Ph.D., Antioch University, 2020, Leadership and Change

This single, exemplar case study explored the context and social processes that shape person- and family-centered culture in a long-term care (LTC) home, using grounded theory and situational analysis for the data collection and analysis. Findings revealed one core dimension: needing to be heard, valued, and understood, and five key roles: personal support workers (PSWs), executive director (ED), senior leadership, nurse managers, and residents and families, which informed five dimensions, each focused on enhancing care for residents: (a) attending to residents' daily care needs (PSWs), (b) advocating strategically (ED), (c) translating vision into programs and policies (senior leadership), (d) ensuring quality of care on the unit (nurse managers), and (e) seeking social connection and meaningful stimulation (residents and families). These interactions left PSWs with little autonomy, feeling rushed, focused on tasks, and prevented from building relationships with residents. The PSW perspective was often missed in decision-making, as decisions were made for this group rather than with them. A complex theoretical model of the interactions and the systemic blind spot they have unintentionally created is presented in the discussion. The results suggest that empowering PSWs is pivotal to improving quality of care in the LTC sector. Further research is needed to determine which methods of empowerment are most meaningful and effective. Future studies could also explore LTC homes of different sizes and with different types of governance, the competencies required by the different roles to foster a person- and family-centered LTC culture, and the criteria for relational practice and leadership in LTC. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/, and is accompanied by one supplemental file.

Committee: Elizabeth Holloway PhD (Committee Chair); Donna Ladkin PhD (Committee Member); Madelyn Law PhD (Committee Member) Subjects: Gerontology; Health Care; Health Care Management; Organizational Behavior

Psy. D., Antioch University, 2015, Antioch Seattle: Clinical Psychology

Despite a general agreement across health care disciplines that Advanced Care Planning (ACP) and Advanced Directives (ADs) add important elements to a patient's end-of-life care desires, and can inform their loved ones and advocates, help create ease of mind, and enhance quality of care, they continue to remain significantly underused. More than half of Americans transition to chronic and terminal illness without having completed them. The aim of this study was to increase the frequency and enhance the quality of communication about Advance Directives and Advance Care Planning within the clinical relationship. The resulting Interdisciplinary Relational Model of Care (IRMOC) can help clinicians engage in more frequent and effective communication about ADs and ACP. This ontological hermeneutic study considered scholarly and professional, practice-based health services literature, along with juridical, legislative, policy, and philosophical texts that have informed previous models of care. Tacit and explicit phenomena, conditions, and practices of communication about ADs and ACP in the patient-clinician relationship were identified. In response to the phenomena, conditions, and practices identified in this study the IRMOC was formulated and applied to communication about Advance Directives and Advance Care Planning in the patient clinician relationship. The IRMOC was then expanded, made more nuanced, and contextualized within the overall philosophical, theoretical, and practical frameworks that informed the model. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd

Committee: Philip Cushman PhD (Committee Chair); Mary Wieneke PhD (Committee Member); Judith Gordon PhD (Committee Member) Subjects: Aging; Clinical Psychology; Communication; Counseling Psychology; Gerontology; Health Care; Health Education; Health Sciences; Medical Ethics; Medicine; Oncology; Philosophy of Science; Psychology; Psychotherapy; Public Health Education; Therapy

Ph.D., Antioch University, 2022, Leadership and Change

Children benefit from engagement in early education and care (ECE) programs that support their learning and development while also providing a point of connection to critical resources for their families. For children from economically disadvantaged families, the lack of access to high-quality ECE results in a persistent achievement and opportunity gap (Garcia & Weiss, 2015). A significant portion of ECE occurs in home-based early learning environments, also known as family child care (FCC) programs, which play a critical role in supporting children from low-income and immigrant families (Layzer et al., 2007; Porter et al., 2010). Unfortunately, this sector of ECE has seen declining numbers of licensed caregivers over the past decade, due to increased regulatory requirements, low pay, competing commitments, low professional status, and working conditions involving long days in isolation from colleagues or peers (NSECE Project Team, 2016; Tuominen, 2003; Stitou et al., 2018). Using grounded theory methodology, this study explored the lived experience of successful FCC educators, examining the impact of professional identity, intentionality of practice, and management of competing demands on educators' efficacy, psychosocial well-being, and job satisfaction. The stories shared by educators in this study underscore the value of maintaining and supporting this sector of the ECE ecosystem. The findings provide a deeper understanding of the conditions and social processes that allow FCC educators to be effective and thrive in their work. This insight is the key to retaining high-quality programs, recruiting new professionals into the field, and developing strategies to support and strengthen FCC programs that serve young children and their families. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Committee: Elizabeth Holloway PhD (Committee Chair); Harriet Schwartz PhD (Committee Member); Rachel Gooze PhD (Committee Member) Subjects: Early Childhood Education; Education; Education Philosophy; Education Policy; Educational Leadership; Educational Psychology; Educational Theory; Families and Family Life; Gender; Gender Studies; Occupational Psychology; Organization Theory; Personal Relationships; Preschool Education; Teacher Education; Teaching

Ph.D., Antioch University, 2024, Antioch New England: Marriage and Family Therapy

This qualitative study explores how emerging adults engage with relationship education content on social media platforms and the implications for promoting accessible myself in the personal lived experiences of participants while removing listener preconceptions, identifying psychological structures that explain their interactions with relationship content. The findings reveal that emerging adults use a variety of social media platforms, including Instagram, TikTok, Reddit, Facebook, Pinterest, and YouTube, to consume relationship information. Participants prioritize content that is authentic, relatable, and derived from personal experiences over generic or impersonal advice. They value content that encourages healthy communication, self-reflection, and personal growth. The study also highlights the potential influence of participants' professional backgrounds on their engagement with relationship content, with those in social work and STEM fields emphasizing evidence-based advice. Additionally, the study identifies a strong preference for free and accessible content. Participants exhibit caution and discomfort with toxic content that perpetuates harmful stereotypes and behaviors, actively seeking out content that challenges these norms. These findings highlight the importance of creating diverse, relatable, and evidence-based relationship education content across multiple social media platforms to meet the varied needs and preferences of emerging adults. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Committee: Denzel Jones Ph.D. (Committee Chair); M. Dawn Nelson Ph.D. (Committee Member); Amber Vennum Ph.D. (Committee Member) Subjects: Behavioral Sciences; Educational Technology; Health Education; Mental Health; Public Health Education; Therapy

Ed.D., Antioch University, 2024, Education

Beginning at the onset of the COVID-19 pandemic, higher education experienced a sea change in reduced enrollment, altered course delivery models, and increased need for student support. While observing staff's actual impact on the student experience during this time, this study will address the question, “How do professional staff in small private universities a) perceive their contributions to the retention of students and b) perceive their overall value to the institutions they serve?” Owing to gaps in research on professional staff experiences, the literature review synthesizes current trends related to enrollment, retention, and persistence, focusing on small, private, non-profit 4-year institutions; discusses the disparate impact of these trends; examines the context of academic staffing trends; reviews the experiences of professional staff, focusing on critical connections between student and institution, student learning within liminal spaces, gender, and relational practice; and, examining social justice leadership in postsecondary education staffing. This qualitative study employs a constructivist grounded theory method using an initial anonymous questionnaire and interviews with volunteers for a deeper exploration of themes. The pool of nine interview participants comprises mid-level professional staff with at least three years of experience in student-supporting roles from five private universities with under 5,000 students. Potential implications relate to improving student retention practices and eliminating barriers by rethinking staff structures, resource allocation, and investment in student support areas. Further implications are related to staff role satisfaction, socially just models for professional development, and training of the next generation of professional staff. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Committee: Emiliano Gonzalez Ph.D. (Committee Chair); Douglas Judge Ph.D. (Committee Member); Cristy Sugarman Ed.D. (Committee Member) Subjects: Educational Leadership; Ethics; Higher Education; Higher Education Administration; Organizational Behavior

PHD, Kent State University, 2022, College of Nursing

With healthcare shifting to the community, the vast majority of homecare is provided by Certified Nursing Assistants. CNAs are a crucial connection in communication between the client and the Registered Nurse to implement early palliative care. The purpose of the study was to examine the effects of COMFORTTM SM palliative care communication training on the willingness to initiate communication, communication apprehension, and self-perceived communication competence, as well as relational social capital, among community-based homecare RNs and CNAs across time. The study used a one-group pre-/post-test within-subject repeated measures design. The sample included 32 CNAs. Eighteen CNAs completed all three time points. RNs were dropped from inferential analyses. In this study, communication training was operationalized by the COMFORTTM SM Model which represents the seven basic principles of palliative care and is based on narrative, relational communication. The curriculum was developed by Drs. Wittenberg-Lyles et al. While there appeared to be some descriptive changes over time, the vast majority of changes were statistically non-significant, but effect sizes were often moderate to large and would need to be validated in larger samples. Modest findings did provide initial support that community-based homecare CNAs may benefit from communication training to increase their WTC about palliative care to and for older adults. Modest findings also provided initial support that communication training may decrease CNAs' apprehension depending on the context. Additionally, while SPCC decreased following training in all contexts, SPCC had modest improvements in communicating with strangers and acquaintances over time. Finally, trust significantly increased over time. Certified nursing assistants, as essential links between clients and RNs, may benefit from ongoing palliative care communication training to facilitate connection between the client and the RN. A w (open full item for complete abstract)

Committee: Mary K. Anthony (Committee Co-Chair); Denice Sheehan (Committee Co-Chair); Nichole Egbert (Other); Jeffrey Ciesla (Committee Member); Dana Hansen (Committee Member) Subjects: Aging; Communication; Health Care; Health Education; Nursing; Social Research

Ph.D., Antioch University, 2022, Leadership and Change

Leaders planning strategic change face significant ambiguity and uncertainty due to the complex, fast-paced, and volatile nature of organizational life. What one leader sees as an opportunity, another may view as a threat depending on their past experiences, their existing mental models, and their perceptions of uncertainty. Sensemaking and sensegiving theories provide a framework for how leaders retrospectively make sense of new and disorienting information through recursive cycles of interpretation, action, and learning, and seek to influence the meaning-making of others towards a shared vision of the strategic change. Despite decades of research using these theories, studies have yet to examine leaders' perceptions of the locations of uncertainty (i.e., environmental, organizational, or individual) and how they impact leader sensemaking and sensegiving processes. Through a case study of a Vermont hospital, I reviewed documents and artifacts, observed meetings, interviewed leaders (i.e., trustees, executives, and directors) and developed an understanding of the hospital's social/political/historical/cultural context. The study revealed that leaders perceived uncertainty around five trigger situations. Leaders varied in their perceived locations of uncertainty by their level of leadership with all leaders perceiving moderate to high environmental uncertainty, executives and directors perceiving significant organizational uncertainty, and directors most likely to identify individually located uncertainty. Similarly, the specific qualities of uncertainty and leader sensemaking processes varied by perceived location of uncertainty and level of leadership. Of note, leaders were not always able to recognize their own perceptions of uncertainty. The case revealed an unexpected finding in the hospital's positive and relationally-oriented culture which served a protective effect in leader sensemaking of organizational change. Together, the study's findings highlight the ne (open full item for complete abstract)

Committee: Donna Ladkin PhD (Committee Chair); Elizabeth Holloway PhD (Committee Member); Lisa Day PhD (Committee Member) Subjects: Cartography; Cognitive Psychology; Educational Leadership; Epistemology; Health Care; Health Care Management; Medicine; Organizational Behavior; Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2017, Psychology

Youth in foster care face negative outcomes in several areas of functioning. The foster care system has struggled to address these outcomes and has been criticized for focusing excessively on deficits and problems. The current study aimed to employ an asset-based approach to evaluating the Fostering Success camp, a program designed to help improve outcomes in foster youth through building skills and relationships using an experiential learning paradigm. The study utilized repeated measures ANOVAs to determine if significant changes occurred in emotional self-efficacy (ESE), social self-efficacy (SSE), academic self-efficacy (ASE), relational health for a friend (RHF), and relational health for a community (RHC) as a result of camp attendance. Outcomes were measured using the Self-Efficacy Questionnaire for Children (SEQ-C) and the Relational Health Indices for Youth (RHI-Y). Bivariate correlations between attendance and change in SEQ-C and RHI-Y scores were also calculated. Analyses found no statistically significant change in scores or correlation between attendance and change in scores. Campers did report significantly lower SSE and higher RHF than previous community samples. Results are discussed within the context of program development and improvement for Fostering Success and implications for further research.

Committee: Janet Schultz Ph.D., ABPP (Committee Chair); Kathleen Burklow Ph.D. (Committee Member); Jennifer Gibson Ph.D. (Committee Member) Subjects: Psychology

Ph.D., Antioch University, 2016, Leadership and Change

Patient-centered care requires robust physician leadership in all aspects of healthcare in order to lead organizations to this ideal. Programs in Graduate Medical Education provide inconsistent and limited exposure to formal leadership development experiences for physicians in their final year of residency training. Literature addressing leadership training for residents focuses on the scarcity of effective programs that deliver adequate training and provide measurable outcomes. The purpose of this study was to explore how chief medical and surgical residents develop leadership awareness and experience training in leadership and engage chief residents, faculty mentors, and program administrators in a collaborative process, developing a leadership training model within an independent (non-academic) residency training program. To understand the residents' and the institutional experience in this realm, focused interviews were conducted with chief residents from Family Medicine and Surgery, faculty mentors, program administrators, and regional subject matter experts. Professional identity development of the residents was investigated and related to their experiences. Action research was the framework for this study due to the iterative and participative nature of the methods. Subsequent to the interviews, outgoing and incoming chief residents engaged in collaborative sessions during which peak leadership experiences were discussed. The outcomes of the sessions and analysis of the interviews were discussed with the program directors for future consideration of curriculum change. The findings indicated a change in leadership awareness among chief residents demonstrating that stimulus and subsequent reflection prompted the residents to review their roles as leaders, seeking opportunities to apply leadership awareness to their daily work. In order to teach and role model leadership, training has to be implemented that interposes the same rigor as in clinical training. Expe (open full item for complete abstract)

Committee: Laura Morgan Roberts PhD (Committee Member); Jon Wergin PhD (Committee Member); Dianne Shumay PhD (Committee Member); Lynn Wooten PhD (Other) Subjects: Adult Education; Behaviorial Sciences; Education; Educational Theory; Health Care; Health Care Management; Health Education; Medicine

Psy. D., Antioch University, 2015, Antioch New England: Clinical Psychology

The following dissertation outlines a group intervention designed to improve the relational and mental health of female emerging adults who have aged out of foster care. It is argued through review of the literature that emerging adulthood is a unique developmental phase in which relational connections are vital to successful transition to adulthood. Female emerging adults who have aged out of foster care frequently lack these social supports; their isolation renders them particularly vulnerable to psychological and interpersonal problems. Therefore, a mentoring component might be valuable to this population and is included in the current intervention. Included in the following is a treatment manual for the proposed intervention, which is adapted to meet the unique needs of young women aging out of foster care. Extensive recruitment efforts did not yield participants for the group, so the following describes the intervention and manual as planned, but not implemented. The treatment manual that is adapted for these young women is offered as the results of the dissertation. A discussion of the limitations and implications for future research is offered. Lastly, the dissertation concludes with a chapter exploring the complexities inherent in serving marginalized populations, as well as recommendations addressing these unique challenges.

Committee: Martha Straus PhD (Committee Chair); Gina Pasquale PsyD (Committee Member); William Slammon PhD (Committee Member) Subjects: Clinical Psychology