Digital Commons Network^™

Bowel Regimen Protocol Implementation For Pediatric Patients Following Cardiac Surgery, Eryn Watson

Dissertations

Problem: Pediatric patients with congenital heart disease (CHD) are at an increased risk of constipation following cardiac surgery, which contributes to complications and delays in recovery. Standardized protocols are effective tools for prophylactic management of constipation. However, there is no current standardized protocol in place for postoperative bowel management in a pediatric cardiac intensive care unit (CICU).

Method: This quality improvement project (QI) used a descriptive design with pre- and post-implementation data collection to evaluate the effects of a postoperative bowel regimen protocol on constipation rates and compliance with ordering prophylactic bowel regimens. Convenience sampling was used to identify patients …

Implementation Of A Human Papillomavirus Vaccination Toolkit Postpartum, Emily R. Leone

Dissertations

Problem: Human papillomavirus (HPV) is the most common sexually acquired infection in the world (DeCherney et al., 2018). Even a single dose of the HPV vaccine can provide up to 97% protection against HPV 16 and 18, which are the strains that cause 70% of all cervical cancers (Barnabas et al., 2022). Missouri ranks 35th in the country for HPV vaccination (Office of Disease Prevention and Health Promotion, 2020).

Methods: This quality improvement project implemented an HPV toolkit consisting of: 1) staff nurse education in the form of a written presentation 2) patient and provider education in the form of …

Motivational Interviewing For Weight Loss: A Review Of Evidence-Based Outcomes In Overweight And Obese Adults, Marian Dover

Dissertations

Obesity is a significant clinical problem affecting 41.9% of adults in the United States, with profound implications for individual health and healthcare economics. Standard weight loss interventions, often limited to pharmacological treatments and dietary guidance, frequently fail to achieve sustained adherence and meaningful longterm outcomes. This quality improvement (QI) project evaluated the integration of motivational interviewing (MI), a patient-centered counseling strategy, into routine clinical practice at Innovafusion, a medically supervised weight loss clinic in Aubrey, Texas. The aim was to enhance adherence to lifestyle modifications, promote intrinsic motivation, and improve weight loss outcomes among adults aged 18–65. Using a retrospective …

Screening For Depression And Anxiety In Women With Polycystic Ovarian Syndrome, Nicole M. Bondurant

Dissertations

Background: Polycystic Ovarian Syndrome (PCOS) is a multifaceted endocrine disorder that affects up to 20% of women of reproductive age and is associated with an increased prevalence of psychiatric conditions, particularly depression and anxiety. Despite international guidelines recommending routine screening for these mental health conditions in women with PCOS, consistent implementation in clinical practice remains limited.

Methods: This quality improvement (QI) pilot project aimed to address this gap by developing and implementing a standardized screening protocol for depression and anxiety within a suburban concierge OB-GYN clinic specializing in women’s reproductive and sexual health using validated tools—the Patient Health Questionnaire-8 (PHQ-8) …

Implementation Of Mindfulness-Based Interventions And Weekly Visits To Reduce Loneliness In Older Adults, Victoria E. Cobb

Dissertations

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Abstract:

Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population.

Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive …

Race-Neutral Pft: Implementing Patient Activation Measure Following Race- Neutral Pulmonary Function Testing, Ann M. Way

Dissertations

Abstract

Background

The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool.

Purpose

The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient …

Improving Hpv Vaccination Decision-Making For Adolescents And Their Caregiver, Mary E. Hohman

Dissertations

Abstract

Problem: Human papillomavirus (HPV) is a viral infection associated with the development of certain cancers and is the most common sexually transmitted infection in the United States (U.S.) (Centers for Disease Control and Prevention [CDC], 2023). The CDC (2021) asserts that more than 90% of cancers caused by HPV infections could be prevented through the HPV vaccination. The CDC recommends the HPV vaccine series for children ages 11 or 12 years; however, this organization further submits that the HPV series could be initiated as early as 9 years of age through 26 years of age (CDC, 2024). Despite CDC …

Implementing A Turn Team Process To Reduce Hospital-Acquired Pressure Injuries On A Telemetry Unit At A Hospital In The Midwest, Sally Wang

Dissertations

Problem: Pressure injuries (PI) are localized wounds to the skin and soft tissues that typically result from sustained pressure on specific areas of the body (Zaidi & Sharma, 2024). Hospital-acquired pressure injury (HAPI) refers to pressure injuries that develop while a patient is in the hospital (Rondinelli et al., 2018). PI can cause patients to experience pain, decreased feelings of dignity, increased feelings of depression and anxiety, reduced levels of social activity, difficulty sleeping, and impaired cognitive function (Roussou et al., 2023). The Advanced Cardiac Care Unit (ACCU) at Missouri Baptist Medical Center experienced an increase in HAPI cases: …

The Psychological Impact Of Parenting Child Victims Of Trauma, Stephanie Faulkingham

Dissertations

Abstract

Research indicates that non-offending caregivers of traumatized children (NOC) is a population with an elevated risk for increased levels of depression and anxiety and are an underserved population for mental health services. The purpose of this quality improvement project was to determine if screening caregivers of traumatized children using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder (GAD-7) improves identification of depression and anxiety. Participants of this investigation were individuals enrolled in the Children’s Advocacy Services of Greater St. Louis’ 12-week parenting group, TASK (Trauma, Assessment, Skills, and Knowledge). Each participant was asked to complete the PHQ-8 and …

Depression Screening In The Adult Inpatient Oncology Population, Erica Bizub

Dissertations

Routinely screening oncology patients for depression is recommended due to the higher rates of depression in this population as well as the negative impact of untreated depression. The goal of this QI project is to implement a standard depression screening protocol for patients admitted to this hospital, where there is currently no standard screening protocol. There were 110 patients included in this study, and 67 (60.91%) of patients received a PHQ-9 screening. Of the patients who completed the PHQ-9, 21 (19.09%) had a positive screening, which was a score of seven or higher. While there were high rates of provider …

A Program Evaluation: Insomnia In Adults With Major Depression Disorder With Cognitive Behavioral Therapy For Insomnia (Cbt-I), Taylor E. Wilson

Dissertations

Abstract

Problem: In 2023, Compass Health Network (CHN) data analysts found that 91% of CHN patients in the United States who have died by suicide reported problems with sleep, which was the highest risk factor for suicide. The objective of this program evaluation project is to evaluate CHN CBT-I effectiveness on patients ‘suicidality by improving their insomnia.

Methods: CHN quality improvement (QI) project used a quantitative method pre/post score design. Quantitative aggregate data was collected on the participants who met the inclusion criteria via retrospective and prospective chart review prior to CHN implementing the intervention. CBT-I clinicians collected PHQ-9, Columbia-Suicide …

Care Coordination In Pediatric Primary Care, Alyssa K. Durzo

Dissertations

No central documentation of care plans exists for children with special healthcare needs (CSHCN) in the electronic health record (EHR). Providers of a large pediatric primary care office in St. Louis Missouri were asked to identify CSHCN in the practice. Clinic nurses completed a comprehensive chart review of the patients identified and constructed care coordination documents using a pre-established smart-text phrase. Subsequently, these were documented centrally in the EHR under the Problem List.

Likert score data was obtained from providers on the acceptability, appropriateness, and feasibility of the intervention through the verified tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness …

Screen Foundations: How Pediatric Nurse Practitioners Can Implement ‘Family Media Use Plans’ In Primary Care To Reduce Pediatric Behavior Concerns, Katie Anderson

Dissertations

Abstract for:

Screen Foundations: How Pediatric Nurse Practitioners Can Implement ‘Family Media Use Plans’ in Primary Care to Reduce Pediatric Behavior Concerns

Problem: Parents of children 2-5 years-old increasingly reach out to PCPs for escalating behavior concerns, including when the child doesn’t listen well, is inattentive, having tantrums, meltdowns, hitting, yelling, etc. Referrals to psychiatry and/or play therapy result in long waits, or referrals not accepted. Coincidingly, toddler and preschool aged children continue to exceed daily screen time recommendations. This results in a gap of care for families with young children and externalizing behavior.

Methods: This quality improvement project addressed …

District Impact On State-Wide Charter School Policy: Has Normandy Schools Collaborative Punctuated The Equilibrium? Charter School Policy Analysis Of The Missouri Department Of Elementary And Secondary Education, Tracey L. Cannon

Dissertations

Abstract

Punctuated Equilibrium Theory, as applied by Niles Eldredge and Stephen Jay Gould (1941-2002) to the study of species evolution, examined the infrequency of morphological change or stasis discontinuity.1 While groundbreaking in the field of Paleontology and the study of fossil change, the theory has been well-fitting to the decision sciences as introduced by Baumgartner and Jones2, in their 1993 and 2010 publications. Recognizing typical, incremental policy change, its use in this research looks at how stasis, stagnant policy can be punctuated by changes in political or societal views. This study examines the impact of heightened problem discussion for agenda …

Remote Home Blood Pressure Monitoring For Management Of Hypertension, Kathleen M. Oliphant

Dissertations

Remote home blood pressure (BP) monitoring has the potential to improve patient engagement and adherence with the prescribed treatment plan for managing hypertension. This DNP project examined the effects of daily remote BP measurement using transmission of biometric data through a Bluetooth-equipped device paired to participants' smartphones. The clinical management of a chronic condition such as hypertension is a long-term process, but the findings of this DNP project supported the empirical evidence showing that remote BP monitoring improves patient outcomes.

A Qualitative Study Utilizing The Design Thinking Process To Structure And Organize For Small Group Reading Instruction In Third, Fourth, And Fifth Grade, Ashlee Utt

Dissertations

Having educated and knowledgeable classroom teachers in reading instruction is a key tool in changing the dynamics of the struggling readers in schools. Being able to lead reading instruction in both whole and small group ensures students are able to learn and build reading strategies and skills to be implemented during whole group and independent time, where text is utilized with grade-level expectations. Utilizing explicit small group instruction can have a positive effect on student achievement and success. Research has shown that “guided reading makes it possible for students to effectively process an appropriate text every day, expanding their reading …

Giftedness In A Post-Secondary Environment: Academic, Social, And Affective Results And Recommendations, Justin Villet

Dissertations

The field of gifted education has been present in America since the early 20th century (Jolly, 2009). After scholars developed a list of gifted characteristics in the 1950s, the concept of giftedness became far more controversial (Terman & Oden, 1959). Over the last 75 years, gifted education in America has gone from a shining star to complete ambiguity, owing partially to politics and partially to decentralized process (Ford, 2013; Gallagher, 2015; Hodges et al., 2018). This study included an examination of the gifted experience from the secondary to post-secondary environments. The researcher examined various qualitative and quantitative secondary data, including …

A Four-Truth Exploration Of Memory, Social Connection, And Belonging In Fairground And Tower Grove Parks In St. Louis, Missouri, Kenya D. Womack, Adeola N. Adewale, Marie E. Boesch, Gelene M. Strecker-Sayer

Dissertations

Historic racism supported practices such as redlining, discriminatory zoning, and racial steering that separated people and determined the flow of resources and investment into neighborhoods. Communities continue to experience the long tail effects of historic patterns of racism. That is, historic inequities influence the opportunities that residents have to connect with each other and thrive in urban areas. Urban neighborhood parks have the potential to bridge social divides and bring a community together. This basic qualitative research study examines two contested heritage sites in St. Louis, Missouri: Fairground Park, a park in a Black neighborhood that has been historically disinvested …

In Living Memory: Curatorial Perspectives Of Jewish Heritage In Holocaust Public Histories, Hannah M. Lahti

Dissertations

Holocaust Museums present a history of the genocide of European Jews, while Jewish Museums represent the long history and diverse cultures of Jewish life. By examining Holocaust public histories in Poland and the United States, this dissertation outlines the historical and memorial conditions that inform museum exhibits, as well as the curatorial approaches that synthesize historical information, spatial contexts, and material culture into exhibition narratives and historical representation. This dissertation employs exhibition analysis to explain existing curatorial approaches in Holocaust public histories and identifies curatorial principles and methods of display that might translate to new exhibits. Informed by the models …

The Write Time For An Autoethnography: How Writing Project Has Shaped My Understanding Of Professional Learning In Community, Tracy Brosch

Dissertations

This study critically examines the cultural and societal phenomenon that comprises the National Writing Project (NWP), specifically reflecting on my experiences of re-designing Gateway Writing Project professional learning experiences as a leader in the organization. I reflect on my encounters, collaborations, and decisions as an Institute instructor and analyze them within the theoretical framework of Communities of Practice using autoethnography as my research methodology. This autoethnographic narrative documents my analysis and understanding of NWP’s framework of social practices, chronicling my journey from participant to advocate and from organizer to leader. Employing the autoethnographic method enabled me to illuminate my own …

The Hitching Post: American Poetry And Chinese Mythology, Xiamara Elena Hohman

Dissertations

In this dissertation, I examine the ways in which Chinese mythology has figured in American poetry, focusing particularly on the ways Chinese mythologies have served—and continue to serve—as “hitching posts,” quasi-material sites from which meaning can be created and explored. As I am defining it, a myth is a narrative that gives meaning to a lived experience. It explains what we commemorate and worship and renders meaningful both celebration and life. In the first three chapters of this study, I discuss the ways in which Chinese myths and cultural practices have been both used as hitching posts and appropriated by …

Modernism’S Mythic Mothers: Queering Motherhood Through Classical Matrilineage, Samantha Marie Lepak

Dissertations

I position this dissertation at the intersection of modern/contemporary literature, queer/feminist theory, and ancient Greek classics in the hopes of better understanding the spaces in which they meet, engaging with writers from the late modernist era to the present in order to highlight the connections between theories, themes, and practices of queerness from the modernists forward. Using the work of H.D. and writers following in her footsteps, I argue that exploring adaptations of Greek classics written primarily by female and gender-variant authors from the modernist era forward illuminates the extent to which the classics enables writers to “think queerly,” considering …

Maternal Access For Depression In Rural Environments, Simone Parlier

Dissertations

Significance –As many as 25% of birthing persons experience postpartum depression (PPD) within the first year after childbirth making this one of the most common postpartum disorders. PPD is prevalent, incapacitating, and treatable. The first step is identifying those at risk. Rural birthing persons are understudied, and may have unique predisposing characteristics as well as geographic challenges for optimal detection and treatment of PPD. Purpose -The long-term goal is to improve the health of rural families. Using The Theory of Unpleasant Symptoms, the purpose of this descriptive, cross-sectional research was to describe the prevalence of PPD in rural birthing persons …

Ethnicity Through Education: An Analysis Of The Influence Of Formal Education On Ethnicity In Garo Hills, Samirkumar Benedict Talati

Dissertations

In recent decades, the positioning of ethnic groups within the educational context has emerged as an important area of scholarly investigation. The structural, institutional, and local contexts often determine how ethnic groups shape their ethnicity. This study draws from panethnicity and social ontology frameworks to examine ethnic consciousness and the processes of solidarity-building across subgroups within the Garo community in the Garo Hills of Meghalaya. The unequal distribution of educational resources has led to socioeconomic disparities and class formation within Garo society, creating a growing divide between the educated and uneducated Garos. While acknowledging the diversity among subgroups, this study …

St. Louis, Missouri’S Gayborhood And Washington, Dc’S Black Lives Matter Plaza: Revealing The Healing Potential Of Resistance Stories That Are Grounded In Place, Ryan R. Lindsay, Lotte I. Lent, Ackesha J. Patrick

Dissertations

Oppressed people resist, even when facing severe consequences for doing so. At the core of systemic oppression—genocide, slavery, racism, and sexism—is a drive to control and dehumanize. Resistance, however, can serve as a powerful act of rehumanization. From enslaved individuals fleeing plantations to LGBTQ+ individuals risking arrest to gather in mid-20th-century bars, resistance reclaims power and autonomy under oppressive regimes. This study applies South Africa’s Truth and Reconciliation Commission (TRC) “four truths” framework—comprising forensic, personal, social, and healing truths—to the interpretation of contested heritage sites. We argue that sites commemorating resistance hold transformative potential for individual and community healing. Using …

Toward Culturally Responsive Interpretation: Native American Histories, Lifeways, And Ways Of Knowing At The High Desert Museum, Carol Fitzsimmons, Ajena Cason Rogers

Dissertations

Many public museums and historic institutions reflect settler colonial culture and are primarily non-Native led. Although these institutions are trusted, many have perpetuated cultural harm through the theft of belongings, the misrepresentation of stories and histories, and the inaccurate portrayals of cultural content. When interpreting Native American experiences, many non-Native institutions struggle to co-create culturally responsive interpretation. The purpose of this basic qualitative study was to apply the four-truth framework, developed by the South African Truth and Reconciliation Commission, to better understand how the High Desert Museum approached the interpretation of Native American content and stories and to explore how …

The Clinical Utility Of Measuring Emotion Dysregulation In Autistic Youth, Monica S. Trevino

Dissertations

Autistic youth experience disproportionately high rates and severity of emotion dysregulation, which is linked to behavioral challenges, psychiatric comorbidities, familial stress, and increased emergency service and hospitalization use. Despite its clinical significance, emotion dysregulation in autistic youth remains relatively understudied and misunderstood, partly due to the lack of standardized assessment tools and limited research on its heterogeneity within autistic populations. In the present study, structural equation modeling was used to 1) validate the Emotion Dysregulation Inventory (EDI) and assess measurement invariance in a diverse sample and 2) explore associations among emotion dysregulation, autism symptoms, and related child and family characteristics, …

A Design Based, Mixed Method Study On Evaluating Traditional Grading Practices And The Implications For Mastery Learning And Educational Equity In A Midwestern School District, Christina Kirchner

Dissertations

“Grades are an essential currency of our schools. Schools, colleges and employers use grades to determine many important, and in some cases, life-altering decisions-college admission, financial aid and scholarships, athletic eligibility, promotion, retention, awards, and supports” (Feldman, 2018, p. 3). Grading is not addressed in teacher preparation programs, or within professional development during teachers’ careers; teachers have chosen their own way to grade guided by their own personal experiences, uninformed of research or best practice. Using a human centric, design-based approach, the researcher identified multiple discrepancies with grading practices among the K-12 school organization. Within the discrepancies, other issues were …

Impact Of Student Voice In The (Dis) Engagement Of Middle School Students In Urban Elementary School And Academic Achievement, Valandra N. Lloyd

Dissertations

This formative mixed-methods evaluation study explores the impact of culturally inclusive teaching practices on student voice, engagement, and academic outcomes among middle school students in an urban elementary school. Grounded in the theoretical frameworks of Culturally Relevant Pedagogy (Ladson-Billings), Culturally Responsive Teaching (Gay), and Culturally Sustaining Pedagogy (Paris & Alim), the study addresses persistent academic disparities experienced by students of color. Using classroom observations, student surveys, student focus groups, and teacher interviews, the research examines how teacher facilitation and inclusive classroom environments affect behavioral, emotional, and cognitive engagement. Findings will inform actionable strategies to amplify student voice and promote culturally …

Navigating Emotional Transitions: A Study Of Self-Perception And Emotion In Bio-Childfree Women Entering A Blended Family, Janine Cednick

Dissertations

The transition to a blended family is an emotional and psychological adjustment for bio-childfree individuals. The present qualitative study investigated how self-concept and emotional adjustment of bio-childfree stepmothers change when they become members of their new family. With a phenomenological approach, semi-structured interviews were conducted with 12 female participants who were bio-childfree, in a committed relationship with a partner with children, and had cohabited for one year or more. The study aimed to find out how these women cope in their new role, their emotional adjustment to their transition, and the influences that impact their well-being. Thematic analysis of interviews …