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 An exploration of somatic symptoms in health profession students(University of Missouri--Columbia, 2025) Sperling, Edith L; Thompson, Sarah; Hulett, JenniferBackground Health profession student stress, anxiety, and depression is well-known to be elevated, but much less research has been done on the relationship of mental and physical symptoms in this population in the U.S. In this dissertation, I present a scoping review on the previous research done in this area, and then a repeated- measures observational study which assesses the prevalence, severity, and relationship between perceived stress, anxiety, depression, and physical symptoms among first- and second-year medical, dental, veterinary, and physical therapy students at a large health sciences university. Methods PRIMSA-ScR guidelines were followed for the scoping review. For the repeated-measures study, surveys were distributed by university email in August and November of the 2024-25 academic year which included the Perceived Stress Scale with helplessness and self-efficacy subscales, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire scales for depression and somatization, the NIH Toolbox Emotional Social Support scale, and the Simple Lifestyle Indicator Questionnaire. Results The scoping review included 29 articles related to the prevalence, severity, and measurement of somatic symptoms of stress in medical students. In the repeated-measures study, perceived stress, helplessness, self-efficacy, anxiety, depression, physical symptoms, and general self-rated health all significantly worsened over the course of the semester, with physical therapy students most affected. Mental and physical health measures were moderately to strongly correlated at both timepoints. Conclusions Results of both the scoping review and repeatedmeasures study provide evidence for a relationship between mental and physical symptoms in health profession students. More research into measures of mental and physical health in a larger sample size, with other potential moderators and mediators, and with mixed-methods designs, will be useful. Eventually, longitudinal research inclusive of objective measures to track students' mental and physical markers from prior to school, through school, and into professional practice may be indicated to further illuminate the links between mental health, physical health, and career attrition.Item Sperm banking in adolescent and young adult males diagnosed with cancer(University of Missouri--Columbia, 2025) Sandheinrich, Taryn; Armer, JaneBackground: Some 87,050 adolescent and young adults (AYA) were diagnosed with cancer in the United States in 2022. While treatment advances have increased 5-year survival rates to more than 86%, many AYA cancer survivors have long-term deficits secondary to cancer-directed therapy. Interrupted childbearing and infertility can affect AYA self-esteem, quality of life, and relationships. Despite this knowledge, AYA fertility preservation rates have been reported as low as 18%. Purpose: The study purpose was to evaluate factors in the decision to bank sperm in newly-diagnosed AYA males. Methods: A qualitative descriptive design with semi-structured interviews was used to better understand factors in the decision to bank sperm. Grounded theory sampling and analysis techniques were used to collect and analyze data. Results: Eleven AYA male cancer survivors (𝑥= 18 yrs [14-22]) participated in audio-recorded interviews which were conducted in person or by telephone. Nine participants identified as white, two as black, and none as Hispanic. All participants had banked sperm within the previous 36 months. Five themes emerged from data analysis: 1) sperm banking as an "insurance policy;" 2) perceived barriers to banking; 3) perspectives on family-building; 4) information to support autonomy; and 5) guidance in the decision to bank sperm. Conclusion: Participants expressed that they desired information on fertility and fertility preservation. While they appreciated guidance, the decision was ultimately theirs to make. Framing banking sperm as an "insurance policy" helped participants engage in shared decision-making with parents and/or the fertility specialist. Findings provide health professionals caring for AYA male cancer survivors fuller understanding of how to engage and frame fertility conversations to elicit shared decision-makingItem A qualitative exploration of the experience of adolescents and young adults and parents in the decision-making process when seeking emergency department care for a pain episode in sickle cell disease(University of Missouri--Columbia, 2025) Ross, Diana C; Sherwin, LeeAnneSickle cell disease affects individuals in the United States and worldwide. It is an inherited genetic disorder that is marked by recurrent pain episodes as well as organ damage. Parents/legal guardians are legally responsible for making medical decisions for adolescents under the age of 18 years. However, once an adolescent becomes an adult, they are responsible for making medical decisions. The purpose of this study was to explore the thought process of adolescents and young adults with sickle cell disease, as well as their parents/legal guardians in healthcare decision making when considering emergency department treatment for acute vaso-occlusive pain episodes. This study used qualitative descriptive methods with thematic analysis. Nine parents/legal guardians participated in the study; six adolescents under the age of 18 years and one young adult aged 19 agreed to participate for a total of 16 participants. Four themes emerged from the analysis describing the experiences of the participants healthcare decision making regarding whether to use emergency department care: (1) Knowledge acquisition through learning activities; (2) Thought process in healthcare decision making; (3) Discussion to seek vaso-occlusive episode care in the emergency room through consideration of reasons for emergency department care; and (4) Reasons it is the responsibility of parents/legal guardians of children. As adolescents and young adults transition to adult care they become the primary decision-maker for their healthcare needs. It is important that parents/legal guardians and healthcare providers ensure there is an understanding of the process of healthcare decision making prior to transition.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.