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 The Preliminary Effects of Self-Efficacy to Exercise Using a Multicomponent Technology Intervention: Pre/Post Test Design(The Ohio State University, 2023-05) Jensen, Tad; O'Brien, TaraBackground: Over 60% of kidney transplant recipients do not meet the recommended 30 minutes of physical activity five days per week. The purpose of this research was to explore kidney transplant recipients using the Technology, Application, Self-Management for Kidney (TASK) intervention for 12 weeks and to obtain the preliminary estimate of the effects of the TASK intervention in producing change over time for scores in self-efficacy to exercise. Theoretical Framework: The TASK intervention was adapted from the Plan-Do-Study-Act Model, which consists of 4 steps. "Plan" participants created a "plan" by setting goals for their activity level. "Do" implemented personalized solutions to existing routines to help achieve daily goals. "Study" evaluated goal progress via graphics from a mobile application (Lose-It). "Act" determined goal achievement. Methods: The study consisted of a 12-week pre/post-test design. Participants were recruited from a Midwest Medical Center Kidney Transplant Clinic. Participants attended 12-weekly individual sessions remotely using the Zoom platform. During the 12 sessions, the participants completed the four steps of the Plan-Do-Study-Act Model and recorded their daily activity and diet using the Lose-It app. The Self-Efficacy for Exercise Scale was utilized at baseline, 4 weeks, 8 weeks, and 12 weeks. Results: The sample consisted of N=20 participants. After 12 weeks of using the intervention, a significant increase in self-efficacy to exercise was found (baseline mean 61, vs. 12 weeks mean 81(95% CI [6.51, 27.6], d = 0.83, p = 0.003). Participants reported the least challenging area for participating in physical activity to be exercising alone (n=10, 59%) after 12 weeks of using the intervention, and the greatest challenge was feeling pain (n=2, 12%). Conclusions: The data suggests that the TASK intervention was feasible for kidney recipients to use and resulted in increased self-efficacy to exercise. Future studies are needed to explore the underlying mechanism of engagement for using this mobile technology resulting in improvement in self-efficacy to exercise. Role: Contributed to the literature review, data analysis, and abstract preparation.Item Parent Distress Related to Infant Appearance in the NICU(The Ohio State University, 2021-05) Gao, Cristy; Fortney, ChristineObjectives: Parents of infants treated in the neonatal intensive care unit (NICU) are often overwhelmed with emotions regarding multiple factors encased in the NICU setting. This study explores what parents find the most distressing in respect to their infant's appearance throughout their hospital stay. Methods: This was a qualitative study utilizing an optional paper-pencil survey that parents responded to the question, "What is the most distressing thing you see in your baby?" Parents responded weekly for each week they were in the study (maximum of 12 weeks). Responses were transcribed and analyzed by two nurse scientists and one senior nursing student using manifest content analysis. Setting: The sample included 78 mothers and 53 fathers whose infant was admitted in a neonatal intensive care unit at large children's hospital in the Midwestern United States. Of this sample, there were 49 dyad couples, 29 lone mothers, and 4 lone fathers who participated in this study. Demographics: Overall, parents of 82 infants responded. Comments were de-identified using a participant number. Out of all the participating groups, the number of participants in the specific groups is as shown: Group A: 42 infants, Group B: 33 Infants, Group C: 7 Infants. Of the 78 mothers in this study, 5 identified as Hispanic or Latino. Results: Four core concepts, or themes, emerged from the content analysis of the transcripts: What is seen and known; What is seen, but unknown; What is unseen, but known; and What is unseen and not known. Various factors influenced the parents' perception of what was the most distressing thing they saw in their baby including medical interventions, understanding of infant's prognosis, technology within the room, and recognition of infant's symptoms and treatment. Conclusion: Continued research is needed to understand how the NICU environment affects parents' views of their critically ill or unstable infants. In doing so, health care providers can address parent concerns thereby increasing levels of comfort and trust with the treatment team.Item Examining ADL Ability Before Admission to the Intensive Care Unit in Critically Ill Older Adults(The Ohio State University, 2021-05) Nedrow, Travis; Thrane, SusanPurpose/Background: Preexisting comorbid conditions, physiologic changes associated with normal aging, and medical interventions commonly received during an intensive care unit (ICU) stay are factors believed to elevate older adults' risk of poor outcomes. While believed to be an important prognostic indicator, few studies to date have explored the role preadmission functional ability has on critically ill older adults' outcomes. The purpose of this study was to describe older adults' ability to perform basic and instrumental activities of daily living (ADL) prior to an ICU admission. Methods: This study was a secondary analysis of data from the parent study Reiki Intervention for Seriously Ill Elders in the ICU. The sample included 38 adults who were admitted to an ICU, age 55 or older, diagnosed with acute respiratory failure, and within 72 hours of initiation of mechanical ventilation or high-flow oxygen therapy. The Katz Index of Independence in ADL and Lawton Instrumental Activities of Daily Living scales were used to assess the participants' abilities to perform basic and instrumental ADLs independently two weeks prehospitalization. The Katz scale focuses on six core ADLs (bathing, dressing, toileting, transferring, continence, and feeding), rating the participant from 0 (completely dependent) to 6 (completely independent). The Lawton Instrumental ADL assesses eight common household tasks such as using the telephone, doing laundry, and handling finances, ranking them from 0 (lowest functioning) to 8 (highest functioning). Higher cumulative score indicates a greater level of independence. Measures were completed by the patients' family members because patients were sedated. The data were analyzed using descriptive statistics. Results: The mean age of the 34 participants was 66.9 years (SD=5.3). Most participants were male (61.8%), white (73.5%), not currently employed (82.4%), and had at least a high school diploma (88.2%). Most (69.2%) were living in their own home and with a spouse (73.5%) prior to hospital admission. The mean Katz Index score was 5.03/6 (SD=1.66). Most participants were independent with dressing, bathing, and continence (76.5%), toileting and transferring (88.2%), and feeding (97.1%). The mean Lawton IADL score was 6.15/8 (SD=2.24). Most participants were independent with shopping (61.8%), laundry (67.6%), preparing food (70.6%), transportation (70.6%), housekeeping (79.4%), taking medications (79.4%), and handling finances (85.3%). Conclusion: Of the older adults participating in this study, scores indicate that most had moderate to high levels of independence prior to admission to the ICU.Item Family Support and Healthy Eating in African Americans with Type 2 Diabetes(The Ohio State University, 2021-05) Du, Yang; Hu, JiePurpose and Background/Significance: African Americans have a high prevalence of Type 2 diabetes mellitus (T2DM) (13%) compared to Whites (8%). Diabetes self-management is key in T2DM care and healthy eating is an important aspect of diabetes self-management. The study examined the association between family support and healthy eating among African American adults with T2DM. Theoretical/Conceptual Framework: The social-cognitive theory was used to guide the study. Methods: A total of 37 African American participants with T2DM were recruited from a medical center and pharmacy in a mid-western metropolitan. Data were collected using self-reports. The Family Support for Healthy Eating, and Fruits and Vegetable Intake, and Sugar Intake questionnaires. Descriptive statistics were used to describe the characteristics of the participants. Pearson's coefficient correlation was used to exam the relationship between family support and healthy eating. Results: The average age of participants was 59 years old (SD=10) and 62.2% were female. The findings showed that family support for healthy eating encouragement subscale was positively associated with fruit and vegetable intake (r=0.489, p=.008), but not correlated with sugar intake (r = -0.076, p>.05). Conclusions: Family support with positive encouragement is associated with healthy eating among African Americans with T2DM. This finding highlighted the importance of family support in diabetes self-management among African Americans. Future interventions self-management should focus on family support to improve nutrition in African Americans living with T2DM.Item Early pregnancy DNA methylation in stress–related genes and birth outcomes in mothers with mental health diagnoses(The Ohio State University, 2021-05) Minnick, Elizabeth; Anderson, CindyBackground. Maternal mental health influences the intrauterine environment, triggering epigenetic changes at a critical time of embryonic and fetal development through DNA methylation (DNAm) in cytosine-guanine (CpG) sites that alter gene expression. Purpose: The purpose of this study was to examine birth timing/birth weight and differences in DNAm in stress-related genes (NR3C1, HSD11B2, and FKBP5) in first trimester maternal blood from pregnant mothers with/without mental health diagnoses. Methods. A prospective convenience sample of nulliparous women (n=47) were recruited in the first trimester of pregnancy. Genome-wide DNA methylation was quantified in peripheral white blood cells. Maternal history of depression and/or anxiety and birth outcomes were determined by medical record abstraction. Linear regression models examined associations among mental health diagnoses, DNAm at individual NR3C1, HSD11B2, and FKBP5-associated CpG sites, birth timing, and birth weight, controlling for early pregnancy weight and infant sex. Results. A mental health diagnosis was associated with DNAm in CpGs associated with NR3C1 (ten CpGs), HSD11B2 (three CpGs), and FKBP5 (eight CpGs) (p<0.05). After adjustment for multiple comparisons, the association between anxiety and DNAm at NR3C1-associated Cg12466613remained significant (p<0.001). Mental health diagnoses were not associated with birth timing/birth weight. DNAm at four NR3C1-associated CpGs was significantly associated with birth weight (p<0.038). Conclusions. DNAm is altered in early pregnancy among women with mental health diagnoses, supporting epigenetic influences during development and association with birth outcomes. Promoting women's mental health prior to pregnancy has potential to foster the well-being and long-term health of the mother-infant dyad.Item Patient-Nurse Effectiveness with Assistive Communication Strategies (SPEACS): Role in Frustration, Communication and Avoidance in ICU(The Ohio State University, 2021-05) Lund, Audrey; Happ, Mary BethPurpose and Background/Significance: Prior to the COVID-19 pandemic, there were over 900,000 hospital admissions for respiratory failure and invasive mechanical ventilation (MV) in the US annually. Communication difficulty is associated with severe emotional distress among MV patients. Nurses report frustration with and avoidance of MV patients with whom communication is difficult. The SPEACS-2 program (Study of Patient-nurse Effectiveness with Assistive Communication Strategies) provides online training and toolkit to improve nurse communication skills by teaching effective assessment and augmentative and alternative communication (AAC) strategies. This study applied novel measures of student nurse and ICU nurse feelings of frustration and avoidance toward interactions with MV patients before and after SPEACS-2 training. Theoretical Framework: The study was guided by the "nurse-patient communication model" (Happ et al, 2008), informed by communication disorders science and AAC research and practice. Aims: Among nurses and student nurses participating in SPEACS-2 training, (1) determine the relationship between frustration with communication and avoiding contact with patients who are difficult to understand; (2) describe the change in frustration with communication and avoiding contact with patients after SPEACS-2 training relative to before (nurses only); and (3) determine differences between nurse and student nurse groups in frustration with communication and avoidance of contact with patients after SPEACS-2 training. Method: We conducted a descriptive, comparative secondary analysis of Nurse Communication Survey (NCS) data collected in two separate studies with ICU nurses and pre-licensure nursing students. The NCS is a 16-item survey measuring nurse comfort and satisfaction communicating with MV patients in ICU. Individual NCS items measure frustration with communication and avoidance. Results: 263 ICU nurses and 85 student nurses participated in the survey. Findings suggest a weak positive correlation between avoidance and frustration variables (0.302 (p<0.0001). The ICU nurse group showed a significant change post-intervention in feeling frustrated (p =0.0001) but no change in avoidance. There was a significant difference between nurse and student nurse groups in frustration (p<0.0001) and avoidance (p=0.0027). Conclusions: The significant reduction in nurse and student nurse frustration as a result of this communication training intervention may translate into greater nurse satisfaction and better patient experience.Item Enhanced Collection of De-Identified Community Health Data for the Ask A Buckeye Nurse Program: A Quality Improvement Project(The Ohio State University, 2021-05) Salomons, Brian; Fitzgerald, ElizabethBackground: The Ask a Buckeye Nurse (ABN) program was developed to address challenges to health and wellness of African American adult members of an inner-city community in the Midwest. Compared to White Americans, African Americans experience higher levels of poverty and food insecurity. Likewise, chronic diseases, such as heart disease, diabetes, and obesity, remain prevalent. Barbershops are potential sites for health promotion and have become epicenters of community based participatory research (CBPR) for at-risk populations. Additionally, the literature supports the usage of continuous quality improvement projects (CQIP) in African American populations as means to improve health by identifying problems, implementing interventions, and studying effectiveness. Purpose: A CQIP was introduced to: (1) improve the collection of population data and measurement of program outcomes; (2) provide more robust data to demonstrate how many people were screened, referred, and educated; and (3) document population de-identified data of blood pressure (BP), blood sugar (BS), perceived stress (PSS-10), and body mass index (BMI) to gather evidence in support of ABN. A post-screening satisfaction survey was included to better understand the community perception of ABN events. Conceptual Framework: The social-ecological model was used as the conceptual framework. Methods: Health screenings of African American adults were conducted by The Ohio State University faculty and students at a barbershop in inner-city Columbus, Ohio. ABN health screenings measured participants' BP, BS, BMI, perceived stress (PSS-10), and offered an opportunity to complete a satisfaction survey post-screening. Participants also self-reported demographic data and were offered health education information and referrals. All participants were English-speaking, ages 18 years or greater, recruited inside of the barbershop or beauty shop, and consented to the screening. Results: Most community members screened (n = 104) identified as African American (96.9%). The mean age of individuals screened (43.1 years old), gender percentages (male = 58.8%; female = 41.2%), and most frequent zip code (43203 = 24.4%) were identified. Sixty-seven were classified with BP results above normal, and 12 had high BS levels. Thirty-four were classified as overweight or obese. Referrals for follow-up care were made for 18 participants. Results of the satisfaction survey suggest that most participants (86.0%) agreed or strongly agreed that health screenings help them control their health and wellness. Conclusions: Results illustrate that health promoting events are beneficial and supported by this African American community. The participants' willingness to engage in health screenings suggests that barbershops are useful places to offer health interventions and education.Item A Systematic Review of the Effectiveness of Dietary and Physical Activity Mobile Health Applications among Adults with Chronic Disease(The Ohio State University, 2021-05) Babbin, Brooke; O'Brien, TaraProblem: In the United States, six in ten adults have a chronic disease. One affordable self-care resource for patients with chronic disease to reduce complications is to track diet and physical activity using mobile health (mHealth) applications (apps). However, it is unknown how effective mHealth apps are for improving health outcomes. Purpose: The purpose of this systematic review was to examine the effectiveness of interventions that used dietary and/or physical activity mHealth apps to improve health outcomes among adults living with chronic disease or high risk for developing chronic disease. Search Strategy: A total of six databases were searched to identify studies published between the years of 2015 to 2020 using the PRISMA guidelines. Studies were eligible if they were conducted with adults (18 and older), diagnosed with chronic disease or at high risk for chronic disease, and used a smartphone app to improve health outcomes. Outcomes that were measured were activity level, weight, blood pressure, glucose, cholesterol, calorie intake, and fruit or vegetable intake. Two reviewers independently reviewed studies for eligibility. Results of Literature Search: The initial search identified 131 studies. After removing duplicates and assessing the full text papers, a total of eight studies met the search criteria. The mean age of the participants was 51 years, the duration of studies ranged from 2-12 months, and the majority (n= 6) were conducted in a healthcare setting. Seventy-five percent of the studies (n= 6) had a large sample size (>90) and included both diet and physical activity tracking features in the app. Overall, interventions with apps using a multicomponent approach for tracking diet and physical activity (n= 4) were more effective than alternative interventions. Synthesis of Evidence: This review provides evidence suggesting multicomponent interventions using apps with both diet and physical activity features for six months or longer, are effective to increase activity levels in adults living with or at risk for chronic disease. However, the evidence is lacking for which app is the best to be integrated into routine clinical practice and how many features are needed for long-term engagement. Implications for Practice: This study highlights the potential health benefits for reducing inactivity and improving diet in patients living with chronic disease by using multicomponent interventions that use apps with both diet and physical activity features.Item Maternal Cytokine Production Capacity as a Novel Indicator of Readiness for Labor: A Pilot Study among a Prospective Cohort of Low-Risk Black Women(The Ohio State University, 2021-05) Kretz, Kaitlin; Gillespie, ShannonIntroduction. In the United States, 27.1% of labors are induced and 31.9% of births are by cesarean section. When unwarranted, interventions introduce risk, particularly among Black women. Unnecessary medical intervention is less common when women are admitted physiologically ready for labor, which is difficult to discern. Since an inflammatory cascade plays a major role in labor, we aimed to determine whether maternal immune profiles predict odds of spontaneous versus medically-initiated labor and birth. Methods. A prospective cohort of Black women was recruited from central Ohio (n=92). At 28-32 weeks of pregnancy, demographics and obstetric histories were obtained. Whole blood was collected and incubated with lipopolysaccharide. Cytokine production was quantified. Medical records were reviewed. Associations among cytokine production capacity and odds of spontaneous versus medically-initiated labor and birth were examined by logistic regression (controls: age, education, smoking, body mass index, nulliparity, hypertension, fetal sex). Results. Women with medically-indicated inductions or cesarean sections were excluded (n=18), leaving an analytical sample of 74 (54 spontaneous labors, 7 labor inductions, 13 pre-labor cesarean sections). Pro-inflammatory IL-6 production in the high versus mid-tertile (p=0.012; χ2quadratic=5.5, p=0.019) and anti-inflammatory IL1Ra production in the high versus low tertile (p=0.049) predicted lower odds of spontaneous labor. Anti-inflammatory TNFRII production in the low (p=0.027) and high (p=0.014) versus mid-tertile predicted lower odds of spontaneous labor (χ2quadratic=6.1, p=0.014). Conclusions. We are among the first to provide data suggesting that maternal cytokine production capacity may show predictive power for labor readiness. Future work will benefit from additional immune profiling immediately preceding and during labor and larger cohorts. This line of inquiry has the potential to transform allocation of labor interventions.Item A Cross-Sectional Study of Pain Sensitivity and Unpleasantness in People with Vascular Dementia(The Ohio State University, 2021-05) Humbel, Angela; Monroe, ToddAdvanced age holds higher risk of both pain and dementia, with many studies finding dementia often heightens sensitivity to pain. VaD is the second most common type of dementia. Only a few observational or retrospective studies have examined pain responsiveness in VaD, suggesting it may increase pain unpleasantness (i.e., pain affect). We utilized a thermal psychophysics paradigm to examine "mild pain" and "moderate pain" thresholds (oC temperature) and associated unpleasantness ratings (0-20 scale) in a cohort of verbally-communicative, probable VaD patients (n=23). Responses in VaD patients were compared to age- and sex-matched healthy control responses (HC, n=23). Psychophysics were compared between groups by way of a mixed-effects analysis, controlling for depressive symptoms. We found a tendancy toward lower pain thresholds in the VaD group, driven by mild pain (main effect p=0.086, Cohen's d: mild = 0.55, moderate = 0.27). Unpleasantness ratings were higher in the VaD group compared to HC (main effect p=0.003; mild pain p=0.022, Cohen's d=0.79; moderate pain p=0.057, Cohen's d=0.6). We found experimental evidence for greater thermal pain sensitivity in VaD, driven by greater pain unpleasantness. These results are consistent with prior observational findings suggesting VaD may make patients more susceptible to pain, particularly its affective component.Item Could Complementary Health Approaches Improve the Symptom Experience and Outcomes of Critically Ill Adults? A Systematic Review of Randomized Controlled Trials(The Ohio State University, 2019-05) Hsieh, Katie; Balas, Michele; Thrane, Susan; Tan, Alai; Donahue, PaigeSedative, analgesic, and antipsychotic medications are frequently administered in the intensive care unit (ICU) to treat a variety of symptoms. Evidence suggests these medications carry the risk of long-term physical, cognitive, and psychologic impairment. Thus, the purpose of this systematic review was to critically evaluate the effectiveness of various complementary health approaches (CHAs) in treating symptoms experienced by critically ill adults. We searched PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Medline, and PsychInfo for studies published from 1997 to 2017. All randomized controlled trials (RCTs), in English with terms ICU/critical care, music, Reiki, therapeutic touch, healing touch, aromatherapy, essential oil, chronotherapy, or light therapy were eligible for inclusion. Studies conducted outside the ICU, involving multiple CHAs, or enrolling neonatal or pediatric patients were excluded. From 477 articles identified, 32 RCTs were included. The CHAs evaluated included music (n=19), nature based sounds (NBSs) (n=4), aromatherapy (n=3), light therapy (n=2), massage (n=2), and reflexology (n=2). No adverse events or safety related concerns were reported in the eligible studies. There were statistically significant improvements in pain (music, NBSs), anxiety (music, NBSs, aromatherapy, massage, reflexology), agitation (NBSs, reflexology), sleep (music, aromatherapy, reflexology), level of arousal (music, massage), and duration of mechanical ventilation (music, reflexology). Evidence suggests CHAs may reduce symptom burden in critically ill adults and those highlighted here are all within nursing scope of practice and easily implemented.Item Post-Migration Challenges among Bhutanese-Nepali Refugees in Columbus, Ohio(The Ohio State University, 2019-05) Kayuha, Hannah; Kue, JenniferBackground/Purpose: Over 15,000 Bhutanese-Nepali refugees have resettled in Columbus, Ohio since 2008. The majority of research on this community has focused on mental health and the suicide rate among the Bhutanese. However, there is little known about their social support and family resources status, and the post-migration living difficulties (PMLD) they face after resettlement. Methods: Bilingual Nepali-speaking interviewers conducted a community needs assessment with Bhutanese-Nepali women and men, aged 18 years and older living in Columbus, OH. The questionnaire included topics of healthcare practices, cancer knowledge and screening behavior, mental health issues and preferences for mental health services, social support, family resources, and barriers to health/social services and resources. For the purpose of this study, secondary data analysis examined PMLD, social support, and family resources. Descriptive statistics (frequencies, t-test) were conducted using SPSS ver. 24. Results: A total of 201 participants were surveyed. More than half were men (51.7%) and 53.7% were between the ages of 25-44 years. More than 75% were on Medicare/Medicaid, 43.1% have a total family income of less than $15,000, and while over 50% are employed full-time, almost 35% are not working. The most commonly reported PMLD was communication/language difficulties with 54.2% of participants reporting a somewhat to a serious problem. Secondly, 39% of participants reported being unable to find work and insufficient government help with welfare a somewhat to a serious problem. Regarding family resources, there is a significant difference between men and women in terms of monetary resources, t(197)= 1.12, p= 0.019. There is also a significant difference in perceived social support between men and women, t(197)= 1.30, p= 0.003. Conclusions: Results from this study provides greater insight into the cultural and linguistic needs of Bhutanese-Nepali refugees who have recently resettled in Columbus. Language and communication is a major barrier to finding employment and resources. Despite these challenges, participants reported that they have strong social support, which may ease some of the burdens of resettlement. Future studies may want to examine ways to help maintain strong social networks in refugee communities to eliminate post-migration challenges.Item The Impact of Interprofessional Collaborative Care on Patient-Related Outcomes: A Systematic Review of the Literature(The Ohio State University, 2019-05) Berichon, Grace; Loversidge, JaquelineBackground: Health care has typically been provided by a number of different health professionals working in parallel; professions work alongside one another, but remain in their own disciplinary silos. Lack of collaboration has been associated with gaps in care and medical error. To ameliorate these issues, interprofessional collaborative care (IPCC) has developed as a process by which two or more health care professionals work collaboratively to care for a patient. IPCC has been increasingly recognized as an optimal care model with the potential to positively benefit patient- related outcomes. Purpose: The purpose of this systematic review is to assess the impact of interprofessional collaborative care interventions on patient-related outcomes. Data Sources: This systematic review of the literature used research data sources including Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and Cochrane Library Databases. A hand-search was also conducted. Selection criteria included literature that was published between 2011-2018 (rationale – 2011 was the date the Interprofessional Education competencies were published), in English, and in the United States (rationale – U.S. healthcare system uniqueness/different then healthcare systems in other countries). Data Extraction: Included studies were required to focus on patient-related outcomes. Studies that were eliminated were not related to patient-related outcomes, or included interprofessional education of students, or focused on the continuing education of licensed professionals. All abstracts that included those parameters were read, but only studies that were aligned with the purpose of the systematic review were read in full. In addition, a hand-search was conducted; additional studies were identified by screening references cited in included studies. Data Synthesis: Selected studies were abstracted for themes related to patient-related outcomes resulting from IPCC. Ten studies were included in the systematic review. There were multiple IPCC patient outcome-focused interventions which were reported in the literature. The outcomes clustered into the following themes: hospital costs; length of stay; patient satisfaction; patient experience; readmission rates; mortality; medication errors and other adverse events. Conclusions: IPCC was found to have a variety of impacts on patient outcomes, which can be applied to practice models in patient care settings. Most researchers suggested additional research be conducted; research most needed is that which definitively demonstrates quantitative outcomes achieved by specific IPCC interventions.Item Engaging Veterans in Healthcare Research: The Ohio Story(The Ohio State University, 2019-05) Caven, Gwen; Duffy, SoniaPurpose. Veterans in the United States face major health challenges that impact their ability to successfully reenter civilian life and maintain health and quality of life. Despite evidence of differences between Veteran and civilian healthcare, little is known about the perspectives of Veterans about healthcare delivery and utilization of health-related research. The purpose of this study is to improve understanding of Ohio Veterans and key stakeholder perspectives related to healthcare and health-related research. Methods. In this qualitative study, focus groups were conducted with Veteran and key stakeholder (family and friends, service providers, community leaders, etc.). Participants were recruited from the six states with the largest Veteran populations (i.e., California, Texas, Florida, Pennsylvania, New York, and Ohio). This study explores perspectives from focus groups conducted in Ohio. The ten 90-minute focus groups in Ohio (n=38) were transcribed and analyzed. Patterns and relationships of codes were categorized and synthesized into themes related to participants' perspectives of Veteran healthcare and health-related research. Results. Results from these focus groups fell into three categories. Participants were concerned with their overall healthcare related to information on treatment options and decisions, stigma with mental health, and combat and non-combat related health promotion and prevention. The population was also troubled with healthcare system issues such as billing problems, feeling disconnected from benefits and services, and difficulties with the Veterans Choice Program. While participants also expressed mistrust and skepticism when asked about health-related research, they showed interest in potentially taking a larger role in research once their healthcare issues were resolved. Conclusions. Veterans voiced concerns that can be used to redesign healthcare and the research agenda for Veterans.Item The Association between Language Acquisition Method and the Process of Developing Cultural Competency in Healthcare Providers(The Ohio State University, 2019-05) Witkin, Jessica; Fitzgerald, ElizabethCurrent knowledge suggests two groupings for language acquisition method. Heritage language learners acquire language through culturally bound settings; foreign language learners acquire language in formal educational settings. Multiple factors contribute to linguistic attainment. The effects of individuals’ language acquisition methods on the development of cultural competency are unknown. Cultural awareness and training are important factors to addressing healthcare disparities. This study is part of a larger study, Validation of the Spanish Version of the Instrument for Assessment of the Process of Cultural Competency-Revised (IAPCC-R©). The IAPCC-R is a 25-item tool, scored from 25-100, measuring healthcare providers’ levels of cultural competence, with five items measuring each construct of cultural competence. Higher scores correlate with increased cultural competency. This study sought to: (1) determine the reliability of the Spanish translation of the IAPCC-R in various types of language learners and (2) identify the difference between groups’ cultural competency scores. A cross-sectional, survey-based design was used. The study initially targeted members of the National Association of Hispanic Nurses. Recruitment was expanded to include Ohio nurses and other healthcare professionals. Data were collected through a Qualtrics survey. A sample of 262 Spanish speaking healthcare professionals completed the survey. Participants were offered a $5.00 Amazon gift card for their participation. Data analysis was completed in SAS by the research team’s statistician. Cronbach’s alpha was calculated for each language learner group. A one-way between groups ANOVA was conducted to compare the effect of language acquisition method on cultural competency scores. Reliability was calculated for each language learner subgroup: Language Developers (α = 0.81), Language Maintainers (α = 0.41), Latecomers who Personalize (α = 0.53), Language Shifters (α = 0.39), and Latecomers (α = 0.33). Reliability was established in Language Developers. The effect of language acquisition method on participants’ cultural competency score was not significant F (4, 184) = 0.54, p = 0.71. Results suggest that when the IAPCC-R is translated into the Spanish language, the way cultural competency is assessed may benefit from being personalized for different types of language learners. While language acquisition method did not prove to significantly change cultural competency scores, future research would benefit from a mixed methods study with focus groups providing input to the Spanish IAPCC-R© translation.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.