An Examination of Previous Sexual Health Service-Seeking Behaviors and Intentions Among a Sample of College Students Attending a Large Public Southeastern University

Williams, Megan The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

College students experience negative sexual health outcomes such as sexually transmitted infections (STI) and unintended pregnancies. Increasing their use of clinical sexual health services may help reduce these poor outcomes. Currently, little is known about the sexual health service utilization of college students in Alabama or the factors that impact college students' use of sexual health services (SHS) in Alabama. The purpose of this project was to use Andersen's Model of Healthcare Utilization (AMHU) as a framework to explore previous seeking of (PSHS-SB) and intentions to use SHS in Alabama (ISHS) and determine factors associated with college students' use of SHS in Alabama. During spring 2023, 469 University of Alabama (UA) students were recruited for an online, self-report survey regarding sexual health services. The majority of students (82.1%) had sought a SHS in Alabama since they had been enrolled as a student at UA and most (67.2%) intended to utilize at least one SHS in Alabama in the next 12 months. Not considering Alabama as their home state (OR=.044, 95% CI [02, .13]), having awareness of the SHS available in Alabama (OR=1.246, 95% CI [1.10, 1.42]), having a greater number of sexual partners (OR=11.401, 95% CI [3.65, 35.47]), and having had an STI symptom explained past seeking-behaviors of SHS in Alabama (OR=7.935, 95% CI [1.02, 61.96]). Identifying as Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) (OR=2.286, 95% CI [1.25, 4.20]), not considering Alabama as their home state (OR=.094, 95% CI [.05, 0.17]), not being insured by their parent (OR=.372, 95% CI [.15, .90]), having awareness of the SHS available in Alabama (OR=1.127, 95% CI [1.01, 1.26]), and having had an STI symptom (OR=3.561, 95% CI [1.50, 8.44]), contributed to intentions to seek SHS in Alabama in the next 12 months.The lack of utilization of SHS may be putting college students at risk of experiencing negative sexual health outcomes. Several factors uniquely impact college students' use of these services in Alabama. Health educators, clinicians, and college-health professionals should consider incorporating these factors into programming, health services, and awareness campaigns to increase sexual health service utilization by college students in Alabama.

Nursing Faculty's Experiences Teaching Clinical Judgment to Prelicensure Nursing Students: A Qualitative Study

Kerns, Carolyn The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

The Next Generation NCLEX (NGN) tests nursing graduates' clinical judgment based on the Clinical Judgment Measurement Model (CJMM). Faculty are facing challenges because based on Benner's Novice to Expert conceptual model, nursing students are novices and therefore do not possess intuitive clinical judgment due to lacking clinical experience. While research has revealed insights into how clinical judgment based on analytical reasoning can be taught to nursing students, there was no research describing the experiences of nursing faculty who were teaching it. This research gap presented a problem because students are required to pass the NGN to receive nursing licensure. The purpose of this study was to explore how nursing faculty were teaching clinical judgment compared to the conceptual models of Tanner's Clinical Judgment Model (CJM) and the National Council of State Boards of Nursing's CJMM (NCSBN-CJMM).Sixteen qualitative interviews were conducted with full-time nursing faculty at seven universities from the Northeast and Southeast. Semi-structured interview data were transcribed, coded, and analyzed. Participants were teaching clinical judgment in the classroom, simulation, and clinical using the Tanner CJM, the NCSBN-CJMM, Caputi's clinical judgment framework, and without a conceptual model. There was one negative case in which the participant was not teaching clinical judgment.The findings provided insights into the lack of depth, inconsistencies, and omissions in participants' pedagogy in teaching students how to think and arrive at their clinical judgments. Since the Tanner CJM and the NCSBN-CJMM are conceptual models, they were too generally constructed to provide in-depth guidance on how faculty should teach clinical judgment. The study also provided the unexpected findings of program, student, and faculty factors affecting their teaching clinical judgment.The study has implications for policy makers because faculty are teaching the application of clinical judgment in a manner to support passing the NGN without teaching students how to think deeply, for educators because they lack pedagogical knowledge which necessitates the need for professional development, and for practitioners because staff nurses and preceptors lack clinical experience and professional development in clinical judgment to teach nursing students.

A Qualitative Exploration of Self-Care Behaviors for Disease and Symptom Management Among College Students With Type 1 Diabetes Mellitus

McFadden, Ny'Nika T The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

Although only 2.5% of college students have been diagnosed with Type 1 Diabetes Mellitus (T1DM), the effects of inadequate management can lead to hospitalizations, additional development of chronic health conditions, and early mortality. Therefore, T1DM self-care behaviors (e.g., administering insulin, monitoring blood glucose) must be performed to minimize disease exacerbations. Previous research has shown that college students with T1DM are improperly administering insulin and infrequently monitoring their blood glucose levels. Though previous research has utilized quantitative and qualitative methods to examine T1DM self-care behaviors among college students with T1DM, the literature is limited on disease and symptom management experiences among college students with T1DM. Therefore, this qualitative study used the middle-range theory of self-care of chronic illness integration of symptoms as a theoretical framework to conceptualize and explore T1DM self-care behaviors utilized for disease and symptom management.Participants engaged in self-care maintenance through carrying supplies, inserting consumed carbohydrates into their medical device, checking blood glucose, administering insulin, and engaging in physical activity. Self-care monitoring behaviors included recording and tracking changes to their blood glucose. Self-care management behaviors consisted of adjusting insulin rates, changing pump/pod sites, and consulting with their provider. Symptom management findings were physiological awareness and technology alerts to determine that symptoms were present (i.e., symptom detection). Symptom interpretation experiences included analyzing blood glucose trends and examining the situational causes of their blood glucose changing. Symptom response experiences consisted of immediately responding to hypoglycemia and situational responses to hyperglycemia. Barriers and facilitators that impacted T1DM self-care behaviors included barriers such as 1) diabetes burnout, 2) college lifestyle, 3) difficulty receiving medical supplies, 4) insurance limitations, and the facilitators consisted of 1) years of experience, 2) tangible support with supplies, 3) emotional support for disease and symptom management, 4) informational support for disease management, and 5) technology assistance for disease and symptom management. Findings from this study can be used for future interventions for college students with T1DM, and can guide healthcare professionals, health education and promotion practitioners, and family, friends, and romantic partners on how to support disease and symptom management among full-time college students.

Critical Analysis of the Reliability and Prediction Error of a Novel Smartphone Application for Measuring Body Composition

Metoyer, Casey The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

A smartphone application was recently developed that measures body composition from a 2-dimensional image of a standing person (%FatIMAGE). Three experiments were performed to 1) determine the reliability of %FatIMAGE in two different body positions and days, 2) determine the reliability of %FatIMAGE across different cameras, room lighting levels, and colored backgrounds, and 3) assess the potential sources of error related to %Fat estimation with bioimpedance, skinfold, and IMAGE. In the first study, %FatIMAGE was measured in the anterior (ANTDay1) and posterior (POSTDay1) positions, then again within 48 hours of the first visit (POSTDay2). The ANTDay1 was significantly lower compared to the reference, whereas the POSTDay2 was not. In the second study, %FatIMAGE was estimated in different megapixel cameras (12MP, 8MP, 5MP, and 0.7MP), different room lighting conditions (i.e., low=LL, medium=ML, ambient=AL, and bright light=BL), and different colored backgrounds (White=WB, Black=BB, Green=GnB, Orange=OB, and Gray=GyB). Conditions were compared to a reference (8MP, AL, and WB). The 0.7MP was significantly higher than the reference, whereas the 12MP and 5MP were not. The LL was significantly higher than the reference, whereas the BL and ML were not. The BB, GnB, and GyB were significantly higher than the WB, whereas the OB was not. In a third study, %Fat was measured via bioimpedance, skinfold, %FatIMAGE, and a criterion 4- compartment model. The constant error (CE) was calculated (%Fat condition - criterion) for each method (SKFERROR,BIAERROR., and IMAGEERROR). The CE was correlated with markers of physical activity (PA) and muscular fitness (MF): the International physical activity questionnaire (IPAQT, IPAQV, IPAQM); Perceived functional ability questionnaire (1mileSUB and 3mileSUB); Physical Activity Rating questionnaire (PA-R): handgrip test (HG); and push-up test (PU). SKFERROR displayed a small correlation with PU, while IPAQV, 1mileSUB, 3mileSUB, PA-R, and PU were associated with IMAGEERROR. Regression analyses indicated that only PU contributed to the model for SKFERROR and IMAGEERROR. In conclusion, the IMAGE produced acceptable reliability across different camera, lighting, and background conditions but attention should be paid to clothing color in contrast with background color. In addition, further evaluation of MF measures is recommended, as higher PU were associated with greater IMAGEERROR.

Nursing Ethics and Failure to Fail in Clinical Nursing Education

Wiggins, Cheree' The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

The phenomenon of failure to fail (FTF) was introduced into nursing literature in 1990 by Annette Lankshear, a British nurse educator who published a study examining nurse preceptors' failure to fail students performing poorly during a clinical preceptorship (Duffy, 2013). In the United States (US), most undergraduate nursing programs utilize full-time faculty to teach in the classroom and clinical settings. Clinical nursing faculty (CNF) are responsible for training, evaluating, and assigning clinical performance grades for up to 10 students who may be enrolled in their clinical group. Limited research has been published in the US exploring the phenomenon of FTF in clinical nursing education. A gap in the literature also exists examining the level of ethical responsibility a clinical nursing faculty believes they assume after evaluating a student's clinical performance as unsatisfactory. This cross-sectional, descriptive qualitative study was guided by deonance theory and duty orientation and focused on eight female CNF who teach, evaluate, and assign clinical performance grades to groups of students enrolled in two associate and two bachelor's degree nursing programs in the south part of a southern state. This study sought to answer two research questions: 1) what reasons do clinical nursing instructors provide for assigning a passing clinical performance grade to a student they assess as unsatisfactory; and 2) what ethical responsibility does a clinical nursing instructor assume in the student clinical performance evaluation and grade assignment process? The study produced evidence of inconsistencies in the clinical performance evaluation systems used by each program, variances in reporting student failure to meet clinical performance objectives, subjective descriptors used on current clinical performance evaluation tools, and grading leniency that could be factors contributing to FTF in clinical nursing education.

Assessing Patient-Centered Cancer Communication Through a Secondary Analysis of Hints Data and Question Prompt Lists Available on NCI-Designated Cancer Center Websites

Lockhart, Jala The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

Background: Approximately 1.9 million people will be diagnosed with cancer in 2023. Annually, over 250,000 cancer survivors are diagnosed and treated at NCI-Designated Cancer Centers. When experienced, patient-centered care (PCC) has led to survivors being more engaged in their care as well as having fewer unmet care needs. PCC requires survivors to participate in communication activities that can be influenced by personal health literacy and socio-demographic factors.Purpose: This study explored the association between PCC and health literacy in cancer survivors. Secondarily, this study assessed the characteristics and literacy demands of question prompt lists (QPLs) found on NCI-Designated Cancer Center websites.Methods: A sample of cancer survivors (n= 593) was used to examine PCC, health literacy, and socio-demographic variables. The relationship between the variables was analyzed through a correlation analysis and one-way multivariate analysis of variance. Secondarily, a cross-sectional content analysis of websites served as the data source while QPLs served as the unit of analysis. Two trained coders evaluated the literacy levels of QPLs using validated tools: 1) SMOG, 2) FKGL 3) PEMAT 4) CDC CCI, and 5) SAM.Results: The sample consisted of not married (51.4%) Non-Hispanic White (68.5%) females (53.1%), that had an annual income above the federal poverty line (63.3%). PCC (μ= 22.5 ± 4.1) and health literacy (μ= 10.9 ± 2.6) had a weak correlation (r= 0.04, p< 0.01), yet age, race, education, marital status, and sex each had significant mean differences on PCC and health literacy.About 41% of NCI-Designated Cancer Center websites did not have a QPL available. Thirty-nine centers had a total of 89 QPLs with an average of 16.4 questions. The health literacy demand assessments resulted in 76.4% of QPLs having "good" understandability, 62.9% having poor actionability, 82.0% having superior suitability, and 92.1% having suboptimal clarity. The average readability of QPLs was the 7th-grade reading level.Discussion: The health literacy and PCC of U.S. cancer survivors could be improved considering that there were subgroup mean differences attributable to socio-demographic factors. NCI-Designated Cancer centers can contribute to the improvement of health literacy and PCC by providing QPLs that are health literate.

Identifying Concerns with Integrating the QSEN Quality Improvement Competency from the Perspective of Full-Time Nurse Educators Across the United States: Implications for Nursing Education

Bell-Wilson, Leakie The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

Over a decade ago, 14 nursing leaders developed six Quality and Safety Education for Nurses (QSEN) competencies, transforming nursing education. Despite the QSEN developers' valiant efforts to integrate the QSEN competencies into nursing curricula, the diffusion by faculty is slow, inconsistent, and lacks methods to effectively evaluate students' competency achievement. One of the least integrated competencies is the quality improvement (QI) competency (Dolansky et al. (2017). The purpose of this study is to use the Concerns-Based Adoption Model (CBAM) framework, and stages of concern questionnaire (SoCQ), to identify barriers to integrating the QSEN QI competency from the perspective of full-time nurse educators across the United States and the implications for nursing education. Given the importance of the innovation, it is necessary to examine how nurse educators have accepted the integrating of the QSEN QI competency into the classroom and understand their concerns throughout the implementation period. The aims of the study are multifold; identifying nurse educators' primary and secondary highest stages of concern (SoC), assessing nurse educators' Stages of Concern towards QSEN QI integration in nursing curricula based on professional and pedagogical demographics, and investigating statistically significant relationship between the SOC and nurse educators' innovation demographics. For data collection, adhering to the (CBAM) framework, the study uses the stages of concern questionnaire SoCQ, a 35-item, Likert scale, eight-point diagnostic survey to measure the concerns of individuals actively involved in a change process. The study uses descriptive statistics and MANOVA to analyze the data. .

Figured Worlds in Nursing Education

Lakin, Brooke The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

Novice nursing faculty that transitions from expert practitioner to new faculty member experience challenge in this professional move. This transition is affected by many factors which may either hinder or propel their career into academic nursing. Strong peer support, rich clinical experience, and student success are factors that facilitate a positive transition and shaping of the identity from practitioner to educator. Navigating a barren academic landscape and working with "the old guard." holding tight to obsolete practices could cause negative outcomes as new faculty learn and adapt to their new role.This study found that novice nursing faculty with five years or less and their formation of a new identity is affected by many factors. These tools, meaningful practices, and power inside the college of nursing where these eight faculty members are employed have impact on the identity formation of these new faculty members. This qualitative study examined these eight faculty members and their reports using the figured world framework by Dorothy Holland (1998).

Resistance Trained Women's Response to Blood Flow Restriction Training

Fleming, Abby Renee The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

Low-load resistance training (20-30% one-repetition max (1RM)) with blood flow restriction (LI-BFR) is able to induce similar strength, hypertrophic, and vascular adaptations to traditional high-load resistance training (>65% 1RM) (HIRT). Minimal research has been conducted examining the combination of HIRT and BFR (HIRT+BFR). Of the available research, the results are inconsistent, and none have looked at an exclusively female sample. With the lack of female participants in this specific area of research and training research in general, the need for further research in female subjects is necessary, as there are potential physiological adaptations from what is observed in males. The three studies of this dissertation were conducted to understand the physiological, vascular, and hormonal adaptations to HIRT+BFR training in resistance trained women. In study 1, 4-weeks of a lower-body HIRT+BFR training was implemented to determine changes in strength, muscle activation, movement velocity, and peak power. Results indicate similar adaptations between HIRT+BFR and HIRT alone for all measurements (all p ≥ 0.05) except bar velocity during deadlift 1RM, where HIRT+BFR presented a decrease post-training (p < 0.05). Study 2 examined changes to vascular reactivity after the same 4-weeks of HIRT+BFR training. HIRT+BFR and HIRT produced similar changes to femoral and tibial arterial measurements (all p ≥ 0.05). Acutely, during the initial 1RM testing session, the HIRT+BFR group significantly increased femoral artery time-averaged mean velocity (TAMV) from pre- to post- exercise (p = 0.007). During the final 1RM testing session there was also a time effect for femoral artery TAMV (p = 0.005), though only the HIRT group was significantly increased (p = 0.023). Study 3 examined the hormonal response to an acute bout of lower-body HIRT+BFR. There were no significant changes to dehydroepiandrosterone sulfate (DHEA-S) in either group (all p ≥ 0.05). Insulin-like growth factor 1 (IGF-1), however, did trend towards a time effect (p = 0.051), where the HIRT+BFR group significantly increased post-exercise (p = 0.025). The combination of HIRT and BFR does not seem to enhance performance or vascular adaptations but may promote greater hormonal responses over HIRT alone.

Exploring Student Engagement in Large Classes Using Mobile Polling

Glaze, Teresa Carol The University of Alabama ProQuest Dissertations & 2023 해외박사(DDOD)

The call for transformation of nursing education continues to be supported by professional nursing organizations and nursing leaders. It is needed to support transition of nursing graduates who are facing an increasing technological work environment, higher patient acuity, and the challenges of making rapid critical decisions for care. The current coronavirus (COVID-19) pandemic forced faculty and students to leave the "brick and mortar" structures of classes behind in Spring 2020. It also promoted new teaching strategies, such as mobile polling, for online learning environments to support engagement of students. Poll Everywhere and Kahoot are applications that can provide an alternative to the "sage on the stage" and traditional PowerPoint-only lectures while augmenting learning and promoting engagement. The purpose of this study was to explore student engagement in large classes using mobile polling. This qualitative study was conducted with 17 prelicensure students from two cohorts who had experienced large classes with and without mobile polling. Data were collected from the participants of two focus groups and 14 individual interviews. The study used Bandura's Social Cognitive Theory (1986) as a framework for development of the study and as a lens to filter the data collected. Qualitative inquiry produced descriptive data, which focused on three major themes and points of discussion including (a) mobile polling activity, (b) learner attributes, and (c) social learning. Multiple subthemes emerged from the first major theme including mobile poll characteristics, timing of polls, and discussions. Additional subthemes developed from the second major theme including learning style, accommodations, motivation, accountability, self-efficacy, prior experiences, and participants' engagement definitions. From the third major theme, additional subthemes of interaction between students and faculty emerged. These data points provided valuable insight into the use of effective mobile polling to promote engagement in large classes. Overall, the participants reported the use of mobile polling in large classes increased their engagement and encouraged faculty to continue and increase the use of polling for future courses. The effective use of mobile polling to promote engagement from the participant's perspective is dependent on various factors, which are discussed as themes and subthemes in this research study.