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2025 Laurie Glass, PhD Storytelling Session
No full textDr. Laurie Glass, Professor Emeritus at the University of Wisconsin- Milwaukee College of Nursing and Director of the Center for Nursing History, tells stories about Margaret Newman and Martha Rogers
Supplemental Data: Analyzing Point of Care Tools Through Faculty, Resident, and Stakeholder Buy-In: Promises and Pitfalls
Full text linkCosts for UpToDate, the library’s primary point of care clinical tool, had increased to half of the acquisitions budget but without user affiliation data to facilitate cost sharing. A working group led by librarians was formed to review alternatives. Surveys indicated users preferred UpToDate and renewal was recommended by the working group, with costs being shared between the academic unit and the hospital. These results showed that the library can effectively lead analysis projects with this level of visibility, but persuading users to consider alternatives to a trusted tool can be challenging.
Appendix 1 is a general survey meant to learn more about how UpToDate is used, to gauge its importance to researchers, measure the intensity of use, and to learn if there are any products that are considered comparable.
Appendix 2 was a follow up survey we designed to encourage users to review a point of care tool independently, learn about how useful it is to the user, and to gauge how quickly they could arrive at the answer sought.
Appendix 3 is the clinical question template we developed for faculty and other clinicians to test individual point of care tools to determine currency and accuracy.
Appendix 4 is a library evaluation of Dynamed, to determine if improvements made to the product have resulted in one that is superior to UpToDate
The Effectiveness of GAD-7 Screening in High School Students
Full text linkPurpose/Background
Adolescent mental health is a growing concern, with anxiety disorders being particularly prevalent among high school students. Left untreated, anxiety can significantly impact academic performance, social functioning, and long-term mental health. The COVID-19 pandemic exacerbated these challenges, highlighting the critical need for effective screening and intervention strategies. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated tool for identifying anxiety disorders, yet its application in high school settings is limited. This scoping review explores the effectiveness of GAD-7 in increasing mental health referrals and improving anxiety outcomes in high school students.
Methods
A comprehensive search was conducted across PubMed, CINAHL, PsycINFO, Cochrane, and Scopus databases, focusing on studies published between 2014 and 2024. Inclusion criteria targeted peer-reviewed articles evaluating GAD-7 implementation in adolescents aged 14–19 years, with measurable outcomes such as mental health referral rates and anxiety symptom reduction. Studies not meeting these criteria or published in languages other than English were excluded. Four articles meeting the inclusion criteria were critically appraised and synthesized.
Results
The review revealed that three of the four studies demonstrated significant increases in mental health referrals following GAD-7 implementation. Two studies reported reductions in anxiety symptoms among students referred to mental health services. The GAD-7 consistently showed reliability in identifying moderate to severe anxiety cases, facilitating earlier intervention and access to mental health resources.
Implications for Nursing Practice
Integrating the GAD-7 into high school settings can address gaps in adolescent mental health care by promoting early identification and timely referrals. These findings support the development of school-based mental health programs incorporating the GAD-7 to mitigate long- term consequences of untreated anxiety and enhance overall student well-being. Further research is recommended to explore the tool’s long-term impact and cost-effectiveness in diverse educational settings
Effectiveness of the Use of an Opt-out Script to Increase HIV Screening in Adolescent Clients in Pediatric Primary Care Clinics in West Tennessee: A Scoping Review
Full text linkPurpose/Background
The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) recommend one-time human immunodeficiency virus (HIV) screening for all adolescents. Pediatric primary care providers are on the front lines of adolescent healthcare and can provide testing that is adolescent-friendly, confidential, and easily accessible. This scoping review aims to synthesize the evidence and assess the literature on the efficacy of using an opt-out script to increase HIV testing in adolescent well-child checks.
Methods
A literature review was conducted between October 2022 and August 2024 to collect studies assessing adolescents aged 12-18, provider-led sex education, and rates of HIV screening. Using the criteria mentioned above, the Cinhal, Pub Med, EMBASE, Cochrane Library, and Access Medicine databases were searched, and 22 articles were found. The CDC website provided current HIV screening recommendations and the opt-out script. Ten inclusion articles were critically appraised and placed into a synthesis table and an evaluation summary table to organize findings.
Results
Our scoping review proves that taking advantage of an opt-out script leads to provider confidence in discussing HIV. It provides adolescent-friendly services during well-child visits in adolescents between 12 and 18, making them more comfortable discussing HIV education and completing HIV testing. In increasing the use of the opt-out script, awareness of HIV in adolescents will improve as well as lead to an increase in HIV prevention, protection, and treatment.
Implications for Nursing Practice
By utilizing and optimizing an opt-out script during adolescent well-child checks, there will be an increase in HIV education by providers and, thus, an increase in HIV testing. Utilizing an opt-out script will give providers the confidence to discuss HIV testing, provide the adolescent with a nonjudgmental approach to HIV testing, and allow the adolescent to experience adolescent-friendly health services to increase HIV education and testing
Evaluating Referral Rates for Positive Postpartum Depression Screenings at Telehealth and Well-child Visits: A Scoping Review
Full text linkPurpose/Background
Postpartum depression (PPD) affects one in nine women. It has distressing impacts, including behavioral and attachment issues and toveruse of healthcare services. PPD occurs within 4 weeks to 12 months postpartum. A scoping review was conducted to compare referral rates to mental health providers after PPD screenings were conducted via telehealth versus those completed at well-child visits.
Methods
Peer-reviewed articles published within five years before the initial search, beginning September 2022 and ending November 2024, were selected. Articles were sourced from several publications using an online library database with various MeSH terms and Boolean operators. Search results were narrowed to ten articles, and the Rapid Critical Appraisal (RCA) tool was used to determine the level of evidence and significance. Following article evaluations, two assumptions were made: 1) PPD screenings increase with various screening opportunities and 2) standardized PPD screening tools and guidelines for patient education and referrals enhance treatment and management.
Results
Evidence levels varied from Level I to Level VI. Topics ranged from telehealth effectiveness and interventions to pediatricians connecting women with mental health providers. Six articles showed an increase in PPD screening rates. Mental health referrals increased, patient satisfaction increased, and positive PPD screens increased in four studies. The Edinburgh Postnatal Depression Scale (EPDS) was used for screening in nine articles. Several studies concluded that screening increased when a standardized screening tool was used and when providers were properly educated on appropriate referrals. Overall, research on postpartum depression (PPD) screening is limited, highlighting the need for further research.
Implications for Nursing Practice
Research recommendations can be implemented into nursing practice, specifically for midwives, when conducting screenings during postpartum visits. Screenings beyond six weeks postpartum can occur via telehealth visits. Midwives can also develop good rapport with pediatricians to assist with referrals
Exploring the Matriculation and Resource Utilization of African American Students with Hidden Disabilities in the Health Sciences
Full text linkIntroduction. Learning disabilities result from genetic and neurobiological factors that alter brain function, such that cognitive processes related to learning are affected. Hidden disabilities can be defined as a non-apparent chronic condition that interferes with a person’s activities of daily living. While learning disabilities may be hidden, there are non-learning disabilities, such as dyslexia, autism, depression, fibromyalgia, and attention deficit hyperactivity disorder. While all races/ethnic groups have persons within their population who are disabled, African Americans are at a double disadvantage due to race and disability status. Therefore, the intersectionality of race and disability status among African American students in the health sciences may pose unique barriers to these students, both of which have a history of inherent inequalities that have plagued both disabled persons and African Americans for many years. While there is minimal literature that addresses the effect of hidden disabilities on students in the health sciences, there is a plethora of research on school-age and high-school students. Students with hidden disabilities (SHD) may be impacted by their disabilities when aiming to complete rigorous programs in graduate programs at health science centers. The Student Academic Support Services and Inclusion (SASSI) at The University of Tennessee Health Science Center (UTHSC) reported that African American students disclose their disabilities to institutional officials at lower rates than students of other races. This literature introduces the question of whether inadequate knowledge of and lack of use of institutional accommodations for African American students with hidden disabilities negatively impact matriculation in their respective graduate programs.
Purpose. The purpose of this study was to assess how African American students with hidden disabilities perceived their disabilities, disclosed the disabilities, and how their hidden disabilities impacted their matriculation through their programs and the use of institutional resources.
Methods. This study employed purposive sampling to select students for semi-structured interviews. Participants were selected from colleges at UTHSC. Semi-structured interviews were conducted via Zoom. 20 interviews were recorded, transcribed, and coded according to descriptive phenomenological analysis.
Results. The data from this study resulted in 47 clusters, each exhibiting various components to student’s experiences, grouped into 3 overall themes and 10 subthemes. The first was student’s perception of having a disability was lacked positivity, with 19 clusters supporting this overall theme, and 3 sub-themes under this overall theme. The second was experiences with disclosing disability status with 13 clusters supporting this overall theme, and 3 sub-themes under this overall theme. Finally, the last overall theme was access to and use of institutional resources, with 15 clusters supporting this overall theme, and 2 sub-themes under this overall theme as well.
Conclusion. The academic success of African American students with hidden disabilities is a multi-faceted phenomenon that da working tandem between the student, professors, and institutional officials. For African American students who have hidden disabilities, it is important that these students received equitable and fair treatment during the graduate careers to promote their success. The implementation of the student recommendations is a start for evolving the current processes and procedures to reduce barriers to obtaining and accessing institutional resources and accommodations for African American students. The results of this study showed that African American students with hidden disabilities had a unique experience in the health sciences. The intersectionality of race and disability status should be realized as a true phenomenon and considered by professors and institutional officials who have a direct impact on these student’s success and progression. The results from this study are a strong foundation to future studies that can lead to potential policy reformation and implementation to better support and alleviate present barriers that African American students face
Perinatal Mood and Anxiety Disorders (PMADs): A Scoping Review
Full text linkPurpose/Background Perinatal Mood and Anxiety Disorders (PMADs), including postpartum depression, anxiety, and psychosis, significantly impact maternal and infant health. This scoping review consolidates current literature on PMADs, emphasizing prevalence, risk factors, screening, and treatment. The primary aim is to identify research gaps and inform clinical guidelines to enhance perinatal care.
Methods A literature search followed PRISMA guidelines from August 2022 to November 2024. Databases searched included PubMed, CINAHL, Scopus, and Google Scholar, using terms such as perinatal mood disorders and maternal mental health. Inclusion criteria were English-language studies from the past decade addressing PMADs during pregnancy and up to one year postpartum. Of the 32 studies identified, 11 met the criteria for detailed analysis. Extracted data included study design, sample size, prevalence, screening tools, interventions, and outcomes.
Results Standardized screening protocols, such as the Edinburgh Postnatal Depression Scale (EPDS), and culturally tailored cognitive-behavioral interventions were effective. Nursing-led and community-based approaches, including home visitation, reduced PMAD symptoms and improved care adherence. Socioeconomic barriers and limited resources were significant challenges, especially in underserved populations. Research gaps persist regarding PMADs in marginalized groups and the long-term effects on maternal and infant health.
Implications for Nursing Practice This review highlights the need for accessible, culturally sensitive, evidence-based PMAD management—nursing has a key role in screening, intervention delivery, and policy advocacy. Future research should prioritize equitable care models to improve maternal and infant outcomes globally
The Lived Experience of Acute Stroke Advanced Practice Registered Nurses (APRN) Working in Expanded Roles: A Mixed Methods Study
Full text linkIntroduction. Nurse practitioners have made credible gains through the six decades since inception to cover the growing need for outpatient family care. Nurse practitioners are now working in all aspects of medicine by continuing to fill gaps with healthcare needs that persist due to physician shortages. Stroke neurology is a medical specialty plagued by a shortage of physician specialists in hospital acute care which can limit acute stroke diagnosis and treatment capabilities. Stroke nurse practitioners (SNP) are vascular neurology trained specialists who fill relatively new hospital roles to assume traditionally physician-based responsibilities in an expanded role. This study aims to understand SNPs working in expanded roles to build knowledge of their lived experience.
Methods. A convergent mixed methods design with quantitative and qualitative results merged was used to provide a comprehensive representation of the SNP lived experience. Each participant completed a questionnaire using SurveyMonkey. The questionnaire included personal, education, and work role data, as well as barriers to scope of practice. The questionnaire also included the Dempster Practice Behavior Scale (DPBS) that measures nurse practitioners’ perceived autonomy. Qualitative methods used semi structured focus group interviews after questionnaires were completed. Quantitative data was analyzed using SPSS; qualitative data was analyzed with NVIVO to identify themes. The quantitative and qualitative data were then integrated to support meta-inferences.
Results.A total of 14 SNPs were enrolled: age (Mdn= 44, IQR 38.75, 50.25), 85.7% were female, years of work experience (Mdn = 13, IQR 4.5, 21). All were Masters prepared with five completing higher levels of education. Nine participants worked in reduced or restricted states. Most SNP duties entailed diagnosis, treatment and management of acute illness for assigned patients and administration of thrombolysis. The DPBS findings showed high total autonomy (Mdn = 130, IQR 120.75, 140.50); subscale findings were: Readiness (71.43% high scores and 28.57 moderate scores); Empowerment (71.43% high scores and 28.57 moderate scores); Actualization (100% high scores); and Valuation (85.71% high scores and 14.29 moderate scores). The following themes emerged from the SNP interviews: 1) Independence with subthemes of work related confidence and clinical leadership; 2)Barriers with subthemes of policy-driven and physician-driven scope of practice restrictions; 3) Collaboration with neurology physicians and physician specialties. Merging of data produced meta-inferences confirming SNPs working in expanded roles are highly educated, experienced clinicians with high levels of practice autonomy that is discordant with practice barriers, and their scope of practice. SNPs expanded neurovascular knowledge showcases their value and enhances collaboration with physicians and other practitioners.
Conclusions. The numbers of primary and comprehensive stroke center hospitals continue to increase in the USA, whereas there is an ongoing vascular neurology shortage. The demand for SNPs will continue to increase to meet patient care needs. While highly educated and autonomous, SNPs must become more aware of their scope of practice and legal restrictions to practice expansion to ensure regulatory compliance and increase efforts to remove unnecessary barriers to practice
2025 HEC Storytelling Recording 1
No full textThe art of storytelling is a vital component of oral history, serving as a primary method for preserving and transmitting cultural practices, knowledge, and history across generations. Historically, oral storytelling was the key to maintaining traditions before written language emerged. The oral traditions of storytelling been essential for passing down knowledge in societies without written records. Through interviews and recordings, oral histories capture individual experiences, enriching our understanding of past events. Storytelling exists universally across cultures and ages. Culturally, storytelling bridges cultures by offering insights into diverse perspectives, beliefs, and values. It dynamically connects generations and fosters a sense of community through shared narratives. Today, storytelling continues to connect generations, share personal narratives, and foster community bonds. It fuels the delivery of messages making stories effective tools for conveying information, sharing lessons, and inspiring actions that are relevant for modern times. We used storytelling during and following the health as expanding consciousness dialogue as a way to capture lessons learned and new messages about health as expanding consciousness (HEC) theory to create a shared meaning about theory use in nursing education, practice, and research. This site contains a few recorded stories from participants who attended the 2025 HEC dialogue. Additional stories will be uploaded for future listening
Racial Differences in Distress Symptoms Among Black and White Women with Hormone Receptor-Positive Breast Cancer on Adjuvant Endocrine Therapy
No full textIntroduction. Depression is a pervasive mental health condition, often likened to the common cold of psychiatry due to its high prevalence, particularly among women. It significantly contributes to disability, personal suffering, and increased mortality, especially in the context of chronic illnesses like breast cancer. As one of the most common cancers affecting women globally, breast cancer not only poses physical health challenges but also engenders profound psychological distress, with rates of depression varying widely among patients. This emotional burden is exacerbated by the complexities of cancer treatment and the societal factors that influence health outcomes, particularly among racial minorities. Research indicates that women diagnosed with breast cancer experience significant rates of distress and depression throughout their treatment and survivorship phases. The co-occurrence of these psychological symptoms can complicate treatment adherence, leading to poorer health outcomes and quality of life. Notably, Black women face unique challenges, including systemic barriers to healthcare access, cultural attitudes toward treatment, and experiences of discrimination, which contribute to their lower adherence rates to adjuvant endocrine therapy (AET) compared to their White counterparts. Understanding the trajectories of distress and depression among breast cancer survivors, particularly through the lens of racial differences, is crucial for developing effective interventions that enhance psychological resilience and improve patient outcomes. This dissertation aims to explore the intersection of depression, treatment adherence, and racial disparities among women with early-stage hormone receptor-positive (HR+) breast cancer. By examining the psychological and psychosocial impacts of breast cancer across different stages of the disease trajectory, this research seeks to identify key predictors of distress and develop tailored interventions that address the unique needs of diverse populations. Ultimately, this work underscores the importance of a multidisciplinary approach to cancer care that prioritizes the mental health and well-being of all survivors.
Methods. This dissertation encompasses three distinct studies examining psychological distress and depression among women diagnosed with early-stage hormone receptor-positive breast cancer. The first study is a narrative review of literature that involved a systematic search of the PubMed and CINAHL databases, supplemented by Google Scholar to capture relevant articles published in English. Utilizing search terms such as breast cancer, distress, depression, trajectories, racial differences, and survivorship, a total of 24 studies were included based on criteria that focused on adult breast cancer survivors and examined psychological distress or depression as a primary outcome. The second study employed qualitative methods through four focus groups with 28 women, divided into two groups of Black women and two groups of White women, all diagnosed with early-stage hormone receptor-positive breast cancer. Participants were recruited from the West Cancer Center and engaged in discussions about their experiences with breast cancer diagnosis, treatment, and survivorship. These discussions were audio-recorded, transcribed, and analyzed using Saldana’s value-based coding method, which facilitated the identification of themes related to emotions, values, attitudes, and beliefs. The third study utilized a historical cohort design to assess the prevalence of distress and depression among women undergoing AET at the West Cancer Center from January 1, 2015, to December 31, 2019. A total of 1,501 patient charts were reviewed, yielding 122 eligible participants. Data were collected at five time points using the Patient Care Monitor (PCM), which captures patient-reported outcomes regarding treatment side effects and emotional symptoms. Distress and depression were measured using single-item scales ranging from 0 (not a problem) to 10 (as bad as possible), alongside sociodemographic and clinical characteristics to analyze their relationship with reported levels of distress and depression.
Results. The results of this dissertation reveal significant insights into the psychological distress and depression trajectories among women diagnosed with early-stage HR+ breast cancer. In the narrative review, diverse trajectories of psychological distress were identified, including stable low distress, acute distress with recovery, and persistent high distress, with studies indicating that Black survivors experienced consistently higher levels of distress compared to non-Hispanic White survivors. Notably, pre-existing mental health conditions were found to significantly influence these trajectories, underscoring the need for tailored interventions. The qualitative study highlighted six salient themes from focus group discussions with women undergoing AET, including Emotional Resilience and Support, Information Needs and Communication, Treatment Adherence Strategies, the Impact of Side Effects on Quality of Life, Spiritual Beliefs and Coping Mechanisms, and Healthcare System Navigation Challenges. Participants emphasized the critical role of emotional support and clear communication with healthcare providers while navigating treatment side effects and adhering to medication regimens. In the quantitative cohort study, baseline characteristics of 122 women showed significant differences in age and body mass index between Black and White participants, with Black women being younger and having a higher BMI. The prevalence of distress and depression at AET initiation was reported at 72.1\% and 75.4\%, respectively, with trends indicating an increase over time, particularly at the 12-month follow-up. Significant predictors of distress included a history of mental health diagnoses and baseline anxiety, while depression was associated with menopausal status and previous mental health conditions. Correlation analyses revealed that the total number of medications at diagnosis and AET initiation was significantly associated with distress and depression, suggesting that medication burden may serve as a proxy for other clinical predictors. Overall, these findings highlight the complex interplay of demographic, clinical, and psychosocial factors affecting the emotional well-being of breast cancer survivors, emphasizing the necessity for ongoing support and targeted interventions throughout their treatment journeys.
Discussion and Conclusion. This dissertation provides a multifaceted exploration of psychological distress and depression trajectories among women with hormone receptor-positive breast cancer, emphasizing the nuanced influences of race, mental health history, and social determinants on these experiences. The narrative review revealed a complex interplay of demographic and clinical factors affecting psychological outcomes, highlighting that while many survivors experience improvements in well-being over time, a significant number continue to face persistent challenges, particularly among Black women who may encounter systemic barriers and cultural stigmas that complicate their mental health journeys. The qualitative findings underscored the importance of personalized patient-provider communication and the role of emotional support systems in navigating treatment, with distinct differences in coping strategies observed between Black and White women. Specifically, Black women often drew strength from their faith and community, while White women expressed feelings of fear and isolation. In the quantitative analysis, pre-existing mental health diagnoses emerged as critical predictors of distress and depression, overshadowing race as a direct determinant, indicating that addressing mental health concerns is essential for improving psychological outcomes during adjuvant endocrine therapy. The moderate predictive ability of the models suggests the need for further research into additional unmeasured factors, such as social support and treatment adherence, which may also influence psychological well-being. Overall, these findings highlight the urgent need for culturally competent, holistic approaches to breast cancer care that integrate mental health support, tailored interventions, and ongoing follow-up to enhance the overall quality of life for all survivors. Future research should prioritize diverse populations and longitudinal studies to better understand the long-term impacts of treatment on mental health, ultimately contributing to more equitable healthcare practices and improved outcomes for women facing breast cancer