Digital Commons Network^™

Healthcare Professionals' Experiences Of Mental Health Crises Among People Experiencing Homelessness, John P. Gilmore

International Nursing Research Congress (INRC)

Background: People experiencing homelessness face significant barriers to accessing mental health care, often resulting in untreated psychological distress and crisis presentations. In Ireland, the absence of dedicated mental health services for this population means that frontline clinicians frequently manage acute mental health deterioration within generalist settings not designed or resourced for such care.

Aim: To explore the experiences of healthcare professionals responding to mental health crises among individuals experiencing homelessness and to identify systemic, relational, and organisational factors influencing care delivery.

Methods: A descriptive qualitative study informed by critical realism was conducted using semi-structured interviews with 14 healthcare professionals, including …

Clarifying The Concept Of Virtual Nurse: A Concept Analysis For Aging And Chronic Care, Chia-Hui Chou, Heng-Hsin Tung

International Nursing Research Congress (INRC)

As the global healthcare landscape grapples with aging populations and the growing burden of chronic diseases, digital innovations like the Virtual Nurse (VN)—AI-powered embodied conversational agents—are gaining recognition for their potential to support patient self-management and improve care delivery. This study applies Walker and Avant's 8-step concept analysis to clarify the definition, boundaries, and essential characteristics of the Virtual Nurse. Thirteen peer-reviewed articles published from 2010 to 2021 were reviewed, focusing on their applicability to older adults and chronic disease management. Four defining attributes emerged: (1) clinical interactivity, (2) human-like empathy, (3) accessibility and understandability, and (4) scalability with feedback …

Experiences With Microaggression Of African American Female Faculty Who Work In Predominantly White Institutions, Teffany Jonte Malone

Walden Dissertations and Doctoral Studies

The problem addressed through this study is the gap in the literature on the experiences of African American female faculty in higher education institutions with racial microaggressions while working in predominantly White institutions (PWIs). Grounded in Delgado and Stefancic’s critical race theory, the purpose of this basic qualitative study was to explore African American female faculty’s experiences with racial microaggressions and recommended support their institutions can put in place at PWIs in California. For this basic qualitative design, data were collected through semistructured interviews with 15 African American female faculty members employed at PWIs in California. Through qualitative content analysis, …

Adults’ Lived Experiences With Placement In Child Protective Services During Adolescence, Michaela First Haynes

Walden Dissertations and Doctoral Studies

Perceptions of safety and emotional support during involvement with child protective services (CPS) during adolescence may play a significant role in shaping attachment experiences and relationships in adulthood. Although researchers have examined the effects of child maltreatment and foster care involvement, limited research has explored how adolescents perceive emotional support and safety during CPS involvement and how those experiences influence attachment in adulthood. The purpose of this qualitative study was to explore the lived experiences of adults who experienced CPS involvement during adolescence and to understand how perceptions of safety and emotional support are reflected in their adult attachment relationships. …

Exploring The Experiences Of Nigerian Army Personnel With Toxic Leadership, Shamsideen Toyin Shafaru

Walden Dissertations and Doctoral Studies

Toxic leadership has been shown to be present in Nigeria, promoting negative consequences for organizations and adverse effects on employee performance. However, how toxic leadership behaviors impact Nigerian Army operations and the performance of personnel have not been studied. Exploring toxic leadership in the Nigerian Army is important because the way in which leaders exercise influence determines the effects it has on followers. The purpose of this general qualitative study was to examine the lived experiences of Nigerian Army personnel who had worked as subordinates of individuals who exhibited toxic leadership traits and its impact on their performance. The theoretical …

The Lived Experiences Of Midlife Black Women In Atlanta Managing Hypertension Through Nonpharmacological Interventions, Beth Feagins

Walden Dissertations and Doctoral Studies

In this qualitative phenomenological study, the beliefs and lived experiences of midlife, low-income Black women with hypertension were explored, concentrating on understanding how social determinants of health influence effects adherence to diet, physical activity and stress management. Social determinants of health and how health beliefs shape adherence to behaviors were examined. The study was guided by a dual theory approach of the social cognitive theory and theory of planned behavior. Six women, identified as Black, between the ages 40-60, diagnosed with hypertension and living in Atlanta, Georgia, participated in the study. Data was analyzed using Moustakas’ phenomenological analysis and revealed …

Staff Education To Improve Clinical Staff Knowledge, Confidence, And Use Of The Patient Health Questionnaire-9 (Phq-9) In Outpatient Depression Screening, Madjou Stella Ngantche

Walden Dissertations and Doctoral Studies

Depression is one of the most common mental health conditions encountered in outpatient practice, yet inconsistent use of standardized screening tools contributes to missed opportunities for early identification and intervention. In outpatient settings, nurses and other clinical staff are often responsible for administering depression screenings; however, many lack formal education on the standardized use of the Patient Health Questionnaire-9 (PHQ-9). To address this practice gap, this Doctor of Nursing Practice (DNP) staff education project was implemented in an outpatient setting to determine whether staff education on the use of the PHQ-9 would improve staff knowledge, confidence, and intent to use …

Effects Of Exercise On The Quality Of Life And Functional Capabilities For Individuals With Spinal Cord Injury, Luis Ellerbe

Doctorate in Kinesiology

Spinal cord injury (SCI) can significantly impact physical functioning, mental health, social support, and overall quality of life. The purpose of this study was to examine the effects of a 12-week standardized exercise program on quality of life and functional capabilities in adults with SCI. Participants completed a self-guided exercise program consisting of aerobic and strengthening activities performed twice weekly for 12 weeks. Outcome measures included the Spinal Cord Independence Measure (SCIM), 6-Minute Walk Test (6MWT), Hospital Anxiety and Depression Scale (HADS), and Multidimensional Scale of Perceived Social Support (MSPSS). Assessments were completed at baseline, post-intervention, and at a 6-month …

Postmodern Fantasy & Its Twin Traditions, Skyler J. Alexander

Honors Thesis

Fantasy literature is diverse and difficult to categorize; nevertheless, throughout the twentieth century two main subgenres emerged: sword-and-sorcery and high fantasy. This thesis examines the differences and similarities between these two traditions, how contemporary examples of the genre fit into or diverge away from the traditions that influenced them, and proves in the negative what and how much of contemporary fantasy fiction is original to itself, with no prominent antecedent. The analysis was performed by comparatively reading two contemporary fantasy novels, The Eye of the World by Robert Jordan and A Game of Thrones by George R. R. Martin, with …

Multimodal Digital Libraries: A Response To Culturally And Linguistically Sustaining Classrooms, Abigail Lopez

Masters Projects

Poorly represented minority groups fail to connect reader identity backgrounds

with the characters in texts due to curriculum traditionally relying on English dominant

translations. This system challenge deficit fails students by placing limitations on the

exposure of rich vocabulary, cultural awareness and sets up lack of engagement. This

project is grounded in Culturally and Linguistically Sustaining Pedagogy, Sociocultural

Theory, Constructing Reader Identities and Engagement theories that transforms

student diversity into an instructional practice that empowers multilingual learners.

To empower students, this digital culturally relevant library optimizes educator

planning time. This digital library provides immediate access to multicultural books

alongside a …

Experiences Of Novice Assistant Principals: Perceptual Evidence From Texas, Gregory Vidal

Electronic Theses and Dissertations

Assistant principals play essential roles in supporting instructional leadership and campus operations. However, limited research has examined how novice assistant principals experience their transition into administration and interpret their preparation and support. This study addressed the gap in understanding how novice assistant principals in a suburban Texas public school district made sense of their preservice preparation and early leadership practice, and how these experiences shaped their perceptions of training and organizational supports. The purpose of this qualitative, experiential, phenomenological study was to explore the lived experiences of novice assistant principals during their first three years in the role. The study …

Faktor Yang Berhubungan Dengan Perilaku Merokok Pada Pekerja Tambang Batubara Di Pt X Kabupaten Kutai Kartanegara, Alma Feriyanti, Lies Permana, Ida Lestari, Rina Tri Agustini

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Smoking behavior remains a significant public health concern, particularly in high-risk occupational settings such as coal mining. Coal mine workers are exposed to various occupational stressors and psychological challenges that may contribute to smoking behavior.

Objective. This study aimed identify factors associated with smoking behaviour among coal mine workers at PT X in Kutai Kartanegara regency.

Methodes. A quantitative cross-sectional study was conducted involving 113 respondents selected from total population workers using convenience sampling. Data were collected through a structured questionnaire assesing smoking behavior, length of employment, and psychological stress levels. The chi-square test was applied to examine associations …

The Effectiveness Of "Little Doctor" Training On Health Knowledge And Behavior Of Karawang Primary Students (2025), Aurelia A. Erawan, Shahnaz F. Azzahra, Rubee P. Risdiyanto, Patricia Andini, Muhammad K. Ramadhan, Ailsa T. Kirana, Istingadah Desiana Md, Raden M. Rifada Md

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Acute respiratory infection (ARI) remains a major public health problem in Indonesia, with West Java reporting the highest incidence. Poor Health-Related Behavior (HRB) practices are associated with increased ARI risk. The "Little Doctor" program is a government initiative that focuses on school health and aims to promote HRB among students. Along with this goal, this study aimed to determine the effectiveness of the program in improving knowledge of HRB and ARI among elementary school students in Pancawati Village, Karawang Regency.

Methods. This study employs a quasi-experimental one-group pretest-posttest design. Participants were selected based on inclusion criteria referring to the …

Ildar Niyazov V. Attorney General United States Of America

2026 Decisions

Agency

The Consequences Of Using Human Behavior To Train Ai, Lauren Treiman

McKelvey School of Engineering Graduate Student Theses & Dissertations

Artificial intelligence (AI) is now an integral part of everyday decision making. These systems not only help us make choices but also learn from our behavior. Therefore, it is important to understand how our interactions with AI influence these systems. Current approaches often assume that the behavior used to train AI accurately reflects how people would naturally behave. However, people are often informed that their choices will be used for AI training, and as a result, may change how they would normally act. In this dissertation, we combine psychological and computer science perspectives to investigate the consequences of this awareness. …

Workforce Solutions For Primary Care Physician Shortages In Veterans Health Administration Outpatient Clinics, Quintin Warner

Walden Dissertations and Doctoral Studies

The shortage of primary care physicians (PCPs) in the Veterans Health Administration (VHA) hospital system highlights the need for strategies to effectively mitigate this issue. The purpose of this integrative review was to examine the literature on primary care physician shortages in VHA hospital-based outpatient clinics and determine evidence-based solutions. The review question centered on strategies and best practices that can be implemented to address PCP shortages in VHA outpatient clinics. The Donabedian Model provided the framework for analyzing structural factors, processes, and patient outcomes. A comprehensive review of the literature resulted in 40 articles being screened for quality and …

Probation Officers’ Experiences Supervising Domestic And Intimate Partner Violent Probationers, Megan Davis

Walden Dissertations and Doctoral Studies

This study includes insights regarding potential supervision challenges that are faced by probation officers overseeing domestic and intimate partner violence (IPV) probationers, emphasizing the importance of effective management to enhance offender accountability and victim safety. The relationship dynamic between probation officers and domestic and IPV probationers influences recidivism rates, highlighting the importance of effective and empathetic supervision. The purpose of this study was to identify gaps in training, supervision strategies, and resources, with a focus on integrating attachment-based practices to improve outcomes. Guided by the attachment theory, the research included key questions about supervision effectiveness and relational dynamics. Employing a …

Effective Strategies Small Business Owners Use To Sustain Their Businesses During Periods Of Disruption, Tracey Starr Moon

Walden Dissertations and Doctoral Studies

Small businesses experience significant challenges sustaining operations during periods of disruption, including economic uncertainty, natural disasters, supply chain interruptions, and other environmental changes. This is a concern for small business owners because disruptions can reduce revenue and strain limited financial and operational resources, putting their continued survival at risk. Grounded in the resilience theory, the purpose of this qualitative pragmatic inquiry project was to identify and explore effective strategies small business owners use to sustain their businesses during times of disruption. The participants were six small business owners in the southern United States. Data were collected through semistructured interviews and …

Strategies To Improve Communication Among Culturally Diverse International Manufacturing Teams, Bessem Enow Nchenge

Walden Dissertations and Doctoral Studies

Inefficient communication and insufficient collaboration in multicultural organizations can result in suboptimal team performance and stifle employee creativity. Manufacturing firm leaders who struggle with communication issues are concerned about deterioration in team cohesion, worker productivity, and information flow. Grounded in the theory of planned behavior, this qualitative, pragmatic inquiry research project explored strategies that leaders of international manufacturing firms use to bridge cultural differences and improve communication among international team members to enhance team performance. The participants were six leaders from manufacturing firms in the southwestern United States with international manufacturing agreements who demonstrated measurable success in improving communication among …

Staff Education To Improve Skills In Detecting And Addressing Medication Nonadherence Among The Psychiatric Nursing Staff, Uchenna Owunna

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project was a staff education project focused on addressing the knowledge gap of medication nonadherence patterns by the psychiatric nurses in outpatient settings. Nonadherence to psychiatric medications is a major health issue that leads to disruptions of care and symptom relapse, hospitalization, and suboptimal treatment outcomes as well as high healthcare costs. Thus, improving the capacity of the psychiatric nurses to enhance medication adherence through staff education is essential. The purpose of this DNP project was to determine if a comprehensive medication adherence education program would increase psychiatric nurses’ knowledge and skills in assessing …

Immigration Status And Lung Cancer Diagnosis In U.S. First-Generation Immigrants, Valeriya Lockwood

Walden Dissertations and Doctoral Studies

The healthy immigrant effect (HIE) is an observed phenomenon in which immigrants exhibit better health outcomes than native-born residents, though relatively few studies have examined its role in chronic diseases in the United States. The purpose of this quantitative cross-sectional study was to assess the associations between immigration status, age, sex, race/ethnicity, median household income, and geographic location and lung cancer diagnosis in first-generation immigrant adults aged 18 or older. The subsequent health trajectory model provided the theoretical framework for the study. Data were obtained from the SEER*Stat Database 1975-2022 (N = 1,993). Binomial regression analysis showed that immigrants were …

Relationship Of Covid-19-Related Racial Discrimination And Oppressed Identities On Chinese American Mental Health, Allison A. Fong

Doctoral Dissertations

Although anti-Asian hate has been present throughout history, the country witnessed an uptick in race-based violence and discrimination against Asian Americans during the COVID-19 pandemic. Utilizing the framework of intersectionality, this quantitative cross-sectional study aimed to capture the additive impact of various forms of oppression, including COVID-19-related racial discrimination, on levels of depression, anxiety, and life satisfaction in Chinese American college students (n = 35) in the Greater San Francisco Bay Area. Within this relationship, bicultural identity integration was also explored as a possible moderator. Although regression analysis did not show significant relationships between COVID-19-related racial discrimination and intersectional discrimination …

``But What About Me?'': A Structural Redesign For Cascading Trust Into An Integrated Culture Of Care, Hazelin Hei Laam Ngan

Patient Experience Journal

In healthcare, patient experience (PX) and employee experience (EX) are often managed as separate priorities despite their interdependence. This article presents a case study from NYC Health + Hospitals/Community Care, a 250-person safety-net division providing home-based services across New York City. In response to frontline staff repeatedly asking, ``But what about me?'' when offered PX best practice suggestions, the organization integrated patient experience, staff engagement, and wellness into a unified Care Experience portfolio led by the Chief Experience Officer. From this structural redesign emerged a practical framework for trust-building organized around three pillars: Purpose, Presence, and Partnership. Purpose aligns staff …

Patient Psychological Safety: A Qualitative Study Of Patient Experiences, Derick R. Simmons, Cheryl Rathert, Ryan Valayil, Maria Joseph, Ibraheem Jawadi

Patient Experience Journal

There is growing interest in understanding patients' experiences with psychological safety during healthcare encounters. Recent studies reveal that patients describe needing patient psychological safety (PPS) to form connections with their care providers, which are associated with better health outcomes. Therefore, it is critical to examine indicators of PPS. Using a phenomenological interpretive approach, this study utilized a patient narrative survey methodology to qualitatively explore how and why patients experience a lack of PPS during their healthcare encounters. We surveyed patients from across the U.S. and analyzed responses among a sub-sample of respondents to an open-ended question whose responses indicated they …

Patient-Centred Care: An Integrated Bibliometric And Structural Equation Modelling Approach, Japheth Nuhu Ahmed

Patient Experience Journal

This study investigates how communication and service quality in Patient Relationship Management impact patient satisfaction through trust. The literature in this field is predominantly in developed countries, whereas it is scarce in sub-Saharan Africa. Combining bibliometric analysis and structural equation modelling, the study highlights emerging research trends and provides empirical evidence to guide healthcare practitioners, policymakers, and researchers in improving patient care. To strengthen its theoretical foundation, the study integrates the Social Exchange Theory and Expectancy–Disconfirmation Theory to explain the model. The study retrieved quantitative data from the Scopus database for bibliometric analysis. A questionnaire was used to collect data …

From Anticipation To Relief: Anxiety Reduction And Patient Experience As Indicators Of Trust During Dental Extractions In Orthodontic Treatment, Kanza Tahir, Mubassar Fida, Rashna Hoshang Sukhia

Patient Experience Journal

Trust is central to healthcare encounters involving fear and uncertainty. This quasi-experimental study evaluated changes in anxiety before and after dental extractions performed during orthodontic treatment planning and examined whether patient experience factors were associated with post-extraction anxiety. Fifty patients aged 11–40 years undergoing fixed orthodontic treatment requiring extraction were recruited consecutively at a tertiary care hospital from October 2023 to June 2024. Anxiety was measured immediately before and after extraction using the Beck Anxiety Inventory. Post-procedure patient experience was assessed with a structured questionnaire addressing reassurance, communication, privacy, shared decision-making, perceived understanding, and overall experience. Paired t-tests and simple …

Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust In Their Inpatient Physicians—A Convergent Mixed-Methods Study, Marlise Jeanne Pierre-Wright, Ibrahim Badreldin Mokhtar, Uma Thachapuzha, Yashoswini Chakraborty, Revika Singh, Rachel O'Conor, Jing Song, Julia Lee, Maria E. Theodorou, Christine Schaeffer, Kimberly Collins, Muriel Jean-Jacques

Patient Experience Journal

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants …

Navigating Uncertainty: Patient Experiences Of Birads 0 Mammogram Results, Petranea Smith, Jasmine Warren, Marina Demas, Roberta Goldman, Joanne E. Wilkinson

Patient Experience Journal

Objective: Describe experiences of patients receiving BIRADS 0 (inconclusive) mammogram results in electronic health portals. Methods: Recruited eighteen patients who had received BIRADS 0 results via the portal in the last 5 years.Semi-structured interviews yielded qualitative data, analyzed sequentially using the immersion crystallization method to identify content and then iterative coding both individually and in groups. A team of 4 researchers coded and analyzed the transcripts, using repeated meetings and a shared spreadsheet to organize codes and develop thematic elements via visual organization. Results: Themes included baseline comfort/trust with healthcare and how it interacted with anxiety about the uncertainty of …

Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii

Patient Experience Journal

Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …

Pathways To Patient-Provider Conflict In Nigeria: A Structural Equation Model Of Expectations, Communication, Trust, And Organizational Constraints, Akaninyene O. Unaam, Christie Divine Akwaowo, Edidiong A. Unaam

Patient Experience Journal

Objective: This study empirically investigated the drivers of patient-provider conflict and tested a conceptual model linking treatment expectations, communication, trust, and organizational constraints to conflict intensity in Nigerian tertiary care. Methods: A cross-sectional survey of 400 patients (response rate 82.3%) and 150 healthcare providers (response rate 71.2%) from three Nigerian tertiary hospitals was conducted using stratified random sampling. Validated, culturally adapted scales measured unrealistic treatment expectations, communication barriers, organizational constraints, trust, and conflict intensity. Data were analyzed using Structural Equation Modeling (SEM) with maximum likelihood estimation and bootstrapping for mediation testing. Multi-group confirmatory factor analysis established measurement invariance across samples. …