Digital Commons Network^™

Optimizing Advance Care Planning: Leveraging An Electronic Medical Record Prompt To Impact Advance Directive Documentation, Annette L. Meares

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Advance Directives (ADs) support patient-centered care by documenting preferences for future medical treatment. While the Centers for Medicare & Medicaid Services (CMS) incentivizes AD documentation through billing codes, national adoption remains low.

Local Problem: A rural Northern Illinois primary care practice had electronic referral capabilities for ACP; however, referrals remained low and inconsistent during Medicare Annual Wellness Visits (AWVs), limiting opportunities for AD completion.

Methods: This quality improvement project targeted Medicare AWV patients without ADs documented in the electronic medical record (EMR). During a 10-week pre-intervention period, baseline data were collected. In the subsequent 10-week intervention phase, an …

Case Management For End-Stage Renal Disease Patients, Jamie L. Andrews

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Social determinants of health (SDOH) and health literacy directly impact adults with end-stage renal disease (ESRD) on hemodialysis (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2022; Ulrich, 2020). Adults with ESRD account for 1.5 million hospital admissions and 500,000 re-admissions within 30 days annually (NIDDK, 2022). Case management is essential in reducing re-admissions for adult ESRD patients, requiring abilities to identify factors affecting adult ESRD patients appropriately.

Methods: Therefore, an evidence-based practice (EBP) project using the IOWA Model framework was implemented to increase the knowledge base in identifying care and resources for ESRD patients for telephonic …

Exploring Factors Associated With Adverse Childhood Experiences And The Development Of Posttraumatic Stress Symptoms Among Children And Adolescents, Ayesha Qureshi, Sarah Delahanty Phd, Sima Sharghi Phd, Lisa Shauver Ms, Ayla Mapes Phd

Williams Honors College, Honors Research Projects

Adverse Childhood Experiences (ACEs) have a significant influence on long term mental and physical health risks, including the development of Posttraumatic Stress Symptoms (PTSS). The current study examined the association between demographic and geo-coded environmental factors and ACE exposure and PTSS development among pediatric patients seen in a behavioral health department at a children’s hospital. Geo-coded factors included Child Opportunity Index (COI scores) and Rural Urban Area Commuting Codes (RUCA). ACE-related factors (type of ACE, ACE overall score) were also included when examining PTSS. Machine learning results indicated that models incorporating environmental data and ACE-related factors performed better than models …

Working With Foster Families: What Providers Should Know, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Foster parents play a vital, yet often challenging role in the lives of children who have experienced trauma and instability. Navigating the healthcare system for children in foster care can be particularly complex and overwhelming, requiring understanding, collaboration, and a unique approach from healthcare professionals. This page offers insights and practical ideas for healthcare professionals to effectively support foster parents, ultimately contributing to the well-being of the children in their care.

For questions about this publication or others, please email [email protected]

childrens.com/fostercare

Ensuring The Health And Well-Being Of Children After Adoption, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children in foster care have higher rates of health concerns and healthcare utilization than their peers who have not experienced foster care. For example, one study found that children in foster care had 2.5- and 2.3-times higher odds of having a mental health diagnosis and developmental disability diagnosis, respectively. Data on our patient population supports these findings, revealing that 70.4% of our patients had chronic or complex chronic health conditions.

For questions about this publication or others, please email [email protected]

childrens.com/fostercare

What Are The Genetic Influences Of Alcohol Sensitivity And Alcohol Metabolism? A Narrative Review Of Human Studies, Erwin Murray, Karen G. Chartier Phd, Msw

UROP Posters

Background: Alcohol sensitivity and alcohol metabolism are two phenotypes associated with alcohol use disorder (AUD) influenced by genetics. This narrative review aims to answer “What are the genetic influences of alcohol sensitivity and alcohol metabolism?” to gain a better understanding of the genetic aspects of AUD.

Methods: A database search was performed in PubMed. Empirical human genetic studies published between 2009 and 2025 that focused on alcohol sensitivity (measured by the Self-Rating of the Effects of Alcohol scale) or alcohol-metabolizing genes were eligible for review. Studies were screened to determine inclusion for the current review.

Findings: Fifteen …

Exploring Approaches To Address Racial Discrimination, Stigma, And Provider Communication In Sickle Cell Disease Pain Management Through Interprofessional Education And Collaboration, Ronisha Edwards-Elliott

Graduate Research Theses & Dissertations

This dissertation presents research across three publishable manuscripts that investigate why structural and systemic racism persist among patients with sickle cell disease (SCD) seeking pain management, and how interprofessional collaboration and education can help reduce disparities through shared learning, accountability, and standardized care (Chapters Two through Four). A scoping review identifies current interventions and strategies aimed at sharing the pain experiences and feelings of being unheard by SCD patients (Chapter Two). Findings of the scoping review revealed that although interventions and strategies exist and have been tested, the lack of implementation or buy-in from healthcare professionals has allowed racial discrimination …

Pathways To Green River District Health Department, Gracelyn P. Bush

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

In an effort to decrease Neonatal Abstinence Syndrome (NAS) in the Green River District of Western Kentucky, this grant proposes the expansion of the evidence-based University of Kentucky PATHways program to the Green River District Health Department (GRDHD). To protect the health of both women and children, this program will specifically target pregnant women with substance use disorder (SUD). This program will deliver a group-based prenatal and postpartum curriculum with the integration of Peer Recovery Support Specialists, specifically modeled on Social Cognitive Theory and the adoption of whole-person care. The proposed program spans a three-year time frame, beginning with program …

Burnout Among Nurses In The United States, Faheem Ohri

Social Work Dissertations - Archive

Burnout is an exhausted state of the body, mind, and emotions, characterized by feelings of “depersonalization and reduced personal accomplishment” resulting from prolonged and continuous occupational stress. Burnout among nurses in the United States (U.S.) is a growing concern with significant implications for healthcare professionals and patient outcomes. Nurse burnout compromises patient safety and workforce stability, but pre-pandemic national correlates remain understudied. This dissertation examined employment settings and demographic correlates of burnout among U.S. nurses using the National Sample Survey of Registered Nurses (NSSRN) secondary datasets. Compared inpatient burnout odds pre-/post-pandemic using national twin surveys. Jackknife complex survey logistic regression …

Building Healthcare Students’ Research Skills Through Co-Creating A Game To Teach Research: A Qualitative Study, Lise Johns, Leanne Bisset, Stacey Weightman, Gary Grant, Mary-Ann Shuker, Thea Van De Mortel

Health Professions Education

Purpose. Healthcare students may lack the knowledge and confidence to apply research. This study evaluated the impact of immersion in student-academic co-creation and evaluation of a gamified resource on healthcare students’ research knowledge, and confidence.

Method. A qualitative descriptive design was utilised. Student partners contributed to all aspects of design, implementation, and evaluation of the game. Students’ perceptions of this process were evaluated via a group interview and thematic analysis.

Results. Six undergraduate students from five healthcare disciplines participated. Two overarching themes were identified. The first related to impacts of the immersion process on students’ own research knowledge and confidence, …

1st Place Research Paper: Increasing The Accessibility Of Trauma Focused Cognitive Behavioral Therapy (Tf-Cbt) For Adolescents With Developmental Language Disorder: A Pilot Study, Lauren A. Fillet

Eric M. Scandrett Graduate Library Research Prize

Research has demonstrated that adolescents with developmental language disorder (AWDLD) perform more poorly compared to typically developing peers on measures of narrative production.This limitation may not only impact education and social life, but also possibly post-traumatic stress recovery, as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) involves a Trauma Narrative production activity (D’Amico et al., 2022). A limited amount of research has been conducted on adapting TF-CBT for children with intellectual disability, developmental disabilities, and Autism Spectrum Disorder (ASD) (D’Amico et al., 2022; Anderson & Cook, 2015). However, there is currently no available research explicitly addressing how TF-CBT can be individualized to …

Preliminary Evaluation Of A Brief Intervention To Enhance Trauma-Informed Attitudes Among Educators And School Mental Health Counselors, Cheri Shapiro, Kara Lee, Courtnie Collins, Tristan Collier, Carl Sorensen

Publications

Professional development training designed to advance knowledge of the impacts of trauma and trauma-responsive practices for educators and counselors in schools and mental health settings have become common. Given the popularity of these training approaches, it is important to understand the potential impact on trauma-informed attitudes and beliefs. This descriptive, exploratory study examined changes in traumainformed care attitudes as a function of participating in a novel intervention designed to support trauma-informed practices in a sample of elementary school educators, administrators, and school mental health counselors (n=194) from one state in the Southeastern US. Positive changes in trauma-informed attitudes from pre …

Behavioral Health Training For Integrated Behavioral Health: A Delphi Study, Nicholas Schmoyer, Lisa Corbin, Jessica Huffman, Gülşah Kemer

Counseling & Human Services Faculty Publications

Using a classical Delphi design, the authors used an interdisciplinary panel of behavioral health experts in integrated behavioral health (IBH) to identify foundational skills and knowledge counselor educators need to teach clinical mental health counselors for IBH practice. Eighty-eight statements were identified. Implications are provided for counseling and other behavioral health educators.

Confidentiality In Addiction Treatment: Navigating 42 Cfr Part 2 Within Human Services, Chaniece Winfield, Jessica Huffman

Counseling & Human Services Faculty Publications

Recent federal legislation, including the Mental Health Parity and Addiction Equity Act (MHPAE) and the Comprehensive Addiction and Recovery Act (CARA), has placed greater emphasis on quality integrated health care, with a focus on access, treatment options, and evidence-based practices. Changes to Federal 42 CFR privacy protections also impact individuals seeking substance use disorder treatment, either as a primary diagnosis or comorbidity. Human service professionals, as generalists in the behavioral health field, provide vital treatment, recovery, and prevention services for individuals with substance use and addictive disorders. This paper explores the implications of these legislative changes, particularly regarding privacy protections …

Navigating Recovery: Insights From Distance Learning Human Services Students' Abstinence Experience, Chaniece Winfield, Jill Kivikoski, Catalina Kraft

Counseling & Human Services Faculty Publications

With the rise in overdose and problematic drug use in the United States, it is crucial to develop competent human service practitioners in addiction treatment and recovery settings. This qualitative study explores the virtual abstinence experience of distance learning human services students, using Mezirow’s transformative learning theory to examine how a 21-day experiential abstinence prompts critical reflection and perspective transformation. The study investigates the socio-emotional and physiological factors influencing participants' progress toward sobriety, including cravings, withdrawal, isolation, and relapse triggers. Findings highlight how participants' critical reflection leads to a deeper understanding of addiction and recovery, as well as an enhanced …

Whether To Offer Interventions At The End Of Life: What Physicians Consider And How Clinical Ethicists Can Help, Joelle Robertson-Preidler, Mikaela Kim, Sophia Fantus, Janet Malek

Faculty and Staff Publications

Background: Advances in life-prolonging technologies increasingly create dilemmas for physicians who must decide whether to offer various interventions to patients nearing the end of life. Clinical ethicists are often consulted to support physicians in making these complex decisions and can do so most effectively if they understand physicians' reasons for making recommendations in this context.

Methods: Semi-structured interviews were conducted with surgeons, nephrologists, intensivists, emergency physicians, and oncologists regarding the considerations they have used to make decisions about offering interventions for patients nearing the end of life. Interview transcripts were thematically analyzed.

Results: We identified six types of considerations physicians …

Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Research News, Grants, 2025, Volume 3, Soumyajit Majumdar

Grants (2015-)

Grants and contracts awarded during July - September 2025.

Exploring Perceptions Of Accommodations In Ot Fieldwork: A Mixed Methods Study, Courtney A. Gohean, Courtney Gohean

West Chester University Doctoral Projects

This study employed a convergent parallel mixed-methods design to explore the perceptions and experiences of occupational therapy (OT) fieldwork educators, academic fieldwork coordinators (AFWCs), and Level II OT students with disabilities regarding accommodations during fieldwork. Quantitative data were collected through an online Qualtrics questionnaire completed by 45 fieldwork educators. Qualitative data were gathered through semi-structured interviews with seven AFWCs and seven OT students/new graduates who had used Section 504 accommodations during Level II fieldwork. Thematic analysis revealed key themes among students and AFWCs, including barriers to disclosure, variability in support and communication, the need for proactive planning, and concerns regarding …

The Integrated Support Plan For End-Of-Life Care (Isp-Eolc), Kaitlin R. Sugarman

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

The Integrated Support Plan for End-of-Life Care (ISP-EoLC) workbook was developed to address the growing need for structured, occupation-based resources for occupational therapy practitioners (OTPs) working in end-of-life care. Rooted in evidence-informed practice, this workbook guides OTPs in supporting patients and caregivers through one of life’s most complex transitions. Each chapter of the workbook focuses on a key topic, including early recognition of OT needs, meaningful role participation, iterative interventions, caregiver support, and interdisciplinary collaboration. Designed to be both educational and interactive, the workbook includes patient and caregiver-directed activities that promote communication, reflection, and emotional connection. It also offers practical …

Know More Falling: Community-Based Fall Prevention, Edward R. Mcwithey

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

The aging population is expected to grow to 2 billion worldwide by 2050 (Rosado et al., 2021). Aging is classified as a determinant risk factor for falls and fall-related injuries (Rosado et al., 2021). This capstone project aimed to promote understanding and address fall prevention in the older adult population with multiple stakeholders throughout the Dallas, Pennsylvania community. Project goals included developing community partnerships, providing education and addressing wellness and health equity among community-dwelling older adults through multifaceted interventions. The literature search yielded a synthesis and analysis of current evidence focused on community-based fall programming, adding to the body of …

Death And Dying Across The Lifespan, Paige Sala

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

Death and Dying Across The Lifespan centers on the creation of three interdisciplinary educational courses focused on end-of-life care for three distinct age groups: geriatrics, adults, and pediatrics. The courses aim to improve undergraduate students’ competence in addressing death and dying with patients, caregivers, and other healthcare professionals within the team. The courses were developed in response to growing evidence that supports the need for education on death, dying, and caring for individuals at the end of life. Many students are not adequately exposed to these topics in current curricula, despite the importance of interdisciplinary collaboration in this area of …

Mistrust Among Injured Immigrant Workers: A Conceptual Framework, Maude Arsenault, Daniel Côté, Jessica Dubé

Revues de littérature, synthèses de connaissances

Background

In Quebec, injured workers have access to medical assistance, wage replacement indemnities, and rehabilitation measures, with most injuries resolved easily. However, a small percentage of cases require a lengthy rehabilitation process, which is particularly complex when involving immigrants. The therapeutic alliance is at the heart of the process, involving mutual trust and confidence and a degree of consensus about the therapeutic interventions to be used and, ultimately, the return to work.

Objective

This article delves into the concept of mistrust as more than the absence of trust, and sheds light on its role in the rehabilitation process of immigrant …

“I Learned To Bottle Up My Feelings From A Young Age”: A Narrative Analysis Of Latina Young People’S Family Mental Health Socialization, Jenn M. Lilly

Social Service Faculty Publications

Latina young people report high levels of mental health problems and low levels of helpseeking

compared with their white peers, but little research has examined factors influencing

their mental health views. Inductive analysis of 25 participants’ narratives revealed that Latina

young people described three stages in the development of their mental health-related beliefs,

attitudes, and behaviors: undergoing a process of family mental health socialization, suffering

in silence, and attaining a new perspective. Within each of these phases, participants shared

stories that attest to their agency and resilience. This research uncovers a novel theoretical

construct, “family mental health socialization,” which elucidates …

Digital Zines As Mental And Sexual Health Communication Tools For Latina Teens: Format And Content Acceptability And Initial Findings, Jenn M. Lilly, D'Andrah Almanzar, Susan R. Pace, Dante D. Bryant

Social Service Faculty Publications

Recognizing the potential of digital zines (defined as selfpublished,

online publications combining artwork and

text) as culturally tailored health communication tools,

this article examines the acceptability and impacts of two

digital zines about mental and sexual health created by

Latina young people for Latina teens as a health communication

strategy. We conducted an anonymous online

survey completed by Latina teens who read the zines (32

for sexual health and 33 for mental health). Data analysis

aimed to explore, summarize, and interpret the collected

data using an artificial intelligence (AI)-enhanced

approach. Survey participants found the zine format and

content acceptable and …

Factors Affecting The Joy Of Life In Old Age: A Scale Development Study, Yalçın Karagöz, Yusuf Karaşi̇n, Mustafa Filiz, Mehmet Ateş

Adultspan Journal

This study aims to introduce a measurement tool into the literature that can reveal the factors affecting the joy of life in older adulthood. Participants included 266 individuals aged 55 and over living in Izmir, Turkey. The process of developing the scale includes the following stages: problem identification, item pool creation, expert opinion, form shaping, pilot application, and finalizing the scale. The exploratory factor analysis revealed that the scale consists of 6 different dimensions, and the variance explained by these dimensions was found to be 65.184%. The acceptable values for the scale's fit indicators are as follows: χ²/df0.90, IFI > 0.90, …

Assessing The Impact Of High-Fidelity Simulation Experiences On Student Confidence In A Controlled Academic Environment, Jillian K. Pindar, Peyton Belton, Madison Griffin, Abbi Hancock, Lucero Limones, Kristi Self, Elizabeth K. Schmidt

Journal of Occupational Therapy Education

A quasi-experimental one group pretest-posttest design was utilized with 19 first-and-second-year doctoral occupational therapy students at a university in Tennessee to evaluate confidence, performance, benefits, challenges, and recommendations from an acute care simulation experience. Student confidence was evaluated using a researcher-developed survey immediately before and after a high-fidelity simulation using a pre-programmed mannequin and standardized script. A performance assessment evaluated students' skills during the simulation. The post-test survey included open-ended questions on perceived benefits, challenges and recommendations. Overall, students demonstrated increased confidence in vital sign monitoring and modification (heart rate, blood pressure, respiratory rate), medical equipment identification, and safe patient …

Perceptions Of Occupational Therapy Student Fieldwork Readiness In The Acute Care Setting, Jackie Dusing, Lisa Borrero, Elizabeth Horrall Stith, Kristina Watkins

Journal of Occupational Therapy Education

Occupational therapy student readiness for Level II fieldwork is necessary for preparing novice clinicians and is challenging to assess, as it requires applying didactic knowledge in real-world clinical settings. There is currently a gap in the literature regarding student perceptions of their readiness for Level II fieldwork, especially in the acute care setting. The aim of this qualitative study is to better understand Doctor of Occupational Therapy (OTD) students’ perceptions of readiness for Level II fieldwork in an acute care setting. This basic interpretive qualitative research study utilized a purposeful sampling with students completing their Level II fieldwork in various …

Exploring The Teaching Methods And Approaches Used By Australian Educators To Teach Occupation, Melanie J. Roberts, Barb Hooper, Bernadette Sebar, Jim Woodburn

Journal of Occupational Therapy Education

Occupational therapy education standards for teaching occupation are inconsistently applied and there is a lack of evidence to inform teaching practice in Australia. This qualitative study explored what teaching methods and approaches Australian occupational therapy educators used in their classroom, and why those methods were used. The research was completed in two phases: narrative inquiry guided Phase I where educators were interviewed about the methods and approaches used to teach occupation. In Phase II video-reflexive ethnography was implemented, where a video recording of teaching was used as a prompt for a reflexive discussion about the educator’s teaching approaches. The interviews …

Temporal Occupational Patterns Amidst Covid-19: A Comparative Analysis Of Occupational Therapy Graduate Students’ Self-Reports, Amanda C. Jozkowski, Julie M. Werner, Meagan Downey

Journal of Occupational Therapy Education

This study employed a qualitatively-driven mixed method approach to exploring temporal occupational patterns among occupational therapy graduate students in the United States during the COVID-19 pandemic. Data collected from cohorts in 2021 and 2022 were contrasted with those previously reported for 2019 and 2020, highlighting how these patterns evolved over time. Notable changes in time use were identified between the 2021 and 2022 cohorts. In 2022, students reported increased time spent in class and in driving/community mobility, while their time dedicated to physical activity, health maintenance, and family interactions declined. The analysis revealed the complexity of students' time use due …