Digital Commons Network^™

Improving Transition To Adult Care: Assessing Health Insurance Literacy In Adolescent Patients With Congenital Heart Disease, Kaitlyn V. Mudge

Doctor of Nursing Practice Final Manuscripts

Background: With advances in surgery and medical management, 95% of children with congenital heart disease (CHD) survive into adulthood. Transition to adult care is an intricate process. Up to 60% of adolescents fail to follow through with cardiology care, facing three times the risk of needing emergency services. Only 25% of young adults with CHD knew of the need to change their care to an adult provider and to acquire health insurance as an adult. One barrier to successful transition is a lack of insurance coverage and limited insurance health literacy. Higher insurance literacy is associated with increased utilization …

Narrative Roots - What We Inherit, What We Tell, What We Become: Intergenerational Storytelling, Meaning-Making, And Mental Health, Adam Sholder

Critical and Creative Thinking Capstones Collection

This capstone synthesis explores how the family stories we inherit and the stories we tell across generations shape who we become, with particular attention to their impact on identity and mental health. Drawing on narrative identity theory, reflective practice, and relational understandings of family life, it introduces the Recursive Narrative Integration Model, which positions intergenerational storytelling as both a method of inquiry and a mechanism of meaning-making. Informed by a recursive process of creative and reflective writing, this synthesis approaches storytelling not only as an object of study, but as a lived and generative practice through which experience and narrative …

Trends Of Pediatric Psychotropic Polypharmacy In Massachusetts Before And During The Covid-19 Pandemic, Gianna D'Ambrozio

Graduate Doctoral Dissertations

Youth in the U.S. and internationally are increasingly being diagnosed with depression and related psychiatric conditions (Murthy, 2021) many of whom are being subjected to non-evidence-based, or what has been termed irrational, psychotropic polypharmacy (Barnett & Concepcion Zayas, 2019). Psychotropic polypharmacy can be defined as “the use of 2 or more psychiatric medications in the same patient,” (Zito et al., 2021) though definitions can vary. Using data from the Center for Health Information Analysis’ Massachusetts All-Payer Claims Database, this study examined the sociodemographic factors associated with high rates of polypharmacy, a hypothesized increase in pediatric psychotropic polypharmacy rates in Massachusetts …

Enhancing Physiological Complexity Through Mindfulness: A Wearable-Based Intervention For First Responders And Their Partners, Thurmon Lockhart, Rahul Soangra, Christopher W. Frames, Sun-Kyung Lee, Amberlee Martin, Susanne Lee, Abigail H. Gewirtz

Physical Therapy Faculty Articles and Research

Background/Objectives: First responders frequently encounter high-stress environments that challenge physiological resilience and autonomic regulation. Heart rate variability (HRV) complexity is a critical marker of adaptive capacity and stress regulation. This study assessed the impact of a wearable-based mindfulness intervention on HRV complexity among first responders using a smartwatch. Methods: A total of 87 first responders participated in a one-month wearable-based intervention. Participants wore Garmin Vivosmart 5 devices to continuously collect PPG data (photoplethysmogram), focusing on beat-to-beat intervals (BBIs). The intervention involved daily Ecological Momentary Assessments (EMAs) and individual randomization to either a mindfulness message, a prompt to access an audio …

Perinatal Mental Health Screening And Care Among Those With Pregnancy Complications, Alison N Goulding, Terri L Fletcher, Emily S Miller

Faculty, Staff and Students Publications

Perinatal mental health conditions are common and, without effective treatment, can contribute to adverse maternal and child outcomes. In the United States, mental health conditions are a leading cause of maternal morbidity and mortality, contributing to over 20% of pregnancy-related deaths. This expert review aims to assess current literature and provide recommendations regarding mental health care in high-risk patients who experience pregnancy complications. Individuals experiencing pregnancy complications are at increased risk for perinatal mental health conditions, including depression, anxiety, and post-traumatic stress disorder, as compared to those with uncomplicated pregnancies. Despite this increased disease burden, there is limited research on …

A Literature Review Of Burnout And Associated Tools In Residency Programs, Foluso Obisanya, Fatima Mncube-Barnes, Kudiratu A. Proctor, Charles A. Mcdaniel, Donna M. Alexander, Tyrece D. Hunter

Graduate Medical Education Research Journal

Background. Burnout poses considerable challenges in workplaces, particularly for resident physicians. This intricate phenomenon stems from a myriad of factors that include, but are not limited to, staff shortages, excessive workloads, specific job responsibilities, work environments, and individual psychological factors. The Accreditation Council for Graduate Medical Education encourages institutions to incorporate wellness as a fundamental component of residency training programs.

Methods. The aim of this review was to investigate burnout among resident physicians via a comprehensive literature review to elucidate this significant issue and identify potential preventative intervention strategies. We analyzed the issue of burnout across various residency specialties, providing …

The Importance Of Socialization: Family, School, Peer, And Media Influence On White Identity Development, Miandria Erickson

Honors Projects

This study aims to explore the different aspects of socialization that can impact one’s White racial identity development, in order to analyze why White individuals struggle to describe their racial identity. Acknowledging an individual’s White identity is an imperative aspect to understanding diversity and race, and yet, White individuals will often have difficulty recognizing and explaining their racial identity. This qualitative study used data collected from semi-structured interviews of 60 young White college participants (ages 18-25) in two different geographical locations, the Northwest and Southeast of the U.S.^[1] Several themes were extracted from these interviews, among them were family, …

A Call To Action: Towards A Compendium For Culturally Responsive And Inclusive Pain Management, Arvie Vitente, Rob Sweet, Lester Jones

Philippine Journal of Physical Therapy

Introduction: Pain is a pervasive global health problem, yet its assessment and management remain shaped by biomedical, monolingual, and culturally narrow assumptions that do not fully reflect the lived realities of diverse populations. Although contemporary pain science recognizes pain as a personal experience influenced by biological, psychological, and social factors, inequities persist across racial, ethnic, linguistic, and cultural groups.

Main Body: These inequities affect how pain is expressed, interpreted, documented, and treated, particularly among Indigenous peoples, migrants, refugees, and patients with limited English proficiency. In this perspective, we call for the development of a comprehensive compendium on culturally responsive and …

Can Behavioral Interventions Promote Health Equity In Pediatric Type 1 Diabetes? A Narrative Review Of Promising Treatments, Paul T. Enlow, Jaquelin Flores Garcia, Julia Price, Kristen A. Torres, David V. Wagner

Department of Pediatrics Faculty Papers

Purpose of review: Synthesize data on whether existing behavioral interventions can improve health equity among youth with type 1 diabetes.

Recent findings: While existing behavioral interventions demonstrated efficacy in improving health and/or psychosocial outcomes, evidence that these same interventions may improve health equity were lacking. Most interventions were evaluated using predominantly White and affluent samples and some studies did not report on racial, ethnic, or sociodemographic characteristics of their sample. Only a few interventions have been adapted for youth from minoritized backgrounds. Recent multisystemic and technology/mHealth interventions recruited samples that were sociodemographically representative of youth experiencing disparities, suggesting that these …

Navigating Trust: The Impact Of Social Media Influencers On Gen Z Health Behaviors, Abigail Stelling

Honors Thesis

Social media plays a defining role in the daily lives of Gen Z, influencing how people communicate, access information, and make decisions. More than a form of entertainment, social media is a powerful source that shapes identity, perceptions, and behaviors. As the first generation to grow up fully immersed in a digital world, Gen Z is uniquely impacted by the content and interactions that occur on social media platforms. Within this digital landscape, social media influencers have emerged as powerful figures. These individuals use large online platforms to promote lifestyles, products, and behaviors. Influencers often have the ability to shape …

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 …

Institutional Responses To The College Mental Health Crisis: A Critical Systems Review, Angel Huerta

The Scholarship Without Borders Journal

The mental health crisis among U.S. college students continues to escalate, exposing structural, cultural, and systemic failures within higher education. This review synthesizes evidence on institutional responses, drawing on Bronfenbrenner’s Ecological Systems Theory and Critical Theory, to examine how policies, faculty interactions, campus climate, and resource distribution influence student mental health outcomes. Findings reveal persistent gaps between policy intentions and practice, insufficient counseling capacity, inconsistency in faculty accountability, and inequities affecting marginalized student groups. The review highlights how organizational structures can unintentionally reinforce power imbalances and reproduce harm. Recommendations include system-level alignment of policies and practices, mandatory faculty training, enhanced …

When The Therapist Is An Algorithm: Understanding Autism Spectrum Students’ Acceptance Of Generative Ai As A Mental Well-Being Tool Through The Technological Acceptance Model, Jossy P. George, Peter Muttungal, Benny Jeyekumar Davidson, Nishi Priya

Northeast Journal of Complex Systems (NEJCS)

This study examines the psychological and technological factors of the acceptance and emotional well-being of 349 college students with autism who use generative artificial intelligence tools as sources of psychological and emotional support. Grounded on the model of Technology Acceptance Model (TAM), the research studies relationships among perceived empathy, perceived usefulness, ease of use, emotional trust, continuance intention, and overall well-being. Structural equation modelling found that the perceived empathy was a significant predictor of ease of use and usefulness, while emotional trust and continuance intention proved to be significant predictors of emotional well-being. To reinforce these results, predictive modelling performed …

Cognitive Predictors Of Functional Recovery After Traumatic Brain Injury, Disha A. Thakkar, Charles J. Golden

Archives of Assessment Psychology

This study examined whether the Brief Test of Adult Cognition by Telephone (BTACT), administered during acute rehabilitation, improved the prediction of 5-year functional outcomes after traumatic brain injury (TBI) beyond standard demographic and injury-severity variables. Data were obtained from the Traumatic Brain Injury Model Systems (TBIMS) National Database (N = 6,880; enrolled 2017 onward). Missing data were handled using multiple imputation (20 datasets). Hierarchical multiple regressions were conducted with the Functional Independence Measure (FIM) and the Glasgow Outcome Scale–Extended (GOS-E) as outcome measures. Demographics (age, sex, education, race) were entered in Block 1, injury severity indicators (post-traumatic amnesia [PTA] duration, …

Self-Esteem Development And Emotional And Behavioral Disorders, Bahaa Al Ghraibeh

Archives of Assessment Psychology

Self-esteem is a fundamental psychological construct that develops across the lifespan and influences academic, social, emotional, and behavioral functioning. Research consistently links healthy self-esteem with positive developmental outcomes, including improved educational achievement, stronger interpersonal relationships, and better mental health. At the same time, emotional and behavioral disorders (EBD) are associated with persistent emotional, behavioral, academic, and social difficulties that can interfere with healthy self-development. This paper reviews the developmental trajectory of self-esteem from early childhood through adulthood and examines how the experiences commonly associated with EBD may negatively affect that trajectory. The review discusses how children begin forming self-esteem at …

Prior Traumatic Brain Injury As A Predictor Of Cognitive Deficits After Moderate-To-Severe Injury, Disha A. Thakkar, Charles J. Golden

Archives of Assessment Psychology

Prior traumatic brain injuries (TBIs) are common among individuals who later sustain a moderate-to-severe TBI (msTBI), and cumulative injury models suggest repeated TBIs may worsen long-term cognitive outcomes. This study tested whether prior TBI history independently contributes to cognitive performance one year after an index msTBI beyond demographic and injury-severity factors. Data were drawn from the Traumatic Brain Injury Model Systems National Database (N = 6,880 enrolled since 2017). 2,773 participants completed the Brief Test of Adult Cognition by Telephone at one-year follow-up. Hierarchical regression models evaluated whether prior TBI history accounted for incremental variance in overall cognitive status and …

Assessing Impact Of Heat Waves On Pregnancy And Lactation Amidst Climate Change: A Scoping Review., Susan Anyango, Grace Nakate

School of Nursing & Midwifery, East Africa

Background: The escalation of heat waves, attributed to climate change, represents a global public health concern, with pregnant
and lactating women identified as particularly vulnerable due to Physiological and hormonal changes.

Aim: To review the existing research on the effects of heat waves on pregnancy and lactation, identifying potential health risks and outcomes.

Methods: A structured search across PubMed, Scopus, Web of Science, and Google Scholar was conducted using terms related
to heat waves, pregnancy, lactation, and climate change. Inclusion criteria focused on peer-reviewed empirical
studies in English.

Results: Heat waves are linked to increased risks of preterm labor, low …

Descriptive Qualitative Study Of Nursing Students' Perceptions And Behaviors During Student-Led Class Sessions In Uganda, Proscovia Nakaye, Veronica Nakkonde, Mercy Muwema, Grace Nakate

School of Nursing & Midwifery, East Africa

Introduction: Student-led class sessions are a pedagogical approach where students actively engage in the learning process, influencing content, activities, and pace. This method fosters independent learning, communication skills, and teamwork. While some studies have shown the effectiveness of student-led sessions, nursing students often exhibit challenges, such as inattention and negative attitudes, affecting the quality of learning and patient care. Understanding nursing students' perceptions and behaviors in this context is essential for improving nursing education.

Methods: This descriptive qualitative study aimed to explore nursing students' perceptions and behaviors during student-led class sessions at Uganda Christian University. Sixteen direct-entry nursing students …

Prevalence Of Teenage Pregnancy And Associated Factors Among Adolescent Girls In Bobi Subcounty, Northern Uganda., Grace Auma, Margaret Alioru, Geoffrey Kaujju, Grace Nakate

School of Nursing & Midwifery, East Africa

Methodology: A Cross-sectional study design. A survey was conducted among 4893 married girls aged 15-19 years using quantitative methods. Quantitative data was collected through the structured questionnaire, which was administered, data was collected and entered in EPI-INFO 2020 software, and was cleaned and analyzed using STATA version 15.0. Binary logistic regression was done to examine the factors independently associated with teenage pregnancy. A multistage sampling technique was used.

Results: Our study showed that the prevalence of teenage pregnancy in Bobi Sub-County, Omoro District, is high at 27.5%. Significant Factors contributing to the likelihood of teenage pregnancy included those …

Misconduct Among Nurses And Midwives: A Retrospective Descriptive Study Of Cases Handled At The Uganda Nurses And Midwives Council From 2017 To 2021, Barbara Okiror, Christine Nimwesiga, Patience Muwanguzi, Tom Ngabirano, Mercy Muwema

School of Nursing & Midwifery, East Africa

Background: Media reports on the misconduct of nurses and midwives, including cases of fake credentials, drug theft, and incompetence, are on the rise. However, there are no published studies currently addressing this issue in Uganda. Therefore, to inform effective regulation of the profession, we analysed the misconduct cases involving nurses and midwives reported to the Uganda Nurses and Midwives Council between 2017 and 2021.

Methods: The study retrospectively described misconduct cases received and handled at UNMC from 2017 to 2021 and their outcomes. Following total population sampling, data were extracted from case files and then input into a …

Gastrointestinal Symptoms After Sport-Related Concussion: Prevalence And Patterns In A Multi-Cohort Analysis, Emma Finnegan, Ed Daly, Katherine J. Hunzinger, Lisa Ryan

Department of Exercise Science Faculty Papers

Background/Objectives: Concussions occur across all sports globally; however, inconsistent symptom recognition continues to challenge diagnosis, management, and recovery. Although concussion effects extend beyond neurological dysfunction, gastrointestinal (GI) symptoms remain insufficiently captured within current assessment frameworks and may influence athletes’ fuelling choices and food tolerance during recovery. This study aimed to describe the prevalence and patterns of GI symptoms reported among athletes with a history of concussion and to explore whether symptom prevalence and burden differed by sex and country. Methods: A total of 401 adult athletes (225 males; mean age 32.4 ± 11.3 years) with a history of concussion were …

Resilience And Social Support On Depression Risk For Chronic Obstructive Pulmonary Disease Patients In South Tangerang, Indonesia, Adhityawarman Menaldi, Sali Rahadi Asih, Farah Ainul Mardhiyyah

Kesmas

Chronic obstructive pulmonary disease (COPD) is a major public health concern with psychosocial impacts, such as reduced resilience and depression. This study examined the moderating role of perceived social support on the relationship between resilience and depression among individuals diagnosed with COPD in South Tangerang, Indonesia. A quantitative cross-sectional study was conducted between January and February 2024 using self-administered questionnaires. Participants were adult patients with clinically diagnosed COPD, recruited from all public health centers (PHC) in South Tangerang. A total of 125 participants met the inclusion criteria and were included in the analysis. Participants had a mean age of 41.46±15.69 …

Development And Validation Of An Indonesian Questionnaire For Assessing Paracetamol Self-Medication Knowledge, Attitude, And Practice, Widyana Sagita Putri, Rani Sauriasari, Priharika Septyowati

Kesmas

Paracetamol is a widely used over-the-counter medicine for self-medication and is often perceived as completely safe. However, inappropriate use may result in hepatotoxicity and other adverse effects, particularly at high doses. This study aimed to develop and validate a questionnaire to assess the general Indonesian population’s knowledge, attitude, and practice (KAP) regarding paracetamol self-medication. The validation procedure consisted of three stages: content, face, and construct validation. Three experts assessed the relevance of the items using the Content Validity Index, and five respondents were interviewed to assess the linguistic clarity and comprehensibility of the questions. Construct validity and reliability were assessed …

Determinants Of Behavioral Intention To Change Sexual And Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis, Md Mizanur Rahman, Gerraint Gillan Ahi, Rafazila Ramli, Rasitasam Safii, Jacey Lynn Minoi, Stephanie Chua Hui Li, Ahmad Sofian Bin Shminan, Lee Jun Choi

Kesmas

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, …

Lessons From Adults Who Lived Through Parental Divorce As Adolescents, Nirav M. Patel

Pacific Journal of Health

Experiencing parental divorce during adolescence is a significant life event that can have long-term emotional and psychological effects [1]. This qualitative study focuses on how adults who experienced parental divorce between the ages of 10 and 17 reflect on their emotional, social, and academic experiences during that time. Nine adults participated in semi-structured interviews, which were transcribed, coded, and analyzed by the researcher using Dedoose software. Key findings that emerged from the interviews include emotional struggles, coping strategies, family support, the impact on school, and advice for today’s youth who are currently experiencing divorce. The findings emphasize that open communication, …

Impact Of Eating Disorder Type On General Population Perceptions Of Stigma And Likelihood Of Comorbidity, Gabri Notov, Grace Schroeder, Kaz Skelton, Kevin Summers, Sarah Huff

DU Undergraduate Research Journal Archive

Eating disorders carry a significant risk of mortality, necessitating further research. Previous work has examined how stigma influences treatment seeking in other mental health conditions, creating a potential area for improving disordered eating outcomes. Additionally, prior meta-analyses have discovered high comorbidity of other mental health diagnoses with disordered eating. Some work has attempted to examine the perception of comorbid mental health problems alongside eating disorders, but this construct has not been studied in depth within general populations. To date, no work has simultaneously examined stigmatization and knowledge of common mental health problems with disordered eating in this population. This study …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Scholarly Projects

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Parent-Focused Resource And Staff Crisis Tool For Addressing Teen Suicidal Ideation, Maya Ewing, Jasmine Crisan, Delaney Fewel, Brandon Fung, Kaylee Cornejo, Alyssa Arthur, Christine Elayda

Nursing Leadership in Community Engagement Projects

The team of seven Seattle Pacific University nursing students partnered with an agency that functions as a family resource center. The agency provides emergency shelter, mobile outreach, and basic needs to families in King County. The team created an evidence-based solution focused on education for suicide prevention. Additionally, the team identified a gap in available staff clinical resources during emergencies.

Emotional Intelligence In Physician Assistant Education: Associations With Success, Burnout And Engagement, Mickey Lebowitz, William H. Holmes

Innovations in Health Sciences Education Journal

Abstract

Background Burnout is prevalent among health care professionals and increasingly recognized among health professions students. Emotional intelligence (EQ) has been associated with reduced burnout among clinicians and learners, but data specific to physician assistant (PA) students remain limited. Methods We conducted a retrospective analysis of two overlapping cohorts of PA students from the entering classes of 2021-2023. Emotional intelligence was assessed using the Six Seconds Emotional Intelligence Inventory (SEI®). Burnout was assessed at the end of the first year using the Maslach Burnout Inventory–General Survey for Students and at the end of the second year using the Maslach Burnout …

Environmental And Pharmacological Modulation Of Opioid-Mediated Behavioral Effects In Rats, Corinne Ann Gallagher

Theses and Dissertations

Opioid Use Disorder (OUD) and opioid-associated overdoses continue to pose significant burden to US healthcare systems—both financially and in lives lost. It is imperative to identify risk factors which may predispose vulnerability to OUD development, which could aid in discovery of new therapeutic strategies for susceptible populations. This dissertation investigated the impacts of two such risk factors which modulate opioid-induced reward and behavioral effects: adolescent stress and the adulteration of illicit opioids by xylazine. In Chapter 2, we examined the effects of acute adolescent stress on oxycodone self-administration in rats, and the potential involvement of the locus coeruleus in these …