Digital Commons Network^™

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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.

Grounded Leadership: A Look Into California Community College Mid-Level Leaders, Vicki Hou

Dissertations

Purpose: The purpose of this explanatory mixed-method study was to identify and describe what exemplary California Community College mid-level leaders do to maintain their physical, emotional, intellectual, social, vocational, and spiritual health based on the six dimensions of Rosen’s healthy leader model.Methodology: This study employed a purposive sampling method to select 15 mid-level leaders from two California community college districts. Data collection involved two instruments: the Stay Grounded Survey, administered to all 15 participants, and semi-structured interviews conducted with a subset of five participants. Quantitative data were analyzed using descriptive statistics including mean scores, frequency distributions, and standard deviations. Qualitative …

Leveraging Cultural Agility In K-12 Public Educational Organizations: A Phenomenological Study Of How Superintendents Coach Other Leaders, Curt Eichperger

Dissertations

Purpose: The purpose of this phenomenological analysis was to identify and describe how California K-12 public school superintendents use culturally agile task management competencies while coaching other leaders in their organization.Methodology: This phenomenological study identified and described the culturally agile task-management competencies that 12 California Central Coast Superintendents employ to navigate the complex and ever-evolving public educational landscape. Participants were purposively selected based on specific criteria. The researcher served as the primary instrument of data collection, conducting semi-structured interviews with participants. The data was analyzed and coded to identify themes and subsequent findings. Findings: This study identified eight key findings …

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 …

Bridging The Skills Gap: A Design Thinking Mixed Methods Approach To Workforce Readiness, Bernetta Matory–Sylvester

Dissertations

No abstract provided.

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 …

The Roots Of Our Food: Relationships Are The Seeds Of Care-Based Food Heritage, Nicole E. Post, Raena D. Parsons, Adrian Boone

Dissertations

The purpose of this co-authored, general qualitative research

study was to examine food relationships between individuals,

communities, and Earth. We explored the concept of relational food

systems pertaining to engagement ideas at EarthDance Organic Farm

School and Hawai’i Institute of Pacific Agriculture. Our research

furthers understanding about how to engage people, individually and

collectively, with the land to inspire action. We argue that care-based

relationships can inspire action, helping individuals reconnect with

their food heritage by engaging with land, community, and self.

Heritage site leaders in food systems who center interconnectedness

create places where relationships between people, land, and food …

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 …

Into The Language Barrier: Analysis Of The Debates Of Charles Taylor And Jürgen Habermas With Concentration On The Importance Of Philosophy Of Language, Tom Crosby

Dissertations

Jürgen Habermas (b. 1929) and Charles Taylor (b. 1931) are two of the most important philosophers of the late 20th and early 21st centuries. Throughout their lengthy bodies of work, spanning from the 1960s and continuing today, they were frequent interlocutors, and often responded to one another’s theories and arguments. They also engaged in direct debates in edited volumes to which they both contributed, including Communicative Action: Essays on Jürgen Habermas's The Theory of Communicative Action (1991), Multiculturalism (1994), and The Power of Religion in the Public Square (2011). The goal of this dissertation is to catalogue and analyze Habermas …

"The Divine Light Illuminates The Intellect:" The Role Of Divine Illumination In The Theology Of Meister Eckhart, John Marshall Loving

Dissertations

This dissertation is a study on the epistemological theory of divine illumination in the works of Meister Eckhart (c. 1260 - 1329 CE). Illumination, first asserted by St. Augustine, is the theory that the human intellect is incapable of achieving epistemic certainty regarding what it sensorily receives. To gain this certainty, the mind is reliant upon illumination, wherein the sensed object is known by the mind through the light of that object's divine idea, which also serves as its ontological principle. Divine illumination was the dominant epistemology in Christian thought for centuries until it began to lose its influence in …

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 …

Exploring Latinx Students' Experience With School Connectedness: A Hybrid Thematic Approach To Deductive And Inductive Analysis, Maria Olivia Mendez

Dissertations

This qualitative study aimed to deepen the understanding of school connectedness experienced by Latinx high school students. Specifically, the researcher sought to explore how Latinx students described their connection to school during their high school years. Additionally, to examine whether their experiences aligned with the social and ecological structures outlined in the theoretical model supporting adolescent connectedness to school. If there is alignment, in what ways did it manifest? If not, how did the experiences differ? The study had two primary objectives: (a) to gain insight into how Latinx students experienced school and their sense of connection through their narratives, …

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 …

Evaluating Depression In Adults Undergoing Substance Abuse Treatment: A Program Evaluation Of Intensive Outpatient Program, Chidochomoyo E. Zvirawa

Dissertations

Problem: Depression and substance use disorders (SUDs) frequently co-occur, complicating recovery outcomes. Despite screening recommendations, depression remains underdiagnosed in many SUD treatment settings.

Methods: This mixed-methods program evaluation examined depressive symptoms among adults in an Intensive Outpatient Program (IOP) using the Patient Health Questionnaire (PHQ-8). Depression screenings were conducted at intake, four weeks, and eight weeks. Eight participants meeting inclusion criteria were assessed. Data included demographics, treatment engagement, and PHQ-8 scores.

Results: PHQ-8 scores significantly declined from baseline (M = 11.75, SD = 6.52) to eight weeks (M = 5.13, SD = 5.05), t(7) = 2.76, p = .028, indicating …