Mental Health In The Post-Deployment Transition Assistance Program: A Qualitative Study Of National Guard Members' Experiences, Alayna L. Collins

Antioch University Dissertations & Theses

Objective: National Guard post-deployment and reintegration processes leave servicemembers with a unique urgency to return to their families, homes, and civilian lives due to the timing and location of the post-deployment Transition Assistance Program (TAP); consequently, National Guard members have reported “checking the boxes” on mental health screeners to prioritize a quick and smooth transition (Salahi, 2023). Although researchers have called for data on the experiences of National Guard members undergoing post-deployment TAP since 2005 (Bascetta), no research to date has answered this call. Method: Eight National Guard members who had been deployed and had undergone post-deployment were individually interviewed …

An Examination Of Harm During The Real-Life Experience, Michelle E. Balch

Antioch University Dissertations & Theses

The Real-Life Experience (RLE) has been described as a coercive and arbitrary requirement without evidence of validity or reliability. This can cause more harm than it prevents for a significant subset of transition-seeking transgender clients. For these reasons the RLE was dropped from the WPATH Standards of Care after version six. However, the RLE has been adopted by a number of health insurance companies as a measure of readiness to receive transition services. An Interpretative Phenomenological Analysis (IPA) and semi-structured interviews of five individuals were conducted to evaluate their perceptions of RLE and the meaning they attach to their broader …

Exploring The Use Of Somatic Skills And Techniques In Clinical Supervision, Areka D. Foster

Antioch University Dissertations & Theses

This study explores the lived experiences of clinical supervisors who engage in somatically oriented supervision. Informed by relational-cultural theory and polyvagal theory, the research employs a grounded theory methodology to investigate the potential development of a somatic supervision framework. Eleven participants completed semi-structured interviews and data were analyzed using both thematic analysis and grounded theory techniques. Eleven core themes emerged: (a) conceptualizations of somatic supervision, (b) integration of somatic techniques in supervisory practice, (c) theoretical foundations for somatic supervision, (d) attunement to countertransference, (e) the supervisory relationship, (f) trauma-informed approaches, (g) somatic techniques and practices, (h) initiating and structuring somatic …

Initial Validation Of The Measure Of Practical Existential Wellbeing, Bryant L. Moore

Antioch University Dissertations & Theses

According to the theory of existential psychology, all humans experience existential anxiety, a negative feeling that results from the understanding of certain unavoidable truths. If left unchecked, existential anxiety can lead to symptoms of mental illness. Much work has been done to explore and measure existential anxiety, but little has focused on protective factors within existential theory. This dissertation proposes the construct of existential wellbeing, representing protective factors corresponding to different existential domains. To assess this construct, a new instrument, the Measure of Practical Existential Wellbeing (MPEW), was developed, distributed, and analyzed in relation to other established measures. The MPEW …

Exploring The Perceptions Of Technology Use Of Clinicians And Their Clients, Chase M. Torbergson

Antioch University Dissertations & Theses

The research question guiding this study was: What is the perceived understanding of technology use by clinicians for their work with clients? Fourteen participants completed an online qualitative survey exploring their experiences with technology and media in clinical practice. A thematic analysis revealed four primary themes. The first theme, variations in counselor online media usage, highlighted differences in how counselors engaged with online platforms for education, client connection, and self-care. The second theme, counselor assessment of, and dialogue around, online media use, captured varying levels of intentionality in exploring clients’ digital habits, ranging from minimal inquiry to regular, structured discussions. …

Exploring Mental Health Concerns And Loneliness Among East Asian International Students In U.S. Universities, Shihan Xu

Antioch University Dissertations & Theses

This study examined the unique stressors encountered by international college students, with particular attention to East Asian international students, whose collectivistic cultural values contribute to their mental health status and reported symptoms. Following the COVID-19 pandemic, the rise in stress levels and loneliness highlighted the need for further examination. Using data collected in 2024 through the Counseling Center Assessment of Psychological Symptoms-34 (CCAPS-34) and the UCLA Loneliness Scale, the study surveyed East Asian international students enrolled in universities in the United States to identify prevalent mental health concerns and explore the correlation between loneliness and self-reported symptoms among East Asian …

Becoming And Belonging: Exploring Teachers’ Insights On Community Interest And Engagement In Waldorf Middle School Students, Monica Laurent

Antioch University Dissertations & Theses

This research explores how Waldorf middle school teachers experience, perceive, and support the development of community interest, engagement, and belonging among the early adolescence years of middle school. Adolescence, particularly ages 11 to 14, is a period of profound developmental transition characterized by intense emotionality, evolving identity, increased peer influence, and growing social complexity. Rudolf Steiner’s philosophical and pedagogical framework positions this stage as a time that leads to the birth of the astral or feeling body, contributing to new levels of self-awareness and the emergence of individuality, the beginning of critical thinking, and moral judgment. This period is also …

Beyond Strong: A Phenomenology Of Women Executives And The Connection Between Leadership And Fitness, Nozomi Bullock

Antioch University Dissertations & Theses

Senior-level executive leaders’ work in a dynamic, competitive, 24/7 business environment can be physically rigorous, mentally demanding, and emotionally isolating. The same holds true for women pursuing senior-level leadership roles in corporate America. Women who achieve and succeed in such roles remain the minority: Outsiders in elite spaces who are held to higher standards and overly scrutinized. Among senior-level executive women leaders, those committed to a fitness and training regimen including weightlifting constitute an even smaller minority. Senior-level executive roles require stamina, resilience, and courage—qualities that make up the foundation of the mindset of fitness and strength training (Foyster et …

My Body My Choice: A Qualitative Study Of Volitional Female Sterilization In The U. S. Latina And Hispanic Female Population, Heather Morris Tuip

Antioch University Dissertations & Theses

This qualitative study, utilizing an interpretative phenomenological analysis methodology, elucidates the experience of Latina and Hispanic women living in the United States who have volitionally undergone sterilization or have sought the procedure out for birth control. Understanding the rich, contextual, lived experience of Latina and Hispanic women through an intersectional framework highlights how cultural influences and contemporary policies on reproductive rights informed their personal choice to undergo a female sterilization procedure. The participants of this study shared how they made meaning of their experiences. Within a homogenous sampling of study participants who share ethnicities and genders, six group experiential themes …

Beyond Genes: Non-Canonical Mechanisms Driving Antimicrobial Resistance In Bacteria, Leonard Koolman, Chijioke Emenike, Debasis Mitra, Sourav Chattaraj

Research Outputs: 2025-Present

Antimicrobial resistance (AMR) is traditionally discussed in the context of horizontally acquired resistance genes and point mutations at target loci. However, this gene-centred model fails to account for a large number of clinically important modalities of resistance. There is now substantial evidence implicating bacteria in the ability to escape the effects of antibiotics in a variety of non-canonical ways, which are not considered in traditional diagnostic and surveillance pipelines. Among these factors, we can list those arising from global regulatory networks, phase variability, epigenetic tuning, small RNAs, genome structural variability, and phenotypic states like tolerance and persistence. This review will …

Modelling The Hydrologic Impact Of Land Cover On Stormwater Detention Basins In Harris County, Tx, Kabita Sapkota

Electronic Theses and Dissertations

Harris County on the upper Gulf Coast in Southeast Texas is susceptible to both riverine and coastal flooding due to intense, short-duration thunderstorms, slow-moving frontal systems, and tropical hurricanes. Low-lying terrain, clay soils with poor drainage, high annual rainfall, and a widespread network of bayous and streams all contribute to frequent flooding. To reduce the impacts of urbanization and the loss of surface storage, the Harris County Flood Control District (HCFCD) built detention basins throughout the county to temporarily store stormwater runoff and release it slowly, lowering peak flows and preventing downstream flooding and erosion. These basins vary in land …

A Quality Improvement Project: Increasing Nurse Satisfaction With Patient Educational Material Related To Pain Management Options During Labor, Madison Grant

Master's Theses and Capstones

BACKGROUND:

Pain management is a large portion of what nurses manage during the patient’s time on the labor and delivery unit. The primary forms of pain management that is available to women during this time includes epidurals, nitrous oxide, stadol/diphenhydramine, and nonpharmacological options such as breathing techniques. It is essential that patients are aware of all pain management options prior to entering the unit for delivery, however sometimes nurses have to help to close the educational gap.

LOCAL PROBLEM:

Within the microsystem, it was acknowledged that many patients lacked the education of their pain management options prior to delivery which …

Implementing Nurse-Driven Education On Patient’S Inpatient Boarding Status: An Emergency Department Quality Improvement Project, Jack Wallace

Master's Theses and Capstones

BACKGROUND:

Nurse-led education to inpatient boarding patients in the emergency department is essential to improve patient’s understanding with their care and nurse’s satisfaction surrounding communicating with their patients. Inpatient boarding in the emergency department is associated with poor patient outcomes, adverse events, and reduced communication between patient and nurse.

LOCAL PROBLEM:

Within this microsystem there is a gap in patient understanding of their admission status. This includes who the patient’s provider is, which provider to direct questions to, and why the patient is still in the emergency department.

METHODS:

The plan-do-study-act quality improvement framework was utilized to improve nurse-led patient …

Timing And Temperature Of Newborn Baths: A Qualitative Improvement Initiative Through Nursing Staff Development, Eileen Harwood

Master's Theses and Capstones

Abstract

BACKGROUND: Newborn bathing is a common task performed in a labor and delivery unit of a hospital, a newborn’s bath temperature, timing and how long it is performed, are important metrics to consider. Due to a newborn’s immature thermoregulation, there are multiple implications that come with receiving a bath that is not an optimal temperature or that is too soon after birth. As newborn bathing is often overlooked task due to its quotidian nature, a literature review of current evidence-based practice revealed the urgency to keep the optimal conditions at the forefront of considerations for both nurses and caregivers. …

A Quality Improvement Initiative To Enhance The Effectiveness Of Pre-Anesthesia Documentation And Nurse Satisfaction In The Pacu, Stephanie Colon

Master's Theses and Capstones

Background: Documentation is an essential component of healthcare delivery, especially in perianesthesia nursing. Electronic health records (EHR) have helped create high-quality documentation according to the standards of the American Nurses Association. However, EHRs have been found to be burdensome on nurses when they interfere with their workflow.

Local Problem: The documentation process for pre-operative anesthesia assessments within a nine bed PACU in Southern New Hampshire was found to be inefficient, increased chances of error or mistakes, and delayed patient data being accessible to the team.

Methods: Using the Plan-Do-Study-Act (PDSA) model, a quality improvement project was performed to update and …

A Quality Initiative To Reinforce Nursing Staff Education On Fall Prevention Interventions To Enhance Patient Safety And Outcomes On A Medical-Surgical Unit, Jolena Senesombath

Master's Theses and Capstones

Background:

Patients are at an increased risk for falls on a medical-surgical unit due to a variety of factors such as increased age, medications, altered mobility, and more. Several fall prevention interventions are used to prevent falls, including use of call bells, bed and chair alarms, maintain a clutter free environment, using a fall risk assessment upon admission, and providing patient and staff education. Reinforcing education for nursing staff has been shown to be one of the most effective interventions in preventing and reducing the number of falls as it increases awareness of falls.

Local Problem:

Within the microsystem, patient …

Improving Intensive Care Unit Nurses' Knowledge And Confidence In Performing Effective Spontaneous Awakening Trials: A Quality Improvement Project, Sophia T. Merry-Carreiro

Master's Theses and Capstones

Abstract

BACKGROUND

Mechanically ventilated ICU patents often require sedation for comfort and ventilator compliance. However, oversedation is linked to negative outcomes such as delirium, prolonged ventilation, and increased duration of ICU stay. Current best practices now support the use of daily sedation interruptions such as Spontaneous Awakening Trials (SATs). Despite these recommendations, implementation of SATs remain inconsistent and suboptimal.

LOCAL PROBLEM:

Within the ICU in a northern new England hospital, there was a need to improve nurse confidence and knowledge in SATs practices through staff education.

METHODS:

Using the Plan-Do-Study-Act (PDSA) model, a quality improvement project was developed to improve …

Prioritizing Safety Through Evidence-Based Fall Prevention Signage: A Medical-Surgical Quality Improvement Project, Sonila Murati

Master's Theses and Capstones

Background: Falls in the inpatient setting can result in prolonged hospitalization, injury, and increased healthcare costs. Older adult patients are particularly vulnerable due to age-related physiological decline and comorbidities, underscoring the need for effective fall prevention strategies.

Local Problem: In a medical-surgical telemetry unit at a New Hampshire hospital, monthly patient falls continued to be a persistent concern. Leadership identified inconsistent adherence to fall precautions as a key contributing factor, particularly concerning a predominantly older adult population with high fall risk. This project aimed to reduce preventable falls by reinforcing staff awareness through visual reminders.

Methods: Guided by the Plan-Do-Study-Act …

Enhancing Patient Safety By Increasing Daily Weight Measurement For Intensive Care Through Nursing Education: A Quality Improvement Project, Liz Prior

Master's Theses and Capstones

Background: For critically ill patients in the Intensive Care Unit (ICU), accurate daily weight measurements are crucial for monitoring fluid status and ensuring correct medication dosages. However, variations in measurement techniques, accuracy, and documentation can render this data unreliable. This often leads to a reliance on less accurate measures, which may contribute to longer treatment courses and suboptimal patient outcomes.

Local Problem: At a 3-bed ICU in a critical access hospital, staff interviews revealed inconsistencies among nurses in the daily measurement of patient weights. The lack of a standardized protocol created barriers to the usefulness of serial daily weight data. …

Enhancing Triage Accuracy And Nursing Confidence Of The Emergency Severity Index To Improve The Effectiveness Of Triage Through Targeted Education: An Evidence-Based Quality Improvement Project, Mia K. Saucedo

Master's Theses and Capstones

Background: The Emergency Severity Index system is a standardized triage scoring guide used by emergency department nurses to efficiently assess patients based on severity and projected recourse needs. Studies have found that knowledge and confidence gaps among nurses may lead to improper triage score, leading to the misallocated spread of resources and longer wait times, increasing rates of morbidity and mortality. Early recognition of patient severity is vital for providing proficient patient care and improving patient outcomes and increased education is needed to improve this gap in nursing knowledge and confidence.

Local Problem: At a small, critical care access center …

Reinforcing Nursing Staff Knowledge For Accurate Cam-Icu Assessment And Documentation In A Medical Icu: A Quality Improvement Project, Tiffany Rzepka

Master's Theses and Capstones

Background: Delirium is an acute state of confusion that can lead to increased morbidity and longer hospital stays. Patients in the ICU are at high risk for developing delirium due to additional risk factors such as mechanical ventilation and sedation. The Confused Assessment Method for the Intensive Care Unit (CAM-ICU) is a tool used by nursing staff to document and assess for delirium.

Local Problem: The microsystem in this project is a 16-bed medical ICU in central New Hampshire. In the microsystem, CAM-ICU documentation compliance is tracked monthly, but the accuracy of the documentation is not routinely assessed. Stakeholders have …

Enhancing Patient Outcomes And Safety By Reinforcing Nursing Staff Education About Fall Risks And Prevention In The Orthopedic Unit: A Quality Improvement Project, Sarah S. Walsh

Master's Theses and Capstones

Abstract

Background: Inpatient falls remain a significant concern for orthopedic units, especially among elderly post-surgical patients. Despite existing protocols, fall incidents persist due to various modifiable and non-modifiable risk factors. Nursing staff play a critical role in fall prevention, and targeted education is essential to reinforce best practices.

Local Problem: The orthopedic microsystem reported 13 falls during the 2023–2024 fiscal year, with contributing factors including post-operative weakness, patient confusion, and inconsistent communication. Staff surveys revealed gaps in education, awareness, and communication related to fall incidents.

Methods: A quality improvement initiative using the Define, Measure, Analyze, Improve, Control (DMAIC) model was …

Directing Patient Hand Hygiene Before Meals In The Icu: A Quality Improvement Project To Enhance Patient Safety, Nicholas Davini

Master's Theses and Capstones

BACKGROUND:

Hospital-acquired infections (HAIs) are a major problem in healthcare, increasing patient morbidity, mortality, and costs. While staff hand hygiene is a well-established infection control measure, less attention is paid to patient hand hygiene (PHH) despite CDC recommendations.

LOCAL PROBLEM:

An intensive care unit (ICU) in northeastern Massachusetts had no formal policy for patient hand hygiene, and hospital leadership expressed support for enhancing infection control practices.

METHODS:

Using the Plan-Do-Study-Act model, a quality improvement project was implemented to encourage PHH before meals. Baseline PHH rates were collected through observation. The intervention involved registered nurses (RNs) directing patients to use hand …

Educating Staff On Effective Ways To Improve Medication Discharge Instructions In Emergency Departments (Ed): A Quality Improvement Project, Isabelle L. Kuhn

Master's Theses and Capstones

Background: Emergency Departments (EDs) serve a vital role in treating acute conditions, yet they face challenges in ensuring patients understand discharge instructions, particularly those related to medications. Approximately 70% of ED patients demonstrate deficits in at least one discharge domain, including medication understanding. Limited health literacy, time constraints, and rushed environments contribute to these gaps. Improving discharge communication is critical to reduce medication errors and prevent avoidable readmissions.

Local Problem: In a Northern New England ED, an assessment of the microsystem highlighted that patients often struggled to understand medication discharge information, increasing the risk of non-adherence and readmission. …

Optimizing Surgical Count Accuracy And Efficiency Through Enhanced Operating Room Communication To Promote Patient Safety: A Quality Improvement Project, Jessica L. Limbocker

Master's Theses and Capstones

Abstract

Background: Retained surgical items (RSIs) are classified as “never events” because they are preventable and pose significant risks to patient safety. This quality improvement (QI) project aimed to reduce the risk of RSIs, particularly during Cesarean sections by identifying gaps in surgical count practices and implementing targeted interventions.

Local Problem: At the project site, baseline assessments revealed gaps in surgical count practices. These included inconsistent documentation, absence of formal education on count procedures, and communication barriers among the intraoperative team—all contributing to increased risk of RSIs.

Methods: This QI project implemented a multi-faceted intervention to enhance …

Enhancing Patient-Centered Suicide Prevention: A Quality Improvement Project Addressing Educational Gaps In Staff Caring For Veterans, Shayla Craigue

Master's Theses and Capstones

Veterans are at significantly higher risk for suicidal ideation (SI) than the general population and often encounter barriers to care such as stigma, trauma, and distrust in healthcare systems. This quality improvement project, conducted at a Veterans Affairs (VA) Urgent Care Clinic, aimed to enhance trauma-informed care by addressing educational gaps among clinical staff. Using the Plan-Do-Study-Act (PDSA) model, the intervention included a pre-intervention survey to assess baseline knowledge, a targeted educational poster informed by survey findings, and a post-intervention survey to measure changes in staff confidence, resource awareness, and understanding of the role of the mental health response team, …

Improving Nurse Knowledge And Attitudes Through Education On Integrative Pain Management In A Medical-Surgical Unit: A Quality Improvement Project, Samantha Hamilton

Master's Theses and Capstones

Abstract

Background: Pain management in medical-surgical microsystems is complex, with many patients experiencing acute and chronic pain that can be difficult to control. Nurses often receive limited continuing education on integrative and comprehensive pain management strategies, highlighting a need to improve their knowledge and attitudes toward evidence-based, multimodal approaches.

Local Problem: Nurses in this 38-bed medical-surgical microsystem identified a gap in education related to integrative pain management strategies. This may lead to a reliance on pharmacological interventions and missed opportunities for holistic, patient-centered care

Methods: A 25-day quality improvement project was conducted using an asynchronous educational PowerPoint on integrative …

Improving The Effectiveness Of Post-Anesthesia Care Unit Transitions: A Quality Improvement Initiative Using A Standardized Nurse Handoff Report Sheet, Myra Mcauley

Master's Theses and Capstones

Background: Effective communication during patient handoff in the post-anesthesia care unit (PACU) is essential to ensuring patient safety and continuity of care. Unstructured or inconsistent handoff processes can lead to information omissions and care delays.

Methods: This quality improvement project implemented a structured nurse-to-nurse handoff report tool in the PACU. A pre- and post-intervention survey design was used to assess nurses’ perceptions of handoff clarity, completeness, and satisfaction. Educational sessions supported implementation.

Results: Pre-intervention survey data revealed dissatisfaction with the current handoff process, citing frequent information gaps. Following implementation of the structured tool, post-survey results showed improved communication clarity, increased …

A Quality Improvement Project: Increasing Pre-Term Infant Safety By Enhancing Skin-To-Skin Time In The Nicu, Maureen A. Cassidy

Master's Theses and Capstones

Background: Skin-to-skin (STS) contact, also known as kangaroo care, is a critical intervention for preterm infants, especially for those in the neonatal intensive care unit (NICU). It promotes neurodevelopmental outcomes, physiological stability, and parental bonding. However, STS often falls below recommended daily levels due to a variety of berries. Exploring aids like belly bands may help address these barriers and promote improved outcomes.

Local Problem: STS time in this NICU microsystem falls significantly below nationally recommended levels, with most preterm infants receiving less than one to two hours daily compared to the World Health Organization’s recommendation of 8-24 hours per …

Enhancing Patient Safety And Nursing Satisfaction In The Operating Room By Implementing Standardized Handoff Communication Sheets: A Quality Improvement Project, Hayleigh Mcneil

Master's Theses and Capstones

Background: Communication is essential to workflow in the operating room. In this microsystem, circulating nurses required relief nurses when necessary breaks were needed. Written communication allows for nurses to quickly access information when they are giving handoff reports.

Local Problem: An operating room in a trauma level two hospital in New England had a verbal handoff that was inconsistent and left relief nurses with incomplete reports. This issue caused a decrease in nursing satisfaction with a potential decrease in patient safety.

Methods: Using the Plan-Do-Study-Act model, a written standardized communication sheet was created and implemented. Data was …