Nursing School Theses, Dissertations, and Doctoral Papers

Permanent URI for this collection

https://hdl.handle.net/1805/1135

Browse

Now showing 1 - 10 of 121

A Case Study Design Examining New Graduate Registered Nurse Well-Being
(2024-01) Zidek, Stephanie Marie; Wonder, Amy Hagedorn; Opsahl, Angela; Reising, Deanna; Rybas, Natalia
In the face of multifarious challenges, including individual stressors, nursing workforce fluctuations, and lingering effects of the COVID-19 pandemic, the well-being of new graduate registered nurses (NGRNs) during their initial months of practice is a pivotal concern. This study, employing a qualitative case study design, investigates the wellbeing of NGRNs during their first three months, with the dual objectives of understanding their state of well-being and identifying its facilitators and inhibitors. Data collection involved reflective journaling and structured focus groups with 12 NGRNs from four neighboring hospitals within a large, not-for-profit system over three months. Braun and Clarke’s thematic analysis revealed three critical themes elucidating NGRNs’ complex experiences: (1) emotional and physical well-being, (2) interpersonal relations and support, and (3) professional development and work environment. These insights underscore the diverse challenges the NGRN participants experienced during the transition to practice period, as well as identify facilitators (e.g., preceptor impact, peer support, patient interaction, self-care, supportive services) and inhibitors (e.g., disappointment, fatigue, schedule constraints, shiftwork, overwhelmed feelings, stress, and bullying). Derived from participant insights, the findings advocate for nuanced interventions across various nursing disciplines and settings. Recommendations include integrating emotional resilience curricula in nursing schools, promoting adaptive strategies and supportive policies by nursing boards, developing criteria for program support effectiveness by accreditation agencies, and adopting flexible scheduling and supportive environment policies by health organizations. These strategies address key findings such as disappointment, workplace bullying, and shiftwork complications, bridging the expectation-reality gap for NGRNs. This study contributes to the discourse on NGRNs’ well-being, presenting a structured approach for enhanced support and policy adaptations, facilitating an improved transition into the nursing profession. The comprehensive exploration and thematic insights contribute to the understanding and addressing the well-being of NGRNs, providing a roadmap for enhanced support and policy implementation, ultimately aiming to facilitate a successful transition into the nursing profession.
A Simulation Pre-Brief Scaffold to Support Clinical Judgment and Independence in Clinical Judgment Decision Making
(2024-01) McIntire, Emily S.; Friesth, Barbara Manz; Hendricks, Susan; Reising, Deanna; Danish, Joshua
It is essential that nurses independently assume patient care, yet new nurses lack necessary clinical judgment skills. The purpose of this study was to examine a simulation pre-brief scaffold to support nursing students’ clinical judgment development and clinical judgment independence. The pre-brief experiential learning scaffold for clinical judgment independence (PELS-CJI) framework informed simulation pre-brief in this experimental study. A convenience sample included traditional and accelerated Bachelor of Science in nursing students in their senior year. Participants were randomly assigned to complete a simulation pre-brief with or without the Interactive-Video Recorded Simulation (I-VRS). Nursing student’s total clinical judgment and individual components of clinical judgment (noticing, interpreting, and responding) in simulation were measured by a single evaluator blinded to condition using the Lasater clinical judgment rubric (LCJR) (Cronbach’s alpha .932). To measure clinical judgment independence, the number of unintended conceptual cues during simulation were counted. Participants in the intervention group had higher clinical judgment scores during simulation (n = 31, M = 28.45, SD = 5.163) as compared to the control group (n = 36, M = 25.06, SD = 5.275), t(65) = -2.653, p < .01. A significant relationship for the noticing and responding subscales of clinical judgment was observed between groups, but not for the interpreting subscale. No significant difference in the number of unintended cues was found between groups. Results support that using an I-VRS in simulation pre-brief enhanced clinical judgment in simulation. The use of the I-VRS adds to the existing limited evidence related to simulation pre-brief to support clinical judgment development among undergraduate nursing students. Future research using an I-VRS during pre-brief is necessary to determine if improvement in clinical judgment is retained and transferrable to the clinical setting. Additional testing of the PELS-CJI to guide simulation pre-brief is encouraged.
Activation in Persons with Opioid Use Disorders in Intenstive Outpatient Treatment
(2021-12) Keen, Alyson Yvonne; Lu, Yvonne; Draucker, Claire Burke; Oruche, Ukamaka; Mazurenko, Olena
Persons with opioid use disorder (OUD) often receive intensive outpatient treatment (IOT) but these programs are associated with low rates of completion and high rates of relapse. Enhancing patient activation - taking an active role in one’s healthcare - would likely improve outcomes for persons with OUD in IOT. The overarching purpose of this dissertation is to describe how persons with OUD experience IOT, especially regarding activation. The dissertation includes three components. The first is an integrative review of 29 studies of activation in persons with mental health disorders generally. Results revealed that activation was related to several heath and treatment-related factors and some interventions, most notably educational programs, increased activation. The second and third components were based on interviews with 14 persons who had been enrolled in an IOT program in academic health centers. The second component was a constructivist grounded theory study conducted to describe the process people undergo as they participate in an IOT program. Participants described a process of connecting and disconnecting that included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. The third component was a qualitative descriptive study conducted to describe types of instances in which persons play an active role in their IOT (activation). Participants described six types of instances: (1) making and enacting one’s own treatment decisions, (2) actively engaging in treatment planning with staff, (3) choosing to actively engage in groups, (4) making a commitment to treatment, (5) taking responsibility for one’s own recovery, and (6) taking actions to avoid relapse. The results of this dissertation will inform the development of strategies to enhance activation among persons with OUD in IOT with the goal of improving engagement and program outcomes.
Activities and support provided by family caregivers of persons with type 2 diabetes
(2016-03-11) Scarton, Lisa J.; Bakas, Tamilyn; Miller, Wendy; McLennon, Susan M.; Huber, Lesa
Type 2 diabetes, a chronic condition affecting millions, continues to rise in epidemic proportions. Type 2 diabetes, managed through lifestyle changes, affects the entire family. Family caregivers provide vital support to these individuals; however, little research has been conducted surrounding the perceived difficulty or ease of caregiver activity and supportive behaviors. The purpose of this dissertation was to develop and psychometrically test a scale that measures this difficulty or ease of activities and behaviors. This was accomplished through the compilation of three distinct manuscripts. First, an integrative review was conducted to identify what is known regarding needs and concerns of family caregivers of persons with type 2 diabetes; findings revealed a need for more research. Then, based on these recommendations, a qualitative study was conducted that explored the needs and concerns identified by 33 American Indian, African American, and White family caregivers. All these caregivers had similar concerns related to needing general diabetes information, providing support to the family member, and taking care of their own health. Study themes were used to develop items for a new instrument, the Diabetes Caregiver Activity and Support Scale (D-CASS) that was psychometrically tested with 101 American Indian, African American, and White family caregivers of persons with type 2 diabetes. This study used a cross-sectional, descriptive-correlational design and provided evidence of internal consistency reliability (α = .82) and two-week test-retest reliability (intraclass correlation coefficient = .70) for the D-CASS. Criterion-related validity was established using a single-item criterion measuring overall how easy or difficult it was for caregivers to provide care for their loved ones (r = .65, p < .01). Unidimensionality was supported by factor analysis, with loadings ranging from .45 to .70, with 32% of the variance explained by the first factor (eigenvalue = 4.02). Model testing through a series of three hierarchical multiple regressions guided by a conceptual model provided further evidence of construct validity for the D-CASS. This dissertation provided better understanding of needs and concerns of family caregivers of persons with type 2 diabetes and led to the development of a psychometrically sound diabetes-specific instrument for future research.
Adolescent Birth Mothers After Unintended Pregnancy and Infant Open Adoption
(2009-12-08T19:11:56Z) Clutter, Lynn B.; Sims, Sharon L.
Birth mothers of open adoption are not well studied. This inquiry explored birth mothers’ experiences surrounding unintended pregnancy and infant open adoption placement. The focused objective was to describe adolescent birth mothers’ lives following pregnancy and adoption placement. This qualitative study used naturalistic inquiry, with participants giving 1 to 2 hour tape recorded telephone interviews. Verbatim transcripts were de-identified and systematically analyzed. Birth mother samples were at either 1 to 5 years or 5 to 15 years after infant open adoption placement. Overall both samples chronicled stories from preconception through current life. Birth mothers of both samples were unanimous in their support of open adoption. The sample of 10 birth mothers who were interviewed 1 to 5 years postplacement shared life descriptions from prepregnancy; pregnancy with the decision for open adoption placement and choice of adoptive family; birth in context with the adoptive parents and birth child; postpartum and discharge. Postplacing birth mother findings were presented using the acronym AFRESH: A–adoption accomplishments; F–fresh start; R–relationships; E–emotions; S–support; H–healing. Personal, social, and relational benefits of open adoption far outweighed pregnancy, birth, and emotional challenges. Even though the process and outcome were “hard,” and included personal obstacles, the open adoption placement was “best.” Birth children were viewed as thriving, blossoming, and having a wonderful life. Adoptive families were cherished like those of extended family. Birth mothers thought health care providers should share the option, and then provide adoption friendly care. They also would advise pregnant teens to choose open adoption. Results from the 5 to 15 years postplacement sample of 5 birth mothers yielded themes of (1) satisfaction about decision for open adoption, choice of adoptive couple, and seeing a thriving birth child; (2) personal milestone accomplishments in education, finances, work, life, and relationships; (3) a sustaining sense of being a better person with an improved life; and (4) the essential need for support during and after the process.
Adoption and Implementation of Screening, Brief Intervention, and Referral to Treatment
(2020-06) Thoele, Kelli Marie; Newhouse, Robin; Draucker, Claire Burke; Harle, Christopher; Fulton, Janet
More than 20 million people in the United States have a substance use disorder, resulting in negative individual and societal outcomes. An evidence-based intervention, Screening, Brief Intervention, and Referral to Treatment (SBIRT), involves screening patients to assess for substance use and then providing a brief intervention and referral to treatment when indicated. This evidence-based intervention is underutilized in healthcare settings. The purpose of this dissertation was to contribute to the body of evidence regarding the implementation of SBIRT in healthcare settings. Specifically, the aims of this dissertation were to 1) provide an overview of the evidence regarding the use of implementation strategies to facilitate the implementation of SBIRT, 2) describe implementation of SBIRT by nurses in acute care hospitals, and 3) examine individual and organizational characteristics associated with the intra-organizational adoption of SBIRT. To review the literature, a scoping review was completed on 18 articles that met the inclusion criteria. The review found that leaders often train and educate stakeholders to facilitate the implementation of SBIRT, but less attention has been given to adapting the intervention or engaging patients. Additionally, implementation efforts led to increases in screening, but the evidence regarding the effect on brief intervention is inconclusive, and evidence regarding referral to treatment is scarce. Eighteen nurses participated in a qualitative descriptive study of the implementation of SBIRT, and data were analyzed using content analysis. Participants identified barriers and facilitators associated with the nurses’ attitudes and beliefs about SBIRT, organizational factors, and patients’ response to the SBIRT process. Participants indicated that SBIRT was a useful intervention that was best implemented by providing a clear process and incorporating SBIRT into an established workflow. To examine factors related to intra-organizational adoption of a tool to screen patients for substance use, two hundred twenty-two nurses participated in a crosssectional study. Results of this study indicate that training and the perception of peer usage of the intervention were significantly related to individual nurses’ use of the intervention in practice. The findings of this dissertation can inform research and practice regarding the implementation of SBIRT in healthcare settings.
The Attributes of Nurse Residency Programs Influencing the Newly Licensed Registered Nurse
(2020-12) Kiger, Christina Louise; Otte, Julie L.; DeMeester, Debbie; Draucker, Claire; Hoffmann-Longtin, Krista
New nurses report feeling unprepared, incompetent, and highly stressed, contributing to first-year turnover rates of 25% in some healthcare organizations. Turnover, combined with a preparation-practice gap, has alerted advocacy organizations and researchers to recommend the development of nurse residency programs. Nurse residency programs are a post-graduate training period where new nurses receive enhanced clinical education in the healthcare setting. While highly variable in structure and attributes, programs usually include educational sessions, clinical immersion, and role socialization opportunities. Evidence supports that new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, competence, and decreased turnover rates. Despite this, only half of the hospitals nationwide have implemented a program with most designed around a single health system mission. This dissertation study aimed to identify the attributes of nurse residency programs influencing the newly licensed registered nurse. An integrative review of the literature and evolutionary concept analysis was completed to examine the state of the science of nurse residency programs. Findings revealed a lack of conceptual and theoretical design and variability among program structures, creating a gap in the literature about the attributes of programs that are most influencing new nurses. Based on the literature's noted gaps, a qualitative description study was conducted. Purposive sampling strategies were used to recruit nurses who recently completed varied program models across the United States. New nurses reported the attributes of programs and described how those positively and negatively influenced the transition to practice experience. The overarching themes revealed that new nurses need a cadre of highly supportive individuals across the clinical and educational continuum who espouse astute interpersonal and communication skills. New nurses desire engaging activities with intra and interprofessional team members for clinical skill application, knowledge advancement, and role socialization. New nurses need the structure of meetings at times and in a sequence conducive to learning; and for preceptorship experiences to be facilitated by trained preceptors, on a unit, and of a length that supports confidence for autonomous practice. Future research will include the development and testing of an evaluation tool based on the findings from this study.
Becoming an RN : a hermeneutic phenomenology study of the socialization of graduate RNs
(2017-08-30) Hostutler, Jennifer J.; Reising, Deanna L.; Bemis, Cynthia Marie; DeMeester, Deborah; Miller, Wendy Renee
Nationwide, there has been a trend for acute care facilities to hire a greater percentage of new graduate registered nurses (GRNs). It has been estimated that in acute care 42% of newly hired Registered Nurses (RNs) are likely to be new graduates; and turnover rates for these new hires can range between 35 and 60 percent. A high turnover rate of RNs can have several negative consequences including increased cost in training and recruitment, and decreased quality of patient care. Current literature has identified challenges that occur during the transition period between being a student and becoming a registered nurse. There is a gap in the literature regarding an understanding of the experience of the newly graduate RNs and an understanding of when GRNs feel like they are fully functioning as an RN and part of the health care team. A Hermeneutic Phenomenology study was conducted in a 500 bed acute care facility in Northeast Ohio. Ten GRNs agreed to participate in the study and completed one-on-one interviews with the researcher. Themes that emerged focused on the process of transitioning into the role of RN. Participants discussed challenges of the new RN role, especially their first code experience. Major themes that emerged included: self-esteem and confidence, development of critical thinking, mentoring, bullying, amount to learn, and high expectations.
A brief intervention to improve emotion-focused communication between newly licensed pediatric nurses and parents
(2014-01-03) Fisher, Mark J.; Broome, Marion E.; Friesth, Barbara M.; Magee, Tracy; Frankel, Richard M.
Parents have increasingly participated in their children’s bedside care. Parental participation has led to more provider-parent interactions and communication during such stressful events. Helping parents through such stressful events requires nurses to be skilled communicators. Brief methods of training emotion-focused communication with newly licensed nurses are needed, but as yet are rare. The purpose of this study was to evaluate the impact of a validated brief communication (Four Habits Model) training program for newly licensed pediatric nurses. The intervention focused on ways to improve nurses’ emotion-focused conversations with parents. Information processing and Benner’s novice to expert informed this study. The intervention is based on the four habits model, with “habits” providing a structure for nurses to organize their thinking and behavior during emotion-focused conversations with parents. Thirty-five pediatric nurses with 0–24 months of nursing experience at a large mid-western children’s hospital participated in the study. Mixed methods provided data for this experimental study, using a group-by-trials repeated measures ANOVA design. Participants randomized to the intervention group participated in a one-hour three-part training: adapted four habits model content, simulated nurse-parent communication activity, and debrief. Participants randomized to the control group observed a one-hour travel video. Key outcome variables were Preparation, Communication Skills, Relationships, Confidence, Anxiety, and Total Preparation. Compared with the controls, the intervention group improved significantly in the following areas: Preparation, F(1,33) = 28.833, p < .001; Communication Skills, F(1,33) = 9.726, p = .004; Relationships, F(1,33) = 8.337, p = .007; Confidence, F(1,33) = 36.097, p < .001; and Total Preparation, F(1,33) = 47.610, p < .001. Nurses’ experience level had no effect, with the exception of Anxiety. Nurses with more experience (≥ 12 m) showed a greater reduction in Anxiety, when compared to nurses with less experience (< 12 m), F(1,31) = 5.733, p = .023. Fifty-two percent of the nurses involved in the intervention later reported specific examples of implementing the four habits when working with parents in clinical settings. A one-hour four habits communication-training program is effective in improving newly licensed nurses’ preparation for emotion-focused conversations with parents.
Cancer Treatment-Related Fatigue: Psychometric Testing of the Cancer Treatment-Related Fatigue Representation Scale (CTRFRep) in Patients Undergoing Radiation Treatment for Cancer
(2010-02-02T21:24:42Z) Reuille, Kristina M.; Welch, Janet L.; Keck, Juanita F.; Fulton, Janet S.; Friesth, Barbara Manz
Cancer treatment-related fatigue (CTRF) is recognized as a prevalent and bothersome symptom for patients with cancer. In a model of the CTRF experience, CTRF representation, or the beliefs, thoughts and emotions surrounding the experience of CTRF, is believed to mediate the relationship between CTRF intensity and CTRF distress. To date, there is no reported measure of CTRF representation. The purpose of this descriptive, cross-sectional study guided by Leventhal’s Common Sense Model of Self-Regulation was to evaluate an instrument designed to measure CTRF representation, the CTRF Representation scale (CTRFRep), based on an existing measure, the Illness Perception Questionnaire (IPQ-R). The study included 47 patients (mean age=57.7 years) receiving radiation therapy for cancer interviewed one month post-treatment. 77% of patients had fatigue during treatment. Three content experts and one theory expert assessed content validity of the CTRFRep. The content experts included three behavioral oncology nurse researchers whose focus is on symptom management and/or fatigue. The theory expert was a nurse researcher who is an expert in the area of self-regulation theory. As tested, the CTRFRep consisted of 105 items in 10 subscales addressing beliefs about the Identity, Timeline (Acute vs. Chronic/Cyclical), Consequences (positive/negative), Cause, Control (Treatment/Personal), Symptom Coherence, and Emotional Representation of CTRF. When evaluating psychometrics, the Identity and Cause subscales are analyzed independent of the other subscales. For the Identity subscale, symptoms most reported as related to CTRF were lack of energy, loss of strength, and feeling blue. For the Cause subscale, the most common beliefs regarding causes of CTRF were cancer treatment(s), having cancer, and stress or worry. Results indicate adequate reliability in six of eight remaining subscales (α>=0.70); the item N in those subscales was reduced from 56 to 34. To address construct validity, logistic regression assessed whether CTRFRep mediated the relationship between CTRF intensity and CTRF distress. After controlling for negative affect, the Identity and Consequences subscales were significant mediators – the Acute vs. Chronic Timeline and Emotional Representation scales were partial mediators – of the relationship between CTRF intensity on CTRF distress. These findings indicate fatigue is a problem for people undergoing treatment for cancer, and the CTRFRep may be a reliable and valid measure of CTRF representation for patients undergoing radiation treatment for cancer. Small sample size prevented successful factor analysis of the CTRFRep. Further research of the CTRFRep is warranted.

Browse

Browsing Nursing School Theses, Dissertations, and Doctoral Papers by Title

Results Per Page

Sort Options