The ScholarShip

The ScholarShip is a digital archive for the scholarly output of the ECU community. Its mission is to capture, preserve, and make available the intellectual output of East Carolina University's faculty, staff, and students.

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Access status: Open Access ,
BRIDGING EDUCATIONAL GAPS: THE IMPACT OF THE BASS MODEL ON REFLEXIVITY AND CULTURAL HUMILITY IN MIDWIFERY STUDENTS
(East Carolina University, 2025-12) Lashea, Belinda Kay
ABSTRACT Midwifery education in the United States stands at a pivotal crossroads. While midwife-led care consistently demonstrates improved maternal and neonatal outcomes, particularly among racially and ethnically marginalized communities, the educational and clinical systems in which midwives are trained often emphasize efficiency, hierarchy, and compliance over reflection, presence, and relationship. This dissonance between midwifery philosophy and institutional reality fosters burnout, moral distress, and the erosion of reflective capacity, threatening the sustainability of the workforce and the ethical integrity of care. To meet these challenges, it is essential to implement pedagogical models within midwifery education and practice that emphasize reflection and humility as critical competencies for professional development. This dissertation examines whether structured reflection, guided by the Bass Model of Holistic Reflection, can foster reflexivity and cultural humility among graduate nurse-midwifery students. Reflexivity is defined as the sustained capacity to examine one’s values, biases, and positionality and to apply that awareness within dynamic care environments. Cultural humility is defined as a lifelong stance of openness, self-awareness, and relational accountability. Both are essential competencies for ethical, equitable, and culturally responsive midwifery practice. Despite their recognized importance, few empirical studies have investigated how these capacities evolve over time or how they can be intentionally cultivated through curriculum design. The Bass Model of Holistic Reflection builds on Schön’s reflection-in-action and reflection-on-action, Kolb’s Experiential Learning Cycle, and Mezirow’s Transformative Learning Theory to create a scaffolded process through which learners move from descriptive to critical and transformative levels of reflection. The model aligns with the Midwifery Model of Care, a humanistic paradigm that emphasizes relationship-based, person-centered care, cultural safety, and respect for physiologic processes, while offering a counterbalance to technocratic systems that privilege control and compliance. In this framework, reflection encompasses cognitive, emotional, and relational dimensions, fostering the development of reflexivity. Reflexivity (reflective capacity) subsequently contributes to the cultivation of cultural humility, the enhancement of professional resilience, and the maintenance of ethically sound practice. This research represents the first pilot of the Bass Model within a U.S. graduate midwifery program. Employing a longitudinal, quasi-experimental design, the study tracked sixteen students over two semesters in an ACME-accredited graduate nurse-midwifery program in the southeastern United States. Structured reflection was incorporated into both academic and clinical work through scaffolded journals, peer circles, and faculty debriefs, all carefully aligned with the Bass Model's six phases. To triangulate data and ensure a robust evaluation of reflexivity and humility among graduate nurse-midwifery students, three validated instruments were employed: the Cultural Humility Scale–Adapted (CHS-A), which captured students’ self-perceived humility and relational stance; the Holistic Reflection Self-Assessment (HRSA), measuring self-reported reflective capacity and depth; and the Modified Holistic Reflection Assessment Tool (MHRAT), a faculty rubric designed to assess observable reflective growth and developmental stage. Utilizing these measures in concert provided a multidimensional perspective, integrating both student self-perception and faculty observation to comprehensively track the development of reflexivity and humility over time. Quantitative analyses included descriptive statistics, paired-samples t tests, nonparametric Friedman tests, and Pearson correlations. Results demonstrated a statistically significant increase in faculty-rated reflective depth across five structured activities, χ² (4) = 16.81, p = .002, validating the Bass Model’s effectiveness in fostering reflexivity. HRSA scores remained high throughout the study, with a modest yet significant increase in the first semester, t (14) = 2.25, p = .041, d = 0.58, followed by a moderate, non-significant rise in the second. CHS-A scores increased slightly from pretest (M = 4.73, SD = 0.35) to posttest (M = 4.89, SD = 0.20), though ceiling effects limited measurable change. Correlational analyses revealed modest alignment between self- and faculty assessments, emphasizing the value of mixed-method evaluation. A moderate negative correlation between HRSA and MHRAT scores, r = –.40, p = .17, suggested that students who doubted their own reflexivity often demonstrated the most observable growth. This paradox captures the developmental essence of humility: it is most visible in those willing to remain teachable. Reflexivity and humility thus emerged as interdependent processes, deepening through iterative cycles of reflection and feedback. Findings affirm that structured reflection is both measurable and transformative. As students advanced through the Bass Model’s phases, they demonstrated increased capacity to connect personal values, professional ethics, and clinical practice. The reflective framework fostered self-awareness, cultural humility, and emotional resilience, qualities essential for navigating the moral complexities of modern midwifery. Reflection functioned not only as a learning strategy but also as a protective practice that mitigated burnout, moral distress, and value dissonance, enabling practitioners to sustain alignment with midwifery’s relational and justice-oriented foundations. By integrating reflection throughout the curriculum, this study offers a replicable model for cultivating ethically grounded, culturally responsive, and resilient practitioners. The Bass Model provides midwifery educators with a scaffolded, evidence-based pathway for teaching reflection as both skill and disposition, ensuring that learners internalize reflective habits capable of sustaining lifelong growth and professional integrity. This dissertation extends international research on the Bass Model of Holistic Reflection and contributes the first U.S. application within midwifery education. Its findings demonstrate that structured reflection can bridge the gap between midwifery philosophy and practice, equipping students to remain present, humble, and ethically centered amid systemic pressures. Reflection emerges here as a form of professional preservation, a means of keeping midwives connected to their purpose, their patients, and the philosophy that defines their care. In a healthcare landscape increasingly dominated by technocratic paradigms, structured reflection stands as a quiet revolution; one that preserves the heart of midwifery and sustains the integrity of those who practice it.
Access status: Open Access ,
Exploring the Business Case for Magnet Status: Comparison of Medicare Spending per Beneficiary and Average Cost per Discharge Among North Carolina Hospitals based on Geographic Location, Bed Size, Time of Trend Measures, and Healthcare System Association
(East Carolina University, 2025-12) Peele, Dawn
Research Problem and Objectives Rising healthcare costs are a significant concern for individuals, healthcare providers, and our nation. The vitality of North Carolina (NC) hospitals is impacted by the organizations’ human and fiscal resources. Magnet designation is a human resource strategy utilized by some hospitals to recruit and retain their nursing workforce. This study investigated whether Magnet designation among NC hospitals may also support fiscal strategy, contributing to lower Medicare Spending per Beneficiary, and if differences exist in cost per discharge between Magnet-designated hospitals and non-Magnet-designated hospitals. Additional factors considered included hospital location, bed size, time of trend measures, and healthcare system association status. Methods Independent variables included in this quantitative study included Magnet designation, hospital location (rural/urban and NC Medicaid Managed Care Region), bed size, Disproportionate Share Hospital percentage, system status, county tier, and county tier economic rank. Outcome variables were Medicare Spending per Beneficiary (MSPB) and average cost per discharge among North Carolina hospitals. Using secondary data from 2016 to 2021, four quantitative research questions were analyzed using linear mixed model methodology and included 76 NC hospitals. Results Magnet designation does not support lower Medicare Spending per Beneficiary among NC hospitals. The mean MSPB was 0.972 versus 0.941 (p<.001) for Magnet and non-Magnet NC hospitals, respectively, over 2016-2021. Analysis revealed no significant effect of Magnet status on the average cost per discharge (p = 0.221) over the period from 2016 to 2021. However, the average cost per discharge was significantly higher among Magnet hospitals compared to non-Magnet hospitals when 2016-2019 and 2020-2021 were considered independently. Magnet hospitals’ mean average cost per discharge was $10,604 compared to $7,943 (p<.001) for non-Magnet hospitals in 2016-2019. Similarly, Magnet hospitals’ mean average cost per discharge was $15,725 compared to $8,717 (p<.001) for non-Magnet hospitals in 2020-2021. Other independent variables associated with MSPB and average cost per discharge included bed size and system status, with lower MSPB and lower average cost per discharge observed among independent NC hospitals and those with fewer than 100 beds. Additionally, the DSH% among NC hospitals had an effect on MSPB and average cost per discharge, and the association between DSH% differed between Magnet and non-Magnet NC hospitals. Conclusion Magnet designation does not support a fiscal strategy to lower MSPB and cost per discharge among NC hospitals. However, through consideration of additional independent variables, hospital bed size and whether the hospital is independent or affiliated were found to be associated with lower MSPB and lower costs per discharge, offering additional insight into the drivers of healthcare costs. The findings related to DSH% in relation to MSPB and average cost per discharge warrant further study to fully understand this complex interaction. The methodology and findings of this study provide a framework to further evaluate differences in MSPB and average cost per discharge among N.C. hospitals using additional independent variables.
Access status: Open Access ,
Empowering Communities Through Data: Assessing Low-Cost Air Quality Monitors to Advance Environmental Health Equity in Greenville, North Carolina
(East Carolina University, 2025-12) Brown, Aaliysha
Introduction: Air quality remains one of the leadings causes of respiratory illnesses on a global scale. PM2.5 in particular, is a clear public health concern in areas with limited regulatory monitoring and vulnerable populations. It is critical that affordable air quality options be made available considering the limitations of traditional monitoring. This study assesses the air quality in Greenville, North Carolina while evaluating how AirBeam, Clarity, and Bluesky low-cost sensors perform in comparison to a ADR reference monitor and an EPA regulatory monitor. The goal was to determine if low-cost sensors could accurately reflect PM2.5 trends and support community-based air monitoring. Methods: Stationary low-cost sensors and a reference monitor were set up at the intersection of Greenville Boulevard and Charles Boulevard on tripods. A HOBO weather instrument was also co-located with sensors and reference monitor to assess atmospheric conditions. Data was recorded in hourly intervals on a daily basis from January through December 2024. Data was analyzed annually, biannually, and seasonally. The exclusion of missing and outlier values was applied to improve accuracy and consistency. Performance metrics that include R2, RMSE, slope, and intercept were measured to assess agreement with the reference instrument. Results: Results showed positive relationships between low-cost sensors and reference concentration readings. AirBeam provided the most consistent overall agreement with the reference monitor. Clarity produced the steepest slopes, highest intercepts, and higher RSME indicating stronger sensitivity and more variability. Bluesky recorded the lowest RMSE and the weakest correlations. Each sensor successfully identified major pollution events, including wildfire smoke days. Conclusion: The study demonstrates that low-cost sensors, when properly calibrated, provide dependable and affordable means for monitoring air quality data. This is highly important in underserved and rural areas where traditional air monitoring is limited or unavailable. Implementation of low-cost air monitoring devices offer many benefits and can be a practical method to strengthen environmental surveillance to protect public health.
Access status: Open Access ,
EXAMINING CRANOIFACIAL EDUCATION OPPORTUNITIES IN GRADUATE SPEECH-LANGAUGE PATHOLOGY PROGRAMS: CURRICULUM TRENDS AND ADMINISTRATOR PERSPECTIVES
(East Carolina University, 2025-12) Gilbert, Imani
Graduate education in speech-language pathology (SLP) faces increasing demands to prepare broadly competent clinicians within condensed program timelines and expanding accreditation standards. Specialized topics such as craniofacial anomalies are often among the first to be condensed, embedded, or eliminated, despite their clinical complexity and prevalence. The purpose of this mixed-methods study was to examine the current state of craniofacial education across accredited graduate SLP programs in the United States and to identify the factors that influence decisions regarding its inclusion. The study was designed to use a national survey of accredited SLP graduate programs to provide quantitative insight into the prevalence and structure of craniofacial education opportunities. Of the 281 analyzed programs, approximately 20% offered dedicated and required coursework, 11% offered elective courses, and nearly 69% embedded content within other courses. Additionally, only approximately 64% of programs reported offering clinical experience opportunities for their students, with most programs only having fewer than 25% of students per cohort engaged in such experiences. To give context to these patterns, qualitative interviews were also conducted with program administrators. Four major themes emerged: (1) Barriers, including fragile faculty infrastructure, curriculum overcrowding, and perceived low demand; (2) Facilitators such as faculty advocacy and institutional or regional partnerships; (3) Clinical Preparedness, comparing the relationship between curricular depth and student competence; and (4) Pathways for Improvement, emphasizing centralized resources, various educational models, and longer degree programs. These findings demonstrate a persistent and steady national decline in dedicated coursework and limited student access to specialized clinical training. Collectively, results highlight the need for intentional curriculum design, increased faculty development, and innovative and technology informed approaches to strengthen graduate preparation of speech-language pathologists serving individuals with craniofacial and cleft-related communication disorders.
Access status: Open Access ,
ANCHORING AND ACTIVATING TRANSFORMATIONAL LEADERSHIP: HOW AN EDUCATIONAL LEADERSHIP DOCTORAL PROGRAM CULTIVATES BELONGING AND TRUST
(East Carolina University, 2025-12) Horne, Jennifer Otero
This dissertation examined how East Carolina University’s Doctor of Education (EdD) International Cohort in Educational Leadership advances learning from transactional routines toward transformational outcomes. The study addressed the broader problem that online professional doctorates often prioritize efficiency and credentialing over adult development, specifically in terms of belonging and trust. The purpose was to analyze how the International Cohort’s design creates conditions for persistence, growth, and leadership practice grounded in fairness and inclusion. Three research questions guided the inquiry: (a) How does the program’s learning environment shape transformational development? (b) In what ways do course-embedded opportunities contribute to adult development and leadership practice? Moreover, (c) How do participants interpret and describe the program’s attention to equity, inclusive practices, and critical engagement with institutional norms as influencing their leadership and organizational improvement approaches? A qualitative single-case study examined two cohorts of the EdD program across learning environments, including a Summer Learning Exchange in Bangkok, synchronous WebExchanges, and online coursework. Data were drawn from syllabi, program documents, and student artifacts. Analysis followed constant-comparison methods informed by theories of transformative learning, adult development, and equity as rigor. Two overarching findings emerged. Finding 1, Design Anchors: Belonging, Trust, and Adult Development, showed that identity-based assignments, collaborative routines, and faculty presence cultivated psychological safety and persistence. Finding 2: Design Activators—Praxis for Organizational and Systemic Improvement demonstrated that equity-focused inquiry, participatory projects, and critical reflection translated learning into leadership practice. The study concludes that transformational program design depends on intentionally braiding anchoring and activating forces. When belonging, trust, and adult development intertwine with equity, reflection, and applied leadership, the program becomes a mechanism for meaningful change in professional learning. This braided design, conceptualized as the Helix of Transformation, illustrates how environment, opportunity, and equity-informed practice can transition online doctoral study from transactional routines to transformational outcomes. For students, the framework describes how intentional design cultivates belonging and leadership capacity; for faculty, it offers a roadmap for creating cohesive, reflective, and equity-minded learning environments. The International EdD contributes a blueprint for redesigning online professional doctorates that are academically rigorous, relational, developmental, and relevant to practice.