PhD in Nursing Science
Class of 2025
Dissertation Defenses
Dr. Abeer Mobarki
Exploration of Predisposing and Enabling Factors Associated with Non-Adherence to Postpartum Visits among Arab Immigrant Women in New Jersey
March 14, 2025
Chair:
PhD in Nursing Science, Graduate School – Newark PhD Program
ABSTRACT OF THE DISSERTATION
Factors Associated with Non-Adherence to Postpartum Visits among Arab Immigrant Women in New Jersey
by ABEER M. MOBARKI
Dissertation Directors:
Dr. Charlotte Thomas-Hawkins
The underutilization of postpartum care is a global problem that limits the early detection of physical and mental health complications during the postpartum period. Yet, there are few investigations of the underlying issues and even fewer investigations about immigrant women in the U.S. and their adherence to scheduled postpartum visits and factors that contribute to their non-adherence.
Purpose: This study examined the interrelationships among acculturation oriented to Arabic culture, diminished social support, negative postpartum care beliefs, insurance status, and postpartum visit non-adherence among Arab immigrant women in New Jersey (NJ).
Hypotheses: Five hypotheses were tested: 1) Acculturation oriented to Arabic culture is significantly associated with non-adherence to postpartum visits; 2) Diminished social support is significantly associated with non-adherence to postpartum visits; 3) Negative postpartum care beliefs are significantly associated with non-adherence to postpartum visits; 4) Public health insurance status or having no health insurance is significantly associated with non-adherence to postpartum visits; and 5) Acculturation oriented to Arabic culture, diminished social support, negative postpartum care beliefs, Public or no health insurance status are independent predictors of non-adherence to postpartum visits.
Methods: This study employed a cross-sectional, correlational design. Foreign-born immigrant women who self-identified as Arab, delivered a child within the past two years, and spoke Arabic or English fluently were recruited from mosques and community centers in northern New Jersey and invited to complete the study survey. A single-item measure of postpartum visit non-adherence was used. The Arabic and English Versions of the Acculturation Rating Scale (ARSMA-II) for Arab immigrants were used to assess acculturation orientation level. The Arabic version of the Multidimensional Scale of Perceived Social Support (MSPSS) was used to examine perceived social support. The Postpartum Beliefs Questionnaire was used to examine beliefs about the postpartum.
Results: One hundred thirty-eight Arab immigrant women comprised the study sample. Sixty-eight percent of participants reported non-adherence to postpartum visits. Acculturation oriented to Arabic culture, diminished social support, negative postpartum care beliefs, and insurance status had significant individual effects on the odds of postpartum visits non-adherence. Diminished social support and low perceived susceptibility to postpartum problems had significant independent direct effects on the odds of postpartum visits non-adherence.
Conclusion: The findings from this study can inform tailored interventions to 1) address factors that impede postpartum care and 2) increase the utilization of postpartum care services among immigrant Arab women.
Factors Associated with Non-Adherence to Postpartum Visits among Arab Immigrant Women in New Jersey
by ABEER M. MOBARKI
Dissertation Directors:
Dr. Charlotte Thomas-Hawkins
The underutilization of postpartum care is a global problem that limits the early detection of physical and mental health complications during the postpartum period. Yet, there are few investigations of the underlying issues and even fewer investigations about immigrant women in the U.S. and their adherence to scheduled postpartum visits and factors that contribute to their non-adherence.
Purpose: This study examined the interrelationships among acculturation oriented to Arabic culture, diminished social support, negative postpartum care beliefs, insurance status, and postpartum visit non-adherence among Arab immigrant women in New Jersey (NJ).
Hypotheses: Five hypotheses were tested: 1) Acculturation oriented to Arabic culture is significantly associated with non-adherence to postpartum visits; 2) Diminished social support is significantly associated with non-adherence to postpartum visits; 3) Negative postpartum care beliefs are significantly associated with non-adherence to postpartum visits; 4) Public health insurance status or having no health insurance is significantly associated with non-adherence to postpartum visits; and 5) Acculturation oriented to Arabic culture, diminished social support, negative postpartum care beliefs, Public or no health insurance status are independent predictors of non-adherence to postpartum visits.
Methods: This study employed a cross-sectional, correlational design. Foreign-born immigrant women who self-identified as Arab, delivered a child within the past two years, and spoke Arabic or English fluently were recruited from mosques and community centers in northern New Jersey and invited to complete the study survey. A single-item measure of postpartum visit non-adherence was used. The Arabic and English Versions of the Acculturation Rating Scale (ARSMA-II) for Arab immigrants were used to assess acculturation orientation level. The Arabic version of the Multidimensional Scale of Perceived Social Support (MSPSS) was used to examine perceived social support. The Postpartum Beliefs Questionnaire was used to examine beliefs about the postpartum.
Results: One hundred thirty-eight Arab immigrant women comprised the study sample. Sixty-eight percent of participants reported non-adherence to postpartum visits. Acculturation oriented to Arabic culture, diminished social support, negative postpartum care beliefs, and insurance status had significant individual effects on the odds of postpartum visits non-adherence. Diminished social support and low perceived susceptibility to postpartum problems had significant independent direct effects on the odds of postpartum visits non-adherence.
Conclusion: The findings from this study can inform tailored interventions to 1) address factors that impede postpartum care and 2) increase the utilization of postpartum care services among immigrant Arab women.
Dr. Shanaya Recalde
Interrelationships among RN Staffing, Practice Environment
Ratings, Breastfeeding Attitudes, and Breastfeeding Support Missed Care among Registered Nurses Working on Inpatient Post-Partum Units
March 12, 2025
Chair: Charlotte Thomas-Hawkins, Ph.D., RN, FAAN, FADLN
PhD in Nursing Science, Graduate School – Newark PhD Program
Shanaya Recalde, PhD, MSN, CNM, WHNP-BC
Title: Interrelationships among RN Staffing, Practice Environment Ratings, Breastfeeding Attitudes, and Breastfeeding Support Missed Care among Registered Nurses Working on Inpatient Postpartum Units
The purpose of the study was to examine the effects of staffing levels, RN workload, the nurse practice environment and RN attitude toward breastfeeding as possible barriers to providing breastfeeding support missed care in hospital based inpatient postpartum settings. This was a cross-sectional correlational study. Pearson’s correlation, binary logistic regression and simple mediation analyses were used to capture relationships between breastfeeding support missed care and the study variables.
Demographic data were collected as well as a newly designed Breastfeeding support missed care inventory, to capture breastfeeding support care tasks missed in NJ inpatient postpartum units. Additional instruments included a modified version of the Care Left Undone Inventory, a single item measure for RN staffing, the Individual Workload Perception Scale-Revised, a single item measure of the nurse practice environment, and the Iowa Infant Feeding Attitude Scale. The sample comprised 110 actively licensed RNs working in Postpartum units in NJ. Study findings support previous research that higher workloads and poor practice environments are associated with more breastfeeding support missed care. RNs are more likely to miss tasks related to support, communication, and education. In addition, routine missed care mediated indirect relationships between patient-to-RN ratios, the practice environment, workload, and breastfeeding support missed care.
This study also highlights the conceptual distinction between staffing and workload. This study underlines the importance of adhering to safe staffing guidelines as well as addressing the practice environment as a modifiable variable.
Title: Interrelationships among RN Staffing, Practice Environment Ratings, Breastfeeding Attitudes, and Breastfeeding Support Missed Care among Registered Nurses Working on Inpatient Postpartum Units
The purpose of the study was to examine the effects of staffing levels, RN workload, the nurse practice environment and RN attitude toward breastfeeding as possible barriers to providing breastfeeding support missed care in hospital based inpatient postpartum settings. This was a cross-sectional correlational study. Pearson’s correlation, binary logistic regression and simple mediation analyses were used to capture relationships between breastfeeding support missed care and the study variables.
Demographic data were collected as well as a newly designed Breastfeeding support missed care inventory, to capture breastfeeding support care tasks missed in NJ inpatient postpartum units. Additional instruments included a modified version of the Care Left Undone Inventory, a single item measure for RN staffing, the Individual Workload Perception Scale-Revised, a single item measure of the nurse practice environment, and the Iowa Infant Feeding Attitude Scale. The sample comprised 110 actively licensed RNs working in Postpartum units in NJ. Study findings support previous research that higher workloads and poor practice environments are associated with more breastfeeding support missed care. RNs are more likely to miss tasks related to support, communication, and education. In addition, routine missed care mediated indirect relationships between patient-to-RN ratios, the practice environment, workload, and breastfeeding support missed care.
This study also highlights the conceptual distinction between staffing and workload. This study underlines the importance of adhering to safe staffing guidelines as well as addressing the practice environment as a modifiable variable.
Dr. Monina A. Franco-Tantuico
Debriefing Quality, Engagement and Student Learning Outcomes in ties in Graduate Nursing Education
March 6, 2025
Chair: Rula Btoush, Ph.D
PhD in Nursing Science, Graduate School – Newark PhD Program
Study Rationale: This study aimed at examining the association among debriefer engagement, student engagement, debriefing quality, and student learning outcomes in ANP simulation-based education. Moreover, the study aimed to examine the mediating effect of debriefing quality on the relationship between engagement (debriefer and student) and student learning outcomes.
Methods: This is a quantitative, cross-sectional study. Data were collected using an anonymous, online survey of 218 ANP students, in which they responded regarding a recent debriefing experience after a simulation learning in their current or prior semester.
Results: The multivariate analysis showed that student learning outcomes (cognitive, affective, and behavior learning) are influenced by both debriefer engagement (debriefer contribution, skills, and guidance) and student engagement (cognitive, affective, and social engagement). It also showed that debriefing quality was a significant predictor of student learning outcomes (cognitive, affective, and behavior learning). The mediation analysis demonstrated that debriefing quality is a significant mediator in the relationship between engagement (debriefer and student engagement) and student learning outcomes (cognitive, affective and behavior). Students who had higher levels of debriefer engagement reported higher levels of cognitive, affective, and behavior learning with a high level of debriefing quality. Further, students who were more engaged in debriefing reported higher levels of cognitive, affective, and behavior outcomes with higher levels of debriefing quality. In addition to the indirect (mediation) pathways, debriefer and student engagement measures had direct effect on student learning outcomes learning, with a few minor exceptions.
Conclusions: The results of this study imply that debriefers and students engaged in simulation debriefing must understand the value of debriefer training and student self-awareness of learning styles for maximal learning. Simulation-based education programs need to address the debriefing quality of their simulations for a safer learning environment: (a) reducing the negative emotions that hinder learning, and (b) improving the active and reflective learning processes. This is possible through the debriefer’s timely and constructive loop feedback, continuous guidance, and goal-oriented conversations with the students. Effective debriefing by ANP educators can transform graduate nursing students into empathetic and reflective practitioners, which is required in the advanced nursing role to diagnose and treat patients
Methods: This is a quantitative, cross-sectional study. Data were collected using an anonymous, online survey of 218 ANP students, in which they responded regarding a recent debriefing experience after a simulation learning in their current or prior semester.
Results: The multivariate analysis showed that student learning outcomes (cognitive, affective, and behavior learning) are influenced by both debriefer engagement (debriefer contribution, skills, and guidance) and student engagement (cognitive, affective, and social engagement). It also showed that debriefing quality was a significant predictor of student learning outcomes (cognitive, affective, and behavior learning). The mediation analysis demonstrated that debriefing quality is a significant mediator in the relationship between engagement (debriefer and student engagement) and student learning outcomes (cognitive, affective and behavior). Students who had higher levels of debriefer engagement reported higher levels of cognitive, affective, and behavior learning with a high level of debriefing quality. Further, students who were more engaged in debriefing reported higher levels of cognitive, affective, and behavior outcomes with higher levels of debriefing quality. In addition to the indirect (mediation) pathways, debriefer and student engagement measures had direct effect on student learning outcomes learning, with a few minor exceptions.
Conclusions: The results of this study imply that debriefers and students engaged in simulation debriefing must understand the value of debriefer training and student self-awareness of learning styles for maximal learning. Simulation-based education programs need to address the debriefing quality of their simulations for a safer learning environment: (a) reducing the negative emotions that hinder learning, and (b) improving the active and reflective learning processes. This is possible through the debriefer’s timely and constructive loop feedback, continuous guidance, and goal-oriented conversations with the students. Effective debriefing by ANP educators can transform graduate nursing students into empathetic and reflective practitioners, which is required in the advanced nursing role to diagnose and treat patients
Dr. Angela Alberti
Stress, Self-compassion, and Health Outcomes in Parents of Children Diagnosed with Autism Spectrum Disorder
February 28, 2025
Chair: Rula Btoush, Ph.D
PhD in Nursing Science, Graduate School – Newark Track
Background: Parents of children diagnosed with autism spectrum disorder experience significantly higher levels of stress compared to parents of typically developing children, leading to negative mental and physical health outcomes. Self-compassion has been shown to buffer the harmful effects of stress on health, but little is known about this relationship in parents of children with autism. Study Purpose: This study investigated the relationships among stress, self-compassion, fear of self-compassion, and health outcomes in parents of children diagnosed with autism, specifically exploring whether self-compassion moderated the impact of stress on mental and physical health outcomes.
Methods: A cross sectional, correlational design was conducted with 267 parents of children diagnosed with autism who completed anonymous online questionnaires. The measures assessed stress (general, parenting, autism-related), self-compassion, fear of self-compassion, and various health outcomes. Mental health measures include anty and depression. Physical health measures included health status, health conditions, and immune status. Health risk behaviors included sleep quality, BMI, smoking status, physical activity, and alcohol use. A moderation analysis was conducted to examine whether self-compassion buffered the effect of stress and health outcomes.
Results: The study found significant correlations between higher stress levels and poorer mental health, including elevated anxiety and depression. Parents who reported higher stress also had poorer physical health outcomes, including impaired immune function and a higher number of health conditions. Self-compassion total score was not found to significantly moderate the relationship between stress and health outcomes, but individual subscales were.
The subscales of self-kindness, self-judgment, and overidentification were found to moderate the relationship between depression and, risky alcohol use. Higher levels of self-compassion were found to be associated with improved sleep quality, increased levels of physical activity, lower BMI, less anxiety, less depression, better perceived health, less chronic conditions, and less risky alcohol use.
Fear of self-compassion was identified as a substantial barrier, with parents who reported higher fear of self-compassion showing lower fear of self-compassion. Socioeconomic factors such as lower income, unemployment, multiple children diagnosed with autism, and lower emotional support were also linked to linked to higher stress and poorer health outcomes.
Conclusions: Self-compassion mitigates the impact of stress on mental and physical health outcomes. Nurses and clinicians working with this population should prioritize interventions that promote self-compassion and help parents reduce fear of self-compassion. Future research should explore the long-term effects of self-compassion practices on health in diverse populations of parents of children diagnosed with autism.
Methods: A cross sectional, correlational design was conducted with 267 parents of children diagnosed with autism who completed anonymous online questionnaires. The measures assessed stress (general, parenting, autism-related), self-compassion, fear of self-compassion, and various health outcomes. Mental health measures include anty and depression. Physical health measures included health status, health conditions, and immune status. Health risk behaviors included sleep quality, BMI, smoking status, physical activity, and alcohol use. A moderation analysis was conducted to examine whether self-compassion buffered the effect of stress and health outcomes.
Results: The study found significant correlations between higher stress levels and poorer mental health, including elevated anxiety and depression. Parents who reported higher stress also had poorer physical health outcomes, including impaired immune function and a higher number of health conditions. Self-compassion total score was not found to significantly moderate the relationship between stress and health outcomes, but individual subscales were.
The subscales of self-kindness, self-judgment, and overidentification were found to moderate the relationship between depression and, risky alcohol use. Higher levels of self-compassion were found to be associated with improved sleep quality, increased levels of physical activity, lower BMI, less anxiety, less depression, better perceived health, less chronic conditions, and less risky alcohol use.
Fear of self-compassion was identified as a substantial barrier, with parents who reported higher fear of self-compassion showing lower fear of self-compassion. Socioeconomic factors such as lower income, unemployment, multiple children diagnosed with autism, and lower emotional support were also linked to linked to higher stress and poorer health outcomes.
Conclusions: Self-compassion mitigates the impact of stress on mental and physical health outcomes. Nurses and clinicians working with this population should prioritize interventions that promote self-compassion and help parents reduce fear of self-compassion. Future research should explore the long-term effects of self-compassion practices on health in diverse populations of parents of children diagnosed with autism.