Medicine and Health Sciences Commons^™

Faith Influences On Health Of Rural Appalachian Older Adults In East Tennessee: An Ethnonursing Study, Karina Elizabeth Strange

Doctoral Dissertations

As the U.S. older adult population increases and diversifies, healthcare providers need innovative, cost-effective, and culturally congruent approaches to gerontological nursing care. Decades of multidisciplinary evidence demonstrate that spirituality enhances older adult holistic health. However, although research about spirituality and nursing has become more culturally diverse, little is known about spirituality-health linkages of rural Appalachian older adults (RAOAs). This knowledge gap is significant because Appalachia leads the country in mortality related to chronic comorbidities such as heart disease, cancer, and depression. Given age, poverty, limited transportation, and health provider shortage areas, RAOAs experience severe health disparities. Moreover, spirituality is an …

Addressing Interprofessional Competence In Interpretation Of Electronic Fetal Monitor Tracings, Susan H. Hébert

Doctoral Dissertations

Interpretation of electronic fetal monitor (EFM) tracings is a critical clinical practice skill nurses and physicians perform during the intrapartum stage of pregnancy. However, if performed inaccurately can potentially jeopardize the well-being of the neonate. This risk is present because if concerning EFM tracings are not interpreted accurately, preventative care interventions to promote the well-being of the unborn child do not occur. The project was initiated by completing a scoping literature review on the methods for training and evaluating EFM interpretation competence, which revealed current EFM interpretation training and evaluation methods are lacking. A concept analysis defined nurse competence in …

The Lived Experience Of Losing Employment After Diagnosis With Dementia: A Phenomenological Analysis, Susan K. Blaine

Doctoral Dissertations

The purpose of this study was describing the experiences of people with dementia (PWD) who lose their employment after diagnosis with dementia, but sooner than originally planned. A phenomenological approach based on tenets of Maurice Merleau-Ponty was used. Six telephone interviews were conducted, with participants sharing their experiences. Transcripts were transcribed verbatim, and subsequently analyzed via a hermeneutical analysis approach. Themes were identified within and between transcripts, considering the contextual grounds of Merleau-Ponty’s phenomenology: body, others, time, and world, and the contextual ground of participants’ experience: the stigma of dementia. An overarching, central theme of “still working” was identified across …

The Psychosocial Experiences Of African American Sexual And Gender Minority Caregivers Of People With Dementia, Lakeva Harris

Doctoral Dissertations

Over 50 million people in the United States provide unpaid care to a family member or friend. One-third of these caregivers (16 million) provide care to someone with Alzheimer’s disease and related dementias (ADRD). Of these caregivers, more than 20% state caregiving has led to a decline in their health. African American caregivers are less likely to report being in very good or better health than their white caregiving peers. Similarly, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) caregivers are more likely to report fair or poor health than their heterosexual, cisgender peers. The overlap of these minoritized identities may …

Psychosocial Effects Of Providing Nursing Care To Patients From A Multi-Casualty, School-Associated Shooting Event, William Travis Mccall

Doctoral Dissertations

Secondary traumatic stress describes symptoms consistent with post-traumatic stress disorder but that result from witnessing or experiencing the trauma of another individual through a helping relationship. The associated symptoms include intrusions, avoidance, and hyperarousal. Secondary traumatic stress is also associated with the development of compassion fatigue and burnout. The current state of the science identifies that secondary traumatic stress may affect those nurses who provide care to critically ill or injured patients. Research has most commonly examined the prevalence of secondary traumatic stress, compassion fatigue, and burnout among nurses in emergency department settings. While attention is frequently given to the …

Cultural Influences Related To Childhood Obesity In Burmese Children And Adolescents In The Southeast United States, Rebecca Elizabeth Chatham

Doctoral Dissertations

Abstract

Childhood obesity is an unrelenting public health problem disproportionately affecting racial and ethnic minorities. There are multiple, complex factors related to the prevalence of childhood obesity from genetics to behavior to environment. Although ethnic minorities are disproportionately affected by childhood obesity and have a variety of cultural identities, research rarely examines cultural factors. In addition, qualitative research into childhood obesity rarely seeks the perspectives of children. This research study sought to address these gaps by interviewing children from an ethnic minority. The purpose of this study was to discover cultural influences that contribute to or prevent childhood obesity from …

Fall Risk Factors Among Hospitalized Older Adults With Alzheimer’S Disease And Related Dementias, Jean Bettencourtt Sconza

Doctoral Dissertations

Falls are a common and devastating complication of hospital admission for older adults. Falls are especially significant for those with Alzheimer’s Disease and related dementias (ADRD) as they are at high risk to fall and to suffer injuries from falling. Despite the large body of research on falls in hospitals, less is known about fall risk factors among patients with ADRD. The purpose of this retrospective case-control study was to determine which risk factors are predictors of falls among hospitalized older adults with Alzheimer’s disease and related dementias (ADRD) by comparing those who fell with those who did not fall. …

The Lived Resettlement Experience For Single Refugee Mothers From The Democratic Republic Of Congo, Lauren Michelle Mefford

Doctoral Dissertations

At least 72% of the 50,000 Congolese refugees resettled in the USA in the last 5 years are women and children. Many are single refugee mothers (SRM) disadvantaged by obstacles (i.e., childcare) that hinder them from becoming self-sufficient within the required timeframe post-resettlement. Published research on resettlement has focused general challenges, but an understanding of the unique needs and perspectives of SRMs is lacking. This phenomenological, qualitative study provides insight into the lived resettlement experience for SRMs from the Democratic of Congo (DRC). Participants (n=7) were recruited from a refugee resettlement agency in East Tennessee and partook in open-ended, unstructured …

Do Personal Factors And Interpersonal Influences Affect Commitment To A Plan Of Action For Physical Activity Among African-American Women?, Bobbie W. Brown

Doctoral Dissertations

The lack of physical activity (PA) among African American (AA) women is a predisposition to chronic diseases associated with obesity. Women, particularly AA women, who are between 35 and 60 years of age, are particularly noted to be at highest risk for developing obesity-related chronic diseases. Few PA studies have included AA women older than 25 years of age and younger than 65 years of age (Carter-Parker, Edwards, & McCleary-Jones, 2012).

All analyses were conducted using SPSS Version 21 (Armonk, NY: IBM Corporation) and statistical significance was assumed at an alpha value of .05. The assumption of normality for continuous …

Rural Appalachian Person And Family Decision Making At End Of Life, Mary Lou Clark Fornehed

Doctoral Dissertations

The dynamics of delivering care to persons at end of life (EOL) have dramatically changed in the last twenty years. Improved management of chronic illness and provision of aggressive life sustaining measures for an illness once deemed fatal are more common, significantly increasing longevity. While it is estimated that more than 40 million persons with life-limiting illness worldwide are candidates for some form of palliative or end-of-life care (EOLC), less than 14% of them will receive it.

When coping with life-limiting illness, people and their families are asked to make many complex and difficult decisions about EOL, palliative, or hospice …

A Grounded Theory Inquiry Into Crying In Women Dealing With The Emotional Stress Of Personal Crisis, Mary Bess Griffith

Doctoral Dissertations

The belief that crying leads to healing is so widely held and of such longstanding that many healthcare professionals—including nurses, physicians, psychiatrists, and psychologists—accept it as fact even though there is little substantiating scientific evidence. Crying is commonly believed to be an essential factor in restoring mind-body equilibrium after physical and/or emotional trauma has been experienced. If, as has been hypothesized by many scientists and healthcare practitioners, emotional crying is a biopsychosocial healing modality, then specifics of its therapeutic praxis, including limitations and ambiguities, should be incorporated into nursing education and practice. In this grounded theory study, the meaning and …

The Effects Of Motivational Interviewing On Heart Failure Self-Care During Transitional Care In An Appalachian Population, Jennifer Lynn Mabry

Doctoral Dissertations

Research has shown that patients who are successfully engaged in self-care for a chronic illness have a higher quality of life and reduced hospitalizations than those who are not. According to the National Center for Health Statistics, transitional care in the home setting has seen a 51% increase in mortality over the last 15 years (Reeder et al., 2015). This finding contrasts with the reported decline in hospital readmissions for chronic illnesses. With the lack of agreement on best practices for patient discharge education, transitional care has proven to be a weakness in chronic illness care that requires further research. …

“You Came To Not Normal Land”: Nurses' Experience Of The Environment Of Disaster: A Phenomenological Investigation, Stasia Elizabeth Ruskie

Doctoral Dissertations

Previous research suggests US nurses are unprepared for disaster, and suffer from adverse psychosocial outcomes following their disaster response. Current disaster preparedness focuses on providing hospital-centric trauma and acute care in fully resourced Western conditions, and does not include the environmental realities of the disaster setting. This study utilized an existential phenomenological approach to explore the meaning of the nurse’s experience of the disaster environment. Eleven nurses with broad disaster expertise and training levels participated in this research. The essence of their disaster experiences can be summed up by the central theme of “You came to not normal land.” Four …

Examining The Relationships Between Gratitude And Readiness For Self-Directed Learning In Undergraduate Nursing Students, Kellee Renee Vess

Doctoral Dissertations

The purpose of this study was to explore the relationships between gratitude and readiness for self-directed learning among nursing students enrolled in a four-year baccalaureate nursing program. For this study a sample of 59 nursing students were selected from a four-year baccalaureate nursing program, situated in a private, faith-based college in the Southeast United States. During data collection, participants were asked to complete the Gratitude 6-item questionnaire [GQ-], the 40-item Self-Directed Learning Readiness Scale for Nursing Education [SDLRS-NE], and two demographic questions (i.e., age and class rank). Using both parametric and nonparametric statistics, this study examined eight research questions, and …

Experiences Of Newly Licensed Registered Nurses Who Stay In Their First Jobs, Lisa D. Kirkland

Doctoral Dissertations

Most newly licensed registered nurses go to work in acute care hospitals, which means they enter an increasingly complex healthcare environment where they experience staffing shortages, high nurse-patient ratios, and workplace violence. The purpose of this study is to attempt to understand the experiences of newly licensed registered nurses who have endured the early years of bedside hospital nursing and continue to work in their first nursing job. The existential phenomenological philosophy of Merleau-Ponty serves as the guiding framework for this qualitative research study. Following IRB approval, criterion and snowball sampling were used to recruit newly licensed registered nurses who …

Developing An Optimal Model For Infant Home Visitation, Isaac Atuahene

Doctoral Dissertations

The United States, Great Britain, Denmark, Canada and many other countries have accepted home visitation (HV) as a promising strategy for interventions for infants after births and for their mothers. Prior HV studies have focused on theoretical foundations, evaluations of programs, cost/benefit analysis and cost estimation by using hospital/payer/insurance data to prove its effectiveness and high cost. As governments and private organizations continue to fund HVs, it is an opportune time to develop and formulate operations research (OR) models of HV coverage, quality and cost so they might be used in program implementation as done for adult home healthcare (HHC) …

Newly Licensed Registered Nurses' Experiences With Clinical Simulation, Carrie Ann Bailey

Doctoral Dissertations

The purpose of this study was to understand how new graduate nurses perceive the value of simulation in making the transition into professional practice. This study will use a descriptive qualitative approach with a sample of first year nurses. Kolb’s Experiential Learning Model serves as this study’s conceptual framework. For the current study, the sample consisted of 10 newly graduated, female nurses with less than one year of experience working in the hospital setting were interviewed. Data analysis included interviews and transcription by the researcher. Finally, participants were asked about themes to increase rigor. Four themes emerged from this research: …

Exploring Holistic Comfort In Children Who Experience A Clinical Venipuncture Procedure, April Athena Bice

Doctoral Dissertations

Children often experience the uncomfortable effects of invasive procedures as a part of primary health supervision and during times of illness. Inadequate procedural comfort management can lead to numerous lasting harmful effects including distrust of healthcare providers, future intensified pain responses, negative cognitive and emotional experiences, and psychosocial health problems (Czarnecki et al. 2011). Holistic comfort has been well documented in adult literature but little research exists on the understanding of holistic procedural comfort from the child’s perspective. The purpose of this study was to explore perspectives of children age 4 to 7 years and their caregivers regarding procedural holistic …

Living With Hypertension: Experiences Of Black Men Related To Their Perceptions Of The Clinical Encounter At Diagnosis, Glenda Mccartney Feild

Doctoral Dissertations

Introduction: In the U.S., hypertension (HTN) is the most common primary diagnosis and HTN related illnesses are the number one cause of death. Being a member of the Black population increases the risk for developing HTN. Black males are reported to develop HTN earlier in life and have a high incidence of undiagnosed, untreated, and uncontrolled HTN. Sociocultural and gender barriers influence this population’s perceptions of medical experiences, which affects their participation in health-promoting behaviors such as eating a healthy diet, engaging in regular physical activity, avoiding tobacco, limiting alcohol consumption, and decreasing stress.

Purpose: The purpose of this study …

"I Saved The Iguana": A Mixed Methods Study Examining Responder Mental Health After Major Disasters And Humanitarian Relief Events, Suzanne Marie Boswell

Doctoral Dissertations

The purpose of this mixed methods study was twofold. The first was to use Hobfoll’s (1989) Conservation of Resources theory to predict psychological stress based on responders’ perceptions of resource adequacy. The second was to use qualitative interviewing to gain a more comprehensive understanding of the disaster/humanitarian responder experience.

The study is significant given the expanding role of nurses within disaster/humanitarian response organizations. Furthermore, psychological stress results in increased turnover of human resources in these organizations. This turnover is detrimental to humanitarian systems that already lack adequate coverage and sufficiency because funding and human/material resources grow at a slower pace …

Exploring Perceptions Of Staff Registered Nurse Preceptors For Undergraduate, Pre-Licensure Nursing Students, Katherine C. Hall

Doctoral Dissertations

Staff nurses are increasingly called upon to accept more responsibilities and roles in addition to provider of patient care, including that of preceptor. Aside from dealing with demands of high acuity patients, working long hours with inadequate staffing, and carrying heavy workloads, nurses may view teaching and supervising students as an additional burden, time-consuming, and not part of their role. The purpose of this dissertation was to explore staff nurse experiences as preceptors to undergraduate, pre-licensure nursing students. Emphasis was placed on exploring RN’s perceptions of the role, specifically the preparation for, support in, and understanding of what the role …

Discovery Of The Meanings, Expressions, And Practices Related To Malaria Care Among The Maasai, Cecily Weller Strang

Doctoral Dissertations

Each year, malaria invades and infects 300 million persons, kills up to 1 million, and 90% of deaths are among children in Sub-Saharan Africa. Malaria illness and deaths cost Africa $12 billion in lost productivity. Eighty percent of all malaria cases occur in 17 African countries; one is Kenya, where one group suffers incessantly from malaria, the Maasai. Their pastoral, indigenous lifestyle places the Maasai men, women, and children daily at malaria risk. Although malaria is preventable and treatable, high mortality and morbidity occurrence continues. Global interest in malaria care includes prevention, treatment, and eradication. The current use of generic …

Exploring Neonatal Intensive Care Nurses’ Affective Responses To Providing End-Of-Life Care, Stephanie Lynn Lewis

Doctoral Dissertations

Significance. The Joint Commission established standards to evaluate comprehensive end-of-life infant care and the positive outcomes of such care are well documented. However, findings from multiple studies conducted over the last decade indicate that end-of-life care in the neonatal intensive care unit is not provided consistently or holistically to all dying infants. Because nurses are the healthcare professionals most often responsible for providing this care, anything that detracts from their ability to provide it, including their own affective responses, needs to be addressed.

Aim. The purpose of this study was to explore—through lived and told stories—the affective, interactional, and …

Living With The Choice: A Grounded Theory Of Iraqi Refugee Resettlement To The U.S., Lisa Ann Davenport

Doctoral Dissertations

Though the United States has become a place of increasing resettlement for refugees, particularly Iraqi refugees who have been forced to flee their homeland due to violence, persecution and civil unrest, little is known about Iraqi refugee resettlement in the United States, or the way in which resettlement impacts health and adjustment. A grounded theory study was conducted to develop a substantive theory of Iraqi refugee resettlement. Participants in the qualitative study included 29 Iraqi refugees and 2 community partners who participated in face-to face interviews. Data analysis and interpretation revealed fundamental concepts related to Iraqi refugee resettlement. Results of …

The Lived Experience Of Transitioning From The Foster Care System To Adulthood, Carla Renee Parker

Doctoral Dissertations

Approximately 408,000 children were in foster care in the United States at the end of fiscal year 2010 (U.S. Department of Health and Human Services, 2012). Some children return to their families of origin; however, some children remain in the foster care system until they reach age 18 or 21 and must leave, which is called “emancipation” or “aging out” (U.S. Department of Health and Human Services, 2012). Transitioning foster youth are at risk for many negative consequences including poverty and homelessness. These negative consequences are associated with significant health implications, such as mental health problems and risky sexual behaviors. …

Enhancing Critical Thinking Disposition And Clinical Judgment Skills In Senior Bsn Students Via Electronic Interactive Simulation, Deborah Lynne Weatherspoon

Doctoral Dissertations

Problem
The problem investigated in this study was the lack of empirical evidence available regarding the effectiveness of electronic interactive simulation (EIS) for developing critical thinking disposition and clinical judgment skills in the senior baccalaureate nursing student.

Aim
The aim of this study was to identify an effective method of experiential learning simulation that may be independently accessed by the learner with a goal of enhancing critical thinking disposition and clinical judgment skills of senior baccalaureate student nurses (BSN).

Purpose
The purpose of this experimental study was to compare the effects of EIS to traditional paper case studies on the …

Generational Differences In Empowerment, Professional Practice Environment, Incivility, Authentic Leadership, Job Satisfaction, Engagement And Intent To Leave In Acute Care Nurses, Lisa Marie Haddad

Doctoral Dissertations

Aim. The aim of this study was to examine generational differences among acute care nurses on empowerment, professional practice, authentic leadership, incivility, job satisfaction, engagement and intent to leave the current job.

Background. Empowerment in nursing is a well-studied subject. Perceptions of professional practice environments, authentic leadership and incivility are related to empowerment. An increase in empowerment has been linked to job satisfaction and the likelihood of leaving one’s job or the profession. The nursing shortage forces attention to job satisfaction and keeping the professionals we currently have in the profession. Generational differences exist within different cohorts of nurses and …

“I’Ve Accomplished Something Here” The Lived Experience Of Employed Breastfeeding Mothers: A Phenomenological Analysis, Jennifer Diane Stewart-Glenn

Doctoral Dissertations

Abstract

The purpose of this study was to describe the experience of employed breastfeeding mothers. Using a phenomenological approach based on the works of Merleau-Ponty, the researcher completed 13 interviews in which mothers with experience working full-time while breastfeeding were asked to describe their experiences. The interviews were transcribed verbatim and analyzed using a hermeneutical approach developed by Pollio and applied to nursing research by Thomas. Each interview was examined within the context of all the interviews to identify themes found throughout.

While participants’ experiences were grounded in the unsupportive world of the workplace, aspects of their experience became figural …

How Do Psychiatric Healthcare Workers Prevent The Use Of Restraint And Seclusion?, Kelly A. Carlson

Doctoral Dissertations

The purpose of this grounded theory method study was to understand the complex, interactive, and interrelated processes that psychiatric healthcare workers engage in to prevent the use of restraint and seclusion. Without supporting evidence of therapeutic validity, restraint and seclusion are commonly used by psychiatric healthcare workers to control disruptive patients. The Substance Abuse and Mental Health Services Administration issued a call for the elimination of restraint and seclusion use in psychiatric care settings in 2003. Workplace violence, another major public health concern, is both a cause and effect of the restraint and seclusion use. Individuals continue to be needlessly …

It Transforms All Of You: Lived Experiences Of Partners Of Iraq Combat Veterans With Traumatic Brain Injuries, Laurel Sue Cassidy

Doctoral Dissertations

Just over two million service men and women have been deployed to the wars in Iraq and Afghanistan over the past ten years. Conservative estimates suggest that nearly one fifth of those deployed sustain a blast induced mild traumatic brain injury (TBI). Nearly half of those in the service are married, meaning a large number of spouses unexpectedly find themselves navigating a “new normal” after their partner returns from combat with ongoing sequelae from a TBI.

Ultimately, a sizeable number of spouses of Iraq combat veterans with TBIs have found themselves in the role of caregiver. The large majority of …