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Full-Text Articles in Medicine and Health Sciences

The Benefits Of Art Therapy On Stress And Anxiety Of Oncology Patients During Treatment, Helen Shiepe May 2023

The Benefits Of Art Therapy On Stress And Anxiety Of Oncology Patients During Treatment, Helen Shiepe

Expressive Therapies Capstone Theses

Within the last ten years research on art therapy and its positive impact on oncology patients’ stress and anxiety during treatment has been minimal. Oncology patients whether they are children or adults when diagnosed experience similar reactions due to their diagnosis, treatment, and in some cases end of life care. The current question is whether or not art therapy does have a positive impact on decreasing the stress and anxiety with oncology patients while undergoing treatment. Deane, Fitch & Carmen (2000), discussed art therapy as a healing art that is “intended to integrate physical, emotional, and spiritual care by facilitating creative ...


Examining The Use Of Expressive Arts Therapies In Neurorehabilitation Treatment Planning, Rebecca J. Horner May 2023

Examining The Use Of Expressive Arts Therapies In Neurorehabilitation Treatment Planning, Rebecca J. Horner

Expressive Therapies Capstone Theses

Those undergoing neurorehabilitation after stroke and traumatic brain injury report a diminished sense of overall wellness. This paper examines the conceivable benefits of introducing expressive arts therapies, which is the therapeutic use and combination of the visual arts, movement, drama, music, writing and other intermodal creative processes, into physical therapy and neurorehabilitation treatment planning. Expressive arts therapies have the capacity to engage with an individual’s physical, emotional, social and spiritual states concurrently. They simultaneously offer the ability to promote an increased sense of well-being, address mind-body disconnects, and process trauma non-verbally.

The sections of this narrative literature review focus ...


Examining State Of Flow And Its Future In Dance/Movement Therapy: A Literature Review, Rachael A. Cohen May 2023

Examining State Of Flow And Its Future In Dance/Movement Therapy: A Literature Review, Rachael A. Cohen

Expressive Therapies Capstone Theses

This paper analyzes State of Flow, the definition codified by Mihaly Csikszentmihalyi and analyzes how Flow as a concept has developed in current psychological and artistic research, alternative therapies, and mainstream medias. This paper also views existing Dance/Movement Therapy frameworks such as Body-Mind Centering and Kestenberg Movement Profile to see how Csikszentmihalyi’s definition could integrate into current Dance/Movement Therapy practice, as well as looks at Laban Movement Analysis and its future in Dance/Movement Therapy. This thesis also examines how gender and neurodivergence may impact how one can experience State of Flow.


Developing A Lifestyle Intervention Program For Overweight Or Obese Preconception, Pregnant And Postpartum Women Using Qualitative Methods, Chee Wai Ku, Shu Hui Leow, Lay See Ong, Christina Erwin, Isabella Ong, Xiang Wen Ng, Jacinth Jia Xin Tan, Fabian Yap, Jerry K. Y. Chan, See Ling Loy Dec 2022

Developing A Lifestyle Intervention Program For Overweight Or Obese Preconception, Pregnant And Postpartum Women Using Qualitative Methods, Chee Wai Ku, Shu Hui Leow, Lay See Ong, Christina Erwin, Isabella Ong, Xiang Wen Ng, Jacinth Jia Xin Tan, Fabian Yap, Jerry K. Y. Chan, See Ling Loy

Research Collection School of Social Sciences

The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention ...


Coach And Athlete Perceptions Of The Effects Of The Menstrual Cycle On Female Athletic Performance, Erin Dietz Jul 2022

Coach And Athlete Perceptions Of The Effects Of The Menstrual Cycle On Female Athletic Performance, Erin Dietz

Honors Projects

The purpose of this study is to examine the knowledge of the effects of the menstrual cycle on female athletic performance from both athletes and their coaches at the NCAA Division III level. Recommendations for coaches based on the findings of the research are provided. The study investigates whether female athletes and their coaches are aware of the physiological and psychological effects of the menstrual cycle and how they are managed throughout the course of a sport season.


Neurocardiovascular Instability (Ncvi) Risk As A Predictor Of Cognitive Function In The Long Life Family Study, Rebecca Abraham Jun 2022

Neurocardiovascular Instability (Ncvi) Risk As A Predictor Of Cognitive Function In The Long Life Family Study, Rebecca Abraham

Dissertations, Theses, and Capstone Projects

In aging populations, the abnormal neural control of the cardiovascular system has been examined within the construct of neurocardiovascular instability (NCVI). The main research aim addressed whether baseline features of NCVI could predict cognitive function (i.e., decline) at follow-up within long-lived families. Across 941 subjects, baseline NCVI risk was indexed by two features: (1) self-reported syncopal or fall events and (2) average seated BP. The Low NCVI risk group included those who were normotensive (e.g., within normal BP range) and reported no NCVI features (n=379). The Moderate NCVI risk group included those who elicited pre-hypertensive (elevated BP ...


Exploring Social Identity Threat And Safety Cues For Lesbian, Gay, Bisexual, Pansexual, And Queer Cisgender Women In Ob/Gyn Care, Rachel Fikslin Jun 2022

Exploring Social Identity Threat And Safety Cues For Lesbian, Gay, Bisexual, Pansexual, And Queer Cisgender Women In Ob/Gyn Care, Rachel Fikslin

Dissertations, Theses, and Capstone Projects

Lesbian, gay, bisexual, pansexual and queer (LGBPQ) cisgender women (CW) experience a number of health inequities compared to heterosexual cisgender women related to sexual and reproductive health. Heterosexist health care cultures may signal social identity threat for LGBPQ-CW that may undermine their health care engagement and outcomes. In three online studies, I examined the effects of two heterosexist cultures (i.e., gender essentialism and pronatalism) as well as two potentially identity-safe alternatives (i.e., gender diversity and reproductive/sexual autonomy) on the identity threat and health care engagement experiences of LGBPQ-CW in OB/GYN care.

In Study 1 (n = 213 ...


Effects Of Telephone Follow-Up On Medication Adherence And Rapid Readmission Among Discharged Adults With Schizophrenia Spectrum Disorders (Ssds), Romilynn Danko, Madalyn Cosensci May 2022

Effects Of Telephone Follow-Up On Medication Adherence And Rapid Readmission Among Discharged Adults With Schizophrenia Spectrum Disorders (Ssds), Romilynn Danko, Madalyn Cosensci

Doctor of Nursing Practice Final Manuscripts

High rates of 30-day readmission after acute care discharge are a big concern for patients with psychiatric disorders. These high rates not only reflect poor patient outcomes, but also result in higher hospital costs. For adults with schizophrenia spectrum disorders (SSDs), a review of current research shows that non-adherence to medication has been significantly associated with rapid readmissions and that using an intervention such as follow-up telephone calls after discharge can help prevent readmission through increased medication adherence. Using the Iowa model framework as a guide, the purpose of this evidence-based practice project was to pilot a post discharge procedure ...


Increasing Mental Health Literacy In The Black Church, Jonathan Allotey May 2022

Increasing Mental Health Literacy In The Black Church, Jonathan Allotey

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project was to increase mental health literacy, assess stigmatizing attitudes, and increase help seeking behavior in leadership within an African American church.

Background: The Black church has historically been a central institution for community support and leadership within these churches are often ill equipped to address the mental health needs of congregants. African Americans underutilize mental health services and are reported to have more chronic mental illnesses. Lack of mental health literacy may result in difficulty recognizing the risk factors, signs, symptoms, and treatments related to specific mental illnesses.

Evidence Based Intervention and Methods: Participating ...


Female Sex Offenders: Double Standards, Sofia Enes May 2022

Female Sex Offenders: Double Standards, Sofia Enes

Kean Quest

This paper will discuss female pedophiles, rapists, and sex offenders, also known as female sex criminals, the double standards, of how they are viewed in the criminal justice system, how the medical fields view them, the psychological effects of their actions on their victims, and how the public views them. Unlike male pedophiles, rapists, and sex offenders of that gender; female pedophiles are not as readily identified as male pedophiles. Since female sex criminals do not always conform and fit the stereotypes that are more commonly found in male sex criminals, it is much more difficult for authorities to detain ...


Toward Holistic Mental Wellness: A Literature Review Of Mindfulness-Based And Focusing-Oriented Art Therapies, Lesley Vernon May 2022

Toward Holistic Mental Wellness: A Literature Review Of Mindfulness-Based And Focusing-Oriented Art Therapies, Lesley Vernon

Expressive Therapies Capstone Theses

Modern day living, for all its benefits, is synonymous with record levels of stress. The mental health clinician’s role is to assist clients in accessing the skills and tools necessary to reduce and alleviate the symptoms of stress-induced anxiety. Mindfulness is emerging as a potent and effective tool to restore one’s state of well-being. Likewise, engaging in art therapy has been shown to reduce stress and foster resilience. Grounded in humanistic and existential theories, this literature review aimed to assess the impact and effectiveness of two intermodal holistic therapies, specifically mindfulness-based art therapy (MBAT) and focusing-oriented art therapy ...


Building Character By Building Characters: A Literature Review Examining The Efficacy Of Tabletop Roleplay As A Creative Intervention For Developing Social Skills In Adolescents, Kathleen Angela L. Bautista May 2022

Building Character By Building Characters: A Literature Review Examining The Efficacy Of Tabletop Roleplay As A Creative Intervention For Developing Social Skills In Adolescents, Kathleen Angela L. Bautista

Expressive Therapies Capstone Theses

In the realm of tabletop roleplay games, Dungeons & Dragons (D&D) earned a reputation as the most prolific franchise within the genre and has since prevailed as a popular bonding activity for peer groups of all ages and backgrounds. Among the player base in the D&D community are those that gleaned its potential to offer a conducive space for personal growth, particularly in the realm of psychosocial development, given that D&D sessions facilitated dynamic social interactions among the members. The emphasis on imagination in D&D nurtures the tenets of intermodal expression, as players are encouraged to explore ...


Healing Our Connection With Nature: An Expressive Arts Community Engagement Project, Meghan Mccrillis May 2022

Healing Our Connection With Nature: An Expressive Arts Community Engagement Project, Meghan Mccrillis

Expressive Therapies Capstone Theses

A community engagement project was created and implemented, comprised of two events for which the author facilitated nature-based expressive arts experiences to explore the integration of nature and expressive arts therapy. The events were offered to two different groups of community members, one for nature-curious adults held outdoors on the trails of a local conservation trust, and another for young children at a local library. The healing impact of nature connection and nature connection experiences are explored through a literature review, event methods, and the author’s personal experiences of the project via artmaking. The results include an emphasis on ...


Where I’M From: Internal Manifestations Among Cambodian Women Using The Expressive Arts A Literature Review, Noeun Chhim May 2022

Where I’M From: Internal Manifestations Among Cambodian Women Using The Expressive Arts A Literature Review, Noeun Chhim

Expressive Therapies Capstone Theses

Chronic mental illness has affected many Cambodian people, but, culturally, Cambodians aren’t accustomed to opening up and discussing their feelings, rather defining mental illness to craziness and seeking help is presumed taboo. Thus, Cambodians are often reluctant to talk about their experiences and/or their related illnesses. Though Cambodians have experienced inconceivable suffering and violence during the Khmer Rouge era, for the purpose of this thesis, I will be discussing the role of Cambodian women and investigate the extent of what they’ve witnessed and experienced. Cambodian women have suffered through many years of trauma and grief, during and ...


The Neurobiology Of The Healing Arts: Expressive Arts Therapy As An Effective Treatment For Adults Diagnosed With Complex Ptsd Due To Complex Trauma In Childhood: A Literature Review, Cheryl Ratliff May 2022

The Neurobiology Of The Healing Arts: Expressive Arts Therapy As An Effective Treatment For Adults Diagnosed With Complex Ptsd Due To Complex Trauma In Childhood: A Literature Review, Cheryl Ratliff

Expressive Therapies Capstone Theses

Empirically based therapies for posttraumatic stress disorder (PTSD) have been found to be less effective in treating more severe trauma presentations such as complex PTSD (CPTSD). Neurobiological investigation provides a framework for examining the physical and psychological effects of trauma on brain and nerve structures and provides insight into how to effectively treat CPTSD. This literature review examined symptomology of CPTSD resulting from complex trauma in childhood, neurobiological effects of trauma and their implications for treatment, and the efficacy of the current treatment models, primarily those of eye movement desensitization and reprocessing (EMDR), narrative exposure therapy (NET), and somatic psychotherapies ...


Drama Therapy Interventions That Support Students With Asd During Covid-19, Olivia Reyes May 2022

Drama Therapy Interventions That Support Students With Asd During Covid-19, Olivia Reyes

Expressive Therapies Capstone Theses

Due to the coronavirus (COVID-19) pandemic that began in December 2019, many people experienced traumatic losses, environmental stressors, and overall daily challenges. One of the populations most at risk during this time were those with an autism spectrum disorder (ASD). Those with mental health illness and developmental differences are experiencing the pandemic in different ways. Individuals with ASD tend to have both developmental differences and mental health challenges that motivate individuals to seek medicinal and therapeutic help, along with other services to support their daily needs. This literature review addresses the negative and positive impacts COVID-19 has had on the ...


Using Expressive Arts Therapies To Aid The End-Of-Life Transition For Older Adults: A Literature Review, Rosemary Lape May 2022

Using Expressive Arts Therapies To Aid The End-Of-Life Transition For Older Adults: A Literature Review, Rosemary Lape

Expressive Therapies Capstone Theses

This literature review presents the use of expressive arts therapies as they may be applied to end-of-life care for older adults. Death is inevitable and if given the chance to prepare, the expressive arts modalities provide a foundation to process the emotions associated with the ending of a life on earth. Expressive arts provide the opportunity to communicate in non-traditional ways which have the ability to locate subconscious themes. End-of-life care previously revolved around pain management. In more recent years it has evolved to caring for the whole person emotionally, socially, psychologically, and physically. Sources were found utilizing resources provided ...


Moving Through Loss: The Experience Of Ambiguous Loss With Hospitalized Children, The Development Of A Method, Peyton Edington May 2022

Moving Through Loss: The Experience Of Ambiguous Loss With Hospitalized Children, The Development Of A Method, Peyton Edington

Expressive Therapies Capstone Theses

The current method examined the effects of ambiguous loss with medical transplant patients in a pediatric hospital by utilizing a dance/movement therapy intervention. The development of this method was based on ambiguous loss theory with a dance/movement therapy approach. The explored literature identified central themes of ambiguous loss, such as resilience. These themes were connected to the practice of dance/movement therapy, such as embodiment. With this connection, the intervention was developed and implemented with participants. The central themes that emerged from the intervention were change, loss, meaning-making, and hope. One child and two adolescents were participants in ...


Dance/Movement Therapy As A Transdisciplinary Approach To Treating Trauma, Destany Schadder May 2022

Dance/Movement Therapy As A Transdisciplinary Approach To Treating Trauma, Destany Schadder

Expressive Therapies Capstone Theses

This thesis considers dance/movement therapy as a transdisciplinary approach to treating trauma in the body. It explains what the functions of the brain are, how trauma negatively affects it, and how posttraumatic stress disorder is expressed in both the body and the brain. It discusses multidisplinary approaches, it shows how these approaches leverage the body in treating trauma. Moreover, it demonstrates the benefits and advantages of a dance/movement therapist in supporting individuals who have experienced traumatic events. To achieve these goals, this thesis discusses research by neuroscientists, such as Damassio (1999), who maintain that the body and mind ...


How Geek Therapy Plays Into Expressive Arts Therapy: A Literature Review, Caroline Bryan May 2022

How Geek Therapy Plays Into Expressive Arts Therapy: A Literature Review, Caroline Bryan

Expressive Therapies Capstone Theses

Within this paper, I explore how geek therapy plays well with the methods of expressive arts therapy. The combination of geek therapy and expressive arts therapy can assist clinicians in immediately connecting with their clients and identifying strength-oriented narratives that honor the client’s preferences, modes of expression, and pop culture affinities. This engagement with expressive approaches utilizing affinity-based interventions can lead to a deeper sense of understanding of the client’s intra-, inter-, and extra-personal relationships. Through this literature review of expressive arts therapy and geek therapy, primarily focusing on video games in therapy, clinicians from all walks of ...


Chronotype, Shift Work, And Sleep Problems Among Emergency Medicine Clinicians, Emily L. Hirsh, Thomas W. Britt, Zachary Klinefelter, Justine Liptak, Cody Meyers, Katie Daniels, Lauren A. Fowler May 2022

Chronotype, Shift Work, And Sleep Problems Among Emergency Medicine Clinicians, Emily L. Hirsh, Thomas W. Britt, Zachary Klinefelter, Justine Liptak, Cody Meyers, Katie Daniels, Lauren A. Fowler

Journal of Wellness

Introduction: Extensive research has demonstrated that shift work can be detrimental to sleep. Chronotype, the preference for time of day to sleep or be active, can influence how we function at different times of day and how shift work impacts us. This study was designed to assess the chronotype of emergency physicians (EPs) and emergency advanced practice providers (EAPPs) and examine how chronotype was related to sleep problems and shifts worked over a three-month period.

Methods: A survey assessing chronotype and sleep quality was sent to 225 EPs and EAPPs in a single, large academic Department of Emergency Medicine. An ...


Mindful Resources: A Guide To Mindfulness-Based Interventions, Lexi Marie Vogel May 2022

Mindful Resources: A Guide To Mindfulness-Based Interventions, Lexi Marie Vogel

Dissertations, Theses, and Projects

Although mindfulness is often associated with wellness, relaxation, and simplicity, the literature surrounding it is extensive and often complex. The abundance of mindfulness research and resources presents a challenge for educators, parents, and other individuals interested in mindfulness-based intervention. This project examines the literature surrounding mindfulness with emphasis on interventions, targeted benefits, potential barriers, and key considerations to aid in the development of the resource guide, Mindful Resources: A Guide to Mindfulness-Based Interventions. Translating the information from the comprehensive literature review into this resource guide will simplify the process of selecting appropriate interventions and provide users with a sample of ...


Investigating The Effect Of Meaningful Relationships On Team Chemistry, Isabel N. Fairbanks May 2022

Investigating The Effect Of Meaningful Relationships On Team Chemistry, Isabel N. Fairbanks

Honors Thesis

Team chemistry in sports is one of the more vital factors that potentially impacts the overall success of a team. There is increasing growth in the school of thought surrounding the use of team building in sports to develop the best teams built for success. Many programs exist in athletics and other environments that strive to promote strong team culture. This literature review examines the influence sports psychology has on the success of a sports team and current programs that exist in both the business environment and athletics, intending to improve team culture. Furthermore, the book containing the experiment on ...


Reflective Journaling Intervention To Impact Self-Awareness, Professional Health, And Overall Well-Being In Nurses, Brittany M. Langan, Katherine Keppen May 2022

Reflective Journaling Intervention To Impact Self-Awareness, Professional Health, And Overall Well-Being In Nurses, Brittany M. Langan, Katherine Keppen

Doctor of Nursing Practice Projects: College of Nursing

Background. Burnout among nurses has been on the rise and was exacerbated with the pandemic. Reflective journaling after work may be a strategy to decrease feelings of burnout. Reflective journaling, as an intervention, has been shown to improve self-awareness, compassion fatigue, and burnout among nurses. The purpose of this study was to pilot a 4-week reflective journaling intervention in hospital-based nurses and describe participant professional quality of life, self-awareness, and overall well-being.

Theoretical Framework. The Theory of Reasoned Action (TRA) was chosen as the theoretical framework because it identifies the belief that performing a particular behavior will lead to a ...


A Mixed-Methods Examination Of Transgender Youth Desistence, Mirae J. Fornander May 2022

A Mixed-Methods Examination Of Transgender Youth Desistence, Mirae J. Fornander

Research Days

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Background: Access to gender-affirming medical care (GAMC) for transgender/gender diverse (TGD) individuals is one of the most pressing social justice issues of our time. Research has begun to identify the benefits of GAMC. However, little is known about the healthcare needs of TGD youth, especially those who discontinue GAMC. Available literature lacks clear and consistent terms to define TGD youth who stop care. Further, a significant criticism of current research is the assumption that discontinuing care is equivalent to detransitioning. There are no studies, to our knowledge, that differentiate between TGD youth who choose ...


Self-Reported Sexual Behavior In A Pediatric Gender Clinic Sample, Mirae J. Fornander May 2022

Self-Reported Sexual Behavior In A Pediatric Gender Clinic Sample, Mirae J. Fornander

Research Days

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Background: Previous studies of transgender/gender diverse (TGD) youth indicate differences in rates of sexual behaviors between TGD youth and their cisgender peers. However, few studies have reported the sexual behavior and preferences of TGD youth in a large clinic sample, and no studies, to our knowledge, have utilized questionnaires that do not assume the sex or gender of one’s sexual partner.

Objectives/Goal: The current study aims to explore the self-reported sexual behavior of TGD youth presenting for gender-affirming medical care.

Methods/Design: Retrospective chart review of 589 patients (ages 12-22, M= 15 ...


Exploring Social Media Usage And Its Effects On College Students' Mental Health: A Mixed-Methods, Intervention Study, Kimanh Le May 2022

Exploring Social Media Usage And Its Effects On College Students' Mental Health: A Mixed-Methods, Intervention Study, Kimanh Le

Health and Kinesiology Theses

Background: Social media can cause detrimental effects to college students’ mental wellbeing. The purpose of this study was to examine UT Tyler students’ social media usage and its effects on mental health such as depression, anxiety, stress, self-esteem, and the fear of missing out (FoMO). The researcher wanted to see if one specific social media site, Instagram, had more deleterious effects compared to other social media platforms and if reducing time usage would help improve mental health.

Methods: A mixed-methods, intervention design was used. An online quantitative survey link, which contained questions about demographics, social media usage, and mental health ...


Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn May 2022

Providing Effective Assessment Feedback To Patients: Lessons Learned From Feedback After A Severe Injury, Kelsie Mcquinn

Graduate School of Professional Psychology: Doctoral Papers and Masters Projects

This paper seeks to articulate lessons learned from feedback received after a severe injury in order to help guide neuropsychologists provide effective feedback to patients. Given that there is no agreed upon conceptual framework for providing neuropsychological assessment feedback, parallels are drawn from what works in clinical psychology – the working alliance. I use personal examples to highlight how the working alliance, as well as other psychological principles, can help inform neuropsychologists provide the most effective feedback to patients.


Helping Our Heroes: An Evaluation Of Mental Health And Organizational Policies Surrounding Suicide Prevention And Postvention Strategies For Nebraska First Responders, Maria S. Mickles May 2022

Helping Our Heroes: An Evaluation Of Mental Health And Organizational Policies Surrounding Suicide Prevention And Postvention Strategies For Nebraska First Responders, Maria S. Mickles

Capstone Experience

Suicide is ranked as one of the leading causes of death in the United States. Over 40,000 individuals die by suicide each year (Stanley, Hom, & Joiner, 2016; Vigil et al, 2021), and, in 2020, it was ranked in the top 9 causes of death for all ages (10-64), and second for those 10-14 and 25-34 years of age (Centers for Disease Control and Prevention, 2022). These statistics disproportionately reflect first responders (i.e., firefighters, dispatchers, law enforcement, EMS, paramedics, etc.), as they die by suicide more than the general public (National EMS Management Association, 2016). Within their line of work of ...


Perceived Sources Of Stress Related To Burnout Amongst Emergency Department Staff Due To The Covid-19 Pandemic: A Literature Review, Sydney Craig May 2022

Perceived Sources Of Stress Related To Burnout Amongst Emergency Department Staff Due To The Covid-19 Pandemic: A Literature Review, Sydney Craig

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Emergency departments (ED) are usually considered high stress environments. The effects of the COVID-19 pandemic and the accompanying challenges such as frequent exposure to the novel virus, lack of personal protective equipment (PPE), being over worked and underpaid, and the uncertainty surrounding the overall trajectory of the COVID-19 pandemic have resulted in an increased level of burnout for ED staff, especially nurses. This study involves a meta-analysis of current literature surrounding ED burnout including incidence rate and causes during the COVID-19 pandemic. Because studies indicate upwards of three fourths of ED staff reporting increased stress and burnout, finding ways to ...