Nursing School Theses, Dissertations, and Doctoral Papers

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Heart Failure Family Caregivers: Psychometrics of a New Quality of Life Scale and Variables Associated with Caregiving Outcomes
(2007-09-21T13:58:18Z) Nauser, Julie Ann; Bakas, Tamilyn
The number of patients with chronic heart failure (HF) is at an all-time high and the incidence is expected to increase as our population ages. HF patients experience impaired cognition, exertional shortness of breath, and persistent fatigue; therefore, family members are needed to assist with their care at home. Although existing literature suggests that HF caregivers experience negative physical, mental, and social outcomes, there is a lack of studies guided by a conceptual model to determine factors associated with these outcomes. The purpose of this study was to determine factors associated with HF caregiver depressive symptoms, life changes, and quality of life guided by a conceptual model derived from Lazarus and colleagues’ transactional approach to stress. Psychometric properties of a new HF caregiver-specific quality of life (HFCQL) scale were also determined. Using a descriptive design, a convenience sample of 100 HF caregivers was interviewed by telephone using established measures along with the new HFCQL scale. The 16-item HFCQL scale, which measures physical, psychological, social, and spiritual well-being demonstrated evidence of internal consistency reliability (alpha = .89); 2-week test-retest reliability (ICC = .83); construct validity, as evaluated with factor analysis (loadings > .32) and hierarchical multiple regression (59% variance, p < .001); and criterion validity, as shown with significant (p < .001) correlations with the Bakas Caregiving Outcomes Scale (r = .73), SF-36 general and mental health (r = .45; .59), and a single overall QOL item (r = .71). Using hierarchical multiple regression, the model constructs accounted for 35% variance of depressive symptoms, 46% variance of life changes, and 59% variance of HFCQL (p < .001). Factors significantly associated with these outcomes included caregiving task difficulty, uncertainty, social support, and threat appraisal. Support for the conceptual model was provided, and potential areas for intervention development were identified. The new HFCQL scale showed potential as a quality outcome measure in HF caregivers, and might be used to screen HF caregivers for poor quality of life. Further research using the proposed conceptual model and the HFCQL scale is warranted. Tamilyn Bakas, DNS, RN, Chair
TRANSITION TO ADULTHOOD: THE EXPERIENCE OF YOUTH WITH PHYSICAL DISABILITIES LIVING WITH A SERVICE DOG
(2008-04-14T12:15:20Z) Modlin, Susan Jane; Swenson, Melinda M.; Austin, Joan K.; Sims, Sharon L.; McGrew, John
The focus of this qualitative descriptive study is the experience of physically disabled young people as they transition into adulthood while living with a service dog. The cornerstone of young adulthood is transition. For any young adult leaving home, the transition involves inter- and intra-personal changes that affect future well-being. Unfortunately, the majority of young adults with congenital disabilities are less likely to be fully employed and to live independently than their non-disabled peers. To date, very little research about living with a disability exists from the point of view of young adults. Even fewer qualitative research studies exist that focus on service dog teams. This research report will add to the body of nursing knowledge about people with disabilities and their experience of transition in the areas of health, work/school, relationships and identity. The findings result from descriptive analysis of interviews with four young adults and one parent. Using qualitative descriptive methods, the researcher identified three themes that defined the experience of transition. It’s different now contained stories regarding life before and after obtaining the service dog. This theme included elements of personality development similar to any young adult in transition, such as identifying “who I am now.” Going places was the most personal theme, describing the social implications of going or not going places and the environmental and personal barriers related to learning to drive. Calling the shots centered on the ability to make choices for themselves and the dog, as well as to participate in age appropriate milestones, such as attending college and living away from home. The findings of this study will be useful to professionals who place service dogs with persons with disabilities, rehabilitation specialists who desire appropriate interventions to facilitate transitions, and nurse researchers and clinicians who desire to understand the bond between animals and human beings.
Predictors of Sleep-Wake Disturbances in Breast Cancer Survivors Compared to Women Without Breast Cancer
(2008-08-22T13:37:48Z) Elam, Julie Lynn; Carpenter, Janet S.
Current evidence shows that sleep-wake disturbances are a persistent problem in women surviving breast cancer. The purpose of this study was to refine the knowledge regarding the incidence, prevalence, and predictive factors of sleep-wake disturbances in breast cancer survivors (BCS) compared to age-matched women without breast cancer (WWBC). The cross-sectional, convenience-sample consisted of secondary data from BCS and WWBC who were recruited by two parent quality of life studies. Subjects were matched within +/- 5 years of age. The sample consisted of 246 BCS and 246 WWBC who were a mean age of 48 years old (SD=8.50), Caucasian (70%), employed (69%), married or partnered (76%), postmenopausal (59%), with a college education (56%), and with at least one concurrent medical problem (95%). Results showed that BCS had more prevalent sleep-wake disturbances (65%) compared to WWBC (55%). The poorest sleepers were BCS, women with hot flashes, poor physical functioning, depressive symptoms, or with moderate or high levels of distress related to a life event. BCS had higher PSQI scores indicating poorer sleep quality and higher sleep disturbances compared to WWBC. Predictors of the severity of poor sleep quality and sleep disturbances were BCS, women with higher number of co-morbidities, women with hot flashes, lower levels of physical functioning, higher depressive symptoms, and greater impact of a life event. Disease and treatment related factors did not predict poor sleep or sleep quality in BCS. Sleep disturbances are a problem in long-term BCS. Knowledge of contributing factors provides useful information during clinical evaluations and treatment of BCS reporting poor sleep. Additional research is needed to determine the impact of poor sleep on quality of life and develop/test effective interventions for long-term BCS.
Factors Associated with Post-Stroke Depressive Symptoms and Quality of Life
(2008-10-13T18:02:08Z) Johnson, Elizabeth A.; Bakas, Tamilyn; Austin, Joan Kessner; Perkins, Susan M.; Pressler, Susan J.; Williams, Linda S.
Stroke is the leading cause of adult disability with over 5 million American adults experiencing physical, psychological, and/or social limitations related to stroke. Although depressive symptoms and poor quality of life (QOL) are key outcomes for stroke survivors, little is understood about how these outcomes are affected by stroke survivors’ evaluation of their experience. The concept of cognitive appraisal, an evaluation of the meaning of a situation for one’s well-being, may explain some of the factors associated with post-stroke depressive symptoms and QOL. The purpose of this study was to determine factors associated with post-stroke depressive symptoms and QOL using a conceptual model derived from the transactional theory of stress originally proposed by Lazarus and Folkman. Three aims guided this study: to determine whether (a) depressive symptoms at 4 months after stroke are predictive of stroke-specific QOL at 10 months; (b) perceived social support, self-esteem, and optimism at 1 month after stroke predict depressive symptoms among stroke survivors at 4 months; and (c) threat appraisal at 1 month after stroke is a mediating variable between perceived social support, self-esteem, and optimism at 1 month after stroke and depressive symptoms at 4 months. A secondary analysis of data from 392 stroke survivors in the Randomized Trial of Treatment for Post-stroke Depression (AIM study) was conducted. Using a descriptive correlational design and multiple regression analyses, longitudinal associations among perceived social support, self-esteem, optimism, threat appraisal, depressive symptoms and stroke-specific QOL were examined. Perceived social support, self-esteem, and optimism were significantly associated with threat appraisal. Threat appraisal was significantly associated with post-stroke depressive symptoms. Stroke-specific QOL was found to be stable between 4 and 10 months. Partial mediation of the relationship between the explanatory variables and depressive symptoms by threat appraisal at one month post-stroke was demonstrated. In conclusion, threat appraisal is an important factor to consider in future research and intervention development in relation to post-stroke depressive symptoms.
Nursing Perceptions of Patient Safety at Hamad Medical Corporation in the State of Qatar
(2009-03-18T18:27:21Z) Al-Ishaq, Moza A Latif; Ebright, Patricia R.; Keck, Juanita; Stokes, Lillian; Jeffries, Pamela R.
The ability to improve the safety of patient care delivery is dependent on the safety culture, or the norms surrounding reactions following an error, the learning that takes place, and the proactive strategies in place to prevent future errors. While measurement of patient safety culture is now common in the United States (US) using instrument specifically developed for US healthcare organizations, no measurements of safety culture had been conducted at Hamad Medical Corporation in the State of Qatar, a Middle Eastern country; nor were valid or reliable instruments available. The purpose of this study was to assess registered nurses’ perceptions of the safety culture in the units where they provide nursing care at Hamad Medical Corporation using a modified version of the Agency for Healthcare Research and Quality (AHRQ) patient safety culture an instrument (Hospital Survey of Patient Safety Culture). Eight hundred surveys were distributed to all randomly-selected nurses from eight targeted clinical services with a response rate of 57%. Survey results were compared with those from US hospitals using the original AHRQ survey. Ranking of subscales for this study in terms of strengths and areas needing improvement were almost identical to the ordering of US hospital results, with teamwork within units ranked highest and indicating a strength; and the subscale non-punitive response to error the lowest and indicating an area for improvement. Positive response rates in terms of safety culture for this study were generally lower on most subscales compared to the US results and may reflect the intensity of patient safety improvement activity in the US over the last eight years in response to the Institute of Medicine’s report on medical errors in 1999. Results from this study provide a baseline measurement for safety culture at Hamad Medical Corporation and beginning adaptation of an instrument that can be used in other Middle Eastern healthcare organizations in the future.
Vigilance Experiences: Cancer Patients, Family Members, and Nurses
(2009-03-18T18:29:44Z) Kooken, Wendy Carter; Haase, Joan E.; Carpenter, Janet S.; Ramanujam, Rangaraj; Ebright, Patricia R.
VIGILANCE EXPERIENCES: CANCER PATIENTS, FAMILIES, AND NURSES Cancer disease, treatment, and errors in health care put patients at increased risk for poor outcomes. To improve outcomes and protect patients, researchers recommend increased vigilance; yet, research on vigilance in health care is minimal. There are even fewer studies on patients, family members, and nurses’ experiences of vigilance, although such studies could contribute to understanding mechanisms that foster vigilance within and across groups. The purpose of this study was twofold: Aim 1 was to describe the experiences of vigilance as perceived at the individual levels of patients receiving treatment for cancer, family members of a patient with cancer, and oncology nurses. Aim 2 was to evaluate commonalities in the lived experience of vigilance as described by patients receiving treatment for cancer, one of their family members, and a nurse caring for them. A qualitative, empirical phenomenological method guided this research. The sample consisted of 7 cancer patients, 6 family members of cancer patients, and 7 oncology nurses. Broad, data generating questions were constructed to elicit rich, narrative descriptions of participants’ experiences with vigilance, which were audio-taped and transcribed. Each participant group data were individually analyzed, using Colaizzi’s method. Significant statements from each participant were identified, restated in the language of science, and interpreted for formulated meanings. From formulated meanings, theme categories were constructed and merged across participants within the groups. A narrative of the commonalities of the experience within each group was developed. The across group commonalities were analyzed in a matrix. A total of 5,272 total significant statements were derived from three participant groups. Eleven themes were derived from patient data, ten from family member data, and ten from nurses’ data. Vigilance appeared as a complex, multidimensional phenomenon, which is implicitly shared within and across these three groups. Common vigilance themes found across all 3 groups included: identification of threats, the key importance of knowledge, trust, hope and connectedness, the beyond the call of duty nature of vigilance, ways vigilance takes energy and effort, what promotes and interferes with vigilance, and vigilance as a shared phenomenon. Implications were found for the healthcare system and nursing care.
The Use of Skin Conductance as a Marker of Intuitive decision making in nursing
(2009-03-18T18:41:07Z) Payne, Leslie K.; Sims, Sharon L.; Carpenter, Janet S.; Ironside, Pamela M.; Ebright, Patricia R.
A quasi-experimental design was undertaken to explore the possibility of utilizing electrodermal activity as a marker of intuitive decision making in nursing. This study compared 11 senior female nursing students to 10 female nurses with more than five years of nursing experience completing a clinical decision making task utilizing MicroSim© program software while measuring skin conductance response (SCR). The clinical decision making task chosen was based on the cognitive continuum theory. The somatic marker hypothesis is also a theoretical base for this study. This theory suggests that physiological markers are present during decision making. An independent t-test was conducted in SPSS comparing the total number of skin conductance responses generated and overall score in the card task and clinical scenario between the two groups. According to the Somatic Marker Hypothesis, the researcher’s definition of intuition, and the results of this experiment, SCR generation shows promise as a marker of intuitive decision making in nursing.
Stress and Coping in Nurse Managers: A Qualitative Description
(2009-03-18T18:50:58Z) Shirey, Maria R.; McDaniel, Anna M.; Doebbeling, Bradley N.; Ebright, Patricia R.; Fisher, Mary L.
Objective: This study provided a qualitative description of stress and coping as perceived by today's nurse manager incumbents. Background: The healthcare work environment as a source of overwork and stress has been implicated in today's nursing shortage. Nurse managers play a pivotal role in creating work environments for staff nurses, but little is known about the nature of nurse manager work. Methods: This qualitative descriptive study determined what situations contribute to nurse manager stress, what coping strategies they utilize, what health outcomes they report, and what decision-making processes they follow to address stressful situations in their roles. A purposive sample of 21 nurse managers employed at three U.S. acute care hospitals participated in the study. Participants completed a demographic questionnaire and a 14-question interview incorporating components of the Critical Decision Method. Content analysis was completed and themes identified. Results: Difficult situations reported included feeling pressure to perform, interpersonal conflicts associated with organizational communication deficits, and issues of human resources and staffing. Nurse managers utilized a combination of emotion-focused and problem-focused coping strategies. When comparing novice nurse managers (3 years or less in role) with experienced nurse managers (greater than 3 years in role), the novices used predominantly emotion-focused coping strategies, a narrow repertoire of self-care strategies, and experienced negative psychological, physiological, and functional outcomes related to their coping efforts. Experienced nurse managers working as co-managers demonstrated mostly problem-focused coping strategies, a broad repertoire of self-care strategies, and reported no negative health outcomes. The study produced a cognitive model in the form of 10 questions that guide nurse manager decision-making related to stressful situations. The study generated four themes amenable to intervention. Conclusions: Performance expectations for nurse managers in acute care hospitals have increased since the 1990's making the role requirements unrealistic. Rising expectations increase nurse manager stress perceptions, making coping more difficult, and potentially harming nurse manager and work environment well-being. Findings from this study suggest that to address stress, coping, and complexity in the nurse manager role requires a combination of strategies that address individual factors as well as organizational culture, supportive structures, and systems that facilitate the role.
The Paradox of Respect and Risk: Six Lakota Adolescents Speak
(2009-06-23T21:40:14Z) Isaacson, Mary J; Swenson, Melinda M.; Russell, Kathleen M.; Stiffler, Deborah; Zimmerman, Larry J.
Adolescence is a time of turbulence as young people stretch parental boundaries, seeking where they fit in society. For many American Indian adolescents this time involves the initiation of dangerous high-risk behaviors. Potential causes posed for this are: loss of identity, loss of cultural values and traditions, lack of positive role modeling and feelings of hopelessness. Survey research has been the predominant method of data collection. Very few studies of Native American youth use storytelling, even though stories are a part of many Indian cultures. The primary purpose of this study was to describe the phenomena of respect and risk from the viewpoint of the Lakota adolescent. I employed hermeneutic phenomenology with photography to help the adolescents illuminate these somewhat abstract concepts. I recruited participants from a single reservation on the Northern Plains. I collected data through non-structured interviews and participant observation. I analyzed the data using hermeneutic phenomenology based on Gadamer. Ecological systems theory provided a framework to assist me in understanding the multiple dimensions present in the adolescent’s stories. The phenomena of respect and risk from the perspective of these Lakota adolescents revealed a paradox. Each can be either positive or negative, depending upon the circumstances or the context of the situation. This paradox became the pattern among the participants. The pattern is the rock (inyan) and the wind (tate). The rock and the wind are deeply interconnected, and the influence of one may impact the other. Three themes emerged from this pattern: role modeling (positive or negative), identity, and feeling valued. These themes are consistent with current research regarding adolescent high-risk behaviors. These stories are significant in that they are personal accounts by these adolescents. This study has implications in nursing education, nursing practice, and health policy. Nursing education must attend to teaching students to listen and to become comfortable working with other cultures. As nurses advocate for future programming, it is essential that the research that guides the policies and programming be community-based action research. As society becomes more diverse, nursing must embrace many perspectives, helping all to achieve the highest quality of health and well-being.
Effective Teaching in Clinical Simulation: Development of the Student Perception of Effective Teaching in Clinical Simulation Scale
(2009-06-23T21:51:22Z) Reese, Cynthia E.; Jeffries, Pamela; Pesut, Daniel J.; Halstead, Judith; Bakas, Tamilyn
Clinical simulation is an innovative teaching/learning strategy that supports the efforts of educators to prepare students for practice. Despite the positive implications of clinical simulations in nursing education, no empirical evidence exists to inform effective teaching in simulated learning environments. The purpose of this research is to create an instrument to measure effective teaching strategies in clinical simulation contexts. The conceptual framework for this study is the Nursing Education Simulation Framework. The Student Perception of Effective Teaching in Clinical Simulation (SPETCS) is a survey instrument scored on a 5-point Likert scale with two response scales: Extent and Importance. The Extent response scale measures participants’ perception of the extent to which the instructor used a particular teaching strategy during the simulation, and the Importance response scale measures perception of the degree of importance of the teaching strategy toward meeting simulation learning outcomes. A descriptive, quantitative, cross-sectional design was used. Evidence to support content validity was obtained via a panel of simulation experts (n = 7) which yielded a content validity index of .91. A convenience sample of undergraduate nursing students (n = 121) was used for psychometric analysis. Internal consistency reliability met hypothesized expectations for the Extent (α = .95) and Importance (α = .96) response scales. Temporal stability reliability results were mixed; correlations between administration times met expectations on the Importance scale (ICC = .67), but were lower than expected on the Extent scale (ICC = .52). Both response scales correlated within hypothesized parameters with two criterion instruments (p < .01). The Importance scale was selected for exploratory factor analysis (EFA). EFA revealed 2 factors: Learner Support and Real-World Application. The result of careful item and factor analysis was an easy to administer 33 item scale with 2 response scales. The SPETCS has evidence of reliability and validity and can serve as a tool for the assessment, evaluation, and feedback in the ongoing professional development of nurse educators who use clinical simulations in the teaching/learning process. In addition, results of this study can support the identification of best practices and teaching competencies in the clinical simulation environment.

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