Digital Commons Network^™

Empowering Caregivers, Protecting Patients: An Ambulatory Central Line Quality Improvement Initiative For Education And Follow-Up, Elizabeth Martinez, Belinda Bordeaux, Stephanie Langevin, Cristina Herrera, Mary Smith, Merissa Doyle, Barbara Stein, Kimberly Poshar, Marissa Dunlap, Allison Silva, Eric Werner

Department of Pediatrics Faculty Publications

Introduction: Preventing ambulatory central line-associated bloodstream infections (A-CLABSIs) is challenging due to inconsistent education, follow-up, and home care practices. Pediatric intestinal failure (IF) patients are particularly vulnerable. This institution aimed to decrease its IF A-CLABSI rate by 25% within 2 years through a standardized, step-by-step central line care education program.

Methods: Using the Toyota problem-solving method, the team reviewed data and performed a root cause analysis of the prioritized problem, implementing a 2-phase education program. Phase 1 delivered in-hospital education using videos, handouts, and hands-on teaching with skill demonstration. The existing pediatric central line skills class was expanded and offered …

Gratitude Journaling And Mindfulness To Mitigate Burnout In Mental Health Staff, Jennifer Davis

Doctor of Nursing Practice Projects

Burnout among mental health professionals in inpatient behavioral health settings negatively affects staff well-being, job satisfaction, and patient care quality. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the effectiveness of an 8-week mindfulness and gratitude journaling program implemented on a rural behavioral health unit in North Carolina. Guided by Jean Watson’s Theory of Human Caring, the intervention aimed to enhance resilience and workplace wellness through daily mindfulness and reflective journaling practices. A repeated cross-sectional design using anonymous pre- and post-intervention surveys was conducted with 30 staff participants. Thirty participants enrolled in the study, and 24 completed the …

The Mediating Effect Of Socioeconomic Status And Persistent Poverty On Racial And Ethnic Disparities In Pediatric Cancer Mortality In The United States, Josiane Kabayundo, Apu Das, Cheng Zheng, Emma Hymel, Krishtee Napit, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

BACKGROUND: Socioeconomic (SE) factors have been shown to mediate racial and ethnic disparities in adult cancer mortality. However, evidence in pediatric cancer is limited, especially at finer geographic levels.

OBJECTIVE: Evaluate the mediating effect of socioeconomic status (SES) and persistent poverty in racial and ethnic disparities in childhood cancer mortality using census tract-level data.

METHODS: Data were obtained from the 2006-2020 SEER Incidence Data with Census Tract Attributes Database and included children 0-19 years. Neighborhood-level SES was measured using a composite variable with five categories. Census tracts were classified as persistently poor if 20% or more of the population lived …

Association Between Caregiver Status And Physical And Mental Health Among National Senior Games Athletes, Chibuzo Uchechukwu Victor Obasi

Graduate Research Theses & Dissertations

As the population ages, more people rely on informal caregivers, which puts many older adults at risk for health problems. Caregiving can be meaningful and strengthen family bonds, but it often leads to more psychological stress, especially for older adults who also have their own health concerns. Research shows that regular physical activity can help older adults build resilience and improve their mental well-being. Still, we know little about the health of older caregivers who stay very active. This study examines the health effects of caregiving among members of the National Senior Games Association (NSGA), a group of highly active …

Transition To Home Guideline For Patients With Diabetes, Kathleen R. Burgner

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Diabetes is a leading contributor to preventable hospital readmissions. These hospital readmissions often result from fragmented discharge planning, poor care coordination, and limited post-discharge support. At a 915-bed academic medical center in Southern California, the diabetes-related readmission rate was 13.3%, compared with 11.4% among patients without diabetes. This project aimed to develop an evidence-based Transition-to-Home (TTH) guideline for hospitalized patients with diabetes and evaluate the strength of its recommendations through multidisciplinary stakeholder review.

Methods: An evidence-based guideline development project was conducted over 8 weeks. A comprehensive literature search in CINAHL, MEDLINE, PubMed, and ScienceDirect identified current evidence on transitional …

Building Mental Health Literacy: The Impact Of Youth Mental Health First Aid On Emerging Youth Professionals, Burgin Rome

2026 Research Poster Competition

Nearly half of individuals in the United States will experience a mental health disorder during their lifetime, with many symptoms first emerging in childhood or adolescence. Adolescence is a critical developmental period characterized by emotional, social, and psychological changes that increase vulnerability to mental health challenges. Although public awareness of mental health has grown, stigma and societal taboos continue to limit open dialogue and delay intervention. As a result, many young people experience a significant gap between the onset of symptoms and receipt of professional support, which can worsen mental health concerns and contribute to long-term consequences that persist into …

Family- And Cultural-Level Influences For Latine Adolescent Nicotine Use: A Qualitative Study Informing Prevention, Cindy M. Hernandez Castro

Theses and Dissertations

Early tobacco use among Latine adolescents represents a critical public health concern, with 23.8% reporting current use and exceeding rates among other racial/ethnic groups (Birdsey et al., 2023; Gaddy et al., 2022). This early initiation elevates risks for nicotine dependence and related morbidity in adulthood (Tsao et al., 2023). Guided by Structural Ecosystems Theory (Szapocznik & Coatsworth, 1999) and contemporary grounded theory analysis (Braun & Clarke, 2006; Charmaz, 2006; Noble & Mitchell, 2016), this study examined multilevel influences on nicotine-related attitudes among Latine youth, including: (1) familial factors (i.e., parental monitoring, caregiver-youth communication), (2) cultural dynamics (i.e., cultural values and …

Socialization Interventions For Older Adults In Assisted Living Facilities: A Systematic Review, Anoop S. Muvva

Honors Undergraduate Theses

Older adults, defined as individuals over the age of 65, are a growing population in the United States, with projections estimating this group will reach approximately 80 million persons by 2050. Over 90% of older adults are diagnosed with a chronic condition, which can make it difficult to carry out the activities of daily living. As a result, some older adults reside in assisted living facilities, where dedicated staff provide daily support. However, issues in the delivery of care within these settings, including unmet socialization needs and complications among care staff, may contribute to social isolation. Programs designed to address …

Examining The Barriers To Healthcare Among Native Hawaiian And Pacific Islander Populations Living In Hawaii, Gracie L. Kaye

Honors Undergraduate Theses

The state of Hawaii was annexed by the United States in 1898, and served as a starting point from which the U.S. influenced Hawaii's socioeconomic conditions and healthcare access. The literature review examines healthcare views and outcomes among Native Hawaiian and Pacific Islander residents, utilizing various tools and resources to investigate how these factors have impacted overall health statistics and the reasons behind these trends. Results found that the western colonization of the island and the disease outbreaks led to an initial mistrust of “western ideas.” Additionally, due to long-standing cultural beliefs, there is a natural preference for traditional cultural …

The Knowledge, Experiences, And Attitudes Of Nurses Regarding Trauma-Informed Care For Sexually Abused Intrapartum Patients, Kayleigh Mcgraw

Honors Undergraduate Theses

Labor and delivery nurses care for women from diverse backgrounds who are preparing for a life-changing event, often marked by fear, excitement, sadness, and joy. However, 1 in 5 women in the United States have experienced rape or attempted rape, and for these survivors, labor can become re-traumatizing. Many report flashbacks, dissociation, and a sense of “being back in the rape” during childbirth. Research further links prior sexual assault to unplanned cesareans, traumatic births, and childbirth-related PTSD. Trauma-informed care (TIC) provides a framework to reduce these risks by encouraging providers to understand trauma, recognize signs of distress, and act to …

Oral Health Access Among Ethnic Minority Older Adults In The United States, Jasleen K. Sodhi

Honors Undergraduate Theses

Oral healthcare is a critical yet often overlooked component of overall health among U.S. adults. Ethnic minorities for older adults face heightened risks of poor oral health and related health conditions, while experiencing disparities in access to care. This study aimed to systematically examine and synthesize existing literature to assess the extent to which oral health disparities exist among ethnic minority older adults in the U.S. and explore the roles of socioeconomic factors on these disparities. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, we conducted a systematic review of peer-reviewed articles published in English …

Risk And Protective Factors Of South Asian American Youth Mental Health, Jasmine Kaur

Honors Undergraduate Theses

South Asian American youth represent a rapidly growing yet understudied population in United States mental health research. Much of the existing literature aggregates diverse Asian American subgroups, obscuring the unique sociocultural experiences of South Asian adolescents and young adults. This thesis examines the risk and protective factors influencing the mental health of South Asian American youth aged 15–25. A systematic review of peer-reviewed literature was conducted using the databases Web of Science, MEDLINE, PsycINFO, and CINAHL Plus with Full Text. Search terms included culturally specific identifiers, migration-related terminology, youth demographic terms, and mental health outcomes. After removing duplicates and applying …

Exploring The Link Between Hospice Setting And Caregiver-Reported Quality Scores, Aidan J. John

Honors Undergraduate Theses

Access to high quality hospice care largely varies across different care environments and regions within the United States. This can shape the experiences of family caregivers who support patients at the end of life. As hospice enrollment expands nationwide, understanding how care delivery changes between home-based services and more skilled inpatient and outpatient services has become integral for examining overall performance.  There are many noticeable differences in provider availability and resources between different programs that can influence the level of support families receive, including timeliness of symptom management and effectiveness of communication with hospice staff. This study evaluated whether hospice …

Improving Healthcare Professionals’ Comfort Level Screening For Intimate Partner Violence, Madison M. Mitzel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: Pregnancy increases a woman’s risk of experiencing intimate partner violence (IPV). Although healthcare visits typically increase during pregnancy, IPV screening is often overlooked, and many women remain unaware of available domestic violence resources. 
Local problem: Globally, women are impacted by IPV, with those living in rural areas facing a higher risk. 
Methods: The Abuse Assessment Screen (AAS) was implemented in a rural women’s health facility to screen patients for IPV. Prior to implementation, healthcare professionals within the facility received education regarding the screening protocol and available resources for patients. 
Interventions: The comfort level of the healthcare professionals discussing IPV …

Utilizing Youth Mental Health First Aid: A Community-Based Prevention Strategy To Increase Teh Confidence Levels Of Seventh-Day Adventist Adults In Assisting Youth With Mental Health Distress, Sarah Hillebert

DNP Research Projects

Abstract 

Objective: Youth Mental Health First Aid (YMHFA) is an initiative from the National Council for Mental Wellness that trains adults in identifying and responding to adolescents exhibiting mental health distress. This DNP project evaluated the effectiveness of YMHFA in increasing the mental health literacy and confidence scores of Seventh-day Adventist (SDA) adults. Method: quality improvement, pretest-posttest quasi-experimental design was used. Participants were SDA adults aged 22 to 74 who work with youth in school, church, or camp settings (n=19; Mean age = 48.5 years, SD = 10.5). The quantitative MHFA 2.1 measured mental health literacy and confidence to intervene, …

Aging With A Chronic Illness: Symptom Burden, Everyday Challenges, And Quality Of Life Among Older Adults With Multiple Sclerosis, Swasati Handique

Social Work Dissertations

This three-article study examined the quality of life and everyday lived experience of older adults living with multiple sclerosis (MS). The first article is a scoping review of 14 peer-reviewed studies published between 2012 and 2025, conducted in accordance with Arksey and O’Malley’s five-stage framework and the PRISMA checklist. The second article is a cross-sectional study using the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) Phase II data set of 60 older adults living with MS. Multiple linear regression and moderation analysis was conducted to examine the association between physical symptom burden and quality of life, and whether participation …

Geospatial Disparities In Adolescent Mental Health Resources: School- And Community-Level Evidence From Travis County, Texas, Sharon V Munroe, Jingjing Gao, Gayla Ferguson, Muinat Abolore Idris, Eric C Jones

Faculty, Staff and Student Publications

Background: Adolescents in the United States face growing mental health challenges, with nearly one in three high school students reporting poor mental health in the past 30 days. Schools increasingly serve as key access points for mental health care. However, geographic disparities in access to school-based mental health services remain underexplored.

Purpose: This study examines the spatial distribution of adolescent mental health resources in Travis County, Texas, and evaluates how school- and community-level factors are associated with the presence of on-site school social workers.

Methods: School locations, enrollment data, and the presence of on-site social workers were mapped and analyzed …

Adapting A Smartphone-Based Auricular Point Acupressure Self-Management Program For Rural Chronic Musculoskeletal Pain: Qualitative Study, Jungkyung Min, Peiyin Hung, Jane N Bolin, Rupsikha Bora, Sarah Pace, Patricia Pitones, Hulin Wu, Jennifer Kawi

Faculty, Staff and Student Publications

Background: Chronic musculoskeletal pain is more prevalent in rural areas where access to pain interventions, including complementary approaches like Auricular Point Acupressure (APA), remains limited. APA is a non-invasive, needle-free approach, and its smartphone-based self-management delivery model has not been optimized for rural contexts.

Objectives: To explore the perspectives of rural partners on adapting a smartphone-based Auricular Point Acupressure-Self-Management (APA-SM) program to better meet rural needs. Study objectives were to: (1) refine the APA-SM program for rural adults, (2) identify implementation barriers, (3) understand practice workflows and engagement, and (4) identify strategies to integrate the APA-SM program into rural pain …

A Qualitative Examination Of Human Papillomavirus Vaccine Access, Beliefs, And Behaviors Among Adult Males Aged 18–35: Applying The Health Stigma And Discrimination Framework, Jacquelin I Cordero, Louis D Brown, Jesús M Alemán, María E Fernández, Serena A Rodríguez, Eva M Moya

Faculty, Staff and Student Publications

Background: Males, who disproportionately account for 83% of oropharyngeal cancer cases, are underrepresented in health promotion research, including human papillomavirus (HPV) vaccination studies. The initial exclusion of males in HPV vaccine research, policies, and interventions has negatively affected male vaccine uptake. Furthermore, stigma, a well-documented barrier to healthcare engagement, has been overlooked in HPV vaccination behaviors. This study aimed to provide a more contextualized understanding of HPV vaccine disparities among adult males by applying the Health Stigma and Discrimination Framework (HSDF) to examine how stigma is produced, enacted, and sustained across social systems, which may impact male vaccine uptake.

Methods: …

Navigating Mental Wellness: A Peer-Led Journey Into Adult Services, Kristin G. Haberek

DSW Capstone Projects

Students with severe emotional disturbances (SED) occupy one of the most underserved intersections in American education and mental health care. As they age out of children’s services, they face abrupt service discontinuation, disrupted therapeutic relationships, and adult systems ill-equipped to meet their needs. These vulnerabilities, including heightened risks of crisis, hospitalization, homelessness, and justice involvement, constitute a central practice problem. This capstone addresses these transitions across three scholarly products: a systematic literature review, a theoretical concept paper, and a practical application paper, tracing a unified arc from diagnosing structural failures to proposing an evidence-informed, equity-oriented clinical response. Synthesizing key findings …

The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …

Correction: Feasibility Of Conducting A Pilot Randomized Trial Of A Mindfulness-Based Intervention Among Sheltered Young Adults Experiencing Homelessness, Diane Santa Maria, Paula Cuccaro, Erica Sibinga, Kimberly Bender, Ethel Jacko, Widumini Liyanage, Jennifer Jones, Stanley Cron

Faculty, Staff and Student Publications

This corrects the article "Feasibility of conducting a pilot randomized trial of a mindfulness-based intervention among sheltered young adults experiencing homelessness" in volume 16, 1649664.

Improving Pediatric Emergency Department Lethal Means Safety Documentation Rates For Adolescents With Mental Health Concerns, Cassandra L. Stegall, Ana-Maria Mcgill, John Fanton, Paul C. Mullan

Department Psychiatry & Behavioral Science Faculty Publications

Introduction:

Lethal means safety counseling (LMSC) is recommended for children presenting to the emergency department (ED) for a mental health (MH) evaluation. Currently, no gold-standard guidelines exist for documenting LMSC in the ED.

Methods:

This quality improvement project was conducted in the ED of a tertiary children's hospital. Baseline data were analyzed for access to any LMSC documentation (ALD) for "firearms/guns," "sharps," or "medication," and for complete LMSC documentation (CLD) if access to all 3 types was documented. The first intervention period added open-ended screening questions about access to lethal means to the MH-licensed clinical social worker note template. Intervention …

Exploring Healthcare Students' Perceptions About Race And Privilege At A Large Academic Medical Center: A Pilot Study Of A Peer Education Program, Elizabeth A. Brown, Dante Pelzer, Katrina Black Reed, Chinieka Jackman-Rogers, Madison Kimmell

Health Behavior, Policy & Management Faculty Publications

Amid the racial unrest stemming from the summer of 2020, in the United States, many institutions had difficult conversations about race and the impact of racism with employees, students, and patients. In January 2021 and February 2021, we recruited undergraduate students for the Peer Education Program (PEP), a voluntary program conducted at a large academic medical center, and encouraged students to have a safe space to discuss controversial topics in healthcare. From April 2021 to July 2021 four interdisciplinary healthcare students met once a month for 1 hr to discuss privilege, race/racism, leadership, and advocacy and their influence on health …

Recognizing Excellence: Key Traits, Qualities, And Behaviors Of The Exceptional Fieldwork Educator In Occupational Therapy, Piper Hansen, Lydia H. Schallenberg, Jayde M. Kahn, Jacqueline Rizzi, Ariel Torres

Journal of Occupational Therapy Education

All students of occupational therapy enrolled in accredited programs are required to complete Level I and Level II fieldwork experiences. A critical factor in shaping successful fieldwork experiences is the fieldwork educator, who guides clinical learning, models professional behaviors, and supports skill development for practice readiness. Despite the importance of the fieldwork experience, the fieldwork educator, and the impact of the supervisory relationship, there is limited understanding of the unique attributes and strategies that distinguish exceptional occupational therapy fieldwork educators. This study sought to investigate the key traits, qualities, and behaviors of the exceptional fieldwork educator in occupational therapy and …

Predictors Of First-Attempt Nbcot Success: A Multivariable Analysis Of Occupational Therapy Graduates, Kristina Hartsook, Sean Brim, Arlenys Loffredo

Journal of Occupational Therapy Education

First-time pass rates on the National Board for Certification in Occupational Therapy (NBCOT) examination have declined in recent years, highlighting the need to better understand factors associated with licensure readiness. This study examined academic, internal, and external predictors of first-attempt NBCOT success among occupational therapy graduates. A retrospective, cross-sectional survey design was used with a sample of 40 graduates from a single institution. Participants completed a post-examination survey assessing academic performance (graduate grade point average [GPA]), self-management skills (time management), external demands (workload, stress, support), study behaviors, and engagement with preparation resources, including the Occupational Therapy Knowledge Examination (OTKE). Descriptive, …

Stress Dynamics Between Clinical Supervisors And Allied Health Students: A Scoping Review, Piao Wang, Laurie Peebles, Aine O'Connor, Xinrong Li, Yongsheng Wang

Funded Scholarship

Stress within clinical supervision in allied health education functions as a reciprocal and relational process that shapes both learning and professional development. This scoping review synthesizes findings from 54 studies published between 1980 and 2024 to examine how stress is experienced, transmitted, and managed between students and clinical supervisors. Four interconnected domains were identified through the synthesis: the supervisory relationship, systemic and contextual pressures, personal factors, and the placement environment. Together these domains illustrate how organizational demands and supervisory strain influence student engagement, feedback processes, and educational outcomes. The literature provides valuable descriptive insight but remains fragmented, methodologically inconsistent, and …

Advancing Interprofessional Communication: Preliminary Outcomes Of A Novel Collaboration Framework In A Student Head Injury Clinic, Natalia Noce, Kelly Ann Pena, Susan Paparella, Andrew Lynch, Erin Keller, Aaron Dallman, Pamela Rothpletz-Puglia

Journal of Occupational Therapy Education

When healthcare providers practice interprofessional practice, care improves, and medical errors are reduced. Interprofessional Education Collaborative (IPEC) principles and the Team Strategies and Tools to Enhance Patient Performance and Safety (TeamSTEPPS®) frameworks are utilized in healthcare education to develop interprofessional collaborative practice skills, but there is little understanding of how these skills change over time. We sought to evaluate the development of interprofessional collaborative practice skills by examining graduate occupational therapy, physical therapy, and speech-language pathology students' first-hand reports of their experiences over time in an interprofessional head injury clinic. We employed an applied interpretive qualitative research approach longitudinally collecting …

Effective Teaching Behaviors Of Adjunct Faculty In Occupational Therapy Education: Perspectives Of Students, Adjuncts, And Core Faculty, Kayla Collins, Marian Gillard, Christine Davis, Kirsten Davin, Barbara M. Doucet, Bridget Scheidler

Journal of Occupational Therapy Education

Adjunct faculty constitute nearly half of the higher education workforce in the United States, yet they often receive limited preparation and institutional support for their teaching responsibilities. In occupational therapy education, where rapid program expansion has heightened reliance on adjunct instructors, understanding which teaching behaviors are most valued is critical to ensuring instructional quality, student success, and professional readiness. This study examined perceptions of effective adjunct teaching behaviors in a doctoral occupational therapy program using the Teaching Behavior Checklist (TBC), a validated 28-item measure of teaching effectiveness. Participants included students (n = 33), adjunct faculty (n = 19), and core …

Exploring Microaggressions Experienced By Students Of Color In Occupational Therapy Programs: Fostering A Climate Of Belonging, Laurie Knis-Matthews Ph.D., Ot, Sara Frommer Otd, Otr/L, Jacquelyn Pierre Otd, Otr/L, Geena Santomo Otd, Otr/L, Corrine Pineda Msot, Otr/L, Jackeline Artiles Otd, Shaniqua Bradley Ph.D., Lcsw

Journal of Occupational Therapy Education

Microaggressions, which are subtle and often unintentional acts of bias, continue to shape the educational experiences of students from marginalized backgrounds, yet their nuanced nature makes them difficult to define and address. This phenomenological qualitative study investigated the lived experiences of occupational therapy graduate students of color regarding microaggressions within their academic programs. Using purposeful sampling, five occupational therapy graduate students from various United States institutions participated in individual, semi-structured interviews. Thematic analysis revealed four key themes: It’s Hard to Describe a Microaggression without Using Examples and Explaining the Emotions Behind It; These Microaggressions Had Immediate and Long-Term Consequences on …