Research and Publications - School of Nursing

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Biological Perspectives: Adrenergic, Cholinergic, GABAergic, and Glutaminergic Receptor Function in the CNS
(Wiley, 2001) Keltner, Norman L.; Hogan, Beverly; Knight, Tamecka; Royals, Ann Lee
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.
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.
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.
Coping Among Black College Women: A Transformative Study of Gendered Racism
(Wiley, 2024) Burton, Wanda Martin; Ezemenaka, Christina; Jaiswal, Jessica; Guyotte, Kelly W.; Sanders, Angelica M.
Black women in the United States are placed at higher risk for mental health challenges, including distress and depression, due to structural inequities. Black college women enrolled in predominantly White institutions may be particularly exposed to stressors related to gendered racism, but there is limited knowledge about this population's coping strategies. A cross‐sectional survey and focus group were utilized to understand and disrupt participants’ experiences of gendered racism. In phase one, a survey assessing coping strategies and mental health outcomes was conducted with 168 Black women enrolled at a predominantly White institution in the southeastern United States. Logistic regression results indicated that several coping strategies including behavioral disengagement, self‐blame, self‐distraction, denial, and positive reframing were significantly associated with depression and psychological distress, all p< 0.05. Phase two included a single focus group with a subset of the sample from phase one. The focus group findings supplemented the survey results, suggesting education (more accurately consciousness‐raising) as a foundational theme that seemed to create space for humor and social support as coping subthemes and created a transformative space where participants spoke openly about gendered racism. Findings from this study highlight the societal underpinnings that shape Black college women's experiences of gendered racism. College settings should endeavor to provide formal and informal support for Black women to minimize the harms related to gendered racism.
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
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.
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.
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.
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.

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