Implementation Of Mindfulness-Based Interventions And Weekly Visits To Reduce Loneliness In Older Adults, Victoria E. Cobb

Dissertations

Implementation of Mindfulness-Based Interventions and Weekly Visits to Reduce Loneliness in Older Adults

Abstract:

Problem: Social isolation and loneliness have emerged as a significant public health issue for the older adult population. Loneliness has been linked to both physical and mental health effects. According to current literature, there is no standard intervention to treat loneliness in the older adult population.

Methods: This quality improvement (QI) project utilized a descriptive cohort design and the Visit-A-Bit screening assessment instrument. Undergraduate nursing students implemented mindfulness interventions during weekly visits over an eight-week period at an independent living facility located in the Midwest. Descriptive …

Implementing Behavioral Management And Social Skills Training For Pediatric Patients With Adhd And Their Caregivers, Meagan A. Conwell

Dissertations

Problem: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 11.4% of children in the United States. Patients diagnosed with ADHD struggle with focus, hyperactivity, and impulsivity, resulting in executive and emotional dysfunction, poor social skills and quality of relationships, and poor school performance.

The American Academy of Pediatrics guidelines recommend that school-age children diagnosed with ADHD should receive both medication management and behavioral management training (BMT) for the best treatment outcomes. Research over the last decade has found that combining social skills training (SST) with BMT results in even better outcomes for these patients. Less than half of pediatric …

Race-Neutral Pft: Implementing Patient Activation Measure Following Race- Neutral Pulmonary Function Testing, Ann M. Way

Dissertations

Abstract

Background

The introduction of a race-neutral equation to predict normal values on pulmonary function testing (PFT) has led to changes in the diagnosis of pulmonary diseases previously diagnosed using a race specific equation. Minority patients appear to be most likely impacted by this change, potentially impacting how they self-manage their pulmonary health. Patient self-management can be measured and assessed by using the Patient Activation Measure (PAM) tool.

Purpose

The purpose of this project is to assess patient activation levels amongst minority patients with a new or changed pulmonary diagnosis to identify a possible need for interventions to improve patient …

Implementing A Turn Team Process To Reduce Hospital-Acquired Pressure Injuries On A Telemetry Unit At A Hospital In The Midwest, Sally Wang

Dissertations

Problem: Pressure injuries (PI) are localized wounds to the skin and soft tissues that typically result from sustained pressure on specific areas of the body (Zaidi & Sharma, 2024). Hospital-acquired pressure injury (HAPI) refers to pressure injuries that develop while a patient is in the hospital (Rondinelli et al., 2018). PI can cause patients to experience pain, decreased feelings of dignity, increased feelings of depression and anxiety, reduced levels of social activity, difficulty sleeping, and impaired cognitive function (Roussou et al., 2023). The Advanced Cardiac Care Unit (ACCU) at Missouri Baptist Medical Center experienced an increase in HAPI cases: …

The Psychological Impact Of Parenting Child Victims Of Trauma, Stephanie Faulkingham

Dissertations

Abstract

Research indicates that non-offending caregivers of traumatized children (NOC) is a population with an elevated risk for increased levels of depression and anxiety and are an underserved population for mental health services. The purpose of this quality improvement project was to determine if screening caregivers of traumatized children using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder (GAD-7) improves identification of depression and anxiety. Participants of this investigation were individuals enrolled in the Children’s Advocacy Services of Greater St. Louis’ 12-week parenting group, TASK (Trauma, Assessment, Skills, and Knowledge). Each participant was asked to complete the PHQ-8 and …

Depression Screening In The Adult Inpatient Oncology Population, Erica Bizub

Dissertations

Routinely screening oncology patients for depression is recommended due to the higher rates of depression in this population as well as the negative impact of untreated depression. The goal of this QI project is to implement a standard depression screening protocol for patients admitted to this hospital, where there is currently no standard screening protocol. There were 110 patients included in this study, and 67 (60.91%) of patients received a PHQ-9 screening. Of the patients who completed the PHQ-9, 21 (19.09%) had a positive screening, which was a score of seven or higher. While there were high rates of provider …

A Program Evaluation: Insomnia In Adults With Major Depression Disorder With Cognitive Behavioral Therapy For Insomnia (Cbt-I), Taylor E. Wilson

Dissertations

Abstract

Problem: In 2023, Compass Health Network (CHN) data analysts found that 91% of CHN patients in the United States who have died by suicide reported problems with sleep, which was the highest risk factor for suicide. The objective of this program evaluation project is to evaluate CHN CBT-I effectiveness on patients ‘suicidality by improving their insomnia.

Methods: CHN quality improvement (QI) project used a quantitative method pre/post score design. Quantitative aggregate data was collected on the participants who met the inclusion criteria via retrospective and prospective chart review prior to CHN implementing the intervention. CBT-I clinicians collected PHQ-9, Columbia-Suicide …

Care Coordination In Pediatric Primary Care, Alyssa K. Durzo

Dissertations

No central documentation of care plans exists for children with special healthcare needs (CSHCN) in the electronic health record (EHR). Providers of a large pediatric primary care office in St. Louis Missouri were asked to identify CSHCN in the practice. Clinic nurses completed a comprehensive chart review of the patients identified and constructed care coordination documents using a pre-established smart-text phrase. Subsequently, these were documented centrally in the EHR under the Problem List.

Likert score data was obtained from providers on the acceptability, appropriateness, and feasibility of the intervention through the verified tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness …

Screen Foundations: How Pediatric Nurse Practitioners Can Implement ‘Family Media Use Plans’ In Primary Care To Reduce Pediatric Behavior Concerns, Katie Anderson

Dissertations

Abstract for:

Screen Foundations: How Pediatric Nurse Practitioners Can Implement ‘Family Media Use Plans’ in Primary Care to Reduce Pediatric Behavior Concerns

Problem: Parents of children 2-5 years-old increasingly reach out to PCPs for escalating behavior concerns, including when the child doesn’t listen well, is inattentive, having tantrums, meltdowns, hitting, yelling, etc. Referrals to psychiatry and/or play therapy result in long waits, or referrals not accepted. Coincidingly, toddler and preschool aged children continue to exceed daily screen time recommendations. This results in a gap of care for families with young children and externalizing behavior.

Methods: This quality improvement project addressed …

Maternal Access For Depression In Rural Environments, Simone Parlier

Dissertations

Significance –As many as 25% of birthing persons experience postpartum depression (PPD) within the first year after childbirth making this one of the most common postpartum disorders. PPD is prevalent, incapacitating, and treatable. The first step is identifying those at risk. Rural birthing persons are understudied, and may have unique predisposing characteristics as well as geographic challenges for optimal detection and treatment of PPD. Purpose -The long-term goal is to improve the health of rural families. Using The Theory of Unpleasant Symptoms, the purpose of this descriptive, cross-sectional research was to describe the prevalence of PPD in rural birthing persons …

Assessment Of Relationships Between Quality And Staffing In The Ambulatory Care Environment, Rachel E. Start

Dissertations

ABSTRACT Background The United States healthcare system underperforms compared to other industrialized countries where cost and quality are concerned. Nursing is accountable, as a profession recognized by society, to ensure health and livelihood in the patients and populations served. Advancing the role of the ambulatory care nurse and providing valid strategies to measure the contribution of the nursing profession in this setting is a tactic that many organizations are pursuing to achieve this paradigm shift. The assessment of relationships between measures of structure, process, and outcome within the ambulatory care setting across a variety of organizations may have the potential …

Evaluating Depression In Adults Undergoing Substance Abuse Treatment: A Program Evaluation Of Intensive Outpatient Program, Chidochomoyo E. Zvirawa

Dissertations

Problem: Depression and substance use disorders (SUDs) frequently co-occur, complicating recovery outcomes. Despite screening recommendations, depression remains underdiagnosed in many SUD treatment settings.

Methods: This mixed-methods program evaluation examined depressive symptoms among adults in an Intensive Outpatient Program (IOP) using the Patient Health Questionnaire (PHQ-8). Depression screenings were conducted at intake, four weeks, and eight weeks. Eight participants meeting inclusion criteria were assessed. Data included demographics, treatment engagement, and PHQ-8 scores.

Results: PHQ-8 scores significantly declined from baseline (M = 11.75, SD = 6.52) to eight weeks (M = 5.13, SD = 5.05), t(7) = 2.76, p = .028, indicating …

Targeting Eya1 Phosphatase Activity In Mll-Rearranged Leukemia, Lola Badmus

Dissertations

MLL-rearranged (MLL-r) leukemia is an aggressive subset of acute leukemia, accounting for up to 10% of adult and 70% of infant AML and ALL cases. These leukemias are driven by MLL fusion proteins, which recruit epigenetic cofactors to dysregulate gene expression, leading to poor prognosis and resistance to conventional chemotherapy. Previous lab work identified EYA1’s role in leukemogenesis, establishing it as a therapeutic target in MLL-r leukemia. EYA1, is a transcriptional coactivator and protein tyrosine phosphatase (PTP). Originally a gout medication, benzbromarone (BBR), was identified in an NCI Diversity Set screen as an EYA1-specific PTP inhibitor. BBR provides a tool …

Intersecting Inequities: Latinx Access To Mental Health Services, Melissa Thorson

Dissertations

This study examined barriers to mental health service utilization among Latinx populations using data from the 2022 National Survey on Drug Use and Health (NSDUH). Through the theoretical frameworks of Minority Stress Theory and Toxic Stress Theory, the study investigated the relationships between age, language proficiency, socioeconomic status, and mental health service access among different Latinx subgroups. Statistical analyses included chi-square tests, multiple regression, and mediation analyses on a sample of Latinx adults (N = 9,852). Results indicated associations between age and English proficiency (χ² = 145.23, p < .001, Cramer's V = 0.38), with 45% of adults aged 50 and older reporting limited English proficiency. Socioeconomic analysis revealed that 32% of older Latinx adults reported family incomes below $20,000, with insurance status partially mediating the relationship between income and service utilization (indirect effect = 0.15, 95% CI [0.08, 0.23]). differences in utilization rates emerged among Latinx subgroups (F(6, 1243) = 8.76, p < .001, η² = 0.12), with Mexican-origin individuals showing higher utilization (10%) compared to Puerto Rican individuals (2-3%). Age and socioeconomic status demonstrated interaction effects (β = 0.18, p < .01), while language proficiency moderated the relationship between age and service utilization (β = 0.24, p < .001). These findings suggest that barriers to mental health service utilization among Latinx populations are complex and interconnected, requiring multilevel interventions that address linguistic, cultural, and socioeconomic factors simultaneously. Implications for healthcare policy and service delivery are discussed, emphasizing the need for culturally responsive and linguistically appropriate mental health services.

Comparative Genotoxicological Analysis Of Occupational Pesticide Exposures: An Experimental Approach And Systematic Review, Moustafa Samy Sherif

Dissertations

This dissertation investigates the genotoxic and cytotoxic effects of pesticide exposure through three complementary research components: a systematic review of occupational pesticide exposure in Arab countries (AraSys), a systematic review on encapsulated versus conventional pesticide formulations (Encap-Sys), and experimental toxicological assessments of various pesticide formulations in human cell lines (Pyr-Ex). This experimental component includes cytotoxicity assays using propidium iodide and DNA damage assessments via alkaline comet assays in HL60 and HepG2 cell lines exposed to pyrethroid insecticides and glyphosate-based formulations.

The AraSys systematic review revealed a critical positive association between occupational pesticide exposure and DNA damage in agricultural workers in …

The Rose That Grew From Concrete: Exploring The Romantic Experiences Of Black Men With Histories Of Childhood Sexual Abuse, Tatyana Nichelle Smith

Dissertations

Contemporary research typically characterizes Black heterosexual relationships by dismal marriage and divorce rates, largely ignoring the reality of how Black men develop attachments with their romantic partners and therefore continuing to perpetuate deficit perspectives of Black men (e.g., the cause of conflictual romantic relationships and “broken” Black families). What may be less understood about these relationships is the influence of childhood trauma, such as childhood sexual abuse, and Black men’s experiences of gender role conflict. Research shows that Black men’s experiences of childhood sexual abuse and socialization about masculinity have important implications for how they come to view themselves and …

Assessing The Relationship Between Combat Exposure, Wartime Service, And Barriers To Substance Use Disorder Treatment In Post 9/11 Veterans., Robert Near

Dissertations

Substance use disorders (SUDs) represent a critical public health concern, particularly within military and veteran populations. The complex interplay of mental health challenges, combat exposure, and the unique stressors associated with military service contribute to a heightened vulnerability among veterans. Research from the United States Department of Veterans Affairs (USDVA) underscores the prevalence of these issues, indicating that approximately 1 in 10 veterans from the Iraq or Afghanistan wars treated by the VA are diagnosed with a SUD (Veterans Affairs, 2023). Additionally, veterans from all eras show a higher propensity for binge drinking when compared to the general population, further …

The Interplay Of Accommodation And Oculomotor Vergence Within Young Adults With Binocularly Normal Vision And Typically-Occurring Convergence Insufficiency, Sebastian Fine

Dissertations

Concerted binocular coordination evoking oculomotor and refractive responses to visual stimuli are essential to daily function. Oculomotor dysfunctions can inhibit binocular responses to visually-near stimuli and have high comorbidities to accommodative dysfunctions. Three visual cues for inward (convergent) and outward (divergent) oculomotor movements, when presented concertedly create natural-viewing conditions: disparity- the binocular difference in light cast onto the fovea due to differing ocular perspectives, blur- the acuity of a visual target which stimulates accommodation, and proximal- the perceived distance of a visual stimuli based on size.

This study aims to quantitatively investigate oculomotor vergence and accommodation performances between individuals with …

Building A Grounded Theory Of Resilience Among Survivors Of Chronic Ischemic Stroke, Erin Marie Tompkins Doan

Dissertations

Abstract

Stroke is disruptive with elusive recovery and adjustment. Beyond traditional aspects of stroke rehabilitation, literature suggests adjustment to stroke should also include intervention with focus on resilience. A gap exists between conceptualization, theoretical models, and strategies for supporting resilience in persons with chronic ischemic stroke. This three-manuscript dissertation research comprised a scoping literature review, a pilot study, and a phenomenological case study. We employed a convergent mixed methods design in which we implemented and studied outcomes of an adaptive mindfulness intervention. We implemented eight focus groups with eight adults and four individual interviews over 13 months. The Brief Resilience …

Leading Change For Transgender And Gender Diverse Healthcare: Assessing Organizational Readiness, Braxten Lovett

Dissertations

Background: Transgender and gender-diverse (TGD) individuals face persistent stigma and systemic discrimination across multiple societal domains, with healthcare settings—intended as safe spaces—often being among the most harmful. Despite increased visibility of TGD populations and growing research on their health inequities, inclusive healthcare remains insufficiently addressed by many healthcare leaders, adding to the urgency to advance equitable, inclusive care. Additionally, structural cisnormativity and binary gender frameworks continue to perpetuate misinformation, erasure, and health disparities. Addressing these entrenched barriers requires systemic reform rooted in cultural humility, inclusive practices, and a commitment to dismantling cisnormative bias within healthcare delivery and policy. This study …

Parent’S Health Literacy And Stress Level In The Inpatient Pediatric Setting, Tina C. Smith

Dissertations

Purpose: This study examined the relationship between parent health literacy and stress levels during their child’s inpatient hospitalization.

Background: In 2019, over five million pediatric hospitalizations occurred in the United States. Parents are central to their child’s care, but stress and sociodemographic factors may hinder their ability to understand and apply health information. This study explored how stress and other variables impact parent health literacy during hospitalization.

Methods: A cross-sectional design included a demographic survey, the Perceived Stress Scale (PSS-10), and the Newest Vital Sign (NVS). Bivariate analyses (Chi-square, t-tests) and logistic regression were used to assess …

Efficacy Of A Novel Role-Playing Based In-Class Simulation On Enhancing Clinical Judgment Skills In Senior Baccalaureate Nursing Students, Melodie Jolly

Dissertations

Clinical judgment is a critical skill for nurses, directly impacting patient outcomes and quality of care. However, studies have shown that newly graduated nurses often lacked sufficient clinical judgment abilities to meet the demands of increasingly complex patient populations. This quasi-experimental study aimed to evaluate the efficacy of a novel role-playing based in-class simulation designed to enhance clinical judgment skills among senior baccalaureate nursing students. The study employed a single-group pre-assessment and post-assessment design using Lasater’s Clinical Judgment Rubric (LCJR) as the primary measurement tool. Using a convenience sample, 37 senior nursing students who enrolled in a Term 4 clinical …

The Effects Of Retrieval Practice On Knowledge Acquisition And Durable Learning In Undergraduate Nursing Students, Jessica Everritt Gay

Dissertations

Recent reports of unpreparedness and failure to rescue incidents among new graduate nurses are concerning for nurse educators and health care. New graduates must retrieve and apply learned knowledge to make sound clinical decisions, emphasizing the need for durable learning and knowledge acquisition. Durable learning, which involves understanding and recalling learned information days, weeks, or months later is crucial for clinical judgment. Nurse educators should facilitate durable learning through effective, evidence-based learning techniques such as retrieval practice (RP), which has shown promise in health professions education but is underutilized in nursing education.

This study explored the impact of RP on …

Is There A Relationship Between Motivation And Nursing Student Engagement? A Quantitative, Cross-Sectional, Correlational Study, Angela Coes

Dissertations

Nursing education is concerned with helping to alleviate the nursing shortage in the United States; this can be done by graduating safe competent novice nurses. Motivation and engagement levels in nursing students have been tied to better academic outcomes including graduation rates, transition to practice, and first time National Council Licensure Examination for Registered Nurses pass rates. There was a gap in prelicensure nursing education research in the United States concerning the relationship among motivation, engagement, and possible influential variables.

The purpose of this study was to investigate the relationship between motivation and academic engagement among prelicensure nursing students in …

Useful Measures Of Adult Attachment And Object Relations In Psychotherapy, Matilde A. Torallas Huerta

Dissertations

This is a literature review of objective and projective measures of attachment and object relations in adults, with the objective of reviewing outstanding research to identify the key factors for adult attachment assessment considered within attachment and object relations theories, what measures of adult attachment styles and dysfunction work best, and to provide key themes of assistance in the measurement of attachment and object relations in adult clients in psychotherapy. Theoretical foundations of attachment and object relations theory are reviewed as well as objective and projective instruments grouped by format. The 10 themes found to be useful in the assessment …

Sexual And/Or Gender Minority (Sgm) Stigma Within Nursing Schools: The Relationship Between Stigmatic School Attributes, Minority Stressors, And Sgm Nursing Student Mental Health, Michelle Gee

Dissertations

Nursing education is heteronormative and cis-normative, which has been correlated to stigma and ignorance exhibited by nurses towards sexual and/or gender minorities (SGM). Minority Stress Theory (MST) states that circumstances in the environment that promote stigma related to minority identities lead to unique minority stressors, such as discrimination. These minority stressors subsequently affect mental health. While it is known that SGM patients experience mental health issues that relate to stigma and discrimination in healthcare settings, nothing is known about SGM nursing students dealing with stigma and discrimination within nursing education. The aim of this descriptive correlational study was to inform …

Electronic-Based Determinants Of Health Screening On An Inpatient Behavioral Health Unit, Anyaku O. Okpara

Dissertations

Problem: Approximately 14.1 million Americans are diagnosed with a Serious Mental Illness (SMI). These individuals experience death 10-20 years earlier compared to the general population, primarily due to chronic medical comorbidities and unmet health-related social needs (HRSNs). Mortality rates, increased healthcare utilization, and frequent readmissions in patients with multiple, unmet HRSNs are likely to remain high unless developments such as the incorporation of standardized, multi-domain, social determinants of health (SDOH) screenings into electronic health records (EHRs). The purpose of this quality improvement (QI) project, guided by the Institute for Healthcare (IHI) model for change utilizing the Plan-Do-Study-Act (PDSA) cycle, was …

The Epidemiology Of Major Congenital Anomalies In The United Arab Emirates: The Mutaba'ah Study, Hiba Mahdi Adam

Dissertations

Major Congenital Anomalies (MCAs) are significant contributors to perinatal morbidity and mortality. The absence of clear baseline prevalence data for MCAs hinders the development of targeted interventions to mitigate their burden. Furthermore, studies on adverse obstetric and birth outcomes in pregnancies complicated by MCAs are scarce, emphasizing the need for research to enhance management strategies. This dissertation aimed to: (1) estimate the live birth prevalence of perinatally diagnosed MCAs and describe study population characteristics by MCA status, (2) investigate the impact of MCAs on fetal presentation and delivery mode, and (3) investigate the impact of MCAs on preterm and low …

The Cellular Trafficking And Targeting Of Angiotensin-Converting-Enzyme-2 (Ace2) And Neutral-Amino-Acid-Transporter (B0at1) Variants: Implications For The Pathogenesis Of Associated Diseases And Therapy, Nesreen Fayyad Alkhofash

Dissertations

Angiotensin-converting enzyme 2 (ACE2) and the neutral amino acid transporter B0AT1, encoded by SLC6A19, are membrane proteins with pivotal roles in human physiology. ACE2 is involved in regulating blood pressure and serves as the cellular entry receptor for SARS-CoV-2, while B0AT1 facilitates amino acid absorption in the intestine. The interplay between ACE2 and B0AT1, particularly their physical interaction and co-expression in the intestine, underscores their relevance in both normal physiology and disease. Dysregulation of these proteins has been implicated in conditions such as hypertension, and Hartnup disease and they have been usurped by SARS-CoV-2 to cause COVID-19. Despite their …

Exploring Leadership In Physical Therapy: How Clarity, Connection, And Communication Influence Team Engagement, Burnout, And Achieving Organizational Objectives, Jason Collin

Dissertations

Purpose: The purpose of this mixed methods study was to identify and describe how highly effective PT leaders use the three competencies of HPTs (clarity, connection, and communication) to increase engagement, prevent burnout, and achieve organizational objectives. The second purpose of this study was to determine the degree of importance that highly effective PT leaders perceive the three HPTE core competencies impact their leadership for creating HPTs.

Methodology: The mixed methods study identified and described eight PT leaders’ perceptions of how they use clarity, connection, and communication to build and sustain HPTs. PT leaders were selected through purposive and snowball …