Tan Chingfen Graduate School of Nursing Dissertations

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The mission of the Tan Chingfen Graduate School of Nursing at UMass Chan Medical School is to prepare nurses who embrace diversity and promote health equity to improve the quality of life and human health in the Commonwealth and beyond by leading and innovating in education, research, health care delivery and public service. Since the PhD program began in 1997, students in the Graduate School of Nursing have contributed dozens of doctoral dissertations to the field of nursing. This collection makes this body of work accessible to our students, faculty, potential recruits, the citizens of Massachusetts, and the world.

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In Our World: Uncovering the Meaning of Parent-Nurse Relationships in Childhood Cancer Care
(UMass Chan Medical School, 2023-12-14) Costa, Jennifer; Donna Perry, PhD, RN; Tan Chingfen Graduate School of Nursing
Background: The diagnosis of cancer in a child thrusts parents into a complex healthcare system where they find themselves developing new relationships with pediatric oncology nurses. While parents and nurses acknowledge the meaningfulness and complexity of these relationships, many find it difficult to articulate. The purpose of this study was to understand the meaning and experience of the parent-nurse relationship in childhood cancer care. Methods: This study employed the tenets of Gadamerian hermeneutic philosophy. Data analysis looked to articulate meaningful interpretations of the interviews with parents and nurses of children with cancer through interpretive data analysis and utilized the hermeneutic circle as a way of conceptualizing and understanding the interpretive process. Results: Sixteen interviews (n = 8 parents, n = 8 nurses) were completed. The findings suggested that both parents and nurses of children with cancer navigate through an evolving inner world unique to the cancer experience. The parent-nurse relationships were mutually identified as dynamic, complex, and emotionally laden, and drew on the shared strength, trust, humanity, and interconnectedness of one another. The parent-nurse relationships played a significant role in traversing the challenges encountered with entry into and navigation through the pediatric cancer world. Discussion: The findings provide practical knowledge to inform and enhance relationship development at the clinical level, impact how relationship development is taught at the academic level, as well as inform professional development. This study contributes to the understanding of parent-nurse relationships and opens the door for integration of innovative practices in nursing education and clinical care.
Nurses with Physical Disabilities Experiences During Pre-licensure Education
(UMass Chan Medical School, 2023-08-15) Mantlow, Kimberly D.; Nancy Morris; Tan Chingfen Graduate School of Nursing
PURPOSE: To describe the pre-licensure nursing educational experience of integration and inclusion among RNs with a physical disability during their education. SPECIFIC AIMS: 1) Describe the access RNs with a physical disability had to academic and social opportunities during their prelicensure education program that contributed to academic and social integration (inclusion). 2). Explore perceptions of RNs with a physical disability regarding inclusion and acceptance of their disability as a valued component of student diversity during their prelicensure education program. 3). Describe the contextual factors and key aspects of connection during the pre-licensure educational experiences of RNs who had a physical disability as positive (Disability-Diversity Connect) or negative and disintegrated (Disability-Diversity Disconnect). FRAMEWORK: This study was guided by The Disability-Diversity Disconnect (DDDM) by Aquino (2016). DESIGN: This study design used was qualitative description. It included semi-structured interviews using an interview guide based on the DDDM. RESULTS: 16 individuals with 14 different physical disabilities participated in this study. During data analysis four themes emerged: I Saved My Energy for Learning, Determination, Wanting to Find My People and Secrets, Living a Double Life which has a subtheme, Fear of Judgement. CONCLUSION: : Identification of factors related to inclusion within the academic environment provides insight for future work to examine the needs of prelicensure nursing students with physical disabilities and the potential to improve their future educational experiences.
Ready for Action: A National Study of Pediatric Healthcare Professionals' Attitudes and Beliefs About Weight Stigma
(UMass Chan Medical School, 2023-05-26) Turner, Samantha L; Nancy Morris; Tan Chingfen Graduate School of Nursing
PURPOSE: To quantify pediatric healthcare professionals’ (HCPs’) attitudes and beliefs about weight stigma and levels of implicit and explicit weight bias and describe interventions that are most supported by pediatric HCPs. SPECIFIC AIMS: 1) Determine the distribution of weight bias among pediatric HCPs and identify associations between characteristics and weight bias. 2) Examine attitudes and beliefs of pediatric HCPs about weight stigma and identify associations between characteristics and attitudes/beliefs. 3) Investigate the relationship between HCPs’ weight bias and attitudes/beliefs. 4) Identify interventions most supported by pediatric HCPs. Framework: The Health Stigma Discrimination Framework guided this study. DESIGN: This study utilized a cross-sectional survey of pediatric HCPs. Participants completed the Implicit Association Test (IAT), the Crandall Anti-Fat Attitudes Questionnaire (CAAQ), a researcher-designed questionnaire (BAWSQ), and demographic questions. RESULTS: The sample exhibited a moderate implicit bias (M=0.59, SD=0.41) and explicit bias (M=38.95, SD=10.9). Participants generally agreed with BAWSQ statements and broadly supported interventions. The most-supported intervention was continuing education units (CEUs) for anti-weight bias activities (n=144, 81.36%). Implicit bias was associated with more years in practice, occupation, and age. Explicit bias was associated with practice setting. As explicit bias increased, so did agreement with BAWSQ question 1 (r=0.208, p=0.005), and disagreement with BAWSQ questions 3 and 4 (r=-0.237, p<0.005; r=-0.394, p<0.001, respectively). CONCLUSION: Weight bias is prevalent in pediatric healthcare and pediatric HCPs are invested in approaches to reduce weight bias. Future interventions should be brief, concise, and should aim to broaden awareness of pediatric HCPs about the consequences of weight bias.
Hope for the Future: Key Informants’ Perspectives on HIV Prevention in Dominican Republic Batey Communities
(UMass Chan Medical School, 2023-04-18) Filiau, Alaina; Jean Boucher; Tan Chingfen Graduate School of Nursing
Purpose: The purpose of this study, was to understand the interlocking spheres of cultural identity and health behaviors relating to HIV prevention within the batey communities. Specific Aims: Explore key informants’ perceptions of cultural identity that influence HIV prevention including relationships, expectations, and cultural empowerment among persons, extended family, and neighborhoods. Explore key informants’ perceptions of the cultural factors that enable and nurture protective health behaviors relating to HIV prevention among the DR batey communities. Describe key informants’ perceptions of the positive, existential, and negative dimensions of DR batey culture empowerment with the goal of promoting healthy behaviors for HIV prevention in batey communities. Framework: The PEN-3 Model by Airhihenbuwa provided the theoretical framework as a culture-centered approach to understanding cultural context relating to health behaviors. Design: A qualitative descriptive design with maximum variation was utilized, and data was analyzed using qualitative content analysis. Semi-structured qualitative interviews were completed with key informants within the La Romana region of the Dominican Republic. Results: Semi-structured qualitative interviews were conducted with 12 individuals.
Diagnoses Associated with Intellectual and Developmental Disabilities in Adult Decedents: A Secondary Analysis of Healthcare Cost and Utilization Project National Inpatient Sample (HCUP/NIS) Data
(UMass Chan Medical School, 2023-02-17) Briere, Heather; Nancy Morris; Tan Chingfen Graduate School of Nursing
Purpose: To identify primary and secondary diagnoses preceding death among adults with and without IDD who died during hospitalization. Specific Aims: 1) to describe the commonly reported base diagnostic related groups preceding death among decedents with and without IDD who died during hospitalization in 2019, 2) to determine which base-DRGs had a higher prevalence rate among adults with IDD than among adults without IDD, controlling for age, gender, race, urbanicity of person’s residence, US census division of hospital, and mean income of person’s zip code, and 3) to use the base-DRGs and ICD-10-CMs to examine the conditions of the Fatal Four/Five as conditions of concern preceding death in decedents with and without IDD. Framework: The NIMHD Minority Health and Health Disparities Research Framework. Design: A secondary data analysis using the 2019 Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample (HCUP-NIS). Results: Identified fourteen primary diagnoses at the time of death for decedents with IDD that are represented at a higher percentage than for decedents without IDD and have a significant odds ratio for IDD diagnosis. Conclusion: A new set of conditions is proposed to assist nurses in reducing preventable deaths in decedents with IDD. Dehydration, GI obstruction, respiratory infection, seizures, and sepsis, will be known as the IDD Concerning Conditions. Aspiration, constipation, and GERD, the IDD Contributing Conditions, are conditions that do not cause death in themselves but contribute to the development of at least one of the IDD Concerning Conditions, which do cause death.
Mental Illness Knowledge and Stigma of Jamaican Diaspora & First-Generation Jamaican Americans
(UMass Chan Medical School, 2022-12-15) Nyakako, Rose Marie; Nancy Morris; Tan Chingfen Graduate School of Nursing
PURPOSE: To describe U.S. Jamaican diasporan and first-generation Jamaican Americans knowledge of and stigma towards mental illness. SPECIFIC AIMS: 1. Describe U.S. dwelling Jamaican diaspora and first-generation Jamaican Americans knowledge of mental illness and stigma towards mental illness with identification of drivers and facilitators of stigma. 2. Elicit descriptors used by Jamaican diaspora and first-generation Jamaican Americans to describe mental illness. 3. Determine association of mental illness stigma and mental illness knowledge, to age, gender, education, employment, religiosity, years living in the U.S., socioeconomic status, personal history of mental illness, and family member with mental illness. FRAMEWORK: The Health Stigma and Discrimination Framework. DESIGN: Cross-sectional descriptive survey. RESULTS: Jamaican diaspora years have less knowledge (mean 97.25, SD 10.27) than Jamaican Americans (mean 104.24, SD 7.74; p =.001). Participants > 40 years had less knowledge (mean 97.05, SD 9.54) than those < 40 years (mean 102.08, SD 10.95; p =.003). Jamaican diaspora years have more stigma (mean -.52, SD .76) than Jamaican Americans (mean -1.10, SD .73; p < .001). Participants > 40 years had more stigma (mean -.48, SD .69) than those < 40 years (mean 1.02, SD .87; p <.001). CONCLUSION: Older adults have less knowledge of mental illness and more stigma. Jamaican diaspora has less knowledge and more stigma than First-generation Jamaican Americans. Greater mental illness knowledge is associated with less stigma providing support for ongoing efforts to increase public knowledge of mental illness with added emphasis on word choice/terms used when talking about people with mental illness. PURPOSE: To describe U.S. Jamaican diasporan and first-generation Jamaican Americans knowledge of and stigma towards mental illness. SPECIFIC AIMS: 1. Describe U.S. dwelling Jamaican diaspora and first-generation Jamaican Americans knowledge of mental illness and stigma towards mental illness with identification of drivers and facilitators of stigma. 2. Elicit descriptors used by Jamaican diaspora and first-generation Jamaican Americans to describe mental illness. 3. Determine association of mental illness stigma and mental illness knowledge, to age, gender, education, employment, religiosity, years living in the U.S., socioeconomic status, personal history of mental illness, and family member with mental illness. FRAMEWORK: The Health Stigma and Discrimination Framework. DESIGN: Cross-sectional descriptive survey. RESULTS: Jamaican diaspora years have less knowledge (mean 97.25, SD 10.27) than Jamaican Americans (mean 104.24, SD 7.74; p =.001). Participants > 40 years had less knowledge (mean 97.05, SD 9.54) than those < 40 years (mean 102.08, SD 10.95; p =.003). Jamaican diaspora years have more stigma (mean -.52, SD .76) than Jamaican Americans (mean -1.10, SD .73; p < .001). Participants > 40 years had more stigma (mean -.48, SD .69) than those < 40 years (mean 1.02, SD .87; p <.001). CONCLUSION: Older adults have less knowledge of mental illness and more stigma. Jamaican diaspora has less knowledge and more stigma than First-generation Jamaican Americans. Greater mental illness knowledge is associated with less stigma providing support for ongoing efforts to increase public knowledge of mental illness with added emphasis on word choice/terms used when talking about people with mental illness.
“I felt isolated”: Patients’ Hospitalization Experiences During the COVID-19 Pandemic
(UMass Chan Medical School, 2022-04-25) Patrick, Julia; Nancy Morris; Tan Chingfen Graduate School of Nursing
Purpose: The purpose of this Qualitative Descriptive study was to describe the experience of hospitalized adults during the pandemic who did not have COVID-19. Specific Aims: The specific aims of the study were to: Describe the hospital experience, including but not limited to, interactions with hospital staff, visitation, isolation, physical and emotional stressors, and the environment. Identify perceived comfort needs during hospitalization and perceptions of the nurse’s role in providing comforting interventions. Examine the ability to achieve physical, psychospiritual, sociocultural, and environmental comfort during hospitalization despite the required infection control measures. Framework: This study was guided by Kolcaba’s Theory of Comfort (1994). Design: This was a qualitative descriptive study. Semi-structured interviews were conducted. Interview questions focused on the overall hospital experience, the nurse’s role in their experience, comfort needs, and the experience of having comfort needs met during the hospitalization. Results: Twenty participants took part in this study. Conventional content analysis revealed five main themes. The themes are: I don’t expect the hospital to be comfortable, I was always tense, Wanting human connection, Communication is important, and Nurses are busy. Conclusion: The findings identified a need for targeting education, research, and policy development to improve patient comfort (physical, psycho-spiritual, sociocultural, and environmental). This is important as we look toward improving the overall patient experience during hospitalization.
A Feasibility Study of Therapeutic Conversations with Family Members to Reduce the Symptoms of Post-Intensive Care Syndrome
(UMass Chan Medical School, 2022-05-25) Tehan, Tara M.; Susan Sullivan Bolyai; Tan Chingfen Graduate School of Nursing
PURPOSE: The purpose of this feasibility study was to explore the use of a nurse-centered intervention, the Critical Caring Program, with family members of critically ill adults. The intervention was a series of therapeutic conversations with a family member, beginning in the ICU and following patient discharge from the ICU. FRAMEWORK: The Family Adjustment and Adaptation Response Model (Patterson, 1988) provided the conceptual framework; the intervention was adapted from the Calgary Family Assessment and Intervention Model. DESIGN: A randomized, controlled design with two groups (usual care and intervention) was used to assess the feasibility of the intervention. A convenience sample of 19 adult family members were recruited from an 18-bed ICU from October 2021–January 2022. RESULTS: 151 family members were screened for participation; 40 who were eligible and 19 were enrolled. Overall retention was 58% for the intervention group; 62% for the usual care group. Outcomes revealed no statistically significant differences between groups or changes within groups. The nurses viewed the training and conversations as positive but identified incorporating the visits into routine practice as challenging. CONCLUSION: The Calgary Family Intervention Model is a useful model for addressing families’ need for communication and support. Additional research is needed on incorporating therapeutic conversations into critical care nursing practice.
Individuals With Sickle Cell Disease Using SBAR as a Communication Tool: Secondary Data Analysis
(UMass Chan Medical School, 2022-04-20) Jean-Baptiste, Deborah M.; Maureen Wassef, Ph.D., RN; Tan Chingfen Graduate School of Nursing
Purpose: The purpose of this study was to determine the usefulness of SBAR-cued web-based communication skills training and address study participants' perceptions of the training. Specific Aims: Evaluate the usefulness and accuracy of participants to answer prompts of SBAR-cued communication responses. Describe individuals' perspectives of the acceptability of using SBAR patient-HCP communication simulation to better prepare for ED visits during a SCC. Framework: This study was guided by The Theory of Self-Care Management for Sickle Cell Disease (SCMSCD). Design: A secondary analysis was conducted using a qualitative descriptive approach. Inter-rater reliability (IRR) of qualitative data was used to evaluate the usefulness and accuracy of participants to answer prompts of SBAR-cued communication responses. Content analysis was also utilized to describe individuals' perspectives of the acceptability of using SBAR patient-HCP communication simulation to better prepare for ED visits during a SCC. Results: IRR between raters ranged from 64%-94% with predominant themes of (1) Patient-Provider Communication and Interaction, (2) Patients want to be Heard and Believed, (3) Accuracy of the ED Experience and Incorporating the Uniqueness of each Patient and (4) Overall Usefulness of the Video Trainer emerging. Conclusions: This secondary analysis supported how SBAR can be effectively used to assist patients in a SCC to communicate with their HCP. Participants' responses indicated the training module facilitated communication between patients and HCPs.
Nursing Practice as Knowledge Work Within a Clinical Microsystem: A Dissertation
(University of Massachusetts Medical School, 2008-01-31) LaFave, Lea R. Ayers; Elaine Parker; Tan Chingfen Graduate School of Nursing
Nurses have a key role in keeping patients safe from medical errors because they work at the point of care where most errors occur. Nursing work at the intersection of patients and health care systems requires high levels of cognitive activity to anticipate potential problems and effectively respond to rapidly evolving and potentially harmful situations. The literature describes nursing work at the intersection of patient and health care system as well as barriers to providing safe patient care. However, little is known about the systems knowledge nurses use to negotiate the health care system on their patients’ behalf, or how this systems information is exchanged between nurses. Using the clinical microsystem as the conceptual framework, this qualitative descriptive investigation identified and described: 1) the components of systems knowledge needed by nurses, 2) how systems information is exchanged between nurses, and 3) systems information exchanged between staff nurses and travel nurses. Data were collected from a stratified maximum variation sample of 18 nurse leaders, staff nurses, and travel nurses working within a high-functioning neonatal intensive care nursery within a large academic medical center in New England. Data collection methods included participant observation, document review, individual interviews, and a focus group session. Data were analyzed through constant comparison for emerging themes and patterns. Findings were compared for commonalities and differences within and across groups. Three components of systems knowledge emerged: structural, operational, and relational. Systems information exchange occurred through direct and indirect means. Direct means included formal and informal mechanisms. The formal mechanism of orientation was identified by each participant. Informal mechanisms such as peer teaching, problem solving, and modeling behaviors were identified by participants from each of the three nurse groups. Travel nurses’ descriptions of the common themes focused on individual efficacy. Staff nurses focused on fostering smooth unit functioning. Nurse leaders described common themes from a perspective of unit development. Four overarching domains of systems information were exchanged between staff nurses and travel nurses: practice patterns; staffing patterns and roles; tips, tricks, tidbits, and techniques; and environmental elements. Communication emerged as a common theme across nurse groups and domains of systems information exchanged. These findings have implications for nursing orientation and staff development, continuous improvement at the local level, and curriculum development.
Adolescent Experience with Trauma and Orthopedic External Fixation: A Dissertation
(University of Massachusetts Medical School, 2007-04-01) Patterson, Michele M. Tervo; Susan Sullivan-Bolyai; Tan Chingfen Graduate School of Nursing
Over 13 million adolescents sustain traumatic injuries yearly, resulting in functional disability, disfigurement, psychosocial problems and fractures. These fractures are increasingly being treated with orthopedic external fixation devices (EFDs). The purpose of this study was to describe the experience of traumatically injured adolescents treated with EFDs. The 4 aims of the study focused on the circumstances leading to the traumatic event, experiences following the traumatic event, the impact of EFD treatment, and adolescents’ role in pin-care self-management, which is crucial to preventing infection. This longitudinal, qualitative descriptive study used purposive sampling to recruit 5 male and 4 female adolescents, 13-20 years old, from a New England level-1 trauma center. Participants were injured in motor vehicle crashes (including an all-terrain vehicle), falls, by gunshot, trampoline and football trauma. Interview questions were framed by two themes from a study of adult recovery from physical injury, i.e., the event and fallout. Participants were interviewed within days of the injury, 2 weeks after returning home, and within one month of EFD removal. Data were coded from verbatim transcripts using NVIVO and organized into themes guided by the principles of qualitative analysis. An overarching theme of “old self no more; forever changed” emerged from 26 interviews. The participants’ experience affected all tasks of adolescence: independence from parents, accepting body image, peer relations, and forming an identity. Major themes included “what risk?”, regarding circumstances leading to the traumatic event, mastering the environment, was 2 part first, processing the event, where determining fault and realizing everything has changed, they were ambivalently lucky, and not invincible. Secondly “suck it up and deal with it”, where strategies to deal with traumatic injury emerged (i.e. medication, channeling outlets, and slow caution). EFD experience revealed “Space age robot” and “they’ll do it themselves” as emergent themes. EFDs were described as painless, robotic, no big deal and necessary. One draining pin-site was noted. Findings related to use of self-administered analgesics, information technology, recall of detail, and gender differences in coping may lead to future interventions. These findings lay the groundwork for future studies that may improve care of adolescents during acute recovery from traumatic injury.
Somatic Awareness and Daily Hassles in Women with Acute Myocardial Infarction: A Dissertation
(University of Massachusetts Medical School, 2007-09-01) Stone, Nancy E.; James A. Fain; Tan Chingfen Graduate School of Nursing
Cardiovascular disease is the number one cause of death for women in the United States. Acute myocardial infarction (AMI) carries a more negative prognosis for women than men. Women with AMI have both increased mortality and disability. All researchers who have documented a difference in delay times between men and women note that women delay longer in seeking treatment. In the case of an evolving AMI, women who delay in seeking medical attention will often place themselves outside the limits of reperfusion therapies such as angioplasty and thrombolysis, thereby increasing their risk of an out-of-hospital sudden cardiac death. Several investigators have reported that reasons for delay to treatment may include the presence or absence of “somatic awareness”, that is, how a woman perceives body activity and physiological functioning. The inability of women to disregard social roles and place primacy of caring over their own health issues may limit them from seeking formal care. Social roles and obligations in a women’s life are often influenced by everyday, ordinary happenings which may have a negative impact on decision making. These everyday, ordinary happenings have been defined as “daily hassles”. The Leventhal self-regulatory model of illness behavior, which has been used to study treatment seeking behavior in response to symptoms, provides a coherent framework for interpreting the problem of delayed treatment of myocardial infarction. The Leventhal model proposes that the patients’ belief about their health is structured in a hierarchical fashion and that these structures are based on previous illness experiences and information presented in the social environment. Utilizing a descriptive design, this study examined the relationship between somatic awareness and daily hassles and how these variables influenced a women’s treatment seeking behavior in AMI. The Modified Somatic Perception Questionnaire (MSPQ) was used to measure somatic awareness; and daily hassles were measured through the Daily Hassles and Uplift Scale (DHUS). The questionnaires were administered at least 24 hours post admission to women with AMI. Though there were no significant relationships found between somatic awareness, daily hassles and time to treatment for AMI, the study revealed other pertinent findings. A significant relationship was found between daily hassles and age; revealing that younger participants revealed a higher daily hassle score. Also, a significant relationship was found between total MSPQ and prior cardiac events; indicating infrequent occurrence of intense symptoms experienced by women with a positive cardiac history. Though it is unknown what impact this new knowledge will have on treatment of women with AMI, these findings hold promise for clarifying these areas of research. Keywords: somatic awareness, daily hassles, treatment seeking behavior, women with acute myocardial infarction (AMI).
Ubiety in Nursing Practice — Making each patient the star of the minute
(University of Massachusetts Medical School, 2021-07-30) Amoah, Rita; Carol Bova; Tan Chingfen Graduate School of Nursing
PURPOSE: The purpose of this study was to explore the experiences of registered nurses when practicing ubiety. SPECIFIC AIMS: The specific aims of the study were to: Describe the attributes of the nurse, the care environment, and the person-centered processes nurses needed to possess in order to immerse themselves physically, cognitively, and spiritually into caring for one patient at a time in midst of distractions Explore possible patient-related and nurse-related outcomes when caring for one patient at a time in amidst distractions DESIGN: Qualitative descriptive study guided with the Person-Centered Nursing (PCN) Theory by McCormack and McCance, (2006). A purposive sampling technique was used. RESULTS: 13 nurses, who were nominated to receive the Daisy Award were recruited. One overarching theme: Practicing Ubiety—Making the patient the star of that minute, and 5 subthemes emerged: anticipating and managing distractions, putting my whole self in, self-preservation, my nursing identity, favorable practice environment. In addition, patient-related and nurse-related outcomes were identified. CONCLUSION: Ubiety is a concept that is practiced by expert nurses. Results add to existing knowledge about the characteristics of exemplar nurses who practice person-centered nursing care. The importance of anticipating patient needs as a way to deal with distractions and working with nurses to individualize self-preservation strategies are emphasized.
Experiences with Exposure to a Distant Reiki Intervention during the COVID-19 Pandemic
(UMass Chan Medical School, 2022-01-04) DiBenedetto, Jennifer; Donna Perry; Tan Chingfen Graduate School of Nursing
Purpose: The purpose of the study was to explore the use of virtual distant Reiki as a healing modality to influence the human environmental field patterning. Specific Aims: (1) To determine if it is feasible to recruit and retain participants (through expressions of human choice) to participate in a study comprised of two distant Reiki administrations on a virtual platform. (2) To investigate the preliminary influence of a distant Reiki intervention on pattern of the whole as manifested by participant response in stress and anxiety. (3) To explore the participant’s reflections on their virtual distant Reiki experience within the human environmental field pattern of their home environment as a healing space. Theoretical Framework: The theoretical framework is grounded in Martha Rogers’ Science of Unitary Human Beings. Design: This study incorporates a feasibility, mixed method design. Data was collected through pre and post intervention individualized interviews and two tools (State Trait Anxiety Inventory (STAI) and Impact of Events Scale-Revised (IES-R)). Results: Described changed in pattern manifestation supported the need for home-based interventions during covid 19 pandemic. Quantitative response indicated a statistically significant reduction in perceived stress and anxiety (p< 0.001). Conclusion: The preliminary study findings support the feasibility of a distant Reiki and suggest that nurses, who are Reiki practitioners, may be influential in interacting with the human environmental field to promote change and foster healing.
Moral Challenges, Moral Distress, and Moral Resilience in Critical Care Nurses During the COVID-19 Pandemic
(UMass Chan Medical School, 2021-09-24) Malatesta, Thin Zar; Carol Bova; Tan Chingfen Graduate School of Nursing
PURPOSE: The purpose of this qualitative descriptive study was to describe critical care nurses’ experiences of moral challenges, moral distress, and moral resilience during the COVID-19 pandemic. The specific aims of this study were to: 1. Describe the moral challenges experienced by ICU nurses. 2. Describe moral resilience in terms of integrity, buoyancy, moral efficacy, self-regulation, and self-stewardship among ICU nurses (from Rushton’s framework). 3. Explore the relationship between moral distress and moral resilience to advance the concept of moral resilience in the face of the COVID-19 pandemic. FRAMEWORK: This study was undergirded by an adaptation of Rushton’s conceptual framework of moral concepts. DESIGN: A qualitative descriptive design was used. Participants were recruited between January to May 2021, and a semi-structured interview guide was utilized to interview participants. RESULTS: 17 participants were interviewed for the study. Participants described the four themes of moral challenges: death and dying, pain and suffering, being alone, and being helpless and not in control. Moral resilience was described as: integrity, buoyancy, moral efficacy, self-regulation, self-stewardship, and self-perception. The relationship between moral distress and moral resilience was described as iterative and fluid. CONCLUSION: The findings of the study provided a new domain of moral resilience called self-perception and a revised adaptation of the conceptual framework for moral resilience.
Life Transitions of Children with Idiopathic Childhood Apraxia of Speech: A Qualitative Descriptive Study
(University of Massachusetts Medical School, 2021-04-30) Meza, Patricia J.; Nancy Morris, PhD, ANP-BC; Tan Chingfen Graduate School of Nursing
PURPOSE: The purpose of this qualitative descriptive study was to explore the experiences of emerging adults with idiopathic CAS, as they reflected on their transitions through childhood, adolescence, and young adulthood. SPECIFIC AIMS: Describe the experiences of emerging adults with idiopathic CAS as they reflect on developmental stages of childhood, adolescence, and young adulthood, including the situational experiences of transition occurring between elementary, middle, high school, and post-secondary education, training, or work. Identify strategies and the effectiveness of the strategies utilized by emerging adults with idiopathic CAS to manage experiences during different developmental stages and situational experiences of transition occurring between elementary, middle, high school, and post-secondary education, training, or work. FRAMEWORK: Meleis’ Transitions Theory. DESIGN: A qualitative descriptive design with purposive sampling was used. Data was analyzed using thematic analysis. RESULTS: Findings support the use of Transitions Theory. Three major themes were identified: The Child’s Environment, Implications of CAS, and Strategies. The school environment contributed to many implications for children. Older children were able to develop strategies to overcome challenges. In the school setting, children did not access nurses for concerns related to their CAS. CONCLUSIONS: CAS creates many challenges for children. Emerging adults with CAS report that environments in which people are knowledgeable, patient, understanding, accepting, and supportive help them express themselves freely despite their speech impairment. The nurse’s role in supporting children with CAS during grade school is untapped as they were largely invisible to the children as a potential resource for anything other than an injury or illness. To better facilitate supportive environments in which children with CAS can flourish, nursing assessment and interventions are needed.
Facilitators and Inhibitors of LPN-to-RN Student Transition: A National Survey Study
(University of Massachusetts Medical School, 2021-07-15) Cornine, Amanda; Susan Sullivan-Bolyai; Tan Chingfen Graduate School of Nursing
PURPOSE: The purpose of this national survey study was to describe the transition conditions (facilitators and/or inhibitors) encountered by LPN-to-RN students. SPECIFIC AIMS: (1) describe the frequency of specific transition conditions experienced by LPN-to-RN students; (2) explore relationships between transition conditions experienced by LPN-to-RN students and student (personal) and program (community) characteristics; and (3) characterize (through open-ended questions) transition conditions experienced by LPN-to-RN students that were not included in the empirically-based investigator-designed survey. FRAMEWORK: This study was framed by Meleis et al.’s (2000) transition theory; each transition condition included in the survey was linked to one or more category of transition conditions described by Meleis et al. DESIGN: In March 2020, a cross-sectional national survey was distributed to all LPN-to-RN programs in the United States. RESULTS: 873 students, in programs across 37 states, responded to the survey. The least frequently reported facilitators were emotional support from faculty and finding online courses helpful. The most frequently reported inhibitors were personal stress and balancing school with non-school responsibilities. The most frequent characteristic related to transition conditions was taking classes with non-LPNs. Respondants reported several transition conditions not included in the survey, including prior experiences (facilitator) and challenges related to the COVID-19 pandemic (inhibitor). CONCLUSION: These results suggest areas where faculty can further support LPN-to-RN students through their own actions and highlight the importance of carefully planning how to integrate LPN and non-LPN nursing students if they share classes.
Childhood Asthma: Contextual Influences Affecting Family Management
(University of Massachusetts Medical School, 2021-04-15) Dunn, Melissa A.; Donna Perry; Tan Chingfen Graduate School of Nursing
Purpose: The purpose of this study was to explore the way(s) in which family management of childhood asthma is affected by contextual influences as described in the Family Management Style Framework (FMSF) and to explore additional factors that affect family asthma management. Specific Aims: The specific aims of this study were 1) to describe the everyday experiences of childhood asthma management within families, 2) to explore the way(s) in which family management of childhood asthma is affected by contextual influences (social network, care providers & systems and resources) as described in the FMSF, and 3) to explore additional sociocultural factors (supported by the literature but not currently described in the FMSF) that affect asthma management in families. Framework: The Family Management Style Framework guided this study. Design: A qualitative descriptive design was used to gather data from a purposive sample of female primary caregivers. Demographic data were collected, and individual interviews were conducted using a flexible interview guide. Results: The findings support the contextual influences as described in the FMSF. An additional three contextual themes were identified: environment, emerging threats to health and work-life conditions. The themes are interrelated demonstrating the complexity of asthma management. Conclusion: Family management of asthma is challenging and complex. The findings move towards understanding the connection between family asthma management and the social determinants of health. Nurses can support families managing childhood asthma by considering each of the contextual influences when planning interventions and working on policy initiatives that support the health of children with asthma.
A Video Intervention Targeting Opioid Disposal After General Surgery: A Feasibility Study
(University of Massachusetts Medical School, 2020-05-15) Lewis, Joanne; Carol Bova; Tan Chingfen Graduate School of Nursing
PURPOSE: The purpose of this feasibility study was to explore the use of an online video intervention to prepare surgical patients to properly dispose of unused opioids. SPECIFIC AIMS: Describe the feasibility of recruiting, enrolling, randomizing and retaining participants who recently had a general surgery into the study. Describe the differences in opioid disposal by age, sex, education, and type of surgery for the entire sample and by treatment assignment. Describe the preliminary change in knowledge, behavioral beliefs, normative beliefs and disposal of opioids from baseline to post-intervention by group. Describe the relationship between social desirability and behavioral beliefs, normative beliefs and disposal of opioids. FRAMEWORK: The Theory of Reasoned Action was used to guide both the intervention and the measures. DESIGN: This study used a randomized controlled feasibility study to explore a novel video intervention to teach safe storage and disposal of unused opioids after general surgery. RESULTS: A total of 40 participants were enrolled in the study, average age was 44.7 (range 21-75 years), most were White, educated and employed. Recruitment took 11 weeks and the retention rate was excellent at 85%. Differences in opioid disposal was not significantly different by age, sex, education or type of surgery. The video intervention was positively received, but the majority (80%) still stored their pills unsecured. CONCLUSION: The results demonstrate that a video intervention addressing safe storage and disposal practices of unused opioids is feasible and more research is needed to determine efficacy in increasing rates of secure storage and disposal of unused opioid pills KEYWORDS: Opioids, opioid disposal, general surgery, video education
Eastern Woodlands Native Perspectives and Type 2 Diabetes: A Qualitative Study
(University of Massachusetts Medical School, 2020-08-14) Sadlon, Penni P.; Susan Sullivan-Bolyai; Tan Chingfen Graduate School of Nursing
Purpose: This qualitative descriptive study was undertaken to describe Eastern Woodlands Native adult perspectives, health care beliefs and type 2 diabetes management experiences. Specific Aims: The specific aims were to 1) explore and describe perceptions of type 2 diabetes among Eastern Woodland Native adults and how they relate to their understandings about the cause and treatment approaches to the disease, 2) describe how family, friends, and community intersect with type 2 diabetes management, 3) describe relationships with health care providers and 4) determine resources that would help diabetes-self management within their community. Framework: The PEN-3 Model by Airhihenbuwa was the initial framework used for the study. Methods: A qualitative descriptive design with maximum variation and snowball sampling was used and data was analyzed using qualitative content analysis. Results: The overarching theme of Together We Can Return To Balance comprised five sub-themes: Coming to Know Life Paths with T2DM, Negotiating My Way Forward, Making Important Connections, Acknowledging the Imbalance, and Sticking Closer to Mother Earth illustrating physical, spiritual, and environmental health factors influencing DSM capacities. Conclusion: Native perspectives should be viewed as a crucial contextual variation for type 2 diabetes care when developing DSMES and for improving DSM capacities in these populations.

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