Carroll College, Helena Montana

Nursing Theses

Nursing Honors Theses

Carey Phelan"Nurses’ Commitment and Motivation to Improved Personal Health: The Role of Hospital Administration"
Presented by Carey Phelan

Carey has been invited to present her nursing honors thesis as a poster presentation at the Mayo Clinic’s 2014 Nursing Research Conference Improving Health Through Self-Management in Phoenix, AZ, on March 7, 2014.  Carey has also been selected for an oral presentation of her thesis at the 25th International Nursing Research Congress in Hong Kong on July 24-28, 2014, where she will be collaborating with nursing scholars from around the world.

Two-thirds of adults in the United States are overweight, 34% are obese.  Obesity leads to increased morbidity and mortality, while decreasing the quality of life of individuals and adding enormous fiscal burdens to an employer.  Health care systems are especially feeling the encumbrance of increasing health care costs due to the rise in obesity.  Hospital workers, on average, had higher utilization rates and carry a higher burden of chronic illness than employees in other market segments by nine percent.  Healthier hospital staffs have less absenteeism, are more productive, make fewer mistakes and report greater overall satisfaction.

Nurses comprise the largest sect of the healthcare industry; therefore, the health of nurses affects the overall effectiveness of health systems.  The goal of the research was to ascertain the most efficient interventions in which employers could institute to motivate nurses to increase their physical health.

The study methodology incorporated a mixed design.  Subjects signed a consent form and then completed a demographics questionnaire.  Subjects were given a theoretical case study involving Nurse X.  Nurse X desired to improve her/his health status in three facets:  decrease BMI, increase exercise and to eat healthier.  The participants were asked to transpose themselves as Nurse X and rate (on a Likert Scale) which of the given scenarios would best motivate and gain their commitment to increase their health status.  The scenarios ranged from employers offering more healthy food options to reductions in health insurance premiums for improved health.  

Results indicated that over half (51.9%) of the 139 subjects were either overweight or obese, as calculated by BMI. Triangulation was used to bridge the qualitative and quantitative data. From this, six themes emerged which related to barriers nurses face to optimal health: lack of time, difficulty with twelve hour shifts, physical demands of nursing, lack of a supportive work environment, nurse’s belief that employers only care about the bottom line, personal accountability and obese nurses believing that their excess weight was a benefit for their careers.

This research suggests that employers should emphasize resources on the overweight group, as they were the most motivated and committed towards the interventions proposed. The obese group was the least motivated and least committed towards improving their health.

Karen O'Byrne"Uncertainty and the Individual Receiving Hyperbaric Oxygen Therapy"
Presented by: Karen O'Byrne

The purpose of this thesis was to examine whether individuals receiving hyperbaric oxygen therapy (HBOT) experienced any statistical differences in uncertainty before and after their first session and to explore their feelings regarding HBOT. Participants in this study included 10 prospective HBOT clients, without prior HBOT experience, between the ages of 25 and 53. There were six males, one female, and three who did not identify their gender. Participation was solicited through the use of researcher flyers which were distributed to eligible clients by nursing staff at a hyperabric facility in the Northwestern United States. A mixed-methods design was used to analyze the participants’ feelings regarding HBOT and uncertainty. Data was collected using a pre-treatment and post-treatment survey spanning one session of HBOT. The results of this study indicated a statistcal difference in uncertainty before and after the first session of HBOT with a p-value of 0.012, however, this was only a minor change and the effect size was small. Overall, participants’ generally reported positive interactions with staff. Only two subjects expressed discomfort during their session and one did not report on experience inside the chamber.  The findings of this study indicate a need for knowledgeable and caring nurses who fully educate their clients before treatment begins and who provide comfort and assistance throughout treatment. More research regarding client feelings toward HBOT and uncertainty is needed.

Keywords: hyperbaric oxygen, uncertainty, Mishel

Jade Johnstone"Challenges of Providing Healthcare To Montana Migrant Workers"
Presented by: Jade Johnstone

The purpose of this grounded theory qualitative research study was to explore and gain understanding of the challenges facing healthcare providers when caring for Montana migrant workers. Healthcare providers from the state of Montana were interviewed regarding personal beliefs on the healthcare provided to migrant workers in rural clinics. The participants were also asked for their opinions regarding migrant care for the near future. Data were collected via audio taped interviews, field notes and theoretical memos. Analysis through classic grounded theory was used to establish categories and identify the social process. The core category of this study is "Establishing Common Ground" with the following supportive categories: (a) Accessing Health Care (b) Facing Challenges and (c) Being Called to Serve.

Findings suggest that the participants of this study are dedicated to providing quality medical care to Hispanic clients in rural Montana using limited resources. The research identified the challenges encountered when serving this population and how these challenges were being addressed. Participants expressed how optimal utilization of minimal resources is imperative to sustaining quality care. In addition, the social process of establishing common ground when working with culturally diverse clients is important to health promotion. Researchers can use and modify these categories to fit their clinical practices and create further research in cultural understanding and rural clinical medicine.

Amy Allen"Effects of Educational Intervention on Children's Knowledge of Obesity Risk Factors"
Presented by: Amy Allen

Childhood obesity has become a significant healthcare concern in the US with rates tripling within the last decade. The increasing prevalence of childhood obesity puts these children at risk for several diseases and other associated health problems. This quantitative research study posed the question of the effectiveness of an educational intervention on children's knowledge of obesity risk factors. This investigation assessed obesity awareness and understanding of the importance of physical activity and a nutritious diet before and after an educational intervention in 123 seventh grade students. The health and physical education teacher at the participating school conducted the intervention over two 50 minute class periods. The intervention was developed from the school district's approved health curriculum and from existing research reviewed in this study. A pre, post survey method was used to assess the effectiveness of the educational intervention and descriptive statistics were used to interpret the results. This small-scale school based intervention was effective in increasing knowledge of obesity risk factors in middle school students. The intervention was more effective in increasing obesity awareness and educating about diet and nutrition than portraying the importance of physical activity. More extensive interventions are needed for maximum benefit and long term impact. Continued efforts to reduce and prevent childhood obesity are needed to restore the health of this nation.

Shoshannah Seed "Understanding the Challenges of Hospice Nursing"
presented by: Shoshannah Seed

The purpose of this research is to gain understanding of the challenges of hospice nursing related to dying individuals, their families and the professional environment of a hospice facility. Six hospice nurses participated in a 30-60 minute interview exploring the challenges of hospice nursing. Interviews took place at the place of employment in a private setting. Classic Grounded theory was used to code, collect, and analyze the data. Theoretical memoing was used during all process of research to record relationships between concepts and categories. Hospice nurses cope with daily work stressors by finding a balance between work and their personal life. The core category "finding a balance" had six subcategories: managing time, facing the challenge of working with families, letting go, taking care of yourself, falling back on your team, and setting boundaries. These findings suggest that hospice nurses learn to identify their stressors and maintain personal health and balance by relying on their team and setting boundaries between themselves and their clients. Nurses were able to take necessary actions to promote their own wellness.

"Labor Induction: A Grounded Theory Study"
Lauren VansicklePresented by: Lauren Vansickle

Background: Since 1990, the rates of labor induction in the United States have doubled. In 2006, 22.5% of births (1 in every 5) were induced. The rates of cesarean deliveries have simultaneously risen, reaching an all-time high of 32.3% of births in 2008, nearly a 50% increase since 1996. Numerous studies have indicated a strong correlation between labor induction and a heightened risk for cesarean section.
Purpose: This qualitative research study aims to explore the basic social processes of elective labor induction for women who have had an elective induction.

Sample and Setting: Three women ages 29 to 34 who underwent elective labor induction within the past five years participated in this study.

Method and Analysis: Data was collected through semi-structured, audio-recorded interviews. Tapes were transcribed and analyzed. Classic grounded theory analysis was applied for analysis of the data. Coding was done for similarities and differences using constant comparative analysis.
Results: Analysis yielded six major categories (a) getting ready for birth, (b) deciding to induce birth, (c) undergoing the induction process, (d) trusting the physicians, (e) enduring struggles, (f) valuing nurses. The core category of this study was "Being Induced."
Implications: These research findings provide an insight into the basic social processes of elective labor induction. By understanding such processes, health care professionals could improve standards of patient care as it pertains to prenatal education, informed consent, and the decision to induce birth.

Donita Mariegard"Striving to Maintain Normalcy: Living with Addison's Disease"
Presented by: Donita Mariegard

Purpose: Studies show a correlation between premature mortality rates in individuals diagnosed with Addison's disease. Individuals with this diagnosis go from living active, busy lives to having difficulty maintaining work schedules and struggling to maintain normalcy in everyday life. The purpose of this study was to gain understanding of the issues and problems of living with Addison's disease.

Demographics: Four adult individuals, one male and three females, one which resides in Australia, one in Canada and the other two within the United States participated in this qualitative research study.
Type of Study: Grounded theory qualitative research methodology was utilized.

Data Collection and Analysis: Data collection included in-depth personal interviews and correspondence, field notes and theoretical memos. Classic grounded-theory was used for data analysis.
Findings: The core category of this research was "Striving to Maintain Normalcy" with the following supporting categories: a) Finding a Diagnosis, b) Tolerating Fatigue, c) Experiencing Frustration, Fear, and Depression, and d) Coping with Finances, Workplace Environment, Spiritual Matters and Support.

Nursing Implications: The findings of this study will increase the nurse's understanding of Addison's Disease and bring awareness of the concerns and problems that individuals have living with this disease. 

Generalization: The findings of this research cannot be generalized to all individuals diagnosed with Addison's Disease, however, more research will contribute to a better representation of results.

"Building Nursing Relationships with Individuals with Reactive Attachment Disorder of Childhood"
Liz PhillipsPresented by: Liz Phillips

In the United States alone, 800,000 children within the child welfare system will be diagnosed each year with severe attachment disorder because of serious abuse and neglect Most available treatment or methods of therapy involve psychiatric nurses working to build trust and the formation of healthy attachments and relationships with children with Reactive Attachment Disorder of Childhood (RAD). The purpose of this thesis was to explore relationship building between the psychiatric nurse and the child with RAD from the perspective of the nurse. Participants were four psychiatric nurses currently working in the field who had at least two years of adolescent psychiatric treatment experience. The participants were all asked about their experience forming relationships with children diagnosed with Reactive Attachment Disorder. Field notes and theoretical memos were written throughout the study. A theoretical model was developed to describe the basic social processes. Classic grounded theory analysis was used to analyze the data and discover categories. Transcripts were read, coded, and categories emerged. The core category identified from this study was "Developing a Relationship." The supporting categories were "Recognizing Personal Weaknesses," the nurses' ability to objectively work with a patient while taking care of themselves, "Knowing their Behaviors," recognizing the characteristics and expected behaviors of children with RAD, and finally "Initiating therapy," when the relationship is formed successfully. A theoretical model was developed which describes the cycle of the therapeutic nursing relationship. This model can be used by nurses to gain an understanding of the phases of the therapeutic relationship between the nurse and patient, and can be modified to fit clinical practice.

"The Effect of Diaphragmatic Breathing on College Student Stress"
presented by James McKay

The purpose of this research study was to determine the effect of diaphragmatic breathing on college students’ self-perception of life stressors. A pre-test/post-test design was used in this study. Participants rated their stress on a Liekert-like
scale before and after a five-minute diaphragmatic breathing intervention. ANOVA was used for statistical analysis. Participants were asked to evaluate their stress in the following categories: physical, psychological, socio-cultural, spiritual and overall stress categories. The findings of this study suggested that diaphragmatic breathing for five minutes is effective in reducing perceived stress with a p-value of p < 0.00 for each category. Implications of this study include students reducing
their acute stress by using five minutes of diaphragmatic breathing.

"Knowledge Assessment of Anorexia Nervosa in Undergraduate Students"
presented by Rachel Becker

In the United States alone there are approximately ten million females and as many as one million males who are living with an eating disorder (National Eating Disorders Association, 2005). A recent study reported that 2.2% of adolescents and young adults struggle with AN throughout the world; that is about 270 of every 100,000 individuals aged 15 to 19 (Keski-Rahkonen, Hoek, Susser, Linna, Sihvola, Raevuori, et al., 2007). This current study sought to determine the knowledge that college students have of Anorexia Nervosa because they are the demographic most at risk for developing this eating disorder. This researcher used a general psychology class at a small liberal arts college in the Northwest to conduct this study. The results of this study supported similar research that undergraduate college students have a general knowledge of AN but are lacking education relating to specific characteristics of AN.

"Nutrición para la Vida"
presented by Sarah Potucek

The purpose of this research study was to explore the challenges faced by nurses improving the nutritional status of Latin American immigrants working in Montana and Idaho. Classic grounded theory was utilized to collect, code, and analyze the data. Healthcare providers in Montana and Idaho were interviewed regarding their perceptions on the challenges of enhancing nutrition for Latin American immigrant populations working in Montana and Idaho. The core category of this study is “nutrición para la vida” with four supporting categories: living in poverty, overcoming language barriers, promoting healthy lifestyles, and eating nutritional ethnic foods. The findings of this study suggest that providing culturally appropriate healthcare to Latin American immigrants is vital for this population to achieve and maintain a healthy nutritional status. This study provides a deep understanding of the challenges healthcare providers encounter when providing healthcare to Latin American immigrants working in Montana and Idaho.