Nursing Undergraduate Research Theses and Honors Research Theses
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Undergraduate Research Theses and Honors Research Theses from the College of Nursing. More information is available at the College of Nursing Honors Program web page.
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Item Board Certified Nurse Coaches' Self-Reported Practices/Outcomes, Populations, and Personal Demographics(The Ohio State University, 2024-05) Widmeyer, Rose; Tucker, SharonBackground: Nearly half of Americans suffer from at least one chronic disease, which the CDC estimates accounts for nearly 75% of aggregate healthcare spending. Research indicates that about 70% of chronic diseases may be preventable based on lifestyle behaviors. Nurses are uniquely situated to offer health and wellness coaching to promote health-enhancing behaviors. Aims: The purpose of this study was to survey nationally certified nurse coaches to identify populations they are serving, chronic diseases they coach on, and other practice-related data. Methods: Following IRB approval, an anonymous, electronic survey was sent via an email link to a registry of certified nurse coaches using Qualtrics Software. The survey questions (response options and open-ended) focused on demographics, populations served, practice aspects, and outcome data evaluated. Gift cards were offered to all participants. Results: 424 certified nurse coaches responded to the survey. 96.6% were female and most attended a nurse coaching training program (95.5%). The most common period of coaching individuals was 3 months with 30-90 minute sessions. Most common reasons for coaching included life balance, nutrition, health responsibility, emotional/spiritual/physical wellness, and mental health. The most common client diseases were depression/stress/anxiety, Alzheimer’s/dementia, cancer, chronic pain, heart disease, hypertension, and diabetes. 61 (14.4%) nurse coaches reported using biomarkers to evaluate their practice. Conclusions: The study informs efforts to improve nurse coaching programs, standardize outcome tracking, and better understand nurse coaching through the collection of demographic and practice-related data. Future research can examine specific patient populations, coaching strategies, and data to support CPT coding category 1 billing for certified nurse coaches.Item Oral Feeding Infants with Complex Congenital Heart Disease and Trisomy 21 Pre- and Post-Surgical Intervention: A Comparative Case Study(The Ohio State University, 2024-05) Ochall, Jennifer; Kneeland, TondiPurpose and Background/ Significance: Infants with complex congenital heart disease (CCHD) and infants with Down Syndrome (DS) each have unique and complex feeding difficulties. Little research exists about feeding infants with both conditions. The purpose of this study was to examine oral feeding dynamics during hospitalization of infants with DS needing surgical intervention for CCHD in the first 6 months of life. Framework: A dynamic systems framework was utilized to assess factors that may influence an infant’s ability to feed including feeding constraints (task, external, internal), behavioral responses, and feeding related outcomes. Methods: We used a multiple case study, descriptive design. Infants unable to achieve a nutritive suck were excluded. Feedings were observed pre and post operatively. The unit of analysis was individual feedings, which were assessed per feeding, not per infant. For this study, infant engagement and fluid management were measured with the Dynamic-Early Feeding Skills assessment and coded using the Noldus Observer XT system. Descriptive analysis included percentages of feeding skills exhibited and numbers of discrete events occurring across feedings. Lag sequential analysis (LSA) was calculated to describe probability of relationships between skills. Results: Data from 6 feedings observed in 5 infants were included, 3 pre-op and 3 post-op. In 2 of 3 pre-operative feeds, infants were fully engaged in less than 8% of the feeding, and in 2 of 3 the feeds, infants exhibited no difficulty with fluid management for 93% of the feeding. However, in one feed the infant experienced 11 episodes of loss of milk from nose or mouth. In all three post-operative, feeds, infants demonstrated low engagement (12-75% of feeding) or disengagement (7-88% of feeding). Infants had difficulty managing fluid for less than 14% of the feeding. Brief distress events occurred 1-14 times pre-op and 7-12 times post-op. Pre- and post-operative LSA suggested temporal associations between low engagement and difficulty with fluid management. Conclusion: Engagement and fluid management may be issues for infants with DS and CCHD during pre- and post-operative feedings. More research is needed in larger samples to identify areas for intervention to improve feeding in these high-risk infants.Item Dietary Intake of Red and Orange Vegetables in Pregnancy: Comparison with Dietary Guidelines for Americans(The Ohio State University, 2024-05) Finn, Katherine; Anderson, CindyBackground: National data indicate that many pregnant women do not consume the recommended amount of red/orange vegetables for a healthy diet during pregnancy. The purpose of this study was to characterize dietary patterns of red and orange vegetables, and their associated nutrients (vitamin A, vitamin C, potassium, and fiber) across pregnancy, relative to the 2020-2025 Dietary Guidelines for Americans (DGA) recommendations and examine the relationship of red and orange vegetable intake with weight gain across pregnancy. Theoretical framework: The Developmental Origin of Health and Disease framework guided this research. Methods: This prospective secondary analysis included a convenience sample of nulliparous pregnant women (n=58) derived from a parent study examining the relationship between dietary intake and hypertensive disorders of pregnancy. The participants were prospectively recruited from communities in the Midwest in the first trimester of pregnancy. Demographic data were self-reported. Dietary intake was estimated in each trimester of pregnancy using a food frequency questionnaire (FFQ) documenting intake of individual food items (n=58) with typical servings (e.g., 1 cup winter squash, 1 medium tomato) and frequency of consumption (e.g., per day, week, month) consumed over the past 3 months with frequency of consumption converted to daily intake/servings. The typical dietary intake of red/orange vegetables, vitamin A, vitamin C, fiber, and potassium across the previous 3 months was determined. Weight across pregnancy was derived from medical record data extraction and BMI was calculated. Descriptive statistics (mean + SD), frequencies, and percentages were used to describe variables of interest. Repeated measures ANOVAs average intake across trimesters. Differences between dietary intake in pregnancy and the relationship with gestational weight gain (GWG) were determined by Fisher Exact tests. Significance was set at p<0.05. Results: The majority of the participants did not meet DGA guidelines for red/orange vegetables, (5.17%, 6.9%, and 10.53% in trimesters 1,2, and 3 respectively) but met recommendations for potassium, vitamin A, and vitamin C intake because other sources of food are high in these components. Women who consumed the recommended amount of red/orange vegetables in just one of the three trimesters of pregnancy (p=0.02) and specifically in the third trimester (p=0.02) were more likely to achieve the recommended GWG. Conclusions: In this study, women who consumed optimal red and orange vegetable dietary intake were more likely to experience healthy weight gain during their pregnancy. Women in the third trimester who consumed adequate intake of red and orange vegetables were more likely to achieve GWG. Optimal red and orange vegetable intake can support a healthy weight gain for pregnant women.Item Characteristics of Cancer Survivors Attending a Cancer-Supportive Care Clinic(The Ohio State University, 2024-05) Michel, Chloe; Browning, KristineBackground: By 2032, it is expected that there will be 22.5 million cancer survivors in the United States. A key aspect of cancer survivorship care is ensuring patients have access to appropriate follow-up for unmet needs. The purpose of this study was to describe the characteristics of cancer survivors who attended a cancer-supportive care clinic. Theoretical Framework: The Wilson and Cleary HQOL Theory was used to guide this study. Methods: This retrospective study collected data from an internal database at a comprehensive cancer center between March 2013 and February 2023. The descriptive data included cancer-related health information, comorbidities, and substance use. Results: Data were collected from 9,229 cancer survivors. Ninety percent of survivors had a completed treatment summary and survivorship care plan from a healthcare provider. All cancer diagnoses were included in the study; however, breast cancer was the most frequent (47%). Most were treated with surgery (88%), almost half had chemotherapy (47%), and 39% had radiation. Many survivors reported substance use. Forty-one percent reported current or previous tobacco use, with 22% current use. Sixty-two percent reported current or previous alcohol use, and 9.4% reported current or previous recreational drug use. Twenty percent of the sample reported a diagnosis of depression, and 15% reported a diagnosis of anxiety. Conclusion: Substance use may be more prevalent among this group of cancer survivors who participated in a cancer-supportive care clinic. In addition, many survivors reported mental health disorders. This may suggest additional mental health and substance use screenings along with appropriate treatment referrals could bridge the gap for unmet needs in cancer survivors.Item Depression and glucocorticoid regulation during pregnancy: A pilot study of NR3C1 methylome profiling(The Ohio State University, 2024-05) McKenna, Gillian; Gillespie, ShannonIntroduction: One of every five pregnant individuals are diagnosed with prenatal depression, signifying a maternal mental health crisis. However, little is known about how depressive symptoms affect maternal biology in ways that are pertinent to the health of the pregnancy. In this pilot study, we examined associations among depression diagnoses, depressive symptoms during pregnancy, prenatal glucocorticoid levels, and the epigenetic regulation of NR3C1, the glucocorticoid receptor gene. NR3C1 plays a key role in transmitting cellular signals in response to psychosocial stress and differential expression of NR3C1 has been previously linked to poor birth outcomes. Methods: The parent study enrolled 96 pregnant individuals at 28 weeks 0 days to 32 weeks 6 days of pregnancy, of which we focus on 16 with available epigenome-wide DNA methylation data. All participants completed questionnaires, including the Center for Epidemiological Studies-Depression (CES-D) inventory. Peripheral whole blood was collected, and leukocyte DNA methylation was quantified across approximately 850K cytosine-guanine dinucleotides. After birth, clinical data was abstracted from the medical record. We examined DNA methylation of the 70 dinucleotides in proximity to the NR3C1 gene, identifying dinucleotides with suggestion of a potential association with depression diagnosis, depressive symptoms during pregnancy, and/or prenatal glucocorticoid (i.e., cortisol) levels (α=0.20). Results: Participants (n=16) averaged 25.3 years of age (SD 4.4, range 20-33). Most participants completed some college (n=9) and were multiparous (n=13). Half of participants were nonsmokers (n=8) while half reported smoking in early pregnancy (n=8). Controlling for maternal age, education, smoking status, parity, fetal sex, and white blood cell count, levels of DNA methylation at 13, 7, and 15 cytosine-guanine dinucleotides showed suggested associations with depression diagnosis, depressive symptoms during pregnancy, and prenatal glucocorticoid levels, respectively. Only two dinucleotides were identified more than once. A depression diagnosis and higher prenatal glucocorticoid levels showed suggestive associations with the methylation of cg14621978 (z=1.33, p=0.182; t=1.95, p=0.099, respectively) and cg01751279 (z=1.55, p=0.121; t=-2.03, p=0.088, respectively). Conclusions: In a small pilot study, our findings suggest that prenatal depressive symptoms may shape how the body responds to psychosocial stress and stress hormones. While more work remains to clarify the relationships among depression diagnoses, depressive symptoms, and glucocorticoid regulation during pregnancy, this may provide a unique opportunity to identify targets for the promotion of maternal-infant health.Item An Epidemiological Population Health Study Reveals Social Smoking is Highest in the Western United States(The Ohio State University, 2024-05) Parsons, Abigail; Gawlik, KatePurpose and Background/Significance: Smoking is the leading cause of preventable death in the United States (U.S.). Many people inaccurately believe that social smoking is less harmful than everyday smoking; however, little is known about social smoking patterns in the US. The purpose of this study was to determine the prevalence of social smoking by US geographical region. Method: This was a cross-sectional, national survey on a convenient sample of 59,434 adults from across the United States. Data were collected online from 2015 to 2022 from cardiovascular community screenings associated with the Million Hearts Fellowship program. Measures included demographics, state of residence, and smoking status (current, social, non-smoker, e-cigarette user). US states were divided into regions: West, Midwest, South, and Northeast. Z-tests compared the proportion of social smokers in each geographic region. Results: All regions had a high number of individuals who identified as socially smoking. The West had the highest prevalence of social smoking (12.30%), followed by Northeast (10.17%), South (8.89%), and the Midwest had the lowest (8.03%). Conclusions: This is the first paper to investigate social smoking patterns across US geographic regions. Given the regional differences in social smoking rates, further investigation of contextual factors may enable the design of tailored interventions based on geographic location.Item Social Determinants of Health Factors and Self-Management of Care in Kidney Transplant Recipients: A Descriptive Cross-Sectional Study(The Ohio State University, 2024-05) King, Kelsey; O'Brien, TaraBackground: Managing post-transplant care poses challenges for kidney recipients often due to food affordability and the ability to participate in physical activity. This study explored recipients' self-management of care and the influence of social determinants of health on physical activity and diet. Methods: A single-center cross-sectional study recruited 26 participants via "My Chart" to complete an 86-question survey. Results: Participants, with a mean age of 61, mostly had an associate degree or higher (85%). BMI correlated negatively with avoiding high-calorie foods; age and education correlated positively with physical activity. Conclusions: Kidney transplant recipients exhibit limited exercise and frequent high-calorie food consumption. Targeted interventions, particularly promoting regular physical activity, are crucial for improving post-transplant care.Item The Impact of Years of Nursing Experience on Implicit Bias in Pain Management Decisions Among Registered Nurses: A Secondary Analysis(The Ohio State University, 2024-05) Worstell, Abigail; Chipps, EstherBackground: Implicit bias research has been conducted since the 1930s in many areas, including healthcare. Implicit bias is a belief about a group that is not typically recognized by the individual. Nurses have similar levels of implicit bias to the general population, but theirs may have adverse effects on their patients, such as decreased communication, decreased pain management, and diminished nurse-patient therapeutic relationship. Purpose: What has not been as widely researched is the effect that years of nursing experience has on implicit bias. The purpose of this study is to explore the impact of differences in years of nursing experience on implicit biases among Registered Nurses (RNs). Methods: This is a secondary analysis of a cross-sectional descriptive study that used a series of four vignettes describing a patient’s experience with pain. Participants were randomized to one of two surveys that differed only in the race of the patient in the vignette. An online survey was used to collect demographic data and responses to the vignettes from participants at four academic medical centers. Participants included RNs who work on medical, surgical, emergency, and critical care floors at one of the medical centers. There were no restrictions on years of experience. Results: 443 nurses were included in this secondary analysis. The majority identified as white and female. The questions were analyzed by vignette. Two of five questions examined showed a correlation between years of experience and implicit bias. The other three questions showed no difference in the biases shown between nurses with less than or more than ten years of experience. Conclusions: The results show no convincing correlation between years of experience and implicit racial bias. There were not enough significant differences seen between nurses with less than ten years of experience and nurses with more than ten years of experience to conclude that years of experience affects implicit bias. The two questions showing a correlation were from the same vignette involving a middle-aged female patient and could be caused by other factors such as gender or age bias, rather than racial bias. The study is limited by a small sample size, especially when considering the sample of black RNs.Item An Ethical Analysis of COVID-19 Visitation Policies: A Scoping Review(The Ohio State University, 2024-05) Silleck, Annemarie; O'Mathúna, DónalDuring the COVID-19 pandemic, hospitals instituted strict restrictions on inpatient visitation to protect vulnerable individuals, prevent the spread of the virus and conserve limited supply of personal protective equipment (PPE). These measures resulted in negative consequences for healthcare staff, patients, and families. These visitation policies raised ethical questions about how best to balance the beneficial and harmful consequences. The purpose of this review is to identify and describe the ethical issues and dilemmas associated with hospital visitation restrictions during the COVID-19 pandemic on patients, families, and healthcare staff members. A scoping review was conducted using criteria to search two health databases, PubMed and CINAHL, covering publications from March 2020 to March 2023. We included articles with ethics, morals, or ethical challenges in the title or abstract within any inpatient specialty unit, any country or state, and all ages. Excluded articles were those outside the targeted time range, in other settings such as prisons, schools, and dorms, and travel restrictions. Our initial search yielded 485 articles. After scanning the titles and abstracts followed by full-text reviews, data were extracted, using Covidence, from 25 articles. NVivo software was then used to synthesize data from each article. Information was highlighted and placed in “nodes” or categories using NVivo. We used qualitative thematic analysis to examine ethical concepts regarding COVID-19 visitation policies. Upon review, six main themes, and 41 sub-themes, were established: autonomy, benefit and harm, ethical justification, policy-issues, virtual visitation, and impact on well-being. These themes and sub-themes are the basis of our synthesis of evidence. Findings from this study may assist healthcare institutions to consider ethical implications as part of policy decisions related to the balance of limited visitation and patient safety during a public health crisis.Item Parent Perception of Child Health and Weight Status Compared to Measured Body Mass Index(The Ohio State University, 2024-05) Perez, Hailey; Smith, LaureenBackground: The prevalence of obesity throughout the United States (U.S.) is a long-standing and escalating public health concern. Rural dwelling youth are at higher risk of developing obesity compared to urban and suburban counterparts (Rural Health Information Hub, 2022). Purpose: To drive down the high prevalence of obesity among youth residing in rural areas, the accuracy of parent perceptions about child health and health behaviors was explored. The purpose of this study is twofold: (a) compare parent perception of child BMI status to objectively calculated BMI and (b) compare parent perception of child health to BMI status. Methods: This study is a secondary analysis of community-based randomized-controlled trial to evaluate Mentored Planning to be Active plus Family (MPBA+F) conducted within 14 Appalachian counties. BMI of study participants was obtained using the Tanita DC-430U Body Composition Analyzer at data collection sites. The 8-item, Likert Promis Child General Health survey and the Qualtrics eligibility screening survey was completed by parents. Bivariate correlations were conducted between parent reported BMI, objectively measured BMI, and parental perception of overall health. Results: Our study included a total of sixteen respondents (N = 16), ranging from 11-13 years old in age. Most parents classified their child as overweight (56.2%). However, only 12.5% of children were objectively classified as overweight and 87.5% of children were objectively classified as either obese or severely obese. For 44% of children, parents reported a “healthier” weight status compared to actual measures. The majority of parents (93.7%) perceived their child’s health as good, very good, or excellent. Although over 30% of children were severely obese, no parents perceived their child as having “poor” overall health. Females were perceived to have poorer health (r = -0.828, p < 0.001) compared to males. Conclusion: Obesity is associated with a higher risk for development of diabetes, heart disease, stroke, cancers, and is the leading cause of death and disability within the United States. Due to the majority of parents perceiving their child as having “good” or better overall health, we can make the assumption that an inaccuracy in reporting their child’s weight status may indicate a lack of knowledge about health implications that obesity poses on children.Item Perspectives about the safety of community-dwelling older adults: A qualitative study(The Ohio State University, 2024-05) Butler, Pamela; Rose, Karen; Tate, JudithAs the population ages, ensuring the safety and well-being of community-dwelling older adults becomes crucial. Perceptions of safety can influence older adults’ view of vulnerability and fear, and thus influence health behavior and community engagement. The purpose of this study is to describe safety from the perspectives of community-dwelling, African American older adults. Focus group interviews were conducted with a sample of community-dwelling older adults, aged 55 and above residing in urban neighborhoods in a large midwestern city. We used the Socioecological Model, to guide the development of the interview questions and analysis. All participants completed informed consent. Four focus groups were conducted in person, in the fall of 2021, with 26 older adults, in a library located in the neighborhood. Most of the participants were female (n=19), retired (n=20) and had lived in their homes for great than 10 years (n=14). Manifest content analysis was performed within and between groups. Findings revealed shared perceptions surrounding psychological, social, physical, and environmental factors of safety. Issues such as fear of crime, accessibility of services, personal health, and housing conditions contributed to their understanding of safety. These participants described changes in their neighborhood over time and how those changes impacted their feelings of safety. These results have the potential to influence community planning, policy development, and interventions that can enhance the safety and quality of life for older adults in the community setting. This study focuses on the importance of incorporating older adults’ perspectives in safety initiatives to address the needs and concerns in their communities.Item Use of a Tailored Messaging System to Improve Breast and Cervical Cancer Screening Rates Among Vietnamese Immigrant Women: A Randomized Controlled Trial(The Ohio State University, 2024-05) Allen, Makayla; Tate, JudithPurpose and Background: Cancer is the leading cause of death for Southeast Asian women living in the U.S. Vietnamese women have disproportionately high incidence rates of breast and cervical cancers with strikingly low screening rates for pap tests and mammography compared to all other racial groups. This study aimed to test the efficacy of providing culturally-sensitive tailored messaging systems (TIMS) to improve age-appropriate breast and cervical cancer screening completion among Vietnamese women. Theoretical/Conceptual Framework: The Socioecological Model guided this study and proposes that complex factors at the individual, interpersonal, and institutional levels influence health behaviors. Methods: The Southeast Asian Women’s Health Project study is a randomized control trial that enrolled Vietnamese women who had not received breast and cervical cancer screenings. Women who were randomized to navigation received culturally sensitive tailored messaging for 10 weeks. Women in the information or control group were mailed information on mammography and pap testing only. All participants were contacted post-enrollment to assess cancer screening completion. Results: This study enrolled 66 Vietnamese women, ages 21-84, average age 43.25 (sd= 18.2 years). Of these, 4 completed mammography and 2 completed pap tests. Of these 4, 3 were in the control group and 1 in the intervention. Of the pap tests, both were in the control group. Conclusion: Although tailored messaging has been effective in improving cancer screening rates in other populations and cancer types, screening rates for breast and cervical cancer in this group of Vietnamese women were not improved using the TIMS. Additional analysis of factors that contribute to these results are planned.Item Physical activity and the regulation of blood sugar during pregnancy: A secondary analysis among Black Americans(The Ohio State University, 2024-05) Leipold, Emily; Gillespie, ShannonBackground. High blood glucose levels during pregnancy can be detrimental to the health of mother and child. Physical activity has shown success in managing blood glucose; however, the effect of different types of physical activity on blood glucose remains incompletely understood, particularly among Black Americans who face a disproportionate burden of morbidity. Therefore, we examined associations among physical activity and blood glucose levels from glucose tolerance testing among a cohort of pregnant Black Americans. Framework. Glass and McAtee’s multilevel model. Methods. Participants were enrolled at 28-32 weeks of pregnancy. Participants were interviewed to obtain information regarding socioeconomic factors and surveys were administered, including the Kaiser Physical Activity Survey (KPAS). 50-gram glucose tolerance testing results were abstracted from the medical record. Multiple linear regression models were built adjusting for sociodemographic, clinical, and behavioral characteristics. Results. Participants (n=77) were, on average, aged 26.12±4.39 years. Participants were primarily unmarried (75.32%), received less than a bachelor’s degree (75.32%), and were multiparous (61.04%). In adjusted models, an association between total physical activity and glucose levels was not observed (t=-0.16, p=0.876, β=-0.018). However, greater levels of childcare-related physical activity predicted lower glucose levels (t=-2.04, p=0.045, β=-0.270). When additional behavioral controls (smoking, sleep, stress, alcohol, drug use) were added to the model, the relationship was slightly attenuated (p=0.067). Conclusions. Findings suggest that physical activity beyond the traditional conceptualization of exercise may play an important role in the regulation of blood sugar among pregnant Black Americans. A broadened perspective on physical activity during pregnancy may be needed, impacting recommendations provided by the healthcare team.Item Nutritional Status and the Relationship to Function in Older Women Diagnosed with Breast Cancer(The Ohio State University, 2024-05) Goetz, Rachel; Overcash, JanineBackground: Many older women who are diagnosed with breast cancer are also at risk for malnutrition. Purpose: To evaluate the relationships between malnutrition and functional status in older women diagnosed with breast cancer. Methods: This cross-sectional study included women aged 70 years and over diagnosed with any type of breast cancer and took place at a Midwestern academic medical center. The Mini Nutritional Assessment (MNA), Timed Up & Go Test (TUAGT), Activities of Daily Living scale (ADL), and study instruments required a 20-minute interview. Bivariate and point-biserial correlations were used. Results: Participants (n=72) ranged in age from 70 to 93 years (mean= 77.9). Most were diagnosed with infiltrating ductal carcinoma 52 (72.2%), stage 1 cancer 30 (42.7%), and most were not undergoing treatment with chemotherapy 59 (81.9%) or aromatase inhibitors 37 (51.4%). The MNA score was significantly related to ADL r = 0.40 (p=0.00).Item Implementation Strategies Used to Facilitate ABCDEF Bundle Adoption: A Scoping Review(The Ohio State University, 2020-05) Donahue, Paige; Balas, MicheleProblem: Administration of the ABCDEF bundle (A - Assess, prevent, and manage pain; B - Both spontaneous awakening trials and spontaneous breathing trials; C - Choice of analgesia and sedation; D - Delirium: assess, prevent, and manage; E - Early mobility/exercise; F - Family engagement/empowerment) is associated with improvements in a number of important patient-centered outcomes. Despite its demonstrated safety and effectiveness, overall adoption of the ABCDEF bundle and its individual components into everyday clinical practice remains low. Purpose: The purpose of the scoping review is to identify strategies used by prior studies and quality improvement (QI) efforts to facilitate ABCDEF bundle implementation and critically evaluate the implementation strategies that were used to facilitate adoption of this evidence-based, interprofessional intervention. Methods: A scoping review of electronic databases (CINAHL, PubMed, Web of Science, Scopus, PsychInfo, Medline) was completed. Research studies, QI projects, systematic reviews, or metanalyses published from 2009-2020, in English, and available as full-text articles which described implementation of either the ABCDE bundle or ABCDEF bundle in the intensive care unit were eligible for inclusion. Studies that did not explicitly mention the ABCDE or ABCDEF bundle, were conducted solely with the pediatric population, or focused only on one element of the bundle (e.g., early mobility) were excluded. The Expert Recommendations for Implementing Change (ERIC) compilation provided 73 implementation strategies used to guide data extraction. Content analysis was performed and summary statistics were reported. Results: Ten studies were eligible after screening 368 titles and abstracts and reviewing 23 full-text studies. Across studies, an average of 35 different strategies were used, with studies integrating a range of 8-54 strategies per study. The most frequently used implementation strategies included an implementation glossary, educational materials, bundle facilitation, providing clinical supervision, and recruiting/training for leadership. Seventeen ERIC strategies were not used and, importantly, no studies reported testing the effectiveness of any of the implementation strategies efforts that were used to increase bundle adoption. Implications for practice: Future evaluation of implementation strategies used in ABCDEF bundle implementation is essential to effectively allocate efforts and resources. Future research should focus on t identifying, testing, and reporting the specific methods and resources needed for effective and sustained ABCDEF bundle implementation. Until effective implementation is understood, the excessively high morbidity, mortality, and cost associated with standard critical care delivery will continue and the public health benefit of the ABCDEF bundle will not be fully realized.Item Nurse-perceived infant well-being and associations with survival(The Ohio State University, 2020-05) Thomsen, Kayla; Fortney, ChristineBackground: More than 500,000 US infants are admitted to the neonatal intensive care unit (NICU) each year, with many experiencing discomfort as a result of medical intervention. This study explored associations between COMFORT-B Scale scores and nurse perceptions of infant discomfort, as well as between nurses' perceptions of suffering and QOL (quality of life) and expectations for survival. Theoretical Framework: Fortney & Steward's (2014) Framework for a Good Neonatal Death that highlights accurate symptom assessment as an important component of the neonatal palliative and end-of-life experience was used to guide this study. Methods: In this exploratory descriptive study, infant participants were recruited from a Level IV NICU in the Midwest. Nurses caring for enrolled infants completed the Nurse Perceptions of Infant Well-Being questionnaire regarding their perceptions of the infant symptom experience and expectations for survival. Weekly behavioral observations of infants were obtained before and after standard delivery of care to obtain a COMFORT-B score. Using Pearson's r, nurse survey data was compared to the total COMFORT-B score and associations between nurses' perceptions of the symptom experience and expectations for survival were explored. Results: 237 nurses who cared for 83 infants completed 593 surveys over a period of 28 months. Bivariate correlations indicated that the COMFORT-B score was not significantly correlated with nurse perceptions of infant discomfort. But, nurse-perceived infant suffering was significantly correlated with nurse-reported expectations for survival during hospitalization, within the next 6 months, and within the next year (r=-.296, -.323, -.349, p<0.001). Further, nurse-perceived infant QOL was also significantly correlated with nurse-reported nurse expectations for survival (r=.560, .629, .647, p<0.001). Discussion: Even though associations between COMFORT-B scores and nurse perceptions of infant discomfort were not significant, they are discrepant. It is unclear whether the COMFORT-B scale performs better than the perceptions of the bedside nurse. Further, nurse perceptions of infant suffering or poor QOL is related to expectations for infant survival, which may affect decision-making, recommendations for care, and care delivery. Future research should focus on the development of improved assessment of the infant symptom experience in the NICU, as well as the effect of nurse expectations for infant survival on care delivery.Item Preferred Features in Mobile Health Applications for Kidney Transplant Recipients: A Qualitative Approach(The Ohio State University, 2020-05) Rosenthal, Anna; O'Brien, TaraDespite the increasing number of consumer-based mobile health applications (mHealth apps) for self-care, there is little research exploring consumers' experiences with mHealth apps. Health apps using mobile technology have the potential to provide a platform for kidney transplant recipients to monitor their self-care in real-time. The purpose of this study was to (a) explore kidney transplant recipient's (KTRs') perceptions of the usefulness of mHealth apps, and (b) identify features that KTRs believe are important for using mHealth apps. A qualitative design was used to explore a purposive sample of adult KTRs from a Midwest Transplant Program who used a mHealth app. A trained research assistant conducted face-to-face interviews using a semi-structured interview guide to elicit perspectives on preferences and features of mHealth apps. The interviews were audio-recorded, transcribed verbatim, and coded using the NVivo 12.0 qualitative software. The sample consisted of N = 20 participants with a mean age of 54 (SD = 14.8). The majority of participants were white females (60%) with an associate's degree or higher who earned an average annual income of $66,000 per year or higher. Qualitative content data analysis revealed three themes that participants found useful: health tracking (medication, nutrition, fluid intake, lab values, and activity), feedback (short personalized messages, positive awards using symbols, and color-coded bar graphs indicating normal and abnormal ranges), and usability (large font, words that everyone can understand, and all information stored in one area). Seventy-eight percent of participants were excluded from the study because they did not use an mHealth app. Future studies should consider how to include participants that do not use an mHealth app.Item Depression and Sleep Alterations Associated in the Older Adult Breast Cancer Population(The Ohio State University, 2018-05) Patel, Keya; Overcash, JanineDepression rates nearly double for geriatrics diagnosed with breast cancer. Depression is a serious problem which affects many aspects of life, including sleep. The symptoms of depression and sleep alteration should be managed as part of the breast cancer survivorship care plan. The purpose of this study is to describe the incidence and the relationship between depression and sleep alterations in older breast cancer patients. This prospective study included people aged 70 years and over with any stage of breast cancer receiving care at the James Cancer Center, Comprehensive Breast Center. Participants completed a Geriatric Depression Scale and a Pittsburgh Sleep Quality Index. Demographic characteristics were evaluated using descriptive statistics. To determine the relationship between depression and sleep alternations, correlations were used. The mean age (n=44) was 78 years (range 69-93). The mean score of the GDS was 2.02 and the PSQI was 5.42. The GDS and the PSQI were significantly correlated (r=0.49, p=.001). Nurses must remember that people who screen positive for depression should also be screened for sleep problems.Item Effects of Omega-3 Fatty Acid Supplementation on Biomarkers of Inflammation Linked to Cardiovascular Disease in Aging Adults: Secondary Analysis(The Ohio State University, 2023-05) Barker, Grace; McDaniel, JodiPurpose and Background: Chronic inflammation is a risk factor for the development of cardiovascular disease (CVD), the leading cause of death worldwide. Recent studies provide evidence that targeting specific inflammatory biomarkers such as vascular endothelial growth factor (VEGF) with anti-inflammatory therapies may help prevent CVD. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 polyunsaturated fatty acids that have anti-inflammatory actions, but their cardiovascular-specific effects remain unclear. This study's purpose was to compare plasma levels of six inflammatory biomarkers of CVD between adults consuming EPA+DHA supplements versus placebo. Conceptual Framework: The physiological theory that EPA+DHA moderate inflammation supported the study design. Method: Select data from an ongoing randomized clinical trial testing effects of EPA+DHA supplementation (2.8 g/d) versus placebo on wound healing in older adults were analyzed to determine group differences in plasma levels of IL-6, TNF-α, CRP, VEGF-A, VEGF-C, VEGF-D over 12 weeks for the first 22 participants [EPA+DHA Group (n = 10); Placebo Group (n = 12)]. Due to the small sample size, bootstrapping was used to construct 95% confidence intervals to compare the 12-week change in biomarker levels between and within groups. Results: On average, participants were aged 65.0 years (SD = 9.78); the majority were male (54.5%) and White (50.0%). No significant differences in sociodemographic data between groups emerged. While no significant differences in the mean 12-week change in levels of IL-6, TNF-α, CRP, VEGF-A, or VEGF-C between or within groups were detected, the mean 12-week change in levels of VEGF-D was significantly lower in the EPA+DHA Group versus Placebo Group, 95% CI [-2060.39, -19.1]. Conclusions: EPA+DHA therapy may be effective in reducing levels of VEGF-D, a potent angiogenic cytokine shown to independently predict all-cause mortality in patients with suspected or confirmed CVD. Studies have also shown that down-regulating VEGF-D reduces triglyceride and cholesterol production. Additional nursing research testing EPA+DHA effects on VEGF-D and other inflammatory factors is warranted in larger samples of people at risk for CVD. Cost-effective, safe therapies to reduce inflammation and cholesterol earlier in life may help prevent CVD.Item Opioid Use and Treatment Among Pregnant Women(The Ohio State University, 2023-05) Burkholder, Judith; Morgan, EthanWomen who misuse opioids during pregnancy are at risk for a variety of pregnancy-related complications. Further complicating this risk, pregnant women with opioid use disorder (OUD) also require medication-assisted treatment (MAT) to wean off opioids without causing harm to their fetus. The purpose of this study is to explore the association between opioid misuse and its treatment among pregnant women. Data for this secondary analysis came from the National Survey on Drug Use and Health (NSDUH), a cross-sectional study reflective of the population of the United States of America. A Pearson chi-square test identified: 1) the association between pregnancy status and self-identified need for treatment of prescription pain reliever misuse in the past year; and 2) the association between pregnancy status and past or current treatment for prescription pain relievers. Additionally, a bivariate logistic regression was used to assess the relationship between the self-identified need for treatment and past or current treatment. Among pregnant females, 0.90% (n=5) reported a self-identified need for treatment for prescription pain reliever misuse in the past 12 months compared to 0.32% (n=93) of non-pregnant females. Additionally, 26 (0.72%) of pregnant females reported past or current treatment for prescription pain relievers compared to 402 (0.37%) of non-pregnant females. In bivariate regressions, pregnant females were more likely to self-identify need for treatment (Adjusted Odds Ratio [aOR]=2.80; 95% Confidence Interval [CI]: 1.14-6.93), and they were more likely to receive treatment (aOR=1.95; 95% CI: 1.31-2.90) than non-pregnant females. These results suggest that pregnant women may understand the risks of opioid use during pregnancy and the benefits of MAT. Further research needs to be conducted to identify if this increase in treatment is due to better screening, better access to treatment, or fewer legal consequences for reporting opioid use during pregnancy.