Digital Commons Network^™

A Clinical Pathway For Differential Diagnosis Of Adhd Vs Trauma: Early Childhood Recognition And Intervention, Maria Neiers

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Distinguishing Attention-Deficit/Hyperactivity Disorder (ADHD) from Complex Posttraumatic Stress Disorder (C-PTSD) presents significant diagnostic challenges due to overlapping symptom presentations, shared neurobiological impacts, and frequent comorbidities. This paper explores the nuanced clinical differentiation between ADHD and C-PTSD, and other trauma disorders, in pediatric populations, emphasizing the importance of trauma-informed assessment, early identification, and integrative clinical reasoning. The discussion highlights how structured diagnostic reasoning can reduce uncertainty, enhance diagnostic clarity, and support effective treatment planning. As a central contribution, this paper introduces an original clinical reasoning flowchart and a case conceptualization to illustrate its practical application in real-world diagnostic dilemmas. The need …

Applying Contextual Behavioral Science To Address Addictions In Monsters, Chase Hollander

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

The dominant essentialist paradigm in addiction treatment often conceptualizes addiction as a curse or plague which seizes the individual afflicted by it. Such views are reinforced by neurobiological interventions like Medication-Assisted Treatment (MAT). While MAT can reduce cravings and withdrawal symptoms, its long-term efficacy is mixed, and its emphasis on abstinence as a primary outcome limits its scope. Addiction is a multifaceted phenomenon shaped by physiological, psychological, social, and systemic factors—including stigma, moral judgment, and structural oppression. Essentialist approaches frequently pathologize individuals and obscure these broader influences. In contrast, contextual behavioral sciences and therapies aligned with functional contextualism such as …

Proposed Theoretical Model Of Pediatric Onset Multiple Sclerosis And Restrictive Eating Behaviors, Anna L. Smith

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Multiple Sclerosis (MS), a chronic, demyelinating, autoimmune disease that causes an array of physical and cognitive symptomatology, is commonly diagnosed in adulthood. Pediatric Onset Multiple Sclerosis (POMS) is characterized by diagnosis of the disease before age 18 and accounts for about 5% of MS cases. While there is a growing body of literature examining the impact of adult-onset multiple sclerosis on psychosocial functioning, research specifically addressing POMS remains limited. Moreover, there is a notable gap in the literature regarding the risk of eating disorders among individuals with POMS. This paper will explore a constellation of potential risk factors that may …

Supporting Healthy Siblings In Pediatric Cancer: Advancing Relational Interventions To Heal Invisible Wounds, Kristen K. Wederski

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

Healthy siblings of children diagnosed with cancer occupy a uniquely vulnerable position within the pediatric oncology landscape. Individuals within this population often demonstrate significant emotional distress and can experience long-term psychological challenges. Despite their risk, healthy siblings remain under-researched and under-supported compared to pediatric patients and caregivers. Existing interventions tend to prioritize individual coping skills and psychoeducation and often overlook the critical relational dynamics that shape healthy siblings' psychological adjustment. Grounded in systematic and relational theories, this paper proposes a paradigm shift toward relationally focused interventions that strengthen the caregiver-sibling bond as a core mechanism of change to foster resilience …

Unleashing Nk Cells For Cancer Immunotherapy In Lung Cancer: Biologic Challenges And Clinical Advances, Quinlan Mclaughlin, Dorothy K Sojka, Kathleen Kennedy, Sytse J Piersma, Nan Sethakorn

2020-Current year OA Pubs

Natural killer (NK) cells are a crucial part of the innate immune system and serve as an important effector for killing tumor cells through direct cytolytic activity or immunomodulatory signaling to T cells and antigen presenting cells. NK cells are correlated with increased tumor control and better overall patient survival across various types of cancers including non-small cell lung cancer (NSCLC). Despite their promising potential for anti-tumor killing, NK cell function is often diminished within the tumor microenvironment. There are many factors that lead to decreased tumor-infiltrating NK cell killing, including immunoinhibitory factors from tumor cells and resident tissues, acquired …

Sars-Cov-2 Antibody Responses In Children Exhibit Higher Fcr Engagement And Avidity Than In Adults, Carolyn A Cohen, Ludivine Grzelak, Susan S Chiu, David Sc Hui, Mike Yw Kwan, Owen Ty Tsang, Wai Hung Chan, Yat Sun Yau, Kelly Wk Lee, Masashi Mori, Gaya K Amarasinghe, Samuel Ms Cheng, Leo Lm Poon, Malik Peiris, Sophie A Valkenburg

2020-Current year OA Pubs

As intrinsic differences in humoral immune response to SARS-CoV-2 between children and adults remain unclear, we improved characterisation by defining the kinetics, specificity and function of antibodies to SARS-CoV-2 in children (n = 146, aged 9.4 ± 4.8 years with n = 257 samples) compared to adults (n = 85, aged 39.5 ± 15.2 years with n = 122 samples). We used plasma samples from an infection and vaccination-naive cohort study with RT-PCR confirmed ancestral B.1* SARS-CoV-2 virus infection with asymptomatic or mild disease, collected in Hong Kong between March to December 2020, from acute (0-14 days post infection) to …

The Shift: Embracing Loving Kindness And Nurse Well-Being As A Standard Of Care, Margaret Mcgrath Brown, Jennifer Rodriguez

Creating Healthy Work Environments (CHWE)

In response to mounting evidence of clinician burnout, the US Surgeon General declared a call to action, “we need to build a culture that supports well-being. It’s time to break the traditional silence surrounding the suffering of health workers”[1]. Our clinicians’ suffering in survival mode was confirmed by the findings from participation in a 2021 multi-site study among 60 Magnet hospitals evaluating clinician wellbeing[2].

Our organization embarked on a top-down/bottom-up approach rooted in loving kindness and personal and professional development. Over time, a shift has occurred, and an intentional transformation began towards viewing nurse well-being as a standard of care. …

Building A High-Performing Critical Care Outreach Team: Transforming Care And Collaboration, Heather Joy Cook, Brittany M. Wells

Creating Healthy Work Environments (CHWE)

The Critical Care Outreach Team (CCOT) at our large urban university medical center has become a cornerstone of patient safety and care, driving a significant cultural shift in rapid response and interdisciplinary collaboration from 2014 to 2024. Through the adoption of the six American Association of Critical Care Nurses (AACN) Healthy Work Environment standards, the CCOT has not only reduced cardiac arrests outside of critical care areas but also fostered a collaborative relationship based on trust, clinical excellence, and patient safety among ward staff that has transformed the culture of Rapid Response activations.

Clinical excellence has not been the only …

Introduction Of Code Lavender To Support The Well-Being Of Clinical Staff After Critical Events, Shannon Souther, Eunyoung Lee, Milena Staykova

Creating Healthy Work Environments (CHWE)

Debriefing after critical events can benefit individual healthcare workers and create a healthier work environment within the interdisciplinary team. The desire to participate in interdisciplinary debriefing (IDD) among healthcare workers has been expressed in previous studies. However, it may be difficult for workers to debrief without strong, hospital-wide support.

Purpose: A pilot study was conducted, intended to introduce and measure the feasibility of a new modality to deliver IDD, “Code Lavender.” The new process was aimed at addressing a known barrier to IDD by offering hospital support.

Methods/Implementation: IDD was implemented in 3 ICU settings over a 3-month period. Code …

Fostering Excellence Through Development Of A Code Stroke Response Nurse, Emma Bingham

Creating Healthy Work Environments (CHWE)

Situation: Toronto Western Hospital (TWH) is a Regional Stroke Centre, meaning that patients suspected of stroke bypass other centres to access TWH. This designation results in care for neurologically complex patients, requiring efficient stroke protocols and proficient, knowledgeable clinicians. Notification of a patient en-route to the Emergency Department with a suspected stroke sets off a cascade of events that require a streamlined, coordinated approach; a Code Stroke.

Background: There were many factors reinforcing the need to reevaluate TWH’s Code Stroke protocol, including the change to administration of tenecteplase for ischemic stroke, significant wait times and subsequent unsafe patient ratios in …

Growing Dreams: Enabling Rural High School Students' Healthcare Career Futures Via A Summer Camp, Minerva Gonzales, Adrian Billings, John Dijo, Katie Miller

Creating Healthy Work Environments (CHWE)

Rural health systems and hospitals are foundational to the health and economy of rural communities. Although rural healthcare organizations face multiple challenges, one of the most significant is recruitment and retention of the workforce. According to the American Hospital Association (2022), rural areas account for nearly 70% of Health Professional Shortage Areas (HPSAs). In addition, recruitment to a rural community can be difficult and retainment is even more challenging (Cosgrave et al., 2019). With these challenges in mind, an interdisciplinary and multi-institutional team collaborated to initiate a rural healthcare summer camp for rural high school students from the region at …

Work Safety Climate, Heat-Related Illness, And Pesticide Risks Among Latino Farmworker Adolescents, Fiorella L.Carlos Chavez, Priscilla Carmiol-Rodriguez, Taylor J. Arnold, Evan P. Anderson, Alexandra Brewis, Amber Wutich, Keenan A. Pituch, Scott C. Carvajal, Thomas A. Arcury, David W. Coon

Creating Healthy Work Environments (CHWE)

Among Latino farmworker adolescents (FWA), previous studies found that almost 50% reported HRI and symptoms while working in the fields and that being an older adolescent (compared to a younger one) increased the probability of reporting work-related injuries and HRI. Furthermore, Latino FWA often lack work experience, which could lead to unsafe occupational behaviors. Work safety climate (WSC) is the degree to which a worker perceives management values production over safety. Evidence suggests that weak WSC could lead farmworkers to engage in fewer safety procedures, increasing their risk of occupational injuries. Nevertheless, WSC research on HRI and pesticide risk (PR) …

Emergency Nurses’ Barriers To Caring For Psychiatric Boarders: A Theory Of Planned Behavior Approach, Rachel Keslar, Cindy Bacon

Creating Healthy Work Environments (CHWE)

In 2021 around 2.5 million patients sought psychiatric care through the emergency department.¹ However, emergency department based psychiatric care has challenges including overcrowded hectic environments ^2–5 and prevalent patient violence.^2,4,5 This includes the practice of boarding where medically cleared patients cannot be dispositioned due to inadequate non-emergency department services6 and wait in the emergency department for hours, days, or longer.⁷ This leads to negative patient effects including increased vulnerability,³ distress,⁵ and violence.⁸ The purpose of this presentation is to show how the Theory of Planned Behavior was used to identify practice barriers in caring …

Exploring Secondary Traumatic Stress: The Frontline Psychiatric Mental Health Nurses' Perspective, Stacy Horowitz

Creating Healthy Work Environments (CHWE)

Background: Research demonstrates that Psychiatric Mental Health Nurses (PMHNs) are affected by Secondary Traumatic Stress (STS). As many as 44% of PMHNs experience clinical levels of psychological distress and STS as compared to RNs in other specialties, including those in forensic nursing. Interventions that promote RN resilience are mentioned less frequently in this research.

Objectives: To explore frontline PMHNs’ perspective on STS and remaining safe and engaged at work on the inpatient behavioral health unit.

To solicit PMHNs’ input on helpful interventions to foster the development of "Universal Precautions" against STS.


Method: Eleven PMHNs participated in one of three focus …

Enhancing Resilience In Nursing Education Through The Lens Of Gratitude, Sarah B. Hathcock, Deanna B. Hiott, Carol K. Archuleta

Creating Healthy Work Environments (CHWE)

Resilience has consistently been identified as a hallmark characteristic among individuals who invest themselves in the workplace, while also finding meaningfulness and happiness in their work (Keener et al., 2021). Moreover, resilience is a protective health factor essential to an individual’s ability to negate the harmful effects of stress; it is a construct linked to improved mental and physical health (Asensio-Martínez et al., 2019). Nursing faculty, like all nurses, have the personal responsibility to ensure they are employing practices to foster and maintain their personal well-being, while also contributing to a healthy work environment. The Three Good Things gratitude practice …

Using Faculty And Staff Voice To Drive Workplace Well-Being Strategy, Angela G. Opsahl, Jennifer Louise Embree, Whitney Osborn

Creating Healthy Work Environments (CHWE)

The purpose of this presentation is to describe a faculty and staff wellbeing strategy in an academic setting.

Workplaces supporting wellbeing have employees three to nine times more likely to have good mental and physical health, little stress, no burnout, and high-quality work life, compared to workplaces providing little or no wellbeing support.

Academic leaders saw an opportunity to make a difference in faculty and staff wellbeing. Faculty and staff perspectives were identified through the MiniZ Survey General, and open-ended questions, and leaders developed wellbeing sessions and programs. The first session was a wellbeing workshop hosted just prior to an …

Making Fractals: Expanding Learning Opportunities In The Classroom, Eliza Leszczynski, Eileen Fernández, Elise Lahiere

LASER Journal

Fractals have long been appreciated for their beautiful, self-similar structure and infinite complexity. Commonly found in art and architecture, fractals are not only visually appealing but they have been found to reduce stress in individuals because of their patterns’ connections to nature. Fractal structures can even be seen in familiar real-life objects like trees or cauliflowers. Fractal geometry, with its ability to create complicated effects from simple formulas, provides a way to connect mathematics with visual results that are “spontaneously attractive, and often breathtakingly beautiful". The act of creating fractals can spark curiosity, enabling participants to generate vastly different results …

A Technical And Statistical Analysis Of Unleaded Aviation Fuel (Ul94) Adoption In A High- Volume Collegiate Aviation Environment, Nicholas D. Wilson, Ryan Guthridge, Brandon Wild, Jeremy Roesler, Daniel Kasowski, Nick Geinert, Aaron Terbest, Aaron Fettig, Robert Kraus

Journal of Aviation Technology and Engineering

The University of North Dakota (UND) adopted unleaded aviation fuel (UL94) for approximately a four-month period in the summer and early fall of 2023. The UL94 fuel was used in all reciprocating engine fleets based at the university’s primary training airport, Grand Forks International Airport in North Dakota. During the operational implementation of UL94, the UND flew 46,600 flight hours, consuming 386,778 gallons of fuel across all fleets powered by Lycoming engines. After approximately two months of using UL94, operational reports and maintenance inspections began to indicate potential for exhaust valve seat recession (EVSR), although early indications were limited in …

Contributing Factors To Low Airspeed On Climb-Out As A Precursor To Loss Of Control In Flight, Owen D. Poborsky

Journal of Aviation Technology and Engineering

The nature of aviation is not without inherent risk. Conducting training flight operations increases these inherent risks. Flight data monitoring and voluntary safety action programs seek to reduce risk, as seen in their success at commercial airlines. These successes are slowly permeating into general aviation through programs such as the National General Aviation Flight Information Database (NGAFID). The NGAFID is a program funded by the Federal Aviation Administration that allows general aviation operators to have the ability to collect and share de-identified flight data on an aggregate level to identify trends and increase safety margins during flight operations. This study …

Do You Have T.I.M.E.?: A Resiliency Tool, Jessica Sutterfield

Creating Healthy Work Environments (CHWE)

Aims. The study was designed to examine the problem solving tool as an effective method to increase resilience and emotional intelligence for nurses in a hospital setting.

Background. Burnout has become a concern across the United States for the current nursing workforce and is expected to continue to impact the nursing shortage [1]. Resiliency has long been an issue in a demanding and stressful environment at the bedside as well as the hospital setting in general [2]. While research indicates resiliency training and education are effective in increasing resilience, gaps occur in preparing resilient nurses with a proactive approach and …

Self-Leadership Boosts Collaboration And Patient Outcomes, Carine Prinsloo

Creating Healthy Work Environments (CHWE)

Self-leadership is a pivotal concept that enhances the capacity of healthcare professionals to engage in and promote interprofessional collaboration. Self-leadership involves the ability to self-motivate and manage one's actions through behaviour-focused strategies, constructive thought patterns, and natural reward strategies (Neck, et al 2020). Nurses fostering self-leadership, develop a heightened self-awareness that enables them to recognize when to seek support and collaborate with other healthcare professionals effectively. Nurses who exhibit strong self-leadership skills are more likely to engage in proactive communication and collaboration with their colleagues, utilizing interprofessional resources to improve patient outcomes (Matahela & van Rensburg 2023). This collaboration is …

Peer Champions For Team Well-Being, Richard J. Westphal

Creating Healthy Work Environments (CHWE)

Co-worker peer support is a critical component of unit cohesion and social support in high stress exposure teams and can mitigate stress-related symptoms.1 A primary advantage of co-worker peer support is that it is available when needed and provided by those who “get” the context of the stress experience. The effectiveness of peer support programs has begun to take hold, helping institutions address issues of shame and isolation among their healthcare workers.2 Following the COVID pandemic, we see even more calls for health systems, state boards, licensing bodies, and professional organizations to step up and prioritize clinician well-being.3

There are …

Do Well-Being Programs Improve Work Environments? Evaluating State-Level Nurse Peer Support Programs, Pamela B. De Cordova, Irina Grafova, Jennifer Polakowski

Creating Healthy Work Environments (CHWE)

Introduction: Well-being programs geared to improve the work environment should be tailored to the individual and organization (Browne & Tie, 2024). The New Jersey Nursing Emotional Well-Being Institute (NJ-NEW) launched Stress First Aid (SFA) and Virtual Schwartz Rounds (VSR) – peer support programs to address nurse well-being. SFA is a framework of actions to decrease stressors that exist within an individual’s or organizations’ level of control and facilitate recovery (Dong et al., 2022; McLean et al., 2023; Westphal & Watson, 2021). VSR is an online emotional support program led by 2 mental health facilitators and 2 nurse panelists who share …

Guiding Inclusive Learning: Using Ideas To Transform Workplace Diversity And Well-Being, Vanessa Kay Cameron, Jillian Russell, Jennifer Bodine, Rachel Kelter

Creating Healthy Work Environments (CHWE)

Bias, prejudice, or discrimination can be found in all areas of life through action and inaction, creating a call to action for systemic change in nursing (Wakefield et al., 2021). Given the need for a reflective nursing workforce to reduce health disparities (Stanford, 2020) and the predicted nursing shortage, identifying strategies to recruit and retain a diverse nursing workforce in healthy work environments (HWE) is key (Rosseter, 2023). This work aims to provide strategies for educators to develop inclusive learning environments to promote workplace diversity and wellbeing.

Intentional application of inclusion, diversity, equity, and accessibility (IDEA) principles can foster belonging …

Unity And Kindness Day: A Transformative Event To Promote Equity, Diversity, And Inclusion, Adisa Cartwright, Michelle Santizo, Dahlia Maldonado, Kelli Obazee

Creating Healthy Work Environments (CHWE)

Introduction: Following social unrest in 2020, nurses at a large health system advocated for structures that celebrate diversity, promote equity, and enhance inclusion. This led to the creation of the Unity in Diversity Nursing Professional Governance Council (UID). After a systemwide assessment of nurse wellbeing, a need to improve the practice environment was identified. This led UID to create the Unity in Kindness Day (UKD) event. Since 2022, UID has hosted UKD; a multi-campus and online event aimed at fostering a healthier work environment through promoting equity, diversity, and inclusion (EDI). UKD, hosted by nurses, invites all staff members to …

Night Educators Light The Way: Building Confidence, Resiliency & Competence In Novice Nurses, Christine Dunning, Michael Pancoast

Creating Healthy Work Environments (CHWE)

The Nursing Professional Development team at Northern Westchester Hospital (NWH), a 245 bed community hospital within the larger New York-based Northwell system, heavily invests in recruitment, orientation and training of new graduate nurses. NWH offers a robust onboarding program based through American Nurses Credentialing Center Practice Transition Accreditation Program for medical surgical, intensive care, emergency, and maternal child health units. This heavily structured program draw dozens of novice nurses each year, mostly working on the night shift.

Historically, fewer resources are available off-shift for nurses, particularly access to senior staff and the expertise they provide. Often, this leaves the newest, …

Manifestations Of Nursing Burnout From A Nurse Educator Perspective, Sandra A. Nease, Amanda D'Ann Guerrero

Creating Healthy Work Environments (CHWE)

The role of the Nurse Educator is pivotal in preparing nursing students as they transition into the nursing profession. As the facilitator of nursing education, they share the knowledge and skills necessary for students to deliver high-quality patient care. The nurse educator’s role requires guiding students through strenuous academic coursework, as well as the development of clinical competence. To foster students achieving constant learning, nurse educators dedicate extended time and effort (Hosseini et al., 2022). Nurse educators are often selfless in the pursuit of providing support for their students. Intense emotional interactions with students present a risk for burnout (Maslach …

Climbing Collectively: Clinical Ladder Modernization Leveraging Shared Decision-Making, Shelby Do, Julie Holland, Dorothy Foglia

Creating Healthy Work Environments (CHWE)

The clinical ladder program (CLP) at a large Texas healthcare system is a strategy for enhancing professional well-being through fostering a culture of professional development. An opportunity to evaluate and enhance the CLP arose with an impending change to the workforce management solution that would no longer support the current compensation model. Intentional inclusion of direct care nurses (DCN) allowed for shared decision making (SDM) on the CLP changes.

In addition to compensation changes, inclusion of diverse generational needs, diversity/equity/inclusion, and well-being considerations enhanced the CLP. With direct input from DCN groups, the CLP enhancements correlate more contemporary professional/organizational needs …

Enhancing Er Resident And Preceptor Effectiveness: A Trainer Program Pilot Study, Jennifer R. Wilde, Emily Calabro

Creating Healthy Work Environments (CHWE)

Background: Emergency departments (EDs) present a challenging environment for new graduate nurses (residents), often impacting proficiency and retention. This pilot study aimed to evaluate the effectiveness of an ED Train the Trainer (T3) program, emphasizing the novel IIAR Identify, Intervene, Assess and Reassess model, in improving resident proficiency, confidence, and retention, as well as preceptor confidence. The program addressed the transitional gap between academic preparation and clinical practice by focusing on critical thinking and task management skills.

Methods: After IRB approval, a time-series design was employed. The T3 program incorporated various learning modalities, including face-to-face sessions, instructional videos, and hands-on …

Comparative Analysis Of Patient Acuity Tools: Enhancing Nursing Efficiency With An Ehr Acuity Tool, Carrundlas D. Mathews

Creating Healthy Work Environments (CHWE)

Introduction: This study aims to contrast a mobility acuity tool with an objective, comprehensive patient acuity tool (PAT). The mobility acuity tool subjectively describes the patient’s ability to perform activities of daily living (ADLs) based on a progressive Likert scale. A comprehensive PAT is a standardized system that can be integrated into electronic health records (EHR), quantifying the severity of a patient’s condition and evaluating identified nursing tasks to determine the level of care required in an evolving twenty-four-hours.

Purpose: This study will explore the differences in scope, implementation, nurse perception, and key performance indicators between a mobility tool and …