College of Nursing and Health Innovation: Department of Nursinghttp://hdl.handle.net/10106/19712024-03-27T10:13:59Z2024-03-27T10:13:59ZSelf-Care Narratives: Life Stories of Rural Adults Managing Chronic Illness without Insurancehttp://hdl.handle.net/10106/317662024-03-01T15:51:20Z2023-07-31T00:00:00ZSelf-Care Narratives: Life Stories of Rural Adults Managing Chronic Illness without Insurance
Uninsured rural adults with chronic illness are more likely to experience worse outcomes than insured individuals. Without access to healthcare or insurance, self-care is an important variable in the management of chronic illness in this rural population. Although rural safety-net programs have been implemented for decades, research on the effectiveness of these programs and self-care is rare and limited. Rural health disparity persists while voices from this marginalized population have gone unheard. The purpose of this study was to give them a voice by capturing first person storied accounts of self-care from chronically ill, uninsured, rural non-elderly adults and to describe the importance of self-care in their illness narratives. Storytelling is a common method of sensemaking among rural populations. Using narrative inquiry methodology, stories were collected from 10 rural participants in semi-structured interviews and then transcribed to text for the analysis. Each story was analyzed for structural and thematic elements, then synthesized into a cohesive self-care narrative. The stories divided into four narrative segments: backstories, crisis, tragedy or overcoming, and resolution. These narratives illustrated the challenges faced by rural adults with chronic illness, including inadequate care, financial difficulties, and the need for better support systems. A self-care / self-reliance framework was derived to better explain their real-world experience. Suggested clinical practice changes include integrated and reconfigured services, person-centered care, and support for health policy change and advocacy. Future research should include a clear definition of the term rural, a concept analysis of self-reliance, access to rural research subjects, and an organized research program.
2023-07-31T00:00:00ZTHE RELATIONSHIP BETWEEN NURSE PROFESSIONAL DEVELOPMENT PRACTITIONERS’ PERCEPTIONS OF EMPOWERMENT IN THE WORKPLACE AND INTENT TO STAY POST COVID-19 PANDEMIChttp://hdl.handle.net/10106/317362024-02-08T17:58:18Z2023-08-15T00:00:00ZTHE RELATIONSHIP BETWEEN NURSE PROFESSIONAL DEVELOPMENT PRACTITIONERS’ PERCEPTIONS OF EMPOWERMENT IN THE WORKPLACE AND INTENT TO STAY POST COVID-19 PANDEMIC
Nurse Professional Development (NPD) practitioners in the acute care hospital setting are often undervalued despite their crucial role. During the COVID-19 pandemic, they demonstrated adaptability by rapidly transitioning to virtual formats for onboarding nursing staff, while also shouldering the responsibility of ensuring staff competency in caring for COVID-19 patients. Additionally, NPD practitioners faced heavy workloads, having to retrain nursing staff who worked in indirect patient care roles, while also filling in during critical staffing shortages. To date, no studies have been found that explored key factors that predict intent to stay in the NPD practitioner population pre- or post-pandemic. Thereby, to address this gap, this study’s purpose was to explore the relationship between NPD practitioners' perception of workplace empowerment and their intent to stay post COVID-19 pandemic. A cross-sectional, descriptive, and correlational design was employed. The study included 313 NPD practitioners from various backgrounds who worked in acute care hospitals across the United States. Employing linear regression analyses, the relationship between empowerment and intent to stay, was examined. Results indicated that NPD practitioners' perception of empowerment as a composite construct was significantly associated with their intent to stay, with higher levels of empowerment associated with a greater intent to stay (β =.32, p < .001). In a multivariate model, formal power (β = .150, p = .043) and access to opportunities (β =.149, p = .015) were most positively, significantly associated with intent to stay. These findings emphasize the importance of empowering NPD practitioners to promote their commitment to the organization. The study aligns with Kanter's theory of empowerment, highlighting that empowering work environments positively impact retention. Further research can explore other variables such as job satisfaction and work engagement. Overall, the study offers valuable implications to retain NPD practitioners and improve patient care outcomes in the evolving healthcare landscape.
2023-08-15T00:00:00ZSerious Infectious Events Following Cesarean Sectionhttp://hdl.handle.net/10106/316892023-11-13T20:00:08ZSerious Infectious Events Following Cesarean Section
The purpose of this study was to evaluate trends in the incidence of serious infectious events (SIE), defined as organ space infection, sepsis, and Cesarean Section (CS) wound disruption, during the birth admission or resulting in between January 1, 2009 and December 31, 2014 in the State of Texas. A retrospective analysis of the Public Use Data File, maintained by the Texas Health Care Information Collection was conducted. Records of 627,555 women who had CS and 1,023 women readmitted for CS wound disruption, were included.
During the study period, there was a large decrease in the rate at which SIE occurred (R2=.59). This was potentially influenced by a large decrease in the rate of the diagnosis of endometritis (R2=.41). Decreases in the diagnosis of and readmission for CS wound disruption were not as large (R2=.06; R2=.03). A large increase in the diagnosis of sepsis (R2=.32) among women who gave birth by CS was identified.
Characteristics of women associated with increased odds of developing SIE included being age 19 years and under, Black race. Treatment exposures; internal fetal monitoring, and induction of labor were associated with increased odds of SIE. Comorbid conditions that increased the odds of being diagnosed with SIE included chorioamnionitis, anemia, post term pregnancy, severe pre-eclampsia, obesity, diabetes, early onset of labor, and abnormal fetal heart rate. The odds of being diagnosed with cellulitis and abscess of the trunk were highly increased among women diagnosed with a SIE. Women who gave birth at facilities located in rural counties had lower odds of being diagnosed with a SIE; women who gave birth by CS at teaching facilities had increased odds of being diagnosed with a SIE. No conclusions about pathogens could be drawn.
New Graduate Nurses and Transition to Practicehttp://hdl.handle.net/10106/316472023-11-09T23:05:57ZNew Graduate Nurses and Transition to Practice
A widely acknowledged transition to practice gap exists for nursing students who have recently graduated and are starting their first job as a registered nurse (RN). In an attempt to bridge this gap, new graduate nurses (NGNs) working in acute care hospitals are usually offered additional training in unit-specific knowledge and skills, along with time working with a unit-based preceptor. Hospital-based training programs are typically between two and six months in length, but the transition to becoming a competent RN with experience is estimated to take between 12 to 18 months (Duchscher, 2008). NGNs have much to learn and they perceive the first year of practice to be very stressful. As a consequence, NGN turnover rates by the end of the first year are conservatively estimated between 12% and 25% (Spector et al., 2015).
At six months of experience, NGNs report the highest levels of stress and lowest level of job satisfaction (Spector et al., 2015). However, no qualitative studies have been published that focus on the lived experience of NGNs as they are experiencing it during this period. The purpose of this study was to use phenomenology to explore the lived experience of NGNs as they transitioned to professional practice during their sixth to ninth month of experience. Fifteen NGNs were interviewed and their responses were analyzed for reoccurring codes and themes. Twelve themes emerged from the data and were grouped into four clusters: overwhelmed, relationships, finding my flow, and being a good nurse.
At this stage in their transition, NGNs struggled with knowledge insecurity and effective time management. They felt overwhelmed and verbalized that being stressed all the time is a new normal that they must adjust to. NGNs in this study understood that creating and maintaining workplace relationships was necessary, as they still had questions and needed help from seasoned nurses. These relationships can be complicated because some nurses with experience were critical of NGNs. As a result, NGNs in this study verbalized uncertainty about asking for help for fear that experienced nurses would think they couldn’t manage the responsibilities of being a nurse. At this stage, NGNs want to be a good nurse and give good care to their patients, but need more support from colleagues, hospital-based educators, and managers. The themes found in this study were compared to the concepts found in Duchscher’s stages of transition theory. Limitations of the study were discussed along with implications for nursing practice and directions for future research.