Understanding Nurse Practitioners' Contributions in Shaping Healthcare

Cuccovia, Barbara Ann University of Massachusetts Boston ProQuest Disser 2022 해외박사(DDOD)

Nurse practitioners (NP) are integral members of the healthcare delivery team. The NP role has evolved in practice since the inception of the role in 1965 when the aim was to expand access to pediatric patients in rural areas. Today, NPs can be found in all healthcare settings. Physician shortages and changes in hospital models of care continue to burden the healthcare system. As medical and surgical residents work hours and educational programs continue to have stricter mandates reducing their time on the inpatient wards, hospitals are changing the workforce to have 24-hour NP teams. NPs have been found to provide safe, high-quality patient care and are a solution to ease the burden on our healthcare system. NP scope of practice can be restricted and vary based on their state’s legislation despite standardization of educational requirements. Limits placed on NP scope of practice impact patient access, contribute to increased healthcare costs, and increase administrative burdens. A barrier to NP scope of practice legislation changing has been mostly led by physician advocacy groups. Continual evidence supporting that NPs provide similar care to physicians and the Massachusetts Health Policy Commission demonstrating the impact that NPs have on lowering costs and servicing individuals from underserved areas, has led to legislation for full practice authority that became law in 2021 (Barnett et al., 2021; Fraze et al., 2020; Gellar & Swan, 2021; Massachusetts Health Policy Commission, 2018). Understanding the factors that contribute to NP’s job satisfaction is relevant to healthcare leaders. A multi-study systematic review was completed to understand factors that contribute to NP job satisfaction. Sixteen articles were identified for review and three themes were found that contribute to higher levels of satisfaction: level of challenge and autonomy, patient care, and feeling valued. Themes that contributed to lower levels of satisfaction were reporting structure, organizational commitment, relationships, and benefits/money. NP reporting structure was a consistent theme in evaluating NP job satisfaction yet there is a lack of literature on this topic. A grounded theory study was completed to understand inpatient NP’s perception of their reporting structure. The theoretical model ‘fostering an environment' emerged from the data supported by three categories: time, support, and identity.

The Role of Massachusetts Cultural Council in State Cultural Policy: Institutionalism, Policy Goals, and Perceived Outcomes in the Arts and Culture

Wu, Hsin-Ching University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

Cultural policy in the United States is characterized by its federal political system, in which multiple actors, from the governmental and non-governmental entities, all play a role. The latter consists of individual artists, nonprofit cultural organizations, and the private market. The state governments and their respective state arts or cultural agencies are identified as players of increased prominence (Shuster, 2002). A mixed-methods case study of the Massachusetts Cultural Council (MCC) was conducted to analyze its role, policy goals and instruments, and the perceived effect of its policy. The theory of new institutionalism, which acknowledges the impact of the political system on policy outcomes, frames this investigation. The data was primarily collected from interviews with 33 stakeholders and 11 observation sessions. An additional analysis was conducted on secondary sources, including documents, archival records, spatial information, and survey data from the Cultural Data Profile, which consists of financial and programmatic data from participating nonprofit organizations. A novel typology was conceptualized to classify the policy orientation of the MCC according to the benefit of culture and the societal attitude toward it. The study results show that the MCC is perceived as a key influencer, though its impact is not transformative due to resource constraints. Its position under the office of the Treasurer and Receiver- General, independent from that of the governor, buffers it from the political turnaround. This structural arrangement safeguards its autonomy, which contributes to the lasting nature of its policy and programs. The MCC utilizes policy instruments of grantmaking and constituent services to support a wide range of arts and cultural organizations. It methodologically builds a close relationship with its constituencies, who reciprocally advocate for the continuous public funding of its programs and services. Guided by its leadership, the MCC also innovates its operation by incorporating collaboration and technology to aid in its public mission. These strategies help the agency stay relevant in the political arena. Empirically, the findings present a vital lesson for other agencies to improve their practice. Theoretically, these study results insinuate the critical role of the institutions in safeguarding public values in the process of policymaking.

A Preliminary Evaluation of a Culturally Adapted Stress Management Prevention Workshop for Latinx Students

Arbid, Natalie University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

Mental health prevention programs offer one avenue through which to offer mental health equity. In this investigation, I conducted a preliminary program evaluation of a culturally adapted stress management prevention intervention workshop for Latinx college students. The prevention workshop is an acceptance based behavioral therapy (ABBT) workshop, which was adapted, incorporating feedback from Latinx students, to be culturally responsive to the needs of Latinx students at the University of Massachusetts Boston (UMB), an urban predominantly non-residential institution. Focus groups with Latinx students were conducted to determine the cultural adaptations necessary and these adaptations were integrated into the existing workshop. Then, the culturally adapted stress management prevention intervention workshop was offered as a free service to interested Latinx students. Results from focus group thematic analysis bore several themes and the following were included as adaptations: participants’ managing family responsibilities and expectations, managing multiple responsibilities, feelings of guilt related to this negotiation, mental health stigma, and change of sociopolitical context and discrimination. A total of 19 participants completed the workshop. Participants reported a significant reduction in depression scores and general distress. Decreases in anxious arousal, stress (general anxiety), and experiential avoidance were not statistically significant but had medium to large effect sizes. Quality of life, student course engagement, and mental health continuum total and its subscales were not impacted by the workshop except for the social wellbeing subscale. These findings illuminate the ways this culturally adapted prevention intervention workshop can benefit Latinx students’ mental health. I consider these promising findings in the context of participant demographic variability and current Latinx sociopolitical context. Last, I offer considerations for future directions in Latinx prevention intervention research.

"I Can't Learn that Fast." The Exclusion of Women in College Algebra

Crounse, Karen M University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

The underrepresentation of women in STEM majors and careers reflects unequal societal structures that privilege men over women and prevent women from accessing mathematics-based fields. Mathematics courses can serve as a barrier to studying STEM, especially undergraduate College Algebra in which nationwide more than half of students struggle (Ganter & Haver, 2011; Gordon, 2008). Through a mixed methods research study that employed surveys, focus groups and interviews, this study investigated undergraduate women’s experiences in College Algebra and how these experiences influenced their beliefs about themselves as mathematicians, and their potential path through STEM. This research design was informed by a theoretical framework that includes critical pedagogy and intersectionality as a means of examining inequities, especially for those women who lie at the intersection of gender, race and class. The findings show that the traditional pedagogy in College Algebra is harmful to women, especially Black and Latinx women and women from low income households, and restricts their access to mathematics understanding, isolates them, reduces their confidence and agency and dissuades them from future mathematics classes and STEM. The voices of women in the study inform a new student-centered College Algebra pedagogy that focuses on understanding and dialogue, increasing confidence and agency, and paving a pathway to STEM. This change in pedagogy has the power to disrupt the hegemonic vision of who can be a mathematician and scientist, inspiring and including women, leading to an increase in the diversity of mathematics-based fields and to a more just and equitable society.

Spokespeople or Gatekeepers? A Case Study of Teacher Engagement with the Data Privacy Policy Environment in U.S. Public Schools

Potasznik, Amanda University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

Teachers may not always be able to pay for desirable educational technology programs for their students, but they can adopt extremely popular and valuable software and apps in their classrooms for “free.” Despite this seemingly beneficial arrangement, it can result in teachers, and by extension, students, entering complicated agreements with technology companies. Teacher misunderstanding (or ignorance) of company privacy policies may result in a company’s exploitation of its position in classrooms and access to student data. When teachers require students to sign up for educational technology (EdTech) apps, at either the district’s request or their own discretion, it is imperative to study teacher awareness of and thoughts regarding EdTech privacy policies, as well as legislation at various levels that may influence that awareness and those thoughts. To that end, I conducted a) a policy analysis of documents in the EdTech and governmental privacy policy environment in states with varying degrees of legal protection for student data, and b) a survey of teacher awareness of those documents; I then identified existing discrepancies between the two. I employed theories from the fields of psychology and information science to explain what motivates teachers to include or refuse EdTech in their classrooms. The apps studied in this research were Remind, Kahoot!, Google for Education, and Photomath. Not enough teachers used Photomath in their classrooms for statistical analysis, but the results for the other three apps show significant discrepancies between policies and teachers' understanding of those policies. This study was needed because the influence of state law on teacher policy awareness has not been documented; neither have discrepancies between how popular EdTech companies say they treat student data, and how teachers think the companies treat that data. The results of this study show which policies, and elements therein, are misunderstood by teachers, and that governmental policies must be updated in order to fully protect student data from information-hungry EdTech companies. Results also show that lack of enforcement of current legislation may be further compromising student data privacy.

Organocatalysis for Michael addition-based transformations involving fluorination and other asymmetric reactions

Huang, Xin University of Massachusetts Boston ProQuest Disser 2016 해외박사(DDOD)

Michael addition-initiated cascade asymmetric synthesis is powerful for the construction of molecules bearing multiple stereocenters. Organofluorine molecules play an important role in medicinal chemistry and agricultural chemistry. Presented in this thesis is my effort on the development of Michael addition-based cascade reaction sequences for the synthesis of fluorinated and other asymmetric molecules with biological interest. Organocatalysts, especially recyclable fluorous catalysts such as cinchona alkaloid/thiourea have been used for the reactions. This thesis covers following projects: 1) Michael addition reaction of alpha-fluoro-beta-ketoesters with maleimides to afford two adjacent stereocenters including a fluorinated chiral tertiary carbon; 2) One-pot Michael addition-based cascade reactions including double cascade Michael/aldol reactions for monofluoro- and difluorocyclohexanones; 3) One-pot triple cascade Michael/aza-Henry/lactamization sequence for fluorinated 2-piperidinones bearing four stereocentres; 4) One-pot quadruple cascade fluorination/Michael/Michael/aldol sequence for fluorinated cyclohexanes bearing six stereocentres; and 5) One-pot Michael/Mannich/cyclization reactions for asymmetric synthesis of 5- and 6-membered spirooxindoles bearing up to four stereocenters. Most of above mentioned projects are conducted as one-pot synthesis and using recyclable organocatalysts to afford compounds in good to excellent yields and stereoselectivties. They have green synthetic advantages of pot, atom and step economy (PSAE), minimal intermediate separation, toxic transition metal-free catalysis; and catalyst recovery.

The Experiences of Women on Their Career Pathways to the College Presidency: A Hermeneutic Phenomenological Study

Nahabedian, Audrey M University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

While women earn over half of all PhDs and hold 44% of chief academic officer positions, the percentage of women college presidents has progressed from 23% in 2006 to only 30% in 2016.The problem remains that women continue to be significantly underrepresented in college presidencies. Women seeking college presidencies are more likely to confront unique barriers, including a devaluation of women’s leadership, work-family issues, and lack of mentorship.Because of the lack of empirical research on career pathways of college presidents, this research focused on women who did achieve college presidencies in order to understand how they are experiencing and overcoming obstacles throughout their career pathways. The study’s theoretical framework included a feminist conceptual lens and was informed by Ritchie et al.’s (1997) career development theory and Eagly and Karau’s (2002) role congruity theory.Using a hermeneutic phenomenological approach, the data were collected primarily through semi-structured interviews with a purposeful sample of 18 women college presidents; nine interviews were conducted in person and nine over the telephone. The interviews were supplemented by field notes and additional documentation including professional resumes, video clips, presentations, and articles. Of the presidents interviewed, nine came to the presidency through academic pathways, six through administrative pathways, and three through nontraditional pathways.The major themes pertaining to the presidents’ pathway experiences related to: (1) career transitions, (2) the role of social identities, and (3) resiliency. The challenges the presidents confronted were directly connected to their work environment, discrimination, and work-family issues. Intersectionality was strongly relevant in all the presidents’ stories. Their social identities determined how the presidents experienced events in their professional lives, including how they were positioned in relation to various power structures. Social identities discussed included gender, race, socioeconomic class, first-generation college graduate status, sexual orientation, and regionalism.This research adds to the existing literature by offering a resiliency framework that the presidents used on their career pathways. Through a review of the findings, it became apparent that the presidents’ values/beliefs, personal and professional relationships, career decisions, and leadership approaches collectively strengthened their resiliency. Ultimately, their resilient beliefs and actions furthered their advancement and success.

How Do Emerging Bilinguals Learn Math? The Role of Translanguaging in an English-Only Middle School Mathematics Classroom Setting

Coker, Mustapha K University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

Current research shows that nearly all states are struggling to meet the academic target in mathematics set in 1994 by the National Council of Teachers of Mathematics (NCTM) for multilingual English learners (ELs). According to NCTM standards, ELs are expected to learn mathematics regardless of their English development level (ELD). However, one of the many factors contributing to the learning difficulties of ELs is that the current culture of U.S. public schools does not consider these students’ sociocultural and historical experiences with math knowledge. Another inhibiting factor is that math is about more than just numbers; mathematics education involves terminology, concepts, and oral and written language around problem comprehension and solutions, including the basic language used by math teachers. ELs also use translanguaging (Garcia & Kleyn, 2016) as a tool for triangulating and gaining access to their linguistic repertoire for comprehension of the subject, thereby increasing their success in mathematics classrooms. This qualitative ethnographic case study seeks to understand the role of translanguaging in the mathematics learning of ELs in an English-only math setting. Using a Vygotskian cultural-historical activity theory (CHAT) lens, the study seeks to uncover the potential of translanguaging as a viable strategy for achieving the high standards that NCTM has set for all learners of mathematics.

The Effectiveness of a Mindfulness, Acceptance, Valued Action, and Flexible Coping Intervention for Race-Based Stress on Momentary Coping and Distress Symptoms

Martinez, Jennifer Honculada University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

Racism and racism-related stress has been shown to be associated with negative mental health outcomes among people of color (POC), such as increased depressive and anxious symptoms (e.g., Williams, Neighbors, & Jackson, 2003). Further, approximately up to 98% of all POC report experiencing a racist experience over the past year and in their lifetime, indicating that racism-related stress is a chronic experience. Most research on coping with racism has evaluated the cross-sectional impact of racism and mental health but has yet to identify which coping strategies may be most effective as buffers against the psychological impact of racism. Further, little research has evaluated intervention adaptations specifically targeting strategies to ameliorate the mental health sequelae of racial discrimination. This dissertation examines the effectiveness of a brief mindfulness- and valued action-based health intervention adapted to target POC’s emotional responses and coping in the face of discrimination. This dissertation consists of two monographs. The first monograph is entitled, “Mindfulness and Valued Living in the Face of Racism,” and is composed of a synthesized literature review and provides considerations for mindfulness- and valued-living (MVL) approaches adapted to address racism-related stress. The second monograph presents an empirical quantitative study, entitled, “The Effectiveness of a Mindfulness, Acceptance, Valued Action, and Flexible Coping Intervention for Race-based Stress on Momentary Coping and Distress Symptoms.” The empirical study examined and interpreted data collected from a pilot intervention study using a waitlist-control design and momentary assessment methodology. The study evaluated the effectiveness of a brief MVL intervention for coping with racism, as well as the effectiveness of MVL strategies on negative affect during discriminatory incidences the moment they occur. Twenty-eight students of color were recruited from an urban, public, northeastern university, and were randomized into either an intervention condition or a waitlist control condition. Participants found the MVL intervention adapted to address racism-related distress to be helpful overall. Participants randomized into the MVL condition showed a medium effect of a decrease in depression and stress symptoms from pre- to post-assessment. However, our sample was underpowered to detect statistically significant differences. Implications and future directions are discussed.

Assessing Mental Health Provider Bias toward Clients with Understudied Marginalized Sexual Identities and Practices

Herbitter, Cara University of Massachusetts Boston ProQuest Disser 2020 해외박사(DDOD)

Background: Limited research has directly assessed mental health provider biases toward consensually non-monogamous (CNM) and asexual clients. In the current study, I sought to assess the extent to which mental health providers hold biases toward asexual-identified and CNM-practicing clients, as well as what individual and contextual factors predict such biases. In addition, I aimed to investigate whether sexuality training predicts competency and explicit bias toward asexuality and CNM, and whether these two variables predict implicit clinical bias. Methods: I recruited 193 doctoral-level trainees and practicing psychologists from professional psychology listservs, social media, training program directors, and personal and professional contacts to participate in an online survey. Participant were randomized to one of three conditions. Each participant was presented with a vignette describing a depressed client who was described in one the following ways: asexual, practicing CNM, or monogamous and experiencing sexual attraction. Vignettes were otherwise identical, and all hypothetical clients were described as happily married. Participants were asked questions about attitudes toward this specific client as well as more general questions to asses for bias toward asexuality and CNM practices. Lastly, all participants completed demographic items, questions assessing potential social influences on their attitudes, and questions regarding their professional background and training. Results: I found that, for both asexuality and CNM, sexual orientation, age, and general prior knowledge of asexuality and CNM were relatively consistent predictors of both explicitly and implicitly biased attitudes. I found evidence of implicit clinical bias toward CNM-practicing clients in response to the vignette. Finally, I found that the paths between training and self-perceived competency, as well as between explicit and implicit bias, were statistically significant. Discussion: I discuss implications for research and clinical training, as it is critical that we as a field continue to innovate as we conduct research and create training paradigms that are truly inclusive of sexual, gender, and relationship diversity.