Nursing electronic theses and dissertations (MU)
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The items in this collection are the theses and dissertations written by students of the Sinclair School of Nursing. Some items may be viewed only by members of the University of Missouri System and/or University of Missouri-Columbia. Click on one of the browse buttons above for a complete listing of the works.
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Item Perspectives of emergency triage nurses and evidence of bias in the assessment of people experiencing homelessness(University of Missouri--Columbia, 2024) Jackson, Kim Yvonne; Vogelsmeier, AmyBackground: Implicit bias can have a negative effect on patient assessments and treatment decisions in the emergency department (ED); patients experiencing homelessness (PEH) are particularly vulnerable. Purpose: The purpose of this study was to describe how the potential presence of cognitive biases in ED nurses may influence the triage process in PEH. Method: This qualitative descriptive study used ethnographic methods to guide observations and interviews of ED nurses during the triage process. Qualitative content analysis was used for observation data and thematic analysis was used for interview data. Findings were then compared to identify differences and similarities between the observed presence of bias and nurses' described experiences. Results: Twelve ED nurses were observed for over 128 patient encounters (n= 16, 13 percent PEH; n= 122, 88 percent housed patients); then participated in interviews. Observation findings included two themes, 1) Emergency Medical Services (EMS) Presentation: Words Matter and 2) Nurse Response: Taking Action. Interview findings identified four themes, 1) Objective Interpretation, 2) Subjective Interpretation, 3) Resulting Disparities, and 4) Busy Environment. Differences included nurses' observed actions of often disregarding PEH compared to their perceptions of remaining impartial. Similarities included presence of bias in both observation and interviews and reflected how personal labels and assumptions can influence nurse response. Conclusion: ED nurses may require additional bias awareness education specific to vulnerable populations such as PEH. These findings suggest an opportunity for future research to investigate implementation of bias awareness strategies to mitigate bias presence during the triage process.Item The experiences of using telehealth in older adults in Thailand : a mixed-methods study(University of Missouri--Columbia, 2024) Narasri, Pawena; Sherwin, LeeAnneObjective: This study aimed to explore factors that influenced the intent to use telehealth and describe the experience of using telehealth among older adults in Thailand. Methods: An explanatory sequential mixed methods design was used to study a convenient sample of 105 participants from the seven communities located in the same district in Bangkok, Thailand. Quantitative data included the participants' characteristics, the adapted Technology Acceptance Model Questionnaire, and the eHealth Literacy Scale. Multiple regression was used to investigate the factors affecting the intention to use telehealth. Qualitative data were obtained from 7 individual interviews which were purposefully selected from the participants in quantitative phase and analyzed the data by using thematic analysis. Results: Mean age was 68.18 [plus or minus] 4.86 years. More than half of the participants were female (67.6 percent). Most participants received telehealth services from public hospitals and used telehealth services for home isolation during COVID-19 and for monitoring chronic diseases. Participants had a high level of perceived usefulness, ease of use, and intention to use, while they had low digital health literacy level. The results from multiple regression showed that the digital health literacy level was related to more ease of use ([beta]=0.23, t=4.26, p[less than]0.001); while the ease of use was related to more usefulness ([beta]=0.37, t=5.28, p[less than]0.001). Additionally, digital health literacy has a statistically significant influence on intention to use telehealth ([beta]=0.23, t=3.31, p=0.001), whereas the perceived usefulness and ease of use was not significant influence on intention to use. Seven themes emerged from the qualitative analysis: 1) experiences using telehealth; 2) perceived usefulness; 3) perceived ease of use; 4) social influence; 5) intention to use telehealth; 6) prefer in-person visits; and 7) concerns regarding using telehealth. Data integration was discussed to provide a deeper understanding of the quantitative results. Conclusion: This study found that digital health literacy was the main factor affecting the intention to use telehealth among older adults, however, they had low digital health literacy. Mobile-based telehealth intervention via phone calls and text messages is appropriate among this population. Additionally, educating on the benefits of telehealth could enhance knowledge and potentially enhance usage. Thus, these findings contribute to the literature on telehealth usage in older adults and the need for educational interventions for older adults in low-income settings in Thailand aimed to enhance accessibility of services and achieve optimal health outcomes.Item Family impacts of diabetic extremity wounds : a qualitative case study(University of Missouri--Columbia, 2024) Doss, Elizabeth; Popejoy, LoriOne in every three persons with diabetes mellitus will develop a diabetic extremity wound as a complication of diabetes within their lifetime. Diabetic wounds and subsequent amputations can have significant adverse consequences which affect not only patients, but also the family members who care for them. Informal family caregivers perform many vital health assistance tasks over months or even years of chronic wound treatment. Little previous research on family-wide experiences of diabetic extremity wounds has been performed in the United States. This qualitative dissertation used a multiple case study design to explore the experiences of families caring for a member with a diabetic extremity wound. Themes related to impacts on family functioning, the caregiving experience, and formal healthcare utilization were identified. These findings provide insight into the experiences of families living with diabetic extremity wounds, as well as clinical and research directions for the future.Item Impact of rural habitus on first-time mothers' feeding choices(University of Missouri--Columbia, 2024) Weston, Karry Lee; Bullock, LindaAlthough breastmilk is considered the nutritional gold standard for infants, many U.S. rural infants are not breastfed. The concept of habitus includes the socialization of an individual that shapes perceptions of the outside world and influences behaviors. Exploring rural mothers' habitus could help healthcare professionals to 1) better understand why rural mothers make decisions regarding infant feeding and 2) guide interventions tailored to rural mothers' unique needs. Guided by the concept of habitus, we sought to explore 1) rural mothers' intentions and decision-making around infant feeding their first child, including their unique habitus, and other key community influencing factors, 2) rural mothers' perceptions of how the rural community influenced their infant feeding decisions, and 3) rural mothers' priorities for interventions to support breastfeeding, including needs for information, support, and resources. We developed an interview guide informed by the four constructs that constitute habitus: childhood socialization, education, social class, and predominant feeding in the community. We conducted a qualitative descriptive study to examine the perspectives of first-time mothers in rural Missouri. Using semi-structured interviews (N = 18) via Zoom or by telephone, we asked questions about mothers' decision-making processes regarding how they planned to feed their newborn after delivery. All interviews were transcribed, double-checked for accuracy, and analyzed using line by line coding with NVivo software. The mean age of the 18 mothers was 24 years old (range 18-30) and the mean age of the infants was 6 months old (range 1-11 months). All but one were low income and qualified for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services. Major themes influencing mothers' intentions and decision-making around infant feeding included: 1) I'm educated but not so much on breastfeeding; 2) This is small town culture; 3) I had expectations; and 4) This area lacks resources for mothers. Overall, the mothers in this sample had high expectations during pregnancy to breastfeed discontinued soon after delivery. The mothers' shared experiences of deciding during pregnancy how to feed their infants were impacted by childhood upbringing, family, friends, and communities' views of breastfeeding, as well as community resources such as WIC- a very pro-breastfeeding organization. During pregnancy, the infant nutrition education mothers received strongly encouraged breastfeeding and touted its benefits, and most verbalized the benefits of breastmilk for infant health and immunity. It was clear that the education motivated them to try breastfeeding. However, after delivery, this breastfeeding education was inadequate for these rural mothers in equipping them to overcome the pragmatic issues in being successful at breastfeeding. We hypothesize that the standard breastfeeding education may be adequate for urban women because they have more resources to aide in addressing these pragmatic issues compared to rural women. Hence, the higher rates for breastfeeding found among urban low-income mothers. For rural mothers to be successful in their attempts to breastfeed postnatally, our results point to their needing additional information, especially how to determine if their infant is getting enough nutrition post-delivery and examining messaging in different ways about what to expect in the first days post-delivery when attempting to breastfeed. Future research is necessary to understand what and how to better help women immediately after delivery when the intent is to breastfeed, but the reality ends in feeding their infant formula. Research is also needed to better understand how to effectively communicate that information based on women's habitus and how best to bridge the needed support that may be lacking in rural areas.Item The lived experience of bilateral risk-reducing mastectomy and impact on body image in young women with increased lifetime hereditary breast cancer risk(University of Missouri--Columbia, 2024) Torrisi, Christa; Armer, Jane M.Previvor is a term applied to a person with an identified, elevated lifetime cancer risk but who lacks a cancer diagnosis. Management strategies can be undertaken to decrease the risk of developing certain cancers. For women with a pathogenic variant that increases the predisposition for a breast cancer diagnosis, a bilateral risk-reducing mastectomy (BRRM) is the most effective cancer prevention strategy. Currently, there is a dearth of literature examining BRRM and its effects on young women. This study sought to understand the lived experience of BRRM, along with its impact on body image, in young female previvors in the first 12 months following surgery. Two qualitative methods, descriptive phenomenology and photo-elicitation, were utilized to describe the lived experience of BRRM and body image. Narrative data served as the primary data source, augmented by participant-provided visual data. A sample of 13 women were interviewed. Eight themes were found to describe how young previvors process an increased lifetime breast cancer risk, select BRRM and reconstruction methods, and express the effect of BRRM on body image. Findings provide a rich description of risk-reduction and body image outcomes in young previvors. Results from this project will be used to design future research for improving the physical and psychosocial health of this unique population.