Recent Submissions

  • Associations Between Social Determinants of Health and Net Stress

    Lassiter, Debbie Jo; Department of Physiological & Technological Nursing (Augusta University, 2021-12)
    Stress is known to cause dire physical and mental health outcomes. Extant stress research has lacked a subjective rapid screening tool for further evaluation of high risk individuals. Net stress is a new construct developed in this study as the calculation of an individual’s perceived average stress level compared with their perceived healthy stress level. Measuring net stress provides an additional construct to identify health disparities among individuals at potential risk for mental and physical illness. The two aims were first to develop the net stress construct and secondly to examine and evaluate the relationships between net stress and Social Determinants of Health (SDoH) domain variables from the 2018 Stress in AmericaTM survey developed by APA and The Harris Poll survey and analytics group. The five SDoH domains developed by Healthy People 2020 were Neighborhood and Built Environment, Health and Health Care, Social and Community Context, Education, and Economic Stability. The methods included an exploratory, secondary analysis which included multiple regression to test whether net stress would respond predictably as a valid, new construct within the sample from the survey (N = 3,091). Net stress was regressed on the groups of variables for each domain, then on a model with all variables to determine if there were substantial differences in how net stress responded. Conclusions for this study were that four of the five domains, excepting Education, had substantial associations (0.25 standard deviation) with net stress. Using slightly less restrictive criteria, net stress was associated with variables from all five SDoH domains. Results were that net stress responded as a valid, new construct within this analysis. This study found that individuals with the following circumstances had substantially higher net stress levels: larger household size up to eight residents, single parent family structure, having no insurance, having a low perceived health level, being of bisexual orientation, being female, and having low household income. The Economic Stability domain impacted all other domains. Implications for future research, healthcare practice, nursing theory, and policy were discussed.
  • Belief in Research, Religious Coping, and Willingness to Participate in Clinical Trials among African Americans with Hematologic Malignancies

    Petty, Marjorie Elizabeth; Department of Physiological & Technological Nursing (Augusta University, 2021-12)
    African Americans (AAs) are disproportionately affected by certain types of hematologic malignancies. Despite the efforts of investigators, AAs with hematologic malignancies remain grossly underrepresented in cancer clinical trials. Few studies have evaluated the underrepresentation of this subgroup of patients in the context of their willingness to participate in clinical trials. Yet, willingness to participate in cancer clinical trials among AAs with solid tumors is well documented. The aims of the present study were to determine if a relationship exists between belief in research and willingness to participate in clinical trials and determine if religious coping moderates the relationship between belief in research and willingness to participate in clinical trials. To address the aims, data on religious coping were captured at one time-point using the validated Brief RCOPE scale and also using researcher-generated questions that addressed beliefs associated with research and willingness to participate in cancer clinical trials. The results reported here show there was no statistical difference between belief in research and willingness to participate in clinical trials, and religious coping did not moderate the effect of belief in research on willingness to participate in clinical trials. Statistically significant differences were found between education and belief in research. Participants with less than a high school education had lower belief in research scores than those with some college education, who showed higher belief in research scores. These findings provide preliminary results that suggest future studies are warranted in the study of AAs' beliefs in research. Such studies may contribute to the development of educational interventions to improve the recruitment of AAs with hematologic malignancies into the therapeutic clinical trials for these diseases, with a particular emphasis on educational interventions for those AAs with less than high school education. The study highlights the need for researchers to develop tailored educational approaches on cancer clinical trials for AAs with less than high school education. Such considerations may improve patients’ decision-making and access to novel therapies that could benefit the individual and others. Furthermore, researchers need to assess religious coping methods and develop tailored religious coping strategies that can be implemented into the clinical setting for AAs with hematologic malignancies. Tailored religious coping strategies could improve patient wellness and minimize the consequences of maladaptive religious coping (Pargament et al., 2011) among AAs with hematologic malignancies. Keywords: African American, hematologic malignancies, cancer clinical trial
  • Social Determinants of Health Associated with Parental Hesitancy and Teen Human Papillomavirus Immunization

    Lee, Seth; Department of Physiological & Technological Nursing (Augusta University, 2021-08)
    Background: Human Papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States. HPV-preventive vaccination of teens may be blocked by parental hesitancy, related to negative social determinants of health in the community. Parental hesitancy is one of the most significant barriers to increasing teen HPV vaccine uptake. Aims: The first aim was to determine associations among social determinants of health domain variables and parent-reported vaccine hesitancy of HPV immunization. The second aim was to determine the model that best explains how social determinants of health affect parental vaccine hesitancy of HPV immunization for each of the five reasons not to vaccinate. Methods: This quantitative retrospective study used logistic regression to examine relationships among parent-reported reasons not to vaccinate teens and selected social determinants of health variables utilizing the Centers for Disease Control and Prevention National Immunization Survey-Teen 2018. Variable selection was guided by the Social Determinants of Health Framework, categorized into five key domains: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment (N = 7480). Results: Bivariate associations emerged across reasons not to vaccinate; the most frequent associations included variables such as the education level of a teen's mother and language of the survey interview. Models from multivariable regression with backward elimination indicated that key issues within the domains of education, health and healthcare, and social and community context were associated with parental hesitancy of HPV immunization. Conclusion: Stakeholders should focus on key issues within the domains of education, health and healthcare, and social and community context when designing policy and providing HPV immunization to teens. Taken holistically, key issues within the domains of education, health and healthcare, and social and community context are more likely to lead to vaccine hesitancy based on the findings in this study and require an approach tailored to the needs of the community and its residents. More research is needed to verify these results.
  • Cassandra Radical Feminist Nurses Network: Feminism, Nursing, and a History for the Present

    Dillard-Wright, Jessica Susan; Nursing (Augusta University, 2020-12)
    As the last light of the Equal Rights Amendment (ERA) faded in 1982, a group of radical feminist nurses coalesced around their shared outrage at nursing’s disciplinary failure to engage deeply with feminist causes. The 1982 American Nurses Convention coincided with this last gasp of the ERA, held in a hotel in Washington, D.C. where thousands of nurses, overwhelmingly women, converged for professional development and camaraderie. And although the city outside the hotel roiled in protest, the Convention unfurled with nary a mention of the constitutional amendment that would secure legal equality irrespective of gender. Incensed by this omission, and with nursing’s general resistance to political engagement, these radical nurses descended on the hotel bar and began organizing what would become Cassandra Radical Feminist Nurses Network. Cassandra Radical Feminist Nurses Network (“CASSANDRA” hereafter, in the convention established by the organization in their Newsjournal) was an activist network active from 1982 until 1991. This study used historical research methods to document CASSANDRA’s legacy while unpacking the complex interrelationship between nursing and feminism. This includes examining the influences of race, gender, and sexuality, influences that shapes normative understandings of nursing from its Victorian origins to the present. CASSANDRA was unusual in its overt affiliation as a nurses’ organization with a radical feminist allegiance during an era when feminism and nursing were frequently at odds. As a decentralized, radical feminist “web,” the aim of CASSANDRA was to “create and develop a group that would truly provide an open forum for feminist nurses from all walks of life and how to avoid the usual male-oriented hierarchy and rigidity of most national organizations” (LaGodna, 1982, p. 1). In unfurling the nuances of gender and sexuality that CASSANDRA navigated, it is clear that the work of CASSANDRA envisioned a radical space for collective resistance and connection, reflecting the normative expectations in nursing that stemmed from nursing’s Victorian imaginary. Even while CASSANDRA’s work around gender and sexuality was bold and transgressive, their engagement with race was poorly articulated. Because of this, the organization’s work reinforced white normativity. Ultimately, like mythological Cassandra, CASSNADRA would eventually quiet to a whisper. What understanding the thrums of CASSANDRA, of nursing’s rich and complex history can do is provide a clear view of nursing’s disciplinary history. This is a fundamental prerequisite for a more just, equitable nursing future.
  • Impact of general health on the outcomes of center-based cardiac rehabilitation

    Roberts, Kimberly A; Nursing (Augusta University, 2020-12)
    Background: Cardiovascular disease is the number one cause of death, and cardiac rehabilitation (CR) is effective in reducing the risks of disease progression and mortality by improving physical functioning and quality of life. Despite the significant impact of CR, the completion of CR is low. Factors influencing CR completion have been widely studied, but little is known about the impact of general health on CR completion self-care behaviors, and physical functioning associated with CR completion. Therefore, the purpose of the study was to explore relationships between health beliefs, general health, CR completion, physical function, and self-care behavior. The conceptual framework shows how health belief perceptions, support systems, sociodemographic factors, and general health influence CR completion, physical function, and self-care behavior. Methods: This was a retrospective cohort study using a sample of participants completing the outpatient CR center at a large medical center in the southeastern United States. Multiple linear regression was used to determine the predictors of CR completion, the improvement of physical function, and self-care behavior. Results: HbA1C predicted CR completion, and there was no significant relationship between CR completion and general health. Gender and general health (sitting time, fatigue, anxiety, and depression) predicted the improvement of physical functioning. Age and general health (sitting time, self-care complexity, and disease burden) predicted self-care behaviors. There was no relationship between health beliefs and CR completion. Conclusion: CR completion was predicted by glycemic control, while physical functioning improvement and self-care behavior were predicted by general health indicators. Additional research is needed to validate the findings and develop a sensitive screening tool to identify high-risk patients who are likely to drop out from a CR program. Further research to develop strategies to prevent CR incompletion and poor outcomes prior to patients’ participation is warranted.
  • Improving Heart Failure Outcomes Using Guideline

    Crew, Deborah; Flores, Yolanda; Augusta University Health; College of Nursing (2019-05-01)
    This poster presents a project plan and intervention to improve heart failure.
  • An Essential Oil Intervention for Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Survivors: A Mixed Methods Study

    Langley-Brady, Dawn Louise; Nursing (Augusta University, 2020-12)
    Chemotherapy-induced peripheral neuropathy (CIPN) is a painful, debilitating consequence of cancer treatment and is considered the most adverse of non-hematologic events. Pharmacological approaches to CIPN are often ineffective and cause adverse effects. A problem faced by many breast cancer survivors is poor CIPN treatment coupled with practitioners’ lack of understanding about their subsequent quality-of-life (QOL). Essential oils (EOs) are an underutilized non-pharmacological approach to pain reduction. EO mechanisms of action include non-competing inhibition of 5-HT, AchE, and Substance P and antagonism of TRPA1 and TRPV1. The study aims were to ascertain the effect of an EO intervention (EOI) on CIPN and quality-of-life (QOL) in breast cancer survivors and develop a deeper understanding of CIPN QOL using photovoice methodology. This mixed methods research design employed a randomized, single-blind, placebo-controlled trial. Twenty-six breast cancer survivors with chronic lower extremity CIPN were enrolled in the quantitative strand using purposive sampling. Participants were stratified by baseline pain score and randomized to intervention (n = 13) and placebo (n = 13) groups. Participants topically applied an EOI (containing Curcuma longa, Piper nigrum, Pelargonium asperum, Zingiber officinale, Mentha x piperita, and Rosmarinus officinalis ct. cineole) or placebo three times a day for six weeks. Pain was assessed weekly using the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2) and daily using the Visual Analogue Scale (VAS). QOL was assessed using the QOL:CIPN20 and QOL Adult Cancer Survivor questionnaires(QLACS) at baseline, midpoint, and endpoint. Data were analyzed in SPSS using generalized estimating equations. Test of model main effects were significant for visit (SF-MPQ-2, p = .000; VAS, p = .008; QLACS Pain subdomain, p = .026), but not for visit*group interaction effects. SF-MPQ-2 and VAS positively correlated with QOL:CIPN20 scores (r = .843, r = .671); however, QOL:CIPN20 model main effects were not significant. The VAS %Δ for intervention and placebo groups was -14.67 and -7.57 respectively. This was not statistically significant, but is clinically important. Regardless of group assignment, pain and QOL improved. The EOI was well-tolerated and demonstrated 50% more pain reduction than placebo. A subset of participants(n = 9) were enrolled in the qualitative strand, received photovoice-related training, and spent four weeks photographing their life with CIPN. Participants participated in photo-interviewing, a photo discussion focus group, a photovoice exhibition at a local art gallery, and an event de-briefing focus group. Data were analyzed in NVivo using thematic, visual content, and iconographical analyses. Six primary themes emerged from the data: (a) advice for clinicians, (b) positive photovoice experience, and CIPN (c) causes pain, (d) affects relationships, (e) causes disruptions, and (f) alters self-image. Further research is needed to enhance EO pain-reducing efficacy as a natural nursing intervention. CIPN greatly impacts breast cancer survivors’ QOL and is multifaceted. Nursing care for breast cancer survivors should include education regarding the potential severity and lifelong effects of CIPN and benefits of study participation and group support.
  • Acquiring Situation Awareness through Hand-Off in a Critical Care Environment

    Holden, Tina; Nursing (Augusta University, 2019-12)
    Hand-off communication is associated with 80% of hospital errors. Situation awareness (SA) has been targeted as a strategy to reduce errors and enhance patient safety when providing hand-off communication. Few studies have focused on the influence of SA in hand-off communication in the intensive care unit where the risk of errors is high. The purpose of this study was to develop a substantive theory of critical care nursing hand-off. The study was guided by Endsley’s SA framework. A qualitative study design using Straussian grounded theory methods was used to develop a substantive theory related to critical care nursing hand-off. Data collection strategies included observation of 20 critical care nursing hand-offs followed by 34 semi-structured interviews and took place from 2017 to 2019 in a medical and surgical ICU at two academic tertiary care facilities. Data analysis was conducted using constant comparative analysis and was guided by Endsley’s model of SA. Results revealed that hand-off is a basic social process with a core category of handing-off awareness. The process contained four phases: interactive, reflective, maintenance, and preparatory. The interactive phase was characterized by communication between the giver and receiver of hand-off. During that phase, the 10 critical elements of hand-off were passed on to the receiver. These critical elements included the code status, past medical history, story, systems assessment, trends, changes, rationale, level of organ support, and anticipation. Handing off these elements in a way that flows with logical order affects awareness. Nursing behaviors of the giver associated with handing off awareness are linked to the critical elements. For the receiver, these behaviors include arriving prepared, reporting the critical elements, controlling flow, and making connections between the critical elements. Behaviors for the receiver include being an active listener, validating information, and asking questions within the flow of information. In the reflective phase, the resilient nurse bridges gaps in awareness. The maintenance phase is characterized by nursing actions that support hand-off information recall. In the maintenance phase, SA is maintained through artifacts. Artifacts are tools used by nurses to aid in the cognitive function of hand-off. The preparatory phase is characterized by information synthesis and organization. The four phases of hand-off are re-occurring and are influenced by individual and organizational factors. Individual factors include a nurse’s personal process, experience, socialization, and emotional intelligence. Organizational factors include unit policies, unit artifacts, and safety culture. Theory and research implications include the need for future research to further expand the framework of SA in hand-off, the use of qualitative methods to provide insight into complex areas of healthcare, and the need for educational interventions on SA hand-off. Practice implications include evaluation of current hand-off practices in the ICU and evaluation of organizational influences on hand-off. The study concludes that the theory of handing-off awareness in the ICU is a continuous process that occurs over four phases in a repetitive cycle that starts again with each shift change. The critical elements, flow, nursing behaviors, time, and external factors influence the ability of the nurse to achieve optimal SA.
  • Evaluating the Impact of High Fidelity Patient Simulation on Clinical Reasoning in Undergraduate Nursing Students

    Gee, Rebecca Mathews; Nursing (Augusta University, 2019-12)
    Introduction: Graduate nurses must enter nursing with clinical reasoning skills that will allow them to appropriately care for patients. With limited clinical sites, nurse educators are challenged to graduate clinically-competent nurses who possess clinical reasoning skills that will allow them to appropriately care for patients. The use of high fidelity patient simulation (HFPS) as an adjunct to clinical experiences may be a solution, but previous studies have shown limited evidence that HFPS improves clinical reasoning in nursing students. A variety of tools have been used to measure clinical reasoning (or one of its components). However, most of them were not specific to nursing. Without a consistent, nursing-specific tool, exploration of HFPS effects on clinical reasoning skills is challenging. The Nursing Specific Script Concordance Test (NSSCT), a validated nursing-specific tool measuring clinical reasoning, was used for this study. The purpose of this study was to examine the impact of HFPS on the clinical reasoning skills of first-semester, pre-licensure, Bachelor of Science in Nursing (BSN) students. Two specific aims were explored: 1) determine whether teaching with HFPS scenarios improved the clinical reasoning skills of pre-licensure, first semester BSN students, and 2) determine whether the NSSCT detected a significant difference in NSSCT mean scores before and after HFPS scenarios. Methods: This study used a two-group, randomized crossover design with 14 first-semester, pre-licensure, BSN students (n = 8; n = 6). Each participant took a baseline NSSCT, followed by the experimental group participating three simulation scenarios and the control group participating in the standard curriculum only. Then a second NSSCT was administered to each participant. Then, the control group participated in the three simulation scenarios while the experimental group participated in the standard curriculum only. Then, a third NSSCT was administered. NSSCT mean scores were compared between and within the groups after each administration. Results: There were no statistical differences (p = 0.494) in mean NSSCT scores in pre-licensure, first-semester, BSN, students after participating in HFPS scenarios, inferring that in this sample, HFPS did not significantly increase clinical reasoning. There were no statistical differences in mean NSSCT scores (p = 0.064) between the control group and experimental group after the second NSSCT administration, suggesting that the clinical reasoning skills were not different between students who completed the three simulation scenarios versus students who participated in the standard curriculum alone. Finally, there were no statistical differences (p = 0.596) between the control group and experimental group after all participants completed the three simulation experiences. Conclusions: The results from this study did not conclude that HFPS improved clinical reasoning in first-semester, pre-licensure, BSN students. However, due to the limitations of this study (small sample size [n = 14], test/retest reliability, and history) a replication study with modifications should be considered to fully examine the effect of HFPS on clinical reasoning in pre-licensure, BSN students.
  • Non-invasive Biomarkers to Detect Acute Kidney Injury in Premature Infants

    Marin, Terri; Williams, Bryan; Bhatia, Jatinda; Sharma, Ashok; Mundy, Cynthia; Cockfield, Christy; College of Nursing; Department of Pediatrics: Neonatology; Department of Population Health Science; Department of Obstetrics and Gynecology; et al.
  • SF12v2 Health Scores for African Americans in a Cluster-randomized Community Trial

    Joshua, Thomas V.; Gavin, Jane T.; Marion, Lucy; Williams, Lovoria B.; College of Nursing
  • Role of Aging in the Expression of Pain-related Depression of Nesting in Mice

    McPherson, Sarah; Department of Physiological and Technological Nursing (Augusta University, 2018-05)
  • Relationships among Health Literacy, Self-Care, and Hospital Readmission Status in African American Adults with Heart Failure

    Sarfo, Robert; Department of Physiological and Technological Nursing (5/22/2018)
    Approximately six million adults are diagnosed with heart failure (HF) yearly in the U.S., with one million subsequent hospitalizations. Of these, 25%-30% are readmitted within 30 to 90 days of initial discharge. Little is known about relationships among health literacy (HL), self-care and 30-day hospital readmission status in adult African Americans (AAs) with HF. The primary purpose of this study was to explore relationships among HL, baseline self-care maintenance (BSCM), and 30-day hospital readmission status in adult AAs with HF. Two secondary purposes were to determine whether BSCM mediated the relationship between HL and readmission status and whether there was a moderating effect of age, gender, education, insurance status and perceived social support (PSS), on the relationships of HL with BSCM and readmission status. Using a one-month prospective cohort design, HL, BSCM, PSS, basic conditioning factors, and 30-day readmission status were measured in participants from two large hospitals in the Central Savannah River Area in Georgia. Statistical analyses included logistic regression, Pearson product-moment correlation, chi-square tests of independence, and mediation and moderation analyses. Eighty-nine participants were enrolled in this study. Most participants (71.9%) were male, and their mean age was 53.25 years (Standard Deviation, SD = 12.74; range 25-88 years). Of the 89 participants, 28.1% experienced at least one readmission within 30 days of discharge. The following findings have p values < .05. BSCM varied significantly with HL (X2 = 6.97 (degrees of freedom, df = 2, sample size (N) = 89)). Higher PSS was significantly associated with higher BSCM (r = .29). HL was significantly correlated with age (r = -.62). The influence of age on the relationship between HL and readmission status was significant (b = .005). Elderly patients (> 65 years) scoring high on HL had a higher probability of readmission, and younger patients (< 40 years) scoring low on HL had a higher probability of readmission. Post hoc analysis showed that lower ejection fraction predicted readmissions (odds ratio = 3.1, 95% confidence interval = 1.03 - 9.05) after controlling for the other predictors. The findings provide a basis for further research to better understand the impact of HL, self-care maintenance, and other patient characteristics on readmission of AAs with HF.
  • Female Teens Step It Up with the Fitbit Zip: A Randomized Controlled Pilot Study

    Linck, Donna Teresa; Department of Physiological & Technological Nursing (5/22/2018)
    Physical inactivity is a global pandemic. Six percent of all deaths globally (approximately 3.2 million people) are the result of insufficient physical activity, and 80% of adolescents worldwide do not get the recommended levels of daily physical activity. Depression is a major cause of disability worldwide and is a significant disease of burden for most age groups. Female adolescents are more than twice as likely to experience depressive symptoms as their male counterparts. The primary purpose of this randomized controlled pilot study was to determine if the use of electronic activity monitors, specifically Fitbit Zips, and daily step goals would increase physical activity participation in female adolescents. The secondary purpose was to determine if participation in a 12-week intervention using Fitbit Zips together with step goals would reduce depressive symptoms in female adolescents. The tertiary purpose was to determine the feasibility of recruiting and retaining female adolescents (80% or more) in the study and having them adhere to the research protocol. There were no available research studies examining physical activity and depressive symptoms in female adolescents using Fitbit Zips as an intervention to increase physical activity and decrease depressive symptoms. A convenience sample of 44 female adolescents from two church youth groups in the southeastern United States participated in the study. The mean age of the participants was 16.6 years. Psychosocial variables such as self-efficacy, social support, and commitment to a plan of action were assessed. Using mixed model analysis, no significant differences (p = .678) were found between the experimental (Fitbit-E) and control groups (Fitbit-C) on average median steps per day. The Fitbit-C group had 6,088.3 (SE = 668.6) average median steps per day at baseline, but only had 2,783.7 (SE = 698) average median steps per day at posttest. The Fitbit-E group had a lesser decline with 6,279.1 (SE = 661) average median steps per day at baseline and 4,339.4 (SE = 728) average median steps per day at posttest. Both groups’ depression scores, as measured by the CES-D, decreased from pretest to posttest, indicating an improvement in depressive symptoms. However, the difference between the two groups on depression scores was not statistically significant (p = .425). Post hoc pairwise comparisons yielded statistically significant decreases in depression scores for the Fitbit-C group (p = .002) and for the Fitbit-E group (p < .001) from pretest to posttest. Additionally, 42 out of 44 participants (95%) completed final CES-D surveys, and 35 out of 44 (79.5%) had some final step count data at post-test. Therefore, it was feasible to recruit and retain 80% of the participants in this RCT pilot study, and they did adhere to the protocol. This study helps bring to light the importance of promoting physical activity and assessing for depressive symptoms in the female adolescent population. Although there were no significant differences between the experimental and control groups on depressive symptoms for the 12-week intervention period, within each group there were significant decreases in depressive symptoms. The results from this study provide the groundwork to further investigate the impact of EAMs on physical activity and depressive symptoms in female adolescents.
  • Vitamin D Moderators and Supplementation Outcomes

    Havens, Robyn Lynn; Department of Physiological and Technological Nursing (2017)
    Abstract Robyn L. Havens Vitamin D Moderators and Supplementation Outcomes (Under the direction of Dr. Elizabeth NeSmith) Vitamin D insufficiency is a global health concern affecting approximately 1 billion people, including about one third of the American population. Vitamin D insufficiency promotes the development of chronic diseases. The people most at risk for developing chronic diseases from vitamin D insufficiency are those individuals in the vulnerable populations who experience poor health outcomes. Currently, researchers and clinicians disagree as to the recommended daily allowance and therapeutic range supporting sufficient serum vitamin D concentrations. To provide data to resolve this disagreement, the objectives of this secondary analysis were to determine if age, sex, and body mass index were moderators of serum vitamin D concentration and if varying dosages of vitamin D supplementation affected serum interleukin-6 concentrations. The data records of 60 healthy male and female African American participants were examined who were aged 13-45 years, categorized as overweight or obese, and exhibited a baseline serum vitamin D concentration ≤ 50 nmol/L. The participants were randomized into four treatment groups for the original study: 1) a control group that received a placebo; (2) a group that received monthly supervised doses of 18,000 IU (equivalent to 600 IU/day); (3) a group that received monthly supervised doses of 60,000 IU (equivalent to 2,000 IU/day); and (4) a group that received monthly supervised doses of 120,000 IU (equivalent to 4,000 IU/day). After 16 weeks of vitamin D supplementation, the only statistically significant interaction found was with sex as a moderating variable despite the small sample size of men. No other significant interactions were found, including no interaction with vitamin D supplementation and interleukin-6. Despite lacking statistical significance, the data results suggested that the 2,000 or 4,000 IU/day dosages of vitamin D supplementation was needed for the overweight/obese African American participants to achieve a sufficient serum vitamin D concentration > 50 nmol/L as recommended in the 2011 Institute of Medicine report. These results also suggest that the overweight/obese, African American adolescents and adults needed much more vitamin D supplementation than the 600 IU/day recommended by National Institute of Health researchers. Lastly, the findings suggest that the national clinical guidelines published by the Endocrine Society may warrant revision to at least 2,000 IU/day to be effective for individuals in vulnerable populations. Future research is needed to further elucidate the role vitamin D plays in maintaining overall good health and the benefits of vitamin D supplementation. Keywords: vitamin D, vitamin D insufficiency, vitamin D supplementation, age, sex, body mass index, interleukin-6, vulnerable populations conceptual model
  • Early adolescents' physical activity and nutrition beliefs and behaviors in an urban cluster in the southeastern United States

    Hawks, Miranda R.; Department of Physiological and Technological Nursing (2016)
    Obesity in early adolescents is a significant public health problem that has adverse health consequences, to include increasing the risk of developing type two diabetes and hypertension. Factors such as the environment, nutrition, and physical activity contribute to obesity in early adolescents. The purpose of this ethnographic study was to explore the physical activity and nutrition beliefs and behaviors of early adolescents in an urban cluster in the southeastern part of the United States. The researcher recruited early adolescents at a community organization and collected data using three ethnographic methods: semi-structured interviewing, participant observation, and collection of artifacts. Data were analyzed using constant comparative analysis to shed light on the meaning of early adolescents’ communications about their physical activity and nutrition beliefs and behaviors. Themes that emerged from data analysis included recognizing benefits of physical activity and healthy eating, family influences, connecting with the community, peer influences, electronic media influences, and developing a sense of self. This study contributes to nursing science in three ways. First, all early adolescents recognized both physical activity and healthy eating as beneficial for promoting their health and improving the quality of their lives. Second, early adolescents described their mothers as the most influential family member for both their physical activity and healthy eating behaviors. Third, the community organization was identified as the main facilitator of early adolescents’ physical activities within their immediate environment outside their home. These findings explain three different points of entry that the nursing community can use, separately or together, for their health promotion strategies to encourage physical activity and healthy eating among early adolescents.

    Gollan, Srisuda Siera; Department of Physiological and Technological Nursing (9/15/2017)
    The objective of pre-hospital trauma care is ensuring that the most severely injured persons are transported to the facility best suited to meet their complex needs (Fitzharris, Stevenson, Middleton, & Sinclair, 2011; Hoff, Tinkoff, Lucke, & Lehr, 1992; Leach et al., 2008; Sasser et al., 2012). To support pre-hospital decision making regarding trauma triage destination determinations, the Guidelines for Field Triage of Injured Patients decision scheme (FTDS) was developed as an algorithmic decision tool (Sasser et al., 2012). The purpose of this study was to examine pre-hospital trauma triage transport decision making by EMS providers from multiple perspectives. This study used a concurrent mixed methods triangulation design (QUAL+QUANT). Mixed methods included: (1) Grounded theory methodology to describe a model of decision making used by EMS providers to make trauma triage determinations and (2) quantitative analysis of secondary data to determine how the FTDS criteria are utilized by EMS providers. The FTDS criteria were also examined relative to trauma outcomes: level of trauma team activation (TTA), patient disposition when leaving the emergency department (ED), and the injury severity score (ISS). A model of Interpreting Trauma into Action was elucidated to describe the processes used by EMS providers. Pre-hospital providers based their trauma transport decisions on the perceived patient level of injury severity. The FTDS criteria were not explicitly used in this study region, but were interwoven into practice through employer policies and other training. The convergence of these findings indicated congruence between the model and trauma outcomes. The quantitative data indicated relationships (p<.05) between 12 of the 29 FTDS criteria and trauma outcomes. Both sources of evidence supported the relationships between the model of Interpreting Trauma into Action, the FTDS criteria, and specific trauma outcomes.
  • Topical Hyssopus officinalis (hyssop) essential oil for the reduction in terminal respiratory secretions

    Langley-Brady, Dawn; Department of Physiological & Technological Nursing (The International Clinical Aromatherapy Network, 2015)
    Purpose: Terminal respiratory secretions (TRS) occur in up to 90 percent of all dying persons and are often distressing to caregivers. Unfortunately, current pharmacological approaches to reduce TRS are often ineffective. The purpose of this project was to review the literature for ascertaining the effectiveness of topically applied Hyssopus officinalis (hyssop) essential oil for TRS reduction in patients at end-of-life. Methods: A literature search was conducted for peer-reviewed journal articles with the keywords: human, essential oil, hyssop and its chemical constituents, death rattle, TRS, and end-of-life, resulting in a combined 245,067 articles. A filtering-down approach was used to narrow articles by respiratory, human, clinical trial and topical. Results: The literature review found insufficient information regarding topically applied Hyssopus officinalis (hyssop) essential oil for reduction of TRS in patients at end-of-life. No studies were found assessing any essential oil efficacy for TRS. Several studies of pharmacological approaches to TRS management were found; however, none demonstrated efficacy. Conclusion: The TRS-reducing efficacy of topical Hyssopus officinalis (hyssop) essential oil has not been previously investigated, but has been demonstrated in home hospice use. This literature review provides a foundation for future research investigating topically applied Hyssopus officinalis (hyssop) essential oil for TRS reduction in patients at end-of-life.
  • Exploration of Two Methodologies for Measuring Clinical Judgment in Baccalaureate Nursing Students.

    Call, Marlene W.; Department of Physiological and Technological Nursing (5/8/2017)
    Introduction: Senior nursing students need a requisite level of preparedness to safely care for an acutely ill, complex patient once they graduate and become independent clinicians. This level of preparedness may be evaluated by measuring clinical judgment (CJ) with the Lasater Clinical Judgment Rubric (LCJR). The LCJR contains 11 indicators that represent the actions and behaviors necessary for demonstrating CJ. Two methods of simulation, high fidelity patient simulation (HFPS) and objective structured clinical examination (OSCE), replicate the healthcare environment so students may safely demonstrate clinical skills without harming an actual patient. The purposes of this study were to 1) explore the use of the LCJR in the OSCE setting, and 2) elicit and compare the number of LCJR indicators that occur in the HFPS and OSCE settings for senior baccalaureate nursing students. Two research questions were explored: 1) comparing the representation of indicators between the OSCE and a single HFPS and question 2) comparing the representation of indicators between the OSCE and two HFPSs. Methods: This study used a two group, randomized crossover design with 23 senior nursing students in their last semester of a Bachelor of Science in Nursing program (n = 11; n = 12). Each participant performed patient care during two HFPS scenarios and 12 OSCE stations, followed by a written debriefing. Clinical performances were video recorded for each participant. CJ was evaluated by the reviewing the video recordings and counting the number of times an LCJR indicator occurred during the HFPS and OSCE settings. Counts for each indicator in each setting were established for the OSCE by adding indicator counts for each and for the HFPS by adding each indicator for the two scenarios. Comparisons of the OSCE to individual HFPSs as well as the combined HFPS means were performed using paired t-tests with an alpha value of 0.05. Results: The mean number of times that the LCJR indicators occurred in the OSCE setting was significantly higher (p < 0.05) than in either individual HFPS setting, indicating that the OSCE setting provided more opportunities for measuring CJ than a single HFPS setting. When comparing the OSCE to the combined HFPSs setting the mean counts of LCJR Indicators 3, 4, 5, 7, and 9 were higher in the OSCE, while counts for LCJR Indicators 2, 6, and 8 were higher in the combined HFPS settings. Indicators 3, 5, and 7 count means were more than five counts higher, indicating a likely impact on the accuracy of CJ scores regarding those indicators and a more favorable environment to measure those indicators within the OSCE setting. Participants reflected on their simulation experiences by answering written questions during the debriefing sessions to measure Indicators 10 and 11. Opportunities to measure Indicator 10 were similar between the two settings, while Indicator 11 occurred more in the students’ written OSCE debriefing than in HFPS debriefing. No variability existed with Indicators 10 and 11, thus statistical significance could not be determined. Conclusions: The overall higher mean count of LCJR opportunities in the OSCE setting suggests that OSCE provides a comparable number opportunities to measure CJ of senior nursing students. While previous research has validated the use of the LCJR tool in the HFPS setting, the results of this study suggest that the LCJR may be used in the OSCE setting and be similarly suitable. The OSCE uses less faculty resources than HFPS and thus may be a more cost-effective mode for evaluating CJ. However, additional research is needed to establish the validity and feasibility of using the LCJR tool in the OSCE setting to measure CJ in senior nursing students prior to graduation.
  • Effect of mentoring relationships on professional socialzation of the pre-licensure clinical nurse leader graduate

    Gazaway, Shena Borders; Department of Physiological and Technological Nursing (5/8/2017)
    The professional socialization of a nurse begins during their education experience and continues throughout their career as they acquire new roles and responsibilities. For pre-licensure clinical nurse leader graduates (PLCNLGs), the challenge is to meld the ideals learned during their education experience with the protocols and regulations necessary to practice successfully in their first professional nursing position. While all novice nurses experience difficulty with professional socialization, PLCNLGs have an additional stressor due to the prevailing belief that a Master’s-prepared nurse should be an expert nurse clinician before assuming the title of Clinical Nurse Leader. No matter their educational program, early professional socialization helps all newly licensed nurses, identify with the profession and provide a philosophical foundation with which to build a dynamic career. Mentoring is a low-cost strategy that may help achieve early professional socialization. Mentors provide the necessary support, career lifeline, and professional guidance during the PLCNLG’s transition from student to independent clinician. A positive mentoring relationship creates a trusted partner and confidant who eases the negative feelings associated with this transition process. Nursing research is needed to establish the best mentoring strategy to support the PLCNLG’s professionalism and career trajectory since differences exist in the foundation underlying each mentoring relationship. This study used a mixed methods longitudinal design with two instruments, the Nurses Professional Values Scale-Revised (NPVS-R) and the Nurses Role Conceptions Instrument (NRCI), plus focus groups to examine the impact formal and informal mentoring relationships had on the professional socialization of PLCNLGs. Participants were recruited from the pre-licensure Clinical Nurse Leader program nursing program of a large university located in the southeastern portion of the United States. Phase I data collection took place on campus just before graduation (n=69), nine months later the participants were approached to participate in the Phase II portion of data collection. A final sample of 22 participants completed Phase II with six of them participating in the focus groups. Using a one-way ANOVA, statistically significant differences were not found between the types of mentoring (formal, informal, both, none) and NPVS-R or NRCI bureaucratic and professional role orientation. However, a significant difference was seen with the service role discrepancy and mentoring relationship. Focus group results led to the development of a conceptual model which supports the manner in which mentoring impacted the professional socialization process of PLCNLGs. The integrated quantitative and qualitative results provided evidence that participants were greatly impacted by mentoring relationships. These relationships were established on trust and with people who were willing to help them grow in their nursing role. Participants reported increased confidence, comfort, and competence in their nursing role due to the actions of their mentors. The results of this study added critical knowledge regarding the professional socialization process from the perspective of the PLCNLG. The mixed method integrated approach highlighted how mentoring impacted this socialization process when quantitative analysis did not produce statistically significant results. Nurse executives and leaders should use this research to establish goals for employing mentors and successfully cultivating best practice for pairing mentors and mentees to decrease PLCNLG employment dissatisfaction and turnover.

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