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Articles 31 - 60 of 3997
Full-Text Articles in Medicine and Health Sciences
Give Love With Lovenox: Reducing Pulmonary Embolism Risk In The Postpartum Unit Through Lovenox Prophylaxis Nursing Education, Guadalupe Sierra Arroyo
Give Love With Lovenox: Reducing Pulmonary Embolism Risk In The Postpartum Unit Through Lovenox Prophylaxis Nursing Education, Guadalupe Sierra Arroyo
Master's Projects and Capstones
Problem: This quality improvement project aims to improve nurse education on Lovenox prophylaxis to reduce pulmonary embolism occurrence post-discharge amongst high-risk postpartum women who underwent vaginal/cesarean deliveries and to increase patient medication compliance in the Family Baby Unit (FBU) at Hospital X.
Context: The quality improvement project occurred on the Family Baby Unit (FBU) at Hospital X. This 25-bed unit has recently had an increased rate of pulmonary embolisms post-discharge due to poor Lovenox medication adherence amongst patients and lack of education among nurses.
Intervention: Data was collected in the microsystem. This data was collected through questionnaires to assess nurses' …
Dodge The Fall: A Newborn Fall Prevention Initiative, Linda Nguyen
Dodge The Fall: A Newborn Fall Prevention Initiative, Linda Nguyen
Master's Projects and Capstones
Problem: In the past year, three separate newborn fall incidents occurred on the postpartum unit at Hospital X. This project aims to increase nurse-to-patient education on newborn fall prevention, thereby reducing the number of newborn falls on the unit.
Context: This quality improvement project was implemented on the postpartum unit at a hospital located in San Francisco County. At this hospital, the postpartum unit consists of 10 beds in postpartum and 11 beds in antepartum. Currently, there is no standardized method used by registered nurses to prevent newborn falls.
Intervention: The requirement for mothers to sign the Pledge Form for …
Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn
Give Love With Lovenox: Improving Nurse Education On Lovenox Prophylaxis To Reduce Pulmonary Embolism Risk On The Postpartum Unit, Jennifer G. Domingo Rn
Master's Projects and Capstones
This quality improvement project aims to improve nurse education about Lovenox prophylaxis to reduce the risk of pulmonary emboli – post-discharge – amongst high-risk postpartum women who underwent vaginal and cesarean deliveries on the family baby unit. This project took place in a Family Baby/Postpartum Unit at Hospital SC. This unit has a total of 25 beds with an increased prevalence of pulmonary embolism following cesarean delivery. Nurses were given anonymous pre- and post-survey questionnaires and provided educational sessions with distributed handouts. A unit needs assessment was conducted using the 5 P’s. Out of the 72 nurses on the staff …
Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Monica P. Rabago Moreno
Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Monica P. Rabago Moreno
Master's Projects and Capstones
Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths as well as hospital length of stays.
Context: A microsystem assessment, in the emergency department (ED) unit, was performed in Hospital A located in the Greater San Francisco Bay area by Clinical Nurse Leader (CNL) students. This ED unit cares for a variety of critical care patients ranging from urgent to life-threatening conditions.
Intervention: An intervention was not implemented in the ED unit due to time constraints and limitations; however, CNL students provided recommendations …
Improving Triage Accuracy In The Emergency Department, Joselyn Silverman
Improving Triage Accuracy In The Emergency Department, Joselyn Silverman
Master's Projects and Capstones
Problem: High rates of patients being mis-triaged was occurring at Hospital X leading to poor patient outcomes and incorrect staffing levels.
Context: This quality improvement project took place at Hospital X’s emergency department. A stakeholder analysis and a microsystem assessment along with a staff survey was created in order to determine areas of improvement and staff responsiveness.
Interventions: Eight educational seminars were conducted along with Hospital X leadership and students created supplemental materials for the staff to use on a daily basis.
Measures: Two data pulls were conducted over the course of the quality improvement project; one prior to the …
Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Camila Sanchez
Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Camila Sanchez
Master's Projects and Capstones
Problem: The purpose of this quality improvement (QI) project revolves around increasing overall staff nurse compliance, enhancing their sepsis education resources, and usage of their provided education and bundle. This goal was created to produce more positive patient outcomes at Hospital X, along with its improved management of sepsis. Hospital X is an acute care facility located in the San Francisco Bay Area.
Context: The unit that was studied during this QI project was the emergency department of Hospital X. This unit provides level I trauma services in addition to other types of emergency care and contains 44 beds. Not …
Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy
Improving Triage Accuracy In The Emergency Department, Catriona E. Clohessy
Master's Projects and Capstones
Problem: Hospital Z’s emergency department was experiencing a triage inaccuracy rate that exceeded the accepted national benchmark of 10%. This quality improvement project aimed to reduce triage inaccuracy to less than 10% in the emergency department at Hospital Z, through improved education and availability of supplemental reference materials.
Context: This quality improvement project was conducted in a 40 bed emergency department at Hospital Z. This microsystem serves a diverse patient population from the surrounding community that experience a variety of conditions requiring emergency medical intervention.
Interventions: Clinical Nurse Leader nursing students partnered with unit leadership to create a new ESI …
Resocialization Of An Inpatient Handoff Sepsis Bundle Checklist On A Medical-Surgical Unit, Sophia Kawada
Resocialization Of An Inpatient Handoff Sepsis Bundle Checklist On A Medical-Surgical Unit, Sophia Kawada
Master's Projects and Capstones
Problem: In September 2023, it was found that only 25% of nurses were familiar with an inpatient handoff sepsis bundle checklist (IHSBC) on a Medical-Surgical Unit in Hospital A. This evidence-based project aimed to improve resocialization of the IHSBC such that compliance to the bundle continues to be maintained well above the benchmark of 75%. Context: Clinical Nurse Leader (CNL) students at the University of San Francisco conducted a microsystem assessment of the Medical-Surgical Unit at Hospital A. This hospital aimed to maintain high rates of compliance with the IHSBC. Interventions: Resocialization of the IHSBC was completed in October, and …
Improving Triage Accuracy In The Emergency Department, Vince Harrington
Improving Triage Accuracy In The Emergency Department, Vince Harrington
Master's Projects and Capstones
Problem: Mistriage was occurring at higher than acceptable rates. In turn, this caused poor staffing levels and patient outcomes. This project seeks to improve triage accuracy according to the Emergency Nurses Association’s (ENA) Emergency Severity Index (ESI) algorithm.
Context: The Emergency Department in a prominent bay area hospital that was experiencing high rates of mistriage.
Interventions: The staff nurses were required to attend a retraining on the Emergency Nurses Association (ENA) Emergency Severity Index (ESI) algorithm. Following the retraining, a follow up online exam with sample patients must be passed at 100%. Furthermore, badge buddies containing the ESI algorithm will …
Depression Screening Tool For Hysterectomy Patients, Dede C. Mihedji
Depression Screening Tool For Hysterectomy Patients, Dede C. Mihedji
Doctor of Nursing Practice (DNP) Projects
Abstract
Background: The prevalence of hysterectomies in the United States ranges from
5.1 to 5.8 per 1000 women (Harnod et al., 2018). A standardized screening tool for assessing
depression preoperatively could mitigate the worsening of postoperative depressive symptoms in patients scheduled for a hysterectomy.
Local Problem: Currently, there is no standard of practice to routinely screen for depression in preoperative patients scheduled for hysterectomy surgeries. However, as with any surgical intervention, there are risks of long-term complications. Studies have identified that a hysterectomy may increase the risk of cardiovascular events, menopause, depression, and other outcomes (Madueke-Laveaux et al., 2022). …
Supporting Mental Health In Children By Providing Basic Skills And Knowledge Of Mental Health To Middle-School Teachers, Mariaelena Falcon
Supporting Mental Health In Children By Providing Basic Skills And Knowledge Of Mental Health To Middle-School Teachers, Mariaelena Falcon
Doctor of Nursing Practice (DNP) Projects
Background: Mental health first aid training in middle school is an effective way to help teachers gain the necessary knowledge and confidence needed to support students with mental health distress and provide early interventions.
Local Problem: Lack of mental health training may result in teachers facing challenges in identifying and addressing mental health issues among their students. Specific problems resulting from this include limited awareness, insufficient skills, and strategies to effectively communicate and engage with students in mental health distress, and stigma surrounding mental health may make teachers uncomfortable discussing mental health.
Methods: The project will take place at Harper …
Implementing An African American Cultural Awareness Program For Skilled Nursing Facility Staff, Adekemi T. Adedipe
Implementing An African American Cultural Awareness Program For Skilled Nursing Facility Staff, Adekemi T. Adedipe
Doctor of Nursing Practice (DNP) Projects
Background: Patient care is most effective when patients and providers establish a therapeutic connection in a cultural context. Nurses’ lack of awareness of a cultural context for patient care impairs establishing a therapeutic provider/patient relationship, with care of lesser quality and poorer health outcomes as consequences.
Local Problem: Staff at a Northern Californian skilled nursing facility (SNF) caring for African American patients with mental illness lacked self-awareness of the cultural context of care. Staff did not consider cultural constructs of care in treating patients and developing care plans.
Methods: Educational intervention to increase the cultural competence of a skilled …
Beyond The Physical Wounds: A Proactive Approach To Mental Health Recovery After A Traumatic Injury, Christine Mcgahey
Beyond The Physical Wounds: A Proactive Approach To Mental Health Recovery After A Traumatic Injury, Christine Mcgahey
Doctor of Nursing Practice (DNP) Projects
Beyond the Physical Wounds: A Proactive Approach to Mental Health Recovery After a Traumatic Injury
Background: Every year, millions of Americans incur a life-threatening traumatic event and are admitted to trauma centers to treat their acute physical injuries. While traumatic injury is closely associated with developing post-traumatic stress disorder (PTSD), patients are rarely evaluated for PTSD risk or educated about long-term psychological sequelae.
Local Problem: The predictive value of early screening to quantify PTSD risk in trauma patients is well documented in the literature. However, in a 241-bed Level II Trauma acute care hospital, there was no protocol to evaluate …
A Quality Improvement Project On Anxiety Management Before Ketamine-Assisted Psychotherapy, Kiera Paulo
A Quality Improvement Project On Anxiety Management Before Ketamine-Assisted Psychotherapy, Kiera Paulo
Doctor of Nursing Practice (DNP) Projects
Background: This Quality Improvement project sought to determine if a brief progressive muscle relaxation (PMR) session could decrease patient anxiety before receiving intramuscular (IM) injections for ketamine-assisted therapy. Problem: The Kerstin Helgason, NP clinic does ketamine-assisted therapy, and many patients express anxiety beforehand, either due to a fear of needles or nerves surrounding the medication treatment. Intervention: This project implemented a brief progressive muscle relaxation therapy for patients with anxiety before receiving their IM injection. Measures: The patient’s anxiety levels were measured before and after the PMR therapy using a five-point Likert scale ranging from none to very severe. Results: …
Community Health Worker Certification Program - Motivational Interview, Advocacy, Communication And Conflict Resolution, Stella Antony
Community Health Worker Certification Program - Motivational Interview, Advocacy, Communication And Conflict Resolution, Stella Antony
Doctor of Nursing Practice (DNP) Projects
Background: Rural residents have health disparities more than urban populations. The significant health inequities in the underprivileged population include a higher incidence of chronic diseases, lack of access to healthy foods, health care, health insurance, unhealthy eating habits, poor socioeconomic status, cultural and language barriers, and lack of health literacy. As locals, Community health workers (CHWs) meet these populations and can improve healthy lifestyle changes and advocate for their community.
Local Problem: The population in Fresno and Tulare County in Central Valley, California, is underprivileged, lacks access to proper health care, and has higher rates of health disparities, including chronic …
Mindfulness Based Self Care Toolkit For Psychiatric Healthcare Staff, Harkirat Kaur Bajwa
Mindfulness Based Self Care Toolkit For Psychiatric Healthcare Staff, Harkirat Kaur Bajwa
Doctor of Nursing Practice (DNP) Projects
Abstract
Background: Healthcare personnel (HCP) are at high risk of stress, burnout, and compassion fatigue (CF). Up to 50% of physicians and 33% of nurses experience burnout in the United States. Higher rates of burnout were noted during the recent SARS-CoV-2 (COVID-19) pandemic due to the increased need for mental health services among patients and HCP.
Problem: Stress, burnout, and CF are associated with increased medical errors, poor patient safety, and higher staff turnover rates. One-third of nurses report they intend to leave the profession because of burnout which contributes to financial burden for hospitals. A higher nurse turnover rate …
Environmental Ozone Exposure, Gestational Health, And The Lung-Placental Axis, Russell Hunter
Environmental Ozone Exposure, Gestational Health, And The Lung-Placental Axis, Russell Hunter
Biomedical Sciences ETDs
Adverse gestational outcomes of pregnancy are a globally occurring threat to fetomaternal health, with limited clinical prognostic and intervention strategies aside from premature labor induction. Epidemiological data shows strong correlations between gestational exposure to air pollution and the incidence of adverse gestational outcomes. The research presented here was designed to evaluate potential murine models of gestational exposure, as well as quantify maternal cardiovascular damage therein. These studies employ radiotelemetry, echocardiography, single cell RNA-sequencing, and untargeted lipidomic analyses in efforts to study these effects. Results implicate cardiovascular responses to mid-gestational ozone exposure as evidenced by decreased maternal cardiac output and increased …
On The Anti-Adipogenic Function Of Collagen Triple Helix Repeat-Containing Protein 1, Matthew E. Siviski
On The Anti-Adipogenic Function Of Collagen Triple Helix Repeat-Containing Protein 1, Matthew E. Siviski
Electronic Theses and Dissertations
Adipogenesis is regulated by the coordinated activity of adipogenic transcription factors, including PPAR-gamma (PPARG) and C/EBP alpha (CEBPA). Thus, dysregulated adipogenesis predisposes adipose tissues to adipocyte hypertrophy and hyperplasia. We have previously reported that mice possessing a homozygous null gene mutation in collagen triple helix repeat-containing protein 1 (CTHRC1) have increased adiposity compared to wildtype mice, supporting the concept that CTHRC1 regulates body composition. Herein, we investigated the anti-adipogenic activity of CTHRC1. Using 3T3-L1 preadipocytes, we showed significantly reduced adipogenic differentiation in the presence of CTHRC1 commensurate to marked suppression of Cebpa and Pparg gene expression. In addition, CTHRC1 increased …
Minoritized Medical Students' Integration Of Professional Identities: A Phenomenological Study, Travis Erickson
Minoritized Medical Students' Integration Of Professional Identities: A Phenomenological Study, Travis Erickson
Electronic Theses and Dissertations
This qualitative study fills a gap in the extant literature by exploring how medical students with minoritized identities make meaning about sense of self-definition and emerging professional identities while enrolled in medical school. More specifically, the focus of this study explored how minoritized medical students perceived their sense of self and dimensions of identity were shaped during their medical education, and what perceptions these medical students had about how they manage their professional identity development. Emergent themes included: (a) making connections between self-definition and professional identities, (b) past experience of difference shaping identities, (c) self-definition with complexity, (d) fluidity as …
Experiences Of Black American Millennials: A Qualitative Study Of Internalized And Externalized Coping In The Face Of Racial Trauma, Natalia Angelique Giles
Experiences Of Black American Millennials: A Qualitative Study Of Internalized And Externalized Coping In The Face Of Racial Trauma, Natalia Angelique Giles
Doctoral Dissertations
The experiences Black Americans have faced when standing against racial trauma have impacted the Black community for generations. Though previous generations faced overt styles of racism throughout the eras of slavery and Jim Crow, the invalidation and discrimination have remained consistent within the experiences of the Black American millennial (BAM) generation. Current experiences BAMs face are a combination of both overt and covert styles of racism, which increase mental exhaustion, reduce motivation, and leave the individual psychologically defenseless. The purpose of this qualitative study was to examine the experiences of BAMs in the face of racial trauma. This qualitative research …
Feasibility And Measurement Of Bedside Pumping In The Nicu: A Mixed Methods Study, Jessica Gomez
Feasibility And Measurement Of Bedside Pumping In The Nicu: A Mixed Methods Study, Jessica Gomez
Dissertations & Theses (Open Access)
Abstract
Background: Supporting preterm infants with mother’s own milk (MOM) can improve health outcomes and decrease mortality.1 Freshly pumped MOM, within four hours of expression, has the highest availability of bioactive components versus stored MOM. However, fresh milk is often not readily available due to the disconnected process of breastfeeding that occurs with preterm infants in the NICU. One convenient solution to improve access to fresh MOM is for the mother to pump at the infant's bedside. This intervention could improve the mother's pumping experience and provide the infant access to fresh MOM.
Purpose: This study aimed to evaluate …
Numerical Investigation Of Subglottal Stenosis Effects On Human Voice Production, Dariush Bodaghi
Numerical Investigation Of Subglottal Stenosis Effects On Human Voice Production, Dariush Bodaghi
Electronic Theses and Dissertations
This dissertation aimed to advance knowledge of how subglottal stenosis impacts voice production physiology. An in-house fluid-structure-acoustic interaction approach based on the hydrodynamic/acoustic splitting technique was employed. This technique was rigorously verified for simulating phonation by matching the acoustic behavior to a compressible flow solver for phonation-relevant geometries. Simulations of an idealized 2D vocal tract model demonstrated the effects of supraglottal acoustic resonance on vocal fold kinematics and glottal flow waveform. Results showed that the acoustic coupling between higher harmonics and formats generated pressure oscillations, modifying vocal fold dynamics and glottal flow rate.
A major novelty was the incorporation and …
Improving Intimate Partner Violence Screening In A Women’S Health Practice Through Implementation Of An Evidence-Based Screening Tool, Jasmine Weber
Improving Intimate Partner Violence Screening In A Women’S Health Practice Through Implementation Of An Evidence-Based Screening Tool, Jasmine Weber
Doctor of Nursing Practice Projects: College of Nursing
The purpose of this quality improvement project was to implement intimate partner violence screening in an outpatient women’s health clinic with no prior screening process in place. Current recommendations are to screen all reproductive age women for intimate partner violence 6 . During a three-month period 170 patients out of 260 eligible patients were screened using the HARK screening tool, 7 of those patients screened positive and were offered referrals to social work. While universal IPV screening was not achieved, a screening rate of 64% is a remarkable improvement from an apparent absence of screening prior to project implementation.
Screening For Uterine Fibroids In Black Women, Winnie N. Kagendo
Screening For Uterine Fibroids In Black Women, Winnie N. Kagendo
Doctor of Nursing Practice (DNP) Projects
Background: Uterine fibroids are benign growths in the uterine muscle that affect around 70% of women. Black women have a higher risk, with three times the likelihood of developing fibroids compared to other races.
Problem: The issue of uterine fibroids continues to be poorly addressed in healthcare settings. Black women continue to be particularly adversely impacted by this problem. There is a lack of better screening methods, leading to late detection and limited treatment options for those hoping to maintain fertility.
Methods: A quality improvement project was implemented at a primary care clinic in Loma Linda, California, using the Uterine …
Implementation Of Implicit Bias Training In A Doctor Of Nurse Practitioner Program, Macdana Selecon
Implementation Of Implicit Bias Training In A Doctor Of Nurse Practitioner Program, Macdana Selecon
Doctor of Nursing Practice (DNP) Projects
Background: Implicit bias in healthcare delivery refers to the unconscious mental associations healthcare providers make about patients from various social groups. Numerous studies suggest implicit bias contributes to health disparities primarily amongst marginalized groups. Furthermore, patients report a lower quality of communication from healthcare providers with higher implicit racial bias. In 2021, Assembly Bill 1407 (Nurses: Implicit Bias Courses Act) was passed to address the negative impact of bias on patient outcomes and requires California nursing schools to provide implicit bias training for nursing students.
Problem: All graduate nursing programs do not provide implicit bias (IB) training. As a result, …
Implementation Of Fast-Track Triage Process To Improve Ambulance Patient Offloading Time (Apot) In A Psychiatric Emergency Services (Pes) Unit, Oke Augustine Umeugoji
Implementation Of Fast-Track Triage Process To Improve Ambulance Patient Offloading Time (Apot) In A Psychiatric Emergency Services (Pes) Unit, Oke Augustine Umeugoji
Doctor of Nursing Practice (DNP) Projects
Abstract.
Background.
Ambulance delays in hospital EDs have recently been significant in the United States. This delay has been attributed to emergency department overcrowding, a record number of 911 calls, a shortage of ED staff (doctors and nurses), and poor resources available in the communities as alternatives to an ED visit. Local Emergency Medical Service Authorities (LEMSA) monitor and determine the community standards for measuring ambulance offload delays (AOD), usually in minutes.
Problem.
Lengthy ambulance patient offload times and their subsequent impact on EMS have been significant all around the state of California as well as nationwide. The ambulance delay …
Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik
Developing And Implementing An Infection Prevention Practice Fellowship Program, Sejal Naik
Doctor of Nursing Practice (DNP) Projects
Developing and Implementing an Infection Prevention Practice Fellowship Program
Abstract
Background: The COVID-19 pandemic placed huge demands on infection prevention programs (Blanchard et al., 2022), seriously taxing a profession already mired with progressively increasing workload and responsibilities (Bryant et al., 2016).
Local Problem: In a rapidly changing environment, infection preventionists (IPs) contend with pandemic surges, emerging infections, and supply chain disruptions. The NCAL Region of an integrated health system experienced IP turnover, and in the absence of a formal training program, newly hired IPs experienced variable to no opportunities to develop their competencies.
Methods: A literature review on infection prevention …
Evaluation Of Effectiveness Of Cultural Competence Program Implemented As Standard Practice To Improve Nurses’ Cultural Competency (Cultural Awareness, Cultural Cultural Knowledge, Cultural Skill), Improving Patient Care In A Community Hospital, Kendra Elam
Doctor of Nursing Practice (DNP) Manuscripts
The need for a culturally competent healthcare workforce is increasing as diversity increases in the United States’ patient population. Cultural competence is necessary because it helps the healthcare provider to offer the best care to every patient while considering and incorporating their cultural diversity and the patient holistically. Healthcare providers should be culturally competent to provide compassionate, caring, patient-centered care that promotes safety and quality in healthcare, reducing healthcare disparities. Culturally competent care supports social justice and health equity; it encourages health care as a human right. There is evidence that cultural competence and humility in professional development improve providers' …
Implementation Of A Self-Care Management Program Utilizing Telehealth In Adults With Hypertension, Diann Schmitt
Implementation Of A Self-Care Management Program Utilizing Telehealth In Adults With Hypertension, Diann Schmitt
Doctor of Nursing Practice (DNP) Manuscripts
Hypertension (HTN) can lead to heart disease which is the leading cause of death in the United States for men, women, and most racial and ethnic groups. Evidence-based practice supports early recognition of available self-care management (SCM) modalities to impact hypertension improvement and medication adherence. Best practices for heart disease prevention and management include lifestyle modification, reducing out-of-pocket costs, self-management support and education, and self-measured blood pressure monitoring. Successful evidence-based approaches within literature have addressed the modalities and successful outcomes.
The Plan-Do-Study-Act (PDSA) is a quality standard of The Institute of Health Improvement (IHI) was used to conduct this project …
Patient Education Improvement Initiative For Self-Management Of Congestive Heart Failure Among Senior Residents Of A Long-Term Care Facility, Abigail A. Abella, Brooke Sheck, Daniela Ramos, Ivy H. Nguyen, Mary Tran, Roshni Nagarajan
Patient Education Improvement Initiative For Self-Management Of Congestive Heart Failure Among Senior Residents Of A Long-Term Care Facility, Abigail A. Abella, Brooke Sheck, Daniela Ramos, Ivy H. Nguyen, Mary Tran, Roshni Nagarajan
Master's Projects and Capstones
The purpose of this quality improvement project was to use evidence-based practices to determine if personalized education on disease self-management would lead to improved treatment adherence in a residential facility. The target population consisted of four elderly female patients who had been diagnosed with congestive heart failure (CHF) and were struggling with the self-management of their disease. Contributing barriers to effective CHF self-management were determined using a root cause analysis, and included a lack of educational templates, declining cognitive ability of the residents, and no electronic health record (EHR). Using the Self-Determination theory, the interventions were implemented. Phase one was …