PhD Graduates 2020

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PhD in Nursing Science
Class of 2020

Dissertation Defenses

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Rationale for study: Of the more than 65 million people estimated to have epilepsy worldwide, 10.5 million are children; one third of whom have drug resistant epilepsy (DRE). Although caring for a child with epilepsy impacts the lives of the child and family, parents who care for children with DRE have been found to experience more stress, as this severe form of epilepsy negatively affects the child’s physical growth, mental development and disorders, and behavior disturbances. This study examined the lived experiences of parents with children with DRE to gain insight into how they described and gave meaning to their own quality of life relating to their lived experience.

Method: A purposeful sample of ten parents of children with DRE participated in the study, equally represented by men and women. The participants’ ages ranged from 27 years to 56 years, with a mean age of 45 years. Using distinct interview guides to facilitate conversation, three interviews were conducted over the course of a four-month period. Time for reflection occurred between each interview, with field notes and journal reviews done by the researcher. The transcribed interviews were also reviewed at the beginning of each subsequent interview to ensure accuracy of the stories shared.

Results: The semi-structured interviews and narrative analyses portrayed parents’ life stories pertaining to what it is like to care for a child with DRE. Narrative life patterns emerged and culminated in five shared areas: what is best for my child, functioning in silos, maintaining balance, living with uncertainty, and finding meaning and purpose.

Conclusions: A composite narrative told the story that represented the patterns of parents’ experience caring for a child with DRE, which provided a deeper insight into their lived experience. Understanding their experience provided valuable information, such as, the support they need and how best to assist them as they care for their children.

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The purpose of this study was to examine the relationship of Life Habits and Life Satisfaction with the influence of a moderating variable, Cognitive Reserves, in a group of older individuals, ranging from 75 to 101 years old. Low to moderate levels of Cognitive Reserves moderated the relationship, but at levels of higher Cognitive Reserves, the relationship was not able to achieve significance.

The final sample consisted of 137 participants who were residents of one of five New Jersey Continuing Care Retirement Communities (CCRC) in central and northern New Jersey. Participants were interviewed and completed three surveys: 1) Assessment of Life Habits (LIFE-H 3.1);2) Life Satisfaction Index for the Third Age-Short form (LSITA-SF) and 3) Cognitive Reserves Index Questionnaire (CRIq) as well as a general demographic questionnaire.

Findings indicated that males (55%) rated their health as very good over women (36%), while females (22%) rated their health as excellent over men (10%). Significant differences in Life Satisfaction appeared across age groups (X² (2, N=131) =5.665, p=.05). Participants divided into 3 groups for age; (75-83 years, (M=27.17, SD=9.53), 84-86 years (M=29.44, SD=11.0) and 86 and older (M= 30.8, SD=8.54). Results indicated older participants reported lower life satisfaction. Simple linear regression was used to predict life satisfaction based on the subscale of cognitive reserves-Working. CR- working was found to be a significant predictor of life satisfaction (F (1,136) = 4.793 p<.05) with an R² of .034.

In performing moderation analysis, low to moderate levels of Cognitive Reserves were found to significantly influence the relationship between Life Habits and Life Satisfaction. However, this relationship did not hold for high levels of Cognitive reserves. Life habits were significant predictors of life satisfaction in this sample (F (1,135) =5.211, p<.05) with an R² of   .037.

These findings may have implications for geriatric and adult health nursing. Nurses can monitor for changes in perceptions of life habits, or abilities, that may signal a decreased capacity to carry out common activities of daily living. Nurses can identify elder adults at risk for cognitive decline and related safety issues, and possible decline in health status.

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Approximately 50% of cancer patients experience pain even when they take standard pain medications. These pain medications have many side effects, like headache, vomiting, and addiction. Complementary or alternative medicine have become increasingly popular in the US. Complementary or alternative medicine therapies are defined as replacing of or combining with primary care. Complementary or alternative medicine therapies such as auricular acupressure (AA) may decrease medical costs by reducing doctor’s visit and usage of pain medication. The ear acupoints may be stimulated by pressure from fingers, hands, or automatically by the seeds themselves. The basic theory behind AA is that the outer ear, brain, and every part of body are connected by nerve system. When a patient stimulates auricular acupoints, the body produces some opioid substances and hormones or increases anti-inflammatory reaction. Auricular acupressure intervention may empower cancer patients to increase their pain self- management because they need to self-administer AA at their home. Cancer patients may well self-administer AA therapy if they get supported by healthcare providers. There are few studies that have assessed the effect of AA on cancer pain. The purpose of this study is to evaluate the feasibility and effect of AA intervention on cancer patients experiencing pain. One group repeated measure and five visits in time to evaluate retention, adherence, and completion of AA therapy and to assess alleviating cancer pain by an AA intervention. This study was done at Rutgers University and participants’ home. The participants were withdrawn at 33% in the study, adhered to this AA intervention at 99.4% and completed the AA intervention at 100%. The pain severity, pain interference, and the neuropathic pain showed a statistically significant decrease throughout the 4-week AA intervention. As pain severity and pain interference improved in this study, body pain and physical component in quality of life had also improved during the AA intervention period. However, the depression score did not show a statistically significant improvement in this study. Further research with AA therapy with bigger sample size and robust research design is required to build on the evidence on the feasibility and the effect of AA intervention.

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The terms “health disparities” and “social justice” are popular buzz words in health care. These terms have been applied locally and internationally when examining the current health conditions and health resources. Since 2010, Haiti has gained much attention from the world with relief efforts and increased attention on the apparent health needs in the country. Despite these efforts, the overall health statistics of the country have not improved (Brown, 2010; Garfield & Berryman, 2012; WHO, 2014). In 2010, in response to the global epidemiological transition, the World Health Organization (WHO) shifted its attention to worldwide non-communicable diseases (NCDs) such as cardiovascular disease, cancer, diabetes, and respiratory diseases. With this shift in attention, hypertension has been identified as a worldwide health concern. The purpose of this focused ethnography is to describe Haitians’ perceptions of hypertension which contribute to the meaning of and beliefs about this chronic illness, in order to more fully understand the needs of Haitian adults with hypertension. Kleinman’s Explanatory Model of Illness (Kleinman, A., Eisenberg, L., & Good, B., (1978) serves as the theoretical background for the study. The overarching theme identified is that Haitians perceive hypertension to be a feeling that one gets which should be treated at that moment to prevent falling down. This feeling presents differently and can vary with occurrences and individuals. The feelings identified as being associated with hypertension can actually be a variety of symptoms to include: headache, blurry vision, dizziness, burning, weakness, and shortness of breath. These feelings, known as symptoms in allopathic medicine, are consistent with presenting clinical manifestations of hypertension as well as consistent with the complication of stroke often associated with uncontrolled hypertension. The findings in this study can be expanded upon to inform management and treatment options for this population as well as provide recommendations for healthcare providers serving in developing countries.

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Background: There is no consensus regarding the definition and quantification of lymphedema. Moreover, most studies in breast cancer related lymphedema (BCRL) did not include lymphedema symptoms and its effect on outcomes. Therefore, the results from the studies in BCRL have presented a wide gap in the findings. Moreover, despite its importance for health outcomes, there is a paucity of studies that have examined emotional distress (ED) over time in women with BCRL, and little is known of the pattern of ED over time who experience symptoms of lymphedema and who are at risk for lymphedema following treatment for breast cancer.

Study Purpose: This study aimed to identify and further understand the determinants of ED in breast cancer survivors.

Methods: This is a secondary analysis ofde-identified data collected prospectively from 140 women who were diagnosed with breast cancer between December 2011 and April 2014. The inclusion criteria were women aged 21 years and over who were diagnosed with a first-time diagnosis of stage 1-III breast cancer and were scheduled for surgical treatment. Lymph volume was measured by the perometer, and 26 lymphedema symptoms and 12 ED symptoms were collected via the Breast Cancer & Lymphedema Symptom Experience (BCLE-SEI) instrument at pre surgery, four to eight weeks, and 12 months post-surgery. Using the framework of the theory of unpleasant symptoms, physiological factors (i.e., age, BMI and lymph fluid volume), situational factors (i.e., level of education, marital status, type of surgery, type of therapy) and lymphedema symptoms were examined.

Results: The level of ED over time did not decline spontaneously, but increased 12 months after surgical treatment. Situational factors examined were not associated. Two physiological factors, BMI and lymph volume, were significantly associated with ED post-surgery. Lymphedema symptom intensity was significantly associated with ED post-surgery. A lymph volume increase of ≥ 5 % (OR= 3.9, 95 % CI; 1.469-10.452) and a high level of lymphedema symptom intensity score ≥ 9 (OR=8.7, 95 % CI; 3.362-22.356) were independently associated with a likelihood of high ED 12-months post-surgery in an adjusted model.

Implications: The findings from this study offer clinically relevant evidence-based knowledge regarding lymphedema, lymphedema symptoms and ED symptoms to inform the health care professionals to improve of the care in breast cancer survivors. The results can be used to assist in the early detection and assessment of ED and lymphedema symptoms in either the absence or presence of lymphedema in breast cancer survivors.

PhD in Urban Systems / Health Track
Class of 2020

Dissertation Defenses

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This quantitative, non-experimental study investigated the impact of housing status on the relationship between acculturative stress and depression for Asian international college students. The research focused on students originating from China and India. Theoretically, country of origin is an important factor in shaping acculturative stress levels, yet most research on acculturative stress has focused on Asian students as a whole rather than grouping them by subregion. This study sought to demonstrate the importance of disaggregating study participants by subregion. Additionally, it sought to examine the relationship between acculturative stress and depression, as previous research has shown that there is a direct relationship between these two factors. Finally, it sought to explore the role of housing in this matter. While there is strong evidence that housing both influences health and serves as a form of social support for university students, there is a gap in research regarding its exact role. The current study addressed three questions: (1) is there a difference in housing status, acculturative stress, and depression levels between Chinese and Indian international college students? (2) what is the relationship between acculturative stress and depression for Chinese and Indian international college students? and (3) does housing status moderate the relationship between acculturative stress and depression for Chinese and Indian international college students? Mann-Whitney U, Chi-square analysis, simple linear regression, multiple linear regression, and Hayes moderation analyses were conducted to answer these questions. Results indicated that there was a difference in acculturative stress levels between Chinese and Indian international students, with Chinese students having higher levels of acculturative stress. There was no statistical difference in depression scores or housing status between the two groups. However, there was a statistically significant relationship between acculturative stress and depression, with higher acculturative stress scores associated with higher depression scores. Multiple linear regression also showed that acculturative stress was a significant predictor of depression when controlling for both demographic and housing related factors. Results also show that housing did not moderate the relationship between acculturative stress and depression. These findings may be used to inform universities policies seeking to optimize housing policy and improve college environments for international students.

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Rationale for the study
Cancer screening disparities exist among immigrant groups in the United States, yet the
cancer screening behaviors of ethnic Black immigrants remains relatively unknown. Low cancer screening rates among ethnic Black immigrant groups are associated with various structural, and sociocultural barriers. These barriers may be the same for all ethnic Black immigrants but evidence is lacking. The Garifuna, an Afro-Amerindian Central American group experience structural forces in their homelands and settling communities in urbanized spaces in the US with little known of their cancer screening practices. The purpose of this study was to examine breast, cervical, and colorectal cancer screening practices among Garifuna women residing in the boroughs of New York City, and to identify any disparities in their cancer screening practices. The study examined levels of adherence to the recommended breast, cervical, and colorectal cancer screening guidelines and their association with demographic factors, access to healthcare services, perceptions/barriers, acculturation, identity and level of guideline knowledge.

Method
This study used a mixed method approach of interviews with eight key informants knowledgeable on the health behaviors of Garifuna women and surveying of four hundred Garifuna women, age 50 years and older residing in the New York City area. Content analysis was performed on key informant interview transcripts which confirmed survey sociocultural variable choices. Univariate analysis was used to describe the survey study sample and bivariate analysis to measure level of association between variables. Logistic regression examined the predictive nature of variables in explaining cancer screening adherence.

Results
Four hundred two Garifuna women completed surveys over a twenty-two month period. The results show that disparities exist in cervical cancer screening and are suggested in colorectal cancer screening. Models for colorectal cancer screening by colonoscopy and fecal occult blood testing were the most predictive of the cancer screening types with knowledge and health belief models having the highest predictive variability.

Conclusion
Further studies on cervical and colorectal cancer screening among Garifuna women are recommended to identify additional barriers contributing to these cancer screening disparities, and to develop culturally appropriate interventions aimed to end disparities in this unique immigrant group.

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Primary healthcare is the foundation of the nation’s healthcare infrastructure. It is an essential component of advancing healthcare reform and better health outcomes for all. Federally Qualified Health Centers (FQHCs) constitute one of the largest networks of primary care providers both in New Jersey and across the nation. The Patient Protection and Affordable Care Act (ACA) has recognized that FQHCs are critical providers of primary healthcare to millions of uninsured and underinsured individuals. A significant body of literature suggests that FQHCs can exhibit strikingly different levels of readiness to function as sustainable providers, but there has been little research focusing on their capacity to adapt and meet the growing demands of the current healthcare environment. This qualitative study examined the capacity of New Jersey’s FQHCs to expand and sustain access to primary healthcare services. It also explored the impact of the ACA on FQHC capacity building in the state. In Phase 1 of the project, both the Brown et al. (2001), Conceptual Framework for Mapping Capacity and the results of a focus group of FQHC administrators, staff and clinicians, and other industry leaders were used to design a semi-structured interview guide. In Phase 2 of the project, twenty in-depth interviews were conducted with FQHC board members, administrators, clinicians and staff from a wide range of New Jersey FQHCs. Study participants reported different levels of FQHC readiness to respond to the ACA and varying levels of ability to engage in capacity building for enhanced organizational performance. Study findings also highlight how the contexts in which New Jersey FQHCs operate influence their approach to sustainability and the degree to which they engage in capacity building. Finally, the results of this study point to the need for research that examines the impact of public policy on capacity building in FQHCs nationwide.