Christine E. Lynn College of Nursing

Infant feeding is a universally recognized practice yet, it is profoundly influenced by culture. While it is well accepted that breast milk is the gold standard for infant feeding in the United States, the persistence of breastfeeding disparity among minorities, particularly among Black women in the U.S. is not well understood. According to the literature, Black mothers in the U.S. remain among the least likely to both initiate and exclusively breastfeed. Although infant feeding research related to African American women's practices has been widely explored, there is a paucity of knowledge related to the experiences and practices of foreign-born Black women in the United States. More studies are needed to examine factors influencing the infant feeding practices of foreign-born Black women. This research may identify new strategies for addressing breastfeeding disparity among Black populations. This ethnographic research employs Leininger's Cultural Care Diversity and Universality Theory and Bronfenbrenner’s (1994) Social-Ecological Model to explore influencing factors on Black Jamaican women’s infant feeding practices during the first six months of life. By applying these theories as a guide for inquiry, this study seeks to identify influencing factors on Jamaican women’s infant feeding practices in the United States. Data collection involved conducting semi-structured interviews and focus groups with 14 participants aged between 30 and 40 years. Five themes emerged from the data: (1) It’s What I Saw, It’s What I Know, (2) Me Personally, (3) Riding Out The Storm, (4) During the Storm, (5) On De Road and Outta Door. The findings highlight the need for culturally competent nursing care to promote infant health within this growing population in the United States.

The worldwide threat of Diabetes Mellitus (DM) has been increasing rapidly, and is now an estimated 463 million, of which 55 million people originate from Middle East and Nort African (“MENA”) region (international Diabetes Federation [“IDF’], 2020). In Saudi Arabia, the prevalence of diabetes has roughly reached a ten-fold increase in the past three decades, placing Saudi Arabia’s incidence as one of the highest globally (Almubark et al., 2022). The purpose of the study was to examine the relationship between health and diabetes self-management among Saudi adults with Type 2 Diabetes Mellitus (T2DM). The study further aimed to explore how Saudi adult with T2DM seek and utilize diabetes knowledge to self-manage their diabetes. The study was guided by Leininger’s Culture Care Diversity and Universality Theory (2002). Leininger’s Sunrise Enabler- Model provided a framework to explore the various factors that affect diabetes self-management through a cultural lens. This model provides a comprehensive understanding pf multiple factors influencing diabetes self-management.
A sample of 66 Saudi adults with T2DM aged 40-61 and older was recruited from diabetes center and Primary Healthcare Center (PHCC) at National Guard Hospital King Abdulaziz Medical City Jeddah, Saudi Arabia. A Parallel Mixed Method (PPM) design was applied, using semi-structured interviews, Diabetes Self-management Questionnaire (DSMQ), Short Test of Functional Health Literacy in Adult (S-TOFHLA), and sociodemographic surveys.

The veterans are a unique community shaped by past military experiences that may have positive and negative effects on their well-being as soldiers. With nearly half of the 18.4 million veterans in the United States living beyond 61 years, age-related physical and mental health conditions may impact the veterans’ well-being. Promoting veterans’ well-being has been studied extensively but literature on how they define it is scanty. It is critical to understand how veterans define well-being to inform future program development to address mental health needs. The purpose of this study is to discover the meaning and the lived experience of well-being among veterans. The methodology used for this study was a qualitative hermeneutic interpretative phenomenological approach to understand the meaning of veterans’ well-being. It allowed the phenomena to surface while exposing the essence of and the experience. The sampling method for recruiting participants was purposive sampling, with semi structured interviews conducted via ZOOM and direct observations at Veteran Service Organizations (VSOs) to obtain data. Fourteen veterans participated in this study, comprising eight males and six females with majority aged over 61 years. In terms of race/ethnicity, 64 % were White, 21% Hispanic and 15 % African American. With the use of Max van Manen’s analysis strategy, seven major themes emerged: (a) A Connection With A Special Bond To The Military Sisterhood/Brotherhood, (b) The Lingering Effects Of Military Service Continue To Simmer In Veteran life, (c) Feeling Grateful/Prideful Through Appreciation For Their Military Service, (d) Healthy Companionships/Relationships With Mutual Respect Yield Veteran Equilibrium, (e) Creating A Veteran Framily/Fraternity, (f) Self-fulfilment By Giving Back And Making A Life With A Purpose and (g) Veterans Living A Healthy Life Caring For Self. Six of the seven themes addressed the veterans’ well-being. The lingering effects have persisted and challenged the Veterans’ emotional well-being. However, they were able to express their military camaraderie even in the veterans’ life. Programs based on social relationships that allow connections with veterans and/or their significant others need to be established.

Background: Almost seven million persons in Saudi Arabia are diagnosed with Type 2 Diabetes Mellitus (T2DM). Lack of knowledge regarding T2DM among Saudi caregivers may impact T2DM management and disease outcomes, yet established educational programs for their caregivers are scant. There is a need to discover T2DM informal caregivers’ knowledge and its relation to patients' T2DM management, prior to designing educational interventions.
Purpose: The purpose of this quantitative, correlational study was to measure disease knowledge among informal caregivers for patients with T2DM in Saudi Arabia, and to compare findings to the patient-health status presented by HbA1C level. This study was conceptualized within nursing caring science, using Nursing as Caring Theory (Boykin & Schoenhofer, 2001), and the Individual and Family Self-Management Theory (Ryan & Sawin, 2009).

There are two types of stigmas: self-stigma and public stigma. The focus of this dissertation was public stigma. The public stigma encountered by persons with Alzheimer’s Disease (AD) contributes to the isolation of families due to the effort made by AD caregivers to adjust to social challenges (Abojabel & Warner, 2019). According to the Saudi Alzheimer’s Disease Association (2022), there are 130 thousand documented cases of AD, which comprised 9% of the aged population. The severity of stigmas can vary across cultures because stigmas of disease are connected to cultural norms (Corrigan, 2014). Most studies conducted in Saudi Arabia have assessed public stigma regarding mental illnesses, but no study has been found regarding public stigma within the AD scope. Population-based approaches that attempt to clarify stigma level prevalence in representative samples are important to develop methods to address these disparities and ensure equitable access to health care within the population's cultural context.
The aim of this study was to 1) identify the relationship between public stigma and the level of AD knowledge among the Saudi population and 2) identify the potential factors that were associated with public stigma and AD knowledge levels among Saudi community members, within the context of a caring science perspective using critical caring theory and specific-situation theory.

Excessive alcohol use, in addition to economic and social impacts, increases the risks of numerous chronic health problems, which further increase societal costs (Gloppen et al., 2022). Over 5% of the global burden of disease and injury as calculated in disability-adjusted life years, stems from alcohol use (World Health Organization [WHO], 2023). In the United States, nearly 30 million persons in 2021 experienced alcohol use disorder (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2023a). Among these, the Latino population is prone to be diagnosed with alcohol use disorders (NIAAA, 2023a). Limited research is available regarding alcohol use among a particularly vulnerable Latino group: farmworkers (Arcury et al., 2016). To date, no phenomenological studies exploring the lived experiences of Latino farmworkers (LFWs) who drink alcohol have been found in the literature.
The purpose of this study was to explore the lived experience of LFWs who use alcohol through a phenomenological approach to gain a greater understanding of LFWs’ experiences with alcohol. A semi-structured interview guide containing open-ended questions was used as the main qualitative measure. A sociodemographic survey was used at baseline to collect the participants’ sociodemographic data and to assess patterns of alcohol intake. Eighteen participants were interviewed. Interviews were audio-recorded on a digital recording device, and they were transcribed by the student researcher. Analysis of the transcriptions was performed by the student researcher and a dissertation committee member using Colaizzi’s (1978) seven-step phenomenological analytic method and ATLAS to search for themes.

Falls among older adults are steadily increasing and contribute to the growing mortality and morbidity rates of this population. Fall prevention measures are complex and require a multidimensional approach to reduce associated risk factors. Older adults with more engagement were less prone to feelings of loneliness and, consequently, exhibited elevated levels of physical, psychological, and social well-being. This project explores the potential use of chair yoga as a non-pharmacological intervention to enhance balance and well-being among older adults residing in an assisted living facility. Evidence shows physical activity using yoga can decrease fall risk factors and improve psychological health. The project leader provided instruction on the implementation of chair yoga over a six-week period. The findings showed an improvement in balance based on the BERG Balance Test, and the WHO-5 Well-Being Index demonstrated an improvement of well-being. These results highlight the benefits of chair yoga in improving balance and a sense of well-being in this population. Further investigation is needed in motivational strategies, recruitment, and staff engagement. This project emphasizes the importance of physical activity programs among older adults residing in Assisted Living Facilities to improve overall health and well-being.

Background: Suicide is a major health problem that is among the leading causes of deaths in the United States and can be prevented through community-based interventions. Suicide rates in older adults are increasing. Common suicidal risk factors include a decline in cognitive function, having other psychiatric comorbidities, and dementia. The risk for suicide increases for individuals within the first three months of receiving a dementia diagnosis and includes the first three months of another subgroup of individuals who were diagnosed with dementia before the age of 65.
Purpose: The purpose of this quality improvement project is to educate the staff at a memory and wellness center in Boca Raton on how to use a standardized suicide screening tool to improve their knowledge and perceived comfort in utilizing the tool and providing care to patients with dementia.

Chronic disease affects over 51% of Americans and often results in emotional, financial, and spiritual distress. Additionally, the exorbitant cost of managing chronic disease is creating a significant burden on healthcare systems. Self-management, which is crucial to disease outcome includes lifestyle changes and adherence to treatment regime. However, these lifestyle changes often cause emotional and physical struggles for those diagnosed with chronic disease. Spirituality is recognized as a source of support to alleviate stress and anxiety and provide the individual with the strength to make sense of the experience and move forward with their lives. The aim of this quality improvement project is to determine if a 10-week spiritual health education program enhances adults’ ability to self-manage their chronic disease. The education program included weekly bible devotionals and discussions on adapting healthy living including exercises and mindfulness meditation. The spiritual health education intervention sessions were provided online via Zoom and in-person. Participants were recruited from community churches. Inclusion criteria: English-speaking, adults (older than 18 years), with at least one chronic condition. All participants were asked to complete the Spiritual Needs Questionnaire (SpNQ) and the Self-Management Assessment Scale (SMASc). Paired samples t-tests were conducted to evaluate differences in participants SpNQ and SMASc scores pre and post receiving the spiritual education sessions. Significant differences were found between the test-retest scores on the SMASc questionnaire. A chi-square test was used to evaluate differences in the SMASc scores between virtual and in-person groups. There were no significant differences found in the test-retest SMASc scores. Additionally, differences were not found on the SpNQ scores between participants who received the education sessions online or in-person. The findings from this project can easily and cost-effectively be implemented in multiple, accessible locations.

Residents in long-term care settings with behavioral psychiatric symptoms in dementia (BPSD) are at increased risk of experiencing lower quality of life due to inconsistency in staff assignments. BPSD and inconsistent staff assignments affect residents' quality of life due to stress and anxiety experienced during activities of daily living (ADLs), interfering with caregiving and daily functioning. According to Brennan et al. (2017), “By minimizing the number of different staff who provide care during a resident’s stay, consistent staff assignment promotes more resident-centered care and is thought to result in improved resident functioning and quality of life” (p. 851). There is an urgency for healthcare providers, administrators, and caregivers to address this problem. The purpose of this program evaluation project was to assess the effect of consistent caregivers’ assignments on residents in long-term care facilities exhibiting behavioral psychiatric symptoms of dementia (BPSD). This project was implemented at Brookdale Palm Beach Gardens and consisted of a convenience sample of residents from the memory care unit (N=21). Additionally, 19 caregivers were trained and assisted with the data collection using the Agitated Behavior in Dementia (ABID) scale for the nine-week duration of the intervention. Furthermore, an extensive review of medical records and medication administration records was completed to identify the frequency of psychotropic medications used to relieve BPSD. The descriptive statistics data were analyzed for nine- weeks using Intellectus statistics software program (2021). The descriptive statistics included means, standard deviation, and frequency distributions. The variables distribution is not considered to be asymmetrical about its means, and it is not markedly different than a normal distribution. The improvements that were seen throughout the program, though not statistically significant, should not be ignored; they can be promising for a similar future project.