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Abstract Missed appointment, referred to as “no-shows,” are appointments that were not attended or previously cancelled at least 24-hours prior to the scheduled time. Missed appointments negatively impact patients as well as health care systems. According to Ullah et al. (2018), the financial impact of missed appointments on the healthcare system is more than $150 billion a year. Also, patients with chronic health problems (who are noncompliant with their scheduled appointments) may cause their conditions to worsen. Researchers have implemented several strategies to reduce the negative effects of no-shows. The purpose of this literature review was to explore the effectiveness of appointment reminders. The question driving this literature review was whether the implementation of appointment reminders via other means were more effective in reducing no-show rates, compared to the standard appointment reminder via telephone call. An electronic search was conducted using CINAHL and PubMed. Inclusion criteria consisted of English language, peer-reviewed, academic journal articles published from 2017 to the present. A variety of articles were found, and five of those were critiqued for this review. The literature was synthesized using the John Hopkins Nursing Evidence-Based Practice Model. The key finding of this review is that telephone calls are the most efficient and feasible form of appointment reminders (Lance et al., 2021 & Lavin et al., 2017). Since phone bills are a normal expense for most businesses, health systems should be able to implement the use of this strategy. Keywords: appointment adherence, no-show, missed appointments, appointment attendance

Since deinstitutionalization of state hospitals began almost 50 years ago, there has been an increase in the population with mental illness seen in the prison system. A combination of factors were looked at when studying causes behind incarceration, including active symptoms of mental illness, socioeconomic status, social support systems, history of trauma, history of drug abuse, police education on mental illness, and public perspective on mental illness. This study is a literature review focusing on people with mental illness in the prison system, with particular attention to women. It is costly to house inmates for any extended period of time. Specialized housing, needed for people requiring greater supervision, including those with mental illness, is particularly expansive. These funds were intended to go into community programs supporting those with mental illness after release from the institutions of the past. Without this support, many people with mental illness wind up homeless and turning to substance abuse, which leads to opportunities for incarceration. While further research is needed, there is evidence of promise shown in the combined efforts of increased case management and social support systems along with increased education of law enforcement officers on the symptoms and handling of cases of people with serious mental illness.

The purpose of this dissertation was to examine whether a breast cancer survivor’s view of God influences her religious coping strategies, depression, anxiety, stress, fear of recurrence, and psychological well-being. These variables were selected based on literature that demonstrates relationships among them for breast cancer survivors. The specific aims of this dissertation were to: 1) identify religious coping strategies common to each of the four views of God; 2) examine the relationship of psychological well-being (Ryff) and religious coping strategies; and 3) examine differences in depression, anxiety, stress, fear of recurrence, and psychological well-being among women holding various views of God. Three manuscripts comprise this dissertation. The first manuscript is a systematic review of the literature describing what is known about the relationships between psychological adjustment and religion/spirituality (R/S) in women with breast cancer. The second manuscript examines the psychometric properties of the Image of God Scale in a population responding to a crisis event, women with breast cancer. The original scale was developed from a general population survey. Finally, the third manuscript investigates the relationships between view of God, religious coping strategies, and psychological adjustment in women with breast cancer. The systematic review identified three primary themes: 1) R/S domains and psychological adjustment; 2) dynamics of R/S conservation and struggle; and 3) reframing the cancer experience. The psychometric analysis confirmed the original 2-factor model with factor loadings ranging from .56 to .83. Cronbach’s alphas for the two subscales – belief in God’s anger (.80) and belief in God’s engagement (.89) – were consistent with those established at development. Differences were found between views of God and use of religious/spiritual coping strategies focused on Spiritual Conservation and Spiritual Struggle. Psychological Well-Being (SPWB) was inversely correlated with Spiritual Struggle. Differences were noted for psychological well-being, Fear of Recurrence, and the Stress subscale in women who viewed God as highly engaged or not. No differences were noted for the same variables in women who view God as more or less angry. Direct comparisons between groups and variations in outcomes based on common views of God could lead to effective screening for persons at risk for particular outcomes and to effective individualized interventions.

The purpose of this study was to describe the perceived barriers to obtaining psychiatric treatment at the Johnson City Community Health Center. The context of the study was a rural area in Eastern Tennessee. Five patients with confirmed DSM-IV mental health diagnoses were recruited during treatment and interviewed at the Johnson City Community Health Center after their scheduled appointments with a Mental Health Nurse Practitioner (MHNP). The semi-structured interview focused on perceived barriers to obtaining treatment, perceptions of treatment received, and perceived availability of treatment. From those interviews, two themes were identified and each of which had two sub-themes identified: Realities of Treatment with the sub-themes of Therapy-Related Realities and Logistics Realities, The Way It Is with the sub-themes of Take Care of It Myself and Don’t Want People to Know. The findings indicate that there is a duality of positive and negative aspects of treatment at Johnson City Community Health Center. Understanding the needs and perceptions of those with psychiatric diagnoses will assist all staff and mental health providers in developing programs that are better suited for those with psychiatric diagnoses receiving treatment from Johnson City Community Health Center.

This qualitative research study explores what veterans living in the Appalachian region experience in receiving care for Posttraumatic Stress Disorder through personal interviews. These interviews will give insight into how veterans in Appalachia perceive their care through specific questions pertaining to healthcare for Posttraumatic Stress Disorder. A convenient sample of veterans attending the specific study site was used for this study. An email, which contained information about the background and nature of the study was used for participant recruitment of veterans. In addition, flyers with the same information were posted throughout the study site. This study will highlight specific details of veterans’ care for Posttraumatic Stress Disorder that will help to accumulate information on the care given to veterans in Appalachia. The Appalachian region is described by the Appalachian Regional Commission as "a 205,000 square mile region that follows the spine of the Appalachian Mountains from southern New York to northern Mississippi"(The Appalachian region- Appalachian Regional Commission, n.d.).

The purpose of this qualitative interpretive descriptive study was to better understand children’s perceptions of the use of motivational interviewing (MI) as a communication style for childhood obesity treatment. Childhood obesity in the United States has reached epidemic proportions and much research effort has been dedicated to reversing this trend. One approach that has demonstrated positive outcomes in the clinical setting is MI. Leading organizations in pediatric healthcare now recommend MI as a communication style to be used for childhood obesity-related behavior change. Although empiric studies have demonstrated improvement in outcomes when this communication style is used with patients and families, no study to date had looked at MI from the perspective of the child. Thorne’s (2008) framework for interpretive descriptive research was used for this study. Individual interviews with children ages 7 through 13 were conducted in an outpatient weight management clinic that utilizes MI as the primary communication style for facilitating behavior change. Qualitative data analysis was conducted utilizing Thorne’s recommendations for interpretive descriptive research. Five themes emerged from the data: 1) Empowerment, 2) Freedom to be Me, 3) Educating without “Educating”, 4) Unconditional Support, and 5) Blossoming. A conceptual model was developed from the research findings to help clinicians working with children in similar contexts glean a deeper understanding of the use of MI with children. Future research endeavors should focus on the implementation of this model in clinical practice to strengthen the conceptual links and determine applicability to practice.

This thesis attempted to examine stressors associated with the psychiatric technician profession and levels of burnout amongst them. This was accomplished through the use of a survey which included demographic data, the Maslach Burnout Inventory Human Services Survey (MBI‑HSS), an adaptation of the Nursing Stress Scale (NSS) and a self‑care assessment tool. A total of three research questions were examined statistically including levels of burnout on subcategories (personal accomplishment, emotional exhaustion and depersonalization), most common stressors identified by psychiatric technicians and percentage of participants who utilized therapy to cope with work related stress. The survey was made available via survey monkey and posted on the website for the California Association of Psychiatric Technicians website and via links posted on Union Chapter social media pages. A total of 123 Psychiatric Technicians participated in the study. Results indicated high levels of emotional exhaustion, depersonalization and personal accomplishment among psychiatric technicians. Results indicate that extended work hours and staffing minimums were significant issues impacting union members. Also significant among participants, was high level of difficulty attending work due to work related stress during the last three months. For future research, it is recommended that similar studies of psychiatric technicians be conducted to provide further insight into burnout, how it happens and how to avoid it.

The purpose of this study was to investigate the Hardiness level of battered women residing at a South Florida shelter and to investigate if there was a major difference in the hardiness level of women who were first time in a shelter as opposed to those who had been previously in shelters. Using a descriptive design, the Health-Related Hardiness Scale was given to 50 battered women residing at a shelter. The results confirmed our hypothesis that proposed that hardier women would leave their abusive environment. The total hardiness of these women was (M= 148.86 SD= 22.64). Furthermore, no major differences were found among the two groups, the total hardiness for the women who been in shelters before was (M=150.17 SD= 26.06) and for those who were first time users was (M=148.45 SD= 21.81). The results provide a baseline to begin to understand the role that hardiness play in the lives of battered women. These findings and future studies may have implications for breaking the cycle of domestic violence.