2019 UMKC Dissertations - Freely Available Onlinehttps://hdl.handle.net/10355/680002024-03-29T05:19:57Z2024-03-29T05:19:57ZA descriptive, cross-sectional, correlational exploration of perceived stress, quality of life, and family functioning in parents of a child with congenital heart disease: The PinCHeD StudyGregory, Mary Rebeccahttps://hdl.handle.net/10355/711032020-01-27T18:18:20Z2020-01-01T00:00:00ZA descriptive, cross-sectional, correlational exploration of perceived stress, quality of life, and family functioning in parents of a child with congenital heart disease: The PinCHeD Study
Gregory, Mary Rebecca
Background: As survival rates for infants born with severe forms of cardiac disease improve, attention is directed to evaluating factors that affect the child’s short- and long-term outcomes, including parental stress, quality of life, and family functioning. Facing the unique struggles of having a child with congenital heart disease (CHD) can often result in high stress for the child, their parents, and other family members and may result in adverse effects in family functioning. Mothers of a child with CHD tend to report higher levels of stress and poorer quality of life and family functioning when compared to mothers of heart-healthy children or children with other chronic illnesses. Paternal perspectives when having a child with CHD have been understudied in comparison to mothers of a child with CHD.
Purpose: The purpose of this descriptive, correlational, cross-sectional study was to explore parental perceptions of stress, quality of life, and family functioning when having a child with CHD. Factors that influence parental stress, quality of life, and family functioning when having a child with CHD are described, and relationships between the perceived factors and comparisons between the perceptions of mothers and fathers were made. relationships being examined. McCubbin and Patterson’s (1983a, 1983b) double ABCX theory of family adjustment and adaptation was chosen as the framework for this study.
Methods: A purposive sample of 62 parents of a child with a CHD below six years of age, who had received neurodevelopmental care from the Cardiac Neurodevelopmental program at Children’s Mercy Hospital in Kansas City, Missouri were included in the study. The parents completed the following instruments: The Pediatric Inventory for Parents (PIP), The Pediatric Quality of Life Inventory™ Family Impact Module (PedsQL™ FIM), and a demographics survey.
Results: Thirty-one parent pairs participated in this study. The mean age for mothers and fathers were 36.68, ±5.353 and 38.48, ±5.941, respectively. Race and ethnicity of the parent population was largely homogeneous, with mothers (n = 31, 90.3%) and fathers (n = 31, 93.5%) being of White race, and, of parents who reported ethnicity, mothers, (n = 19, 100% White) and fathers, (n = 21, 54.8% White; 12.9% Hispanic or Latino). The mean education level for mothers and fathers was just under that of a bachelor’s degree (mothers μ = 9.90, SD= 1.720) (fathers μ = 9.61, SD = 1.706). Parent pairs had a mean relationship length of 11.37 years. The children with CHD of the participating parents were mostly male (n = 19, 61%). The child’s mean age at time of parent survey completion was 4.83 years and have 18 different fundamental CHD diagnoses among the sample.
Among 62 parents of 31 children with CHD, all subscale and summary scale median stress scores for fathers fell within the low stress range except for total frequency of stress (n =31, Mdn = 86.00, IQR = 35), which fell within the moderate stress range. Mothers reported median scores in the low stress range for all subscales except for the following subscales that had scores in the moderate stress range: emotional distress frequency (n = 31, Mdn = 33.00, IQR = 118), emotional distress difficulty (n =31, Mdn = 37.00, IQR = 20), total frequency (n = 31, Mdn = 86.00, IQR = 47), and total difficulty (n = 31, Mdn = 86.00, IQR = 47). There was a statistically significant difference (Z = -2.30, p = 0.02) in the role functioning subscale where fathers (n = 31, Mdn = 16.00, IQR = 10) reported less difficulty in role functioning than mothers (n = 31, Mdn = 21.00, IQR = 16). In regards to quality of life, fathers reported high levels of quality of life in all subscales and summary scales, and mothers reported high levels of quality of life in all subscales except emotional functioning, worry, and the health related-quality of life (HRQOL) summary scale, which were all in the moderate range. Statistically significant scores were found in emotional functioning, where fathers reported statistically significant (Z = -2.52, p = 0.01) better emotional functioning (n = 29, Mdn = 450.00, IQR = 162) in comparison to mothers (n = 29, Mdn = 350.00, IQR = 250), and in communication, where fathers reported statistically significant (Z = -2.38, p = 0.02) better communication (n = 29, Mdn = 275.00, IQR = 100) in comparison to mothers (n = 29, Mdn = 225.00, IQR = 137.5). There were no statistically significant differences between family functioning scores between mothers and fathers. All measured factors of parental stress and quality of life were found to have statistically significant relationships with family functioning (p ≤ 0.05). Regarding the relationship between stress and family functioning, fathers of a child with CHD reported lower mean scores in every PIP subscale and summary scale compared to mothers. Regarding the relationship between quality of life and family functioning, the PedsQL-FIM quality of life summary score and family functioning summary scores are positively correlated (r(58) = 0.84, p = 0.00).
There were no statistically significant relationships between the severity of the child’s heart defect type, as measured by the STAT and parent reports of stress, quality of life, and family functioning (p < 0.05). Additional analyses determined time since most recent cardiopulmonary bypass surgery had a positive association on communication of both parents (r(58) = 0.275, p = 0.03), and fathers of a child with CHD (r(28) = 0.396, p = 0.03). Regarding the frequency of past cardiopulmonary bypass (CPB) procedures, the only statistically significant difference (U = 3.00, p = 0.007, r = -0.63) found was among fathers of a child who had had one CBP procedure and fathers of a child who had had four (n = 4, Mdn = 25.00, IQR = 4) CBP surgeries when compared to those whose child had had only one CBP surgery (n = 14, Mdn = 17.00, IQR = 7). Having a child with CHD and abnormal brain imaging negatively influenced many aspects of their parents’ quality of life and family functioning (p < 0.05): physical function (r(58) = -0.296, p = 0.02); social functioning (r(58) = -0.254, p = 0.05); worry (r(58) = -0.281, p = 0.03); daily activities (r(58) = -0.314, p = 0.01); parent HRQL summary score (r(58) = -0.260, p = 0.04); family functioning summary score (r(58) = -0.260, p = 0.05); and total FIM score (r(58) = -0.267, p = 0.04).
When their child had received early intervention services, there were statistically significant associations in all of the parents’ reports of worry, (r(58) = -0.281, p = 0.03); and daily activities, (r (58) = -0.328, p = 0.01). For gender-based sub groups, fathers had statistically significant associations with worry (r(29) = -0.374, p = 0.04), and mothers had statistically significant associations found with the daily activities subscale (r(29) = -0.393, p = 0.03).
Discussion: The differences between fathers and mothers of a child with CHD were not clinically meaningful. The descriptive statistics for scaled and summary scores indicated that parents who report better outcomes in their stress and QOL also report better overall family functioning and vice versa. These results indicated that parent perceptions of their stress, QOL, or family’s functioning were not significantly impacted by the severity of the child’s heart defect; therefore, severity of CHD type should not be used to predict which parents may experience high levels of stress or poorer QOL and family functioning. Results also demonstrated as more time passed, QOL for parents improved and may serve as an indicator of parents developing bonadaptation related to their child’s health condition. Having a child with CHD and a known developmental delay or brain injury may serve as a better indicator for identification of parents and families who will benefit from supportive interventions.
Conclusions: This pilot study demonstrated feasibility for additional research about the experiences among parents of a child with CHD to understand their needs for support, and to determine if fathers report similar outcomes as mothers, who are much more prevalent in research addressing parental outcomes when having a child with CHD. Longitudinal and interventional studies will assist in determining timing and effectiveness of supportive interventions for parents of a child with CHD. Parent-supportive policies will benefit from additional father-inclusive research and advocacy.
Title from PDF of title page viewed January 27, 2020; Dissertation advisor: Sue Lasiter; Vita; Includes bibliographical references (page 165-197); Thesis (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2019
2020-01-01T00:00:00ZA Heuristic Multiple-Case Study of Culturally Relevant Practices of Six Urban Elementary School PrincipalsWright, Angela Gracehttps://hdl.handle.net/10355/719692020-03-11T13:53:26Z2019-01-01T00:00:00ZA Heuristic Multiple-Case Study of Culturally Relevant Practices of Six Urban Elementary School Principals
Wright, Angela Grace
The purpose of this heuristic multiple-case study was to explore the practices of six urban elementary school principals regarding the use of culturally relevant practices in their schools. The central question was: How do urban elementary principals perceive their preparation for providing teachers assistance with culturally relevant instruction? Data sources included a qualitative questionnaire, in-depth semi-structured interviews, observations, and documents. Within case and cross analysis were incorporated with coding the data for patterns and meaning. The most prevent theme was Leadership for Curriculum and Instruction that consisted of monitoring student data and supporting standards. Findings suggested that most of the co-researchers were unprepared to assist teachers with culturally relevant practices. None of them considered equity leadership as a way to provide equity and justice within districts and schools. What they valued about elements of culturally relevant practices, especially the richness of students’ backgrounds and celebratory multicultural education as starting points for implementation, was compromised by preparation coupled with Midway School District’s (pseudonym) reform agenda of assessment, standards and monitoring data that derailed support for culturally relevant practices.
Title from PDF of title page viewed March 11, 2020; Dissertation advisor: Loyce Caruthers; Vita; Includes bibliographical references (pages 269-293); Thesis (Ed.D.)--School of Education. University of Missouri--Kansas City, 2019
2019-01-01T00:00:00ZA qualitative case study deconstructing teachers' decisions in the pre-active stage of teaching to illuminate considerations made for teaching 21st-century skills and knowledgeCalcara, Carl Michaelhttps://hdl.handle.net/10355/710462020-01-13T17:56:12Z2019-01-01T00:00:00ZA qualitative case study deconstructing teachers' decisions in the pre-active stage of teaching to illuminate considerations made for teaching 21st-century skills and knowledge
Calcara, Carl Michael
The purpose of this heuristic case study was to develop a deeper understanding of how middle-level teachers in one Midwestern middle school account for teaching 21st-century skills and knowledge, within the context of a standardized curriculum. This study seeks to obtain descriptive information for how teachers account for 21st-century skills and knowledge in their instruction while in the pre-active stage of teaching. The central question was: What intentional considerations do teachers make in the pre-active stage of teaching for meeting the needs of diverse learners? Data collection included classroom observations, lesson reflection journals, individual teacher interviews, and a focus group interview. Through the process of within-case and cross-case analysis, aided by the use of a qualitative data software, NVivo 12 Qualitative Data Analysis, themes identified in the data were: Pre-Active Stage Inputs, 21st-century Framework Comprehension, Barriers to Implementation, and Fidelity to Curriculum. The findings supported much of the reviewed literature related to teacher decision making and inputs with regard to instruction. However, the study revealed that deficit thinking and the pressures of standardization and curricular accountability had a more detrimental impact on teachers’ ability and willingness to implement 21st-century skills and knowledge into lessons, especially when the curriculum did not intentionally include 21st century skills and themes. These findings may guide instructional leaders as well as classroom practitioners toward a more rigorous and comprehensive 21st-century aligned pedagogy.
Title from PDF of title page viewed January 13, 2020; Dissertation advisor: Loyce Caruthers; Vita; Includes bibliographical references (page 228-252); Thesis (Ed.D.)--School of Education. University of Missouri--Kansas City, 2019
2019-01-01T00:00:00ZA retrospective study of the clinical capstone experience on perceptions of practice readiness in associate degree student nurses and perceptorsEricson, Kendra M.https://hdl.handle.net/10355/709052020-03-17T19:38:26Z2019-01-01T00:00:00ZA retrospective study of the clinical capstone experience on perceptions of practice readiness in associate degree student nurses and perceptors
Ericson, Kendra M.
Purpose of the Student Transitional Experience into Practice (STEP) study was to explore differences in perceptions of practice readiness between associate degree student nurses and their preceptors after a clinical capstone experience. Significance: Commonalities are reported by student nurses and newly licensed registered nurses facing the daunting task of becoming competent clinical practitioners. The novice nurse has reported that exposure to the workplace setting, professional roles, and acquisition of psychomotor skills aided in their perception of practice readiness and perceived competency level. Nursing educators seek innovative teaching modalities that assist in producing sound, competent generalist graduate nurses. Graduate nurses need to be able to demonstrate theoretical competency on the NCLEX-RN and be able to function independently as a registered nurse once in practice. Method: This STEP study was a pilot quantitative, retrospective design employing secondary data analysis of associate degree nursing students at a multi-campus Midwest community college. Instruments: The Casey-Fink Tool measured perceptions of student nurse practice readiness and their preceptors’ perceptions of student readiness following the final clinical capstone experience. The survey instrument is a three-factor set of correlated subscales: demographics/clinical experience, competency skill performance, and professional identity of the student nurse. Procedure: This STEP study utilized collected data from the Casey-Fink Tool survey data obtained during the spring 2018 clinical capstone course from 100 students and preceptors. Analysis: A descriptive analysis of the Casey-Fink Tool survey data, including exploratory factor analysis, was used to identify subscales and study findings. Nursing Implications: This STEP study advances the future of nursing education by exploring curricular methodologies to aid in the preparedness and practice readiness of the student nurse upon graduation.
Title from PDF of title page viewed January 6, 2019; Dissertation advisor: Christine Zimmerman; Vita; Includes bibliographical references (pages 110-114); Thesis (Ph.D.)--School of Nursing and Health Studies. University of Missouri--Kansas City, 2019
2019-01-01T00:00:00Z