Research and Publications - School of Nursing

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Intraoperative Ketamine Administration for Enhanced Pain Management
(2024-07-02) Colin Tomblin
Introduction: Ketamine has been around for over 50 years in the United States and is now commonly used in anesthesia practice. When administered in subanesthetic doses, it is an effective alternative to opioid administration for postoperative pain control without the unwanted side effects of higher doses. Total joint arthroplasty is one of the most performed orthopedic surgeries and effective pain control is a must. The research evidence reflected lower pain scores in the immediate and early postoperative periods (6-24 hours) in patients who underwent total joint replacement surgeries and received intraoperative ketamine. Methods: The project design was a retrospective chart review using Cerner 1Chart of patients aged 40 to 65 years old who underwent total knee arthroplasty or total hip arthroplasty surgery. The postoperative pain scores of the patients who did and did not receive intraoperative ketamine were collected and analyzed pre and post educational intervention. Results: A total of 80 cases were analyzed with half being pre-educational intervention and 40 pos-educational intervention. A Chi-Square Test and t-test were performed on the data obtained from the retrospective chart review. There were no statistically significant differences in ketamine administration by CRNAs before and after the intervention (chi-square = .29, p = .59). There were no statistically significant differences in patient’s self-reported levels of pain based on the administration of ketamine (t(78) = 1.13, p = .26). Discussion: The overall sample size was relatively small, and more data could be collected over a longer time frame to be analyzed. Assessing and trending the postoperative pain scores over a 6–24-hour period could yield useful information.
Gendered racial microaggressions and black college women: A cross-sectional study of depression and psychological distress
(Taylor & Francis, 2022-10-13) Burton, Wanda Martin; Paschal, Angelica M.; Jaiswal, Jessica; Leeper, James D.; Birch, David A.
Objective: We assessed the association between gendered racism, the simultaneous experience of sexism and racism, depression, and psychological distress in Black college women using an intersectional instrument, the gendered racial microaggression scale. Participants: Black college women enrolled at a predominantly white institution (PWI) in the southeastern U.S. (N=164, response rate = 77%, mean age 21.67). Methods: We used a cross-sectional survey to explore the impact of stress appraisal and frequency of gendered racial microaggressions on depression and psychological distress using validated scales. Results: 30% reported depression and 54% reported severe psychological distress. Correlations indicate significant relationships between gendered racism, depression and psychological distress, with the strongest relation reported between the frequency of gendered racism to depression. Regression analyses suggest significant relationships between gendered racism, depression and psychological distress. Conclusion: Gendered racism has significant bearing on the mental health of Black college women attending a PWI. Implications for interventions are discussed.
Memories of adult survivors of childhood cancer: Diagnosis, coping, and long-term influence of cancer
(Taylor & Francis, 2022-02-03) Hinton, Tori; Burns-Nader, Sherwood; Casper, Deborah; Burton, Wanda Martin
Purpose: This study examines adult childhood cancer survivors’ memories about diagnosis, coping, and life effects of cancer.Research approach: This qualitative study used inductive content analysis to analyze open-ended responses completed in a survey conducted in 2018.Participants: 27 adult survivors (15 male, 12 female) of childhood cancer, ranging in age from 20–39, who were at least 5 years post treatment.Methods: Participants recruited through Amazon MechanicalTurk responded to a survey which included open-ended questions about experiencing childhood cancer to examine their:(1) memories of initial reactions to cancer; (2) memories of coping during cancer; and (3) reflections of the cancer experience on who they are today.Findings: Inductive content analysis was performed to reveal categories related to the stories shared by participants regarding their memories of childhood cancer experiences. Participants’memories of diagnosis reflected categories such as psychological reactions and family support. Memories of coping reflected themes of family support and distraction. Participants’ reported strength and resilience as impacts of cancer on their present lives. Implications for Psychosocial Providers: These findings indicate that survivors of childhood cancer have strong, specific memories about diagnosis and coping during cancer and highlight the potential long-term implications of having cancer. The findings also illustrate the importance of appropriate psycho-social support for childhood cancer patients and survivors.
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.
Challenges to Providing Integrated HIV Prevention in Substance Use Treatment Settings: Frontline Staff Perspectives on HIV and Sex-Related, Education, Communication and Stigma
(Taylor & Francis, 2023-10-11) Jaiswal, Jessica; Griffin, Marybec; LoSchiavo, Caleb; Cox, Amanda; Hascher, Kevin; Dunlap, Kandyce; Walters, Suzan; Burton, Wanda Martin; Grini, Benjamin; Mumba, Merci; Eaton, Ellen
Introduction Substance use treatment settings can play a critical role in ending the HIV epidemic. Community-based methadone clinics are potentially useful sites to offer biomedical HIV prevention, but little is known about how clinicians and other clinic staff communicate with patients about sexual behavior and HIV-related topics. Methods Thirty semi-structured interviews were conducted at two methadone clinics in Northern New Jersey. Participants included medical providers (physicians, RNs, DNPs), methadone counselors, intake coordinators, lab technicians, and other auxiliary staff members. Results: Three major themes were identified: (1) HIV education is primarily provided by external organizations, (2) there is limited staff-patient communication around HIV and sexual behaviors, and (3) HIV stigma is prevalent among staff and patients. Conclusion To implement PrEP in methadone treatment settings, clinic staff must be able to engage in non-judgmental communication about HIV and sex with patients. Additionally, federal and state funding for HIV prevention in substance use treatment settings must be prioritized to enable clinics to access the necessary training and resources.
Nursing Faculty Workforce Development Project
(Wolters Kluwer, 2024) Welch, Susan; Acker, Kristi; Burton, Wanda Martin; Cheshire, Michelle; Sartain, Andrea; Wedgeworth, Monika; Welch, Teresa
A proposed nursing faculty workforce development project by a college of nursing within a research-intensive institution will increase the number of nurse faculty from the current population of BSN-prepared nurses from underserved communities in a state to earn a Master of Science in nursing (MSN) degree with a nursing education specialty. This project will be accomplished through partnerships between a college of nursing and academic institutions with large nursing student populations from underserved communities. In addition, the project will incorporate the employment of MSN students at academic partner institutions within a clinical nurse faculty role. The proposed project will continue after an initial federally funded grant to continue the project and address the nurse faculty shortage from diverse populations and advance health equity and culturally congruent health care in the state. The project will also enhance partnership building with stakeholders, such as statewide academic institutions, to impact underserved communities.
Race as a Structural Determinant of Mental Health
(Slack Journals, 2024) Burton, Wanda Martin; Mumba, Mercy Ngosa
In the United States, one in five adults (52.9 million) were living with a mental health disorder in 2020 (Centers for Disease Control and Prevention [CDC], 2023). According to the CDC (2023), mental health encompasses emotional, psychological, and social well-being and affects thoughts, feelings, and behaviors. Although higher prevalence rates of mental disorders are not typically reported in racialized minority groups due in part to imperfect racial categorizations and measurements, researchers contend that complex social and structural factors, including inequities in the social determinants of health (SDOH), contribute to Black American individuals’ stress and mental health concerns (Burton et al., 2023; Kim & Bostwick, 2020; Millet et al., 2020). In addition, Hispanic and non-Hispanic Black adults are less likely to receive routine treatment for mental health disorders due to several factors, including lack of access to treatment, mistrust, and stigma (National Alliance on Mental Illness, 2023). Moreover, people with mental health disorders o􀅌en receive mental health care in emergency departments (EDs) when routine care is lacking. National data from 2018 to 2020 show that mental health-related ED visits were highest among Black American individuals for substance use, anxiety, and mood disorders compared to Hispanic and non-Hispanic White ED patients (Peters et al., 2023).
Gendered Racism: A Call for an Intersectional Approach
(Slack Journals, 2022) Burton, Wanda Martin
Inequities in social determinants of health (SDOH) contribute to health disparities that outweigh an individual’s ability to make healthy choices. SDOH refer to environmental conditions that affect a wide range of health, functioning, and quality of life outcomes and risks. They are complex, interdependent, and often grouped in five categories: economic stability, education access and quality, health care access and quality, neighborhood and the built environment, and social and community con- text. Within the social and community context, discrimination has increasingly received attention since the American Public Health Association established its National Campaign Against Racism (Jones, 2016a,b). Understanding, revealing, and redressing racism as a social and structural determinant of health may help eliminate racialized health disparities. Yet, for those who are at the inter- section of multiple oppressions, focusing on racism alone may not go far enough.
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.
Fostering resilience and mental health support in a post COVID-19 environment
(Wiley, 2022) Horton, Abby Grammer; Mumba, Mercy N.; University of Alabama Tuscaloosa
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.
Integrity of Databases for Literature Searches in Nursing Avoiding Predatory Journals
(Lippincott Williams & Wilkins, 2021) Oermann, Marilyn H.; Wrigley, Jordan; Nicoll, Leslie H.; Ledbetter, Leila S.; Carter-Templeton, Heather; Edie, Alison H.; Duke University; University of Colorado Boulder; University of Alabama Tuscaloosa
The quality of literature used as the foundation to any research or scholarly project is critical. The purpose of this study was to analyze the extent to which predatory nursing journals were included in credible databases, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, commonly used by nurse scholars when searching for information. Findings indicated that no predatory nursing journals were currently indexed in MEDLINE or CINAHL, and only one journal was in Scopus. Citations to articles published in predatory nursing journals are not likely found in a search using these curated databases but rather through Google or Google Scholar search engines.
Innovative use of a flipped-classroom approach to teach fundamental nursing skills
(Elsevier, 2023) Wilson, Kimberly E.; Hobbs, Jill R.; University of Alabama Tuscaloosa
Prelicensure nursing students are required to master fundamental nursing skills. The COVID-19 pandemic created challenges in maintaining excellence while teaching skill acquisition. The purpose of this study was to evaluate skill validation scores and student satisfaction and self-confidence using a flipped classroom approach and a low-fidelity simulation model to innovatively teach skill acquisition. Researchers used a quasi-experimental method to compare skill validation scores of a control group and intervention group using independent samples t-test. Researchers also evaluated whether prelicensure nursing students had satisfaction and self-confidence with this teaching strategy. Findings suggested that skills validations scores were no different using a flipped-classroom approach than in-person instruction. Prelicensure nursing stu-dents were satisfied and self-confident following the implementation of this teaching strategy. This teaching strategy has the potential to decrease in-person clinical practice time, provide alternative opportunities for clinical make-up and remediation, and decrease cost. (c) 2022 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
A Comparison of the Biomechanical Performance of 3 Negative Pressure Wound Therapy Foams
(Lippincott Williams & Wilkins, 2022) Gibson, Daniel J.; University of Alabama Tuscaloosa
PURPOSE: The purpose of this study was to compare 3 foam dressings to (1) determine the biomechanical performance of existing negative pressure wound therapy (NPWT) foams and (2) to determine if a test foam is possibly suitable as an antimicrobial "white" foam alternative for use in NPWT. DESIGN: A comparison of mechanical performance of 3 foams used for vacuum-assisted NPWT. SUBJECTS AND SETTING: Preclinical laboratory study using an in vitro model. METHODS: The performance of a "white" foam (polyvinyl alcohol [PVA]), an antimicrobial "black" foam (polyurethane [PU]), and an antimicrobial white foam alternative (test PVA) were tested and compared using 3 mechanically relevant criteria. First, the fluid removal rate was measured for 72 hours. Next, the pressure input was compared to the pressure directly beneath the center of the foam. Finally, the spread of negative pressure beneath the foam was measured and compared. RESULTS: Significant differences were found in fluid removal rates; specifically, the PU foam removed fluids faster than the PVA and test PVA foams, and the currently available PVA foams performed similarly. Both the PU and test PVA foams were able to transmit the negative pressure through the center of the dressing, while the typical PVA foam began failing at 140 mm Hg, with 50% of the samples failing at 200 mm Hg. All PU replicate foams evenly distributed the pressure, while 47% to 60% of the test PVA foams and 7% of the typical PVA foams distributed pressures evenly. CONCLUSIONS: Study findings suggest that the test PVA foam does not mechanically interfere with NPWT and performs equivalently to currently used foams. These results suggest that the test PVA may be modified and incorporated into a vacuum-assisted NPWT device. In addition, the methods employed in these experiments provide a reproducible means to compare biomechanical compatibility of various NPWT foams, dressings, and subdrape devices.
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.
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.
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.
A Comparative Analysis of Rural versus Urban Preschool Children's Sugar-Sweetened Beverage Consumption, Body Mass Index and Parent's Weight Status
(Sage, 2022) Montgomery, Michele; Johnson, Paige; Ewell, Patrick; University of Alabama Tuscaloosa
Background Childhood overweight and obesity continues to be a major public health concern, especially in minority, low-income, and rural populations. In order to develop health promotion interventions aimed at reducing obesity rates, there is a need to identify which populations have the highest rates of obesity and the risk factors associated with these high rates. Methods Data collected from low-income, preschool children and their parents in an urban community and a rural community in Alabama were analyzed and compared. Body Mass Index (BMI) was collected during school based health screenings, and information regarding parent's BMI and child's consumption of sugar-sweetened beverages (SSBs) were collected by parent report. Results Of the 363 children screened, 12.8% (15.2% rural and 11.9% urban) were considered overweight, and 15.8% (20.2% rural and 14.2% urban) of the sample was classified as obese. Rates of overweight and obesity for mothers were 27.6% (25.3% rural and 28.4% urban) and 48% (56.3% rural and 44.8% urban) respectively and 39.6% (53.3% rural and 34.4% urban) and 34.6% (28.3% rural and 36.9% urban) for fathers. Parents reported their child consumed 3.82 SSBs per day. Overall, mother's BMI, father's BMI and sugar-sweetened beverage consumption was positively associated with child's BMI. However, there were no significant interactions between the rural and urban groups. Conclusion Rates of overweight and obesity remain high in low-income, predominantly minority preschool children and their parents in two communities in Alabama. Consumption of SSBs, mother's BMI, and father's BMI are three factors impacting the weight status of low-income preschool children. These factors are significant in both rural and urban children.
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.

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