Filtering by
- All Subjects: Immigration
- Creators: Estrada, Emir
This undergraduate honors thesis explores the process and motivating factors associated with immigrants from Mexico who are in the process of becoming U.S. citizens. This project is based on 20 interviews with Legal Permanent Residents (LPR) of Mexican origin who have had lawful permanent status for 20 years or more. While immigrants are eligible to apply for citizenship after five years of being LPRs, most, like my respondents, take longer. Why do LPRs experience a delay of 20 years or more in applying for citizenship? Findings from this study reveal that motivating factors associated with becoming a U.S. citizen are 1) a desire to be socially accepted and integrated by and into American society; 2) to overcome the fear of failing their citizenship interview; and 3) to change the growing anti-immigrant rhetoric by becoming citizens and increasing the presence of naturalized citizens in American society. Respondents also revealed that their bilingual-speaking children were the biggest motivators that helped with accessing information in regard to citizenship and voting.
My research addresses several substantive debates. I found that rather than emigrating for rational reasons—as neoclassical theory of migration posits—the migrants in my study tended to rationalize their reasons for emigrating through processes of cognitive dissonance. Further, where previous scholarship has tended to conflate issues of national, ethnic, and racial discrimination, I disentangle the processes that motivate discriminatory behavior by showing how seemingly innocuous references to “nationality” can be driven by a desire to hide racial prejudices, while at the same time, conflating all as “racism” can reflect a simplistic analysis of the contributing factors. I show how past historical structures of colonialism and slavery are manifest in current forms of structural violence and how this violence is differentially experienced on the basis of nationality, perceived racial differences, and/or ethnicity. Additionally, my research expands theories related to the spatial dimension of discrimination. It examines how zones of marginalization shape the experiences of low-wage migrant workers as they move through or occupy these spaces. Marginalizing zones limit workers’ access to the sociality of the city and its institutional resources, which consequently increase their vulnerability.
Individual well-being is determined by stressful events that one encounters, by personal and external sources of resilience, and by perceptions of oneself and the stressful events. For the migrants in my study, their stressors were chronic, cumulative, and ambiguous, and while they brought with them a sufficient amount of personal resilience, it was often mitigated by non-compliance and lack of enforcement of UAE laws. The result was a state of well-being defined by isolation, fear, and despair.
My research addresses several substantive debates. I found that rather than emigrating for rational reasons—as neoclassical theory of migration posits—the migrants in my study tended to rationalize their reasons for emigrating through processes of cognitive dissonance. Further, where previous scholarship has tended to conflate issues of national, ethnic, and racial discrimination, I disentangle the processes that motivate discriminatory behavior by showing how seemingly innocuous references to “nationality” can be driven by a desire to hide racial prejudices, while at the same time, conflating all as “racism” can reflect a simplistic analysis of the contributing factors. I show how past historical structures of colonialism and slavery are manifest in current forms of structural violence and how this violence is differentially experienced on the basis of nationality, perceived racial differences, and/or ethnicity. Additionally, my research expands theories related to the spatial dimension of discrimination. It examines how zones of marginalization shape the experiences of low-wage migrant workers as they move through or occupy these spaces. Marginalizing zones limit workers’ access to the sociality of the city and its institutional resources, which consequently increase their vulnerability.
Individual well-being is determined by stressful events that one encounters, by personal and external sources of resilience, and by perceptions of oneself and the stressful events. For the migrants in my study, their stressors were chronic, cumulative, and ambiguous, and while they brought with them a sufficient amount of personal resilience, it was often mitigated by non-compliance and lack of enforcement of UAE laws. The result was a state of well-being defined by isolation, fear, and despair.
Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).
Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.
Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.
Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.
Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.