The Aftermath of Violence: The Lived Experience Phenomena of Assult in Nursing by Kathleen Clark, RN, Ph.D.

February, 2016

As Chair of Dr, Clark's Faculty Dissertation Committee, I am pleased to present the Abstract of her  Ph.D. Dissertation from Walden University.  Drs. Jeanne Connors and Raymond Thron served as Members of the Faculty Dissertation Committee.

Abstract

Despite the high incidence of violence directed at registered nurses while on duty, there is limited qualitative data that explores the lived experience of returning to the workplace after an assaultive incident. This phenomenological study sought to explore and analyze the phenomena of registered nurses who are employed in high-risk settings. The research questions considered the detailed descriptions of the experiences of nurses returning to the workplace. The conceptual framework was resiliency, as these participants continued to survive and thrive after the adverse assaultive events. Data were collected using in-depth interviews from purposeful sampling. Nine registered nurses working in the high risk areas of inpatient psychiatry and emergency departments provided detailed descriptions about the phenomena. Data management was an inductive, iterative analysis completed and facilitated by the use of NVivo 10 software program. The study found that participants had a brief emotional response post assault mitigated by the community of nursing personnel from their immediate surroundings and felt that assault was “part of the job.” Providing a true culture of safety would include enhancements to the internal community of bedside nursing practice. In addition, research is needed on interventions that can effectively enhance the internal community after assault by patients. This study contributes to positive social change by providing registered nurses, an oppressed group, a voice to mitigate negative consequences associated with assault in the hospital setting.

MRI as an Adjunct to Conventional Mamomography Screening for Cancer in Dense Breast Tissue

February, 2015  As Chair of the Walden University Faculty Dissertation Committee, I am pleased to present the Abstract prepared by Rachel S. Connett, Ph.D. in Health Services.  Dr. Marilyn Simon served as her Committee Member.

Abstract

 Diagnostic methods to effectively image dense breast tissue (DBT) can pose challenges. While conventional mammography is the gold standard for breast cancer screening, conventional mammography can miss about 78% of cancers in DBT and ultrasonography can miss 24% or produce false positive results. Magnetic resonance imaging (MRI) has a high sensitivity for imaging DBT and produces a smaller number of false positives, but MRI is used to image only women with an elevated threat of breast cancer; it is not routine for this population. The purpose of this study was to determine to what extent conventional mammograms can miss breast cancer in women with DBT and to determine if an adjunct method of imaging DBT might detect breast cancers that are missed by mammography alone. This mixed methods study was based on the theoretical framework of von Bertalanffy’s general systems theory, Miller’s living systems theory, and the theory of intelligent medical diagnosis. Key research inquiries were as follows: (a) Can MRI can be used for screening women with DBT as an adjunct to conventional mammography? (b) What were the lived experiences of women with breast cancer in DBT prior to and after the breast cancer diagnosis? Key results showed that (a) a significant number of women with DBT had breast cancer that was undetected by mammograms; (b) women with DBT can benefit from breast cancer screening by adding an adjunct screening method (MRI or ultrasonography). This study may contribute to social change by making the breast cancer screening community aware of the potential benefit of adding MRI as an adjunct to conventional screening so that more breast cancers are detected in the early stages of the disease.

Marketplace Clinics Complimenting Community-Based Diabetes Care for Urban Residing American Indians

May, 2015  I am pleased to share with you the Abstract of the doctoral dissertation completed by Robert Rick, Ph.D. in Health Services at Walden University. I served as Chair of his Faculty Dissertation Committee.  Dr. Raymond Thron served as Committee Member.

Abstract

Many inner-city populations experience disproportionately high disease rates. Among those adversely affected are the Minneapolis, Minnesota 20,000 American Indian residents who experience limited health care access and suffer threefold diabetes health disparity. This research project evaluated the extent to which marketplace clinics, such as those located in the pharmacy areas of CVS, Walmart, Target, or Supervalu stores extended their business model to be more culturally aware and inclusive of medically underserved and urban Indian persons with diabetes. The quantitative study was conducted within the Patient Activation Measure (PAM) analytical framework in assessing one’s knowledge, skills, and confidence for self-managing diabetes health and health care. The study’s main theoretical foundation is that complementary marketplace and community-based self-management education motivates self-determination, which in turn, actuates diabetes health improvement. A case-control study tested whether marketplace clinics and activated support group participants got better at managing their diabetes relative to the control group. The positive effects of marketplace clinics and community-based complementation were borne out with respect to significantly improved blood sugar control, weight loss, and healthful lifestyle adaptation. Implications for social change include sharing this complementary network with Minneapolis medically underserved and urban Indian neighbors. Social change progress could also be realized by incorporating patient activation methods with diabetes health prevention for 30 Urban Indian Health Organizations that are located in large cities throughout the country.

Prostate Cancer & Afro-Caribbean Men: Experiences, Perceptions and Beliefs

February, 2015  I am pleased to have Chaired the Walden University, Faculty Dissertation Committee for Harold E. Taitt, Ph.D in Health Services.  Dr. Jim Goes served as Committee Member.   Please read the Abstract of Dr. Taitt's research:  PROSTATE CANCER & AFRO-CARIBBEAN MEN: EXPERIENCES, PERCEPTIONS, & BELIEFS.

                                                                       Abstract

Despite the high incidence of prostate cancer (PC) amongst men of African descent, there is a paucity of qualitative data that explores how Afro-Caribbean men perceive their risk, susceptibility to, and management of this disease.  This phenomenological study sought to explore and analyze beliefs about PC in a sample of Afro-Caribbean men who reside in the United States (U.S.).  The research questions considered the perceptions, beliefs, and lived experiences of participants.  The conceptual framework is a synthesis of the health belief model (HBM) and the theory of reasoned action (TRA), primarily because the TRA allows for a culturally-based relevance and perspective that is lacking in the HBM.  Data were collected using in-depth interviews from a purposive sample of 13 U.S. participants from 7 Caribbean territories, who provided detailed descriptions of their perceptions.  Data management and inductive, iterative analysis were facilitated through the use of the NVivo 10 software program.  This study found that participants had a low level of awareness and education about PC, but they also believed that if PC were caught early, they have a good chance of a long life.  There was no indication that culture played a significant role in their attitudes, beliefs, and perceptions of the disease.  Education about PC should be targeted to this population as well as their significant others. In addition, qualitative research is needed to compare perspectives of Afro-Caribbean, African American, and African men who all reside in the United States.  This study may contribute to positive social change by providing practical strategies that may increase screening and early diagnosis among Afro-Caribbean men, thereby reducing the mortality from this disease.

Research: The Wife Caregiver of the Prostate Cancer Patient at Home

July, 2014

I am pleased to share the Abstract of the doctoral dissertation of Mary Beth O'Brien, Ph.D., who recently completed research regarding the wife caregiver to the prostate cancer patient.

Abstract

Wife Caregiver Experiences in the Prostate Cancer Patient at Home

by

Mary Elizabeth O’Brien

MSN, Catholic University, 1982

BSN, Alderson-Broaddus College, 1974

Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Health Services

Walden University

August 2014

Abstract

The purpose of this qualitative case study was to explore the experiences of wife caregivers of patients diagnosed with prostate cancer cared for in the home rather than in a medical facility. The focus was on understanding their experiences using Lawton’s Appraisal of Caregiving Scale interview schedule and one open-ended question. Guided by systems theory and stress theory, this study examined the caregiving demands, whether these demands reduced the quality of life for the wives, and whether caregivers have sufficient information to care for their husbands at home. Twenty wife caregivers were asked to describe their specific personal experiences. The data sources analyzed were the demographic matrix, the interview schedule using the Likert scale, and the one open-ended question. Findings revealed that the wife caregivers and their husbands with older age, more education, or more years of marriage were less burdened by the demands of caregiving, and this responsibility did not appear to affect their quality of life. However, the wives acknowledged needing more information to provide adequate care for the husbands when at home. The implications for social change for health care professionals in understanding the wives’ caregiving experiences might reveal a new dimension in caregiving and contribute to the social change dynamic of care for both the prostate cancer patient and his caregiver.