Dunphy, Lynne M.

The leading cause of disability among older adults is osteoarthritis (OA) (Centers
for Disease Control and Prevention [CDC], 2017). Chronic pain associated with arthritis
interferes with daily living among older adults and has been related to depression
(Zanocchi et al., 2008). Research suggests that ethnicity and psychosocial factors may
influence health outcomes of older adults with arthritis who are experiencing chronic pain
and depression (Im, Guevara, & Chee, 2007; Wilson et al., 2014). The influence of
ethnicity on depression among older adults with OA experiencing chronic pain is the
phenomenon of interest for this study. Chronic pain that interferes with activities of daily
living gives rise to disability, followed by potential episodes of depression. This currently
is impacting the quality of life for older adults with OA. The aim of this study was to gain new insight regarding the relationship and
predictive factors for depression between pain interference, gender, and ethnicity among
older adults with OA pain and depression. This study examined the research question, “Does ethnicity, gender, and pain interference predict depression among older adults with
osteoarthritis?”
This study was a secondary analysis of existing data from the National Institute of
Health National Center for Complementary and Integrative Health (Park, McCaffrey,
Newman, Cheung, & Hagen, 2014) study titled, The Effect of Sit ‘N’ Fit Chair Yoga on
Community-Dwelling Elders with Osteoarthritis. A descriptive retrospective correlational
design was utilized to investigate factors that predict depression. Statistical analysis
included multiple linear regression and analysis of variance. The study sample (n = 104)
consisted of community-dwelling older adults ages 65 years or older with osteoarthritis.
Findings indicated that (1) ethnicity, gender, and pain interference did predict
depression; (2) there were no significant difference in depression between Hispanics and
non-Hispanics while controlling for pain interference; and (3) there was statistically
significant differential interaction with depression when pain interference increased, with
Hispanics reporting higher levels of depressions as pain interference increased, as
compared to non-Hispanics.
The new knowledge gained from this study may help guide healthcare providers
in developing effective alternative approaches for improving health outcomes of
mismanaged ethnically diverse older adults with OA.

Ethnically diverse older adults are the fastest growing population in the U.S. This population may experience transitional processes associated with immigration, acculturation, aging, and end of life (EOL). Advances in technology lead to increases in care options, which can cause uncertainty to make decisions for EOL. Unmade decisions about care prior to becoming unable to communicate are associated with burdens of last-minute decisions at EOL, unwanted intensive EOL treatments for people who may die naturally of old age, financial and emotional costs, and decreased quality of life. In the U.S., a multicultural country with a variety of care options, advance directive (AD) completion and advance care planning (ACP) may improve culturally competent and person-centered care at EOL. However, the rate of AD completion and ACP is low among Americans, especially immigrant communities. These communities, including Iranian-American older adults, have been frequently understudied, and there is a gap in studies of EOL desires, attitudes, and actions/behaviors. This inquiry focused on planning ahead for EOL care across transitional processes that older immigrants may face. The aim was to enhance culturally competent care for older adults through distinguishing significant factors, which may influence planning for EOL care. Specific purposes were: To identify relationships between attitudes toward planning for EOL care and social supports, spirituality, healthcare system distrust, and acculturation; to identify a relationship between attitudes and proactive actions toward planning ahead in Iranian-American older adults. Conceptual frameworks for this descriptive, cross-sectional study included Culture Care Diversity and Universality and Transitions theories. Findings from 135 participants revealed that they were new immigrants to the U.S. (mean year of 23 in the U.S., 97% born in Iran) and highly educated and insured with high health statuses. About 55% preferred non-intensive treatments and/or homecare at EOL, and 52.6% had not communicated their EOL wishes. Attitudes toward planning ahead for EOL were positively associated with acculturation and healthcare system distrust, and negatively associated with spirituality. No significant association was found between attitudes and social support. Furthermore, favorable attitudes predicted higher proactive actions to communicate wishes. Implications for practice, policy, education, and recommendations for further studies were discussed.

This dissertation analyzes a nursing artifact: the infant/invalid feeder. A material
culture analysis, developed by the author, is utilized for the in depth study of 12 feeders.
This work assumes that Caring is the core value of what constitutes nursing and nursing
practice. The expression of the aesthetics of nursing through the act of feeding and use of
infant/invalid feeders, aesthetic knowing and expression of that knowing, links caring and
caring presence.
The act of feeding another, whether sick or infant has been the domestic sphere of
women throughout history and is also considered one of the most important duties of the
nurse. For centuries women have provided nourishment to others. Much of this has been
accomplished through the use of utensils designed specifically for the purpose of feeding
those too ill or young to independently do so themselves. Material culture study, a method of examining artifacts and the cultural messages
that they contain is employed as the methodology for research. A detailed investigation
of the nursing literature reveals that there have been no material culture studies of
nursing's artifacts to date. In this dissertation the author designed and utilized her own
model for the analysis of 12 invalid feeders.
The material culture analysis of the twelve feeders leads to a greater
understanding of the history and evolution of nursing practice in the United States.
Significance and recognition of feeders in England and their continued use versus their
obscurity and unfamiliarity in the United States serves an example of the changes and
differences that have occurred within the social context of the culture as a whole and
nursing culture in particular.
Feeding of patients with feeders by nurses serves as an example of the
complexities of human caring and the aesthetic practice of nursing. Nurses can gain from
the material culture studies of nursing artifacts, paying greater attention to the ways that
make us human and humane. This work has related the caring and the aesthetic of
nursing practice to the everyday act of feeding and challenges nurses to continue to find
ways to demonstrate nurturing and caring to those we have the privilege to nurse.

The purpose of this study was to develop a theory of survivorship in long-term breast cancer patients, and a subsequent educational program to assist health care practitioners to guide these survivors. Seven women who had survived breast cancer for at least 10 years, were interviewed over a twelve month period. This qualitative study used Glaser & Strauss's grounded theory method to generate the process of survivorship for these women. The emergent core category, "life's journey" was characterized by two core variables, "caring with self" and "completing the grieving process". The following themes emerged from within these variables: coping strategies, maintaining support networks, accepting self-image, motivating stressors, seeking information, and relying on spirituality. Implications for nursing and recommendations for further research are presented.

With expanded nursing roles emerging in the health care system, it is imperative to identify psychological barriers that can limit the potential of these practitioners. If feelings of inadequacy exist in the RNFA, the nurse may pursue tasks that are less than those of which the person is capable. The purpose of this study was to ascertain if RN First Assistants (RNFA) experience the impostor phenomenon, an intense, subjective feeling of achievement-related fraudulence. The Impostor Phenomenon Scale, a 14 item, 7-point Likert Scale, was self-administered to 109 registered nurse First Assistants to determine the degree of security and comfort they experience in their roles. The results of this research indicated that the RNFA sample did not experience the impostor phenomenon. The demographic data presented some facts that can possibly explain the high degree of competency that RNFAs perceive in their role.

From 1850 to the present doctors have been examining the phenomenon now known as fibromyalgia, primarily in upper-middle class women. Some sources relate this to a lack of clearly defined roles for women since industrialization and urbanization changed family life. Medicine has not been able to effectively determine the etiology and treatment for this syndrome. Women's voices are "falling on deaf ears". Documented cases of fibromyalgia go back as far as biblical times. It is found in all geographic areas and has been labeled with many different names. In spite of these facts, it was not until 1990 that a name and a diagnostic criteria for fibromyalgia syndrome was established. In order to understand the impact illness has had on women this paper will explore the relationship of historical events, social and medical views toward women and fibromyalgia-like illnesses from 1850 to the present.

The purpose of this paper is to enable the reader to gain a truer understanding of the treatment of Urinary Incontinence over the past one hundred and fifty-five years. Specifically this work will compare medical and nursing interventions to those of the alternative medicine and lay or popular medicine practices. Grounded in historicism, the study produces a documentary effect allowing the reader to empathize with the healers of the past. The social context of the specific time frame was integrated into the study illuminating the Jacksonian and Progressive eras. In addition, the birth of professional nursing as we know it rose alongside allopathic medicine. This research is relevant to nursing history because it provides context for the work of nursing. Medicine used advancing technology to catapult the profession into a position of power capable of dictating advertising standards and influencing legislation. The significance of this study is its contribution to the paucity of existing knowledge of the history of Urinary Incontinence interventions. The nursing significance will outline the development of the profession as well as outlining nursing interventions and care of the incontinent person. This is the first comparison of the popular treatment with the prescribed treatment of Urinary Incontinence in the illuminated time period.