12230 research outputs found
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Welcome to TJ Library - Video Tour
No full textVideo tour of the remodeled TJ Library Tip Tuesday! Need to find your way to (and in) the library? Check out this quick clip showing the North/Quad entrance and a sneak peek of the fresh new design! Whether you\u27re studying, meeting friends, or just exploring, we’ve got you covered. Follow @UMSLLibraries for more tips, updates, and campus life hacks! #UMSL #UMSLLibraries #TipTuesday #LibraryVibes #CampusLife #StudySmart #LibraryDesign #FollowForMore #StudentHackshttps://irl.umsl.edu/libpub/1061/thumbnail.jp
Improving HPV Vaccination Decision-Making for Adolescents and Their Caregiver
Full text linkAbstract
Problem: Human papillomavirus (HPV) is a viral infection associated with the development of certain cancers and is the most common sexually transmitted infection in the United States (U.S.) (Centers for Disease Control and Prevention [CDC], 2023). The CDC (2021) asserts that more than 90% of cancers caused by HPV infections could be prevented through the HPV vaccination. The CDC recommends the HPV vaccine series for children ages 11 or 12 years; however, this organization further submits that the HPV series could be initiated as early as 9 years of age through 26 years of age (CDC, 2024). Despite CDC recommendations, in 2023, only 76.8% of teens aged 13-17 years received one dose of the HPV vaccine, and 62.6% were up to date with the vaccine series (CDC, 2024).
Methods: This quality improvement project aimed to determine if HPV education and recommendations by healthcare providers could increase vaccination rates among adolescents ages 9-17 years old. A mixed-methods design was used, combining retrospective chart review with parental surveys to evaluate HPV vaccination uptake and identify barriers to vaccination.
Results: After 12 weeks of implementation, there was no statistically significant difference in the increase in HPV vaccination rates. However, provider education and recommendation were associated with a clinically significant increase in vaccine acceptance.
Implications for Practice: This project demonstrated that provider recommendations on HPV vaccinations can increase vaccine acceptance rates among adolescent caregivers
Post-9/11 Navy Service Members’ Barriers to Using Military Educational Benefits
Full text linkThere are studies explaining how many service members are using military educational benefits or the challenges service members incur after they have enrolled in school and are attending classes. There are also studies that report how many service members use military educational benefits. However, studies exploring why some service members, or some Post-9/11 service members in particular, do not use military educational benefits has been limited. The purpose of this study was to discover why many service members in the United States Navy do not or did not take advantage of military educational benefits. This study also sought to find out if service members think they are being adequately informed about military educational benefits for which they are eligible. Adult education participation, particularly barriers to it, served as the framework for the study. Four Navy service members, one female and three males, from a midwestern metropolitan area who met Post-9/11 criteria for military educational benefits participated in the study. Qualitative case studies were used. One-on-one semi-structured interviews were conducted twice. Five themes emerged: (a) lack of communication; (b) lack of knowledge; (c) frustration; (d) lack of confidence; (e) finance/family. Other themes that emerged from the second round of interviews were information access and awareness, complexity of eligibility rules, communication gaps and military trauma. All of them, however, expressed a desire to change their early decisions if they had the opportunity to do it all over again. Results from the study suggest that the lack of information about educational benefits can hinder service members from making essential lifelong decisions. Recommendations include revamping the VA website and promoting the educational benefits at the post-secondary level
Network Analysis of Biopsychosocial Factors Associated with Trauma Exposure: Impacts on Inflammation
Full text linkThis study adds to current understandings of the relationship between trauma exposure and inflammation through network analysis of the sociodemographic sequelae that may influence this relationship. A reductive approach has been helpful in establishing the relationship between a pro-inflammatory state and trauma exposure, however understanding of the role of additional factors in this relationship is necessary to better understand how inflammation may serve as a transdiagnostic factor relating to mental health and biopsychosocial variables. 999 trauma-exposed individuals from the National Longitudinal Study of Adolescent to Adult Health (Add Health), 1994-2018 study at three timepoints (ages 18—26, 24—32, 33—43) were included. Data included trauma history, socioeconomic, and health behavior data collected via survey methods, and inflammation determined by high sensitivity C-reactive protein level. Network analysis (mixed graphical modeling, directed acyclic graphing) was used to determine the network structure of the trauma exposure (childhood maltreatment and adulthood traumatic event exposure)-inflammation relationship as it relates to cigarette use, socioeconomic status, substance use, depressive symptoms, age, race, and sex. Individuals reporting childhood maltreatment were more likely to experience higher than normal levels of CRP. Individuals reporting trauma history were more likely to have used substances and cigarettes within the past month. Cross-sectional network analysis suggests relationships between inflammation and biological sex and race. Childhood maltreatment evidenced relationships with biological sex, race, income, and cigarette use. Adulthood trauma exposure shared relationships with biological sex, race, substance use, and cigarette use. Depressive symptoms shared relationships with biological sex, race, income, adulthood trauma, substance use, and cigarette use. Longitudinal network comparison indicated network stability over time. Directed network analysis indicates demographic, social, and trauma exposure variables may influence inflammation, psychological symptoms, and health behaviors. The present study provides support for the importance of considering demographic, social, and health behavior variables when investigating trauma exposure and systemic inflammatory impacts. Results denote the importance of considering these factors in research, case conceptualization, and treatment. Future studies may benefit from application of a systems approach to better contextualize these processes within the individual and social environments within which they occur
Toward Culturally Responsive Interpretation: Native American Histories, Lifeways, and Ways of Knowing at the High Desert Museum
Full text linkMany public museums and historic institutions reflect settler colonial culture and are primarily non-Native led. Although these institutions are trusted, many have perpetuated cultural harm through the theft of belongings, the misrepresentation of stories and histories, and the inaccurate portrayals of cultural content. When interpreting Native American experiences, many non-Native institutions struggle to co-create culturally responsive interpretation. The purpose of this basic qualitative study was to apply the four-truth framework, developed by the South African Truth and Reconciliation Commission, to better understand how the High Desert Museum approached the interpretation of Native American content and stories and to explore how a culturally responsive non-Native institution interprets the High Desert Plateau. Along with an introduction and conclusion, this dissertation includes two products that highlight our findings in different ways: an academic journal article and a creative nonfiction chapter. Both products feature themes derived from reflexive thematic analysis and illustrate how to interpret Native American stories to minimize harm, celebrate Indigenous resiliency, and support deep partnerships. We conducted 16 semi-structured interviews with Indigenous and non-Indigenous staff, volunteers, and partners; 10 visitor interviews; onsite observations; and an analysis of museum exhibits. We found that as the High Desert Museum worked iteratively to cultivate relational accountability, practice story stewardship, and center Indigenous worldviews, a synergistic effect emerged. This synergy resulted in exhibits and programs that fostered meaningful connections and nurtured a sense of belonging. We argue that focusing on relational accountability, Indigenous worldviews, and story stewardship, while engaging iteratively in readiness and reflection, creates a foundation for culturally responsive interpretation. We anticipate that culturally responsive interpretation could be applied to other non-Native sites of public history, could help foster deep partnerships with marginalized communities, and could mitigate cultural harm and promote cultural healing
Illuminating Trauma & Resilience In Educational Spaces: Expanding Narratives to Promote Historical and Critical Civic Empathy at Little Rock Central High School National Historic Site
Full text linkAbstract
The 1957 desegregation crisis at Little Rock Central High School marked a defining moment in the Civil Rights Movement and continues to symbolize the broader struggle for racial equality. This dissertation examines equity in educational spaces through a four-truth lens that was first articulated by the South African Truth and Reconciliation Commission and explores forensic, personal, social, and healing truth. Using Little Rock Central High School National Historic Site (CHSC) and park interpretation as the focal point, our qualitative research study used reflexive thematic analysis to examine oral interviews, onsite observations, and various documents and artifacts, and to illuminate how historical empathy contextualizes trauma and racial injustice in educational spaces like CHSC. We argue that acknowledging trauma in past educational spaces fosters historical and critical civic empathy, encourages resilience and healing, and reshapes perceptions of educational equity. When resilience is augmented by sustained reconciliation efforts, healing can emerge. Our research reveals that trauma remains relevant, and may be pervasive, in educational spaces even today. Providing opportunities for diverse audiences to cultivate historical and critical civic empathy through interpretive and educational programs at heritage sites is essential to sustaining reconciliation work and healing traumas past and present.
Keywords: trauma acknowledgment, historical and critical civic empathy, resilience, healing, four-truth lens, educational equity, National Parks, 1957 desegregation crisis, Little Rock Central High School, Little Rock Nine, park interpretation, school desegregatio
Implementing a Standardized Protocol to Screen for Depression in a Gastroenterology Outpatient Clinic
Full text linkProblem: There is a lack of mental health screenings for depression taking place in outpatient gastrointestinal (GI) clinics. Outpatient gastrointestinal (GI) offices are not consistently screening patients for depression despite a rise in depression rates and the known adverse impact depression can have on the GI tract.
Methods: This Quality Improvement (QI) study used a descriptive research design guided by the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model. Its purpose was to implement a 10-week PHQ-2/PHQ-8 depression screening protocol at a large midwestern health center\u27s gastroenterology outpatient clinic. The study used purposive sampling, including all GI outpatients aged 18+ with any GI condition and no history of depression, as it aimed to identify new cases of depression.
Results: Out of 127 documented visits during the study period, 89 patients (70.08%) were screened for depression using the PHQ-2. Of these, 19 (21.35%) screened positive and underwent further screening with the PHQ-8. Ultimately, 4 patients (n = 4, 100%) were referred to either a primary care (n = 3, 75%) or a psychiatric (n = 1, 25%) provider for further follow-up.
Implications for Practice: The findings suggest that utilizing the PHQ-2/PHQ-8 depression screening protocol can help identify undiagnosed depression in patients with GI issues. This proactive screening approach should be continued as it may help prevent the development of chronic GI symptoms that can be associated with untreated depression
Implementation of a Nurse-Driven Process to Decrease NPO Times in a Geriatric Emergency Department
Full text linkProlonged nil per os (NPO) status for geriatric patients in the emergency department is a critical safety issue, leading to increased rates of delirium, hypoglycemia, and perioperative complications. A quality improvement project was designed to address this problem through a targeted, nurse-driven intervention. In geriatric patients (age ≥70) in a geriatric emergency department, this project aimed to determine if implementing an electronic health record (EHR)-prompted nursing workflow to obtain a diet order would reduce the length of time patients were kept NPO compared with standard practice. An EHR documentation tool was designed and implemented along with targeted nursing education sessions at a large Northeastern hospital. A prospective chart review was conducted over a four-week post-implementation period. Outcomes included the time from provider assignment to diet order and the rate of missed diet orders. Data were analyzed using Interrupted Time Series Analysis (ITSA) for time-based outcomes and Chi-square analysis for categorical data. Nurses utilized the new workflow for 294 patients, representing a 37.9% adoption rate. The intervention resulted in a statistically significant immediate reduction of 65.5 minutes in the time from provider assignment to diet order (p = .002, 95% CI [−106.06, −24.95]). Furthermore, missed diet orders decreased significantly by 6.2% (p = .001, 95% CI [37.3%, 44.4%]). The implementation of a nurse-driven, EHR-prompted workflow successfully reduced prolonged NPO status and missed diet orders in a clinically meaningful way. This evidence-based project demonstrates that nurse-led, technology-supported interventions can significantly improve the safety and quality of nutritional management for geriatric patients in the emergency setting
Transportation: A Barrier to Healthcare Access Among Disabled, Older Adults with Diabetes and Hypertension in Rural Areas
Full text linkProblem: Transportation is essential for health service utilization (clinic appointments, diagnostic services, and picking up medications from the pharmacy (Hansmann & Razon, 2024). Shekelle et al. (2022) in their systematic review and meta-analysis indicated that the U.S. rural population is 60 million. Rural areas continue to experience transportation as a significant barrier to health, a key social determinant of health. It causes delayed or foregone care in approximately 3.6 million people annually, resulting in more than 25% of missed appointments. Methods: This quality improvement project utilized a descriptive and observational design. A convenience sample of Medicaid patients receiving care at Mercy Family Clinic in Wright City was identified, and qualitative data were collected during the implementation period. The data collected included the patients’ age group, the number of times non-emergency medical transportation (NEMT) was offered, the distance from home to the clinic, the number of emergency room (ER) visits, and the diagnoses. Results: With the implementation of the quality project, thirty-two Medicaid patients were seen and reminded of the availability of NEMT. Of those, three missed their appointments, 9.3% (n=3). Implications for Practice: Interventions aimed at closing the transportation gap in rural areas are crucial for improving the health outcomes of this population by reducing the number of missed appointments
Implementation of Quantitative Blood Loss to Detect Postpartum Hemorrhage after Vaginal Birth
Full text linkProblem: In the U.S., postpartum hemorrhage (PPH) is attributed to maternal morbidity and mortality, resulting in long-lasting effects of extended recoveries, surgical interventions, birth-related trauma, interruptions in mother-infant bonding, or death. Performing estimated blood loss (EBL) measurement methods postpartum is subjective and often associated with over- and underestimations of blood volume. The delay in recognition interferes with timely, efficient, and appropriate interventions, yielding a PPH (≥1000ml).
Methods: A quality improvement (QI) project was initiated with a descriptive, pre-implementation/post-implementation focus on a high-risk Labor and Delivery unit to explore the effects of Quantitative Blood Loss (QBL) measurements on the identification of PPH. A visual education tool was created and distributed to unit staff members to educate them on proper QBL technique post spontaneous vaginal delivery (SVD). A retrospective chart review was completed for all SVDs within the pre-implementation (Feb-Apr 2024) and post-implementation (Feb-Apr 2025) period while referencing the inclusion and exclusion criteria to formulate a convenience sample. The total blood loss (in milliliters), PPH rate, and EBL versus QBL utilization were collected and analyzed through retrospective chart reviews.
Results: A total of 156 women were included in the study. Of the total included, n=89 represented the pre-implementation period and n=67 represented the post-implementation period. The pre-implementation period reported that 48 participants (53.9%) had the EBL blood loss measurement method, and 41 (46.1%) had the QBL blood loss measurement method. A total of nine (10.1%) PPHs were identified; five utilizing EBL and four were identified utilizing QBL, demonstrating a statistical value of p 0.938 between groups. The post-implementation period reported 20 (29.9%) participants with EBL utilization and 47 (70.1%) participants with QBL utilization. Seven (10.4%) PPHs were identified; one utilizing EBL and six utilizing QBL, demonstrating a statistical value of p 0.238. Although not statistically significant, the PPH rate increased by 0.3% and displayed a clinical significance between the EBL compared to QBL groups during the pre- and post-implementation period. EBL utilization decreased by 24% and QBL utilization increased by 24% between pre- and post-implementation, exceeding the project\u27s aim of 15%.
Implications: Implementation of QBL on a high-risk Labor and Delivery unit objectively measures blood loss and, in addition, creates a standardized approach to practice, eliminating the possibility of variance. Awareness of quantitative blood volume allows physicians and unit staff members to respond promptly with appropriate interventions, promoting early detection and efficiency. Further improvement projects should focus on the continued utilization of QBL and explore barriers to widespread implementation in practice