Medicine and Health Sciences Commons^™

An Exploration Of The Mental Health Experiences Of Young Women With Diminished Ovarian Reserve, Brittany M. Woods

All ETDs from UAB

Infertility is a reproductive disease resulting in the inability to conceive. One in six individuals will experience infertility in their lifetime. Diminished ovarian reserve (DOR) reduces the quantity and/or quality of a female's oocyte pool and is a known cause of infertility. Although this occurs during normal ovarian aging in the late 30s and early 40s, DOR can also impact younger women, increasing their risk for psychological distress from an unexpected diagnosis. The purpose of this dissertation is to develop a deeper understanding of the mental health experiences of young women with DOR through the generation of three manuscripts. Manuscript …

Factors Impacting Serious Illness Care In Alabama: An Assessment Of The Current State Of Hospital Palliative Care, Amy M. Beasley

All ETDs from UAB

BACKGROUND: Palliative care (PC) use has been shown to offer many benefits to patients and families. Hospital PC has expanded in the United States, though growth has been limited within hospital types and geographic locations. According to the Center to Advance Palliative Care (CAPC), Alabama was rated a “D,” indicating that significant improvements in PC are needed. The purpose of this study was to develop a thorough description of access to palliative care in Alabama hospitals. METHODS: A mixed methods multiple case study was employed with quantitative data embedded into a qualitative case study approach. Four hospitals were selected based …

A Qualitative Descriptive Study Exploring Infertility Help-Seeking Among African American Women, Andrea G. Wells

All ETDs from UAB

BACKGROUND: Failure to achieve pregnancy (infertility) affects over 6 million women ages 15–44 in the United States. African American women have more difficulty getting pregnant than White women but are less likely to seek help for infertility. According to the current research, there are several factors (cost, insurance coverage, etc.) that create difficulty for women to seek help to get pregnant. However, little is known about the factors that influence or impede infertility help-seeking among African American women. The purpose of this study was to explore the barriers and facilitators to infertility help-seeking among African American women.METHODS: Factors affecting infertility …

Evaluating The Association Among Demographic, Disease, And Symptom Profiles And Quality Of Life In Connective Tissue Disease-Related Interstitial Disease, Lanier O'Hare

All ETDs from UAB

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Connective tissue disease-related interstitial lung disease (CTD-ILD) results in an unrelenting symptom burden and may progress to death. The morbidity and mortality associated with CTD-ILD likely has a profound impact on individuals’ quality of life (QOL). Quality of life is a phenomenon that has yet to be sufficiently described in the literature on CTD-ILD. The factors associated with QOL in other chronic lung diseases have been described, but because of the different clinical and demographic characteristics of CTD-ILD, it is unknown if these same factors are associated with QOL in CTD-ILD. The purpose of this study was to examine …

Life-Space Mobility In The Older Adult, Community-Dwelling Cancer Survivor In The Deep South: A Secondary Data Analysis, Richard A. Taylor

All ETDs from UAB

By 2040, the U.S. is projected to have 26.1 million cancer survivors; 73% of these will be over 65 years old. Much is known about life-space mobility (LSM) in patients with non-cancer serious illnesses. Restricted LSM affects every aspect of an older adult’s life; their independence, autonomy, and quality of life (QOL). To date, there are no studies examining LSM in older cancer survivors. Therefore, we examined LSM, factors that affect LSM, and the relationship between LSM and QOL in older cancer survivors using existing data from the University of Alabama at Birmingham (UAB) Study of Aging (SOA) (NIA AG15062). …

The Influence Of Sleep Duration And Sleep Efficiency On Abdominal Adiposity And Blood Pressure In Adolescents Ages 16 To 18 Who Participated In The Cleveland Children's Sleep And Health Study: A Secondary Data Analysis, Shameka Rodgers Phillips

All ETDs from UAB

Introduction: Abdominal adiposity and blood pressure (BP) are two major modifiable risk factors for cardiovascular disease (CVD), the leading cause of death in the world. The impact of abdominal adiposity and BP on health, particularly CVD, begins in childhood. Older adolescents tend to have the highest prevalence of abdominal adiposity and BP in the pediatric population. Despite interventions like diet and exercise, the prevalence of excess abdominal adiposity and elevated BP continues to increase during late adolescence. Evidence suggests that sleep duration and sleep efficiency impact abdominal adiposity and BP in adults and the pediatric population, but limited studies have …

Exploring The Relationship Between Chronic Stressors And Protective Factors And Preterm Risk In An African American Pregnant Population, Megan Mileski

All ETDs from UAB

BACKGROUND: In the United States, infant mortality is a serious public health issue, particularly for the African American (AA) population. Despite ample research investigating explanations for the significantly higher infant mortality rate (IMR) for AA infants in the United States, the reason for the racial disparity remains unknown. Reports suggest that chronic, life-course stressors may increase risk of preterm birth (PTB), the leading contributor to the high IMR for AA infants. Adverse childhood experiences and perceived racial discrimination, experienced over the life course, have the potential to increase a stress response in AA women, leading to PTB. Psychosocial resources may …

Evaluation And Revision Of The Practice Environment Scale Of The Nursing Work Index For Acute Care Hospital Staff Nurses, Caitlin Marley Campbell

All ETDs from UAB

The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most frequently used instrument for measuring the nursing work environment. The original PES-NWI obtained its items directly from the parent instrument, the Nursing Work Index, which was developed in the 1980s. However, potential value change among younger generations and vast historical, social, and technological transformations in the way healthcare is provided may have led to different factors that compose a favorable work environment for nurses working today. The purpose of this dissertation was to evaluate and revise the PES-NWI for use in today’s nursing workforce. To accomplish this …

Relationship Between Neighborhood Deprivation And Epigenetic Age Acceleration With Pain In Adults With Musculoskeletal Pain, Pamela Jackson

All ETDs from UAB

Residents of high-deprivation neighborhoods shoulder a greater burden of age-related health conditions, including experiencing worse chronic musculoskeletal pain outcomes, compared to residents of more affluent neighborhoods. Advancing age is a risk factor for chronic health conditions, which epigenetic modifications may explain. Epigenetic age acceleration occurs when an individual’s epigenetic age is older than their chronological age, and that discordance has been identified as a strong predictor of age-related conditions. Epigenetic age acceleration has also been correlated with neighborhood deprivation. However, the mechanisms for neighborhood disparities in chronic musculoskeletal pain remain unclear. The purpose of this dissertation study was to examine …

Predicting Change In Quality Of Life In Patients With Advanced Cancer And Family Caregivers Using Gps Data, Kyungmi Lee

All ETDs from UAB

Patients with advanced cancer and their family caregivers often experience poor quality of life. Measuring patient and caregiver physical and mental quality of life is typically performed using participant reported outcome measures, especially validated questionnaires. However, this self-report approach has several limitations, including recall bias, respondent burden, and social desirability bias. One potential solution to these limitations may be to use passive data collected by personally owned smartphones (e.g., GPS data) to model and assess the quality of life in family caregivers and patients with advanced cancer. Yet, there is no evidence to date that passively collected smartphone data is …

Heart Rate Variability And Stress In The Intensive Care Unit Nursing Workplace, Paula Miller Levi

All ETDs from UAB

Intensive care unit (ICU) nurses work in a demanding environment, facing repeated encounters with trauma and ethical issues when caring for patients. Psychological stressors can include death of patients, violent acts by patients or their families, caring for suffering patients, and moral distress from performing futile care. These factors place ICU nurses at increased risk of developing post-traumatic stress disorder (PTSD). Suffering from chronic PTSD symptoms can negatively impact nurses’ psychological and physical health. There are also consequences for patients and hospitals, including increased risk for substandard care, decreased government reimbursements from poor patient satisfaction scores, and retention issues. Few …

Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards

All ETDs from UAB

Universal access to palliative care (PC) is a human right that much of the world has not accomplished and educating a PC workforce is critical to PC advancement. Higher PC disparities exist in low-and-middle income countries, such as Jamaica. The World Health Organization Public Health Model and the International PC Initiative’s PC roadmap emphasize the importance of PC education. The purpose of this mixed methods dissertation study was to investigate the PC experiences and educational needs of healthcare interprofessionals who provide care for patients with late-stage serious illnesses in Jamaica. Three specific aims incorporated quantitative investigation of physicians’, nurses’, and …

A Pilot Mixed Methods Study Examining Factors Affecting Return To Work Among African American Stroke Survivors, Kristin D. Ashley

All ETDs from UAB

BACKGROUND: Stroke is a highly prevalent and disabling condition among African Americans. Although there is limited research regarding barriers and facilitators to return to work among stroke survivors, evidence suggests that African American stroke survivors return to work (RTW) less frequently than Caucasians. Most of the research on this topic has been conducted in European countries, leaving significant knowledge gaps on RTW among African Americans in the United States. The purpose of this study was to identify factors that affect RTW for African American stroke survivors and then build upon those results to better understand facilitators and barriers to RTW. …

Implications Of Day-To-Day Oulsatility Index Change And Corticosteroid Use In Pediatric Traumatic Brain Injury, Jeremy D. Jordan

All ETDs from UAB

A traumatic brain injury (TBI) is a disruption of the normal function and structure of the brain after a direct or indirect injury. In children, TBI continues to be a significant cause of mortality resulting in the death of over 20 children per day in the United States (Reuter-Rice et al., 2015). Additionally, children who survive TBI have increased rates developmental delay, physical disabilities, neurologic impairment, and mental health disorders (Barlow et al., 2005). A TBI occurs in two phases. The primary injury is the physical insult to the brain that occurs at the time of the injury. The secondary …

The Relationship Between Anosgnosia For Hemiplegia After Stroke And Fall Events In The Acute Inpatient Stroke Rehabilitation Population, Elizabeth Mosley Byrd

All ETDs from UAB

Background/Significance: Inpatient falls on acute stroke rehabilitation units remains a significant issue that negatively affects healthcare costs and causes physical and psychological injury. Prevelance of falls in the stroke rehabilitation population may be due to the presence of anosognosia for hemiplegia (AHP), which is as an unawareness of physical disability. Though the link between AHP and falls has been suggested in the literature, a formal investigation has not been conducted to address the relationship between the variables. Purpose: To explore the association between the presence of anosognosia for hemiplegia after stroke and patient fall events while admitted to an acute …

An Exploration Of The Manifestation Of Parentification Among Young Carers Of Persons With Huntington’S Disease, Bailey Hendricks

All ETDs from UAB

Due to the progressive deterioration of motor, cognitive, and psychological function experienced by individuals diagnosed with Huntington’s disease, there is the potential for children in the home to adopt a caregiving role. These young carers typically serve as informal, secondary caregivers, providing multifaceted, extended care without any lessening of typical family, home, or school/work-related responsibilities. In time, this role may result in parentification, a type of role reversal with both positive and negative outcomes for the child. A secondary analysis of qualitative data of the experiences of children who have a parent with Huntington’s disease was conducted. Transcripts of qualitative …

An Evaluation Of The Impact Of Medical Home Structures And Care Processes On Temporary Profile Days Among Active-Duty U.S. Army Soldiers, Tanekkia M. Taylor-Clark

All ETDs from UAB

Readiness, the Armed Forces’ ability to carry out a range of military operations, is one of the U.S. Army’s highest strategic priorities. The medical readiness of soldiers is a critical component of overall operational readiness. The greatest threat to medical readiness is acute musculoskeletal injuries (MSIs). Medical providers place soldiers on medical limitations referred to as a “temporary profile” to facilitate treatment and recovery of acute MSIs. Poorly managed temporary profiles negatively impact soldiers’ work attendance and performance, leading to the loss or limitation of over 25 million training/duty days annually. Changes within the primary care setting, including implementing the …

Challenges For Nurse Anesthetists Re-Entering Practice Following Substance Use Disorder Treatment, T'Anya Marye Carter

All ETDs from UAB

Substance use disorder (SUD) is a persistent, relapsing condition that is present in approximately 10% of anesthesia providers, who, compared to other healthcare providers, face a greater risk of developing an SUD by virtue of constant access to medications. The ability of Certified Registered Nurse Anesthetists (CRNAs) to obtain employment or maintain employment after treatment for SUD treatment is not well documented. CRNAs in recovery from SUD in the United States experience challenges when attempting to return to work following treatment for SUD for reasons yet to be identified. The purpose of this qualitative multiple-case study was to explore the …

Self-Efficacy And Sexual And Reproductive Health In Women With Cystic Fibrosis: A Mixed Methods Study, Janet L. Brown

All ETDs from UAB

SELF-EFFICACY AND SEXUAL AND REPRODUCTIVE HEALTH IN WOMEN WITH CYSTIC FIBROSIS: A MIXED METHODS STUDY JANET BROWN DOCTOR OF PHILOSOPHY IN NURSING ABSTRACT BACKGROUND: Cystic fibrosis (CF) is the most common life-limiting genetic disorder among Caucasians. There are approximately 30,000 individuals with CF in the United States and over 70,000 worldwide, with approximately 1,000 new cases diagnosed globally each year. In other chronic diseases, a positive relationship between self-efficacy and behavior has been identified. Self-efficacy may be a factor related to behaviors, including underutilization of sexual and reproductive health (SRH) care services for women with CF.METHODS: Self-efficacy and utilization of …

Added Sugar Consumption And Prediabetes In U.S. Adults: A Cross-Sectional Analysis Of The National Health And Nutrition Examination Survey, 2013-2018, Nadia Markie Sneed

All ETDs from UAB

Prediabetes is a modifiable risk factor for type 2 diabetes (T2D) that effects 88- million U.S. adults. Added sugar is linked to the risk for prediabetes through direct and indirect mechanisms that promote hepatic and whole-body insulin resistance. Added sugar is overconsumed and totals ~13% of American’s daily caloric intake, with consumption highest for non-Hispanic Blacks and Hispanic minority populations also disproportionality affected by prediabetes and T2D. The effects of total added sugar on prediabetes have been mixed; however, total added sugar intake has primarily been examined using added sugar proxies (e.g., sugar-sweetened beverages, fructose), likely increasing systemic measurement error …

Influence Of Race, Gender, Rurality, And Dyadic Health On Symptom Pattern Trajectories In Persons With Advanced Heart Failure, Macy Lynn Stockdill

All ETDs from UAB

Individuals living with heart failure experience a high symptom burden that must be addressed to improve their quality of life as well as the quality of life of their family caregivers. This is a challenging task as different situational and individual factors, including clinical/physiological factors and cultural factors, can affect an individual’s symptom experience. The purpose of this dissertation study was to examine existing symptom pattern trajectories and associated factors (sociodemographic, clinical/physiological characteristics, dyadic health) among a sample of under-resourced and racially diverse older adults with advanced heart failure living in the Deep South. This purpose was accomplished through four …

Developing A Core Set Of Nursing-Sensitive Indicators For International Pediatric Oncology Nursing Practice, Courtney Erin Sullivan

All ETDs from UAB

Although nursing sensitive indicators (NSIs) have been developed to measure factors influencing nursing care quality and patient outcomes in general and in select specialty areas, a core set of NSIs for international pediatric oncology nursing practice does not exist. Quality nursing care delivery in pediatric oncology is essential to achieving optimal patient outcomes and closing the 50% survival gap between high-income and low- and middle-income countries. To enhance global childhood cancer outcomes influenced by nursing, this dissertation research was conducted with the purpose of developing a preliminary core set of NSIs for international pediatric oncology nursing that is important, actionable, …

Understanding Adolescent Sexual Health Through Exploration Of Their Perceptions, Behaviors, And Beliefs, Jessica L. Corcoran

All ETDs from UAB

Adolescents in the United States disproportionately experience adverse sexual health outcomes compared to adolescents in other developed countries. The purpose of this dissertation is to provide an in-depth examination of adolescent sexual health through the generation of three manuscripts. The first manuscript will provide an integrative review of adolescents’ perceptions of sexual health education programs. The second manuscript will illuminate the five-year trends in adolescent chlamydia rates by region, race, and sex. The third manuscript will provide a qualitative analysis from interviews with African American adolescent females in the southern U.S. Manuscript one reviewed studies from 2008 to 2019. The …

Alabama's Acute Care Registered Nurse Workforce: A Study In Supply And Demand, Tracey Dick

All ETDs from UAB

Background/Significance: Nurses comprise the largest sector of the total health care workforce. Acute care hospitals have historically been major employers of registered nurses (RNs). What is currently known about Alabama’s acute care RN workforce supply is limited. Additionally, a paucity of data is available to describe employer demand. Alabama’s aging population, chronic disease burden, and health care system reforms suggest that the demand for RNs will continue to grow. Data are needed to provide a greater understanding of current and future RN supply and demand to inform workforce planning, educational investment, and state health policy. Purpose: To characterize the current …

Exploring The Nursing Work Environment And Patient Outcomes Associated With Nurse-Reported Workplace Bullying: A Mixed Methods Study, Colleen Anusiewicz

All ETDs from UAB

Workplace bullying (WPB) in nursing is a workplace problem that can undermine the safety culture necessary to minimize adverse patient events and improve health care quality. Nurses continue to experience and report WPB despite a substantial and growing body of evidence reflecting the negative effects of WPB on nurses, published position statements and alerts, and the initiation of workplace violence policies and protocols. To decrease WPB and inform the development of effective anti-bullying interventions, there has been a shift in focus from individual factors and interpersonal relationships among nurses and health care workers to organizational factors that contribute to nurse-reported …

Sexual Behaviors And Non-Initiation Of The Hpv Vaccine Among Young Adult Cancer Survivors, Brooke Cherven

All ETDs from UAB

Advances in treatment for childhood cancer have led to increased survival rates. There are currently an estimated 400,000 survivors of childhood cancer living in the United States who are at risk for developing subsequent malignancies, including cancers associated with the human papillomavirus (HPV). HPV is the most common sexually transmitted infection; sexual behaviors associated with increased risk for HPV acquisition include younger age at first intercourse, multiple sexual partners, and inconsistent condom use. The prevalence of high-risk sexual behaviors, and the relationship between sexual behaviors and HPV vaccine non-initiation among young adult cancer survivors is unknown. This study used data …

A Survey Of Shoulder Injuries In Commercial Truck Drivers Using A Retrospective Medical Record Review, Bryan Combs

All ETDs from UAB

Introduction: Musculoskeletal injuries in the occupational setting have significant impact on the worker, employer, and healthcare system. Commercial truck drivers (CTD) experience some of the highest rates of injury, missed days of work, and workers’ compensation costs compared with other workers. In this population, back injuries occur most commonly, followed by shoulder injuries which require 5 times more days away from work. Commercial truck drivers are significantly impacted by shoulder injuries; however, little is known about the unique mechanisms of injury, specific injuries, or possible preventative measures among this group of workers. Methods: A retrospective medical record review was completed …

Nursing Staff Approaches To Providing Oral Hygiene In Stroke Survivors With Dysphagia: A Grounded Theory Study, Willard Edward Brewer

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The purpose of this qualitative grounded theory study was to explore how the nursing staff approaches oral hygiene in stroke survivors with dysphagia during the rehabilitation phase of recovery and what guides their decisions. Oral hygiene is a proven effective task known to prevent systemic health disparities (i.e. aspiration pneumonia, diabetes, gastrointestinal disparities, and even stroke). However, there are no current evidenced-based guidelines that provide instruction on how to execute oral hygiene to stroke survivors with dysphagia. Little is known about how nurses make decisions to implement oral hygiene in stroke survivors with dysphagia. Using a theoretical sampling strategy, data …

Occupational Health Outcomes In Women Living With And At Risk For Hiv, Jenni Wise

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Women living with HIV (WLWH) are now able to work and need to work to attain the fruitful benefits of employment. Regardless of the need for income, employment provides esteem, confidence, structure, social support, and is associated with improved physical and psychological outcomes. Yet, in spite of the documented benefits associated with employment, an estimated 60% of WLWH are not employed. Thus, occupational disparities among WLWH contribute to disparities in health and quality of life among this population. While the historical trajectory of HIV is unique compared to other populations with chronic disease, evidence suggests that gender-specific difference in socioeconomic, …

An Exploratory Study Of The Influence Of Perceived Organizational Support, Coworker Social Support, The Nursing Practice Environment, And Nurse Demographics On Burnout In Palliative Care Nurses, Marcia Ann Lowe

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AN EXPLORATORY STUDY OF THE INFLUENCE OF PERCEIVED ORGANIZATIONAL SUPPORT, COWORKER SOCIAL SUPPORT, THE NURSING PRACTICE ENVIRONMENT, AND NURSE DEMOGRAPHICS ON BURNOUT IN PALLIATIVE CARE NURSES MARCIA A. LOWE SCHOOL OF NURSING ABSTRACT Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in healthcare, including nursing, medicine, and social work. Working with palliative care patients and their families is innately challenging and may predispose nurses to burnout. The purpose of this study is to examine the influence of perceived organizational support (POS), coworker social support, the nursing practice environment, and nurse …