PhD, University of Cincinnati, 2024, Nursing: Nursing - Doctoral Program

Background: Many children are directly and indirectly affected by the opioid epidemic and the consequences of opioid use during pregnancy through prenatal opioid exposure. Prenatal opioid exposure is associated with adverse neonatal and long-term outcomes and may develop into neonatal opioid withdrawal syndrome. Although recent reviews largely suggest negative outcomes after prenatal opioid exposure, they are limited by the heterogeneity of identification methods used to ascertain exposure. The impact of varying identification methods on the prevalence and outcomes of exposure is not clearly understood. The use of big data and larger data linkages in nursing science may help illuminate the impact of varying identification methods used to ascertain prenatal opioid exposure. Aims: This three-manuscript dissertation aimed to (1) discuss the use and potential of big data for nurse scientists, (2) conduct a scoping review of the varying identification methods in current literature, and (3) perform a secondary data analysis of a large integrated data to explore the prevalence of prenatal opioid exposure across identification methods to inform research, practice, and support children and families impacted by prenatal opioid exposure. Methods: The first manuscript was a discursive paper that provided an introductory guide for leveraging big data in nursing research. The second manuscript was a scoping review that synthesized the various identification methods used to ascertain opioid exposure in the United States over the last decade. Insights from the scoping review generated three identification methods leveraged in the third dissertation manuscript: (1) Maternal data (e.g., toxicology and diagnoses), (2) Infant data (e.g., toxicology and diagnoses), and (3) Combined method using maternal and infant data. The third manuscript was a secondary data analysis of a large perinatal linkage database in the Midwest to explore the prevalence of prenatal opioid expo (open full item for complete abstract)

Committee: Joshua Lambert Ph.D. (Committee Chair); Sara Arter Ph.D. R.N. (Committee Member); Nichole Nidey Ph.D. (Committee Member); Samantha Boch Ph.D. R.N. (Committee Member) Subjects: Nursing

PhD, University of Cincinnati, 2023, Nursing: Nursing - Doctoral Program

Background: Expert literature reviews and evidence synthesis, such as systematic, scoping, or integrative reviews, represent some of the highest levels of evidence in the health sciences. There is a paucity of research concerning the methodology of integrative reviews, which are prevalent in the nursing literature. Because integrative reviews may incorporate the retrieval, appraisal, and synthesis of a variety of evidence types (empirical [quantitative, qualitative, and/or mixed methods], non-empirical, theoretical, and/or methodological), the integrative review is a somewhat unique type of evidence synthesis. While there is a growing body of literature concerning the methodological rigor of integrative reviews in nursing, advancements in methodological tools are lacking. Purpose: The overarching aim of this dissertation research is to develop and test an appraisal tool to assess the methodological and reporting elements of nursing integrative reviews. The Integrative Review Methodology Appraisal Tool (IRMAT) appraises whether recommended methodological elements are present in published integrative reviews in the nursing literature. Methods: A scoping review was conducted to identify methodological elements of nursing integrative reviews. The 210 methodological elements identified from the scoping review were coded and thematically analyzed to align to the Ellis Model of Information-Seeking Behavior, which resulted in 34 items being generated. Generated items were analyzed by a panel of five nursing integrative review experts for face and content validity. The subsequent version of the tool was used by 204 survey participants and two independent raters so that construct validity, internal consistency reliability, and inter-rater reliability could be analyzed statistically. Results: The expert ratings were used to calculate content validity at the item level using the Content Validity Index (CVI). Twenty-eight items demonstrating sufficient conte (open full item for complete abstract)

Committee: Elaine Miller Ph.D. (Committee Chair); Carolyn Smith Ph.D. (Committee Member); Youn Seon Lim Ph.D. (Committee Member) Subjects: Nursing

Doctor of Philosophy, Case Western Reserve University, 0, Nursing

Acute myocardial infarction (AMI) remains one of the most common causes of death in the United States and allocates a tremendous amount of healthcare expenditures that go beyond $12 billion annually. Machine learning (ML), a subset of artificial intelligence, has emerged as valuable methodological tool to advance nursing and biomedical research. The ML has shown to build predictive models that allow detection of risk factors, assist in diagnosis, and propose personalized treatments plans that may lead to enhanced patients' outcomes. From this perspective, the purpose of this study was to develop and evaluate the predictive performance of a random forest machine-learning model with a conventional multivariate logistic regression model established to examine the influence of individuals predisposing, enabling, and need factors on health service use outcomes (in-hospital mortality, 30-day readmission) of AMI patients guided by the Andersen Model (2008). The cross-sectional retrospective study utilized the Medical Information Mart for Intensive Care which comprises patients admitted to a large tertiary-level academic center of the Harvard Medical School in Boston, MA. The variables of interest include age, gender, ethnicity, type of insurance, body mass index, existing comorbidities, in-hospital mortality, 30-day readmission. Patients with a primary diagnosis of ST-segment elevation MI and non-ST-segment elevation MI cared for at emergency department or critical care units were included in the study. Predictive models for each health service use outcomes were built using RStudio. There were a total of 1171 AMI patients included in the study, 255 (21.8%) patients with STEMI and 916 (78.2%) patients with NSTEMI. Predictors of in-hospital mortality and 30-day readmission included age and existing comorbidities. The accuracy rate, sensitivity, specificity, and AUC for the random forest models were 68-75%, 72-81%, 41-50%, and 0.58-0.59, respectively. On the other hand, the a (open full item for complete abstract)

Committee: Ronald Hickman Jr., PhD, RN, ACNP-BC, FNAP, FAAN (Committee Chair); Mary Dolansky PhD, RN, FAAN (Committee Member); Nicholas Schiltz PhD (Committee Member); Richard Josephson MD, MS, FACC, FAHA, FACP, FAACVPR (Committee Member) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2021, Nursing

Emerging adulthood (ages 18-25 years) is a period of increased disruption and shifting dependency. During this developmental period, women have the highest rates of unintended pregnancy and sexually transmitted infections. However, little is known about how emerging adult-aged (EA) women define sexual and reproductive health (SRH) or how they make decisions about care needs. Prior research has relied on primarily quantitative data from either college-enrolled women or women living in the community, making it difficult to explore experiences across diverse social contexts. This study resulted in creation of a grounded theory of EA women's SRH management and decision-making. The EM(e)RGE Theory is based on EA women's preferred definitions and actions of SRH promotion and risk reduction, as identified by EA women with diverse educational and socioeconomic backgrounds. Results from this study indicate emerging adult-aged women engage in a complex and cyclical process of passively and actively managing their sexual and reproductive health. The EM(e)RGE Theory of emerging adult-aged women's sexual and reproductive health management provides needed insight into the unique health management processes used by a disparate population of women. Women also provided various definitions of SRH, that were organized in to one of three categories, `being safe,' `healthcare,' and `mind-body connection.' The EM(e)RGE Theory and SRH definitions presented in this study provide valuable guidance for future exploratory and intervention research aimed at improving the health and well-being of a unique sub-population of women.

Committee: Laureen H. Smith PhD, RN, FAAN (Committee Chair); Judith A. Tate PhD, RN (Committee Member); Rita H. Pickler PhD, RN, FAAN (Committee Member); Karen Patricia Williams PhD (Committee Member) Subjects: Nursing

PHD, Kent State University, 2020, College of Nursing

An important clinical relationship within our healthcare system is that between the certified registered nurse anesthetist (CRNA) and the anesthesiologist. What constitutes the phenomenon of collaboration has been intensely debated between CRNAs and anesthesiologists. The issue of collaboration is intertwined with consideration of scope of practice, supervision, autonomy, and job satisfaction. A deep examination of history brings forward the relationship between Agatha Hodgins and George Crile who together revolutionized the practice of anesthesia. Nurse Anesthetist Agatha Hodgins was the director of the Lakeside School of Anesthesia and George Crile a world-famous surgeon. The collaboration between Crile and Hodgins resulted in some prolific accomplishments that influence clinical practice to this day. This collaboration between Hodgins and Crile and the use of George Crile's considerable clout was the impetus that tipped the legal scales in support of nursing's first specialty - anesthesia. This relationship is an illustrative moment in history that allows for a forward-looking example of collaboration, shedding light into how to approach the phenomenon of collaboration. The purpose of this historical research study was to investigate the relationship between Agatha Hodgins and George Crile using post structuralism as a thematic guide to uncover how this collaboration informs future nursing practice. This study employed Joan Wallach Scott's theory of using gender as a category of analysis to investigate nursing's place in the history of healthcare in the United States with an emphasis on past and present interpretations of this history. This research contributes to the literature by uncovering those areas in anesthesia practice where the optimization of collaboration can lead to the better utilization of healthcare resources to vulnerable and marginalized populations.

Committee: Pamela Stephenson Ph.D, RN (Committee Chair); Denice Sheehan Ph.D., RN, FPCN (Committee Member); Timothy Scarnecchia Ph.D (Committee Member); Lori Kidd Ph.D, RN (Committee Member); Kenneth Bindas Ph.D (Other) Subjects: American History; Health Care; Nursing

Master of Sciences, Case Western Reserve University, 2018, Clinical Research

Background: Vision impairment (VI) and cataract are common causes of disability in U.S. adults age 65 and older, but are especially, highly prevalent in institutionalized elderly. Objective: To estimate prevalence of VI and cataract in both populations and compare prevalence trends since 1985. Method: A meta-analysis included studies containing both nursing home and community elderly populations. A secondary (synthetic) meta-analysis also included studies containing only one of the two populations, pooled by 10-year cohorts. Results: The meta-analytic pooled prevalence estimates for VI and cataract in nursing home elderly are .50 and .48. In community elderly, these estimates are .04 and .17 respectively. Both meta-analyses indicate significantly higher odds (p<.001) of VI in nursing home elderly (OR1=26.123, OR2=31.097) and cataract (OR1=8.868, OR2=6.378). VI trends in both groups are remaining stable. While community studies are showing a rise in cataract prevalence, nursing home studies indicate a declining trend since mid-1990's.

Committee: Sara Debanne PhD (Advisor); Douglas Rowland PhD (Committee Member); James Spilsbury PhD (Committee Member); Jonathan Lass MD (Committee Member) Subjects: Aging; Epidemiology; Ophthalmology

PHD, Kent State University, 2017, College of Education, Health and Human Services / School of Teaching, Learning and Curriculum Studies

The purpose of this qualitative study was to investigate and describe nursing students' and clinical instructors' understandings of critical thinking and to discover which clinical experiences were significant in allowing students to develop critical thinking abilities. Interpretive qualitative methodology was used to explore students' and instructors' perceptions of critical thinking experiences that occurred during clinical education. Data were obtained from 11 student participants and 4 instructor participants using responses to prompts defining critical thinking experiences and follow-up interviews. There were three overarching findings from this study: (a) students and instructors described similar characteristics of clinical experiences that were significant in developing critical thinking including complex situations warranting independent identification, interpretation, and decision making by students; (b) students and instructors described critical thinking as the ability to process an unclear situation, understand the significance of the context, and know what to do next; and (c) students and instructors revealed a disconnect regarding instructor significance and role during clinical experiences. The findings of this study have demonstrated the importance of clinical experiences and preparing for them and debriefing after them for students and the development of their critical thinking. Implications for nursing education include the need to implement certain strategies that maximize critical thinking experiences in the clinical setting, the need for education and training for clinical instructors, and the need for improved discourse between students and instructors regarding clinical experiences.

Committee: William Kist (Committee Chair); Alicia R. Crowe (Committee Member); Susan Stocker (Committee Member) Subjects: Education; Nursing

Doctor of Philosophy (PhD), Ohio University, 2017, Higher Education (Education)

Non-traditional college students enrolled in online academic studies experience higher attrition rates than traditional aged students in a campus setting. In recent years, the body of knowledge regarding academic success of not only online students has been widely examined, as has the success of students enrolled in undergraduate nursing programs. However, research that utilizes available survey instruments to determine characteristics of successful students in online RN to BSN programs is minimal to this point. Increased retention of students in online RN to BSN academic programs is critical to ensure student satisfaction, education institution revenue generation, and to address the projected future nursing shortage. Using Bean and Metzner's non-traditional student attrition model as a framework, existing instruments were modified and utilized to capture student characteristics at the onset of their online baccalaureate nursing study in an effort to determine whether student academic success in an online RN to BSN program could be determined by similar characteristics as online students in general. Quantitative statistical analysis was completed of Likert-scale data aligning with Bean and Metzner's non-traditional student attrition model. Additional student characteristics examined were age, gender, marital status, computer availability, educational background, hours worked weekly, current semester hours of enrollment, previous online college education enrollment, length of time since previous college enrollment, and current educational funding source. It was concluded that characteristics affecting attrition and success of online undergraduate students in general are dissimilar to characteristics affecting RN to BSN student success. However, it was determined that grade point average level of the initial baccalaureate course in question was found to be positively correlated to future enrollment in subsequent terms. Other factors specific to this academic (open full item for complete abstract)

Committee: Peter Mather (Advisor) Subjects: Education; Educational Technology; Health Education; Higher Education; Higher Education Administration; Nursing

Master of Gerontological Studies, Miami University, 2014, Gerontology

More than a million immigrants from the former Soviet Union are currently living in the United States. Many of those immigrants arrived to the United States in older age. While previous studies were focused on the Russian immigrants' utilization of healthcare services in the United States, almost no studies examined the older Russian-speaking immigrants' hardships in the Soviet Union. A thematic analysis approach was used to analyze interviews conducted with 16 immigrant women from a Mid-Atlantic region, who moved to the US after the collapse of the Soviet Union. Seven identified themes were broken down by two major categories: childhood and adulthood in the Soviet Union and older age in the United States. The findings suggest that views of long-term care, intergenerational support, and socio-economic status are deeply rooted in the cultural and societal expectations of the country of origin.

Committee: Kate de Medeiros (Committee Chair) Subjects: Gerontology

PhD, University of Cincinnati, 2013, Nursing: Nursing - Doctoral Program

Shared governance models have been implemented in health care organizations throughout the world over the past three decades. Moving from a vertical governance structure to a shared leadership organizational model requires significant changes in the culture of an organization, and in the behaviors, beliefs and values of its members. The purpose of this study was to discover, describe and systematically analyze the expressions, meanings, lifeways, beliefs, and values of selected clinical nurse shared governance council leaders in a pediatric health care organization. The aims of this study were to: 1) gain new knowledge from the participants through interviews, focus group sessions and field work that may prepare nurses as leaders; 2) discover barriers that may exist in the development of the caring lifeways that are needed to prepare nurses as leaders; and 3) analyze how caring relationships develop to promote nursing leadership. Ethnonursing research methods (Leininger, 1997) were used to discover previously unknown knowledge about the participants' experiences. The findings illustrated how caring relationships assisted clinical nurse council leaders to discover leadership within themselves, find their own voice, give voice to other nurses, accept personal and professional accountability for nursing practice, and advocate for patients and families. Caring leadership practices were all levels of nurses equally sharing their beliefs and values about nursing practice. However, the values and beliefs that nurses experienced in a hierarchical organizational culture could sometimes be in opposition to a nursing culture with the values and beliefs of shared governance. Mutuality in shared governance was clinical nurse council leaders engaged in equitable, reciprocal communication with managers to share leadership and decision making about nursing practice, and grow professionally to become nursing leaders.

Committee: Edith Morris Ph.D. (Committee Chair); Marilyn Ray Ph.D. (Committee Member); Denise Gormley Ph.D. (Committee Member); Rebecca Lee Ph.D. (Committee Member) Subjects: Nursing

Doctor of Philosophy, Miami University, 2011, Gerontology

How do we translate evidence-based interventions into practice in nursing homes? For years, researchers have focused on developing standardized, reliable procedures to improve care for nursing home residents. As a result, we now have a myriad of best practices to recommend in a number of areas. However, as we learn what nursing home staff should do, we discover that this often is what they are not doing. Several reasons account for this chasm between evidence-based practice and usual practice in nursing homes, including staffing problems, rigid regulations, inadequate reimbursement, and poor management. Rarely cited, however, is the role researchers, advocacy groups, policymakers, and other change agents play in their efforts to translate research into practice. To the extent that specific translational efforts have gone unexamined, they represent an area that may significantly advance quality improvement. That rationale is the basis for this dissertation. The work begins by critically examining the role of nursing home change agents, taking into account evidenced-based principles of innovation dissemination and identifying recommendations to enhance dissemination efforts and speed the translation of research into practice in nursing homes. These recommendations are then applied to two studies of distance learning courses (one on incontinence management, the other on nutritional care)are promising. In each course, multiple staff members in each participating nursing home were able to attend monthly teleconferences that not only improved their knowledge of the recommended evidence-based intervention but also provided a structure and extended support for implementing that intervention with at least some residents. Most participants reported that they would take a similar course again and would recommend the course to colleagues; 57.1% of all participants (total N=175) said they preferred the distance learning model to a more traditional one- to two-day training prog (open full item for complete abstract)

Committee: Robert Applebaum PhD (Committee Chair); Suzanne Kunkel PhD (Committee Member); Rebecca Luzadis PhD (Committee Member); Kathryn McGrew PhD (Committee Member); Jane Straker PhD (Committee Member) Subjects: Gerontology; Health Education; Instructional Design; Nursing

Master of Science (MS), University of Toledo, 2006, Nurse Educator

Caregivers of persons with stroke participated in a bimonthy interview process for a year-long NIH study. The current study described that lived experience for these caregivers. Phenomenology was used as a conceptual framework and method of data collection. Data were gathered from telephone interviews with 14 participants (n=3 men, n=11 women) from the control group of the NIH study. Most subjects were white Americans, aged 33 to 74 years, caring for their spouses. Using Colaizzi's (1978) method for data analysis allowed the following themes to emerge from the interviews: (a) looking forward to talking with someone; (b) feeling helped and staying connected; (c) being busy caregiving and taking care of business; (d) helping others; and (e) being ambivalent or negative about the interview process. Orem's (2001) self-care deficit nursing theory was used to reflect upon the themes to suggest research and interventions to help caregivers develop their dependent care agencies.

Committee: Linda Pierce, Ph.D., R.N. (Advisor) Subjects: Health Sciences, Nursing

BS, Kent State University, 2011, College of Nursing

Purpose: Individual characteristics may influence nurses' choice of clinical specialties. Despite reports concerning general consistency of personality type across specialties, differences among specialties exist and may require unique skill sets. Thus, it is arguable that nurses across specialties may have unique traits. These traits may influence why some nurses choose and excel in specific clinical specialties. The purpose of this study was to describe the lived experiences of nurses as told by the participants and interpret the narrative data to gain understanding of how they enacted nursing in their clinical specialty, identifying themes related to a nurse's sense of clinical fit across specialties. Theoretical Framework: As a philosophy of science and method of interpretation, hermeneutic analysis provided information regarding participants' subjective sense of fit between their individual characteristics and their clinical area of expertise. Participants: Nine clinically-expert nurse faculty members, familiar with student and clinician characteristics, specializing in pediatric nursing, mental health nursing, maternal health nursing, oncology nursing, medical-surgical nursing, telemetry nursing, emergency nursing, critical care nursing, and perioperative nursing. Methods: Qualitative investigation described nurse characteristics across specialties. Interviews and demographic assessments were conducted with a purposive sample. Data were analyzed using Lanigan's approach to Heideggarian hermeneutics. Responses were sorted to identify characteristics by theme according to specialty. Data description, reduction, and interpretation resulted in better nurse characteristic understanding. The method supported auditability of themes and supports the credibility of the investigator's interpretations. Results: Similarities and variances emerged among participants across specialties. Analysis revealed a continuum between interpersonal nurse focus and environmental n (open full item for complete abstract)

Committee: Laura Dzurec PhD (Advisor); Stidham Warner PhD (Advisor); Mary Beth Lukach MSN (Committee Member); Patricia Tomich PhD (Committee Member); Sara Newman PhD (Committee Member) Subjects: Academic Guidance Counseling; Adult Education; Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Business Administration; Business Education; Continuing Education; Cultural Anthropology; Educa; Education; Educational Leadership; Educational Psychology