Research and Publications - School of Nursing

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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.
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.
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.
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.
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.
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
From crisis management to multi-level interinstitutional partnerships: Development of the southeastern conference deans nursing coalition
(WB Saunders, 2023) Andrews, Jeannette O.; Niederhauser, Victoria; Sanford, Julie; Prevost, Suzanne; Porche, Demetrius; Heath, Janie; Jeffries, Pamela; Fahrenwald, Nancy; University of South Carolina Columbia; University of Tennessee Knoxville; University of Mississippi; University of Mississippi Medical Center; University of Alabama Tuscaloosa; Louisiana State University Health Sciences Center New Orleans; University of Kentucky; Vanderbilt University; Texas A&M University College Station
The Southeastern Conference (SEC) Nursing Dean's Coalition is a purposeful alliance organized to collaboratively address several challenges that arose during the COVID-19 pandemic. Over the last three years, this strategic team of academic leaders has evolved from a crisis response team to a multidimensional support team, leveraging both individual and collective strengths, to provide several benefits to the dean members, as well as other SEC nursing faculty members, students, and institutions. Participation has grown from the original 12 deans to engage a broader team of associate deans and nurse leaders in faculty development, research, service, and di-versity, equity, and inclusion. This article describes the origin, evolution, and outcomes of this coalition to date, as well as visions for the future.

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