Implementation of an Evidence-Based Postpartum Depression Screening Tool in a Level IV Neonatal Intensive Care Unit

Problem: Postpartum depression (PPD) affects up to 40% of mothers with infants admitted to the Neonatal Intensive Care Unit (NICU), yet many remain undiagnosed due to the absence of standardized screening protocols. Early identification and referral to Perinatal Behavioral Health Services (PBHS) is critical to support maternal well-being and improve neonatal outcomes. Methods: This evidence-based quality improvement project utilized a descriptive and correlational design to evaluate the impact of implementing the Patient Health Questionnaire-8 (PHQ-8) for PPD screening among mothers of infants born ≤ 32 weeks’ gestation in a Level IV NICU. A convenience sample of 29 mothers received the PHQ-8 via phone at 48-hours and four-weeks postpartum. Referrals to PBHS were initiated for mothers who screened positive (PHQ-8 ≥ 5) and consented to a referral. Screening and referral rates were compared to retrospective pre-intervention data. Results: Among participants, 65.52% (n = 19) screened positive at either time point. Referral rates to PBHS significantly increased following PHQ-8 implementation (p = .001), with 14 mothers consenting to services. Six of ten mothers referred at 48-hours showed symptoms improvement by week four. While no significant change in overall screening positivity or severity was observed between time points, symptom fluctuation emphasized the importance of repeated screening. Implications for Practice: Routine use of the PHQ-8 in the NICU setting can increase identification of PPD and facilitate timely referral to PBHS. Integrating simple, validated screening tools into standard NICU workflows may address unmet mental health needs in high-risk mothers. Repeated assessments at multiple time points can enhance early intervention and promote long-term maternal-infant health

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St. Louis, Missouri’s Gayborhood and Washington, DC’s Black Lives Matter Plaza: Revealing the Healing Potential of Resistance Stories that are Grounded in Place

Oppressed people resist, even when facing severe consequences for doing so. At the core of systemic oppression—genocide, slavery, racism, and sexism—is a drive to control and dehumanize. Resistance, however, can serve as a powerful act of rehumanization. From enslaved individuals fleeing plantations to LGBTQ+ individuals risking arrest to gather in mid-20th-century bars, resistance reclaims power and autonomy under oppressive regimes. This study applies South Africa’s Truth and Reconciliation Commission (TRC) “four truths” framework—comprising forensic, personal, social, and healing truths—to the interpretation of contested heritage sites. We argue that sites commemorating resistance hold transformative potential for individual and community healing. Using qualitative methods, our research team analyzed interviews, observations, documents, and artifacts through reflexive thematic analysis. We highlight two case sites: a historically LGBTQ+ “gayborhood” in St. Louis, MO, and Black Lives Matter Plaza in Washington, DC. Our findings reveal (a) a framework for interpreting sites of resistance and their healing potential; (b) the value of storytelling that honors complex, painful histories; and (c) a call to shift interpretive practices toward vulnerable, inclusive truth-telling. This work is presented through both a scholarly article and a creative nonfiction disquisition. By centering the voices of those with lived experiences of oppression and resistance, we underscore the importance of acknowledging painful pasts in heritage interpretation. In doing so, we advocate for interpretive strategies that reclaim humanity, foster healing, and honor the resilience of marginalized communities

Employee Salary Report [University of Missouri - St. Louis] 2025

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Network Analysis of Biopsychosocial Factors Associated with Trauma Exposure: Impacts on Inflammation

This 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

Development and Validation of the Informal Safety Leadership Measure

This research develops and validates a measure of the emerging concept of informal safety leadership (ISL), which integrates elements of safety leadership and informal leadership to address a significant gap in organizational safety literature. Despite extensive research on formal safety leadership, there remains limited understanding of how non-managerial employees influence safety practices and culture within organizations. This dissertation develops and validates a comprehensive measure of informal safety leadership through a sequential mixed-methods approach incorporating a pilot study and two additional studies. First, a pilot study employed focus groups with health, safety, and environmental professionals to identify key dimensions of ISL. Study 1 focused on the development and refinement of a multi-dimensional ISL scale with data from 300 employees across high-risk industries. Exploratory factor analysis yielded a robust five-factor structure representing core ISL behaviors: Advocacy (proactive safety communication and initiatives), Support (responsiveness to others\u27 safety concerns), Reluctance (hesitancy to engage in safety leadership), Mindset (safety knowledge and priorities), and Reporting (promoting incident documentation and transparency). Study 2 confirmed this factor structure in a separate sample (N = 283) and established the scale\u27s convergent, discriminant, and criterion-related validity. The ISL measure revealed strong psychometric properties and predicted important safety outcomes including influence on others\u27 safety behaviors, vigilance, and compliance. Supplemental analyses revealed that ISL operates differently across organizational contexts, with medium-sized organizations showing the highest ISL scores, suggesting optimal conditions for informal safety leadership emergence. The findings contribute to both research and practice by providing a psychometrically sound instrument to measure informal safety leadership, enhancing our understanding of how safety culture develops through informal influence processes, and offering organizations practical insights for recognizing and leveraging informal safety leaders to reduce workplace injuries and fatalities

Implementing a Turn Team Process to Reduce Hospital-Acquired Pressure Injuries on a Telemetry Unit at a Hospital in the Midwest

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: 4 in 2022, 12 in 2023, and 16 in 2024. Method: This quality improvement project utilized a descriptive, observational design. A turn team process was implemented over an eight-week period. To enhance compliance with the two RN skin assessment, the assessment process was integrated into the turn team program. Additionally, satisfaction surveys were distributed to staff before and after the eight-week implementation to evaluate staff satisfaction with the unit’s previous process for completing every two hour turns and the turn team process. Education on PI were also provided to staff. Data were collected through retrospective chart review. Results: The pre-implementation phase had a total of four PIs and the post-implementation phase had two acquired PIs. Staff compliance with patient turning increased from 85.25% to 100% and wedge utilization increased from 11.5% to 37.5%. Compliance with completing two RN skin assessment decreased from 96.72% to 95.83%. Survey results showed significant improvements in overall satisfaction, feeling of ease of use, and a feeling of positive contribution to team work with the turn team process

Building a Grounded Theory of Resilience Among Survivors of Chronic Ischemic Stroke

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 Scale and Stroke Specific Quality of Life were used to measure resilience and quality of life pre- and postintervention. We used advanced theory construction techniques (Hage, 1972; Walker & Avant, 2019), grounded theory methods of coding, Wilcoxon signed-rank tests, and descriptive statistics to develop a grounded theory of resilience in chronic stroke. The model of psychological resilience in chronic stroke was developed from the antecedents, attributes, and consequences of resilience. Core categories associated with the bounded case were Antecedents to Poststroke Resilience, The Obstacle Is the Way, and Embodied Mindfulness. Overall, results showed resilience scores increased from a mean of 3.22 ± 1.01 to 3.45 ± 1.09, whereas quality of life scores rose from a mean of 169.50 ± 29.93 to 182.88 ± 39.35. The energy subscale with quality of life demonstrated a statistically significant increase (p = .034). The selective code, Sand Mandala (the essence of resilience, growth, and thriving after stroke) symbolizes a participant’s insight to drop the notion of returning to pre stroke state and developing acceptance by mindfulness, impermanence, holism, healing transformation, and community. Stroke care often neglects psychosocial factors, despite their significant impact. Stepping back from “door to needle” to “door to lifelong recovery” broadens the view on the continuous impact of stroke. Future research should explore theoretical frameworks, health inequities, and resilience in stroke longitudinally. Nurses, the most ubiquitously dispersed and capable group of healthcare providers in the United States, are prepared to support a life worth living after stroke

Motivational Interviewing for Weight Loss: A Review of Evidence-Based Outcomes in Overweight and Obese Adults

Obesity is a significant clinical problem affecting 41.9% of adults in the United States, with profound implications for individual health and healthcare economics. Standard weight loss interventions, often limited to pharmacological treatments and dietary guidance, frequently fail to achieve sustained adherence and meaningful longterm outcomes. This quality improvement (QI) project evaluated the integration of motivational interviewing (MI), a patient-centered counseling strategy, into routine clinical practice at Innovafusion, a medically supervised weight loss clinic in Aubrey, Texas. The aim was to enhance adherence to lifestyle modifications, promote intrinsic motivation, and improve weight loss outcomes among adults aged 18–65. Using a retrospective and prospective comparative chart review design, baseline data from standard care alone were compared to outcomes from MI-enhanced interventions over an 8-week period. Weight loss was measured using bioimpedance analysis, and adherence and motivation were assessed with the Weight Efficacy Lifestyle Questionnaire–Short Form (WEL-SF). Although no statistically significant difference in mean weight loss was observed between groups (t(88) = 0.37, p = 0.714), participants receiving MI demonstrated improved motivation and self-reported adherence behaviors. These findings suggest that MI addresses psychological and behavioral barriers that impede sustained weight loss. Clinical recommendations include routine MI integration to strengthen patient self-efficacy and adherence. Future studies should assess MI\u27s longterm impact and explore objective adherence measures to further inform evidence-based obesity management

Getting the Unbanked, Banked: An Adult Education Intervention Program to Increase the Usage of the Banking System by Low-Income Families

Financial literacy describes the skills, knowledge and tools consumers use to make informed financial decisions to meet their goals. The purpose of this study was to determine how many consumers utilize the resources offered by banks and credit unions and for those who do not, after participating in an intervention, will begin to do so. The Transtheoretical Model of Behavior Change served as the theoretical framework. It has been shown to be a useful model to examine adults’ change in financial behaviors. The sample consisted of 65 adults who lived within specific zip codes in a large metropolitan area in the midwestern United States. Participants completed a pre-survey asking questions about their use of a checking account, savings account, credit cards, and budgeting. Once completed, they completed an audio intervention program called the Money Smart program by the FDIC and then a post survey. The intervention describes the resources (checking account, savings account, home loan, etc.) used by banks and credit unions and how using them will be beneficial whereas the post-survey asked if they are open to using the banking and credit union resources. Relative to resources, most participants indicated they would increase their use of resources related to checking and savings accounts. Additionally, most participants indicated they would reduce the number of credit cards they used. As a result of the financial literacy intervention program, the participants increased their knowledge on monitoring their household finances. Implications include understanding that a one-time financial seminar is enough to change adults’ financial behaviors