Nursing School Theses, Dissertations, and Doctoral Papers

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Independent Simulation Observation and Reflection: A Feasibility Study
(2025-11) Searles, Krista Elaine; Carpenter, Janet; Friesth, Barbara; Moorman, Meg; Hmelo-Silver, Cindy
Clinical reasoning is essential for safe and effective nursing practice, yet traditional strategies for fostering clinical reasoning development in prelicensure nursing students are often limited by scheduling constraints, faculty availability, and resource demands. As nurse educators seek flexible, student-centered approaches to strengthen clinical reasoning skills, independent learning strategies that can supplement existing methods are increasingly valuable. This feasibility study examined Independent Simulation Observation and Reflection (ISOR), a theory-informed, asynchronous learning strategy in which students observe recorded simulations and complete guided reflections. ISOR is designed to serve as a low-resource, flexible complement to traditional strategies that can reinforce clinical reasoning through repetition and reflection. The study employed a within-subjects, quasi-experimental design. Undergraduate students enrolled in a nursing leadership course were recruited for voluntary participation. Participants completed both the ISOR activity and a virtual case study control assignment. After each activity, students completed surveys assessing acceptability, feasibility, and usability. Quantitative survey data were analyzed to compare student perceptions across the two learning strategies, and qualitative feedback provided additional context about perceived benefits and barriers of each strategy. Findings demonstrated that ISOR was similar to the case study in terms of acceptability, feasibility, and usability. Students found ISOR to be flexible, low-stress, and engaging, and reported that observing and reflecting on a simulation helped them apply prior learning, bridging the theory-practice gap. Barriers to implementation were minimal and primarily centered around technological issues that should be addressed prior to broader implementation or further study. The results of this study indicate that ISOR is a viable teaching strategy which could be implemented into nursing curricula with minimal disruption. Qualitative results also suggest that ISOR provides an opportunity for students to practice clinical reasoning skills. Further research is needed to investigate the impact of ISOR on clinical reasoning outcomes, to explore how repeated use of ISOR may influence engagement and learning outcomes, and to validate these results in a larger multi-site study.
Spirituality in Adolescents and Young Adults with Cancer: A Qualitative Descriptive Study
(2025-11) Oyedele, Oladele Oladimeji; Ellis, Rebecca Barlett; Draucker, Claire Burke; Otte, Julie; Miller, Wendy Trueblood
More than two decades ago, both the World Health Organization and the United Nations acknowledged spirituality as a core dimension of child development and an essential element of quality healthcare. Despite these recognitions, spirituality has not been well integrated into healthcare providers’ practice and training, especially in adolescent and young adult (AYA) cancer care, because there is a lack of understanding of spirituality informed by AYAs’ lived experiences. To build evidence-based programs and healthcare providers’ training that supports spirituality in AYA cancer care, there is a need to describe the experiences of spirituality among AYA during cancer diagnosis and treatments. This dissertation used a descriptive qualitative research design to describe the experiences of spirituality among AYA during their cancer diagnosis and treatment. Study aims were to (1) describe how AYA with cancer (a) describe themselves, (b) define spirituality, (c) experience sources of support, (d) articulate the meaning of life, and (e) articulate their spiritual beliefs; and (2) Aim 2: describe how AYA’s cancer experiences influence their spirituality and how their spirituality influences their experiences with cancer and their healthcare. A conventional content analysis was used to analyze the transcripts. The 11 AYA participants described themselves in terms of diverse cultural and religious beliefs. Their spirituality definitions often were rooted in religious perspectives, especially Christianity, and emphasized connections with a higher power or beliefs that shaped how they lived their daily lives. Sources of support came from several persons, especially family and friends. Participants’ cancer journeys led them to appreciate life more, feel closer to God, and evaluate their meaning and purpose in life. Many participants agreed that healthcare providers should address spirituality, while others expressed ambivalence about it. When providers addressed participants’ spirituality, it created a sense of closeness between participants and their providers. The participants’ spiritual views, in turn, helped them cope with cancer and maintain a positive outlook, improving their health.
Clinical Preceptorship of Nursing Students at an Academic Hospital in Kenya: A Descriptive Study of Preceptor Contributions and Student Perspectives
(2025-08) Weindorf, Lisa Michelle; Reising, Deanna L.; Cheriyattil von Gaudecker, Jane; Riner, Mary Elizabeth
Nursing education exists to prepare a nursing workforce competent to meet the healthcare needs of the population. Practical learning and experiences nursing students receive in the clinical setting are critical to nursing education’s effectiveness. Preceptorship is the teaching-learning method used in Kenyan, clinical, nursing education, but little is known about this model in the Kenyan context. This qualitative descriptive study set in Eldoret, Kenya was conducted to (1) describe the contributions Moi University School of Nursing & Midwifery faculty, Moi Teaching & Referral Hospital bedside nurses, and clinical nurse educators bring to the nursing students’ preceptorship experience at Moi Teaching & Referral Hospital, (2) describe the strategies Moi University School of Nursing & Midwifery faculty, Moi Teaching & Referral Hospital bedside nurses, and clinical nurse educators use to conduct nursing students’ preceptorship at Moi Teaching & Referral Hospital, and (3) describe the nursing students’ perspective of their preceptorship experiences at Moi Teaching & Referral Hospital. Data was collected from faculty members, bedside nurses, and clinical nurse educators through one-on-one interviews and from 3rd and 4th year nursing students through focus group interviews. Data was analyzed using constant comparative analysis. The results revealed unique contributions faculty, bedside nurses, and clinical nurse educators provided nursing students’ preceptorship and strategies used to accomplish each contribution. Faculty members were involved from preparation to final assessment. Bedside nurses provided practical training and opportunities for growth. Clinical nurse educators added hospital standards and quality improvement. Nursing students described their preceptorship experience as a “two-sided story”, acknowledging contributions from each preceptor role, but also expressing barriers to learning. Students’ learning was guided by clinical learning objectives and influenced by their relationships with nurses and their own self-initiative. Challenges to the preceptorship experience emerged naturally from preceptor and student data and included conflicting responsibilities and teaching-practice differences. This study deepens the understanding of Kenyan nursing education and provides foundational knowledge for future studies on clinical education and preceptorship in the Kenyan context.
Experiences of Non-Hispanic Black and African American Women with Postpartum Healthcare
(2025-06) Sposato, Margaret Fallon Van Brunt; Otte, Julie; Ellis, Rebecca; Draucker, Claire; Johnson, Jasmine; Tully, Kristin
Racial and ethnic disparities in maternal mortality and morbidity are stark in the United States, especially for non-Hispanic Black and African American women who experience elevated rates of pregnancy-related deaths and severe maternal morbidity. Effective postpartum healthcare is essential for preventing pregnancy-related deaths, successfully managing complications, and optimizing childbearing women’s health, yet little is known about non-Hispanic Black and African American women’s experiences with postpartum healthcare in the year following delivery. The purpose of this study was to describe non-Hispanic Black and African American women’s experiences with postpartum healthcare throughout the one-year postpartum period from their perspectives. Semi-structured interviews were conducted with 20 postpartum non-Hispanic Black and African American women in Indiana within 12 months of childbirth. The participant narratives were analyzed using qualitative content analysis. Participants identified eight types of positive experiences and eight types of negative experiences interacting with healthcare providers, nine types of healthcare facilitators and 12 types of healthcare barriers encountered during the one-year postpartum period, and eight recommendations for improving postpartum healthcare. The findings revealed (1) participants’ feelings about their postpartum healthcare were primarily influenced by relational experiences with providers (e.g. feeling attended to or dismissed) and whether their care needs were or were not met by providers, and (2) participants’ experiences accessing healthcare were primarily influenced by health system factors (e.g. having or not having enough appointments), resource and practical factors (e.g. childcare), and financial and insurance factors (e.g. having health insurance). The study results provide preliminary insights into non-Hispanic Black and African American women’s experiences with healthcare in Indiana during the one-year postpartum period and suggest there may be multiple opportunities throughout the postpartum year for healthcare providers and the health system to optimize this population’s healthcare experiences.
Nurses' Perspectives of Safe Sleep Education in the Prenatal Appointment: A Descriptive Qualitative Study
(2025-05) Bufink, Elizabeth Anne; Otte, Julie L.; Draucker, Claire B.; Bartlett Ellis, Rebecca J.; Turman, Jack E.
Approximately 20,000 infants die in the United States before their first birthday. Sleep-related deaths occurring in infants during the first year of life are a significant contributor to infant mortality rates in the United States with approximately 3,700 occurring each year. These deaths are associated with noteworthy racial disparities differences with SUID rates twice as high for non-Hispanic Black/African American than non-Hispanic White infants. Unsafe sleep practices, such as unsafe location, position, and bedding, contribute to sleep-related deaths in infants and are modifiable. Safe sleep education (SSE) in the prenatal environment allows for early access to safe sleep guidelines with further reinforcement of the teachings in the continuum of care. The qualitative descriptive study used interviews with prenatal nurses to describe their perspectives on integrating SSE into prenatal clinic visits. From these interviews, six categories emerged: current state of teaching SSE, facilitators and barriers to teaching SSE, nurses’ attitudes about SSE, nurses’ knowledge of safe sleep guidelines, nurses’ comfort level providing SSE, and best practice/recommendations for SSE, including tailored education to account for patient individual differences. These categories provide new information concerning safe sleep education in the prenatal environment. The information provides new avenues for intervention development to address the lack of sleep education in all prenatal patients, but especially in underrepresented groups, closing one area of health disparities regarding safe sleep. Additionally, the categories highlight the importance of policy and funding mechanisms to support these future interventions. The overarching goal is to decrease the infant mortality rate through safe sleep education introduced early in routine prenatal appointments and continued through the continuum of care.
Receptiveness to Social Support: Understanding the Conflicting Relationship Between Social Support and Medication Adherence in Adults with Type 2 Diabetes Mellitus
(2024-12) Elomba, Charles Donald; Bartlett Ellis, Rebecca; Carpenter, Janet S.; Knopf, Amelia; Staten, Lisa K.
Out of the 38 million Americans living with diabetes, about 34 million have Type 2 diabetes mellitus (T2DM). The chronicity of T2DM, the progression of the disease as pancreatic beta cells continue to decline in function, the propensity of the disease to affect multiple aspects of life, and the complex management strategies required to reduce the risk of diabetes-related complications highlight the significance of diabetes management. Antidiabetic medications are utilized in diabetes management to enhance glycemic control. Although adherence to antidiabetic medications is crucial, non-adherence is common and attributed to a variety of factors, such as social support. While social support is a promising approach for improving medication adherence, research on its influence has produced conflicting results, with some studies reporting significant relationships and others not. Receptiveness to social support might explain the conflicting findings between social support and medication adherence. Thus, a qualitative descriptive study involving 14 adults with T2DM was conducted to describe (a) factors that motivate them to take medications as prescribed, (b) their perceptions of the role of social support in T2DM medication management, and (c) their receptiveness to current or future social support for medication taking. Thematic analysis identified five themes: receiving the diagnosis and taking medications for T2DM (motivational factors), receiving support (perceptions of social support), envisioning the future, and advising others (receptiveness to social support). Participants described internal and external motivators for taking their medications and how social support from their support system, including their family, positively influenced their medication management by providing emotional encouragement, practical advice, and increased confidence. Privacy, trust, perceived need, and reluctance to ask for help were identified as factors influencing receptiveness to social support. The findings provide crucial insights into social support’s influence on T2DM medication management. They suggest that individuals’ openness to social support influences its effectiveness in enhancing medication adherence. These insights can guide future studies to incorporate receptiveness to social support, providing a more comprehensive understanding and enabling the development of instruments to measure it and theories that account for its influence, thereby enhancing the use of social support-related resources to improve medication adherence.
Symptom Clusters and Self-Management in Adolescents with Inflammatory Bowel Disease
(2024-07) Malloy, Caeli Louise; Miller, Wendy Trueblood; Rawl, Susan; Kroenke, Kurt; Monahan, Patrick; Steiner, Steven
Inflammatory bowel disease (IBD) encompasses a range of chronic conditions, including Crohn’s disease and ulcerative colitis, that cause intestinal inflammation and wide-ranging, debilitating symptoms. Adolescents and young adults represent the peak age group diagnosed with IBD. For individuals with IBD, engaging in effective disease self-management and symptom management is crucial to supporting quality of life. However, youth are often ill-equipped to handle the challenges of managing a chronic condition in the context of the typical developmental challenges of adolescence and young adulthood. This dissertation explored self-management challenges and symptoms in adolescents and young adults with IBD. First, an integrative review of the literature on symptom clusters in individuals with IBD was conducted. Results revealed that symptom clusters remain an understudied phenomenon in IBD research, illuminating a gap in current understanding of the symptom experience of individuals with IBD. Second, the self-management challenges of adolescents with IBD were explored in a thematic analysis of 83 posts made in an online IBD support community. Six emerging themes about self-management challenges were identified: Desire for Normalcy; Dietary Changes; Education and Career; Healthcare System; Relationships with Others; and Symptoms and Complications. Results underscored the ways in which IBD self-management challenges permeate every aspect of life for adolescents living with the condition. Finally, a cross-sectional survey of symptoms and self-management was conducted in 105 adolescents 13-17 years old with IBD. Through latent class analysis, three symptom cluster profiles were identified: a high symptom burden profile, a low symptom burden profile, and a low energy profile. Regression analysis revealed significant demographic and self-management predictors of symptom profile membership. The results of these studies will guide future research to develop and test theoretically grounded, tailored self-management interventions aimed at promoting effective symptom management and enhancing quality of life in adolescents with IBD.
Data Mining Teen Narratives on Reddit: Revealing Insights in Cyber Victimization Experiences
(2024-07) Antisdel, J'Andra Lashay; Miller, Wendy Trueblood; Ellis, Rebecca Bartlett; Jones, Josette; Carter, Gregory A.; Oruche, Ukamaka
As teens increasingly turn to the internet and social media for entertainment and social connection, they are faced with increasingly dangerous situations as technology advances and aggressors seek to harm and exploit victims online. This qualitative study used data mining and Word Adjacency Graphing (WAG), a type of computational analysis, with the aim of analyzing how teens on Reddit describe and discuss their experiences of cyber victimization. WAG modeling allowed for an examination of public, unsolicited teen narratives revealing patterns and alarming insights that were identified in six themes, including psychological impact, coping and healing, protecting yourself online, protecting yourself offline, victimization across various settings, and seeking meaning and understanding. These themes encompassed the impact of cyber victimization and its profound effects on the mental and emotional well-being of teens, emphasizing the importance of updated assessment methods and a trauma-informed approach in healthcare settings. In addition, the trauma expressed by teens highlighted the importance of recognizing cyber victimization as a serious adverse event impacting mental health. This approach would encourage open discussions, validate teens’ experiences, and focus on understanding and responding to the impact of trauma. The findings call for comprehensive strategies in healthcare to screen and assess for cyber victimization effectively, thereby supporting and empowering teens in overcoming these traumatic experiences.
The Relationship Between Instrumental Activities of Daily Living and Hospitalizations: A Systematic Review and Meta-Analysis
(2024-07) Collins, Jason Joseph; Newhouse, Robin P.; Levoy, Krisin; Basile, David P.; Jung, Miyeon
Instrumental activities of daily living (IADL) have been defined as the activities for which their performance is necessary for continued independent living arrangements and that are more complex than routine activities of daily living. Evidence has reported the presence of IADL impairments in patients discharging from hospital. However, there is little research evaluating the role of IADLs as a modifiable risk factor in preventing hospitalizations among high-risk groups, such as heart failure. This oversight leaves gaps in discharge planning, in connecting patients to needed services that address impaired IADLs. The purpose of this dissertation was to improve knowledge of the relationship between IADLs and hospitalizations by: 1) describing the theory that underpins the relationship between IADLs and hospitalizations; 2) completing a systematic review to narratively synthesize the state of use of IADL scales across studies examining hospitalizations among high-risk groups (i.e., heart failure); 3) completing a meta-analysis to estimate the overall association between IADLs and hospitalizations among the high-risk groups; 4) conducting tests of moderation using meta-analytic techniques to determine whether the overall association between IADLs and hospitalizations varied based on certain IADL scale characteristics (e.g., number of components). Founded upon the Theory of Self-Care of Chronic Illness, the systematic search produced 4,932 articles, with 23 meeting criteria. The systematic review revealed that IADL discussions have been present in healthcare literature internationally since 1969; significant heterogeneity exists in the number of IADL components; the legacy work of Lawton and Brody (1969) remains prevalent but not panoptic; and IADLs have been studied in a wide variety of illnesses. The meta-analysis revealed that IADL impairments were positively associated with hospitalizations (OR=1.40, 95% CI: 1.24, 1.58; k=22, p<.001). Tests of moderation indicated that the IADL scale (QM=0.496, p=0.481) and item composition (QM=0.189, p=0.664) did not explain variation among effect sizes, indicating that the IADL scale formulation did not impact the relationship between IADLs deficits and hospitalizations. This dissertation provides compelling evidence that assessing IADLs may yield a significant opportunity to identify modifiable risk factors to reduce hospitalization. More work is needed to standardize IADL measurement at discharge to identify patients at high risk.
Enduring Uncertainty Through the Lens of Osteoporosis: A Mixed Methods Study
(2024-06) Vlaeminck, Caitlin Mae; Miller, Wendy Trueblood; Carter, Gregory; Crowder, Sharron J.; Otte, Julie; Longtin, Krista
Osteoporosis is a chronic illness that is underdiagnosed and often poorly managed. Uncertainty is a phenomenon experienced by individuals diagnosed with chronic illness. There are no published American studies describing whether women diagnosed with osteoporosis experience uncertainty. Experiencing uncertainty can lead to decreased quality of life (QOL), delays in decision-making, and negative impacts on relationships. A mixed methods approach was used using descriptive statistics and two scales, The Mishel Uncertainty in Illness Scale-Community Form (MUIS-C) and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health scale, and Interpretative Phenomenological Analysis (IPA). Significant negative correlations were found between levels of uncertainty and physical health status and between physical and mental health. The qualitative study focused on describing the experience individuals had with the diagnosis of osteoporosis. Data were collected through semi-structured interviews with fourteen Caucasian women who all had a diagnosis of osteopenia or osteoporosis. Thematic analysis revealed five themes that could be chronologically processed: The Sentinel Event, Adapting to Chronic Disease, Navigating Uncertainty, Being Less Than, and What the Future Holds. The findings of this study have implications for how healthcare providers share knowledge and education about the disease of osteoporosis with individuals. Future research should include women and men from diverse racial and ethnic backgrounds. This inclusive approach is crucial for ensuring that preventive measures and management strategies are tailored to the diverse needs of all individuals, fostering equity and efficacy in osteoporosis care.

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