Gastrointestinal Diseases: Diagnosis, Symptoms & Management

Gastrointestinal Diseases
Group 5:
Leticia Bernal Leon
Daydig Rodriguez
Maria Rodriguez
Karina Silveira
Instructor:
Dr. Alain Llanes Rojas, DNP, APRN, FNP-BC
Miami Regional University
Diagnosis, Symptoms & Illness Management
MSN5600
Gastroesophageal Reflux
Gastroesophageal reflux that does not cause symptoms is known
as physiologic reflux. In nonerosive reflux disease (NERD),
individuals have symptoms of reflux disease but no visible or
minimal esophageal mucosal injury
Gastroesophageal reflux disease (GERD) is the reflux of acid
and pepsin or bile salts from the stomach to the esophagus that
causes esophagitis. The severity of the esophagitis depends on
the composition of the gastric contents and esophageal mucosa
exposure time.
Definition & Classification
Causes
GERD can be caused by abnormalities or alterations in
1. Lower esophageal sphincter function
2. Esophageal motility

3. Gastric motility or emptying
Esophageal function studies include the following:
Determination of the lower esophageal sphincter (LES) pressure
(manometry)
Graphic recording of esophageal swallowing waves, or
swallowing pattern (manometry)
Detection of reflux of gastric acid back into the esophagus (acid
reflux)
Detection of the ability of the esophagus to clear acid (acid
clearing)
An attempt to reproduce symptoms of heartburn (Bernstein test)
Risk Factors
Obesity
Hiatal hernia
Use of drugs or chemicals that relax the LES (anticholinergics,
nitrates, calcium channel blockers, nicotine)
Cigarette smoke.
Trigger Factors
Coughing
Vomiting
Straining at stool
Asthma
Chronic cough
Sinusitis.
Common Symptoms
Heartburn that occurs 30 to 60 minutes after meals and when the
patient bends over or lies down.
Regurgitation of sour or bitter gastric contents
Belching, and fullness of the stomach
Upper abdominal pain within 1 hour of eating.

Atypical Symptoms
chronic cough
asthma attacks
chronic laryngitis
sinusitis
discomfort during swallowing.
Noncardiac chest pain.
Dysphagia
Clinical manifestations are related to mucosal injury from acid
regurgitation and the frequency and duration of reflux events.
The symptoms worsen if the individual lies down or if
intraabdominal pressure increases because of coughing,
vomiting, or straining at stool.
Uncomplicated GERD that is responsive to first-line therapy
does not require an endoscopy.
Patients who do not respond to therapy and those with suspected
complications should undergo an endoscopic examination
Management & Evaluation
Differential diagnosis
Gastritis
Peptic ulcer
Gastric cancer
Cholelithiasis
Angina pectoris.
Diagnosis of GERD is based on the history and clinical
manifestations.
An upper endoscopy with biopsy is the standard diagnostic

procedure for GERD. It confirms the diagnosis and documents
the type and extent of tissue damage.
Esophageal endoscopy: shows hyperemia, edema, erosion, and
strictures. Esophagitis is divided into four grades, which are
determined endoscopically:
Grade 1 is defined by erythema of the distal esophagus.
Grade 2 consists of scattered erosions.
Grade 3 involves confluence of erosions involving less than
50% of the diameter of the esophagus.
Grade 4 involves confluence of erosions involving greater than
50% of the diameter.
Tissue biopsy: Dysplastic changes can be identified (Barrett
esophagus)
Impedance/pH monitoring measures the movement of stomach
contents upward into the esophagus and the acidity of the
refluxate.
H. pylori Test: it is detected using the urea breath test, this is
the most accurate method.
H. pylori–specific serum immunoglobulin G (IgG) and
immunoglobulin A (IgA) antibodies.
Measurement of H. pylori stool antigen levels.
Diagnosis
For most patients, empiric treatment is initiated based on the
severity of symptoms, history, and physical examination.
If H. pylori bacterium is present
Combination of antibiotics to kill the bacterium will be ordered
for two weeks
(amoxicillin, clarithromycin, metronidazole, tinidazole,
tetracycline and levofloxacin)
The antibiotics used will be determined by patient
characteristics and current antibiotic resistance rates.
Eliminating or reducing use of injurious drugs, alcohol
consumption and smoke cessation

Help the ulcer to heal with medication.
Proton pump inhibitors are the agents of choice for controlling
symptoms and healing esophagitis. These drugs require at least
30 minutes to take effect; they also can be taken before a meal
(omeprazole, lansoprazole, rabeprazole, esomeprazole and
pantoprazole)
Histamine H2-receptor antagonist to reduce acid production
(famotidine, cimetidine and nizatidine)
Antacids to neutralize stomach acid it can provide symptom
relief
Cytoprotective agents to protect the lining of GI Tract
(sucralfate and misoprostol)
Prokinetics to reduce reflux by increasing LES tone and
promoting peristalsis and gastric emptying.
(metoclopramide or bethanechol)
Treatment
Laparoscopic fundoplication is the most common surgical
intervention when medical treatment fails.
Nonpharmacological Treatment (Lifestyle Modification
Treatment)
Sit up for at least 1 hr after eating.
Elevate head of bed 6-8 in, using blocks.
Avoid straining, lifting, bending over, and wearing tight belts,
especially on a full stomach.
Avoid drugs that decrease lower esophageal sphincter pressure
such as theophylline, nitrates, calcium channel blockers, α-
adrenergic antagonists, β-agonists, and benzodiazepines.
Avoid anticholinergics and other drugs that decrease salivation;
avoid drugs that decrease peristalsis.
Avoid foods that decrease lower esophageal sphincter pressure
such as onions, garlic, mint, and alcohol.
Avoid foods that are esophageal irritants such as citrus, vinegar,
caffeine, chocolate, peppermint, red sauces, spicy and high-fat

foods, and large meals, as well as excessive fluid intake with
meals.
Cease smoking and alcohol use to reduce GI and esophageal
irritation.
Strive for a gradual, sustained loss of 2 lb per month if
overweight.
Most patients have very mild disease, although it is possible for
the patient to develop rare complications such as:
Active erosive esophagitis: Severe esophagitis causes mucosal
injury and inflammation with hyperemia, increased capillary
permeability, edema, tissue fragility, erosions, and ulcerations
Fibrosis and thickening may develop. Edema, fibrosis
(strictures), esophageal spasm, or decreased esophageal motility
may result in dysphagia with weight loss.
Esophageal adenocarcinoma: In all, 10% of patients with GERD
develop Barrett's esophagus, precancerous lesions (Barrett
esophagus) with progression to adenocarcinoma can be a long-
term consequence.
Complications
Gastritis
Definition
Gastritis is an inflammatory disorder of the gastric lining. This
injury to the mucus lined barrier that protect the stomach wall
allows digestive juices to damage the stomach. It can affect the
corpus, fundus or antrum, or the entire mucosa (pangastritis).
The most common Causes are:
Drugs and chemicals like Nonsteroidal anti-inflammatory drugs
(ibuprofen, naproxen, or indomethacin), aspirin,
chemotherapeutic agents, alcohol, and cigarette smoke
Helicobacter pylori infection–Shock and hypotension can
decrease mucosal blood flow contributing to acute gastritis.

Gastritis can be:
Acute: occur suddenly.
Chronic: appear slowly over the time and involves chronic
inflammation, mucus atrophy, and epithelial metaplasia that
progresses over years.
Classification
Gastritis
Gastritis
Chronic gastritis is usually classified as:
Type A, or immune (fundal) is the most rare and severe form of
gastritis and is associated with loss of T-cell tolerance and
development of autoantibodies against parietal cells or intrinsic
factor, or both. Pernicious anemia can develop from decreased
vitamin B12 absorption and is a risk factor for gastric
carcinoma
Type B, nonimmune (antral) associated with H. pylori that may
trigger the immune response. Chronic use of alcohol, tobacco,
and nonsteroidal anti-inflammatory drugs are contributing
factors. H. pylori can also progress to autoimmune atrophic
gastritis and involve the fundus, thus becoming pangastritis
Type AB, or pangastritis (types of chronic gastritis occur and
the antrum is more severely involved.
Type C, is associated with reflux of bile and pancreatic
secretions into the stomach, causing chemical injury.
Gastritis
Symptoms can usually be managed with consumption of smaller
meals, and including a soft, bland diet.

Burning ache in upper abdomen
Nausea
Vomiting
Anorexia
Feeling of fullness in upper stomach after eating
Epigastric tenderness
bleeding
Symptoms
Gastritis
Doctor may first take a medical history and perform a physical
exam, then diagnostic tests will be ordered, such as:
Laboratory tests for H. pylori.
H. pylori is detected using the urea breath test, this is the most
accurate method.
Measurement of H. pylori stool antigen levels.
Endoscopy. An endoscopy with biopsy is the standard
diagnostic procedure. It confirms the diagnosis and documents
the type and extent of tissue damage.
Upper gastrointestinal series (barium swallow): creates images
of your esophagus, stomach, and small intestine. During the X-
ray, you swallow a white liquid (containing barium) that coats
your digestive tract and makes an ulcer more visible.
Diagnosis
Differential Diagnosis
GERD
PUD
Cholecystitis
Pancreatitis
Diverticulosis
IBS

Usually, treatment will involve killing the H. pylori bacterium
if it is present:
Combination of antibiotics to kill the bacterium will be ordered
for two weeks
consumption and smoke cessation.
Proton pump inhibitor to block acid production and promote
healing.
pantoprazole)
relief
Gastritis
Treatment
In some cases, gastritis can lead to :
Peptic Ulcers Disease
GI bleedings inducing iron deficiency anemia
Pernicious anemia can develop because intrinsic factor is less
available to facilitate vitamin B12 absorption. Gastric secretion
analysis confirms achlorhydria and loss of intrinsic factor
Gastritis
Complications

Peptic Ulcer Disease
Definition
Your digestive tract is coated with a mucous layer that normally
protects against acid. But if the amount of acid is increased or
the amount of mucus is decreased, you could develop an ulcer.
Peptic ulcers are open sores that develop on the inside lining of
the lower esophagus, stomach, or upper portion of the small
intestine.
The most common Causes are
infection with the Bacterium H. Pylori
habitual use of aspirin and NSAIDs
secondary to some diseases and certain lifestyles
Excessive use of alcohol, smoking, obesity
Gastritis, acute pancreatitis, COPD, Cirrhosis
Genetic predisposition
Age greater than 65 years and socioeconomic status.
Psychologic stress but the exact mechanism of causation is not
known
Risk factors include
Peptic ulcers can be
Single or multiple,
Acute or chronic,
Superficial or deep.
Superficial ulcerations are called erosions because they erode
the mucosa but do not penetrate the muscularis mucosae.
True ulcers extend through the muscularis mucosae and damage
blood vessels, causing hemorrhage or perforating the
gastrointestinal wall.

Gastric or duodenal
Gastric Ulcer: that occur on the inside of the stomach – typical
“food-pain “pattern
Duodenal Ulcer: that occur on the inside of the upper portion of
the small intestine (duodenum)-- typical “pain-food-relief”
pattern.
Classification
Burning stomach pain
Feeling of fullness, bloating, or belching
Intolerance to fatty foods
Heartburn
Anorexia, nausea and vomiting
Dark blood in stools, or stools that are black or tarry (melena)
Trouble breathing
Feeling faint
Unexplained weight loss
Symptoms
CHARACTERISTICSGASTRIC ULCERDUODENAL
ULCERIncidenceAge at onset50–70 years20–50 yearsFamily
historyUsually negativePositive Sex (prevalence)Equal in
women and menEqual in women and menStress
factorsIncreasedAverageUlcerogenic drugsNormal useIncreased
useCancer riskIncreasedNot
increasedPathophysiologyHelicobacter pylori infectionOften
present (60%–80%)Often present (95%–100%)Abnormal
mucusMay be presentMay be presentParietal cell massNormal or
decreasedIncreasedAcid productionNormal or
decreasedIncreasedSerum gastrinIncreasedNormalSerum
pepsinogenNormalIncreasedAssociated gastritisMore
commonUsually not presentClinical Manifesta tionsPainLocated
in upper abdomenLocated in upper
abdomenIntermittentIntermittentPain-antacid-relief patternPain-

antacid or food-relief patternFood-pain patternNocturnal pain
commonClinical courseChronic ulcer without pattern of
remission and exacerbationPattern of remissions and
exacerbations for years
Table 1. Characteristics of Gastric and Duodenal Ulcers
To detect an ulcer, doctor may first take a medical history and
perform a physical exam. Then diagnostic tests will be ordered,
such as:
Laboratory tests for H. pylori.
H. pylori is detected using the urea breath test, this is the most
accurate method.
Measurement of H. pylori stool antigen levels
Diagnosis
Endoscopy. An endoscopy with biopsy is the standard
diagnostic procedure for PUD. It confirms the diagnosis and
documents the type and extent of tissue damage.
Upper gastrointestinal series (barium swallow): creates images
of your esophagus, stomach, and small intestine. During the X-
ray, you swallow a white liquid (containing barium) that coats
your digestive tract and makes an ulcer more visible.
GERD
Gastritis
Nonulcer Dyspepsia
Cholecystitis
Pancreatitis
Diverticulosis

IBS
Differential Diagnosis
Treatment for peptic ulcers depends on the cause.
If Patient is positive for H. pylori an antibiotic combination
therapy is ordered for two weeks
consumption and smoke cessation
Proton pump inhibitor to block acid production and promote
healing
pantoprazole)
relief
Surgery
The primary objectives are to reduce stimuli for acid secretion,
decrease the number of acid-secreting cells in the stomach, and
correct complications of ulcer disease.
Treatment
Bleeding. Bleeding can occur as slow blood loss that leads to
anemia or as severe blood loss that may require hospitalization
or a blood transfusion. Severe blood loss may cause black or

bloody vomit or black or bloody stools (hematemesis or melena)
Perforation. Peptic ulcers can eat a hole through (perforate) the
wall of your stomach or small intestine, putting you at risk of
serious infection of your abdominal cavity (peritonitis).
Obstruction. Peptic ulcers can block passage of food through
the digestive tract, causing you to become full easily, to vomit
and to lose weight either through swelling from inflammation or
through scarring.
Gastric cancer. Studies have shown that people infected with H.
pylori have an increased risk of gastric cancer.
Complications
Protect yourself from infections: You can take steps to protect
yourself from infections, such as H. pylori, by frequently
washing your hands with soap and water and by eating foods
that have been cooked completely.
Use caution with pain relievers drugs: for instance, take
medication with meals and find the lowest dose possible that
still gives you pain relief. If you need an NSAID, you may need
to also take additional medications such as an antacid, a proton
pump inhibitor, or acid blocker
Prevention
Cirrhosis
Is an irreversible inflammatory, fibrotic liver disease. Structural
changes result from injury (alcoholism, viruses (hepatitis),
steatosis, chemicals) and fibrosis. The liver may be larger or
smaller than normal and is usually firm or hard when palpated.
Cirrhosis develops slowly over a period of years. Its severity
and rate of progression depend on the cause.
Hepatitis virus B and C

Excessive alcohol intake
Idiopathic
Nonalcoholic fatty liver disease (NAFLD), also known as
nonalcoholic steatohepatitis (NASH)
Autoimmune disorders
Hereditary metabolic disorder
Prolonged exposure to chemicals
Right-sided heart failure
Definition
Causes
Earliest symptoms pruritus, weight loss, fatigue, weakness,
malaise, dark urine, pale stool.
Advanced Symptoms anorexia, nausea, vomiting, hematemesis,
abdominal pain, chest pain, menstrual abnormalities , impotence,
sterility, neuropsychiatric symptoms (difficulty concentrating,
irritability, and confusion)
Late-stage: Jaundice
Cirrhosis
Signs and Symptoms:
Complications
Jaundice, portal hypertension, ascites, hepatic encephalopathy,
varices with gastrointestinal bleeding, hepatorenal syndrome,
hepatopulmonary syndrome, and portopulmonary syndrome.
Cirrhosis
Diagnostic
The diagnosis is based on the individual's history and clinical
manifestations.
The results of liver function tests are abnormal, and serologic
studies show elevated levels of serum enzymes (i.e., alanine

aminotransferase (ALT), aspartate aminotransferase (AST), and
γ-glutamyltransferase) and bilirubin, and decreased serum
albumin levels.
Prolonged prothrombin time cannot easily be corrected with
vitamin K therapy. Malnutrition is often present.
Liver biopsy can confirm the diagnosis of cirrhosis, but biopsy
is not necessary if clinical manifestations of cirrhosis are
evident.
US, CT scan, MRE
Treatment
There is no specific treatment, but many of the complications
are treatable. Rest, nutritious diet, corticosteroids, antioxidants,
drugs that slow fibrosis, and management of complications such
as ascites, gastrointestinal bleeding, anemia, infection, and
encephalopathy slow disease progression. Liver transplant is the
treatment for liver failure, and artificial liver support systems
are being developed.
Cirrhosis
Management
Immunizations (Pneumococcal, influenza, Hepatitis A and B)
Ascites (Paracentesis, sodium restriction of 1 to 2 g/day,
Spironolactone, Furosemide, Monitor electrolytes, BUN, and
creatinine level. The serum-ascites albumin gradient (SAAG)
paracentesis to remove 1 or 2 L of ascitic fluid and relieve
respiratory distress.
Encephalopathy (Lactulose is useful for reducing urea
production in the colon, thus lowering blood ammonia levels in
patients with portal systemic encephalopathy d/d cirrhosis.
Rifaximin decreases intestinal production of ammonia and is
used for lactulose non responders.
Jaundice (total plasma bilirubin concentrations greater than 2.5
to 3 mg/dL). The treatment for jaundice consists of correcting
the cause). Refractory edema (thiazide, loop diuretic and
sodium restriction)

Cessation of alcohol consumption slows the progression of liver
damage, improves clinical symptoms, and prolongs life.
Cirrhosis
Primary biliary cirrhosis
Secondary biliary cirrhosis
Hepatocellular carcinoma
Hemochromatosis
NASH
Primary sclerosing cholangitis
Parasitic infection (e.g., Schistosoma mansoni)
Differential Diagnoses
Cholelithiasis (Gallstones) and Cholecystitis
Gallstone formation is termed cholelithiasis. Inflammation of
the gallbladder or cystic duct is known as cholecystitis.
Definition
is Inflammatory or infectious conditions causing gallstone
formation and bile duct obstruction. Stone formation in the
gallbladder occurs when certain substances reach a high
concentration in bile and produce crystals.
Gallstones are formed from impaired metabolism of cholesterol,
bilirubin, and bile acids. All gallstones contain cholesterol,
unconjugated bilirubin, bilirubin calcium salts, fatty acids,
calcium carbonates and phosphates, and mucin glycoproteins.
Gallstones are of three types depending on chemical
composition: cholesterol (70% cholesterol and the most
common [70% to 80% of gallstones]); pigmented (black [hard]
and brown [soft] with less than 30% cholesterol); and mixed.
Risk factors

Obesity; rapid weight loss in obese individuals; middle age;
female sex; use of oral contraceptives; Native American
ancestry; genetic predisposition; gallbladder, pancreatic, or ileal
disease; low high density lipoprotein (HDL) cholesterol level
and hypertriglyceridemia; and gene-environmental interactions.
Clinical Manifestations
Heartburn, flatulence, epigastric discomfort, pruritus, jaundice,
and food intolerances, particularly to fats and cabbage. The pain
(biliary colic) is most characteristic, occurs 30 minutes to
several hours after eating a fatty meal, and is caused by the
lodging of one or more gallstones in the cystic or common duct
with obstruction and distention. It can be intermittent or steady
and usually is located in the right upper quadrant and radiates to
the mid-upper back. Jaundice indicates that the stone is located
in the common bile duct. Abdominal tenderness and fever
indicate cholecystitis.
Complications
Can include pancreatitis from obstruction of the pancreatic duct.
Diagnosis
Is based on the medical history, physical examination, and
imaging evaluation. Imaging techniques include transabdominal
ultrasound, endoscopic ultrasound, and magnetic resonance
cholangiopancreatography.
Evaluation and Treatment: Cholelithiasis
Oral bile acids (ursodeoxycholic acid or chenodeoxycholic acid)
may dissolve cholesterol stones, but the stones may recur when
the drug is discontinued.
Laparoscopic cholecystectomy is the preferred treatment for
gallstones that cause obstruction or inflammation. Use of
transluminal endoscopic surgery is advancing rapidly.

Endoscopic retrograde cholangiopancreatography and
sphincterotomy with stone retrieval are used for the treatment of
bile duct stones. Large stones, or intrahepatic stones, may be
managed with open surgery or lithotripsy.
Ursodiol
Gallstone dissolution: 8 to 10 mg/kg/day in two or three divided
doses
Gallstone prevention: 300 mg 1 tablet PO BID
Patients with stones larger than 2 mm, acute condition in the
abdomen, known sensitivity to the drug, acute pancreatic
gallstones, or acute cholecystitis are not candidates for the
drug.
Milk Thistle: has been shown to protect the liver after exposure
to hepatotoxins such as acetaminophen, ethanol, and halothane,
and to restore liver function in patients with hepatitis and
cirrhosis
Treatment more specific for Cholecystitis
Treatment includes pain control, replacement of fluid and
electrolytes, and fasting. Antibiotics (penicillin and
aminoglycoside) are often prescribed to manage bacterial
infection in severe cases. Acute attacks usually require
laparoscopic gallbladder resection (cholecystectomy).
Obstruction also may lead to reflux of bile into the pancreatic
duct, causing acute pancreatitis.
CBC with differential
UA
LFTs
Serum pancreatic enzymes
Serum electrolyte values
BUN and creatinine

Blood cultures
hCGs
Electrocardiography
Ultrasound
CT scan with contrast
Diagnostics
Bowel obstruction
Chronic cholecystitis
Diverticulitis
Gastroenteritis
Irritable bowel syndrome
Pancreatitis
Renal colic
Appendicitis
Differential Diagnostics
Ulcerative colitis
Is a chronic inflammatory disease that causes ulceration of the
colonic mucosa, in the inner lining of Colon and rectum.
Those ulcers produce pus and mucous, which cause abdominal
pain and the need to frequently empty your colon.
Definition
Causes of Ulcerative Colitis
Abnormal immune response
Genetics
Environmental factors (Diet, stress, viral/bacterial infection,
NSAID use)
Ulcerative Colitis
Frequent bloody diarrhea with passage of purulent mucus
Abdominal cramps and pain
Persistent diarrhea accompanied by abdominal pain and blood in
the stool

Fever
Elevated heart rate
Urgent bowel movements
Bloody stools
Dehydration
Weight loss
Anemia
Ulcerative colitis
Signs and Symptoms
Types of Ulcerative Colitis
Ulcerative colitis
Ulcerative Proctitis
Bowel inflammation limited to less than six inches of the
rectum
Symptoms
Rectal bleeding
Rectal pain
Urgency in your bowel movements
Left-Sided Colitis
Continuous inflammation begins at the rectum and extends as
far into the colon as the splenic flexure
It also includes proctosigmoiditis, which affects rectum and
the sigmoid colon.
Symptoms
Loss of appetite
Weight loss
Bloody diarrhea
Pain on the left side of the abdomen
Ulcerative colitis

Extensive Colitis
Affects the entire colon.
Continuous inflammation begins at the rectum and extends
beyond the splenic flexure.
Symptoms
Loss of appetite
Bloody diarrhea
Abdominal pain
Weight loss
Diagnostic test
Colonoscopy
Barium enema
X-ray, CT scan
Blood test: It shows low hemoglobin values, hypoalbuminemia,
and low serum potassium levels.
Stool studies: White blood cells or certain proteins in your stool
can indicate ulcerative colitis
Ulcerative colitis
Rupture of bowel
Toxic Megacolon
Weigh loss, dehydration
Anemia
Loss of form of haustra (“lead-pipe sign”)
Complications
Crohn Disease
Infectious colitis
Chronic schistosomiasis
Amebiasis
Intestinal tuberculosis
Infectious, ischemic, or radiation colitis
Acute self-limiting colitis (ASLC)
Colon cancer

Ulcerative colitis
Treatment
Anti-inflammatory drugs:
Aminosalicylates:5-aminosalicylic acid (5-ASA)First line
ttx Sulfasalazine (Others: Mesalamine, Balsalazide, Olsalazine)
Corticosteroids: (Prednisone, Budesonide, Hydrocortisone,
Methylprednisolone)
Immunosuppressors/modulators: To reduce immune system
activity when other drugs don’t work/off steroids. Take several
weeks to 3 months to start working.
Immunosuppressors(azathioprine, cyclosporine, methotrexate)
Immunomodulators: Target proteins made by the immune
system. Neutralizing these proteins decreases inflammation in
the intestines. (Adalimumab, Infliximab, etc)
Treatment UC
Antibiotic, antidiarrheal, tylenol (NO NSAIDS)
Severe cases: Surgery
Proctocolectomy: removal of colon and rectum, patient will
have permanent ileostomy
or
Ileorectal anastomosis:Colon and rectum removal, and pouch
created that attaches to ileum which allows stool to pass from
small intestine to anus.
Crohn Disease
Signs and Symptoms
Right lower quadrant intermittent abdominal pain.
Ulcers (mouth and GI tract)
Lower abdominal pain 1 hour after eating.
Diarrhea (may have pus, blood, or mucus).
Fever
Fissure (anal that bleeds)
Bloating

Weight loss.
Abnormal liquid stools.
Types of Crohn Disease
Ileocolitis: Inflammation in the ileum and colon, is the most
common type of Crohn’s disease.
Ileitis: Inflammation in the small intestine (ileum).
Gastroduodenal: Inflammation affect the stomach and the
duodenum’
Jejunoileitis: Patchy areas of inflammation develop in jejunum).
Crohn Disease
Diagnostic test
Complications
Colonoscopy
Barium Enema (BE, Lower GI Series)
CT scan
Small bowel series or a capsule endoscopy (camera pill)
Anti–Glycan Antibodies (Crohn Disease Prognostic Panel)
Intestinal obstruction.
Fistulas.
Abscesses.
Anal fissures.
Ulcers.
Malnutrition.
Sepsis
Amebiasis
Appendicitis
Bacterial Gastroenteritis
Diverticulitis
Giardiasis
Irritable Bowel Syndrome
Ulcerative Colitis
Viral Gastroenteritis

Crohn Disease
Treatment
Anti-inflammatory drugs:
Aminosalicylates:5-aminosalicylic acid (5-ASA)First line
ttx Sulfasalazine (Others: Mesalamine, Balsalazide, Olsalazine)
Corticosteroids: (Prednisone, Budesonide, Hydrocortisone,
Methylprednisolone)
Immunosuppressors/modulators: To reduce immune system
activity when other drugs don’t work/off steroids. Take several
weeks to 3 months to start working
Immunosuppressors(azathioprine, cyclosporine, methotrexate)
Immunomodulators: Target proteins made by the immune
system. Neutralizing these proteins decreases inflammation in
the intestines. (Adalimumab, Infliximab, etc)
Acetaminophen for mild pain
Antibiotics to prevent or treat complications that involve
infection, such as abscesses and fistulas.
Loperamide: severe diarrhea.
Surgery is generally performed to manage complications
Crohn Disease
Non-pharmacological intervention
Avoid carbonated drinks, popcorn, vegetable skins, nuts, and
other high-fiber foods, lactose
Drink more fluids
Eat smaller meals more often
Keep a food diary to help identify foods that cause problems
High calorie, low fat, low fiber, and low salt diet
Crohn Disease
Differences
Ulcerative Colitis

Only the colon and rectum (large intestine) are affected
Affects the inner-most lining of the large intestine (submucosa
to mucosa)
Cure is surgery
Continuous lesions
Crohn Disease
Can affect any part of the GI tract from the mouth to the anus
Can affect the entire lining of the intestinal wall to serosa
No cure, surgery helps with quality of life
Skip lesions
Definition
Disorder of brain-gut interaction characterized by abdominal
pain with altered bowel habits.
Causes
Still unknown but some factors can lead to IBS like:
Dysmotility: Problems with how your GI muscles contract and
move food through the GI tract.
Visceral hypersensitivity: Extra-sensitive nerves in the GI tract.
Brain-gut dysfunction: Miscommunication between nerves in
the brain and gut.
Factors associate
Stressful or difficult early life events.
Depression/anxiety
Alcohol consumption/smoking
Signs and Symptoms
Abdominal pain or cramps, usually in the lower half of the
abdomen.
Bloating.
Bowel movements that are harder or looser than usual.
Diarrhea, constipation or alternating between the two.

Excess gas.
Mucus in the stool(may look whitish).
Types of IBS
Celiac disease
Lactose intolerance
Ulcerative Colitis.
Microscopic Colitis.
Rome IV Criteria: Recurrent abdominal pain, on average, at
least 1 day per week in the last 3 months, associated with two or
more of the following criteria:
1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of stool
CBC
C-reactive protein
Fecal calprotectin
Colonoscopy, X-ray, CT scan
Stool test
Lactose intolerant test
Crohn's Disease.
Stress.
Diverticulitis.
Gallstones.
Treatment

Pharmacotherapy is based on severity and is targeted at specific
symptoms.
All patients with alternating constipation/diarrhea:
Increased dietary fiber (25 g/day)
Pain
Antispasmodic (anticholinergic) medication—short term
TCAs—long term
Diarrhea
Loperamide—short term; often used for breakthrough diarrhea
Antidepressants (TCAs)—long term
Alosetron (ordered by GI specialists) if resistant to all other
interventions
Constipation
Fiber
Laxatives
Non-pharmacologic Treatment
Dietary changes:
Fluids should not be taken with foods
Increase fiber in the diet (fruits, vegetables, grains and nuts).
Drink plenty of water
Avoid : caffeine, chocolate, teas and sodas.
Limit cheese and milk.
Make sure to get calcium from other sources, such as broccoli,
spinach, salmon or supplements.
symptoms.
Activity changes:
Exercise regularly.
Don’t smoke.
Try relaxation techniques.
Eat smaller meals more often.
Food diary to know which foods trigger flare-ups. Common
triggers are red peppers, green onions, red wine, wheat and
cow’s milk.

Behavioral and psychological therapies, stress management, and
meditation.
Cancer of the Digestive System
Esophagus : (2.6 percentage of deaths)
Stomach: (1.8 percentage of deaths)
Colorectal: (8.25 percentage of death)
Cancer of the tube that runs from the throat to the stomach
(esophagus).
Definition
The most common cells are Squamous cells and
Adenocarcinoma. Chronic inflammation, intestinal metaplasia,
and dysplasia (Barrett esophagus [columnar rather than
squamous epithelium in the lower esophagus]) induced by
gastroesophageal reflux accelerates the formation of esophageal
adenocarcinoma. Both adenocarcinoma and squamous cell
carcinoma develop neoplastic transformation after long-term
exposure to environmental irritants (basal and squamous cell
hyperplasia).
Pathogenesis
Esophageal Cancer
Causes
Factors that can increase your risk of esophageal cancer
include:
Smoking
Heavy alcohol consumption
Chronic heartburn or acid reflux
Gastroesophageal reflux disease (GERD)
Malnutrition
Barrett’s esophagus, a condition that sometimes develops in
people with GERD

Achalasia, a rare disorder of muscles in the lower esophagus
Not eating enough fruit and vegetables
Undergoing radiation treatment to the chest or upper abdomen
Signs and symptoms
Difficulty swallowing (dysphagia)
Weight loss without trying.
Chest pain, pressure or burning.
Worsening indigestion or heartburn.
Coughing or hoarseness.
Esophageal Cancer
Diagnostic Tests
Barium swallow test. If you're having trouble swallowing,
sometimes a barium swallow is the first test done.
Computed tomography (CT) scan.
Magnetic resonance imaging (MRI) scan.
Positron emission tomography (PET) scan.
Upper endoscopy.
Endoscopic ultrasound.
Bronchoscopy.
Thoracoscopy and laparoscopy.
Treatment
Treatment of gastroesophageal reflux is essential for the
prevention of Barrett esophagus.
Esophageal carcinoma is treated with endoscopic
radiofrequency mucosal ablation.
Radiation therapy: The use of X-rays, gamma rays and charged
particles to fight cancer
Chemotherapy: The use of anticancer drugs to treat cancerous
cells
Surgery: The use of an operation to remove the cancerous tissue
from the body.
Combination of therapies.
Esophageal Cancer

Esophageal Cancer
Obstruction of the esophagus. Cancer may make it difficult for
food and liquid to pass through your esophagus.
Pain. Advanced esophageal cancer can cause pain.
Bleeding in the esophagus. Esophageal cancer can cause
bleeding. Though bleeding is usually gradual, it can be sudden
and severe at times.
Complications
Prevention
You can take steps to reduce your risk of esophageal cancer.
For instance:
Quit smoking. If you smoke, talk to your doctor about strategies
for quitting. Medications and counseling are available to help
you quit. If you don't use tobacco, don't start.
Drink alcohol in moderation, if at all. If you choose to drink
alcohol, do so in moderation. For healthy adults, that means up
to one drink a day for women and up to two drinks a day for
men.
Eat more fruits and vegetables. Add a variety of colorful fruits
and vegetables to your diet.
Maintain a healthy weight. If you are overweight or obese, talk
to your doctor about strategies to help you lose weight. Aim for
a slow and steady weight loss of 1 or 2 pounds a week.
Cancer that occurs in the stomach.
Definition
Pathogenesis
Environmental factors and genetic predisposition combine to
cause injury, inflammation, and the progression to gastric
adenocarcinoma. About 1% to 3% of gastric cancers are
familial. Gastric adenocarcinoma usually begins in the glands of
the stomach mucosa, commonly in the prepyloric antrum.
Atrophic gastritis progresses to intestinal metaplasia, dysplasia,
and adenocarcinoma.

Stomach Cancer
Causes
Signs and symptoms
Infection with H. pylori that carry selected virulence factors. H.
pylori is causatively linked to mucosa- associated lymphoid
tissue (MALT) lymphoma (a low-grade B-cell lymphoma) that
can originate in the stomach.
Dietary factors, such as salt added to food, food additives in
pickled or salted foods and low intake of fruits and vegetables.
Dietary salt enhances the conversion of nitrates to carcinogenic
nitrosamines in the stomach. Salt is also caustic to the stomach
and can cause chronic atrophic gastritis.
Lifestyle factors, such as alcohol consumption and cigarette
smoking. Smokers have a higher incidence of H. pylori
infection.
The early stages of gastric cancer are generally asymptomatic or
produce vague symptoms such as loss of appetite (especially for
meat), malaise, and indigestion.
Later manifestations include unexplained weight loss, upper
abdominal pain, vomiting, change in bowel habits, and anemia
caused by persistent occult bleeding.
Stomach Cancer
Stomach Cancer
Diagnostic Tests
Treatment
Barium x-ray film shows the lesion.
Direct endoscopic visualization (microscopic examination of
exfoliated cells obtained by lavage during endoscopy).
Biopsy usually establish the diagnosis.
Surgery is the only curative treatment for early stages of
disease.
Screening and eradication of H. pylori infection are the best

preventive approaches to gastric cancer.
Early diagnosis and chemotherapy combined with radiation
improve post-surgical outcomes.
Abstinence from alcohol and smoking improves outcomes.
Dietary modifications include high intake of fruits and
vegetables, vitamin C, carotenoids, and fiber and reduced intake
of salt, salted food, and red meat.
Small Intestine Cancer
Definition
Small intestine carcinoma is rare and represents less than 3% of
gastrointestinal cancers. The most prevalent tumor type is
adenocarcinoma, which is followed by carcinoid tumors
(neuroendocrine serotonin-producing tumors), sarcomas, and
lymphomas (neuroendocrine serotonin-producing tumors).
Carcinoma is more common in people who have familial
adenomatous polyposis or Crohn's disease.
Abdominal pain
Yellowing of the skin and the whites of the eyes (jaundice)
Feeling unusually weak or tired
Nausea/Vomiting
Losing weight without trying
Blood in the stool, which might appear red or black
Watery diarrhea
Skin flushing
Signs and symptoms
Risk factors
Gene mutations passed through families. Some gene mutations
that are inherited from your parents can increase your risk of
small bowel cancer and other cancers.
Other bowel diseases. Other diseases and conditions may
increase the risk of small bowel cancer, including Crohn's

disease, inflammatory bowel disease and celiac disease.
Weakened immune system. If your body's germ-fighting
immune system is weakened.
Diagnosis
CT
MRI
Positron emission tomography (PET)
X-rays of the upper digestive system and small bowel after
drinking a solution containing barium (upper gastrointestinal
series with small bowel follow-through)
Nuclear medicine scans, which use a small amount of
radioactive tracer to enhance imaging tests
Endoscopic tests involve placing a camera inside your small
intestine so that your doctor can examine the inside walls.
Endoscopic tests may include:
Surgical resection followed by tumor types specific treatment.
Surgery can involve one large incision in your abdomen
(laparotomy), or several small incisions (laparoscopy).
Chemotherapy. Chemotherapy uses powerful drugs to kill
cancer cells.
Targeted drug therapy. Targeted drug treatments focus on
specific weaknesses present within cancer cells.
Immunotherapy. Immunotherapy is a drug treatment that helps
your immune system to fight cancer.
Treatment
It's not clear what may help to reduce the risk of small bowel
cancer, since it's very uncommon.
Eat a variety of fruits, vegetables and whole grains.
Drink alcohol in moderation
Stop smoking.
Exercise most days of the week at 30 min.

Maintain a healthy weight.
Complications
Prevention
An increased risk of other cancers. People who have small
bowel cancer run a higher risk of having other types of cancers
Cancer that spreads to other parts of the body.
Colon and Rectum Cancer
A cancer of the colon or rectum, located at the digestive tract's
lower end. Is the third most common cause of cancer and cancer
death.
Stage 0 (carcinoma in situ): involves only the mucosal lining.
Stage I: Extension of cancer to the middle layers of the colon
wall, no spread to lymph nodes.
Stage II: Extension beyond the colon wall to nearby tissues
around the colon or rectum, and through the peritoneum.
Stage III: Spread beyond the colon into lymph nodes and nearby
organs and through the peritoneum.
Stage IV: Spread to nearby lymph nodes and has spread to other
parts of the body, such as the liver or lungs.
Definition
Risk Factors
Hereditary and Medical Factors
Family history of colorectal cancer
Familial adenomatous polyposis
Hereditary non-polyposis colorectal cancer
Inflammatory bowel disease after 10 years
Type 2 diabetes mellitus
Modifiable Risk Factors
Smoking or chewing tobacco
Obesity

Physical inactivity
Moderate to heavy alcohol consumption
High consumption of processed meat
Red meat consumption (large variations among studies) High-
fat, low-fiber diet
Lower Risk
Diets high in cereal grains, vegetables, milk; fish; folic acid,
calcium, and vitamin D; magnesium and selenium; and low in
fat.
Postmenopausal estrogen use Physical activity
Use of NSAIDs
Signs and symptoms
A change in bowel habits.
Blood in or on your stool (bowel movement).
Diarrhea, constipation, or feeling that the bowel does not empty
all the way.
Abdominal pain, aches, or cramps that don't go away.
Weight loss and Anemia.
Diagnosis
Blood tests (Complete blood count, tumor markers and liver
enzymes)
Imaging tests (X-rays, CT scan, MRI scan, PET scan ultrasound,
angiography)
Biopsy
Diagnostic colonoscopy (done after you show symptoms, not as
a routine screening test)
Proctoscopy.
Treatment for colon cancer usually involves surgery to remove
the cancer. Removing polyps during a colonoscopy
(polypectomy).

Endoscopic mucosal resection.
Minimally invasive surgery (laparoscopic surgery).
Other treatments, such as radiation therapy and chemotherapy,
might also be recommended.
Treatment
Anal carcinoma
Definition
Is very uncommon cancer. Anal cancer is a disease in which
malignant (cancer) cells form in the tissues of the anus.
The squamous cell carcinoma is the most prevalent tumor type.
Other anal malignancies include adenocarcinoma, lymphoma,
and sarcoma.
Most common, infection with the human papillomavirus (93
percent).
Followed by anal involvement in Crohn's disease.
Squamous cell anal cancer is more likely in people who have
been infected with the human immunodeficiency virus.
Having a personal history of vulvar, vaginal, or cervical
cancers.
Having many sexual partners or repetitive anal intercourse.
Risk factor
Anal carcinoma
Signs and symptoms
Diagnosis
Bleeding from the anus or rectum.
A lump near the anus.
Pain or pressure in the area around the anus.
Itching or discharge from the anus.
A change in bowel habits
Physical exam and health history.
Digital rectal examination (DRE).
Anoscopy.

Proctoscopy.
Endo-anal or endorectalultrasound.
Biopsy: The removal of cells or tissues with signs of cancer
Surgery and combination chemoradiation are used to treat anal
carcinomas, depending on their stage.
Treatment
Burisch J, Munkholm P. Inflammatory bowel disease
epidemiology. Current Opinion in
Gastroenterology. 2013;29(4):357–362.
Edmunds, M., & Mayhew, M. (2013). Pharmacology for the
Primary Care Provider (4th Edition). Elsevier Health Sciences
(US). https://online.vitalsource.com/books/9780323087902
Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends
in the prevalence of Crohn’s disease and ulcerative colitis in a
commercially insured U.S. population. Digestive Diseases and
Sciences. 2013;58:519–525.
McCance, S.H. K. ([Insert Year of Publication]).
Pathophysiology (8th Edition). Elsevier Health Sciences (US).
https://online.vitalsource.com/books/9780323583473
Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence
and prevalence of the inflammatory bowel diseases with time,
based on systematic review. Gastroenterology. 2012;142(1):46–
54.
Pagana, K.P.T.P. T. ([Insert Year of Publication]). Mosby's
Manual of Diagnostic and Laboratory Tests (7th Edition).
Elsevier Health Sciences (US).
https://online.vitalsource.com/books/9780323697057
References

Doctoral Project Plan (DPP)SCHOOL OF
COUNSELING AND HUMAN SERVICES DOCTORAL
PROJECT PLANSTATEMENT OF ORIGINAL WORK
I understand that Capella University’s Academic Honesty Policy
(3.01.01) holds learners accountable for the integrity of work
they submit, which includes, but is not limited to, discussion
postings, assignments, comprehensive exams, and the Capstone.
Learners are expected to understand the policy and know that it
is their responsibility to learn about instructor and general
academic expectations concerning the proper citation of sources
in written work as specified in the APA Publication Manual, 6th
Ed. Serious sanctions can result from violations of any type of
the Academic Honesty Policy, including dismissal from the
university.
I attest that this document represents my work. Where I have
used the ideas of others, I have paraphrased and given credit
according to the guidelines of the APA Publication Manual , 6th
Ed. Where I have used the words of others (i.e., direct quotes), I
have followed the guidelines for using direct quotes prescribed
by the APA Publication Manual, 6th Ed.
I have read, understood, and abided by Capella University’s
Academic Honesty Policy (3.01.01). I further understand that
Capella University takes plagiarism seriously; regardless of
intention, the result is the same.
Signature for Statement of Original Work (MUST
COMPLETE)Learner Name
Ashley CookMentor Name
Dr. Amy LyndonLearner Email
[email protected]Mentor Email

[email protected]
Learner ID
1367748
Date
11/23/2021
Capstone Project Plan ProcessYou will use this form to
complete your keystone class, obtaining Milestone 1, and
obtaining Milestone 2 approval. The goals of this process are:
(1) facilitate the planning of the details of your doctoral
research project, (2) allow for scientific merit review, and (3)
facilitate your progress through the Capstone. You must obtain
approval of your Doctoral Project Plan before seeking IRB
approval, collecting data, and writing your Capstone
manuscript. Approval of your Doctoral Project Plan (DPP) will
satisfy the Capstone Milestone 2, indicating that the Doctoral
Project Plan (DPP) has passed the scientific merit review part of
the IRB process.The scientific merit process is designed to
ensure that a proposed research study contains an appropriate
level of scientific rigor and merit before ethical review. Rigor
is achieved if the study is well-designed and has adequate
resources so that participants are not exposed to unnecessary
harm. Merit is achieved if the rights and welfare of the human
research participants are protected
**Obtaining Scientific Merit approval for the Doctoral Project
Plan (DPP) does not guarantee you will obtain IRB approval. A
detailed ethical review will be conducted during the process of
IRB approval.How to Use This FormThis Doctoral Project Plan
(DPP) form is intended to help you plan the details of your
Capstone Project. It provides a space for you to work out all
the details of your design. Once you have obtained Doctoral
Project Plan (DPP) approval, you should be able to easily
expand on the information you have submitted here to complete
the deliverable of your proposed Capstone Project and write the
Capstone Final Report because these sections follow the outline

of the Doctoral Capstone Report. It is recommended that you
use this form in a step-by-step way to help you design your
study. Expect that you will go through several revisions before
obtaining approval of this form. Research planning is an
iterative process; each revision often sparking the need for
further revisions until everything is aligned. These iterations
and revisions are a necessary and customary part of the research
process.
Do’s and Don’ts
· Do use the correct form!
· Don’t lock the form. That will stop you from editing and
revising the form.
· To complete the “Learner Information” and Section 1 first.
· Don’t skip items or sections. If an item does not apply to your
study, type “NA” in its field.
· Don’t delete the descriptions and instructions in each section!
· Do read the item descriptions carefully. Items request very
specific information. Be sure you understand what is asked.
· Do use primary sources to the greatest extent possible as
references. Textbooks are NOT acceptable as the only
references supporting methodological and design choices. Use
textbooks to track down the primary sources.
· If you change any design elements after your DPP is approved,
you must submit a revised Doctoral Project Plan. A current
DPP must be on file before your IRB application is submitted.
GENERAL INSTRUCTIONS
Complete the following steps to prepare and submit your DPP
for Scientific Merit Review (SMR) approval for your doctoral
Capstone Project.
· Keystone Learners: Your Keystone Instructor will facilitate
the initial process.
· Capstone Learners: Your Mentor will facilitate this process.
CITI Research Training
Mentees must complete the CITI Research training and submit

their CITI completion certificate to your Keystone Instructor.
CITI Training Module
Milestone 1: Topic Approval
Complete Section 1 (1.1 and 1.2) of the DPP form for topic
approval.
There are two ways to achieve Milestone 1:
1. If Section 1 of your DPP meets the rigor for a viable topic,
your keystone instructor will submit it for school review.
Receiving 80% on the DPP does not mean that it is ready for the
topic plan review.
a. You will work on all sections of the DPP during the Keystone
Course, even if you do not achieve topic approval. This will
allow the Keystone Instructor to introduce you to the necessary
components of the Doctoral Project Plan.
2. If Section 1 is not submitted for topic approval during the
Keystone Course (HMSV8700), your Mentor will submit the
topic plan in the Capstone Course – HMSV9971.
Milestones 2: Doctoral Project Plan
1. Work with your Capstone Mentor to complete and make any
necessary refinements to the DPP form.
a. If you did not receive topic approval in the Keystone Course,
you will refine sections 1 (1.1 and 1.2) and submit it to your
Capstone Mentor. Your Capstone Mentor will submit section 1
for topic approval. After topic approval, you will proceed to
step 2.
2. Once you have topic approval (whether in the Keystone or
Capstone Course), you will refine and complete sections 2 – 7
in the DPP form. Make sure all sections are aligned with the
DHS Programs of Professional Practice and the DHS Doctoral
Capstone Handbook. —changes in one section could necessitate
changes in another section.
3. After you have a polished version, you should review the
DPP criteria with the rubric to ensure you have provided the
required information to demonstrate you have met each of the
scientific merit criteria.

4. Submit the completed form to your Capstone Mentor.
Scientific Merit Review(SMR)
The scientific merit reviewer will review each item against a
rubric to determine whether you have met each of the criteria.
You must meet all the criteria at a level of “Proficient” or
greater to obtain reviewer approval. The reviewer will designate
your Doctoral Project Plan (DPP) as one of the following:
· Approved
· Deferred
· Not Ready for Review
If the Doctoral Project Plan (DPP) is Deferred or Not Ready for
Review:
· The SMR reviewer will provide feedback on any criteria that
you have not met.
· You are required to make the necessary revisions and obtain
approval for the revisions from your Mentor.
· Once you have Mentor approval for your revisions, your
Mentor will submit your Doctoral Project Plan (DPP) for a
second review.
· You will be notified if your Doctoral Project Plan (DPP) has
been approved or deferred for revisions.
· Up to three attempts to obtain Scientific Merit Review (SMR)
approval are allowed. Researchers, Mentors, and Reviewers
should make every possible attempt to resolve issues before the
Doctoral Project Plan (DPP) is deferred for the third time. If a
learner does not pass the scientific merit review on the third
attempt, then the case will be referred to the Research Chair
and/or Program Chair in your School for review, evaluation, and
intervention.
· While you await approval of your Doctoral Project Plan
(DPP), you should begin working on your Ethics Paper. Your
Mentor has a template for you to follow.
· Once you have gained approval on your DPP (Milestone 2),
you are ready to submit your Ethics Paper and IRB application

and supporting documents for review by the IRB Committee.
Milestone 3: IRB Approval
1. Once you obtain SMR approval, you will begin and complete
an eight to 10-page ethics paper. This paper is a conceptual
analysis of ethical principles typically related to all professional
Capstone Projects. Your Mentor has a template for you to
follow.
2. Once your Mentor has approved your Ethics Paper, you will
complete your IRB application through IRBManager and submit
any accompanying materials.
3. Consult the Research and Scholarship area within iGuide for
IRB forms and detailed process directions.
**You are required to obtain scientific merit approval (SMR)
before you may receive IRB approval. Obtaining SMR approval
does not guarantee that IRB approval will follow.
Milestone 4: Pre-Data Collection Call
1. Once you have gained approval from the IRB, you are ready
to schedule your Pre-Data Collection Conference Call. You may
not proceed to data collection until you have completed this
call.
2. Work with your Mentor and Doctoral Committee to set a date
for the conference call.
3. Upon successful completion of the Pre-Data Collection
Conference Call, your Mentor will mark Milestone 4 complete,
and you may proceed with data collection.
Learner and Specialization Information
(MUST BE COMPLETED)
Learners, please insert your answers directly into the
expandable boxes that have been provided.

Learner Name
Ashley Cook
Learner Email
[email protected]
Learner ID Number
1367748
Mentor Name
Dr. Amy Lyndon
Mentor Email
[email protected]
Specialization (check one)
|_| Leadership and Organizational Management
|X| Program Evaluation and Data Analytics
Specialization Chair Name
Specialization Chair Email
Committee Member #1 Name
Dr. Ryan Dunn
Committee Member #1 Email
[email protected]
Committee Member #2 Name
Dr. Andrea Muse
Committee Member #2 Email
[email protected]
Capstone Type (check one)
|_| Research Paper
|X| Professional Product
Deliverable (check one)
Research Paper
|_| Action Research Monograph
|_| Program Evaluation
Professional Product
|X| Service Project
|_| Change Management Plan

Section 1. Topic Endorsemen
Please, use single-spaced, Times Roman 11 pt. throughout the
form – the boxes will expand as you input text.
1.1 Capstone Topic (2 paragraphs)
Clearly describe the topic of the Capstone Project.
This section should include: · FIRST PARAGRAPH: State the
topic of the capstone project. The topic statement shoul d
include the problem or opportunity for improvement in the
project. The concepts of the topic must be clear and focused
and well supported in the literature. · Begin this paragraph
with, “The topic is…”
· SECOND PARAGRAPH: Describe the significance of this
topic to Human Services AND the specialization within your
program. Include a statement about the practical implications of
the project by describing the impact of this Capstone Project on
the organization or community of interest· Example - The topic
of this capstone project is the effectiveness of a transitional
summer program, Helping Others, Inc., on middle school
student's chance of success (graduation) in high school.
The topic should be correctly formed:
· The topic should be appropriate for the specialization.
· The topic should use appropriate language for key
concepts/phenomena.
· The type of action proposed should be specified.
· The community of interest/organization/program or
community and target population should be named.
· The concepts should be appropriately focus
· The topic should be supported by at least ten (10) citations.
· The topic should be in alignment with current literature and

the DHS Programs of Professional Practice.
Use current (within 5-7 years), scholarly, PRIMARY resources
to support statements. Textbooks are not primary resources.
Theses and dissertations are not considered peer-reviewed
published articles. Use APA style in citing all resources.
The topic of this capstone project is improving The Haven’s
ability to assist victims to establish these women’s independent
financial ability through developing a financial literacy training
program. The Haven looks at making the current housing more
reasonably priced, building improved, and low moderate-income
houses using the existing building materials to help create a
community where every person can live in The Haven (The
Haven, n.d.). The Haven is a local non-profit agency that
provides emergency temporary shelter and services to victims of
family violence and sexual assault. The Haven is dual-
programmed and has two emergency facilities: The Battered
Women’s Shelter, which serves victims of family violence, and
the Rape Crisis Center, which serves victims of sexual assault.
Both programs have a 24-hour toll-free crisis line, staffed by
trained personnel, that is available to anyone wishing to utilize
the emergency facilities or the outreach programs (The Haven,
n.d.). This capstone will explore domestic violence and
economic or financial abuse as the background for creating
training protocol on financial literacy for domestic violence
victims for use by The Haven. Financial impediments play a
major role in restricting the freedoms enjoyed by women who
are abused by their intimate partners (Juing et al., 2021). A
batterer is empowered by his partner’s financial dependence,
and a woman’s autonomy is diminished by her abuser’s
financial control. Moreover, financial instability is one of the
greatest reasons why, after gaining freedom, a woman who
experiences battering has limited choices and mayultimately
acquiesce to her partner’s attempts to reconcile (Ortiz-Ospina &

Roser, 2017). Economic instability is a link that binds a woman
to her abuser (Carla Moretti, 2017). Regardless of the
interventions, law enforcement, family, friends, or The Haven,
as long as she remains financially dependent upon her abuser, it
is exceedingly difficult for a woman who experiences intimate
partner violence to stop the batterer’s control. Economic
independence can provide freedom from abuse (Bramley &
Fitzpatrick, 2018). Comment by Muse, Andrea: Great topic!
The significance of this topic to human service is to help human
services personnel to use their resources more effectively by
providing victims training on how to use these financial
resources. The majority of abusers use economic abuse to
control victims (VothSchrag et al., 2020). The impact of this
project is to people of the community of interest helping victims
of domestic violence and their families remain in stable housing
and have financial independence. Through this capstone topic,
the aim is to empower women with financial literacy that would
help them in their lives.
Most victims experience some type of financial abuse, which
reduces their financial literacy (VothSchrag et al., 2020). Thus,
they will need assistance with maintaining the long-term
shelter. Without having many organizations that are willing to
take care of the plight the people are facing, the goals of the
human services field would not be easily fulfilled (Juing et al.,
2021). Human service programs can help victims through the
programs that have been put in place along with hotlines that
are focused directly on these issues. Housing is among the three
most essential life requirements. Haven helps victims who have
been financially abused by building a healthy, empowering, and
strengthening them by looking into what is the cause of the
situation and how they can come up with an idea that can
change it (Soibatian, 2017). The Haven has many programs like
housing, children support, women support groups, income, and
employment service groups. The supporting services try to

assist the individuals with materials and supplies that will help
the individuals with low income to have daily needs. The
victims sometimes are helped by social workers or churches that
focus on stabilizing them and creating a budget that will finance
the living (Jennifer, Patrick, 2011). However, it is projected
that over one billion people are today living in insufficient
housing conditions in urban areas. “In most cities, there are
more than half of the population who lives in informal
settlements in what can be described as life and health-
threatening” (Ortiz-Ospina & Roser, 2017, p 3). More than 100
million people are homeless globally, and data shows that there
are increasing propositions of women and children. The
statistics given give a clear picture of the dire need for having
quality housing globally.
It is indisputable that homelessness continues to be a grand
challenge in our country and globally. In addressing the
problem of homelessness, our organization has been putting up
measures to ensure that we prevent people from becoming
homeless in the first place. This includes outreach efforts
targeting at-risk people in short-term case management
(Moretti, 2017).
1.2 Research Problem (2 Paragraphs)
Write a brief statement of the problem or need for improvement
at the capstone site or program. Clearly describe the gap in
current practice, service, process, policy, and/or the identified
outcome. Identify the performance gap you wish to close and
the potential root causes of the problem.
This section should include:· FIRST PARAGRAPH: Write a
brief statement that fully describes the problem being
addressed. This paragraph introduces the problem that is
informing the research and warrants the need for this study. ·

Begin this paragraph with the statement, “The problem is…”
Example: The problem is that Helping Others, Inc’s transitional
summer program has not consistently improved high school
graduation rates.
· SECOND PARAGRAPH: Identify the need for the study. The
need should be directly related to the problem presented in the
first paragraph. It must identify a gap in current practice,
service, process, policy, or programs. It must identify the need
for the research and the desired outcome.
Example: This study is needed because high school graduation
rates are decreasing in the service community where Helping
Others Inc. provides its transitional summer program.
Decreased graduation rates have negatively affected the
unemployment rate in the area.
The problem is that the victims of domestic violence lack
financial literacy and knowledge to retain long-term housing.
While shelters assist with housing insecurity, the outcomes are
limited by survivors’ abilities to gain and retain control of their
financial ability to remain housed (Klein et al., 2020). Access to
stable housing is linked with better mental health for victims
and their families (Bomsta & Sullivan, 2018). The human
services field increasingly recognizes economic and financial
abuse within intimate partner relationships (Shinn & Khadduri,
2020); for this reason, the human services field has worked to
develop financial empowerment programs to empower survivors
for their financial future (Sikorska, 2021). The problem is
domestic violence and intimate partner violence (IPV) victims
struggle with financial independence. Financial literacy in the
female population is significantly lower compared to the male
population – i.e., the gender gap in financial literacy (Fonseca

et al., 2012; Hasler & Lusardi, 2017; Lusardi & Mitchell, 2008,
2014). This inequality makes women susceptible to financial
abuse by their partners. In recent years, researchers have come
to recognize economic and financial abuse as a unique form of
abuse commonly used by IPV perpetrators to gain and maintain
control over their victims (Polvere et al., 2018). Broadly
defined, financial abuse includes behavior’s that control a
victim’s “ability to acquire, use, and maintain resources thus
threatening her economic security and potential for self-
sufficiency” (Adams et al., 2008, p. 564) and is frequently a
precursor to physical abuse. For example, Adams (2011)
reported that 99% of IPV victims experience financial abuse.
Similarly, Postmus et al. (2012) reported that 94% of the IPV
survivors they surveyed experienced some form of financial
abuse. The Haven can provide short-term housing needs to
victims for up to three months, but once the short-term shelter
ends, victims struggle with maintaini ng the housing
independently (The Haven (valdostaharven.org). Many victims
suffer because their credit scores have been destroyed by their
partners or simply because of a lack of knowledge. Partners
often destroy victims’ credit by harassing them to use their
social security numbers. Victims are not able to retrieve this
information of their resources because many of the abusers
closely monitor the websites that they will visit. The lack of
financial security is brought by a lack of access to safety, so the
housing takes the initiative of educating the victims on how to
secure their homes (Robin & Osub,2020).
The Haven explores a variety of options through local resources
and the needs of the victims (MacKenzie et al., 2020). This
helps The Haven address the most affected people and use the
available local resources, making access to affordable houses
easier (Polvere et al., 2018). The major goal is to ensure that
everybody can live in a house that is decent and affordable
(Benerjee & Bhattacharya, 2020)
In response, this capstone is needed because financial literacy
training is needed to help survivors of domestic violence gain

financial independence. This project seeks to empower women
so that they may be less likely to return to an abuser if they are
to stay financially independent. This capstone fills a gap by
developing training to improve the financial literacy of
domestic violence victims. The rate of domestic violence is 185
incidents per 100,000 population annually (Shinn & Khadduri,
2020); these estimates suggest improving financial literacy can
prevent between 6 to 20 domestic violence incidents per
100,000 population from occurring each year. This capstone
will help The Haven improve women’s financial literacy and
hopefully increase the ability of domestic violence victims to
remain economically independent.
Learners
Specialization Chair Topic Approval
· After completing Section 1, Keystone or Capstone Learners
should submit the DPP form to your Keystone Instructor or
Capstone Mentor for approval.
· Collaborate with your Keystone Instructor or Capstone Mentor
until you have approval for Section 1, “Topic Approval.”
· After you have received your Mentor’s approval for Section 1,
your form will be submitted for SMR review.
|X| Approved
|_| Deferred
|_| Not Ready For Review
Reviewer Name: Dr. Elissa Dawkins
Reviewer signature: Elissa Dawkins
Date: 3/13/2021
Comments: Thank you for submitting your topic plan for
review. Your topic is approved. Please review my comments
above. In addition, you will need to obtain newer, primary
references to support your topic. You will need to include
scholarly literature to back up the need for the program

evaluation. Schedule some time with a librarian and the writing
center to tweak this.
Section 2. Rationale for Study
2.1 Capstone Project Problem Background
This section should further expound on the research problem
and will include a SUMMARY of the review and synthesis of
the research literature on the topic. This should include
citations from at least 15 Articles but should indicate that you
have performed a full review of the literature on the topic.
This section should include:
· A statement about the body of existing literature on the topic.
· A summary of recent research findings on the topic highlights
the most relevant findings of the proposed study.
· A demonstration of how the proposed research could add to
the existing literature on the topic.
Be sure to provide appropriate in-text citations and include
references in the reference section.
*This will not be your Capstone Project literature review but an
initial foundation. You will continue to add to your literature
review throughout your Capstone.
Financial literacy means the victims could understand and use
various financial skills effectively (Kottke et al., 2018).

Financial literacy will lead to overall financial well -being, it is
a lifelong journey of learning and is the foundation of the
relationship that the victims will have with their money
(Khan & Brewer, 2021). Economic abuse may lead to lower
financial literacy; such abuse may also be long-term, as it is not
contingent upon a physical encounter (Krigel & Benjamin,
2020). Economic abuse includes the issues of economic control,
employment sabotage, and economic exploitation (Stylianou,
2018). Financial education provides victims with budgeting
skills, the know-how to balance checkbooks, understanding how
to prevent identity theft, and understanding the lending activity,
and knowing how to manage their debts (NCDAV, n.
d.). Women are not given enough opportunities and properties
that would help them live a comfortable life and support their
children (Bramley & Fitzpatrick, 2018). Such programs also
help them to get a stable job and can get insurance through them
(Kottke et al., 2018).
Strong leadership is very important in helping in effectively
engaging the public and surmounting barriers that are met while
enhancing affordable housing. Strong leadership can motivate
and inspire people to reach financial independence (Kottke et
al., 2018). Financial literacy can help people to manage their
money and finances effectively and afford their housing
(Katula, 2012). Many people have limited knowledge of
investing that leads them to make poor financial decisions.
Many people struggle with investing and saving due to a lack of
financial literacy (Bullock et al., 2020). It requires addressing
two very great challenges: defining the problem and creating a
very strong and long-lasting solution (Fowler et al., 2019).
Leaders are required to articulate and create a compelling vision
for the solution to the housing problem. If this is not ensured,
the affordable housing efforts may get lost among the
competing needs of the community (Mackenzie et al., 2020).
Therefore, the leaders have a great role in assuring that their
cause receives the attention that it deceives as well as the
necessary funding for the program (Quests et al., 2016).

If a program is sufficiently funded, it would mean that the
chances of more people benefiting from the program increase.
Women are more affected by gender violence than are men
(Bullock et al., 2020). Many female IPV victims are left
stranded after domestic violence with nowhere to go, some with
limited or no financial literacy to manage their finances
(Bramley & Fitzpatrick, 2018). Women are more affected by
IPV, The female victims of IPV, especially domestic violence.
This is the group that needs significant help regarding financial
literacy (Benerjee & Bhattacharya, 2020).
2.2 Need for the Project and Evidence to Make Change
Provide a rationale supported by current information regarding
the need for this Capstone Project.
· The results of a needs assessment or an analysis for the
project.
· A description of issues identified in the workplace, project, or
community.
· Any relevant population and organizational demographics and
statistics related to the proposed Capstone Project.
· A description of why the study is important.
· A description of whom the study will benefit.

For financial planning for their clients, The Haven gathers
financial information of their clients. They conduct a financial
survey to analyze the collected data, the data is summarized
based on the goals of the clients. The plan also involves
meeting in person to discuss and review the plans to make a
recommendation for short and long-term goals achievements.
The Haven's financial plans to their clients give the clients
options to consider their way forward based on their goals and
objectives. The client is helped to stay organized and help them
complete the tasks that are in alignment with their goals (The
Haven, n.d.). This may include helping the victims to escape the
abuse and create safer lives for themselves (Muir et al, 2017).
Most of the women The Haven helps struggle after divorce
because they may have been used to stay-at-home mothers and
also limited financial literacy. After divorce, most women have
no savings and are left on their own. Even after divorce, women
struggle with legal and financial issues (Polvere et al., 2018).
The research will help The Haven get more information and data
to work with improving victims’ ability to maintain their
housing, along with other financial benefits (Quests et al.,
2016).
The Haven looks at various options through local resources and
the needs of the victims (Mackenzie et al., 2020). This helps
The Haven address the most affected people and use the
available local resources, making the construction of affordable
houses easier (Muir et al., 2017). The major goal is to ensure
that everybody can live in a house that is decent and affordable
(Shinn & Khadduri, 2020). “The problem requires to be
addressed urgently so that communities can have an effective,
caring system for providing to the needs of the homeless
people” (Gan et al., 2017, p. 23).
Through proper leadership and the training protocol I look to
incorporate, The Haven has a hand in helping victims of
domestic violence and sexual assault to acquire financial

literacy that would enable to manage their finance and budget
(Polvere et al., 2018). However, a training program specifically
geared towards domestic violence victims that is informed by
scholarly and practitioner-based beset practices would
strengthen their ability to help their clients. This would include
them being able to pay for their houses and other daily
expenses. Financial literacy would be a tool that would assist
the victims to be able financially independent and live better
lives and ensure that the problem of homelessness is addressed
(Quests et al., 2016). The issue of housing is especially relevant
for survivors, as abusers deliberately cause housing insecurity
(Valentine & Breckenridge, 2016). Housing can be considered
to be affordable if it is below 30% of the total income.
According to the U.S. Department of Housing and Urban
Development, if a family pays for a house for more than 30%,
this becomes a burden to the family. This gives a clear picture
of the dire need for having quality housing globally (Ortiz-
Ospina & Roser, 2017). Most importantly, the rapid
urbanization necessitates more access to housing as more than
half of humanity is now living in the cities (Morton, et al.,
2018). It is important examining the ways of enhancing the
quality of housing, which means ensuring that everybody is
capable of finding a safe, decent, and affordable house within
the areas where they work, shop, study, and play (Kottke et al.,
2018).
2.3 Theoretical Foundations
Briefly describe the primary theoretical framework or model to
be used for the study that will serve as the lens through which
you will view the research problem and research questions.
NOTE: The theoretical foundation should be a theory from your
discipline that supports the topic and should reflect on how you
understand the topic and constructs in the study. To select the

theory of model for the study, review the DHS Programs of
Professional Practice.
· A review or discussion of the theory that will guide the
project.
· An explanation of how the theory or model defines the
variables or constructs of the study.
· An explanation of how the theory or model will guide the
study.
· A list and explanation of any study assumptions.
Economic empowerment theory will be used in the study and
will also serve as a lens through which the research problems
and research questions will be viewed (Baumol, 1977). This
theory will work to achieve the goal of empowering women and
especially the victims and the survivors of domestic violence
and sexual assault by empowering them with financial literacy
and also with affordable housing. With financial literacy
training, survivors will be empowered to lead better lives for
themselves and their families. . Economic empowerment theory
involves promoting women in their social and economic
development (Haque & Zulfiqar, 2015). This means simply
giving power to women (Karaa, 2019), giving financial literacy
to women by helping them to manage their finances. Training
for victims of domestic violence include empowering women by
acknowledging the economic abuse, along with specific
suggestions on how to develop financial capability and asset
building (Tlapek et al., 2021). In many cases of domestic
violence, and men control all the finances in homes (Lee, 2017).

In addition, traditional gender roles where women were
expected to be just stay-at-home moms and were not mostly
involved in the financial decisions (Hamdar et al., 2015).
Women have long been denied personal control over their
finances. Economic empowerment to women removes the
constraints to lack of opportunities for their development and
their confinement to household environments (Hamdar et
al., 2015).
The Haven gives financial education to women to help them
overcome the homeless problem. The Haven gives personal
attention to ensure that they have paramount success in their
finances. They give investment advice to their clients that are
personalized based on their financial goals (The Haven, n. d.).
The study assumptions of the study are that all women are not
financially literate and that men have more financial literacy as
compared to women. Globally, most finances are handled by
men (Voth Schrag et al., 2019) and a majority of abusers exert
financial control (Postmus et al., 2020).
The other assumption is that all women struggle to get
affordable houses and manage their finances after divorce. It is
assumed that most women are confined to home duties in the
household environments (Lu, 2021).
2.4 Researchers Positionality
In this section, you will define your role, position, and how
positionality will impact your research study.
· The title of your role or position in the organization, program,
or community in your site.
· A description of your job duties at the site.
· A description of how your position will impact the research
project.
· A statement that identifies if you are an insider (work or
volunteer with the organization) or outsider, or a collaborator
with insiders (no affiliation, but working with stakeholders
within the organization).

Current position: Non-affiliated community researcher
My current position with The Haven is as an outsider. I have no
affiliation with The Haven at this time but may apply with the
organization as a human service volunteer. Volunteers with The
Haven help the organization improve the quality of victims’
care and support in their day-to-day operations and assist
victims with immediate needs. Volunteer tasks may include
assisting victims with housing needs, literature reviews,
completing applications, filing papers, assisting staff with
errands, and other miscellaneous things that can be assigned to
help The Haven run smoothly.
The training will be another resource that The Haven will be
able to provide to all victims that are serviced through the
Haven.
2.5 Practical Implications
Please describe the specific practical implications of your
findings that can be used by the stakeholders.
· Minimum of (2) paragraphs. Every statement must be
supported by the literature
· A description of the specific practical implications (who may
benefit) from the research that can be used by any or all of the
following stakeholders:
· the population being studied,
· practitioners, clinicians, or medical practitioners,
· community-based service providers or health organizations,

· educators, colleges/universities or
· the wider community itself.
published articles. Use APA style in citing all
resources.REMEMBER
NOTE: Be cognizant of the limitations and scope of the
proposed research. Do not promise practical implications that
are beyond the scope of the research.
The information gathered from the literature will help providers
conduct important financial literacy training for domestic
violence victims. These providers, specifically at The Haven,
will be in a better place to help the victims of sexual assault and
domestic violence. The Haven foundation aims at the treatme nt
and prevention of sexual assault and domestic violence.
The mutual support from the wider community has helped the
foundation be a success. With the support of the wider
community, the victims feel comfortable having access to the
support needed for their recovery. The practitioners in The
Haven counselling program benefit from a training program, as
they can serve individuals of all ages who have experienced
sexual assault and domestic violence (The Haven, n.d.). The
councilors need the information to address the safety concerns
and needs of sexual assault and domestic violence survivors.
The research will make it easier for the counseling clients to be
identified and assisted referral for health and financial
assistance, personal protection orders, and housing resources.
Victims of domestic violence often make several attempts to
leave an abusive partner and are forced to return for economic
reasons (Shackelford, 2020). Economic self-sufficiency is
frequently the difference between violence and safety for many
victims. Yet financial literacy training can improve survivors’

long-term outcomes (Warren et al., 2019). Domestic violence
advocates must be prepared to address many of the economic
issues that victims face and facilitate opportunities for victims
to learn how they can improve their economic situation. A
financial literacy training program may help most with the
issues of economic control (i.e., controlling access to financial
knowledge) and economic exploitation (i.e., perpetrator
destroys victims’ financial resources or credit) (Stylianou,
2018). Issues such as budgeting, identity theft, banking,
predatory lending, violence in the workplace, housing, and
credit, all play a role in ending domestic violence (NCDAV,
n.d.). In addition, research shows that the resource loss
experienced by IPV victims mediates the relationship between
psychological abuse and mental health (Sauber & O’Brien,
2020), indicating that financial literacy and subsequent
economic success may help alleviate victims’ poor mental
health outcomes.
The people who benefit most from these implications are the
individuals from the community of interest who have been
enrolled in the program. The practitioners are considered the
employees of The Haven, caseworkers, social workers, intake
coordinators, and others. The victims and their families will
benefit because they will be able to manage their finances.
Financial literacy gives the ability to be able to effectively cater
for their expenses in addition to being able to afford housing
stability (). The wider community would be the landlords and
the other people in the community who help with the housing
needs. When financial literacy is best understood by the victims
and their families, they would be on the right path to financial
freedom addition, The Haven has also a residential program that
is exclusively for sexual assault and domestic violence victims
and their children (Shackelford, 2020). Comment by Muse,
Andrea: Is there a citation missing?
Recognizing that a lack of financial stability is one of the
biggest deterrents for women who are considering leaving an
abusive relationship, the Kentucky Domestic Violence

Association (KDVA) formed its Economic Justice Project in the
early 2000s. The program has domestic violence shelters. It is
committed to providing community domestic violence services.
Their purpose is to offer mutual support to the victims of
domestic violence that would collectively advocate for the
victims and their children. Through a network of member
organizations, the Economic Justice Project offers Individual
Development Accounts, free tax preparation, financial
education, and other asset-building services to survivors of
domestic violence (Economic Justice Project, 2021) The
survivors of domestic violence are taught how to effectively
manage their finances. The Haven continues to connect with the
community through engagement, advocacy, and education to
ensure that the survivors are in a better position to support
themselves.
Section 3. Research Theory
3.1 Purpose of the Study
State the purpose of the study. The purpose of the study is to
answer the research question or provide practical answers to a
problem or weaknesses of the current practice, service, or
process, policy.
· A summary of the intended outcomes of the study.
· An identification of who can benefit from this research and
how they might benefit.
· A statement of the purpose of the study and the need that it
addresses.
· A statement about the outcomes or findings of the Capstone
Project and how they will be sustained.

The purpose of the training program is to create economic
empowerment. People that can benefit from this training
program are the victims and survivors of sexual assault and
domestic violence. The emphasis is on empowerment from
survivors and the staff (Finley, 2016). The program saves lives
and continues to provide support and help them to move forward
and have better lives. The purpose is to make as many people as
possible know and benefit from the program. The training
program helps the victims to have financial literacy that would
make them be able to manage their finance and manage their
expenses (McOrmond-Plummer et al., 2016). The training
program will offer critical support and services. Human services
personnel stand in solidarity to eradicate sexual assault and
domestic violence (Ngo & Puente Moncayo, 2021). The people
who benefit most from these implications are the individual
victims of domestic violence who are enrolled in the program at
The Haven. The practitioners are considered the employees of
The Haven, and such practitioners can include caseworkers,
social workers, intake coordinators, and others (Sanders, 2013).
The victims and their families will benefit because they will be
able to manage their finances. Financial literacy helps people to
effectively care for their expenses, in addition to being able to
afford to house (Fan, 2019).
3.2 Research Question(s)
List the primary research question and any sub-questions that
the proposed study will address. The research question(s)
should be correctly formed.
This section should include a research question(s) or sub-

questions that:
· Align with the research problem, the research topic, and the
Capstone title.
· Identify the intended analysis.
· Is phrased in a way that will be answered by the intended
methodology and analyses.
· Identify the specific variables to be explored, use language
consistent with the research design or approach, and identify the
population being studied.
Qualitative Example: How can DHS caseworkers help the
homeless population become self-sufficient?
Quantitative Example: How does employee morale in millennial
research analysts affect creativity?Use current (within 5-7
years), scholarly, PRIMARY resources to support statements.
Textbooks are not primary resources. Theses and dissertations
are not considered peer-reviewed published articles. Use APA
style in citing all resources.
What parts of financial literacy do domestic violence victims
need help within a training protocol?
What are the best means of providing that financial literacy
training to domestic violence victims?
3.3 Capstone Project TitleThe Capstone Project Title should be
correctly formed:· The title should be aligned with the Research
Problem (1.2) and Research Question (2.2), (use the same
terminology for all).· The title should reflect the key variables
or constructs to be studied.· The title should reflect the method
to be employed in the research.· The title should be concise (12
words or less).
Financial Literacy Training: Rebuilding Financially After
Domestic Violence

Section 4. Research Methodology
4.1 Summary of methodology
Briefly describe the Capstone Project research design.
· A description of the methodology (qualitative or quantitative).
· A description of the design (case study, generic qualitative,
correlation, etc.).
· A description of the type of action research (participatory
action, critical action research, action science research, or
appreciative inquiry).
· A description of what data will be collected (validated
instruments, interviews, archival data, organization policies,
and procedures, etc.).
· A description of data analysis that will be used (thematic
analysis, descriptive statistics, inferential statisti cs).
No data will be collected. This is a service project providing a
training program material. For this project, the information will
be collected from The Haven staff and the literature. There will
not be an empirical study; thus, there will be no qualitative or
quantitative methodology. All information received will come
staffing, personnel, the mission statement, the trainer, and
trainees after the training has been provided. All information
will be kept confidential. Comment by Muse, Andrea: An
overview of your training would be helpful: format, materials,
duration, etc.
4.2a Quantitative Measures and Instruments
List and describe each variable and the data collection
instrument or measurement tool you will use to collect these
data. These should include standardized questionnaires,
demographic data, and surveys, etc. See Appendix A for an
example of a completed chart. Only standardized instruments
can be used in quantitative studies.

Attach a copy of each instrument you plan to use as an appendix
to the Capstone research form.
Variable Type
Variable Name
Survey/Questions/ Calculations
Variable Level of Measurement
Instrument Name
Reliability Estimates

*Insert more rows as needed
There are no quantitative instruments for this service project, as
this is not study.
4.2b Qualitative Constructs and Interview Guide
List and describe each qualitative construct and the data
collection method you will use to collect these data. Include the
alignment of the data collection source with the concept. See
Appendix B for an example of a completed chart.
Attach a copy of the interview guide you plan to use
as an appendix to the Research Plan.
Data Source
Specific Data Source
Constructs of Interest
Specific Interview Question
Interview
Interviews with Staff Members
Financial Literacy
Domestic Violence

*Insert more rows as needed
No qualitative interview questions. There are constructs
involved in the development of this service project, but are not
attached to any interview questions.
*4.3 Field Tests
Only complete if the research study is greater than minimal risk.
Field tests must be completed for qualitative interview
questions if the study is greater than minimal risk.
According to 45 CFR 46.102(i), minimal risk means, "The
probability and magnitude of harm or discomfort anticipated in
the research are not greater in and of themselves than those
ordinarily encountered in daily life or during the performance of
routine physical or psychological examinations or tests."
If you are unclear about the nature of the study, please consult
with the Research Chair or Capella’s IRB. IRB approval is not
required before a field test is conducted. The results of the
field test should be submitted as part of the IRB application
once the DPP is approved. Field test experts should be
practitioners in the field that are knowledgeable about the topic.
You may use a Capella faculty who has a relevant background.
· A list of the original interview questions (before the field
test).
· A rationale for each original interview question that explains
how the question will provide answers to the specific research
question.

· The identification of field test experts (name and credentials).
· A description of the suggestions, comments, or
recommendations from the field test experts.
· A list of the final, updated interview questions.
N/A; There is no field test, because there is no study or
interview questions. Therefore there are no participants to be at
risk.
4.4 Data Analysis
Detail the actual data analyses to be conducted to address each
research question.
For each research question and sub-question provide the
following:
· A description of the data source.
· A description of how raw data will be analyzed (transcription,
calculation of scaled variables, etc.).
· A description of how data will be managed, processed, and
prepared.
· The method of qualitative analysis or statistical analysis.
· A description of how data will be stored and protected.
1. Looking in ProQuest, PsycINFO, etc. I will also look at
federal, state, and local governmental agencies like the U.S.
Department of the Treasury’s Financial Literacy and Education
Commission (FLEC, n.d.). Nonprofit entities such as the
National Endowment for Financial Education (NEFE, n.d.) will
also be examined for professional, scholarly, and governmental
information.
2. Here’s a list of questions I will ask as I read each source:
a. Did they identify any best practices?
b. What were their training recommendations? Did they test any

training materials?
c. How well did each source look at subgroups of gender, race,
sexuality, etc.?
3. I will keep track of information by using a synthesis matrix
to review content across multiple sources to identify
commonalities and differences between source information.
4.5 Sample Size
For each data source, describe the sample size, and provide
references to support sample size decisions.
For financial literacy, the terms that I would search for would
be credit report, credit score, assets, bankruptcy, domestic
violence, and financial hardships.
4.6 Assumptions
Identify the key (A) theoretical, (B) topical, and (C)
methodological assumptions of the Capstone Project.
A. A description of the theoretical assumptions will include the
fundamental constructs of the theoretical foundation that you
selected in Section 2.3.
B. A description of the topical assumptions will include the
assumptions revealed from previous research, the literature on
the topic, and assumptions made by researchers in the field.
C. A description of the methodological assumptions will include
an explanation of the epistemological, ontological, and
axiological philosophical assumptions that support the research
methodology.
A. Theoretical assumptions
The theoretical assumption of economic empowerment

theory is that disempowerment is created through structural
oppression, powerlessness, and marginalization through
structural oppression and economic privation (Brenton, 1994;
Gutierrez & Nurius, 1994; Hasenfeld, 1987). The theory aims to
reduce the powerlessness that has been created for the
oppressed and the vulnerable. The other assumptions that are
controversial are that economic empowerment promotes
individualism and that it is a source of unmitigated competition
which may bring conflicts among those that have been
empowered (Wilkinson, 1998).
B. Topical assumptions
The assumption is that women have less financial literacy
than men. Most of the victims of domestic violence are women.
The other assumption is that the survivors will be helped, and
they will have financial literacy that enables them to budget and
manage their finances to cater to their expenses and housing.
The training may not be able to help survivors overcome
structural barriers, such as sexism and racism that disempower
women.
C. Methodological Assumptions
The assumption is that the social reality exists
independently of human interpretation and understanding. There
is an external reality that is independent of what one may
understand or think. The Haven staff or volunteers who would
conduct the training may understand and things differently from
external reality. Thus, all training materials will include
detailed instructions. The other assumption is that reality can
only be understood through the human mind. Ontology deals
with existing things while epistemology deals with what can be
known and how it can be known. One assumption is that the
women who take part in this training are able to retain the
knowledge and are able to practice these financial literacy
skills.
4.7 Limitations
Evaluate the weaknesses of the Capstone Project at this time.

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