The National University System Repository exists to increase public access to research and other materials created by students and faculty of the affiliate institutions of National University System. Most items in the repository are open access, freely available to everyone.
Recent Submissions
Item Patient Safety in Quality Management Operations: Assessing Quality Risk Management Strategies and Maturity in Start-Up CDMOs(2025-11)This applied doctoral project examined the maturity of Quality Risk Management (QRM) strategies within a start-up Contract Development and Manufacturing Organization (CDMO), referred to as Startup X. The study addressed the critical problem of underdeveloped QRM systems in early-stage CDMOs, where limited resources, leadership instability, fragmented governance, and reactive quality risk cultures compromise manufacturing reliability, product quality, regulatory compliance, and ultimately – patient safety. These gaps impede internal operational efficiency, organizational performance, and pose broader public health risks by increasing the risk of quality failures, production delays, and drug shortages across the biopharmaceutical supply chain. The project aimed to evaluate the current maturity of Startup X’s QRM framework, identify systemic and cultural barriers, and develop evidence-based strategies to strengthen quality governance and patient-centered decision-making. Guided by Waldron’s (2017) QRM Maturity Model, this qualitative case study employed semi-structured interviews, document reviews, and process mapping to assess QRM practices. Participants included Quality Control personnel and senior leaders with direct involvement in quality operations. Data was thematically analyzed to identify recurring patterns related to risk management practices, communication, and governance structures. The findings indicate that Startup X is in the emergent to early developing stages of QRM maturity. Key challenges included limited staff competency, inconsistent application of risk assessment tools, insufficient training, and weak cross-functional governance. Despite these limitations, the project successfully established a diagnostic baseline for QRM capability and produced a structured roadmap for improvement. Immediate objectives emphasize embedding risk-based decision-making through a formal QRM charter, assigning risk ownership roles, and instituting comprehensive training programs to cultivate a proactive quality culture. The conclusions of this project provide practical strategies for Startup X and similar CDMOs to progress toward structured and sustainable QRM maturity. Strengthening governance frameworks, standardizing QRM practices, and institutionalizing proactive risk management will enhance regulatory compliance, client confidence, and patient protection, thereby advancing professional practice and quality excellence within biopharmaceutical manufacturing.Item Symptomatology and Mediating Caseload Variables of Community Mental Health Clinicians’ Vicarious Traumatization: A Causal-Comparative Investigation(2026-02)This study addressed a research problem on community mental health therapists’ risk of vicarious trauma, a condition associated with post-traumatic stress symptoms and reduced clinical effectiveness. Because community mental health clinicians frequently treat highly trauma-exposed clients and often manage larger, more complex caseloads, understanding factors contributing to their vicarious trauma risk is critical for supporting therapist well-being and maintaining quality care for vulnerable populations. However, limited prior research has examined the relationship between occupational setting and vicarious trauma. Via a constructivist self-development theory lens, this quantitative, causal-comparative study investigated whether community mental health clinicians report greater vicarious trauma than therapists in other settings and whether caseload size or diagnostic composition mediate this relationship. Trauma therapists in the United States were recruited through social media platforms to complete an online survey on their occupational setting, caseload size and diagnostic composition, and vicarious trauma symptoms using the validated Vicarious Trauma Scale. Although an initial independent samples t-test found no statistically significant difference in vicarious trauma between community mental health clinicians and therapists in other settings, a post-hoc t-test revealed significantly higher vicarious trauma among community mental health clinicians compared to private practice therapists. Mediation analyses using multiple linear regression indicated neither caseload size nor diagnostic composition significantly mediated the relationship between occupational setting and vicarious trauma, though caseload data inconsistencies limit interpretation. These findings suggest occupational setting may influence vicarious trauma risk but is unlikely to act alone, underscoring the need for organizational supports and continued research on additional contributing factors to better protect clinicians’ welfare and treatment quality.Item Parents’ Perception of Early Childhood Parental Involvement in Low-Socioeconomic Communities(2025-11)Early childhood parent involvement sets the pace for academic achievement in later years of schooling and may help remedy underperformance in low-income communities. The study addressed the problem of early childhood parent involvement among parents from low-income communities, which is lacking. The purpose of this generic qualitative study was to explore the perceptions of early childhood parental involvement among parents residing in low-income communities. Ecological systems theory, developed by Urie Bronfenbrenner, and Epstein’s model of parental involvement were utilized as the theoretical foundation for this study. Twenty-four parents of children in preschool through third grade from low-income neighborhoods in the United States were recruited using a combination of convenience and snowball sampling via social media postings. Semi-structured interviews served as the data source. Braun and Clarke’s inductive thematic analysis phases revealed three central themes: Parents viewed involvement as extending beyond participation in the school setting, they encountered structural and contextual barriers, which included financial hardship, time constraints, and inconsistent communication from schools, and despite obstacles, parents demonstrated resilience and employed various strategies to stay engaged in their children’s education. The findings highlighted the need for schools and community organizations to implement inclusive, culturally responsive, and flexible approaches to parent involvement that acknowledge and reflect the distinct lived realities of low-income parents. This study contributes to the growing body of knowledge on parent involvement by amplifying the voices of parents who are often underrepresented in research and practice, and provides educators, policymakers, and communities with valuable insights on how to better partner with families in underserved communities.Item Emotional Intimacy and Power in Queer Romantic Relationships: A Phenomenological Inquiry(2026-02)Queer couples navigate complex intersections of intimacy, power, and sociocultural context, yet systemic models in marriage and family therapy have historically reflected heteronormative assumptions. This study addressed the need for culturally attuned frameworks that honor relational diversity by exploring how queer couples define and experience emotional intimacy and power. Guided by socioculturally attuned family therapy (SCAFT), this phenomenological study examined how twelve queer couples in relationships of three years or longer constructed equity, connection, and relational responsibility within broader social contexts. Data were analyzed using reflexive thematic analysis, with trustworthiness supported through reflexive journaling, peer debriefing, and member checking. Findings revealed three dimensions of queer relational experience: sharedness and turning inward and toward, reflecting intimacy through patience, curiosity, and self-awareness; mutual trust and (re)defining power dynamics, illustrating power as fluid and collaborative; and acknowledge, accept, and accommodate, describing how partners navigated contextual influences, including finances, health, and neurodivergence, to sustain equity. These results support SCAFT’s focus on relational ethics and contextual awareness, suggesting that equity and attunement are co-created through shared vulnerability, repair, and responsiveness. Therapists are encouraged to adopt socioculturally attuned and neuroaffirming practices that strengthen emotional safety, relational flexibility, and shared influence. Future research should expand to include more racially and geographically diverse samples, explore nonverbal communication, and examine the impact of a lack of relational scripts. This study contributes to advancing culturally responsive and relationally just frameworks in marriage and family therapy theory, research, and practice that reflect queer couples’ relational experiences.Item The Therapeutic Alliance in Substance Abuse Counseling From a Therapist’s Perspective: A Qualitative Phenomenological Study(2026-01)Substance use disorder poses a global public health challenge, with treatment dropout and relapse often undermining long-term recovery. A key predictor of successful outcomes in addiction treatment is the therapeutic alliance, but the specific therapist behaviors that foster and sustain a strong relationship, particularly in the context of substance abuse treatment, are not well-defined. This study explores strategies and the behaviors used to establish, develop, and maintain the alliance in substance use counseling, guided by self-determination theory. The population of interest included addiction treatment clients at risk for disengagement and professionals seeking effective engagement strategies. A qualitative methodology was employed using Interpretative Phenomenological Analysis to explore the lived experiences of 15 licensed addiction counselors practicing in Israel. Data were collected through semi-structured interviews and analyzed using a six-stage coding process to identify relevant themes. Findings highlighted the importance of authentic presence, empathic connection, transparency, and emotional safety during initial sessions. Long-term maintenance of the alliance was supported by relational consistency, validation of effort, and autonomy-supportive behaviors that respected client pacing and agency. These results indicate that the therapeutic alliance is not merely a byproduct of effective treatment but a critical mechanism for promoting recovery. This study contributes to the literature by operationalizing relational behaviors aligned with the psychological needs of relatedness, autonomy, and competence. Implications include prioritizing relational skill development in therapist training programs and examining how these behaviors influence client outcomes across diverse populations and treatment contexts.
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