Medicine and Health Sciences Commons^™

Social Determinants Of Health And Disparities In Outcomes Related To Cardiovascular Health In Vulnerable Populations, Jennifer L. Miller

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the mechanism of association between social determinants of health (SDH), particularly limited health literacy, and disparate outcomes related to cardiovascular disease in vulnerable populations. Specific aims were to 1) compare quality of life (QOL), anxiety, and depressive symptoms between genders in implantable cardioverter defibrillator (ICD) recipients; 2) examine the association between multi-morbidity burden and QOL; 3) determine whether health literacy levels independently predict CVD risk in the male prison population; 4) examine the relationship between health literacy and decisiveness regarding end of life (EOL) choices, and 5) examine SDH as predictors of …

Factors Influencing Preference For Surgical Choice Among Women With Early Stage Breast Cancer, Susan G. Yackzan

Theses and Dissertations--Nursing

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among …

Examining Biological And Psychological Variables In Hypertensive Disorders Of Pregnancy, Stephanie A. Kehler

Theses and Dissertations--Nursing

Despite advances in obstetric care, hypertensive disorders continue to complicate pregnancies at a high rate. Worldwide, hypertensive disorders affect up to 10% of pregnancies. The United States has seen a 25% increase in the incidence of hypertensive disorders over the last two decades (American College of Obstetricians and Gynecologists, 2017). These complications constitute one of the greatest causes of maternal and perinatal morbidity and mortality with an estimated 50,000 to 60,000 deaths per year across the world (American College of Obstetricians and Gynecologists, 2017). Although the etiology of hypertensive disorders remains unclear, there may be an association with both maternal …

Determinants Of Pap Screening Among Sub-Saharan African Immigrant Women, Adebola Olamide Adegboyega

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the determinants of Pap screening completion among sub-Saharan African immigrant women. Cervical cancer is a public health problem globally. The risk of invasive cervical cancer remains high among sub- Saharan African immigrant women in the US despite being a preventable cancer. Early detection through Pap screening is crucial for prevention, treatment and prognosis. The specific aims of this dissertation were to 1) examine Pap screening practices among African immigrant women and to identify gaps to guide future research; 2) explore barriers and motivators that influence Pap screening decisions among African immigrant women; …

An Examination Of Maternal Stress And Secondhand Smoke Exposure On Perinatal Smoking Status, Karen R. Damron

Theses and Dissertations--Nursing

The median prevalence of smoking among women of childbearing age in the United States is 22.4%. Of women who identify themselves as smokers in the three months prior to conception, 55% quit during pregnancy; however, 40% of those who quit relapse and return to smoking within six months after delivery. Smoking has been identified as an important means of stress management among smokers in general, and though limited to the perinatal period, pregnancy-specific stress adds to a woman’s typical day-to-day stress burden. Little data exists as to the effect of SHS exposure on smoking status during pregnancy and the impact …

Hearts In The Balance: The Impact Of Desired Versus Received Social Support Needs On Persons With Heart Failure, Melanie P. Schrader

Theses and Dissertations--Nursing

Social support is the collection of tangible and intangible experiences that surround people as they cope with daily stressors. High quality social support is important among patients with cardiovascular disease (CVD) because it has positive effects on social, psychological and physical well-being, and those with good social support cope better with the travails of CVD. Although there are many studies of social support in CVD, little work has been done on the topic of discrepancies between desired and received social support in the context of gender.

The purpose of this dissertation was to determine if there are gender differences in …

The Relationship Of Social Support In Self-Care, Depressive Symptoms, And Quality Of Life Outcomes In Patients With Heart Failure, Shannon C. Shumaker

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate outcomes associated with social support in patients with heart failure and their caregivers. Specific aims were to: 1) examine the association of depressive symptoms with self-care in patients with HF; 2) evaluate the psychometrics properties of the Multidimensional Scale of Perceived Social Support (MSPSS) instrument as a measure of perceived social support in patients with heart failure; and 3) determine whether patient and caregiver perception of relationship quality measured at baseline upon enrollment predicted quality of life at baseline in both patient and caregiver using a multilevel dyadic analysis in patient and …

Effects Of Obesity On United States Farmers: A Pilot Study, Sharon C. Hunsucker

Theses and Dissertations--Nursing

Previous research described the value farmers place on their ability to work. The impact of obesity on workers is an increasing concern in occupational health research; yet, knowledge regarding the impact of obesity on the performance of farm work is limited. Identifying the impact of obesity on farmer’s work ability can guide healthcare workers in promoting and motivating farmers to implement lifestyle changes to improve health and sustain longevity in their ability to work.

The purpose of this dissertation was to examine the impact of obesity on the work ability of U.S. farmers. Specific aims were to 1) examine the …

Identification Of Early Markers Of Occult Tissue Hypoperfusion In Patients With Multiple Trauma Injuries, Kathryn M. Moore

Theses and Dissertations--Nursing

Injury is a global health problem and in the United States is the leading cause of death for persons aged 1 – 44 years. The primary causes of trauma related death are head injury and hemorrhage; hemorrhagic shock is difficult to recognize in the first hours after trauma. Identification of specific and optimal criteria upon which to base effective triage decisions for trauma patients has been an elusive goal for decades.

The purpose of this dissertation was to identify measures available in the prehospital phase of care and in the Emergency Department that should be included for a more comprehensive …

Competitive Food Policy Implementation In Kentucky Schools, Paula Gisler

Theses and Dissertations--Nursing

This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of …

Co-Morbid Symptoms Of Depression And Anxiety And Bio-Behavioral Response To Stress In Patients With Heart Failure, Abdullah S. Alhurani

Theses and Dissertations--Nursing

Heart failure (HF) is a major public health problem throughout the world. It accounts for one death certificate among nine in the United States. Heart failure and sudden death combined are responsible for the largest number of deaths in America. The total costs of HF in the United States are estimated to be $37 billion each year. Despite substantial medical and surgical advances related to treatment of HF, it remains a very costly condition with high mortality and morbidity rates. Although biological factors contribute to high morbidity and mortality in HF, there are many unexplored psychosocial factors that also likely …

Psychological Distress And Cardiac Disease, Tracey Vitori

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications …

Biobehavioral Influences Of Anxiety, Depression, And Hostility Symptoms On Health-Related Outcomes In Patients With Heart Failure, Lynn P. Roser

Theses and Dissertations--Nursing

The incidence of heart failure (HF) has increased each year as more people are living longer with heart disease and other chronic conditions. Recently, there has been much interest in the psychological dimensions of HF and the influence psychological symptoms have on the health outcomes (e.g., self-care, rehospitalization, mortality and quality of life) of patients living with HF. Patients with HF frequently experience symptoms of anxiety, depression, and hostility that may be associated with poor health outcomes. The purpose of this dissertation was to examine how psychological variables influence health outcomes of patients with HF, how psychological variables change over …

A Randomized Controlled Trial Of Anesthesia Guided By Bis Vs. Standard Care And Effects On Cognition, Zohn Centimole

Theses and Dissertations--Nursing

Postoperative cognitive dysfunction (POCD) occurs frequently in individuals undergoing major surgery with general anesthesia. POCD adversely affects morbidity and health-related quality of life. Derived electroencephalographic (EEG) monitoring is utilized to guide the anesthesia provider in titration of volatile anesthetics. POCD has been associated volatile anesthetic neurotoxicity. EEG monitors are known to reduce a patient’s total cumulative dose exposure to volatile anesthetics. There is currently little evidence to support utilization of EEG monitors as a guide to reduce the incidence of POCD.

The purpose of this dissertation was to develop and test a technique of general anesthesia, delivered by anesthesia providers …

Outcomes Associated With Blood Component Transfusion In Adult Trauma Patients, Allison R. Jones

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate outcomes associated with blood component (BC) transfusion in adult trauma patients. Specific aims were to: 1) explore the relationship between traumatic injury, hemorrhage, and BC transfusion, focusing on consequences of the component storage lesion through presentation of a conceptual model; 2) systematically review research literature comparing outcomes of massively transfused major trauma patients based on ratios of BCs received; 3) evaluating the relationship between type of blood transfusion trauma patients received (whole blood versus BCs) and mortality likelihood after controlling for demographic and clinical variables; 4) evaluating the relationship between volume and …

Psychological Well-Being Among Breast Cancer Survivors: Factors That Influence Transition From Primary Treatment To Early Survivorship, Celestine G. Gochett

Theses and Dissertations--Nursing

Eudaimonic psychological well-being (PWB) refers to a lifelong process of purposeful engagement in goal-driven tasks or activities resulting in positive psychological functioning. These activities reflect autonomy, purpose in life, self-acceptance, personal growth, positive relations with others, and environmental mastery. While more women are surviving breast cancer, they face a multitude of late and long term physiopsychosocial challenges that result from being diagnosed and treated. Protective health effects associated with the experience of PWB can potentially mitigate ill-being and benefit overall health of breast cancer survivors (BCS). Adequate preparation by healthcare teams to transition them from primary treatment to early survivorship …

The Psychological Well-Being Of Men Diagnosed With Prostate Cancer, Lee A. Walmsley

Theses and Dissertations--Nursing

Prostate cancer (PC) affects one in eight men in North America and continues to be the most common site of cancer in males, especially among older men in Europe and the United States, and the second most common cancer worldwide. Prostate cancer is, after lung cancer, the most common cause of cancer-related deaths among men with an estimated 27,540 deaths in 2015.

The well-being of patients diagnosed with PC is a largely unexplored research area. Numerous factors likely impact men’s psychological well-being as they progress through the experience of managing PC. Among the various factors that may predict psychological well-being …

The Impact Of Prenatal Depressive Symptoms, Intimate Partner Relationship, And Immune Status On Postpartum Depression, Julia J. Hall

Theses and Dissertations--Nursing

The prevalence of depression during pregnancy in the U. S. is approximately 13%. Poor quality of the intimate partner relationship is significantly correlated with depression during pregnancy. The adverse effects of antenatal depression have been widely documented. The relationship between the intimate partner relationship and depression during pregnancy has not been well delineated in the literature. Little data exist regarding the impact of prenatal immune status on risk for postpartum depression. Due to limited evidence, there is a critical need to examine the relationship among trimester specific cytokines, quality of the intimate partner relationship, and antenatal depressive symptoms on risk …

Explore The Relationship Among Lung Cancer Stigma, Social Support, And Psychosocial Distress, Lisa Maggio

Theses and Dissertations--Nursing

There is longstanding causal relationship between cigarette smoking and lung cancer. Smoke-free policies and anti-smoking campaigns have been linked to the decline in smoking acceptance and contribute to the unintended consequence of stigmatizing smokers. Lung cancer is viewed as a self-inflicted disease and patients’ feel judged in a manner different from other cancers affecting social interactions between family, friends, and healthcare professionals. Lung cancer stigma contributes to depression, anxiety, poor self-esteem, guilt, shame, blame, threatens a person’s social identity, and limits social support that deeply affects patients and their support persons.

This dissertation contains a review of the literature related …

Factors Influencing Depression In Men: A Qualitative Investigation, Lori A. Mutiso

Theses and Dissertations--Nursing

The purpose of this qualitative descriptive study is to describe men’s experiences of depression in order to provide direction for future research of the screening, diagnosing, and treatment of men's depression. Previous research indicates that men experience different depressive symptoms than women, and there is a possibility that men's depression is not being adequately captured by current screening standards, which would theoretically lead to a large number of men with unrecognized, undiagnosed, and untreated depression. If this is the case, this may explain the disproportionately low number of men diagnosed with depression compared to women, in contrast to the disproportionately …

Chiildhood Bullying: Assessment Practices And Predictive Factors Associated With Assessing For Bullying By Health Care Providers, Vicki Hensley

Theses and Dissertations--Nursing

Childhood bullying affects over 25% of today’s youth and causes up to 160,000 missed school days per year. Bullying causes short and long term adverse effects to both mental and physical health. Many organizations encourage healthcare providers to take an active role in bullying prevention. However, there has been little research into the role of primary healthcare providers regarding childhood bullying and the effectiveness of different approaches to screening and management.

Therefore the purposes of this dissertation were to a) explore childhood bullying and the role of the healthcare provider in bullying prevention, b) develop and evaluate the psychometric properties …

The Utility Of The U.S. Diabetes Conversation Map As An Intervention To Promote Diabetes Self-Management Adherence, Lisa Gale Jones

Theses and Dissertations--Nursing

Diabetes has reached epidemic levels, to the currently estimated 29 million individuals who are living with diabetes. Those with diabetes must manage their disease through a combination of medication, physical activity recommendations, and nutritional guidelines. The consequences of non-adherence to recommendations include cardiovascular disease, kidney failure, vision loss, or ultimately, death. Despite the risks of non-adherence, individuals often do not adhere to recommended treatment. Researchers have attempted to identify strategies to promote diabetes self-management adherence, thereby decreasing complications related to the disease.

Specific Aims:

1. describe the factors that prohibit individuals from adhering from diabetes self-management behaviors as well as the …

Cardiovascular Disease Risk Factors Among Emerging Adults In College, Demetrius A. Abshire

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions of cardiovascular risk among emerging adult men in college; 2) compare differences in unhealthy behaviors and obesity between emerging adults in college living in rural, Appalachian Kentucky and urban Fayette County, Kentucky; and 3) compare measures of general and abdominal obesity in predicting blood pressure among …

Sleep Disturbance And Outcomes In Patients With Heart Failure And Their Family Caregivers, Sami Al-Rawashdeh

Theses and Dissertations--Nursing

Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of …

Influence Of Coping Styles On Emotional State, Illness Perception, And Information Sources Of Men With Prostate Cancer, Gwendolyn M. Hooper

Theses and Dissertations--Nursing

Prostate cancer (PCa) has been the leading cause of cancer death in men since1930. While studies pertaining to PCa have primarily focused on the disease and the subsequent side effects of treatment, psychological distress in this group has yet to be adequately addressed. The purpose of this dissertation was to: 1) conceptualize health related quality of life (HRQL) and health seeking behavior of men by describing lifestyle, cultural and health risks associated with being male, 2) evaluate the psychometric properties of the SF-12 Health Survey (SF-12) combined with the urinary and sexual portions of the UCLA PCa Index (UCLA-PCI), 3) …

Barriers To Effective Pain Management In Preterm And Critically Ill Neonates, Sharon W. Lake

Theses and Dissertations--Nursing

The purpose of this dissertation is to explore potential barriers nurses experience in providing effective pain management for preterm and critically ill infants in neonatal intensive care units (NICUs). The specific aims of the study conducted are to examine (a) NICU caregivers’ knowledge about pain, (b) scales used to evaluate pain in infants, (c) NICU nurses’ documented pain practices, and (d) bias in treating pain of certain types of infants.

This dissertation is comprised of three manuscripts. The first manuscript is an integrated review of the literature describing caregiver knowledge, barriers, and bias in the management of pain in neonates. …

Adherence To Physical Activity Among Individuals With Or Without Cardiovascular Disease, Zyad T. Saleh

Theses and Dissertations--Nursing

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD.

The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), …

The Factors That Influence Duration Of Exclusive Breastfeeding: A Mixed Methods Design, Roxanne K. Bowman

Theses and Dissertations--Nursing

Breastfeeding is the gold standard of infant feeding and its benefits extend beyond the mother and child. Multiple organizations recommend exclusive breastfeeding for the first six months of an infant’s life. Exclusive breastfeeding rates nationally and in the state of Kentucky fall below the Healthy People 2020 goals. A mother’s intention to breastfeed has been shown to impact actual breastfeeding behavior. The current state of the measurement of intention was explored through a literature review. A majority of the measures were single item scales. The reliability and validity of the scales should be further tested in diverse populations.

The purposes …

A Grounded Theory Model Of Mother Role Development While In The Neonatal Intensive Care Unit, Kathy B. Isaacs

Theses and Dissertations--Nursing

When a woman discovers that she is pregnant, she begins a process of internal work to develop her mother role. This process has been outlined in the literature for the delivery of a healthy full-term baby, however little is known about the process for mothers of medically fragile babies. A threatened pregnancy and subsequent delivery of a medically fragile baby involves a different process of internal work by the mother to prepare for her role. Mothers with a baby in the Neonatal Intensive Care Unit (NICU) experience stress, uncertainty, and anxiety potentially causing a permanent impact on the successful development …

Medically Ill Smokers And Planning To Quit, Audrey Darville

Theses and Dissertations--Nursing

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high …