College of Nursing
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Item Embargo A Grounded Theory Study of Birthing People’s Decision-Making on Labor Pain Management(East Carolina University, May 2025) Guard, KaitlinUsing a Constructivist Grounded Theory (CGT) approach, this study addressed the following research questions: 1) What sociocultural factors contribute to decision-making about labor pain management among nulliparous birthing people? and 2) How does the pain management decision develop or change from antepartum to delivery among nulliparous birthing people? Data to address the research questions was collected through semi-structured interviews. Seventeen nulliparous participants, at least 37 weeks pregnant, partook in initial interviews following their antepartum outpatient visit. Nine participants were retained for follow-up interviews that took place either at the hospital or over the phone between one day and four months postpartum. The overarching theme, Navigating Decision-making amid Uncertainty, was supported by two theoretical categories: 1) Shaping decisions, which involved receiving advice from social networks, engaging with social media, and awaiting provider-led education, and 2) Shifting decisions, which involved responding to labor realities and considering support system guidance. Of the follow-up participants, seven initially intended to avoid an epidural. However, only two of the seven did so. This shift was often a result of unanticipated pain intensity exacerbated by medical interventions such as the foley balloon and IV Pitocin. Policy and practice changes that promote person-centered care and informed decision-making should be considered. These findings offer a novel perspective on decision-making among nulliparous birthing people. They can serve as a step toward evaluating the potential for an intervention to promote informed decision-making about pain management during labor.Item Embargo The Impact of Virtual Simulation on Clinical Judgment Development in Undergraduate Nursing Students: A Pilot Study(East Carolina University, May 2025) Cherry, Brittany BakerBackground: Healthcare today is more complex than ever, with patients arriving at hospitals severely ill, often with multiple comorbidities. As patient care acuity rises, so does the need for nurses who can make safe and effective clinical judgments while ensuring quality care. Clinical judgment involves recognizing important aspects of a patient's condition, interpreting them, and responding appropriately. For years, clinical judgment and decision-making have been critical in prelicensure education, and recent research has focused on measuring these skills with psychometric precision using case studies and innovative item types on the licensure exam determining whether new graduate nurses are prepared for the complexity of patient care. Method: This study utilized David Kolb’s Experiential Learning Theory and Christine Tanner’s Clinical Judgment Model as the theoretical framework, emphasizing the development of thought processes that enhance learning. A quasi-experimental quantitative research design was employed to assess whether virtual simulation with instructor feedback improved clinical judgment among undergraduate nursing students. A pre- and post-case study assessment using Next Generation NCLEX (NGN) questions, based on the Modified Lasater Clinical Judgment Rubric, was developed to measure clinical judgment before and after virtual simulation. The case study results were graded, and clinical judgment development was evaluated using the Modified Lasater Clinical Judgment Rubric by Christina Zamaripa. Results: The results indicated that the clinical judgment scores on the pre-case study assessment were higher than the post-case study assessment scores, following the virtual simulation with instructor feedback. Despite the decrease in scores, on average, the level of clinical judgment remained the same at the developing. Regarding individual components, skillful response within the responding phase showed significant improvement from the pre- to post-case study assessment score following the virtual simulation, however, the moderate negative effect size indicates that the change was not very large. Conclusion: Findings from this study indicate that while students reported positive perceptions and felt the virtual simulation enhanced their learning, clinical judgment scores declined post-intervention. Despite student engagement, the simulation did not lead to measurable improvements, likely due to factors such as class length, content complexity, and gaps in foundational knowledge. When examining individual components and scoring, students showed some variation in their clinical judgment development. For certain components, their scores declined, while in others, their clinical judgment levels remained unchanged on average. For responding, both the scores and clinical judgment level declined for confident tone. As for well-planned intervention and flexibility, although their scores declined, students remained at the developing level of clinical judgment. When it came to clear communication, the score improved, but their clinical judgment level remained at developing. As for skillful response, the score improved significantly, yet the clinical judgment level stayed at developing. In the reflecting phase, both evaluation/self-analysis and commitment to improvement scores declined, but the clinical judgment level remained at developing. During the noticing phase, scores for focused observation declined, but the level remained unchanged at developing. For recognizing deviations from expected patterns and information seeking, there was a significant decline in both the scores and clinical judgment level. Lastly, in the interpreting phase, there was a notable decline in both scores and clinical judgment level for prioritizing data and making sense of data. These results suggest that the success of virtual simulation in developing clinical judgment is influenced by the students' existing knowledge base. Several factors highlighted in student feedback may have contributed to the decline in post-assessment scores. Despite its limitations, this study offers an innovative teaching approach and a valuable tool for assessing students' knowledge and clinical judgment skills.Item Embargo Perspectives of Refugees from Ukraine on Culture and Healthcare Experiences During US Resettlement(East Carolina University, May 2025) Choufani, MarianneMillions of Ukrainians have been displaced since Russia’s invasion over three years ago. Maintaining cultural identity in refugees can increase resilience, but its influence in the context of healthcare experiences in unclear. Thus, the purpose of this dissertation research was to explore the cultural identity of refugees from Ukraine and how it influences healthcare experiences and nursing care. Two studies were conducted: A pilot focused ethnography with semi-structured interviews, observations/field notes, and public documents/artwork; and an interpretive description study using focus group discussions (FGD). Thematic content analysis was employed for case comparison and themes were inductively derived using a variable-oriented strategy for both studies. Six Ukrainian nurses who lived/worked in the US before the current war were included in the pilot focused ethnography and three themes were: A sanctuary of help, Who am I here?, and Unstable underpinnings. Twelve Ukrainian adult refugees who experienced forced migration after February 22, 2022 were included in the interpretive description study and two themes were: Troubled partnerships and Embedded preventive practices. This research adds to the science with knowledge of Ukrainian refugee cultural identity and healthcare experiences and may help improve refugee-clinician collaboration.Item Open Access Executive Summary: Nurses Navigating Tough Talks Through Roundtable Discussions(2025-04-11) George, Marie CheryItem Open Access Executive Summary: The Effect of Social Media on Contraceptive Decision-Making(2025-04-24) Zoey B. ShifflettBackground: Historically, unintended pregnancies have been a persistent, costly problem for women, families, and the healthcare industry. Social media (SM) is a popular, accessible self-educational tool. Health professionals are encouraged to use SM as an education platform to combat misinformation. Local Problem: The teen birth rate in eastern North Carolina counties is above the national average. Methods: An educational intervention implemented over 12 weeks with three cycles of the Plan, Do, Study, Act (PDSA) framework. Data collection included SM activity, Likert-scale patient surveys, post-implementation Likert-scale provider surveys, and the number of contraceptive appointments. Interventions: Weekly posting of an educational series of contraceptives on Facebook (FB) and Instagram (IG). Results: SM educational series received 101 cumulative likes, 23 cumulative comments, and five cumulative shares of the posts. Both FB and IG had an increase following on both accounts. Most respondents agree to using SM for educational purposes. Eight respondents reported following the clinic’s SM and agreed that the content influenced them to either make an appointment or choose a form of contraceptive. 100% of providers reported a positive effect on their efficiency. Conclusion: SM is an easily accessible tool that may be a solution to receiving reliable health education asynchronously, especially for minorities who may face barriers to care.Item Open Access Item Open Access The Role of Nutrition Education in Reducing Pregnancy Complications(2025-04-22) Lindsay TorruellaItem Open Access False Narratives in Female Adolescent Skincare(2025-04) Elizabeth MoneyFailing to utilize sun-protective behaviors in adolescence is associated with an increased incidence of skin cancer in adulthood. An age-appropriate skincare routine in adolescence emphasizes the daily use of sunscreen; however, persuasive and influential messages from social media promote expensive, unnecessary, and potentially harmful routines and products. Due to developmental age and low e-health literacy levels, adolescents are vulnerable to misinformation. Through the implementation of this pre- and post-test quasi-experimental mixed-method non-control quality improvement project, the author wanted to determine if an educational series, consisting of one in-person and four subsequent virtual sessions, would increase the intent to use sun-protective behaviors, increase e-health literacy, and decrease the intent to use inappropriate skincare routines and products endorsed by social media. The sample consisted of middle and high school adolescents aged 11-18. Although the sample size was small: n=6, limiting most generalizability and statistical significance, there were several significant clinical takeaways following implementation. Within the sample, there was positive behavior change intent with increased sun-protective behaviors and decreased perception of tanned skin as "healthy;" however, results were mixed with self-assessed e-health literacy. In addition, the data also revealed a significant contrast between the concepts of "skincare" and "social media and skincare."Item Open Access Executive Summary: Utilizing Motivational Interviewing to Increase Pediatric Influenza Vaccine Uptake(2025-04-22) Nolan, Alyssa JaneDNP Executive Summary: Use for the paper required to fulfill the Doctor of Nursing Practice program.Item Open Access Safe Sleep Education for Caregivers of At-risk Infants(2025-04-23) Paul, JoannaItem Open Access Executive Summary: Increasing Awareness of and Screening for Diabetic Retinopathy in the Primary Care Setting(2025-04-23) Lauren McPhersonThis executive summary presents a Doctor of Nursing Practice project aimed at improving awareness of and screening rates or diabetic retinopathy. The project focused on developing and implementing a patient-centered educational tool to distribute to patients during appointment preparation with the goal of increasing patient knowledge and engagement in preventative eye care, specifically diabetic retinopathy.Item Open Access The Development of a Dementia Toolkit Making Resources Easily Accessible(2025-04-11) Kristen GroveItem Open Access Improving Scan Compliance while Decreasing Medication Errors(2025-04-17) Christianna ConnPrevious studies examining scan compliance have revealed that many nurses do not follow proper protocols when scanning medications for their patients. In response to low scan compliance rates throughout the unit, on-site education, bedside audits, and informational handouts were provided to nurses working in a community hospital. This quality improvement project highlighted that enhanced education and staff engagement can significantly boost scan compliance rates and increase staff awareness of medication errors and near misses.Item Open Access Enhancing Advance Care Planning in Primary Care Utilizing Project 5 Wishes(2025-04-09) Adam AndrewsThis quality improvement project aimed to enhance advance care planning in primary care by implementing Project 5 Wishes, a structured tool designed to improve patient-provider discussions and documentation. Conducted during Medicare Annual Wellness Visits, the intervention increased the frequency of advance care planning conversations, improved documentation, and enhanced related billing practices. While completion rates remained consistent with national averages, patient understanding and satisfaction improved. Project 5 Wishes effectively promotes patient-centered care, supports providers in facilitating critical conversations, and highlights the need to address barriers to advance care planning across diverse populations.Item Open Access Empowering Behavior Change in Adults with Diabetes Through Nutrition Education and Motivational Interviewing(2025-04-21) Sophia BlountItem Open Access Opioid Use Disorder Education and Trauma-Informed Care Training for Nurses in the Neonatal Intensive Care Unit(2025-04-21) Rebecca ManningWith the ongoing opioid problem in the United States, infants continue to be affected by neonatal abstinence syndrome (NAS), more specifically neonatal opioid withdrawal syndrome (NOWS), when they are born to mothers with opioid use disorders (OUD), whether treated or untreated. While neonatal intensive care unit (NICU) nurses are taught to care for infants with NAS through NAS scoring of their conditions and treatments, there is a gap in their knowledge regarding the NICU patients’ mothers’ OUD and treatment. A literature search supported education and training as remedies, so through an education module that included trauma-informed care (TIC) framework training, NICU nurses at a large tertiary hospital in North Carolina demonstrated an increase in knowledge on a post-module test, in addition to positive feedback. The post-test average score was 95.5% (N=35) compared to the pre-test average of 88.64% (N=60), which further suggests the importance and effectiveness of increased education for NICU nurses.Item Open Access Executive Summary: Improving Patient Comprehension of Atrial Fibrillation Through Visual Education(2025-04-20) Olivia CollinsItem Open Access Utilizing Frailty Assessment to Impact Nursing Care for Patients with End-Stage Kidney Disease: A Quality Improvement Project(2025-04-01) Penelope ZimmermanFrailty is highly prevalent in end-stage kidney disease (ESKD) and predictive of morbidity. Nurses lack frailty education and face practical challenges to assessment which prevent effective inventions to address frailty. A quality improvement project sought to determine if frailty education and utilization of a renal frailty index tool impacts telephonic case management nursing care of ESKD patients by improving knowledge, perception, identification, and assessment of frailty thereby prompting nursing interventions. Positive impacts were seen across all outcomes influencing outreach and resource utilization by nurses. Limitations included a small sample size, time burden, and manual processes. Findings suggest the importance of embedding frailty care into daily practice, automation of frailty scoring, and expansion into advance practice to improve quality of care and reduce cost of care.