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Psychiatric and Mental Health Nursing Commons™
Open Access. Powered by Scholars. Published by Universities.®
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Articles 61 - 90 of 124
Full-Text Articles in Psychiatric and Mental Health Nursing
Impact Of Ante- And Postnatal Depression Screening In Women With Hiv: A Scoping Review, Kimberly M. Grider Bsn, Rn, Pmh-Bc, Bao Chau Le Bsn, Rn, Blessing Okon Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc
Impact Of Ante- And Postnatal Depression Screening In Women With Hiv: A Scoping Review, Kimberly M. Grider Bsn, Rn, Pmh-Bc, Bao Chau Le Bsn, Rn, Blessing Okon Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc
Doctor of Nursing Practice Projects
Purpose/Background Maternal depression has been identified as a strong predictor of poor prenatal care. Among pregnant women living with Human Immunodeficiency Virus (HIV), mental health-related factors such as depression could potentially undermine effective antiretroviral therapy (ART) adherence, increase mortality, and cause poor HIV viral suppression consequently impacting vertical transmission of HIV. This scoping review aims to identify existing knowledge regarding the impact of ante- and postnatal depression screening in women with HIV and to adduce the necessity for effective screening.
Methods A literature search was performed for studies with primary outcomes of depression screening within the context of ante- or …
Adolescent Mothers And Kangaroo Mother Care: A Scoping Review, Genna K. Rivers, Robin B. Dail Phd, Rn, Faan, Robin Dawson Phd, Rn, Cpnp-Pc
Adolescent Mothers And Kangaroo Mother Care: A Scoping Review, Genna K. Rivers, Robin B. Dail Phd, Rn, Faan, Robin Dawson Phd, Rn, Cpnp-Pc
Senior Theses
Kangaroo mother care (KMC), the practice in which mothers hold their infants skin-to-skin against their bare chest, can increase bonding and attachment between mothers and their infants. However, there is not much research on the benefits of KMC within the adolescent or teen mother population (13-19 years old). The purpose of this scoping review was to identify how common KMC is within the teen mother population, determine how KMC varies based on social determinants of health and race/ethnicity within the adolescent mother population, and how KMC impacts adolescent mothers’ maternal attachment and bonding with their infants. PubMed and CINAHL databases …
Increasing The Knowledge Of Opioid Use Disorder (Oud) And Medication Assisted Treatment (Mat) In Advanced Practice Registered Nurses (Aprns) In Georgia, Angela Queen Roberts, Jennifer Goldsberry Dnp, Msn, Fnp-Bc, Aprncne,, Gail Godwin Ph.D. Pmhnp-Bc,Cne, Sallie Coke Ph.D., Aprn, C-Pnp, C-Fnp, Pmhs
Increasing The Knowledge Of Opioid Use Disorder (Oud) And Medication Assisted Treatment (Mat) In Advanced Practice Registered Nurses (Aprns) In Georgia, Angela Queen Roberts, Jennifer Goldsberry Dnp, Msn, Fnp-Bc, Aprncne,, Gail Godwin Ph.D. Pmhnp-Bc,Cne, Sallie Coke Ph.D., Aprn, C-Pnp, C-Fnp, Pmhs
Graduate Research Showcase
The national opioid crisis has had devastating effects on the United States (US) healthcare system with the financial burden totaling more than $2 trillion from 2015 to 2018 (White House Government, 2020) and the physical burden of 128 overdose-related deaths daily (Centers for Disease Control, 2020). According to the Centers for Disease Control (CDC), some of these deaths are the result of deficits in education to healthcare providers about pain management treatment (CDC, 2020). Improved education for healthcare providers has resulted in a significant decline in the total number of opioid prescriptions from 2016-2019 which suggests that successful containment of …
Supporting And Creating Strong Women, Danielle Chee
Supporting And Creating Strong Women, Danielle Chee
Student Research Poster Presentations 2022
No abstract provided.
The Feasibility Of Transitional Psychiatric Care Service In A City With A Population 20, 171 In A Midwestern State, Aubri Ashbacher
The Feasibility Of Transitional Psychiatric Care Service In A City With A Population 20, 171 In A Midwestern State, Aubri Ashbacher
Doctor of Nursing Practice Scholarly Project
Psychiatric patients are a known vulnerable population. This population often ends up in a cycle of decline post-hospitalization that leads to rehospitalization. The purpose of this study is to establish the feasibility for bringing psychiatric transitional care services to the local community. The methods for the study include a qualitative analysis of common themes discussed from the presentation of the idea of transitional care services for this area to area mental healthcare providers. Using a qualitative approach, the project will involve conducting interviews with mental healthcare providers in a midwestern community via Zoom about the feasibility of transitional psychiatric care …
Experience Of Parents Caring For A Child With An Acquired Disability, Brad E. Phillips
Experience Of Parents Caring For A Child With An Acquired Disability, Brad E. Phillips
Graduate Theses, Dissertations, and Problem Reports (ETD)
Background: Parents caring for a child with an acquired disability often report a negative impact on physical, psychological, emotional, and spiritual health associated with caregiver burden related to their child’s complex health needs. This is further complicated by additional challenges related to the loss of a previously healthy child. Traditional patterns of loss follow linear, time-bound stages that have been observed to be unrelated to the experiences of these specific parents and their families. Therefore, the concept transforming loss has been developed to better understand how these parents navigate loss and find meaning in spite of their suffering.
Purpose: The …
The Resilience Vaccine, Sara Horton-Deutch T. Duffy
The Resilience Vaccine, Sara Horton-Deutch T. Duffy
Master's Projects and Capstones
Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.
This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …
A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos
A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos
Nursing & Health Sciences Research Journal
Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …
Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale
Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale
MSN Capstone Projects
Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …
Loneliness, Social Isolation, And Their Connection To Overall Health Across The Lifespan, Paige Miller
Loneliness, Social Isolation, And Their Connection To Overall Health Across The Lifespan, Paige Miller
Senior Honors Theses
Due to recent circumstances, the incidence of loneliness and social isolation has skyrocketed. Fortunately, there have already been countless studies examining the longer-term implications of these two factors on health. Loneliness and social isolation have been found to impact cardiovascular health, stress response, immune function, resilience, mental health, attachment, spiritual health, and many other determinants of health. A variety of research was examined outlining the psychological implications of loneliness and social isolation. These factors also influence physiological processes and can exacerbate a variety of diseases. After presentation of this evidence, a collection of possible interventions will be discussed, and their …
Breaking Down The Impact Of Resilience On Mental Health: An Analysis Utilizing The Resilience Scale For Adults, Sydney K. Cook
Breaking Down The Impact Of Resilience On Mental Health: An Analysis Utilizing The Resilience Scale For Adults, Sydney K. Cook
The Journal of Purdue Undergraduate Research
Resilience is the capacity to recover quickly from difficulties, and previous studies have determined that resilience has a relationship with mental health. However, the association of each aspect of resilience on mental health, depression, and adverse childhood events (ACEs) have not been closely examined. Discerning which aspects of resilience are associated with mental health issues, depression, and ACEs can help psychiatric nurses determine effective treatments and interventions for at-risk patients.
One hundred ninety-five community-dwelling participants (ages 18 to 89) were invited to Purdue University in Indiana and Scripps College in California for the study. Participants completed the Resilience Scale for …
Adverse Childhood Experiences And Urinary Incontinence In Elementary School Aged Children, Amanda Jill Travis Msn, Fnp-C, Margaret C. Harvey Phd, Aprn, Acnp-Bc, Chfn, Michelle Rickard Dnp, Apnp-C
Adverse Childhood Experiences And Urinary Incontinence In Elementary School Aged Children, Amanda Jill Travis Msn, Fnp-C, Margaret C. Harvey Phd, Aprn, Acnp-Bc, Chfn, Michelle Rickard Dnp, Apnp-C
Doctor of Nursing Practice Projects
Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor.
Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient …
Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen
Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen
Doctor of Nursing Practice (DNP) Projects
Abstract
Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …
Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis
Impact Of Social Isolation In Hiv-Positive Individuals During A Pandemic, Corina Jane Bakoylis
Dissertations
Problem: The global pandemic of COVID-19 caused concern for immunocompromised individuals. The purpose of this quality improvement initiative was to assess the impact of social isolation on feelings of loneliness, depression, and social isolation experiences in HIV-positive individuals residing in a long-term care facility.
Methods: A mixed-method convergent design with a purposeful sample of HIV-positive adult residents residing in a long-term care facility was utilized. An evaluation of loneliness using the University of California Los Angeles (UCLA) Loneliness Scale (Version 3) and depression using the Patient Health Questionnaire-8 (PHQ-8) were completed. Personal experiences were also assessed with five predetermined open-ended …
Intimate Partner Violence Education For High School Students, Morgan Foster
Intimate Partner Violence Education For High School Students, Morgan Foster
Dissertations
Problem Adolescents are at risk for experiencing intimate partner violence (IPV). As early as seventh grade, over half of adolescents have reported being in a romantic relationship. Adolescent screening for and education of IPV is minimal, and only the Healthy Relationships Quiz developed by the U.S. Department of Health and Human Services [HHS] screens young adolescents across all aspects of IPV, including psychological and sexual violence. The purpose of this project was to develop an IPV education plan for high school students in a health course.
Methods An educational lesson plan for IPV was created for high school teachers.
Results …
The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch
The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch
The Eleanor Mann School of Nursing Undergraduate Honors Theses
The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.
PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …
Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc
Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc
Doctor of Nursing Practice Projects
Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).
Methods We conducted a retrospective chart review on patients …
Resilience 101: A Resilience Education Intervention For College Freshmen, Angie Childre
Resilience 101: A Resilience Education Intervention For College Freshmen, Angie Childre
Graduate Research Showcase
This evidence-based project sought to evaluate resilience in freshmen college students enrolled in a Bridge scholar program (BSP) in a liberal arts university in the southeastern United States. The American College Health Association (ACHA) found that stress and anxiety were the top two indicators for impacting academics in 2019 and had been at the top since 2009 at the university of study (ACHA, 2019). The study used a pretest and posttest design method with the implementation of a five-week resilience education intervention. The research questions (Q1-5) were: Q1: What effect did the intervention have on BSP student's resilience? Q2: What …
Assisting Nursing Students In Their Development Of Empathy: A Guide To Fostering Requisite Skills For The Art Of Empathetic Communication, Susan Mee
Open Educational Resources
This 7-week lesson plan is designed for use in clinical nursing courses. It is designed specifically for use by Nursing faculty teaching in the absence of state required patient facing clinical opportunity due to COVID restrictions. The lesson plan describes pedagogical techniques and provides video and education OER resources designed to help support the development of empathetic communication skills over 7 weeks. Refection and video debriefing techniques will be employed. Role play will culminate in the group presentation project of a brief video modeling effective therapeutic empathetic communication.
Knowledge About Continuous Positive Airway Pressure Machine Usage Among Nurses At A Tertiary Hospital In Tanzania, Wilson Paulo Lomnyack, Tumbwene Mwansisya, Stewart Mbelwa, Kahabi Isangula, Zephania Saitabau Abraham
Knowledge About Continuous Positive Airway Pressure Machine Usage Among Nurses At A Tertiary Hospital In Tanzania, Wilson Paulo Lomnyack, Tumbwene Mwansisya, Stewart Mbelwa, Kahabi Isangula, Zephania Saitabau Abraham
School of Nursing & Midwifery, East Africa
Introduction: Continuous Positive Airway Pressure (CPAP) provides an air pressure that maintains the patency of the airway in patients with a variety of breathing problems. Nurses provide the hour to hour management of patients who require CPAP. The aim of this study was to assess the knowledge of nurses about CPAP machine usage at the tertiary hospital in Tanzania which serves the largest number of patients who require CPAP.
Method: A hospital-based descriptive cross-sectional study was carried out from March to June 2019 at Muhimbili National Hospital (MNH) and Jakaya Kikwete Cardiac Institute (JKCI) where 149 nurses who consented …
Addressing Psychosocial Outcomes Of Social Isolation In Older Adults, Megan Friesen, Madeline M. Christensen
Addressing Psychosocial Outcomes Of Social Isolation In Older Adults, Megan Friesen, Madeline M. Christensen
Nursing DNP Projects
Purpose and Rationale
The aim of the evidence-based practice (EBP) project is to improve psychological outcomes for socially isolated older adults enrolled in a Homebound Program (HP) through the implementation of an EBP intervention. Social isolation has a multitude of negative consequences, including impacting the psychological health (e.g. depression, loneliness, anxiety) of the older adult population.
Synthesis of Evidence
Meta-analyses, systematic reviews, and randomized controlled trials addressing the clinical problem of social isolation were identified. Through critical appraisal of the evidence, physical activity, psychotherapy, and socialization interventions have shown to decrease depression and loneliness in older adults. There were mixed …
Using A Psychopharmacology Education Program To Increase Primary Care Provider Comfort With Treating Basic Psychiatric Disorders, Latesha Reed
DNP Scholarly Projects
BACKGROUND: Almost 1 in 5 people have been diagnosed with a mental health illness but the supply of psychiatric providers does not meet patient’s needs. Multiple reasons contribute to this shortage and nurse practitioners are part of the solution. Even with nurse practitioners specializing in psychiatric mental health there is still a shortage. Primary care is where most patients first present their mental health issues.
METHODS: Literature review informed the development of the educational intervention presented to the primary care providers using a digital, asynchronous learning format. A gap analysis of organizational needs and weaknesses was used to determine the …
Examining Relationships Among Person Factors, Psychosocial Factors, And Coping Patterns In People Living With Type 2 Diabetes Mellitus In North Central Appalachia, Melissa A. Mccoy
Examining Relationships Among Person Factors, Psychosocial Factors, And Coping Patterns In People Living With Type 2 Diabetes Mellitus In North Central Appalachia, Melissa A. Mccoy
Graduate Theses, Dissertations, and Problem Reports (ETD)
Background: Diabetes is a complex, debilitating illness that imposes disease burden on the individual and society. T2DM is more prevalent in the Appalachian region than in any other Region of the United States. If diabetes is poorly controlled, patients are at risk for negative health outcomes. A gap exists in the literature related to understanding of the relationships among person factors, psychosocial factors, and coping patterns. Another gap in the literature is sex differences among these variables.
Purpose: The purpose of this study is to examining relationships among person factors, psychosocial factors, and coping patterns in people living with T2DM …
Association Between Dietary Macronutrient Intake And High-Sensitivity C-Reactive Protein Levels Among Obese Women In Kuantan, Malaysia, Siti Zuhaidah Shahadan, Azlina Daud, Muhammad Ibrahim, Muhammad Lokman Md. Isa, Samsul Draman
Association Between Dietary Macronutrient Intake And High-Sensitivity C-Reactive Protein Levels Among Obese Women In Kuantan, Malaysia, Siti Zuhaidah Shahadan, Azlina Daud, Muhammad Ibrahim, Muhammad Lokman Md. Isa, Samsul Draman
Makara Journal of Science
Elevated high-sensitivity C-reactive protein (hs-CRP) levels may be associated with an increased risk of cardiovascular disease (CVD). In general, an individual’s dietary intake may influence the hs-CRP level. However, evidence on the influence of dietary macronutrient intake on hs-CRP levels among obese Malaysian women remains fragmented. Therefore, this study aims to investigate the association between the hs-CRP level and dietary macronutrient intake of obese adults living in Kuantan. The assessment of 24-hour dietary recall and venous hs-CRP levels were investigated in 67 women with a body mass index of 27.5 to 39.9 kg/m². The findings revealed that obese women living …
Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor
Undergraduate Honors Theses
The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …
Implementing Mandatory Psychiatric Training For Medical-Surgical Nurses, Hannah Berry
Implementing Mandatory Psychiatric Training For Medical-Surgical Nurses, Hannah Berry
Scholars Week
Hospitals worldwide experience poor outcomes for patients with mental illnesses. Psychiatric patients have a lesser likelihood of surviving a particular illness than does a person with that same illness who does not have a psychiatric comorbidity. This is a bleak reality that nurses have the unique opportunity to influence for the better. Destigmatizing mental illness is perhaps the largest component of stepping toward this goal. Our nurses being more educated on the nature of mental illnesses—their signs, symptoms, and common treatments—will improve care outcomes for patients who suffer from them. Not only should we educate nurses on mental illness for …
Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd
Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd
Dissertations
Abstract
Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …
Improving Care For Homeless Young Adults: A Shelter Client And Health Service Provider Perspective, Kenya Kawanee Hemingway
Improving Care For Homeless Young Adults: A Shelter Client And Health Service Provider Perspective, Kenya Kawanee Hemingway
Grace Peterson Nursing Research Colloquium
The purpose of this study was to determine if the healthcare needs of homeless young adults from the client, shelter staff, and shelter healthcare provider’s perspectives. Data was collected via focus group with homeless unaccompanied young adults (n=4), and an online survey with shelter staff and healthcare staff (n=8) of The Night Ministry (TNM) and Ignite Promise. The focus group was recorded, transcribed, and coded for themes. Inductive analysis revealed themes focused on improving the quality of services provided. Based on the findings, recommendations include assessing the needs of homeless unaccompanied young adults from their perspective utilizing larger sample sizes, …
Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden
Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden
Doctor of Nursing Practice Final Manuscripts
Abstract
TITLE: Mental Health Screening For Low-Income Adolescents
BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.
PURPOSE: The aim of this project is to implement standardized routine …
The Mental Health Experience Among Parents Of Children With Autism, Thao Tran
The Mental Health Experience Among Parents Of Children With Autism, Thao Tran
Doctoral Projects
Parents of children diagnosed with autism spectrum disorder (ASD) face challenges, stress, and mental health issues than parents of children without autism. Mental health experience of parents in underserved communities are not adequately studied. This qualitative study used a phenomenological approach to understand the mental health experience of eight parent caregivers residing in San Joaquin Valley, California. All parents reported the journey was stressful but not all parents described the point when they received the diagnosis as being more stressful than before and after the ASD diagnosis. Parents’ responses to the semi-structured interview that assesses for the degree of ambiguous …