Digital Commons Network^™

Screening For Bullying In A Middle School Setting, Paige Bernau

Dissertations

Problem: Bullied youth are two and a half times more likely to experience depression and three times more likely to experience anxiety and suicidal ideation than their peers (Li et al., 2024). Schools represent a key access point for mental health support and treatment for youth (Duong et al., 2020). Despite this, schools typically do not have formal bullying screening integrated into student support services.

Methods: This program evaluation used a descriptive, observational design to evaluate a bullying screening program in a suburban middle-school. This program used the California Bullying Victimization Scale (CBVS) to assess for bullying victimization (BV) followed …

Implementation Of A Human Papillomavirus Vaccination Toolkit Postpartum, Eriola Arapi

Dissertations

Problem: Despite strong recommendations from the Centers for Disease Control and

Prevention (CDC, 2021) for HPV vaccination in individuals aged 9 to 26, postpartum women

are often overlooked as a target population. Every year in the U.S., oncogenic human

papillomavirus (HPV) infection causes approximately 330,000 cases of precancerous cervical

dysplasia and 12,000 cases of cervical cancer, the most common female cancer attributable to

HPV (Wang et al., 2024). Many providers miss the opportunity to offer the vaccine during the

postpartum hospital stay and the six-week visit—when patients are insured, motivated, and

more accessible.

Methods: This quality improvement (QI) project used …

Implementation Of An Evidence-Based Postpartum Depression Screening Tool In A Level Iv Neonatal Intensive Care Unit, Morgan A. Takacs

Dissertations

Problem: Postpartum depression (PPD) affects up to 40% of mothers with infants admitted to the Neonatal Intensive Care Unit (NICU), yet many remain undiagnosed due to the absence of standardized screening protocols. Early identification and referral to Perinatal Behavioral Health Services (PBHS) is critical to support maternal well-being and improve neonatal outcomes.

Methods: This evidence-based quality improvement project utilized a descriptive and correlational design to evaluate the impact of implementing the Patient Health Questionnaire-8 (PHQ-8) for PPD screening among mothers of infants born ≤ 32 weeks’ gestation in a Level IV NICU. A convenience sample of 29 mothers received the …

Evaluation Of A Behavioral Response Team To Decrease Use Of Violent Restraint, Katherine Skrade

Dissertations

Abstract Introduction: The purpose of this Quality Improvement project was to evaluate the implementation of the Behavioral Assessment and Response Team (BART) and evaluate its effect on occurrence and duration of violent restraints on non-psychiatric floors in a pediatric hospital. This QI project also aimed to correlate the use of the Broset Violence Checklist (BVC) to the utilization of the BART as a means of predicting patient escalation, as well as to assess the effect of booster education on the BVC and BART on bedside staff confidence in utilization of these resources.

Methods: Data was collected across three time periods: …

Implementing A Standardized Protocol To Screen For Depression In A Gastroenterology Outpatient Clinic, Catherine M. Karle

Dissertations

Problem: There is a lack of mental health screenings for depression taking place in outpatient gastrointestinal (GI) clinics. Outpatient gastrointestinal (GI) offices are not consistently screening patients for depression despite a rise in depression rates and the known adverse impact depression can have on the GI tract.

Methods: This Quality Improvement (QI) study used a descriptive research design guided by the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model. Its purpose was to implement a 10-week PHQ-2/PHQ-8 depression screening protocol at a large midwestern health center's gastroenterology outpatient clinic. The study used purposive sampling, including all GI outpatients aged 18+ with …

Palliative Care Beyond Cancer: The Use Of The P-Cares Tool, Breslin E. Meyer

Dissertations

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers?

This project was conducted over 9 weeks, utilizing convenience sampling to select 20 …

Implementation Of Quantitative Blood Loss To Detect Postpartum Hemorrhage After Vaginal Birth, Raven S. Simpson

Dissertations

Problem: In the U.S., postpartum hemorrhage (PPH) is attributed to maternal morbidity and mortality, resulting in long-lasting effects of extended recoveries, surgical interventions, birth-related trauma, interruptions in mother-infant bonding, or death. Performing estimated blood loss (EBL) measurement methods postpartum is subjective and often associated with over- and underestimations of blood volume. The delay in recognition interferes with timely, efficient, and appropriate interventions, yielding a PPH (≥1000ml).

Methods: A quality improvement (QI) project was initiated with a descriptive, pre-implementation/post-implementation focus on a high-risk Labor and Delivery unit to explore the effects of Quantitative Blood Loss (QBL) measurements on the identification of …

Increasing Access To Asthma Education Through Digital Technology And Surveying Preferences Of Children And Families, Corrin E. Brockschmidt

Dissertations

Abstract

Asthma is a chronic respiratory condition impacting approximately 4.6 million children, with high rates of uncontrolled cases in Missouri. This quality improvement project aimed to explore the use of a digital media system to provide asthma education to children and families receiving care in a rural pediatric pulmonology clinic aged 6 months- 21 years of age; and to assess preferred media format, priority topics, and knowledge gained from exposure to digital educational materials. Utilizing a prospective cohort design, families completed a pre-survey to identify educational preferences and tailored digital asthma education through the use of Patient Education Genius (PEG). …

Implementation Of A Nurse-Driven Process To Decrease Npo Times In A Geriatric Emergency Department, Luke D. Little

Dissertations

Prolonged nil per os (NPO) status for geriatric patients in the emergency department is a critical safety issue, leading to increased rates of delirium, hypoglycemia, and perioperative complications. A quality improvement project was designed to address this problem through a targeted, nurse-driven intervention. In geriatric patients (age ≥70) in a geriatric emergency department, this project aimed to determine if implementing an electronic health record (EHR)-prompted nursing workflow to obtain a diet order would reduce the length of time patients were kept NPO compared with standard practice. An EHR documentation tool was designed and implemented along with targeted nursing education sessions …

Transportation: A Barrier To Healthcare Access Among Disabled, Older Adults With Diabetes And Hypertension In Rural Areas, Anne G. Mwangi-Amann

Dissertations

Problem: Transportation is essential for health service utilization (clinic appointments, diagnostic services, and picking up medications from the pharmacy (Hansmann & Razon, 2024). Shekelle et al. (2022) in their systematic review and meta-analysis indicated that the U.S. rural population is 60 million. Rural areas continue to experience transportation as a significant barrier to health, a key social determinant of health. It causes delayed or foregone care in approximately 3.6 million people annually, resulting in more than 25% of missed appointments. Methods: This quality improvement project utilized a descriptive and observational design. A convenience sample of Medicaid patients receiving care at …

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 …

Implementing Behavioral Management And Social Skills Training For Pediatric Patients With Adhd And Their Caregivers, Meagan A. Conwell

Dissertations

Problem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.

The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric …

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 …

Evaluation And Expansion Of Posttraumatic Avoidance Assessment: Proposal Of A Novel Measure Of Posttraumatic Positive And Negative Experiential Avoidance For Use In Research And Clinical Practice, Marissa A. Yetter

Dissertations

Avoidance is a well-established mechanism in the development and maintenance of posttraumatic stress disorder (PTSD) and a central treatment target in gold standard evidence-based interventions. While traditionally defined as avoidance of trauma-related distressing thoughts, emotions, and reminders, emerging research highlights the need for a broader conceptualization of posttraumatic avoidance that includes both negative and positive emotional experiences. The current study aimed to explore an expanded conceptualization of clinically relevant posttraumatic avoidance using an experiential avoidance framework, a more generally defined unwillingness to remain in contact with distressing thoughts, feelings, memories, and other internal experiences. A sample of non-treatment seeking U.S.-based …

Nanoporous Gold Nanoparticles And Model Membrane Systems Applied To The Study Of Lipopolysaccharide (Lps), Dhanbir Lingden

Dissertations

Lipopolysaccharide (LPS), a key structural component of Gram-negative bacteria, is a major trigger of sepsis and septic shock, the systemic inflammatory conditions responsible for millions of deaths annually. Even at concentrations as low as 1 ng/mL, LPS can activate the immune system and initiate inflammatory cascades. According to the Global Burden of Disease Study 2017, sepsis accounted for 48.9 million cases globally, with 11 million deaths, emphasizing the urgent need for improved diagnostic and therapeutic strategies.

Accurate and rapid detection of LPS is vital for early intervention and improved clinical outcomes. While traditional detection methods are still widely used, modern …

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 …

Truth, Resilience, And Healing: Deepen Understanding Of Native American Federal Boarding School Histories, Toya D. Holiday

Dissertations

Indigenous communities have endured the long-standing impacts of U.S. Federal Indian boarding school policy. The history of Indigenous boarding school policies and the underlying intent to enact cultural genocide is unknown and unacknowledged. The perspectives of Indigenous Peoples have been excluded from dominant narratives, and until recently, from heritage site programming, leading to intergenerational trauma, fragmented identities, and the misrepresentation of Indigenous cultures and experiences. This basic qualitative study asked the question: When the four-truth framework, developed by the South African Truth and Reconciliation Commission, is applied to U.S. Federal Indian boarding school policy, Native American boarding school history, and …

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 …

Post-9/11 Navy Service Members’ Barriers To Using Military Educational Benefits, Karen D. Cross

Dissertations

There are studies explaining how many service members are using military educational benefits or the challenges service members incur after they have enrolled in school and are attending classes. There are also studies that report how many service members use military educational benefits. However, studies exploring why some service members, or some Post-9/11 service members in particular, do not use military educational benefits has been limited. The purpose of this study was to discover why many service members in the United States Navy do not or did not take advantage of military educational benefits. This study also sought to find …

Illuminating Trauma & Resilience In Educational Spaces: Expanding Narratives To Promote Historical And Critical Civic Empathy At Little Rock Central High School National Historic Site, Chakakuan Johnson, Linda Nance, Byron Witherspoon

Dissertations

Abstract

The 1957 desegregation crisis at Little Rock Central High School marked a defining moment in the Civil Rights Movement and continues to symbolize the broader struggle for racial equality. This dissertation examines equity in educational spaces through a four-truth lens that was first articulated by the South African Truth and Reconciliation Commission and explores forensic, personal, social, and healing truth. Using Little Rock Central High School National Historic Site (CHSC) and park interpretation as the focal point, our qualitative research study used reflexive thematic analysis to examine oral interviews, onsite observations, and various documents and artifacts, and to illuminate …