Nursing Dissertations (PhD)

Cardiovascular disease (CVD) is the leading cause of death among women in the US, and African American women (AAW) have a disproportionately high rate of deaths from CVD. Physical inactivity plays a major role in CVD development. It has been reported that some rural women have low rates of physical activity; 39% of White women and 57% of women of color are reported to be physically inactive. Rural AAW have a high mortality and morbidity rate related to CVD and a high rate of physical inactivity. The purpose of this study was to describe rural AAW’s perception of wellness in conjunction with their stage of change for engaging in exercise. A questionnaire was designed to obtain demographic information and reliable and valid questionnaires were used to measure perceived wellness and current stage of change for exercise. Using a descriptive, cross-sectional design, a convenience sample of 162 rural AAW was recruited from four rural churches in Selma, Alabama. A one-time meeting was conducted and questionnaires were completed by the participants. Statistical analyses including independent samples t-tests and one-way and two-way ANOVA’s were conducted to determine if there were associations among demographic characteristics, self-reported presence of CVD, perceived wellness, and stage of change for exercise. Findings indicated that there was no relationship between perceived wellness and stages of change for exercise among rural AAW; no relationship was found between perceived wellness and CVD, or CVD and stage of change for exercise. However, 51.3% of the sample reported they were physically active, and 21.6% planned to increase their activity within 30 days. Annual household income and employment status were positively correlated with perceived wellness, suggesting a greater sense of wellness is related to income and employment among these rural AAW. These findings have implications for nursing practice in the areas of facilitating health promoting behaviors and development of exercise and wellness programs for rural AAW.

ABSTRACT

FEASIBILITY OF A NURSE COACHING INTERVENTION FOR RURAL STROKE SURVIVORS

by

LEEANN H. BARFIELD

Rural stroke survivors experience higher mortality rates due to limited access to care, socioeconomic challenges, and lower health literacy. These factors contribute to poorer health outcomes, increased post-stroke complications, and higher hospital readmission rates. This study examined the feasibility, acceptability, and preliminary efficacy of COMBO-KEY, a stroke self-management program adapted for rural stroke survivors in the United States discharged to home. The intervention aimed to reduce post-stroke complications and hospitalizations by enhancing physical function and disease self-management capacity (illness burden, treatment burden, self-efficacy and outcome expectations).

A randomized controlled two-group pre-post test design with a five-week follow-up was used. The intervention group (IG) received weekly 30-minute nurse-led telephone coaching, reminder text messages, and instructional videos on medication, diet, exercise, and rest. The control group (CG) received usual care. Participants were recruited from a hospital in rural Georgia and data were collected via chart review, an online platform, and telephone/virtual interviews.

Of 50 stroke survivors, 26 (52%) were enrolled and 20 (77%) completed the study. Participants were 36-87 years old, 54% identified as male and 65% as Black/African American. Within the five-week period, participants in the IG (n=10) reported two non-hospitalized complications compared to five complications, including three hospitalizations, reported by participants in the CG (n=10). Both groups demonstrated improvements in physical function, treatment burden, self-efficacy and outcome expectations from baseline to five weeks, but the IG improvements were greater, particularly for overall confidence. Findings from the exit survey revealed above average satisfaction scores and mostly positive feedback about the intervention.

The COMBO-KEY intervention adapted for use in the United States for rural stroke survivors was found to be feasible and acceptable with clinically meaningful reductions in post-stroke complications and hospitalizations and improvements in treatment burden and confidence to self-manage following stroke. Future research should focus on refining the COMBO-KEY intervention based on participant feedback and testing it in a larger, more diverse sample to determine its effectiveness.

A descriptive correlational design based on an adapted model of Donabedian’s Structure, Process, Outcome model and Benner’s Novice to Expert theory was used to examine the clinical decision-making of nurses regarding elder abuse. The relationship of the nurses applied knowledge (assessment cues) of elder abuse; demographic questions (e.g. years of experience as a Registered Nurse (RN) and their clinical level of practice status), the use of intuition in nursing practice; and clinical decision outcomes (interventions) for patients in cases of suspected elder abuse was examined. A convenience sample of RNs who worked in the emergency department (ED) in three acute care hospitals, in southeastern United States were asked to complete questionnaires on education about elder abuse, their intuition use, demographic information, applied knowledge of elder abuse, and clinical decision outcomes for suspected elder abuse. The majority of the nurses had participated in the clinical level of practice status program.The convenience sample of 84 RNs consisted of 68 females (81%) and 16 males (19%). The average age of the respondents was 41.43 years. The mean number of years worked as a RN was 13.87 years. Multiple regression results indicated an overall model of two predictors (RNs applied knowledge (assessment cues) and years worked as a RN) significantly predicted clinical decision outcomes (interventions). The model accounted for 25.1% variance in clinical decision outcomes. The t-test revealed there was no difference (applied knowledge (assessment cues) of elder abuse, intuition use in nursing, years working as a RN, clinical level of practice status, and clinical decision outcomes (interventions)) between RNs who received elder abuse education at orientation and those who did not receive the education. The study results suggest that years of working as a nurse supported elder abuse recognition and intervention. The clinical level of practice status of nurses was found not to be a sensitive indicator. Elder abuse education during orientation varied between the hospital settings. The results indicate the educational need for nurses regarding suspected elder abuse.

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among men in the United States. In African American men, the disease is typically detected at a more advanced stage and mortality is twice the rate of Caucasian men. However, African American men are less likely to participate in prostate cancer screening. The purpose of this descriptive study was to assess the relationship between health beliefs, knowledge, and selected demographic variables (age, income and education) and a man’s decision to participate in prostate cancer screening among African American men dwelling in rural communities. The conceptual framework for the study was the Health Belief Model. Participants for the study were recruited through contacts within rural communities within west central Alabama. A convenience sample of 90 African American men between the ages of 40-82 years of age was recruited. Analysis of the research data indicated that there was a statistically significant difference in motivation (health belief), knowledge, and age of men who participated in prostate cancer screening compared to those who did not participate in prostate cancer screening. Forward logistic regression was used to determine which independent variables [health beliefs (benefits, barriers, motivation); knowledge; age; income; and education] were predictors of prostate cancer screening. Results indicated the overall model of one predictor, motivation, was statistically reliable in predicting prostate cancer screening participation among the rural dwelling men surveyed. The model accounted for 15 to 20% of the variance. The sensitivity of the model in predicting those who would participate in prostate cancer screening was 85%. The odds of those who would participate in prostate cancer screening were 1.3 times greater for each one unit increase in motivation. Results indicate a need for more educational and motivational interventions to promote informed decision making by African American men in regards to prostate screening activities. These interventions need to be culturally sensitive and geared toward African American men, specifically those living in rural areas.

Within the United States, about 1.4 million individuals (0.6%) identify as transgender. People who identify as transgender or gender-diverse experience societal challenges like unacceptance, isolation, judgment, and discrimination which can impact healthcare utilization. While their perceived experiences of seeking healthcare services have been detailed with qualitative studies, quantitative research examining factors that may be associated with primary healthcare use is scarce. The purpose of this study was to use concepts from Self-Determination Theory (SDT; i.e., autonomy, competence, and relatedness) to explore transgender and gender-diverse individuals’ motivations to use routine primary healthcare services. Additionally, the gender-affirming actions desired from their healthcare providers was also explored.

A cross-sectional, correlational design was used and individuals self-identifying as transgender or gender-diverse, at least 18 years of age, and living in the United States were recruited via flyers distributed in communities, social media posts, and snowball sampling. Data were collected via surveys administered through an online platform. Data were analyzed using descriptive statistics and logistic regression analyses. Participants were given the opportunity to describe the gender-affirming actions they desired from healthcare providers through responses to an open-ended question. The responses were then reviewed and categorized for dissemination.

Participants (N = 62) ranged in age from 18 to 67 and mostly identified as trans-masculine, had some college or higher education, had healthcare coverage, and were married, partnered, or had multiple partners. In multivariable analysis, participants with lower reported competence to navigate the healthcare system and/or higher perceptions of discrimination had increased odds of avoiding healthcare due to fear of disrespect or mistreatment from a healthcare provider. Responses to an open-ended question about desires for gender-affirming practices included a need for providers to be more educated on trans-related healthcare, to honor and use correct pronouns, and to educate their patients on every step of their medical journey.

Addressing the obstacles transgender and gender-diverse persons encounter in healthcare may lead to them receiving better primary care to manage or prevent health problems and reduce physical and mental health disparities. Findings from this study may give direction for interventions designed to facilitate positive healthcare interactions that may result in increased routine primary healthcare use by the transgender population.

Problem: In the United States, social inequities are concentrated in rural areas, potentially increasing the risk for recent transmission (RT) of tuberculosis (TB), a precursor of TB outbreaks. Most TB cases occur among non-U.S.–born patients; however, little is known about TB in rural areas. This dissertation examined characteristics associated with RT in rural areas.

Methods: TB cases with genotyping results reported to the National Tuberculosis Surveillance System during 2011–2021 were included if they occurred in areas classified as non-metropolitan (rural) by the National Center for Health Statistics. Community characteristics included county-level poverty (American Community Survey) and number of primary care physicians (PCP) per 100,000 (Health Resources and Services Administration). Hierarchical generalized linear models were constructed to estimate the relative association of individual and county characteristics with RT.

Results: During 2011–2021, 7,607 rural U.S. residents were diagnosed with TB. Patients lived in counties with a mean of 20% (SD=7.0) of the population below poverty and 49 (SD=27) PCPs per 100,000. Most patients were male (66.0%), U.S.-born (63.8%), and identified as a racial or ethnic minority (74.1%). TB was attributed to RT for 847 (15.0%) of 5,633 cases with an RT designation. Most patients with TB attributed to RT lived in the U.S. Census South Region (65.6%), followed by the West (27.2%), Midwest (6.4%), and Northeast (0.8%); nearly all were U.S.-born (90.3%). County and patient characteristics, except age, differed significantly by region. In hierarchical models, U.S. birth (odds ratio=5.05, 95% CI: 3.62–7.04), racial/ethnic minority identification (1.54, [1.13–2.11]), incarceration (0.46, [0.26–0.80]), age (0.97, [0.97–0.98]), and county PCP ratio (0.99, [0.98–1.00], p=.02) were associated with RT, whereas homelessness, substance misuse, comorbidities, and county-level poverty were not.

Conclusion: Unlike national epidemiology, most patients with TB in rural areas, and nearly all whose TB was attributed to RT, were U.S.-born. Healthcare providers in rural areas should consider TB as a potential diagnosis among symptomatic U.S.-born patients of racial or ethnic minority groups. More attention is needed to highlight the unique characteristics of patients with TB due to RT in rural areas.

Children with medical complexity (CMC) are a small but growing population with chronic, sometimes life-limiting health conditions and high health care utilization. Their parents experience social and financial hardships and describe care as demanding. Research examining parental mental health is limited. The purpose of this study was to examine relationships among family resources, social support, parents’ perceived workload to care for their CMC and their perceived ability to do the work, and how this impacts family burden and parental depressive symptoms.

A non-experimental, cross-sectional, correlational design was conducted in a national sample of 106 parent participants of CMC, recruited using social media. Pearson’s correlations and multiple regression was conducted to examine relationships among the major variables. Parent participants were largely white (84.9%) biological (91.5%) mothers (98.1%) ranging in age from 23 to 47 years. The majority were married/partnered (86.8%) and college educated (37.7%) with incomes of $50,000 or more (61.3%). Nearly 62% of parents reported clinically significant depressive symptoms.

Higher family resources were associated with less workload (r = - 0.47, p

In this largely homogeneous sample of parents with CMC, depressive symptoms were common, family burden was significant, and both were explained by inadequate resources and high workload. Results emphasize the importance of care coordination support for families, as well as universal screening for social support, family resources, and depressive symptoms.

Hypertension is the most significant risk factor for stroke, and African Americans (AA) experience disparities in uncontrolled hypertension and stroke. No studies have focused on stroke-related factors as predictors of hypertension self-management (HTN-SM) among AA. The purpose of this study was to examine stroke risk perceptions and knowledge, history of stroke symptoms, perceived stress and general health, and self-efficacy for managing HTN as predictors of HTN-SM in middle-aged to older AA; and to examine differences by age groups. This study used a cross-sectional, correlational design guided by the Health Belief Model. AA aged > 45 years were recruited via flyers distributed to various community sites in the southern United States and on social networking websites. Data were collected using questionnaires administered through Qualtrics or by telephone interviews. Participants (N = 142) had a mean age of 63.0 years (SD = 2.0); 74 (52%) middle-aged (45-64 years), and 68 (48%) older adults (> 65 years). On average, participants had HTN for 13.7 (SD = 11.1). Of those who could recall their most recent blood pressure (BP) reading (n = 99;70%), 33% were uncontrolled (i.e., > 140/90). The mean HTN self-care maintenance score used to assess HTN-SM was 58.1 (SD = 16.7); 72% had scores < 70 indicating inadequate HTN-SM. Overall, participants perceived a low-moderate stroke risk and had moderate knowledge, one-third reported a history of stroke symptoms, had vii low-moderate perceived stress, perceived their overall health as good/fair, and had inadequate self-efficacy. There were no significant differences in these variables by age group. The model explained 34.6% of the variance (R2 =.38, F (7, 134) = 11.64, p = .000) in HTN-SM. Self-efficacy (β = .42, p = .000), age (β=.21, p=.003), and perceived health (β = -.20, p = .01) were significant predictors. Higher HTN-SM was significantly associated with lower SBP (r = -.27, p = .006) and lower DBP (r = -.26, p = .011). Most participants self-reported BP in the control range; however, one-third were uncontrolled, and the majority of the sample had deficits in HTN-SM. Building individual self-efficacy for managing HTN, particularly among middle-aged AA, maybe more important than promoting stroke awareness to facilitate engagement in HTN-SM. Education, however, is still needed on knowing one’s BP reading and the personal risk of stroke in relation to uncontrolled HTN.

Type 2 diabetes is a significant problem among veterans in the United States, affecting about 25%. Informal peer support, a type of support that is provided by someone who also has diabetes, may be a useful adjunct to interventions targeting diabetes self-management behaviors in this population. The purpose of this study was to explore informal peer support among veterans living with diabetes, its impact on behaviors and self-efficacy related to diabetes self-management, and glucose control.

A cross-sectional, correlational design was used to evaluate relationships between variables of interest. Non-random sampling was used, and participants were recruited mostly through social media sites. Data were collected using self-report surveys administered via Qualtrics. Data were analyzed using descriptive statistics, correlations, independent sample t-tests, and PROCESS macro.

Participants (N=165) had a mean age of 41.5 (SD=11.27) years, were mostly African American (49.7%), had bachelor’s degrees (58.8%) and were married (76.4%). Most participants had been living with diabetes for less than 10 years (59.4%) and HbA_1C’s of the sample were 7-7.9% (29.7%), 8-8.9 (24.8%), and 9-9.9 (20%). The majority reported having a peer supporter (98.2%). On average, participants had moderate levels of informal peer support, engagement in self-management behaviors, and self-efficacy. Informal peer support was positively associated with diet (r=.48, p<.001), self-management behaviors (r=.52, p<.001), and HbA_1C (τ_b= .26 p<.001). Self efficacy was found to mediate the relationship between informal peer support and diet (B=.21, 95% CI [.11, .31]) as well as a global measure of self-management behaviors (B=.14, 95% CI [.04, .24] , but not medication adherence or glucose control. Those who described their informal peer supporter as a veteran had higher (M=39.06, SE=.75) self-management scores than those described them as non-veterans (M=35.72, SE=1.11), t(159) = 2.59, p=.01).

Veterans need additional support to manage diabetes and control blood glucose, given that survey results were overall moderate, and participants reported suboptimal glucose control. Informal peer support was associated with self-management behaviors which may influence better glucose control. Future research is needed to further explore these relationships and how informal peer support may be used to enhance existing interventions that target peer support and diabetes management for veterans.

ABSTRACT

AN EDUCATIONAL INTERVENTION ADDRESSING POSTPARTUM DEPRESSION: A PILOT STUDY

by

BRITTANY GRISSETTE

Postpartum depression (PPD) affects one in seven women; however, only 15% of women with PPD seek psychological help. Perceived stigma and lack of knowledge regarding PPD have been identified as barriers that prevent women from seeking help. The purpose of this study was to evaluate a theory-based, antenatal educational intervention that addresses barriers to help-seeking behavior for the treatment of PPD. The goal of the proposed intervention was to enhance pregnant women’s willingness to seek psychological help should they develop PPD by decreasing stigma and increasing knowledge.

A single group, pre-test post-test, quasi-experimental, pilot study was conducted with a non-randomized sample of 24 pregnant women. Participants were predominately Caucasian (62.5%). The mean age of the group was 26.54 years (SD = 4.60) and ages ranged from 19 to 35. The mean gravida of the participants was 1.79 (SD= 1.06) and the mean para was .88 (SD = .992) with the number of children ranging from 0 to 3. More than 60% of the participants were married (50%) or partnered (12.5%) and denied a history of mental illness (62.5%).

Findings from the Inventory of Attitudes Towards Seeking Mental Health Services (IASMHS) and the Beliefs About Psychological Services (BAPS) showed that participants reported less stigmatizing views towards seeking psychological help for PPD after the educational intervention as compared to before the intervention (p = < .001; p = .003). Participants also reported increased willingness to seek psychological help for PPD following the intervention (p = < .001; p = .003). Additionally, findings based on the Knowledge of Postpartum Depression (KPPD) showed a significant increase in knowledge of PPD after the intervention (p = .001).

Future research should focus on further development of the educational intervention to include detailed information regarding how to seek help and the addition of significant others as participants. Providing women with more help-seeking information and including their significant other in the intervention may be instrumental for further increasing women’s willingness to seek help while decreasing their significant other’s stigmatizing views regarding PPD and help-seeking. If significant others understand PPD and the maternal benefits of seeking help, they may serve as a facilitator to women’s help-seeking behavior.

Nonalcoholic fatty liver disease (NAFLD) is a progressive spectrum of disorders leading to hepatic steatosis is present with no secondary cause of liver disease. NAFLD is one of the leading cause of chronic liver disease in the United States and the prevalence of this chronic disease is increasing globally. Despite advances in science and treatment, providers rely on lifestyle choices and emphasis on physical activity as a main component of the treatment plan for NAFLD. Physical activity has been well documented in improving liver function tests and reduces the level of intrahepatic adipose tissue. Despite the known benefit, persons with NAFLD do not consistently participate in PA. To date, there are no known studies examining factors that influence level of physical activity in those with NAFLD. The purpose of this study was to examine fatigue, depression, perceived illness severity, exercise-self efficacy, and exercise benefits and barriers as potential factors that may predict level of physical activity in individuals with NAFLD. A cross-sectional, predictive, correlational study was performed. Ninety-eight study participants were recruited from a hepatology clinic in Atlanta, Georgia and data were analyzed to examine predictors of physical activity. Exercise benefits and barriers were found to be significant predictors of level of physical activity in those with NAFLD. Additionally, exercise self-efficacy demonstrated a mediator effect on the relationship between exercise benefits and physical activity. Overall, this research study further advances the understanding of symptom burden associated with NAFLD and factors that may influence level of physical activity.

Abstract

Palliative Care Referral Behavior Among Nurse Practitioners In Hospital Medicine

by

Sharon Jackson White, PhD, RN, FNP-BC, NP-C

Palliative care incorporates holistic care, symptom management, advance care planning, strengthening of patient-family-physician communication, goals of care planning, and improved coordination of care. Healthcare providers practicing in U.S. hospitals do not always refer patients to palliative care who need it. The predominant mode of delivery of palliative care services within hospitals is the consultation service model. In such settings, palliative care services are usually initiated by request that requires a referral for the palliative care team to participate in a patient’s plan of care. Nurse practitioners (NPs) practicing within hospital medicine teams play a significant role in identifying patients who might benefit from palliative care services. The factors that influence their decision to refer patients for palliative care have not been studied. The purpose of this study was to examine the relationships among facilitators to referral, barriers to referral, self-efficacy with end of life discussions, history of referral, and referring to palliative care among NPs in hospital medicine. This study was framed by the Theory of Planned Behavior.

A cross-sectional, correlational design was used. Hospital medicine NPs were recruited using social media platforms and postal mail. Participants used Survey Monkey and paper surveys to complete questionnaires that measured demographics and the concepts of interest.

The study participants (N = 76) consisted of 5 males and 71 females with an age range from 30 to 69 (M = 41.82). The availability of the palliative care teams at their hospitals were 24/7 in person (17.1%), 24/7 hybrid of in person/phone (36.8%), and Monday – Friday day shift only in person (46.1%). Four facilitators (palliative care establishing goals of care, helping with length of stay, spiritual concerns, and when patients have serious illness and/or poor prognoses), two barriers (palliative care not routinely available and unless death is imminent), and two self-efficacy aspects (giving bad news to a patient/family member and discussing DNR orders) influenced palliative care referrals. Referral history did not influence referrals.

The findings from this study emphasize the impact of palliative care availability in NPs’ referral behavior and suggest a need for strategies to overcome this barrier.

Rates of postpartum depressive symptoms (PPDS) have ranged from 10% to 23% in mothers living in the United States. Due to cultural beliefs, Black mothers may be less likely to share their PPDS with their healthcare providers. Therefore, postpartum depression (PPD) may be more common in this population than statistics reveal. Racial identity, an understudied concept in postpartum mothers, has been shown to correlate with psychological health of Black adults. Understanding the influence of racial identity on PPDS and maternal functioning may be helpful in identifying Black mothers at greater risk of developing PPD. The purpose of this study was to assess the relationships between racial identity, PPDS, maternal functioning, and maternal-infant bonding of Black mothers.

A non-experimental, cross-sectional design was used. Black mothers were recruited using social media platforms and flyers distributed at various community locations. Mothers used Qualtrics to complete questionnaires, which measured their demographics and concepts of interest. Hierarchical cluster analysis determined the racial identity groups in the sample and other multivariate statistics were used to examine relationships among variables.

Black mothers (N = 116) ranged in age from 18 to 41 years (M = 29.5 ± 5.3) and their infants were 1 to 12 months old (M = 5.6 ± 3.5). The majority of mothers were married or cohabitating with their partner (71%), had a college degree (53%), worked full-time (57%), and had a total household income of > $26,000 (65%). Six racial identity clusters were identified in the sample (assimilated and miseducated, self-hating, anti-White, multiculturalist, low race salience, and conflicted). The clusters differed in their maternal functioning abilities but not their PPDS. Mothers with a low regard for Black race (i.e. self-hate) or a strong dislike for White race (i.e. anti-White) had lower maternal functioning, and lower maternal functioning was associated with higher PPDS. Individually, PPDS and maternal functioning influenced maternal-infant bonding, but maternal functioning more accurately predicted bonding.

The findings from this study emphasize the need for future research to further explore racial identity in Black postpartum mothers and to develop and utilize culturally appropriate tools to assess PPDS and functioning in Black mothers.

African American (AA) adults are disproportionately affected by type 2 diabetes (T2D) and hypertension, with greater prevalence and disease-related complications. Disease complications may be prevented or delayed with adequate disease self-management (DSM). The literature indicates greater patient activation and health literacy and lower treatment burden and illness burden are associated with improved DSM, but AAs with comorbidities were underrepresented in these studies. The purpose of this study was to examine associations among patient activation, health literacy, treatment burden, illness burden, medication workloads, and medication adherence for AA adults with T2D and hypertension. This study also explored the perceived impact of COVID-19 on medication management.

A non-experimental, predictive, correlational design was used. Participants were recruited using social media and flyers distributed via email. Data were collected via surveys administered through Qualtrics® and telephone/online interviews. Spearman’s correlations and hierarchical regression analyses were conducted to examine relationships among the study variables.

Participants (N = 91) ranged in age from 25 to 73 years (M = 39.6), were mostly male (66%), college-educated (71%), and earning incomes of $30,000 or more (66%). Most were diagnosed with T2D and hypertension for less than five years (respectively, 64% and 75%) and averaged four (±1.3) prescribed medications.

On average, participants had high patient activation scores, low health literacy scores, and moderate levels of treatment and illness burden. Overall, medication adherence scores (M = 2.4) indicated the presence of non-adherence; 66% were classified as non-adherent. The model, including all predictor variables, was significant in predicting medication adherence, accounting for 19% of the variance. However, patient activation was the only significant contributor; for each one-point increase in patient activation, medication adherence improved by .03.The perceived impact from the COVID-19 pandemic on medication management was moderate, with participants feeling worried about leaving their homes (e.g., to get medications) and paying for medications.

In this sample of mostly younger AA men with T2D and hypertension, medication adherence was inadequate, but was only partially explained by patient activation. Further research is needed on DSM in AAs with T2D and hypertension to identify additional factors that may promote or hinder their medication adherence.

People with mental health conditions (PWMHC) represent the fastest-growing population in emergency departments across the United States. Generally, PWMHC experience extended lengths of stay and poorer outcomes when compared to patients with medical problems. The purpose of this study was to examine emergency nurses’ intentions to care for PWMHC. A descriptive correlational design was used to recruit emergency nurses in a health care system in the Southeast United States and from the Emergency Nurses Association. Responses from 104 emergency nurses were used to test two hypotheses and answer one research question. Nurses who had personal contact with PWMHC and more work experience were more likely to express a positive attitude of PWMHC. Nurses with more experience, higher positive attitudes, and more confidence to care for PWMHC were more likely to report positive intentions to care for PWMHC. Nurses with higher subjective norm scores had more negative intentions to care for PWMHC. Managers had significantly lower subjective norms scores than did staff nurses. Nurses, in responses to open-ended questions, felt that support, adequate staffing and resources, time to assess patients, designated areas, and a low stimulating environment were important factors that facilitate caring for PWMHC. Emergency nurses reported that they learned to care for PWMHC from experienced staff. The nurses also indicated that having mentors who were passionate and expressed positive attitudes toward PWMHC promoted learning. Nurses noted a lack of training in emergency psych situations and on-the-job training was not enough to be able to notice early warning signs needed to act quickly and effectively to care for PWMHC. According to the theory of planned behavior, the more favorable the attitude, subjective norms, and perceived behavioral control, the greater the intent to perform a behavior. Findings from the study suggest that nurses with more positive attitudes, more favorable subjective norms, and higher care competency scores have higher manifestations of early recognition skills caring for PWMHC. Future research is needed to identify the care PWMHC actually receive. In addition, future research should focus on testing education and training interventions designed to enhance nurses’ attitudes and competence in caring for PWMHC.

The purpose of this descriptive correlational study was threefold: (a) to assess the relationships between boundary ambiguity, spirituality, marital relationship quality, and caregiver strain and depression among older African American spousal caregivers of persons with Alzheimer’s Disease (AD); (b) to identify which variables are the best predictors of caregiver strain; and (c) to identify which variables are the best predictors of depression. The sample consisted of 25 female and 15 male spouses, who were ages 60 to 87. The data were analyzed using descriptive statistics, Pearson correlation coefficients, and multiple regression. Marital relationship quality was correlated with the two dependent variables, caregiver strain and depression. In hierarchical multiple regression, a model containing gender, years since spouse’s diagnosis with AD and marital relationship quality predicted 40% of the variance in caregiver strain. Marital relationship quality was the only significant predictor for depression. The model containing marital relationship quality predicted 22% of the variance in depression. Additional findings were that participants scored high on the spirituality measure, that years since diagnosis of AD was negatively correlated with boundary ambiguity, spirituality, and caregiver strain, that there was a significant decrease in the quality of the marital relationship since the spouse became a caregiver, and that almost half had no help with caregiving. There was limited support for the proposed conceptual model, therefore, a revised model was proposed. Based on the study results, in dealing with spouses who are providing caregiving to AD patients, nurses need to assess the quality of the marital relationship, and to recognize that the longer the spouse is a caregiver the greater the strain and depression, and that community resources need to be mobilized to assist the spouse with caregiving. A depression screen and marital assessment may provide cues regarding psychosocial needs of spousal caregivers.

Concussions are a common injury for participants in recreational and organized sports activities and are a major public health issue. Females are more likely than males to suffer concussions in gender-comparable sports, and their symptoms may be more severe and longer lasting than in males. Although adolescent and young adult females with sports-related concussions (SRC) may require more treatment interventions than males, we know little about their experiences and the best approaches for their care. Therefore, the purpose of this study was to explore the experiences of late adolescent and young adult females with one or more SRC. Interpretive phenomenology provided a framework to describe and interpret the experiences of 15 late adolescent and young adult females with a history of SRC. Participants ranged in age from 18 to 24 years. An audiotaped semistructured interview was conducted with each participant. Five themes and one pattern emerged during analysis of data from the interviews. The themes were “Telling myself I’m fine,” “So much pain,” “I’m out of the loop,” “I didn’t feel like myself,” and “People don’t understand.” This study explored the day-to-day experiences of late adolescent and young adult women with SRC. These young women did not initially realize the severity of their injury, particularly if they had not suffered a previous concussion. Pain, particularly headache pain, affected their daily life. Sensitivity to light and sound increased headache pain and restricted activities for the young women during recovery. Missing school, sports activities, and social activities contributed to feelings of isolation. The inability to use technology caused the young women to feel disconnected from their peers. Participants felt that they were different from their normal selves during their recovery. Although they understood that their symptoms were not clearly visible to others, the young women were frustrated by the lack of concussion knowledge among their peers. This study contributes to the body of knowledge by helping nurses and other healthcare providers to understand the needs of young women with SRC so that better care can be provided. Recommendations for nursing practice, education, and research were identified in this study.

The number of military fathers separated from their children due to a combat deployment increases as the Global War on Terrorism continues. Father absence may have negative effects on child wellbeing, including behavioral and mental health issues. Communication is important to the father-child relationship, especially when separated thousands of miles away. The Army (Active Duty, Reserves, and National Guard) has deployed more military members than the Air Force, Navy, and Marines combined. However, there is a paucity of literature regarding how Army fathers, particularly National Guard (NG) fathers, communicate with their young children during combat deployment. Therefore, the purpose of this study was to examine the experiences of NG fathers of young children to understand more about communication patterns used to maintain the father-child relationship while deployed to a combat zone.

Interpretive phenomenology provided a framework to study and interpret the experiences of eight NG fathers deployed to a combat zone. Data analysis of semistructured interviews with 8 NG fathers was completed using the interpretive method. Four themes emerged from the interviews with NG fathers: 1) don’t forget me; 2) we make sacrifices; 3) a father’s role; and 4) being a National Guard father means pride.

NG fathers articulated the importance of their fathering role and the great lengths they went through to maintain the father-child relationship during combat deployment. NG fathers felt there were sacrifices they and their families made in support of the military mission. Although NG fathers used many strategies to stay connected to their young children, these fathers still felt a loss of their fathering identity. NG fathers and their families exhibited a sense of pride in the NG father’s service to his country, despite the sacrifices they make. This study contributes to nursing knowledge by increasing the understanding of the needs of NG fathers and their families during a combat deployment.

Recommendations for nursing practice, education, and research were identified in this study and include: early assessment and intervention to reduce negative outcomes, health policies to support this population, and research to determine specific needs and the effects of maternal gatekeeping during combat deployment.

PRESENCE OF PSYCHOSOCIAL SYMPTOMS IN YOUNG ADULT STROKE SURVIVORS POST-ACUTE THROMBECTOMY FOR ISCHEMIC STROKE

Young adults are the fastest growing population of stroke patients. Current treatments enable physicians to reverse hyper-acute large vessel ischemic stroke, and young adult stroke survivors (YASS) are increasingly discharged directly home with few to no apparent neurological deficits. No studies have examined the psychosocial experiences these YASS have once they are home and whether these experiences are associated with stroke-specific quality of life (SSQOL). The purpose of this study was to describe YASS post-stroke symptoms, their understanding and perception of those symptoms, and to examine relationships among psychosocial variables: anxiety, depression, fatigue, illness threat perceptions and SSQOL. A cross-sectional, exploratory design was used. YASS 18-55 years of age and 1- 18 months post-stroke who received a thrombectomy at a metropolitan, comprehensive stroke center and discharged directly home were recruited. Demographic and clinical data (e.g. NIHSS, mRS scores) were collected from the hospital’s electronic medical record. Participants completed questionnaires to assess psychosocial variables using an online or paper survey. Data were analyzed using SPSS version 25. Descriptive statistics and Spearman rho correlations were performed. Participants (N = 14) had a mean age 45 years (SD = 6.2), were 4-18 months poststroke, 71% female, 57% Black, and had discharge NIHSS scores indicating minimal vii neurological deficits (M = 2, SD = 2.6). Five participants were identified as having clinically severe fatigue; three had borderline cases. There was one case of clinically significant anxiety with one borderline case, and one case of clinically significant depression with three borderline cases. All participants perceived some level of threat of the symptoms they were experiencing, and overall SSQOL was decreased. Higher levels of fatigue, anxiety, depression and illness perception threat were significantly related to lower SSQOL. In spite of being discharged home with minimal to no physical deficits, this sample of YASS described psychosocial symptoms, notably fatigue, that may impact recovery and transition back to the community. Further research is needed with a larger sample of these YASS to evaluate their psychosocial needs. Symptom assessments, provision of education, resources and ongoing support before and after discharge home may be beneficial.