College of Nursing
University of South Carolina
15th Annual Research and
Scholarship Day
Featuring The Mary Ann Parsons Lectureship
Envisioning Health Equity:
The Role of Nursing Research and Scholarship
Poster Session & Abstracts
MONDAY
April
4
th
Program Booklet
15th Annual Research and Scholarship Day
featuring Mary Ann Parsons Lectureship
Envisioning health equity: The role of nursing
research and scholarship
April 4, 2016
USC Russell House Student Union
Russell House Ballroom, 2nd Floor
1400 Greene Street
Columbia, South Carolina
This year’s Program booklet showcases nursing-related research and evidence-based
practice projects led by undergraduate and graduate students from the University of
South Carolina. All student-led projects include involvement of a designated research
mentor(s) from the USC College of Nursing.
The purpose of Research and Scholarship Day is to provide a collegial and interactive
environment that:

Highlights how research enhances nursing practice;

Stimulates student interest in research; and

Showcases student research and scholarship that advances nursing-related
science.
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Schedule of Events
Time
9:00 am – 10:00 am
9:00 am – 9:20 am
10:00 am – 12:00 pm
Session
Registration and Light Refreshments
Student poster session
DNP Podium presentation
(Dr. Ashley Sirianni)
Mary Ann Parsons Lectureship:
Location
Russell House Ballroom
Russell House Ballroom
Russell House Ballroom
Dr. Abigail Sewell
Assistant Professor, Department of Sociology,
Emory University; and Postdoctoral Fellow,
University of Pennsylvania
Co-sponsored by the “Radical Black Thought in the
Contemporary South” speaker series, USC African
American Studies, College of Arts & Sciences and
Department of Instruction & Teacher Education,
USC College of Education.
Panel Discussion:
Dr. Abigail Sewell
Assistant Professor, Department of Sociology,
Emory University; and Postdoctoral Fellow,
University of Pennsylvania
Dr. DeAnne K. Hilfinger Messias
Director, PhD Program and Professor, USC
College of Nursing
Dr. Janice Probst
Director, SC Rural Health Research Center and
Professor, USC Arnold School of Public Health
12:00 am – 1:00 pm
Student-Expert Networking Luncheon
Russell House Ballroom
1:00 pm – 3:15 pm
Student Podium Presentations
Russell House Rooms 203,
205
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Mary Ann Parsons
Lecture
Invited Lecturer
Dr. Abigail Sewell
Assistant Professor, Department of
Sociology, Emory University
Postdoctoral Fellow, University of
Pennsylvania
Dr. Abigail A. Sewell is an Assistant
Professor at Emory University in the
Department of Sociology and a Vice
Provost’s Postdoctoral Fellow at the
University of Pennsylvania in the Population Studies Center. Her work focuses on the political
economy of racial health disparities and quantitative methods in race and racism studies.
Because of her research on policing, environmental injustice, and redlining, Planned
Parenthood nominated her as The Future in 2016 – that is, one of 15 Innovators and Visionaries
Who Will Transform Black Communities. Her work has been published or is forthcoming in a
variety of outlets, including Social Science Research, Journal of Urban Health, Sociology of
Race and Ethnicity, and Du Bois Review. Her research has garnered awards and funding from
the Ford Foundation, the National Science Foundation, and the Society for the Study of Social
Problems.
She received her Ph.D. and M.A. in Sociology (Minor in Social Science Research Methods)
from Indiana University and her B.A. summa cum laude in Sociology (Minor in Women’s
Studies) from the University of Florida. She has taught classes on race, health, and research
methods at Emory University, Indiana University, the University of Mannheim in Germany, and
the ICPSR Summer Program in Quantitative Methods for Social and Political Research.
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Panel Discussion
Dr. Abigail A. Sewell is an Assistant Professor at Emory University in the Department of
Sociology and a Vice Provost’s Postdoctoral Fellow at the University of Pennsylvania in the
Population Studies Center.
Dr. DeAnne K. Hilfinger Messias is the Emily Myrtle Smith Professor of Community Nursing at
the College of Nursing and holds a joint appointment with the Women’s and Gender Studies
Program. She is also an Affiliate Faculty with Latin American Studies. Dr. Messias conducts
community-engaged, community-based research with a focus on addressing health disparities
among women and girls, immigrant health, language access issues, and cultural and linguistic
competency. Some of her recent research includes: an analysis of the demographic, behavioral,
and motivational characteristics of youth in the Lexington County Juvenile Arbitration program;
research on Brazilian immigrant women’s transnational health practices; Latinas’ experiences of
accessing cancer prevention services; the health implications of Latinos’ responses to and
experiences during Hurricane Katrina; and the development, testing, and dissemination of the
Language for Healthcare Access initiative, an innovative, community-based English language
curriculum designed to improve healthcare access knowledge, skills, and self-efficacy among
limited English proficient, recently immigrated Spanish speakers.
Dr. Jan Probst is a Professor in the Department of Health Services Policy and Management,
USC Arnold School of Public Health, and the Director of the South Carolina Rural Health
Research Center Professor. The South Carolina Rural Health Research Center focuses on
investigating persistent inequities in health status within the population of the rural US, with an
emphasis on inequities stemming from socioeconomic status, race and ethnicity, and access to
healthcare services. Dr. Probst’s research interests include rural health care delivery, health
disparities, potentially preventable hospitalization. Some of her recent research includes:
Colorectal Cancer Screening Bypass Behavior and Outcomes; Social Determinants of Health
Among Minority Populations in Rural America; and Trends in Rural Children’s Health and
Access to Care.
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Abstracts: Student
Poster and Podium
Presentations
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P01. Infant Feeding Choices of Young African American Mothers
Presentation type: Podium
Presenter(s): Jennifer Beecroft
Mentor(s): Dr. Joynelle Rivers, Dr. Tisha Felder, USC College of Nursing
Background: Health care recommendations state that mothers breastfeed for at least the first 6
months with their infants. Of all the new mothers in the United States, 77% participate in
breastfeeding right after the baby is born. However, mothers of younger ages, are African
American and deliver in South Carolina are significantly less like to initiate or continue to
breastfeed up to 6 month compared to other mothers. This descriptive study compares the
characteristics, maternal history and breastfeeding preferences of pregnant African American
mothers by age.
Methods: Fifty surveys were administered at the Palmetto Health Women’s Health Clinic in
Columbia, South Carolina. To participate in the survey, the participants needed to meet the
following criteria: 1) resident of South Carolina, 2) identify themselves as Black or African
American, 3 18 years or older, 4) fluent in English, and 5) currently pregnant. The survey
consisted of 15 questions that assessed socio-demographics, maternal history and the mother’s
baby feeding preferences using the Iowa Infant Feeding Attitude Scale (IIFAS).
Preliminary Results: Nearly half the population was between the ages of 18 and 24 years old
(52%). Future analyses include comparing the following variables by age (18-24 years versus
25 and over): socio-demographics, maternal history and the mother’s IIFAS scores.
Potential Implications for Health Equity: Due to half of the respondents being between the
ages of 18 and 24 years old, nurses need to explore further the perceptions that young mothers
have towards “breast identity” and breastfeeding due to as it relates to cultural norms today.
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P02. Exploring Adults' Vigilance Behaviors within a Child's Caregiving Cluster
Presentation type: Poster & Podium
Presenter: Kate K. Chappell
Mentor(s): Dr. DeAnne K. Hilfinger Messias, USC College of Nursing
Background: Child sexual abuse is associated with higher incidence of many adult health
problems. Certain economic and social factors place children at higher risk for child sexual
abuse. Literature on adult caregiver vigilance (protective and preventive behaviors) for child
sexual abuse largely focuses on a single caregiver. Examining caregiver vigilance from a social
ecological perspective reflects child sexual abuse as a complex, dynamic, and social
phenomenon.
Purpose: This exploratory study examined how adult caregiver vigilance for child sexual abuse
is expressed within a child's caregiving cluster. How caregiver experiences affect vigilance for
child sexual abuse was explored.
Methods: One-on-one semi-structured interviews were conducted with both biological parents
of a school-age child. Interview questions focused on how each addresses child's safety;
perceptions of child's risk for safety concerns, including child sexual abuse; assessment of
environmental risk for child sexual abuse; and influences on their approach to the child's safety.
For additional perspective, a focus group of child well-being professionals was conducted.
Themes were identified using open coding of interview and focus group session transcripts.
Results: Themes identified across caregiver interviews and the focus group session include 1)
caregiver attention/energy diversion, including caregiver energy for meeting family's basic
needs and out-of-home commitments; 2) vigilance prioritization differences according to child's
age, perceived stability of child's environment, and personal experience biases; and 3)
caregiver approaches to "emotionally" assessing situations versus "scanning."
Conclusions: Influences on caregiver vigilance identified include child's environmental stability
and caregiver gender and personal experience. The findings suggest further study of adult
caregiver risk assessment and vigilance will support focused child sexual abuse prevention
measure development. Preventing child sexual abuse, particularly in families at higher risk due
to economic and social factors, improves children's short-term health outcomes and reduces
adverse childhood experiences, which influence multiple negative health outcomes into
adulthood.
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P03. A Quality Improvement Project Addressing Postpartum Mothers’ Reported Benefits
and Challenges to Rooming In at a Community Hospital
Presentation type: Poster
Presenter: Caylee Cook
Mentor(s): Dr. Kate K. Chappell, USC College of Nursing
Background: Infants from economically challenged areas are at a higher risk for sudden infant
death syndrome and neglect, as well as a shortened breastfeeding period, which impacts
newborn health outcomes. SC ranks 42nd overall in child well-being in the US, considering
economic, education, health, and family measures. Rooming in, the practice of infants staying in
mothers’ room throughout the hospitalization, reduces infant mortality and neglect, and
lengthens breastfeeding periods.
Purpose: This quality improvement project will identify mothers’ reported challenges of rooming
in at a community hospital, in a mostly rural South Carolina county. This project will provide
insight into challenges the facility needs to address to promote program success and reduce
risks to infants linked to poorer child well-being measures.
Methods: A five question multiple-choice survey will be administered to approximately 150
mothers on the post-partum unit. Survey questions include mothers’ identification of benefits
and challenges to rooming in. Demographic variables collected will include education level, age,
race and ethnicity, newborn feeding preference, and household composition. SPSS Version 23
will be used to produce descriptive statistics. Correlations between variables and other
relationships will be analyzed as appropriate for the sample size.
Results: The data analysis will produce suggestions for educational material development and
policy recommendations specifically addressing identified challenges of rooming in for
postpartum mothers in this community hospital setting. The results will identify differences in
benefits and challenges depending on demographic and household composition. The results will
also help determine appropriate reading level for the specific patient population.
Implications: Developing strategic teaching resources and policies will improve mothers’
experiences with rooming in, possibly increasing its’ positive effects. This may help decrease
the occurrence of negative outcomes of infant mortality related to SIDS, physical neglect
occurrences and improve breastfeeding period length for infants in this community.
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P04. Harnessing the Power of Research Electronic Data Capture Application to Abstract
Data from a Mass Casualty Incident
Presentation type: Poster & Podium
Presenter: Sara Donevant
Mentor(s): Dr. Joan Culley, Dr. Robin Dawson Estrada, USC College of Nursing
Background: A current National Institutes of Health and National Library of Medicine funded
study, Validating Triage for Chemical Mass Casualty Incidents–A First Step (1R01LM011648),
explores victim’s medical records to identify features and patterns of chlorine exposure. This
require the abstraction of data from the Graniteville chlorine victims who were exposed to over
42 tons of chlorine gas when two trains collided on January 5, 2005. Nine people died and
hundreds arrived at the local emergency department.
Purpose: This work describes how the research team addressed a number of challenges
throughout the abstraction process by using Research Electronic Data Capture (REDCap) to
efficiently create a research database from the victim’s medical records. Patient data was
recorded on 25 different paper documents with 837 fields. Handwriting, missing data and
multiple entries of similar data on various forms presented significant challenges to: 1)
accurately abstract patient data; 2) develop an efficient abstraction process to electronically
capture all data into a research database; and 3) provide only de-identified data to the research
team.
Methods: REDCap, a secure web application to build and manage databases, was used to
replicate the paper records. Medical coders abstracted the data by entering data directly into
forms created in REDCap. The research team remotely monitored the abstraction progress.
Results: REDCap allowed the research team to duplicate the paper documents and abstract
306 paper medical records. REDCap provided: a secure electronic platform for the data; a
streamlined process to compile and manage data; the exportation of data for statistical analysis;
improved time management of data abstraction process; multi-site remote access; and
integration with structured query language software.
Discussion: REDCap allows efficient and secure data abstraction and management, which
streamlines the process of database compilation. The text fields proved to be difficult and
required manual review and analysis.
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P05. The Fourth Color
Presentation type: Podium
Presenter: April Drafts-Johnson
Mentor(s): Dr. Woody Holton, PhD (History), Mr. Ryan Stevens, (Theatre)
David Sedaris is a modern humor essayist who uses experiences from his daily life to create
vivid, “real-ish” stories to entertain his readers. In nursing and in life, there are interesting tales
to be told. The following stories are imaginative events that are based on the author’s personal
experiences. Stories about family, coming of age, reflections on life, and fictional recounts of
time spent working odd jobs in the hospital are all divided into five themes—the human
experience, making the best of it, loss, darkness, and light. These stories are written in the style
of Sedaris to show that no matter what education or formal training one has, everybody has a
story to tell. Additionally, these stories show the therapeutic value of writing in nursing.
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P06. Evaluating Students with ADD/ADHD: Exploring the Experiences of Teachers
Presentation type: Poster
Presenter: Mary-Madison Driggers (Co-authors: Kay Lawrence, Jessica McCormick)
Mentor(s): Dr. Robin Dawson Estrada, USC College of Nursing
Background/significance: A common challenge for teachers is managing students with
attentional and hyperactivity difficulties, who are at risk for long-term problems such as
depression. Some of these students go on to be formally evaluated and treated for attention
deficit/hyperactivity disorder (ADD/ADHD). As part of the initial assessment, healthcare
providers (e.g., nurse practitioners, pediatricians) routinely request teacher input regarding the
student’s classroom behaviors and learning issues. However, little is known about the
experiences of teachers during the diagnostic process and after students receive a diagnosis
and treatment plan.
Purpose: The purpose of this qualitative descriptive research was to 1) explore how teachers
perceive and negotiate the ADD/ADHD evaluation process; and 2) examine teacher
experiences of interactions with healthcare providers.
Methods: Participants were 13 practicing and retired elementary and middle school teachers
from counties in rural North and South Carolina. Data included semi-structured, audio-recorded
interviews and was analyzed using thematic analysis.
Results: Themes included 1) the creative negotiation of school protocols and systems to initiate
the evaluation process for children the teachers thought might have ADD/ADHD; 2) the
frustrating task of filling out forms detailing the student’s behaviors as the primary and
sometimes only role of the teacher; and 3) awkward interactions as the very few postdiagnosis/treatment communications between teachers and healthcare providers were usually
brokered by the student’s parents.
Discussion/Implications: Effective communication between teachers and healthcare providers
has the potential to improve educational and behavioral outcomes for students with ADD/ADHD.
Implications include acknowledgement of systems influences on a teacher’s ability to facilitate
optimal care for their students with ADD/ADHD. Direct communication with the healthcare
provider, rather than via parents, allows teachers to relay more accurate and candid information.
Finally, ongoing teacher observations may help the healthcare provider adjust treatment plans
as student needs change, and support successful transition into adulthood.
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P07. Using Social Media as a Recruitment Tool for Nursing Research with African
American Women: An Exploratory Study
Presentation type: Poster & Podium
Presenter: Eboni Harris
Mentor(s): Dr. DeAnne K. Hilfinger Messias, USC College of Nursing
Background: Recruitment of young African American women to participate in research using
traditional methods is expensive and challenging. Recruitment barriers include researcher
mistrust, socioeconomic factors, and lack of researcher access to African American
communities and diverse participant pools. Online recruitment is a cost-effective and innovative
modality that may reach a broad participant pool. The aim of this exploratory study was to
assess the feasibility and receptivity to an online research invitation among African American
women in an urban area of South Carolina.
Method: Participant eligibility criteria included being an African American woman between the
ages 18-45 years and living in Upstate area of South Carolina. The recruitment strategy
involved a public Facebook event post with an invitation to participate in either an in-person
focus group or interview. The invitation included information on the research purpose, inclusion
criteria, and a sample consent. Potential participants indicated their interest in participating by
clicking "attending" which prompted a personal on-line contact by the investigator, to confirm
eligibility and willingness to participate.
Results: The Facebook event was posted for 8 days; within 3 days there were 13 responses
from African American women who all met the study inclusion criteria. The first 5 respondents
were invited to participate in the focus group, which was held in a room in a public use building.
Two other respondents were invited to participate in in-person interviews.
Discussion: This feasibility study involved in-person data collection and participation was
limited to a specific geographic area. Online recruitment provided advantages including the
ability to quickly reach the desired target population with little financial burden and ease of
snowball sampling. Potential drawbacks include exclusion of hard to reach populations and
having subjects who self-selected. Utilizing online social networks present a promising tool for
recruitment, demonstrating improved recruiting effectiveness particularly of young African
American female participants.
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P08. Predictors of Group Climate for African American Women with Breast Cancer
Presentation type: Poster & Podium
Presenter: Pearman Hayne
Mentor(s): Dr. Swann Arp Adams, USC College of Nursing/Arnold School of Public Health, Dr.
Sue P. Heiney, USC College of Nursing
Background
African American (AA) women with breast cancer (BrCA) have an increased breast cancer
mortality rate, poor quality of life, and few supportive interventions. AA women with BrCa need
culturally sensitive interventions such as therapeutic groups. A critical component of a
therapeutic group is group climate, i.e. the perceived social environment. However, it is not
known how group members’ attributes affect group climate.
Purpose
The purpose of this analysis was to determine the relationships of anxiety, social desirability,
and demographics with perceptions of group climate within a group intervention for AA breast
cancer survivors.
Methods
The data for secondary data analysis stemmed from STORY (Sisters Tell Others and Revive
Yourself) – a randomized controlled trial to deliver a therapeutic support group via
teleconference for AA women with BrCa. Our sample (n = 28) consisted of women in the
intervention arm who completed group climate evaluations at two time points. We used the data
gathered from the Profile of Mood States-Brief, Marlowe-Crowne Social Desirability Scale, and
Group Climate Questionnaire. We used univariable linear regression to identify which variables
were associated with engagement, one component of group climate.
Results
Social desirability was significantly associated with engagement during the seventh session
(β=0.24, p = 0.01). Patient demographics and tension-anxiety were not significant.
Discussion & Conclusion
We believe that the social desirability trait may have influenced women to report higher levels of
group climate by the seventh session. This influence may be related to the “strength
hypothesis,” which posits AA women feel cultural pressures to portray themselves as resilient
during stress. This may have caused women to inflate their responses to the group climate
items. We believe group leaders should compare the participants’ reports of group climate with
social desirability scores. Group leaders may need to confront discrepancies in order to
maintain intervention fidelity.
Conclusions/Implications: Participants recalled the many challenges they had faced
throughout the diagnostic, treatment and recovery processes. These included persistent
symptoms, stigma, and barriers to effective communication with healthcare providers. Their
collective desire to learn from and support other African-American women diagnosed with lung
cancer signals opportunities for culturally tailored treatment and support interventions. Further
research is needed to enhance lung cancer survivorship and contribute to the development of
interventions focused on health behavior change for this vulnerable and understudied group.
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P09. Community Network Program Centers Training Program: Are There Differences in
Scientific Productivity Among Early/Mid-career Health Disparities Researchers by
Underrepresented Status?
Presentation type: Poster
Presenter: Carly Ingram
Mentor(s): Dr. Tisha M. Felder, USC College of Nursing; Dr. James Hébért, USC Arnold School
of Public Health & Cancer Prevention and Control Program
Introduction/Background: Researchers from underrepresented backgrounds are significantly
less likely to receive R01 funding from the National Institutes of Health (NIH) compared to
whites-despite controlling for key markers of academic and research training. Differences in the
mentoring and training experiences of investigators from underrepresented backgrounds may
contribute to this funding gap. The National Cancer Institute (NCI)/NIH funds the Community
Networks Program Centers (CNPCs) initiative (2011-2016) which includes training students and
early-stage investigators [hereafter trainees] from underrepresented backgrounds to conduct
community-based participatory research to reducing cancer-related health disparities. This
study examined if the scientific productivity (e.g., NIH funding) of CNPC trainees differs by
underrepresented status.
Methods: A 57-item, web-based questionnaire was developed for trainees from each of the 23
CNPC sites across the country. Descriptive statistics were conducted on trainees' academic
characteristics, scholarly productivity (e.g., funded grants, publications) and general and CNPCspecific mentoring and training experiences stratified by underrepresented status.
Preliminary Results: Of the 144 trainees who completed the questionnaire, 65% identified as
being from an NIH-designated underrepresented group. Nearly 50% of the underrepresented
trainees were first generation college graduates as opposed to non-underrepresented trainees
(9.8%). An ad hoc sub-analysis of nursing (n=10) showed that they were all female and 50%
were from underrepresented backgrounds, specifically African American . The majority (70%) of
nursing trainees were first generation college graduates.
Implications for Health Equity: Soon the US will be a majority-minority nation, with
Hispanics/Latinos, being the largest racial/ethnic group. Thus, there will be a greater need for
Hispanics/Latinos to be represented as nurse practitioners and scientists to achieve cancer
health equity. It is more important than ever to encourage first generation college students,
especially nurses, to pursue leadership roles in the research process to accommodate the
diversifying population.
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P10. Nurse Faculty Assessment and Strategies Related to Clinical Judgment in BSN
Students
Presentation type: Poster
Presenter: Kay Lawrence
Mentor(s): Dr. DeAnne K. Hilfinger Messias, USC College of Nursing
Background/significance:
The goal of nursing education is to produce new graduate nurses with the knowledge, skills and
attitudes of an advanced beginner. Clinical judgment, reasoning that is both moral and engaged,
is the most essential.
Purpose:
The aims of this exploratory investigation were to: 1) better understand faculty assessment of
the essential knowledge, skills and attitudes that BSN nursing students must develop and 2) to
identify strategies and techniques aimed at enhancing development of clinical judgement used
by faculty.
Methods:
The purposive, convenience sample consisted of 5 faculty members from a small southeastern
university. Data collection consisted of 2 semi-structured interviews and 1 focus group. The
open-ended questions aimed to elicit educators’ perspectives and examples of teaching
methods they utilized to enhance students’ clinical judgment. Analysis of the transcribed
interview and focus group data consisted of open and comparative coding.
Results:
Assessment skills, anticipation, and reflection were practices mentioned by all participants.
These relate to phases of Tanner’s clinical judgment model which includes noticing, interpreting,
responding and reflecting. There was consensus among participants that belittling students was
not conducive to learning. Similarly, participants agreed that students’ anxiety over psychomotor
skills inhibited their ability to develop higher order thinking skills, while facilitated skill acquisition
contributed to increased student self-efficacy which in turn boosted development of clinical
judgment. An element of clinical judgment not previously noted in the literature was anticipation.
Conclusions/Implications:
There is clearly a need for further research to determine the effectiveness of educational
strategies aimed at enhancing students’ development and application of clinical judgment.
Questions for future research include:
 How do students transfer clinical judgment skills developed within a simulation
environment to clinical settings?
 How do expert nurses describe their trajectories in developing clinical judgement?
 How does the concept of anticipation intersect with theories of clinical judgment?
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P11. Translating Research to Practice: Findings and Implications of a MultiMethod Exploration of Undergraduate Students’ Exposure to Cultural and
Linguistic Diversity
Presentation type: Poster & Podium
Presenter: Jamie Lawson
Mentor(s): Dr. DeAnne K. Hilfinger Messias, USC College of Nursing
The purpose of this research was to assess exposure to cultural and linguistic diversity and
perceived level of preparedness to care for limited English proficient (LEP) patients among
undergraduate nursing and health professions students. Data collection involved 3 audio-taped
focus group interviews with pre-licensure nursing and healthcare profession students (N=8) and
an online survey of undergraduate nursing students (N=63). Themes identified through the
qualitative descriptive analysis of the focus group data included students’ perceptions of
healthcare communication; heightened emotional responses to language asymmetry and
barriers; and how role switching enhanced empathy towards individuals with LEP. There was
evidence of some discordance between students’ reported interactions with LEP individuals and
their perceived level or preparation to care for LEP patients. Among survey participants, 74%
reported “very little or no language proficiency in Spanish” and 80% reported “inadequate
preparedness to work with LEP patients.” Self-reported assessment of formal training and
education indicated 61% of students had “little to no” instruction in Hispanic/Latino culture and
90% reported “very little” to “no training” on working with medical interpreters. Nursing students’
recommendations for enhancing their cultural and linguistic competency included increased
curricular flexibility to allow for more exposure to cultural/linguistic studies; integration of LEP
patient examples into case studies and simulations; incentives and encouragement to pursue
advanced foreign language studies beyond minimum program requirements; and increased
cultural immersion opportunities for nursing and pre-healthcare students. These findings
indicate potential areas for improving and enhancing nursing and pre-professional curricula and
opportunities for developing specific teaching/learning strategies to better prepare students to
communicate with and care for LEP patients. Further research is needed to assess the impact
of educational preparation on nursing students’ levels of awareness, preparedness, and
expertise in caring for LEP patients.
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P12. Teaching Tummy Time to Latino Expectant Parents
Presentation type: Poster & Podium
Presenter: Alexandra Nitsos
Mentor(s): Dr. Robin Dawson Estrada, Dr. DeAnne K. Hilfinger Messias, USC College of
Nursing
Background: Tummy time is preventive positioning of infants (newborn to four months of age)
aimed at strengthening and stretching the child’s neck and upper body muscles and preventing
flattening of the skull. Limited English speaking parents and childcare providers face multiple
barriers in accessing care and may benefit from targeted education and support in order to
effectively perform tummy time with their newborns.
Objective: To adapt, implement, and evaluate a Spanish-language tummy time program for
Latino parents and caregivers with limited English proficiency.
Method: After participating in training from “The Tummy Time Project”, an interdisciplinary
health sciences student group, the student researcher adapted the intervention for the local
Latino population. These steps included 1) translation of educational materials into Spanish; 2)
training bilingual assistants to recruit participants and implement the intervention; and 3) the
development of a pre- and post-intervention participant survey. Participant recruitment sites
were clinics, a health fair, and churches serving the Latino community. The intervention
consisted of a brief instruction and demonstration with baby dolls. Participants were given a
Spanish-language brochure at the end of the instruction to reinforce learning and a tummy time
pledge card they could share with the infant’s health care provider.
Results: 14 women and 2 men participated in eight sessions. Pre-intervention surveys
indicated none of the participants had any prior knowledge of tummy time. After receiving the
educational intervention, all participants correctly performed the return demonstration. Postintervention surveys demonstrated all participants understood the concept of tummy time and
potential benefits for the child.
Discussion: Survey results and on-site observations supported the efficacy and acceptability of
this Spanish-language tummy time educational intervention for Latino parents and caregivers
with limited English proficiency. The results will be used to guide a future educational program
to be implemented by health sciences student volunteers in local clinics.
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P13. Knowledge and Use of Pulse Oximetry and the Wireless Information System for
Emergency Responders (WISER) by First Responders During Triage of Victims of Irritant
Gas Syndrome Agent (IGSA) Disasters
Presentation type: Poster
Presenter: Michael Pallon
Mentor(s): Dr. Joan Culley, USC College of Nursing
Significance: Disasters involving IGSAs pose significant threat to life and require rapid
response to reduce death and disability. Early detection of IGSA disasters is essential and
requires evidence-based triage processes to maximize effectiveness of rescue efforts.
Purpose: To examine overall differences in knowledge and practices of first responders from
rural and urban settings during response to IGSA incidents.
Methods:
1) Developed a survey tool, validated by two experts in emergency preparedness, to study
the use of first responder’s resources for chemical incident. The survey included 39
questions and two scenarios gleaning demographic data, use of WISER, communication
protocols, triage methods, and assessment tools to measure oxygen saturation.
2) Administered survey to 47 volunteer participants during the 2015 Fire Rescue SC
Conference.
3) Used SAS to enter and analyze data.
Results: 1) 57% of participants work in rural and 42% in urban settings; 52% of rural, and 59%
of urban respondents had >21 years of experience; 43% of both groups were 18-44 years of
age and 56% were > 45 years of age. 2) The Emergency Response Guidebook is consistently
named a primary source of information. 3) 92% from urban, 72% from rural settings use pulse
oximetry. 4) 67% from urban settings are not familiar with WISER; there are significant
differences in the availability of information prior to arrival to the scene of an incident between
rural and urban settings. 5) When asked to rank tasks in order, 11% indicated they would begin
patient contact, treatment, and transport, prior to decontamination of IGSA victims.
Conclusion/Implications: While this was a small sample, results provide important insights
into the differences between first responders from urban and rural settings. This information will
be used to improve triage strategies during IGSA incidents.
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P14. “Taking the Weight Off” of Our Troops: Systematic Review of Obesity-related
Interventions in the Military
Presentation type: Poster
Presenter: Sally Singleton
Mentor(s): Dr. Tisha M. Felder, USC College of Nursing, Julia Houston, USC Arnold School of
Public Health, Dr. Nikki R. Wooten, USC College of Social Work
Background: Obesity is a serious health concern in the United States. The prevalence of
obesity is increasing among the general U.S. population and among members of the U.S.
military. Increased rates of obesity in the military population could potentially impact operational
effectiveness and threaten national security. Addressing obesity and related risk factors in this
population is imperative. This systematic review describes peer-reviewed, obesity-related
intervention studies that target active military and veteran populations.
Methods: We conducted an electronic search in PubMed, Web of Science, Military and
Government Collection, PsycINFO, and PILOTS scientific databases for studies published
between 2000 and 2015. For inclusion in the review, studies were: 1) published in English, b)
peer-reviewed, and c) a primary investigation of an obesity-related (e.g., weight loss, binge
eating, etc.) intervention. The search yielded 688 articles, of which five met eligibility criteria. We
compared military or veteran group characteristics, intervention design, treatment modality,
efficacy and outcomes of the interventions for each study.
Results: Across studies, 48% to 71% (range) of participants were European American and
22.1% to 46% were African American. All studies were theory-based. Two used behavioral
theories (Transtheoretical Model of Change, Social Cognitive Theory) and three used Cognitive
Behavior Theory. Two of the five studies used multidisciplinary teams (e.g., psychologists,
physicians, registered dietitians) to implement interventions. Specialized knowledge of
multidisciplinary intervention studies demonstrated greater weight reductions (10-14 lbs)
compared to studies that did not use team-based approaches.
Implications for Practice and Health Equity: Addressing obesity in military populations is an
understudied issue in the published, peer-reviewed literature. Given the increased risk of
obesity-related factors resulting from military service (e.g., posttraumatic stress, developed
eating habits, etc.), more intervention research should be conducted. Future interventions
should consider collaborating with nursing and social work professionals and focus efforts to
recruit other culturally diverse participants.
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P15. Multi-Symptom Management in Hospice Patients during End-of-Life Transition
Presentation type: Podium
Presenter: Ashley Sirianni
Mentor(s): Dr. Stephanie Burgess, USC College of Nursing
The purpose of this quality improvement project is to compare the provider’s
perception following an educational model of using single symptom management versus multisymptom management during the end-of-life transition in adult patients for improved quality of
life outcomes. The appraised evidence indicates that it is critical to have anticipatory
medications at the patient’s residence to manage multiple symptoms rather than focusing
exclusively on a single symptom management such as pain management. In February 2016, the
author conducted an educational model among hospice providers for increasing knowledge and
awareness of multi-symptom management. Thirty (n = 30) Clinical Nursing Directors, Licensed
Practical Nurses, Medical Directors, and Registered Nurse Case Managers from hospice
organizations located in South Carolina were surveyed pre and post intervention regarding their
perception of symptoms, the most prominent distressful symptoms that are experienced by
hospice patients, and the pharmaceutical preference to manage distressful symptoms. With a
response rate of 77%; (n=23) participants pre-test responses indicated that pain (35%) was the
most prominent symptom among patients; Dyspnea/SOB (44%) was identified as the most
distressful symptom for patients; and anxiety/restlessness and increased respiratory secretions
received (35%) as the most distressful symptoms for patients’ families and/ or caregivers
witnessed during a patient’s last two weeks of life. Hospice provider’s post-test responses
indicated that the most prominent symptom was dyspnea/SOB (30%) followed by pain (22%).
Additionally, the presence of anxiety/restlessness had increased by almost (10%) in the posttest results (26%). Healthcare providers reported the most distressful symptom for the patient
was dyspnea/SOB (44%) with the same response rate both pre-test and post-test. However, the
prevalence of pain as the most distressful symptom’s response rate decreased from pre-test
(17%) to post-test (9%). The presence of perceived increased respiratory secretions response
rate increased from pre-test (13%) to post-test (22%). This project was consistent with the
evidence that multi-symptom management is critical in end of life transitions and care providers
must focus on multi-symptoms rather than single symptom.
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P16. Organizational Death: Rural Hospital Closure and the Nurse Executive
Presentation type: Poster
Presenter: Deborah Warden
Mentor(s): Dr. Janice C. Probst, USC Arnold School of Public Health
Background: Nationwide, sixty-one rural hospitals closed between 2010 and 2015; more than
250 additional hospitals are at risk of closure. Nurse executives need to be prepared for this
eventuality.
Purpose: The purpose of this study was to describe the experiences and concerns of nurse
executives involved in the closure of rural hospitals.
Methods: In this descriptive study, we conducted detailed interviews with five former nurse
executives from closed hospitals. Interviews were transcribed and analyzed.
Results: Three themes emerged concerning the roles of the nurse executives of closed rural
hospitals: the flat organizational structure requiring role concentration, the emotional closeness
of staffs in these smaller institutions, and the perception of a crisis. Responding nurse
executives reported feeling unprepared for the administrative tasks of closure and describe their
grieving processes as well as a sense of betrayal.
Conclusions: We found a need for formal direction on how to close a highly-regulated health
care facility. With many rural facilities in dire financial straits, development and dissemination of
contingency plans at the state level is essential. More study is needed to clarify the specific
roles and responsibilities of the rural nurse executive and what sorts of preparation they need to
function best in their settings.
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P17. Not a Death Sentence: Perspectives of African-American Women Living with Lung
Cancer
Presentation type: Poster
Presenter: Lisa Webb
Mentor(s): Dr. Karen Kane McDonnell, Dr. DeAnne K. Hilfinger Messias, Dr. Sue P. Heiney,
USC College of Nursing
Background/Significance: Advances in lung cancer screening and treatment have led to rising
numbers of lung cancer survivors. However, limited evidence exists describing the phenomenon
of African-American women living with lung cancer. Culturally tailored research is needed in
order to design appropriate care interventions aimed at promoting the adoption and
maintenance of health behaviors and improving the quality of life among this population.
Purpose: This qualitative descriptive study explores the experiences of African-American
women with lung cancer through their diagnosis, treatment and recovery and their preferences
for engaging in health behavior change.
Methods: We engaged 18 African-American women lung cancer survivors in audio-recorded
focus group discussions about their treatment and recovery experiences. Multiple analysts first
open-coded the verbatim transcripts then collectively identified four major descriptive themes
from the data.
Results: Survivors verbalized; first, that lung cancer is not an automatic death sentence.
Secondly, they had learned to live with the distress and stigma associated with diagnosis and
the lingering symptoms related to both the disease and treatment. Thirdly, the lack of timely and
adequate information from healthcare providers impacted their ability to effectively cope with
burdensome symptoms, resulting in impaired quality of life. Lastly, more encouraging was the
collective recognition that African-American women surviving lung cancer need to support each
other to improve their ability to cope and modify health behaviors.
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Excerpt from a collection of readings by April Drafts-Johnson (see P05):
For the First Time the Last Time
Somebody died today. That’s all I can think of as I drive home. Somebody died today, and I was
there, right next to them—touching them even. And I didn’t even realize they were dying, no, not
until the real nurse came in and said, “I think this is it.”
The night before I had been at Jacob’s. “I have to pretend to be a nurse tomorrow,” I told him,
our little joke phrase, which means I have to go home early. I left his place at ten and fell asleep
in my own bed until 5:30. When I wiped my eyes this morning, washed my tired face, slid into
my scrubs, stopped by McDonalds on the way to the hospital, I thought it would be a normal
clinical day. Listen to report, look at charts, input and output. Awkwardly try to make
conversation when I’m taking vitals, averting my eyes as I give a bed bath. Bring a patient’s wife
tissues, maybe change a wound dressing if I was lucky.
“You have an easy patient today,” said Ms. Jennifer when she handed out the assignments to
my clinical group. I was relieved. Last week my guy—I mean my patient—that still seems weird
to say, “my patient”—had a million procedures and thought every one of them was some life or
death surgery instead of a normal swallow test. I understood his confusion. This hospital is a
maze and I guess if I suddenly found myself in a gown, helpless in a bed not knowing what was
happening, I’d have a lot of questions too.
This lady—this patient—Ms. Jennifer promises me, will be a lighter load. I can probably help the
others with their bed baths and hopefully she will come up with a vaccination or something for
me to give, Ms. Jennifer explains, since this lady—patient—is on hospice and meds are
discontinued.
Lighter load? I’m not sure anything about this situation seems light, but I nod. Ms. Jennifer
knows what she’s doing, I do not. Ms. Jennifer has been a nurse for twenty years, and I’ve been
pretending to be a nurse for eight weeks.
When I put on my scrubs I am not just a college kid anymore, and that scares me. Patients ask
me for advice, let me prick their fingers and slip my hands up their gowns. If this patient could
see me tomorrow, in my t shirt and jeans, running late to my 8:30 class, would they let me touch
them? Would they tell me their fears? Would they let me see that sacral pressure ulcer?
I know I’m not stupid but sometimes I feel utterly, hopelessly, dumb, just standing there at the
hospital computer like an idiot, writing down all these words to google later. Worse is standing
outside the patient’s door. It’s seven AM and here I am, my hand shaking as I get ready to
knock. “Nursing.” I have to say, confidently, because I have to come in regardless, because they
need to be assessed. Poor things. “I’m sorryI’m sorryI’m sorry,” I think to myself, over and over
again, as I listen to their lung sounds with my freezing cold stethoscope, pinch their fingernails
to check for capillary refill, shine bright lights into their eyes. You can go to bed as soon as I’m
done, I say, surprised that in my whole two months experience nobody has punched me. If
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somebody woke me up and started doing the things I do to these people, I would sock them
right in the nose. Like, get your hands off me.
When the real nurses and I walk into the patient’s room for bedside report, it is dark and she is
sleeping.
“Ms. Neil, 89 year old female, history of HTN, stroke, DM, fracture right ileus, came in last week
after falling at her residence,” last night’s nurse says.
Why isn’t she whispering, I wonder as I furiously jot down my notes, and then it occurs to me
that Ms. Neil is not going to wake up, that the blood in her brain is making it swell so that she
may never wake up. Hospice, Ms. Jennifer said.
“Alright, I will begin my assessment and be sure to take vital signs, looks like she hasn’t had a
bath since yesterday so I’ll make sure to do that too,” I clarify with the day nurse.
“Shouldn’t be too hard,” says the day nurse.
After they leave the room is eerily quiet. Ms. Neil’s breath sounds are raspy and groggy—
rhales???? I write in my notebook, forgetting the term we learned in class. She is breathing on
her own, however ragged. Her heartbeat is a little slow but not bad. I watch her for a second,
her chest rising and falling. She is still and peaceful.
I feel bad that I moved her around so much, so I go and help the others with their patients.
I knock on the door two hours later. I guess it doesn’t matter that I knocked or not, Ms. Neil is
unresponsive to external stimuli as it says in her chart, but it seems rude to just barge in.
“Don’t worry, Ms. Neil, I’m making this water nice and hot for you,” I say as I turn on the tap.
“Okay, I’m just unsnapping your gown, I’m gonna wash your arms first.” I squeeze the washcloth
and gently scrub from her shoulder down. It feels weird to narrate what I’m doing, but the video
we watched in class says to always talk to the patient, even if they can’t hear you. Plus it breaks
the heavy silence.
Ms. Neil’s body is light as a feather. Usually I need another person to turn a patient but her
frame is so tiny I know I can do it myself. I’m wiping her back when I realize that she is breathing
fast. Like really fast. Increased vital signs means increased pain, I remember from a slideshow.
Shit. Here I am torturing this poor lady. I turn her back so she is lying down.
“It’s okay, we’ll take a break,” I say. But even after a minute, her breathing is still weird. Not fast
this time but incredibly slow, with large gaps between breaths. She’s exhaled maybe twice since
I turned her back around. Oh god what have I done?
Luckily the real nurse steps in just as I am about to call her.
“I think I hurt her when I turned her, I was just trying to wash her back, but look at her chest,
that’s not right. What do I do?”
The real nurse steps towards us and puts her hand on Ms. Neil’s shoulder. “It’s okay.”
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Nothing about this seems okay, can’t she see this woman is not breathing normally, how do we
fix it what do I do, oh my god. I’ve just done something horrible to this poor innocent person.
“It’s okay.” the real nurse repeats. “This is it. Hold her hand.”
Suddenly I realize what is going on. This is it. Agonal breathing, classic, just like we learned. I
drop the washcloth and put Ms. Neil’s tiny hands in mine.
“It’s okay,” the nurse says, and I’m not sure if she is talking to me or Ms. Neil.
After a minute, the nurse takes her hand off Ms. Neil’s shoulder and I follow her lead. Ms. Neil
looks exactly like she did when I first walked in except this time she is alarmingly still. The nurse
makes a call, types something into a chart. “First time?” she asks.
It takes me a minute to process what just happened. I nod, something is caught in my throat,
and I start crying as I pour out the unused bathwater. Finally I manage, “Before you came in I
turned her. Did I do that?”
“No honey, not at all. It’s okay. We thought it might happen today. Ms. Neil’s been sick for a long
time, remember? You didn’t hurt her. It’s a good thing you were here otherwise she would have
been alone.”
I nod, trying to contain myself. It’s a good thing you were here, I think. If that nurse hadn’t shown
up what would I have done? The textbooks we read teach us how to perform head-to-toe
assessments and the proper angle to inject medications but not how to comfort people as they
are dying. Not how to stand when your knees are about to give out because the person—that
fellow human being, somebody’s grandmother, probably— in bed before you is taking their last
breaths and there is nothing you can do.
I’m not just a college kid anymore and that scares me.
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“Nursing is an art: and if it is to be made an art, it requires
an exclusive devotion as hard a preparation as any
painter’s or sculptor’s work; for what is the having to do
with dead canvas or dead marble, compared with having
to do with the living body, the temple of God’s spirit?
It is one of the Fine Arts: I had almost said,
the finest of Fine Arts.”
-Florence Nightingale
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