and familismo and psychological flexibility on the relationship between experiences of sexual racism to …

Identity Formation And Role Expansion For Nurse Practitioner Residency Preceptors: A Qualitative Thematic Analysis, Angel Chen Kuo

Doctoral Dissertations

Employer-based nurse practitioner residency programs have been implemented to address the significant shortage of primary care providers in the community clinic settings. However, there continues to be a shortage of clinicians who serve as preceptors to nurse practitioner residents and students. Preceptors, also referred to as clinician educators, are essential in the training of learners and their socialization into the profession. Just as there is a shortage of clinicians of diverse backgrounds to reflect the population served in the community, there is also a significant shortage of preceptors of color to train learners from diverse backgrounds. The purpose of this …

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 …

The Use Of Simulation With The School Of Nursing And Health Professions (Sonhp) Prelicensure Students To Support Affirming Practice With Transgender Communities, Genevieve Charbonneau

Doctoral Dissertations

This dissertation investigates how prelicensure nursing students are prepared to address healthcare disparities with transgender patients, specifically through simulation scenarios at the University of San Francisco School of Nursing and Health Professions Simulation Center.

A critical review of current literature reveals how microaggressions against transgender communities create and sustain barriers to equitable healthcare. The qualitative study was designed to explore the lived experience of prelicensure nursing students who are actively seeking to understand the healthcare needs of transgender patients in the San Francisco Bay Area.

This was a qualitative research study including data that suggests that using simulation scenarios featuring …

Community Based Participatory Research Informed Manualization And Piloting Of E-Training Of A Modified Dialectical Behavior Therapy Intervention, Annika M. Miyamoto

Doctoral Dissertations

This study explores the efficacy of delivering modified dialectical behavior therapy (m-DBT) to direct support staff who work with seriously mentally ill patients with neurocognitive deficits using remote web-based technology. The partnering facility for this study is a residential skilled-nursing facility that provides 24-hour care to individuals under conservatorship. Using a previously piloted m-DBT protocol, qualitative feedback was gathered from four participants with background training in psychology and varying experiences with DBT. All participants had direct knowledge of the treatment environment and experience working with the patient population. Gathered feedback was used to revise the m-DBT protocol to be used …

Patient Reported Outcomes In Sickle Cell Disease Examined Within A Conceptual Model, Swapandeep Mushiana, Marsha Treadwell Phd, Sherif M. Badawy Md, Ms, Liliana Preiss Phd, Allison King Md Mph Phd, Barbara Kroner Phd, Yumie Chen Bs, Jeffrey Glassberg, Victor Gordeuk Md, Nirmish Shah Md, Angie Snyder Phd Mph, Theodore Wun Md

Doctoral Dissertations

Objective: To examine the relations between patient reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD related factors and barriers to care would independently contribute to functioning as measured using the PRO domains. Additionally, pain and other SCD related complications are expected to impact the relation between the variables. Methods: Participants completed a 48-item survey that included socio-demographics and PRO measures, such as social functioning, pain impact emotional distress, and cognitive functioning. …

Mental Health Outcomes Of Various Types Of Fear Among University Students Who Have An Undocumented Legal Status During The Donald Trump Presidency, Liliana Campos

Doctoral Dissertations

Having an undocumented legal status is a risk factor for mental health conditions such as depression and anxiety among university students. Much of the literature on the experiences of university students who hold an undocumented legal status has primarily focused on better understanding the educational, social, financial, and legal challenges among undergraduate students. The literature has addressed how some of these difficulties impact components of their social and mental health wellness. Yet, there is still a dearth of research focused on further understanding the experiences of students who hold an undocumented legal status from a psychological perspective, and specifically, with …

The Use Of Mindfulness Meditation To Increase The Efficacy Of Mirror Visual Feedback For Reducing Phantom Limb Pain In Amputees, Nicolas Sebastian Mills

Doctoral Dissertations

Phantom limb pain is a chronic pain condition that negatively impacts the lives of over half of amputees, and results in considerable morbidity. Currently, there is no gold standard for treatment for phantom limb pain. However, a frequently used intervention is the use of mirror visual feedback, in which the amputee watches the reflection of the adjacent non-amputated limb move and exercise. In the last few decades, mindfulness-based interventions have been increasingly used with individuals living with different types of chronic pain. This study attempts to discover if the addition of a mindfulness-based intervention, such as guided meditation, will augment …

Clinical Work With Adult Male Incest Survivors: Therapeutic Themes And Perspectives, Kathryn B. Rosenberg

Doctoral Dissertations

For psychotherapists, encountering clients who have experienced sexual trauma or abuse is inevitable, whether or not the abuse is disclosed to the therapist; however, mental health professionals receive extremely limited (if any) training on how to identify or effectively support adult clients who are survivors of childhood sexual abuse (CSA). Many people who experienced CSA, especially those who identify as male, remain isolated and invisible in their suffering as adults even within therapeutic spaces, facing what feel like insurmountable barriers – both internal and external – to getting help. When sexual abuse is intrafamilial, these barriers are both amplified and …

Identity Development In Transgender Women Of Color: An Interpretative Phenomenological Analysis, Angel Tseng

Doctoral Dissertations

Transgender women of color have been at the forefront of LGBT rights moments in the U.S. and has been credited for leading the Stonewall resistance (Roberts, 2018). Though much has changed since Stonewall, transgender women of color still face harassment, discrimination, and many other barriers and health risks today. One of the many challenges faced by transgender women of color is identity conflict. The purpose of the study was to examine the identity development processes of transgender women of color. This qualitative research study utilized Interpretative Phenomenological Analysis to explore the lived experiences and narratives of individuals from this community …

Black Women Surviving Sexual Trauma: The Cultural Components Used To Aid Recovery, Charrin Kimble

Doctoral Dissertations

The physical and psychological impacts women face as a result of sexual trauma has been researched extensively. While sexual trauma affects all women, far less attention has been given to cultural impacts on Black female survivors. Black women have unique experiences with sexual trauma due to the intersection of racism and sexism. Given the sociohistorical context of Black women and sexual trauma, research is needed to understand how cultural factors may aid the recovery process of Black women. This qualitative study examined the lived experiences of Black women who survived sexual trauma to understand the role cultural factors may have …

Efficacy Of Integrated Mental Health Care With Dual Diagnosis Patients And Their Utilization Of Psychiatric Emergency Services, Denton Scott

Doctoral Dissertations

Historically, patients with dual diagnosis have been subjected to ineffective treatment and negative attitudes from healthcare providers. Further, these patients are plagued with myriad afflictions that exist beyond substance abuse and mental illness. The treatments and collateral damage associated with the diagnosis impose excessive healthcare costs and can be of significant detriment to society. Largely, patients suffering from dual diagnosis do not receive adequate treatment. As such, psychiatric emergency services are frequently utilized as an alternate treatment, wherein the main focus of care is on the substance abuse alone. This study argues that solely treating the substance abuse is not …

Evaluating The Effectiveness Of Peer Engagement And Knowledge (Peak): A Community-Based Group Intervention For Youth In Hawai‘I, Jennifer T. T. Ho

Doctoral Dissertations

This study is a program evaluation with a mixed methods design that evaluated the effectiveness of Peer Engagement and Knowledge (PEAK), a six-week community-based group intervention that incorporates mindfulness-based interventions (MBIs) to address multiple health behaviors for multiracial youth in Hilo, Hawai‘i. A total of 51 youth, ages 12-23 years old, participated in this study which included pre-/posttest analyses of health risk factors such as substance use and depression and health promoting factors such as resilience, self-esteem, and mindfulness. Responses from two subsets of participants, who engaged in a focus group (n = 11) and composed gratitude letters ( …

The Role Of Stigma On Mental Health Service-Seeking Among Armenian-American Men, Anthony Saroyan

Doctoral Dissertations

This study examined the role of stigma on mental health service-seeking among Armenian-American men who self-identified as having lived through or currently are living with a mental health issue. This qualitative study utilized interpretive phenomenological analysis to ensure that the lived experiences of Armenian-American men are represented through their perspective. A total of six participants engaged in this study. All participants self-identified as male and as having experienced a mental health issue, have utilized mental health services at least once in their lifetime, resided in the San Francisco Bay Area, and as being of Armenian descent. Through exploring the lived …

Compassion Fatigue Among Mental Healthcare Providers And The Impact On Overall Wellbeing, Ruchi Patel

Doctoral Dissertations

Compassion, a virtue of the helping profession, can be jeopardized by a provider’s continuous exposure to the trauma experiences of others. The impact of burnout, secondary stress and compassion fatigue on a mental healthcare provider’s work and personal life has been increasingly studied due to negative ramifications on our community healers. The present study used a cross-sectional design to survey mental healthcare providers across specialty and discipline in efforts to gain a better understanding of the relationship between a provider’s degree of compassion fatigue and specific demographic variables, physical health and their spirituality. One hundred and thirty-seven participants across the …

A Program Evaluation Of A Drug And Alcohol Family Treatment Program, Katrina Ramirez

Doctoral Dissertations

The current study is a program evaluation at John Muir Behavioral Health, Center for Recovery. The research determined the effectiveness of the program at Center for Recovery that is offered to patients that struggle with substance use disorder and their families. The purpose of this study is to assess patients’ behavioral, cognitive and social/environmental factors as it relates to their commitment to sobriety and examine how the involvement of family members influences the patient’s recovery process. I utilized a mixed methodology of quantitative and qualitative interviews of patients and family members. The findings suggest depressive symptoms were negatively correlated with …

The Impact Of Depressive Symptoms On Cognitive Decline And Risk For Dementia, Katheryn Conde

Doctoral Dissertations

As of 2011, the life expectancy for Latinos in the U.S. was 81.6 years, which is higher compared to non-Hispanic Blacks (75.3 years), non-Hispanic Whites (79 years), and Hispanic Black populations (74.9 years; Arias, 2011; Arias, 2015). Latinos have higher age specific prevalence of dementia, which is higher than African Americans and non-Hispanic Whites (Gurland et al.,1999). Latinos experience Alzheimers disease symptoms 6.8 years earlier, with the average onset of 67.6 years which is younger than non-Hispanic Whites (73.1 years; Clark et al., 2005). Furthermore, older Latinos tend to experience depression at a rate of 13% and 35% with the …

There Is A Monster In My House, Cultura Cura Uncovering 11 Milliones De Sueños: Understanding The Emotional And Psychological Experiences Of Undocumented And Mixed-Status Youth And Finding Healing Spaces, Belinda Marie Hernandez-Arriaga

Doctoral Dissertations

This research gives voice to the emotional experiences of mixed-status and undocumented youth, and explores the Mexican cultural arts as a healing space for this community of children. This research expands our mental health understanding of undocumented and mixed status children, capturing the undocu-trauma these participants describe in narrating the chronic fear they live with. Their stories speak to the monster of fear, la migra, witches in the field, Trump, racism, societal violence and trauma that is invisible in their home but alive in their daily lives. The participants in this study narrate the power of the cultural arts to …

Workplace Violence, Organizational Culture, And Registered Nurses' Incident Reporting Patterns In Acute Hospitals In California, Feodora Jacobsen

Doctoral Dissertations

The purpose of this study was to increase understanding of the reporting patterns of WPV Type II in acute hospital settings. Although some patients are abusive toward nurses, that the abuse is underreported to hospital administrators. Qualitative studies identified common themes for underreporting including fear of being blamed, abuse considered part of the job, and not having sufficient time to fill out a formal report. This study is the first quantitative study to explore the changes in mean scores of organizational-culture factors under two mutually exclusive conditions: registered nurses (RNs) who do not report hospital incidents and RNs who do …

Implementation And Strategies To Address Sensory Regulation Of Students With And Without Disabilities In Two Kindergarten Classrooms, Yvette Rosil Mere-Cook

Doctoral Dissertations

Results from previous research studies suggest that inclusive settings benefit all learners. However, general education teachers often do not have built in supports within the classroom to meet the needs of students with disabilities. Implementing a sensory diet curriculum (SDC) is one instructional practice that addresses needs of students with disabilities, such as autism spectrum disorder, and could be applied widely for students without disabilities. Sensory regulation is defined as the body’s physiological process of adapting arousal or alertness levels to cope with sensory events and situational demands that occur throughout the day. The purpose of this study was to …

Effects Of A Mental-Health Clinical Simulation Experience Using Standardized Patients And Two Debriefing Styles On Prelicensure Nursing Students' Knowledge, Anxiety, And Therapeutic Communication And Psychiatric Assessment Skills, Debrayh Gaylle

Doctoral Dissertations

The purpose of this quasi-experimental pretest-posttest study was to compare the effects of two debriefing styles (insimulation and postsimulation) on (a) students’ knowledge of psychiatric assessment and therapeutic communication, (b) students’ performance of a psychiatric assessment using therapeutic communication, (c) students’ perceived anxiety related to a clinical rotation in psychiatric mental-health, and (d) students’ perceptions of the efficacy of the insimulation debriefing. The participants (n = 67) were senior, prelicensure nursing students enrolled in a baccalaureate degree program. Students were assigned randomly to either the treatment or the compression group and participated in a series of simulated interviews using student …

The Effect Of Simulation With Debriefing For Meaningful Learning In Courses Of Nursing Theory And Practicum On Student Knowledge And Perception Of Instruction, Kathleen L. Shea

Doctoral Dissertations

Nursing students are expected to apply knowledge from lectures and laboratories to the clinical setting. One major challenge of nursing educators is facilitating the transfer of knowledge to the clinical-practice setting. Simulation-based education provides students with an experiential-learning activity within the context of a simulated clinical environment. Following the simulation activity, the instructor facilitates a debriefing session and guides student discussion and reflection related to the experience. Debriefing promotes understanding of nursing concepts (Benner, Sutphen, Leonard, & Day, 2010).

The purpose of this research is to compare two debriefing methods: traditional method and Debriefing for Meaningful Learning DML (Dreifuerst, 2012). …

Growing Up With Hiv In Kisumu, Kenya: Participatory Action Research With Young People Living With Hiv, Zoe Alexis Hobbs Marinkovich

Doctoral Dissertations

Forty-one percent of new HIV infections are in young people between the ages of 15-24 (Masquillier, et al., 2012). In addition to new infections, advances in medications are now making it possible for children born with HIV to survive into adolescence and adulthood (Bland, 2011; Gray, 2010). Due to the growing population of youth living with HIV, there is an increased need for adolescent-appropriate care and intervention. While many studies have examined the role of education in preventing HIV transmission for HIV-negative youth in the Sub-Saharan context, few have focused on the education and experiences of young people living with …

First-Year Male Students' Adherence To Traditional Male Gender Roles And Their Attitudes Toward Bystander Approach Behaviors To Stop Sexual Assault, Kamal M. Harb

Doctoral Dissertations

Sexual assault on university campuses may affect any person at any time. However, university-aged women are disproportionally affected by it, with 25% of women reporting being assaulted on campus, and 84% to 97.8% of them perpetrated by young, heterosexual men known to the victim. To curb sexual assault on the university campus, research studies have advocated for the bystander approach. It encourages bystanders (observers) to intervene and ultimately stop a potentially dangerous situation in which a friend or stranger may experience a sexual assault. Despite its popularity, research studies evaluating the bystander approach have reported, at best, modest success with …

Exploring The Experiences Of Latina/Os In Graduate Health Science Programs: A Qualitative Study, Mijiza Malane Sanchez

Doctoral Dissertations

This qualitative study conducted at a Northern California university explored how six Latino/a health science professionals navigated their academic trajectory. The six participants identify as Latino/a and shared their journeys to the health sciences. This study examined how participants utilized their community cultural wealth to navigate the complexities of campus climate during their pursuit of a graduate or professional degree in the health sciences. Research data included narratives from in-depth interviews with the six participants and a focus group.

The key findings of this study illustrate the profound significance of mentorship in the pursuit of health science careers. This study …

A Comparison Of Two Teaching Methods For Pediatric Medication Administration: Multimedia And Text-Based Modules, Renee Granados

Doctoral Dissertations

A Comparison of Two Teaching Methods for Pediatrics: Multimedia and Text-based Modules to Teach Pediatric Medication Administration

Nurse educators are in a position to design and develop effective methods that consider the cognitive structures and how the mind processes information to teach pediatric medication content to nursing students. The majority of methods teaching medication administration use only one mode: the visual mode. One mode to present leaning material does not take advantage of the additive effects of using two modes to present learning material.

The purpose of the study was to compare the effectiveness of two teaching methods to present …