Nursing Commons^™

Adapting The Minority Stress Model Among Middle-Aged And Older Adults With And Without Hiv: Understanding The Interplay Between Minority Stress, Mental Health, And Sexual Risk Behaviors, Alexis R Long Thompson

All ETDs from UAB

This dissertation aims to adapt Meyer’s Minority Stress Model to understand the interplay between minority stress, mental health, and sexual risk behaviors among middle-aged and older adults with and without HIV. The study utilizes data from the MACS WIHS Combined Cohort Study, focusing on adults aged 40 and older. It examines the relationships between perceived stress, psychosocial factors (depression, substance use, social support), and sexual risk behaviors, considering the impact of minority identities such as race, gender, sexual orientation, and HIV status. The findings highlight significant differences in perceived stress, depressive symptoms, substance use, and social support across different intersectional …

Exploring Gaps In Hiv Prevention: Hiv Pre-Exposure Prophylaxis Awareness, Attitudes, Utilization, Coverage, Hiv Testing And Risk Perception Among Sub-Saharan African College Students In The United States, Ikenna Obasi Odii

All ETDs from UAB

This dissertation focuses on increasing HIV awareness and contributing to efforts at reducing new HIV infections among Sub-Saharan African (SSA) college students. It begins with an introductory chapter one and ends in the concluding chapter five. Chapter two presents a systematic review identifying key gaps in HIV Pre-Exposure Prophylaxis (PrEP) knowledge, attitudes, and utilization among Black college students in the United States (U.S). The review synthesizes findings from four studies, revealing that a third of participants demonstrated adequate PrEP knowledge, while PrEP utilization remained under-utilized at three percent. Key barriers to PrEP uptake included fear, low self-perceived HIV risk, infrequent …

Everyday Decision-Making Involvement Among Hispanic & Latinx Dementia Caregivers And Its Associations With Daily Anxiety And Daily Depressive Symptoms, Abigail Poe

All ETDs from UAB

Background: Hispanic and Latinx (H&L) caregivers of individuals living with Alzheimer’s disease and related dementias (ADRD) experience elevated caregiving burden and poorer mental health outcomes compared to caregivers from other racial and ethnic groups. Limited research has examined H&L caregivers’ involvement in everyday decision-making for persons living with dementia (PLWD), particularly how this involvement may relate to daily mental health symptoms such as anxiety and depression. Purpose: This study examined baseline decision-making involvement (DMI), its associations with individual-level factors, and its relationship with daily anxiety and depressive symptoms in H&L ADRD caregivers. Methods: A secondary analysis was conducted using data …

Blood Transfusion Factors That Affect The Outcomes Of Patients Who Experienced Trauma-Related Hemorrhage, Justin Lee Miller

All ETDs from UAB

Trauma is a leading cause of death in the United States and in the world. It is the leading cause of death of Americans between the ages of one to 45 years old and is expected to increase due to increase over the next ten years. Most trauma deaths are attributed to hemorrhage and are considered preventable. The current standard of care for trauma-related hemorrhage (TRH) is damage control resuscitation using either whole blood (WB) or blood components (BC) in a ratio of 1 unit of red blood cells to 1 unit of plasma to 1 unit of platelets. The …

Increasing Patient Safety By Reducing Falls Among In-Hospital Community-Dwelling Patients 65 Years Old Or Older By Using A Shift Change Fall Safety Checklist, Janice Isaac Brooks

All ETDs from UAB

This manuscript is designed to promote and improve healthcare safety, quality, efficiency, and lower medical costs for hospitals and patients. Falls, fall injuries, and their devastating consequences are rising, yet falls are preventable even among senior patients. Search Engines and Key Terms SciWheel was used to save the literature and eliminate duplications. Key terms were used in the Boolean strings: elderly fall prevention, senior fall safety, in-hospital fall prevention, falls in the aging, and fall prevention tools. The CINAHL Plus yielded 58. PubMed search yielded 121. And Google Scholar yielded 32. The total of all three searches was 211. Thirteen …

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 …

Respiratory Symptoms And Psychological Distress In Farmers Living With Copd, Prasert Kham-Ai

All ETDs from UAB

Farmers are susceptible to both Chronic Obstructive Pulmonary Disease (COPD) and psychological distress. It is known that psychological distress is associated with increased respiratory symptoms and triggers COPD exacerbation. Therefore, farmers who have COPD may experience worsening respiratory symptoms as a result of psychological distress. Since no known studies revealed the association between the frequency of respiratory symptoms and the level of psychological distress among farmers with COPD, this study aimed to explore (1) the frequency of respiratory symptoms and the level of psychological distress, (2) the factors related to increased respiratory symptoms and psychological distress, and (3) the association …

Aging With Hiv And Comorbid Chronic Obstructive Pulmonary Disease, Jun Yeong Byun

All ETDs from UAB

Older adults with human immunodeficiency virus (HIV) experience a high prevalence of chronic obstructive pulmonary disease (COPD). Considering having either HIV or COPD is related to worse health outcomes in older adults, aging with both HIV and COPD may synergistically and negatively affect the health outcomes of older people with HIV (PWH) and comorbid COPD. The purpose of this dissertation was to explore the aging of PWH with COPD. This purpose was accomplished through three articles: 1) an adaptation of a gerontological model investigating what is known about the aging of PWH and people with COPD and extrapolating that to …

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 …

An Exploration Of The Values Elicitation Experiences Of Patients With Heart Failure And Their Family Caregivers, Avery Bechthold

All ETDs from UAB

Values, defined as abstract, subjective, and significant core beliefs, which function within a system and priority, are integral to how individuals make decisions, and cope with stressors, including serious illness. However, little research has been conducted to explore the experiences of patients with heart failure (HF) and their family caregivers. Therefore, the purpose of this dissertation was to explore how values are discussed, reflected upon, and acted on by patients with HF and their family caregivers. This purpose was accomplished through four manuscripts and a mixed methods analysis: 1) a concept analysis of values elicitation in the context of health …

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 …

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 …

Care-Resistant Behavior Trajectories Of Individuals Living With Dementia In Nursing Homes And Distal Outcomes In Oral Health: A Secondary Analysis, Chunhong Xiao

All ETDs from UAB

Persons living with dementia who exhibit care-resistant behaviors (CRB) are likely to resist mouth care and have poor oral health. Knowing the “balance” between providing optimal mouth care while managing CRB is critical for developing tailored interventions. No evidence has demonstrated a balance between CRB level, mouth care completion, and oral health status. The overarching goal of this study was to identify a balance or “sweet spot” between enough mouth care to maintain oral health and a manageable level of CRB intensity. The purpose of this study was to examine and describe the characteristics of CRB trajectories as they relate …

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. …

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 …

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 …

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 …

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 …

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, …

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 …

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 …