Research and Publications - School of Nursing

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Imogene King’s Interacting Systems Theory: Application in Emergency and Rural Nursing
(Rural Nurse Organization, 2001) Williams, Leigh Ann
Imogene King is a nursing theorist who has made significant contributions to the development of nursing knowledge. This paper gives an overview of King’s Conceptual Framework and Theory of Goal Attainment and applies the theory to emergency and rural nursing. While all of King’s concepts may not be applicable to emergency and rural nursing, applicable concepts are discussed. Specific clinical examples are presented to support King’s work in practice. The concepts of self, body image, growth and development, time, communication, and interaction are the concepts from King’s theory that the author identifies as being most useful when working with clients in the emergency room and in the rural environment.
Partnership for Healthier Rural Communities
(Rural Nurse Organization, 2001) Lyons, Margaret A.; Crow, Carolyn; Dunn, Linda; Edwards, Becky; Graves, Ann; Shelton, Mitch; Dunkin, Jeri
The purpose of this project was to assess the health status of residents of a small rural community with limited health resources while providing a teaching-learning environment that increases students’ knowledge and skills relative to nursing in a rural community. Twenty-two men, 45 women, and six children participated in a one-day health fair sponsored by a school of nursing. Results indicated that participants need assistance with health promotion in several areas: weight loss/obesity, blood sugar control, lowering cholesterol levels, vision and hearing follow-up, and further screening and possible treatment for depression. Students who conducted the health fair were asked to complete a short questionnaire examining their beliefs related to the usefulness of the health fair. Responses were generally positive; however, some students rated the health fair negatively. Recommendations are given for concentrated follow-up with the study participants as well as suggestions for increasing student assessment of the usefulness of this activity.
Restructuring Rural Health Care: Expanding the PACE for Rural Elders
(Rural Nurse Organization, 2001) VanderMeer, Jeanette; Savage, Grant; Davis, Jullet
The Balanced Budget Act (BBA) of 1997 created an opportunity for improving long-term care for the rural frail elderly by granting permanent provider status to the Program of All-Inclusive Care for Elders (PACE) under Medicare. PACE is a unique managed care model that provides comprehensive, integrated acute and long-term services for frail elders and program providers assume full financial risk. However, all existing PACE sites are currently located in urban settings. This article reviews the PACE provisions in the BBA legislation and describes the current PACE model. Two possible adaptations of the model are discussed for expanding PACE into rural areas.
Biological Perspectives: Adrenergic, Cholinergic, GABAergic, and Glutaminergic Receptor Function in the CNS
(Wiley, 2001) Keltner, Norman L.; Hogan, Beverly; Knight, Tamecka; Royals, Ann Lee
Using Sensors to Measure Activity in People with Stroke
(Taylor & Francis, 2011) Fulk, George D.; Sazonov, Edward; Clarkson University; University of Alabama Tuscaloosa
Purpose: The purpose of this study was to determine the ability of a novel shoe-based sensor that uses accelerometers, pressure sensors, and pattern recognition with a support vector machine (SVM) to accurately identify sitting, standing, and walking postures in people with stroke. Methods: Subjects with stroke wore the shoe-based sensor while randomly assuming 3 main postures: sitting, standing, and walking. A SVM classifier was used to train and validate the data to develop individual and group models, which were tested for accuracy, recall, and precision. Results: Eight subjects participated. Both individual and group models were able to accurately identify the different postures (99.1% to 100% individual models and 76.9% to 100% group models). Recall and precision were also high for both individual (0.99 to 1.00) and group (0.82 to 0.99) models. Conclusions: The unique combination of accelerometer and pressure sensors built into the shoe was able to accurately identify postures. This shoe sensor could be used to provide accurate information on community performance of activities in people with stroke as well as provide behavioral enhancing feedback as part of a telerehabilitation intervention.
Analysis of Electrode Shift Effects on Wavelet Features Embedded in a Myoelectric Pattern Recognition System
(Taylor & Francis, 2014) Fontana, Juan M.; Chiu, Alan W. L.; University of Alabama Tuscaloosa; Louisiana Technical University; Rose Hulman Institute Technology
Myoelectric pattern recognition systems can translate muscle contractions into prosthesis commands; however, the lack of long-term robustness of such systems has resulted in low acceptability. Specifically, socket misalignment may cause disturbances related to electrodes shifting from their original recording location, which affects the myoelectric signals (MES) and produce degradation of the classification performance. In this work, the impact of such disturbances on wavelet features extracted from MES was evaluated in terms of classification accuracy. Additionally, two principal component analysis frameworks were studied to reduce the wavelet feature set. MES from seven able-body subjects and one subject with congenital transradial limb loss were studied. The electrode shifts were artificially introduced by recording signals during six sessions for each subject. A small drop in classification accuracy from 93.8% (no disturbances) to 88.3% (with disturbances) indicated that wavelet features were able to adapt to the variability introduced by electrode shift disturbances. The classification performance of the reduced feature set was significantly lower than the performance of the full wavelet feature set. The results observed in this study suggest that the effect of electrode shift disturbances on the MES can potentially be mitigated by using wavelet features embedded in a pattern recognition system.
Memory and Cancer: A Review of the Literature
(WB Saunders, 2014) McDougall, Graham J., Jr.; Oliver, JoAnn S.; Scogin, Forrest; University of Alabama Tuscaloosa
The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function. (C) 2014 Elsevier Inc. All rights reserved.
Memory Performance and Affect: Are there Gender Differences in Community-Residing Older Adults?
(Taylor & Francis, 2014) McDougall, Graham Joseph; Pituch, Keenan A.; Stanton, Marietta P.; Chang, Wanchen; University of Alabama Tuscaloosa; University of Texas Austin
After age 65, the incidence of episodic memory decline in males is greater than in females. We explored the influence of anxiety and depression on objective and subjective memory performance in a diverse sample of community-residing older adults. The study was a secondary analysis of data on three samples of adults from two states, Ohio and Texas: a community sample (n = 177); a retirement community sample (n = 97); and the SeniorWISE Study (n = 265). The sample of 529 adults was 74% female, the average age was 76.58 years (range = 59-100 years), and educational attainment was 13.12 years (+/- 3.68); 68% were Caucasian, and 17% had depressive symptoms. We found no memory performance differences by gender. Males and females were similarly classified into the four memory performance groups, with almost half of each gender in the poor memory category. Even though males had greater years of education, they used fewer compensatory memory strategies. The observed gender differences in memory were subjective evaluations, specifically metamemory. Age was not a significant predictor of cognition or memory performance, nor did males have greater memory impairment than females.
Ethnic Differences in Nonverbal Pain Behaviors Observed in Older Adults with Dementia
(Elsevier, 2015) Ford, Brianne; Snow, A. Lynn; Herr, Keela; Tripp-Reimer, Toni; University of Iowa; University of Alabama Tuscaloosa
Research supports using nonverbal pain behaviors to identify pain in persons with dementia. It is unknown whether variations exist among ethnic groups in the expression of nonverbal pain behaviors in this special population. The purpose of this descriptive study was to examine ethnic differences in the presentation and intensity of nonverbal pain behaviors among African American, Caucasian, and Hispanic older adults with dementia when screened for pain by certified nursing assistants. Six certified nursing assistants were trained to review and score 28 video recordings of subjects with dementia for nonverbal pain behaviors using the Non-Communicative Patient's Pain Assessment Instrument. Chi-square was used to examine differences among ethnic groups with regard to the display of nonverbal pain behaviors, and ANOVA was used to evaluate differences in the intensity of overall pain across ethnic groups. Of the 168 assessments, pain words (28%), pain noises (29.8%), and pain faces (28%) were observed most often as indicators of pain. Rubbing, bracing, and restlessness were rarely noted. Chi-square analysis revealed ethnic differences in the expression of pain words (chi(2) = 19.167, p < .001). No significant differences were noted across ethnic groups with regards to overall pain intensity. These findings are the first to examine ethnic differences in nonverbal pain behaviors for older adults with dementia. However, future work should examine assessment tendencies of providers in a larger, more diverse sample. (C) 2015 by the American Society for Pain Management Nursing
Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birthweight
(2017) Burton, Wanda Martin; Hernandez-Reif, Maria; Lian, Brad
As a widely used marker of health, birthweight has been a persistent racialized disparity with the low birthweight rate of Blacks in Alabama nearly doubling the national average. The purpose of this study was to examine the role of racial identity and acculturation on birthweight in a sample of Black women living in Alabama. Black women (n=72) in West Alabama were surveyed about the birthweight of their first born child. Correlation and multiple linear regression analyses were conducted. Racial identity was the only significant predictor of birthweight. Mothers with a strong racial identity reported having low birthweight babies less often than those who scored lower on racial identity. Further exploration of racial identity revealed self-image as the essential element that predicted birthweight. Birthweight increased 4.2 ounces for each additional degree of self-image. Results also indicated that birthweight decreased as mothers’ age increased, within the widely accepted optimal maternal age range 21 to 35. Results add to the existing body of literature in support of the positive effect racial identity has on health. Findings on age are congruent with the weathering hypothesis, which states that the health of Black women may begin to deteriorate in early adulthood possibly due to the strain of racism.
Developing the Supporting Choice Observational Tool (SCOT) A Formative Assessment Tool to Assist Nursing Home Staff in Realizing Resident Choice
(Slack, 2017) Palmer, Jennifer A.; Parker, Victoria A.; Burgess, James F.; Berlowitz, Dan; Snow, A. Lynn; Mitchell, Susan L.; Hartmann, Christine W.; Harvard University; Hebrew SeniorLife; Boston University; Harvard Medical School; University of Alabama Tuscaloosa
Quality of care in nursing homes has begun to address the importance of resident choice in daily life, yet there are no published tools to teach nursing home staff how to offer such choice. In the current study, a formative assessment tool was developed that can provide staff with detailed and concrete feedback on how to realize resident choice. The tool was created and refined through 22 hours of ethnographic observation in two Veterans Health Administration Community Living Centers (CLCs), 22 hours of developmental testing in two CLCs, review by a modified Delphi panel, and use of an algorithm to assess its logical structure. The resulting Supporting Choice Observational Tool (SCOT) documents how choice is or is not offered and is or is not enabled within a singular staff-resident interaction. SCOT findings could be used in clinical teaching, quality improvement, or research efforts intent on enhancing nursing home resident quality of life.
Psychometric Evaluation of the MOBID Dementia Pain Scale in US Nursing Homes
(Elsevier, 2019) Herr, Keela; Sefcik, Justine S.; Neradilek, Moni Blazej; Hilgeman, Michelle M.; Nash, Princess; Ersek, Mary; University of Iowa; University of Pennsylvania; University of Alabama Tuscaloosa; University of Alabama Birmingham
Purpose: The Mobilization-Observation-Behavior-Intensity-Dementia (MOBID) Pain Scale is an observational tool in which raters estimate pain intensity on a 0-10 scale following five standardized movements. The tool has been shown to be valid and reliable in northern European samples and could be useful in the United States (US) for research and clinical purposes. The goal of this study was to examine the validity and reliability of the MOBID among English-speaking nursing home residents in the US. Design: Cross-sectional study. Settings: Sixteen nursing homes in Pennsylvania, New Jersey, Georgia and Alabama. Participants: One hundred thirty-eight older adults with dementia and moderate to severe cognitive impairment. Methods: Validity was evaluated using Spearman correlations between the MOBID overall pain intensity score and 1) an expert clinician's pain intensity rating (ECPIR), 2) nursing staff surrogate pain intensity ratings, and 3) known correlates of pain. We assessed internal consistency by Cronbach's alpha. Results: MOBID overall scores were significantly associated with expert clinician's rating of current and worst pain in the past week (rho = 0.54, and 0.57; p < .001, respectively). Statistically significant associations also were found between the MOBID overall score and nursing staff current and worst pain intensity ratings as well as the Cornell Scale for Depression in Dementia (rho = 0.29; p < .001). Internal consistency was acceptable (alpha = 0.83). Conclusions and Clinical Implications: Result of this study support the use of the MOBID in English-speaking staff and residents in the US. Findings also suggest that the tool can be completed by trained, nonclinical staff. (C) 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Blended Facilitation as an Effective Implementation Strategy for Quality Improvement and Research in Nursing Homes
(Lippincott Williams & Wilkins, 2019) Pimentel, Camilla B.; Mills, Whitney L.; Palmer, Jennifer A.; Dillon, Kristen; Sullivan, Jennifer L.; Wewiorski, Nancy J.; Snow, Andrea Lynn; Allen, Rebecca S.; Hopkins, Susan D.; Hartmann, Christine W.; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; US Department of Veterans Affairs; Veterans Health Administration (VHA); Providence VA Medical Center; Harvard University; Hebrew SeniorLife; VA Boston Healthcare System; Boston University; University of Alabama Tuscaloosa
Background: Blended facilitation, which leverages the complementary skills and expertise of external and internal facilitators, is a powerful strategy that nursing stakeholders and researchers may use to improve implementation of quality improvement (QI) innovations and research performed in nursing homes. Problem: Nursing homes present myriad challenges (eg, time constraints, top-down flow of communication, high staff turnover) to QI implementation and research. Approach: This methods article describes the theory and practical application of blended facilitation and its components (external facilitation, internal facilitation, relationship building, and skill building), using examples from a mixed QI and research intervention in Veterans Health Administration nursing homes. Conclusions: Blended facilitation invites nursing home stakeholders to be equal partners in QI and research processes. Its intentional use may overcome many existing barriers to QI and research performed in nursing homes and, by strengthening relationships between researchers and stakeholders, may accelerate implementation of innovative care practices.
Understanding the Dietary Habits of Black Men With Diabetes
(Elsevier, 2019) Lee, Loretta T.; Jung, Seung E.; Bowen, Pamela G.; Clay, Olivio J.; Locher, Julie L.; Cherrington, Andrea L.; University of Alabama Birmingham; University of Alabama Tuscaloosa
Diabetes is highly prevalent in black men. To provide nurse practitioners with practice strategies, we explored black men's perceived needs for dietary health and diabetes self-management using the social cognitive theory. Twenty-five black men participated in 4 focus groups. The data were analyzed using a combination of inductive/deductive content analysis approach. Focus group analysis identified personal, behavioral, and environmental barriers to and facilitators for diabetes self-management. Nurse practitioners may need to provide extra emotional support in the absence of informal social support from families for diabetes self-management and dietary health in black men with diabetes. (C) 2018 Elsevier Inc. All rights reserved.
Older adults' technology use and its association with health and depressive symptoms: Findings from the 2011 National Health and Aging Trends Study
(Elsevier, 2020) Kim, Jeehoon; Lee, Hee Yun; Won, Cho Rong; Barr, Tina; Merighi, Joseph R.; Idaho; Idaho State University; University of Alabama Tuscaloosa; University of North Carolina; University of Minnesota Twin Cities
Background: Information and communication technology (ICT) provides older adults with access to information and resources that benefit their health. Purpose: To explore ICT use among older adults and examine the influence of information technology (IT), communication technology (CT), or ICT use on older adults' self-rated health status and depressive symptoms. Method: A sample of community-dwelling Medicare beneficiaries aged 65 and older in the United States (N = 4,976) from the 2011 National Health and Aging Trends Study. Findings: Older adults who embraced ICT and used this technology for a variety of purposes were more likely to report better health status, and were less likely to experience major depressive symptoms than nonusers. Discussion: In accordance with the Health Information Technology for Economic and Clinical Health Act, nursing professional can play an important role by responding to older adults diverse technology preferences and effectively incorporating them into nursing practice.
COVID-19: Facts, Cultural Considerations, and Risk of Stigmatization
(Sage, 2020) Bruns, Debra Pettit; Kraguljac, Nina Vanessa; Bruns, Thomas R.; University of Alabama Tuscaloosa; University of Alabama Birmingham
Data on COVID-19 supports targeted social distancing could be an effective way to reduce morbidity and mortality, but could inadvertently increase stigma for affected populations. As health care providers we must be aware of the facts of COVID-19, cultural implications, and potential for stigmatization of populations affected by COVID-2019. It is important to consider the real economic impact related to lost workdays due to quarantine and social isolation efforts as well as travel restrictions that may negatively impact access to care and ability to pay for care. Efforts geared towards general education about the disease and the rationale for quarantine and public health information provided to the general public can reduce stigmatization. Countries who are successful at aggressive screening, early identification, patient isolation, contact tracing, quarantine, and infection control methods should also address the risk of stigmatization among populations and the negative effects which could occur. The cases of COVID-19 will continue to rise and the virus will be sustainable for future infections. Timely and appropriate public health interventions addressing cultural impact and risk for stigmatization along with proper screening, treatment, and follow up for affected individuals and close contacts can reduce the number of infections, serious illness, and deaths.
Can Understanding Gut-Brain Axis Biopsychosocial Pathways Improve Clinical Reasoning?
(Elsevier, 2021) Ford, Shannon Hennessy; Hodges, Eric; Thoyre, Suzanne; Baker, Maureen; Bartlett, Robin; University of North Carolina; University of North Carolina Greensboro; University of North Carolina Chapel Hill; University of Alabama Tuscaloosa
Most nurse practitioners (NPs) practice in primary care settings. Cognitive tools to inform and advance NP understanding of biopsychosocial mechanisms can support early recognition, interdisciplinary collaboration, interventions, and prevention of negative outcomes. We describe the development of a model to support NP consideration of gut-brain axis evidence-based pathways, contributing variables, and related health outcomes. The model's outcomes are factors associated with homeostasis or disruption of biological, psychological, and social systems. This cognitive tool aims to support NP awareness of multidomain gut-brain axis relationships to consider with differential diagnoses and clinical treatment of the "whole body system." (C) 2021 Elsevier Inc. All rights reserved.
Caring for an Unconscious Transgender Patient at the End of Life Ethical Considerations and Implications
(Lippincott Williams & Wilkins, 2021) Lippe, Megan; Eyer, Joshua C.; Rosa, William E.; McKinney, Robert; Patterson, Brianna; Matteo, Rebecca A.; Townsend, Haley; Halli-Tierney, Anne; University of Alabama Tuscaloosa; Memorial Sloan Kettering Cancer Center
Individuals who identify as transgender (trans) or other gender-diverse identities are highly marginalized populations within the United States health care system. Transgender individuals experience a broad range of health disparities leading to devastating health outcomes. Experiences with discrimination and biased care often result in a lack of trust in providers and reduced care seeking, yet providers frequently rely on communication with trans patients to build competence. Consequently, when a trans patient has restricted communication, whether due to biological or psychological reasons, their care can be further disrupted. The nursing code of ethics compels the provision of competent care to all patients, regardless of demographics or gender identity, including individuals with serious illness and injury. This article describes an approach to the provision of affirmative, trans-inclusive care in a palliative nursing context that integrates cultural humility and self-reflection into an established patient care framework. The approach is then applied to identify ethical dilemmas present in the case of a trans patient who arrived at a hospital in an unconscious state following serious injury. Nurses' use of the ethical approach when caring for seriously ill trans patients would represent important progress toward fostering a health care system that provides affirmative, trans-inclusive care.
Integration of Health Information Technology and Promotion of Personhood in Family-Centered Dementia Care Intervention Trial
(Slack, 2021) Brown, Ellen L.; Ruggiano, Nicole; Roberts, Lisa; Clarke, Peter J.; Davis, Debra Lee; Agronin, Marc; Geldmacher, David S.; Hough, Monica Strauss; Munoz, Mariateresa (Teri) H.; Framil, C. Victoria; Yang, Xin; Florida International University; University of Alabama Tuscaloosa; University of Alabama Birmingham
Alzheimer's disease and related dementias (ADRD) often result in communication deficits that can lead to negative health outcomes as well as complications for caregiving and clinical care. Although augmentative and alternative communication (AAC) devices have demonstrated efficacy in assisting persons living with dementia (PLWD) in communicating, few devices offer customization for the person's care preferences (e.g., clothing, food, activities) or are designed for integration into clinical care and caregiving. To address this issue, our research team is developing a novel electronic AAC prototype with a touchscreen to promote communication and personhood for PLWD. The current article describes the development of this technology and uses the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement to describe the clinical trial that is planned to test its efficacy. TARGETS: PLWD and their care partners. INTERVENTION DESCRIPTION: Use of AAC Plus to promote communication and personhood for PLWD. MECHANISMS OF ACTION: AAC Plus will provide PLWD and care partners a way to communicate PLWD's daily preferences and provide clinical data for health care providers. OUTCOMES: Determine whether enhanced communication of daily preferences of PLWD will improve quality of life of PLWD and their care partners.
Retrospective and Current Peer Victimization in College Students with Disabilities: Examining the Intersectionality of Sexual Orientation and Gender
(Springer, 2021) Lund, Emily M.; Ross, Scott W.; University of Alabama Tuscaloosa; California State University Monterey Bay
The present, exploratory study examined retrospective and current peer victimization in a multi-university sample of 58 college students with disabilities, 18 (31%) of whom identified as sexual minorities. Fifty-seven participants reported peer victimization during childhood, and approximately half reported experiencing peer victimization in the past 2 months. Students who identified as sexual minorities reported more retrospective victimization but current victimization did not differ between the two groups. Current and retrospective peer victimization were significantly correlated with present psychological distress. Professionals who work with students with disabilities should be aware of the high prevalence of peer victimization and its psychological correlates in this population.

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