Digital Commons Network^™

Integrating Clinical Reasoning Into Mental Health Diagnosis: A Conceptual Framework For Counseling Practice, Ashley F. Waddington, Alexander M. Fields, Haley Ault

Journal of Human Services Scholarship and Interprofessional Collaboration

Clinical reasoning has long guided diagnostic accuracy in nursing and medical fields, but its application in mental health counseling remains limited. This paper presents a conceptual diagnostic decision-making (DDM) process to embed clinical reasoning into the diagnostic process for counselors, incorporating two vital constructs: counselor self-efficacy and counselor bias (implicit and explicit). Grounded in Bandura’s theory of self-efficacy (1977) and Carvalho et al.’s (2017) clinical reasoning model, the framework highlights the cognitive, behavioral, and contextual factors that shape diagnostic decision-making in early-career counselors, including counselor biases. The paper calls for reform in counselor training, emphasizing curriculum enhancements as pathways to …

Nurse-Led Interventions To Reduce Occupational Hand Injuries In Manufacturing, Patti Harter

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Occupational hand injuries cause preventable morbidity, lost productivity, and workers’ compensation costs in manufacturing. Although safety policies and personal protective equipment (PPE) are in place, inconsistent glove use, slow hazard identification, and delayed response still cause injuries. This quality improvement (QI) project evaluated an eight-week, nurse-led injury-prevention bundle at a Texas heavy-vehicle manufacturing facility. The intervention required daily glove inspections, Safety Champion participation, real-time electronic hazard reporting, and corrective action within the shift. Injury outcomes were measured using Occupational Safety and Administration (OSHA) rates per 200,000 work hours and percentage change from baseline. After implementation, hand injury rates fell from …

When Analgesia Is Contraindicated: Non-Pharmacologic Resolution Of Pain Enabling Rehabilitation Participation, Zane Shah, Anand Allam

Gulf Coast Division GME Research Day 2026

No abstract provided.

Strengthening Communication And Collaboration Between The Student Support Triad (Teachers, Caregivers, And Health Professionals) In Schools, Jasmine E. Henley

Occupational Therapy | OTD Capstone Projects

Teachers, caregivers, and health professionals, who are key stakeholders that form a student support triad, each face a range of challenges and barriers that impact their ability to communicate and collaborate with one another, therefore impacting the student and their ability to access and participate in meaningful occupations. Though these challenges and barriers for each stakeholder are well-documented individually, there is limited evidence on solutions to strengthen communication across the triad and solutions that center the student and their engagement in meaningful occupations. This project aims to bridge this gap, despite the greater systemic barriers, by developing remedial solutions that …

Counseling And The Neurodiversity Paradigm: A Call To Action, Emily Goodman-Scott, Rawn Boulden, Aaron Albright, Jenna Alvarez, Betsy M. Perez

Counseling & Human Services Faculty Publications

The counseling profession is rooted in prevention, wellness, mental health, and a critical social justice approach to serving historically marginalized communities, including people with disabilities. The overarching construct of disability comprises subtypes, such as neurodivergence. Given the prevalence of neurodivergent individuals worldwide (approximately 15%-20%), the counseling profession must be prepared to support this community. At the same time, there is a dearth of peer-reviewed literature on neurodiversity specifically for the counseling profession. In this article, we address a timely topic in the profession. We discuss utilizing a critical counseling lens and centering marginalized identities, such as people with disabilities; prominent …

Period Poverty, Gabriel Degraeve, Monica Bennett

SPARK Symposium Presentations

In the United States, 25% of adolescent females lack access to adequate period products (Period., 2025). Limited access to period products disproportionately affects women of color, women from low-income areas, and rural communities (Kuhlmann & Obionu, 2024). One in six women and girls in Tennessee lives under the federal poverty line (Alliance for Period Supplies, 2025) and likely lacks adequate access to these products. This limited access forces women to use alternatives, such as toilet paper or paper towels, or to use period products longer than recommended. This can lead to serious health issues, including toxic shock syndrome, and make …

Reducing Live Discharges In Hospice Care Through A Bundled Intervention, Fiona P. White

Doctor of Nursing Practice (DNP) Scholarly Projects

Introduction

 Among Medicare fee-for-service hospice beneficiaries, the national live discharge rate increased from 16.9% in FY2021 to 19.1% in FY2025. At a Medicare-certified hospice agency in a southern state, the pre-intervention live discharge rate of 35.3% substantially exceeded national norms, with 68.7% of events representing patient-initiated revocations.

Methods

 A pre-post quality improvement design guided by the Plan-Do-Study-Act framework was implemented over 8 weeks at a single site with 106 newly admitted hospice patients and 15 clinical staff. The four-component bundled intervention comprised Revocation Risk Assessment administration within 24 hours of admission, structured patient and caregiver education within 72 hours of …

Suicidality, Self-Neglect, And Medical Refusal In Advanced Illness: An Ethical Case Report, Austin Supak, Sarah Greene, Madeline Adelman, Whitney Snyders

Continental and Mountain Divisions GME Resarch Day 2026

No abstract provided.

Feeding Missoula: Food Insecurity In Rural Children And Youth, Chani Brammer, Braelee Cheeks, Jordin Holland, Rayne Mccollough, Laurel Palmer, Therese Solomon

Undergraduate Theses, Professional Papers, and Capstone Artifacts

In Montana, approximately one in seven children live in a food-insecure household, with rural Montanans in particular facing significant barriers. Existing needs-based food assistance programs, such as SNAP and WIC, have structural weaknesses: SNAP benefits are often not sufficient to last through the month, and those eligible for these programs face a confusing application process, shame and stigma, and logistical hurdles, such as limited transportation.

“Feeding Missoula” began with an evaluation of how current food assistance programs met or failed to meet the needs of rural youth. Our methodology integrated a comprehensive review of existing literature and structured interviews with …

Preparing For Change: Supporting Dementia Transitions Through Occupational Therapy And Caregiver Education, Kelly Ann Mooney

OTD Capstones

This capstone project focused primarily on supporting caregivers of individuals living with dementia within a continuing care retirement community (CCRC). Caregivers of spouses with dementia often experience increased burden, stress, and difficulty navigating the transition from independent living to higher levels of care. Guided by principles of occupational therapy, this project aimed to enhance caregiver knowledge, confidence, and overall well-being through the development and implementation of targeted educational resources and support strategies. 

Interventions included the creation of evidence-based educational handouts addressing common challenges for caregivers such as activities of daily living (ADLs), sleep, mealtime, and behavioral changes. Additionally, a structured …

Ethical Considerations For Hospice Patients In Inpatient Settings: A Systematic Review And Thematic Analysis, Matthew D. Harry

Honors Theses and Capstones

Hospice care is intended to prioritize comfort, dignity, symptom management, and quality of life for individuals with life-limiting illness. However, when hospice-eligible patients are managed within inpatient hospital settings, significant ethical challenges frequently emerge due to the tension between comfort-focused care and the curative, intervention-driven structure of acute care medicine. This paper presents a systematic literature review and thematic analysis examining the ethical considerations surrounding hospice patients in inpatient settings, with particular attention to clinical decision-making, communication, prognostic uncertainty, moral distress among nurses, and conflicts involving patient autonomy and family wishes. A structured review of peer-reviewed literature was conducted using …

Health Insurance As A Mediator Of Neighborhood Deprivation And Pediatric Cancer Survival: An Analysis Of State Cancer Registry Data, Emma Hymel, Cheng Zheng, Jenna Allison, Kendra L. Ratnapradipa, Edward S. Peters, Sarah H. Nash, Mei-Chin Hsieh, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

INTRODUCTION: To develop interventions to reduce neighborhood-level disparities in pediatric cancer outcomes, it is necessary to understand their underlying mechanisms. It has been suggested that individual-level health insurance is a mediator of neighborhood deprivation and pediatric cancer survival.

METHODS: This study was a population-based longitudinal study of children with cancer from 2000 to 2020 in the Iowa Cancer Registry and Louisiana Tumor Registry. Neighborhood deprivation was measured using the Area Deprivation Index. Log-binomial regression models were used to identify predictors of health insurance status at diagnosis. Cox regression models were used to assess the association between health insurance status at …

Harmony In Healing: Addressing The Psychosocial Needs Of Individuals Living With Lymphedema, Bria K. Brombacher

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2026

Lymphedema is a chronic and incurable condition associated with significant physical and psychosocial challenges, including depression, anxiety, social isolation, and reduced quality of life. Despite increasing recognition of these concerns, limited interventions exist that specifically address the psychosocial needs of individuals living with lymphedema. Additionally, individuals within this population often report limited provider awareness of lymphedema within the healthcare system. The purpose of this doctoral capstone project, Harmony in Healing: Addressing the Psychosocial Needs of Individuals Living with Lymphedema, was to promote well-being, improve quality of life, and increase awareness of the psychosocial implications of lymphedema through occupational therapy intervention. …

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

What Is A Standard? Perspectives On Acd’S Standards For Leadership In Oral Healthcare, N. Karl Haden Phd, Facd

Journal of the American College of Dentists

The American College of Dentists’ new Standards for Leadership in Oral Healthcare mark the first attempt in dentistry to articulate standards specifically for leadership, complementing the broader orientation offered by the Ethics Handbook for Dentistry. This article explores the basic question, “What is a standard?” Close reading of the document indicates at least three distinct but related senses of the term: an expectation, a norm, and a guiding principle. The article offers an interpretation of how these three senses fit together coherently. Referencing the Handbook, the article argues that the leadership standards are most impactful only when habituated, when practiced …

Legislative Debate-Attributed Suicidality Among Lgbtq+ Adults: The Buffering Effect Of Community Belongingness, Keith J. Watts, Shawndaya S. Thrasher, Laneshia R. Conner, Nicole Campbell, Louis G. Baser, Dekeitra Griffin, Sydney P. Howard, Missy Spears, Justin X. Moore

Counseling & Human Services Faculty Publications

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative …

Contemporary Approaches To Group Psychotherapy Supervision, Michelle A. Collins-Greene (Ed.), Molyn Leszcz, Nina W. Brown, Ellen Wright, Scott Giacomucci, Les R. Greene, Susan P. Gantt, Leah M. Niehaus, Francis Kaklauskas, Tony L. Sheppard

Counseling & Human Services Faculty Publications

This chapter captures the work of contemporary supervisors of group psychotherapy, all of whom have practiced many years and have trained and supervised innumerable group leaders. They demonstrate the diversity of settings and theoretical orientations that are prominent in the current era. Their essays speak for themselves and provide wonderful illustrations and models for supervisors-in-training and consultation to emulate. They also talk about who influenced, mentored, and supervised them.

Cultivating Connections: Empowering Agricultural Community Members Through Collaborative Care, Kearyn E. Nelsen

Occupational Therapy Capstones

Background: Agriculture and mental health – two words not typically used in the same sentence; however, considering the rate of suicide among those working in the agriculture profession is significantly higher than the general population, the need for both awareness and action is critically important. Despite a lack of research specific to occupational therapy and the agricultural population, occupational therapists on an interprofessional healthcare team are uniquely positioned to serve this population. Interprofessional collaboration is essential when serving agricultural community members, whose needs involve a complexity of physical, mental, social, and environmental factors, each impacting the overall health and well-being …

Introduction Of Occupational Therapy Into A Suburban Supportive Housing Organization, Madeline Kuntz

Occupational Therapy Capstones

Abstract: Unhoused individuals experience compounded barriers beyond housing access and are often underserved within occupational therapy practice. This doctoral capstone project partnered with a nonprofit residential program to develop a research-informed onboarding manual grounded in the holistic occupational therapy framework, Model of Human Occupation (MOHO, O’Brien, 2017). The manual was designed to clarify expectations of the supportive housing program, address diverse resident needs, and promote independence as the organization expands. Development was informed by a comprehensive literature review and informal needs assessment of the organization, identifying anticipatory barriers and supports commonly experienced prior to program entry. Key areas of need …

Child Maltreatment Risk Identification In Complex Caregiving Environments: A Public Health Review Of Split-Custody And Multi-Household Family Contexts, Makenzie Lee

Theses and Dissertations

Child maltreatment remains a significant public health concern with lifelong consequences for children's health, development, and well-being. As children's caregiving environments become increasingly diverse through split-custody arrangements, blended families, kinship care, and other multi-household contexts, recognizing and assessing child safety concerns may become more complex. Although these family structures are not inherently associated with maltreatment, the distribution of caregiving responsibilities and information across multiple households may complicate child maltreatment risk identification.

This capstone presents a scoping review of peer-reviewed literature examining child maltreatment risk identification within complex caregiving environments. The review synthesized evidence related to caregiving environments, caregiver relationships, child …

Developing An Educational Session And Epic-Based Tools To Help Nurses Provide Culturally Sensitive Care To Their Muslim Patients, Laila Albutmeh

Nursing | Senior Theses

Background: Islam is currently the fastest growing religion in the world and the chances of nurses having a Muslim patient is exceptionally high yet many nurses lack the knowledge and resources on how to accurately provide culturally sensitive care to Muslim patients. Hospitals lack educational sessions/training as well as Epic tools to help nurses provide culturally sensitive care to Muslim patients which leads to a knowledge deficit in cultural sensitivity of Islamic beliefs, values, and practices. Purpose: This thesis paper proposes a research design for a nurse education/training program on Islamic beliefs, values, and practices along with an implementation of …

Responding To Social Isolation: The Tole Of Chaplaincy In Addressing Social Determinants Of Health (Sdoh) In Pediatric Contexts, Adam Lubbers, Forest Melton, Simbarashe Sigauke, Sophie Le

2026

This poster describes a pilot program that integrated chaplaincy services into the care pathway for pediatric patients and families who screened positive for low social support, a key social determinant of health. The findings suggest chaplain-led interventions provide effective emotional, spiritual, and practical support, helping address social isolation, caregiver burden, financial insecurity, and other health equity concerns while offering culturally responsive care.

No One Left Behind: Identification Of Healthcare Needs Through System-Wide Social Determinants Of Health Screenings, Rose Dela Cruz, Amanda Marquez, Madison Lemmons

2026

This poster describes a system-wide quality improvement initiative designed to increase completion rates of Social Determinants of Health (SDOH) screenings by addressing workflow barriers, educating staff, and implementing standardized processes across clinical teams. The project demonstrates how interdisciplinary collaboration, nursing engagement, and structured screening workflows can improve identification of social needs and connect pediatric patients and families with resources that support health equity and better health outcomes.

Scaling Up Health Literacy Practices Through A Champion Program, Cameron Stine, Kelli Williams, Diana Montoya, Leslie Moore, Carol Howe

2026

This poster describes the development and expansion of a Health Literacy Champion Program designed to improve the consistent use of health literacy best practices across a healthcare organization. The program successfully expanded from ambulatory nursing to 13 disciplines, using champion training, newsletters, clinical observations, and peer influence to promote plain language communication, information chunking, and teach-back techniques that support patient understanding and safety.

The Use Of Visual Autobiographies In First, Second, And Third-Generation Children Of Immigrants In Navigating Belonging And Identity, Sorprisela Martinez

Art Therapy | Master's Theses

This study explored how autobiographical artmaking supports adolescents of immigrant-origin in understanding identity and sense of belonging through visual and narrative reflection on personal stories. The qualitative research approach was guided by three research questions examining: (1) the ways autobiographical work expresses complexities of immigrant heritage and multiple identities; (2) how narrative lens supports a deeper interpretation of autobiographical expressions; and (3) how adolescents’ understanding of their parents’ migration stories contributes to their own identity formation and self-presentation. Seven adolescents participated in a two-session, arts-based process that included creating autobiographical books, discussion of their images, and reflection on their cultural …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Adolescent Girls’ Experiences Of Digital Dating Abuse Through Social Media: A Scoping Review, Kiara E. Rodriguez

Social Work Theses

Teen dating violence (TDV) is a prevalent adverse childhood experience with lasting psychological and behavioral consequences. As adolescents increasingly engage with social media, with 95% of teens aged 13-17 reporting using it, digital spaces have become a significant context in which dating abuse can occur. Digital dating abuse (DDA) refers to patterns of abusive behaviors that are directed toward a dating partner through digital technologies, including social media and mobile phones. Despite the growing role of social media in adolescent relationships, research on how adolescent girls experience DDA in these contexts remains limited. The central question for this scoping review …

Increasing Nursing Perceptions On Advanced Directives Through Education To Promote Patient Centered Care, Michelle Strong

Master's Theses and Capstones

No abstract provided.

The Influence Of Familial Substance Use Disorder On Perceptions And Attitudes Towards Substance Use Disorders And Participant Substance Use Behavior Among Emerging Adults, Elijah M. Lefeld, Jennifer Stanley

Williams Honors College, Honors Research Projects

This research project explores how the lived experience of having an immediate family member with a substance use disorder (SUD) influences a person’s perceptions, attitudes, and behaviors related to substance use. Rather than focusing on the individual diagnosed with SUD, the study examines the reciprocal impact on family members within the social subsystem. Using a quasi-experimental design, the project will compare participant responses using with and without a familial connection to SUD. Data will be collected through Qualtrics surveys distributed via SONA. These measures will record demographic information, personal substance use habits, attitudes toward addiction, perception of substance use disorders, …

Social Determinants Of Health Affecting Cardiovascular Health Among South Asian Americans, Ann Mary Thomas

Honors Undergraduate Theses

Background: South Asian Americans experience disproportionately high rates of cardiovascular disease, yet the social determinants contributing to these disparities remain understudied.

Objective: This systematic review examines the role of social determinants of health (SDOH) in shaping cardiovascular outcomes among South Asian Americans.

Methods: A systematic literature search was conducted across PubMed, MEDLINE, and Web of Science using predefined search terms related to South Asian populations, cardiovascular health, and SDOH. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines, and study screening and management were performed using Covidence. A total …