Nursing Electronic Theses and Dissertations (UMKC)
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The items in this collection are the theses and dissertations written by students of the School of Nursing. Some items may be viewed only by members of the University of Missouri System and/or University of Missouri-Kansas City. Click on one of the browse buttons above for a complete listing of the works.
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Item Understanding adolescent organ and tissue donation decision-making using a qualitative descriptive design: A-DONOR study(2025) Smelko, Alaina Ruth; Russell, Cynthia L.The critical shortage of organ donors is a national health crisis. In the US, there is a discrepancy between favorable attitudes toward organ donation registration and willingness to donate organs. Though educational interventions increase knowledge and positive attitudes toward donation, this change does not always translate into registration. Current research has yet to qualify adolescent donation decision-making processes. The purpose of this qualitative descriptive study was to understand how adolescents make organ donation decisions, including facilitators and barriers. A purposive sample of 14 adolescents, registered organ donors (n=9) and non-organ donors (n=5), were recruited from a rural Pennsylvania high school. Participants were interviewed in-person or online and interviews were audio recorded. Audio recordings were transcribed by NVivo software and verified. Field notes were incorporated into transcripts for use during conventional content analysis. The age range was 16 to18 years-old with a mean age of 17.5 years old. Of the participants, 42.9% (n=6) were female, 57.1% (n=8) were male, and 92.69 % were white. The primary category for decision-making processes was I made the decision myself. Facilitators included I like helping people and I think I got influenced; conversations with parents were impactful and supported adolescents’ donation decisions. Barriers included I was in the moment, I forgot it [organ donation] was even a question, and I don’t think anyone talks about it [organ donation]; participants shared their confusion with the registration processes, including parental consent for minors. Comparable to the decision-making processes of living organ donors, adolescents in this study demonstrated decisional uncertainty and ownership of their donation decision. Similar to other studies, age was a barrier to becoming a donor while parental support was an important influence in their decision-making. Future implications include education for organ donation registration, collaborative education with parents and adolescents, and replication of this study with a more diverse sample. Policies which limit minors’ independent decision-making should be challenged as adolescents demonstrated decisional competence in their organ donation decisions. This study increased understanding of adolescents’ organ donation decision-making processes, facilitators, and barriers which may increase life-long donor registration, thus decreasing the organ donor shortage.Item Identifying new graduate nurses’ comfort with and perception of expressive touch: a mixed methods study(2025) Cloud, Jade E.; Russell, Cynthia L.Background: Nurses use physical touch to interact with patients and address their needs. Human touch benefits social development, stress/anxiety reduction, and rapport building. Some types of touch, such as expressive touch (or the touch used to convey compassion, such as hand holding) can benefit both the patient and caregiver. However, nurses have been shown to be less comfortable with expressive touch as compared to other forms of touch. Inversely, unconsented touch could cause distress to patients. In either case, touch in any form other than procedural is not currently a part of standardized nursing education, despite the numerous studies that indicate a need for such education. New Graduate Nurse (NGN) orientation programs also lack education regarding expressive touch. Before expressive touch education can be developed, baseline information, such as NGN comfort with and perceptions of touch, must be described. Objective: The purpose of this mixed methods study incorporating a quantitative cross-sectional, descriptive, correlational strand and a qualitative descriptive strand, was to 1) ascertain the NGN comfort level with expressive touch, 2) study the correlations between that comfort level and other demographic data such as ethnicity and years of experience, and 3) describe and explore the “who, what, and where” of experiences from the perspective of individual NGNs. Method: A convergent mixed-methods design was used. Instrument: The Nurses’ Comfort with Touch Scale (a validated quantitative survey tool) and a qualitative interview guide were used for this study. Procedure: A cross-sectional online survey, offering the option to self-enroll in the qualitative strand of the study, was administered during a hospital’s already established NGN onboarding programs. Data were analyzed using statistical software with the assistance of a biostatistician. Results: A total of 108 NGNs participated in the quantitative strand of this mixed methods study. The quantitative sample was 77.8% female, with an average age of 29. Overall, NGNs were between neutral and slightly comfortable with expressive touch. NGNs were most comfortable with holding the hand of a patient experiencing anxiety and least comfortable with letting a patient rest their head on the nurses’ shoulder. No correlation was found between NGN age, months of experience as an NGN, and years of experience at the bedside to NGN comfort with expressive touch. Sex assigned at birth (male) was the only demographic variable to have a predictive relationship with NGN comfort with expressive touch (p=<.001, d=0.945). In the qualitative strand, 12 NGNs participated and six patterns were identified: 1) comfort/presence, 2) anxiety reduction, 3) connection, 4) knowing how, when, and who to touch, 5) a natural part of meeting patient needs, and 6) healing. Discussion: NGN comfort level with expressive touch was slightly lower, though comparable, to other studies that measured nurse comfort with expressive touch. Qualitative findings are congruent with other qualitative studies regarding nurses and expressive touch, though new information such as the perception of expressive touch as healing was discovered. Conclusion: This study provided new ways of understanding the depth of expressive touch and its meaning to NGNs. NGNs perceived expressive touch is an important part of caring for their patients. Discrepancies between the importance of expressive touch to the discipline of nursing and NGN comfort with expressive touch indicate the need for interventions regarding the appropriate use of expressive touch. The findings have implications for theory, practice, and research.Item The mMEDITATION study: a randomized controlled trial evaluating the effect of an mHealth meditation intervention compared to cardiovascular education on adults and older adults with anxiety and stress after myocardial infarction(2025) Barthle, Pamela Ann; Russell, Cynthia L.For adults and older adults with myocardial infarction, anxiety and stress are common sequelae after the event. Anxiety and stress can cause recurrent ischemia, arrhythmias, adverse cardiac events, lower quality of life, and higher mortality. This randomized controlled trial evaluated the effect of an 8-week mHealth meditation intervention compared to a cardiovascular education attention-control intervention on anxiety and stress in a convenience sample of adults and older adults with a non-ST elevation myocardial infarction or ST-elevation myocardial infarction. Engel’s biopsychosocial model, polyvagal theory, and the mindfulness stress buffering model provided the theoretical frameworks for this study. A conceptual model for mHealth meditation research in adults and older adults with myocardial infarction was developed to describe the interconnection of these theories. Study recruitment began on October 25, 2022 and ended on November 1, 2024. Sixty-four participants were included in the final analysis. Anxiety was measured with the state and trait subscales of the State-Trait Anxiety Inventory for Adults and stress was measured with the 10-item Perceived Stress Scale and salivary cortisol levels. Anxiety and stress were measured before and after the 8-week meditation intervention or cardiovascular education attention-control intervention. Between groups analysis revealed no statistically significant differences in delta values for anxiety scores on the State-Trait Anxiety Inventory for Adults (state subscale: p = .448; trait subscale: p = .495), stress scores on the 10-item Perceived Stress Scale (p = .168), or salivary cortisol levels (p = .112) between the meditation and attention-control groups. Limitations, including small sample size, homogenous participant population, inequalities in intervention dose, and factors impacting dependent variable measurement, should be considered when interpreting the results. This study makes a unique contribution to the body of knowledge about the effect of mHealth meditation on anxiety and stress in adults and older adults with myocardial infarction. Further theoretical development is needed to support the conceptual model for mHealth meditation research in adults and older adults with myocardial infarction. Future research might include multi-site, fully-powered, randomized controlled trials that evaluate the effect of mHealth meditation interventions on individuals with a variety of cardiac diagnoses.Item Frailty and factors associated with the change in frailty in adults waiting for kidney transplant: a retrospective, descriptive, longitudinal study(2025) Miller, Theresa M.; Russell, Cynthia L.Background: Frailty in kidney transplant candidates has been shown to be 16.4% nationally. Those who are frail have higher morbidity and mortality while waiting for transplantation. Given the scarcity of organs, frailty testing should be completed in kidney transplant candidates to tailor optimization strategies and anticipate post-transplant risks. The purpose of this study was to identify the change in frailty and the factors associated with the change in frailty in adults waiting for kidney transplantation to determine how often testing should occur. Methods: A retrospective, descriptive, longitudinal design was used. Using the Liver Frailty Index, frailty scores were obtained as part of usual care during kidney transplant waitlist appointments. Kidney transplant candidates with two frailty scores one year apart were included in the study. Demographic, comorbidities, dialysis information, and frailty scores were extracted from the electronic medical record. Results: The study included 262 kidney transplant candidates with a mean age of 57 years. The majority of the sample were male (66.4%), White (62.6%), diabetes was the etiology of end stage renal disease (34%), and on in-center hemodialysis (40.5%). Over the one-year period, 57.3% improved their frailty score and 42.7% worsened. The median difference between the pairs of frailty measures were not statistically different (z = 1.185, p = .069). With the variables distributed into three models, the multiple regression indicated that demographics accounted for 4.4% of the change in frailty score, comorbidities 1.7%, and dialysis information 1.8%. None of the models accounted for a statistically significant amount of variance in the change in frailty score. Conclusion: In congruence with prior results, frailty is dynamic and should be measured on all kidney transplant candidates at all waitlist appointments. In practice, knowledge of the frailty status of the kidney transplant candidate allows for the optimization of prehabilitation strategies and the identification of post-transplant risk. This could be accomplished with a change in national policy to require frailty testing, supported by a transplant frailty theory. Implications for future research include a multicenter replication of the study to increase generalizability and the use of the Liver Frailty Index in all solid organ transplant candidates.Item A pilot randomized controlled trial of a palliative care education intervention compared to usual care on health literacy and quality of life among older adults with chronic obstructive pulmonary disease: the paced study(2024) Counts, Kelly Dannette; Lasiter, SueAdults 65 years of age and older (older adults) with chronic obstructive pulmonary disease (COPD) are living longer, report lower health literacy, experience poorer quality of life (QOL), and seek emergency department care for relief of symptoms such as breathlessness, dyspnea, pain, and anxiety. Uncertainty about illness progression can affect patients' ability to understand health information and make informed decisions impacting QOL. Limited research exists on health literacy and QOL related to palliative care education in emergency departments, making it a healthcare priority. Online education for older adults is effective for increasing healthcare knowledge. The purpose of this pilot randomized controlled trial feasibility study was to test the study research protocol including the intervention or usual care, instruments, recruitment, retention, attrition and to identify trends in health literacy and QOL in older adults with COPD seeking treatment in an emergency department who were randomized into the four-week online standardized palliative care educational intervention or usual care. The expanded chronic care model combined with palliative care constructs provided the theoretical foundation for this study. Feasibility data were collected during the study and feasibility questions were assessed at study completion. The Short Form-36, which measured QOL and the health literacy questionnaire, which measured health literacy, were administered at baseline and at study completion. Of 190 patients screened, 35 met inclusion criteria and were randomly assigned (1:1) to either the intervention (n=17) or usual care (n=18). Attrition was 74% overall with 72% from the intervention group and 82% from the usual care group. Eight participants completed the study, five in intervention and three in usual care. Of these eight, 35% were male, 88% were Caucasian and 35% had a college education. All five intervention participants accessed each of the four palliative care educational videos. All study surveys were completed with no missing data. Within and between groups, QOL and health literacy trends were unable to be identified due to small sample sizes. In conclusion, protocol modifications are needed for future study success. Testing palliative care educational interventions for older adults with COPD treated in the emergency department remains an important goal.