Nursing School Theses, Dissertations, and Doctoral Papers

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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.
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.
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.
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.
Nurse to Family Communication in Intensive Care Units
(2024-05) Dees, Mandy Lynn; Carpenter, Janet; Levoy, Kristin; Longtin, Krista; Reising, Deanna; Wocial, Lucia
Nurse to family communication is a crucial aspect of high-quality care delivery in adult intensive care units (ICU). Adult ICU nurses hold a unique position to engage in meaningful communication with families, often being the most accessible healthcare team members to family. However, these nurses frequently express a sense of ineptitude in their nurse to family communication skills. Simultaneously, families often find themselves unprepared for these adult ICU interactions yet are regularly tasked with the responsibility of surrogate decision-making when patients are incapacitated. Despite the successful utilization of the COMFORT (Connect, Options, Making meaning, Family caregivers, Openings, Relating, and Team) communication intervention in other settings, its implementation in the adult ICU has not been realized. Exploring the perspectives of adult nurses and nurse leaders on the COMFORT intervention topics could enhance the success of its implementation and sustainability in clinical practice. The overall goal of this three-paper dissertation was to advance scientific knowledge about nurse to family communication in the adult ICU setting. An integrative review was conducted to systematically assess available research evidence on enhancing communication between adult ICU patients/families and nurses. Using qualitative focus group approach, the aims of the next two studies were to gather participants’ perspectives of the practicability, appeal, and relevance of each COMFORT communication intervention topics and strategies for its implementation among adult ICU nurse leaders (second paper) and ICU nurses (third paper). Results of these studies indicate the importance of nurse to family communication in adult ICU environments and nurse leaders’ and nurses’ enthusiasm for the implementation of the COMFORT intervention in the ICU setting. Recommendations emerging from the focus group interviews include providing adult ICU nurses dedicated time to complete training during work hours, allowing early adopters to use the COMFORT app before expanding it to the entire unit staff nurse population, making the app accessible on unit computers, providing training suitable for nurses at all experience levels (from early career to seasoned staff), adopting a phased approach to implementation, and offering education on the COMFORT topics in quick, digestible learning tools suitable for a fast-paced nursing unit.
Career Decision-Making in Diverse Nursing Students: Choosing a Career in Nursing
(2024-04) McCord, Geoffrey Aaron; Otte, Julie L.; Ellis, Rebecca; Carpenter, Janet S.; Schall, Carly E.
The nursing profession lacks diversity that reflects the population it serves. The population of LPN/LVN and ADN students are known to be more diverse than BSN students. Little is known about the differences between the students in the three levels of nursing programs (LPN/LVN, ADN, BSN), including reasons for choosing nursing, and barriers and facilitators. The McCord Nursing Career and Educational Decision Pathway Conceptual Framework guided this study. A quantitative survey was conducted of current nursing students in the US. The study asked demographic information as well as motivating factors, barriers, and facilitators for choosing nursing and their program type (LPN/LVN, ADN, BSN). Responses from 741 nursing students in LPN/LVN, ADN, and BSN programs from 26 states. The study found significant differences between the students in the three educational pathways. There are significant racial and financial differences and differences in reasons for choosing nursing, educational background, commitments outside of school, and barriers to goal achievement. LPN/LVN students were more likely to be Black and ADN students were more likely to be Hispanic. There was greater racial diversity in the LPN/LVN and ADN groups. LPN/LVN students are more likely to identify nursing as their first career choice and most want to be an RN. LPN/LVN and ADN students were more worried than BSN students about their family commitments, financial obligations, and their ability to succeed in nursing school. Some of the lack of diversity in BSN programs reflects the challenges that racial minorities face in goal achievement. Identified barriers include outside financial commitments, the cost vii of nursing programs, and the length of time of the programs. The goal to increase diversity in nursing should consider the entire population of those who want to become nurses.
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.
Teaching Gun Violence Prevention in Undergraduate Nursing Programs
(2023-12) Holmes, Sarah Margaret; Draucker, Claire; Moorman, Meg; Halverson, Paul; Otte, Julie; Reising, Deanna
Gun violence is an epidemic that kills over 40,000 persons in the United States annually. Despite that gun violence is a significant public health problem, the topic is not often included in undergraduate nursing curricula. To understand this gap, the purpose of this study was to describe the teaching behaviors and perceptions of undergraduate nursing faculty related to gun violence prevention (GVP) and to explore factors that are associated with their behaviors. A survey was developed to measure faculty behaviors and perceptions. A sample of 102 nursing faculty recruited via social media communications, professional organization electronic discussion boards, and an electronic listserv completed the survey. Descriptive and inferential statistics and content analysis were used to analyze their responses. Whereas most participants were favorable to including GVP topics in curriculum, only 31 had taught about GVP in an undergraduate nursing course. Participants most frequently indicated the following topics and skills should be taught: the role of guns in unintentional injuries, suicide, and intimate partner violence; assessing for gun access; counseling about safe gun storage; and counseling about lethal means restrictions to prevent suicide. Participants indicated that key barriers to teaching about GVP included having too many other topics to teach, lack of standardized educational materials, lack of guidance from accrediting bodies, lack of faculty expertise, and the current political atmosphere. Perceived level of knowledge, level of confidence, and beliefs about teaching GVP were significantly associated with teaching GVP. The findings highlight the need for faculty development programs to increase awareness of gun violence as a public health issue and assist faculty to integrate GVP education into curricula. The findings also indicate that national nursing organizations should develop guidelines, identify competencies, and provide resources related to the inclusion of GVP content in undergraduate nursing programs.
Instrumental Activities of Daily Living Among Patients with Heart Failure
(2023-12) Algashgari, Elham Yousef; Otte, Julie Lynn; Jung, Miyeon; Jung, Miyeon; Pressler, Susan J.; Wierenga, Kelly L.; Stewart, Jesse C.
Heart failure (HF) is a prevalent public health concern affecting 6.2 million Americans. HF is associated with decreased cognitive and physical functioning that may decrease patients' ability to perform instrumental activities of daily living (IADL). IADL are central to maintaining independent living, taking care of oneself, and having a satisfactory quality of life. Little is known about theory-based approaches to IADL in HF and about the facilitators and barriers to treatment fidelity of cognitive interventions, which limit the ability to identify factors amenable to intervention to improve IADL. Thus, a theoretical model was developed to identify explanatory variables influencing IADL in HF based on theoretical and empirical literature. The overall purpose of this dissertation was to establish a theoretical model for IADL and assess the treatment fidelity of supporting clinical trials. Specific aims included: (1) characterizing IADL performance in patients with HF, (2) testing the newly developed theoretical model to assess the relationship between the explanatory variables of age and gender, HF severity, depressive symptoms, physical and cognitive dysfunctions, and IADL performance; and (3) identify facilitators and barriers to treatment fidelity perceived by intervenors while delivering computerized cognitive interventions to patients with HF. The study findings provide knowledge about the level of IADL performance in HF and identify factors that could be targeted for intervention in future studies.

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