Historical research pertaining to the movement of nursing education from hospital based apprenticeships to collegiate based professional education during the mid-twentieth century is being studied by Nancy Barnum, PhD, RNC, Assistant Professor of Nursing at Hope College.

Formal nursing education began as apprenticeship-type training in hospital schools of nursing in which nursing students provided the majority of patient care. The hospital schools were governed by physicians and hospital administrators, and as long as nursing education remained in this setting, nurses were ensconced in subordinate positions within the patriarchal society of medicine and the hospital. In order for nursing to break free of this restrictive relationship and into self-governance, nursing education needed to move out of the hospitals and into collegiate settings.

The major research questions asked by Dr. Barnum have been as follows: To what extent did nurse veterans’ use of G. I. Bill educational benefits following World War II influence the movement of nursing education into colleges and universities? Did the availability of these benefits provide nurse veterans the means to escape nursing’s patriarchal relationship with medicine? Dr. Barnum’s hypothesis of the findings was that increased access to educational funding did bring more nurses into institutions of higher education seeking bachelors and masters degrees, thereby legitimizing nursing education’s place in academia and providing them with more options for practice which would bring about more independence for them and for the profession of nursing.

Archival research was conducted at two types of schools of nursing: one hospital school of nursing and one university school of nursing, as well as in the professional literature published during the time studied. Data was analyzed within the framework of the patriarchal relationships present between physicians and nurses and the gendered organization of the mid-twentieth century hospital and hospital school of nursing. The findings of Dr. Barnum’s research show that nurse veterans did use G. I. Bill funds to attend colleges and universities for degrees in public health nursing. This field of nursing was not traditionally a part of hospital-based diploma programs, and therefore provided additional knowledge and skills. World War II nurse veterans, who had experienced increased autonomy and independence of practice during the war found these attributes in the specialty of public health which allowed them to practice in an environment less governed by physician paternalism.

Future expansion of Dr. Barnum’s research will include oral histories with World War II nurse veterans who used G.I. Bill funds to pursue bachelors and masters degrees in public health nursing once external funding is secured.

Creating and Sustaining Diversity in Baccalaureate Nursing Education

Dr. Barton currently has two areas of research. The first is Creating and Sustaining Diversity in Baccalaureate nursing education. Racial and ethnic minorities in the United States experience disparity in the health care services they receive and in their health related outcomes. Minority healthcare providers are more likely to serve minority medically underserved populations, thus addressing this healthcare disparity in an effective, culturally competent manner (Sullivan, 2004; Robert Wood Johnson, 2005). The purpose of this work is to increase the number of racial/ethnic minority students at a Hope College who successfully graduate from the baccalaureate nursing program and seek employment locally as registered nurses to improve nursing care and health related outcomes for all members of the community. The project was developed as a model for other schools aiming to increase the diversity of their student body. The project planning phase involves identification of perceived barriers to increased minority participation in nursing at the college, planning of evidence- based interventions to overcome the identified barriers, and securing resources for implementation. The second phase of the project is the implementation and on-going evaluation of the project.

Improving Drinking Water Quality for Rural Villages in Africa: A Pedagogy for Empowerment
Principal Investigators:

Jeff Brown, Assistant Professor, Department of Engineering, Hope College
Amanda Barton, Assistant Professor, Department of Nursing, Hope College
Susan Cherup, Professor, Department of Education, Hope College

The adverse health affects associated with drinking “impure” water are well understood. Widespread access to safe drinking water is the exception rather than the norm in Africa. This is especially true in rural settings where the issue of poor water quality is often compounded by insufficient water quantity. The hard realities associated with water-borne illnesses and the impact they can have on a community provide strong motivation for action.

This research seeks to develop an educational framework for training motivated entrepreneurs and NGOs in the effective construction, use and promotion of Manz Biosand Filters. This existing point-of-use filtration technology has shown potential for improving drinking water quality in resource-scarce environments. What is still needed, however, is a model for effective engagement in underdeveloped communities that will result in empowerment rather than reliance. The technology required to address the issue of poor drinking water quality exists, but the means through which this technology can be transferred to communities in need is not well understood.

Professors Barton and Brown began incorporating this project into their scholarship programs at Hope College in the spring of 2006. The objective of this partnership is to increase students’ involvement in interdisciplinary research and provide engineering and nursing students with the opportunity to reach beyond their respective disciplines. The fundamental research questions posed by the Nkuv, Cameroon project are:

1. What strategies are effective for improving water quality in rural villages?
2. How should individual and community health be monitored?
3. How can community health data be incorporated into future engineering decisions?
4. What metrics can be used to assess the long-term sustainability of an engineering intervention?

This project has received funding through a Howard Hughes Medical Institute (HHMI) Interdisciplinary Research Grant, Crossroads Project Faculty Development Grant, EWB-USA, Kappa Epsilon Chapter-At-Large, (the regional chapter of Sigma Theta Tau the nursing honor society) and the National Collegiate Inventors and Innovators Alliance. Total funded amount to date is over $75,000.

The impact of spirituality and the spiritual care provided by nurse practitioners is the focus of study and research by Barbara Baele Vincensi MSN FNP (PhD in progress), assistant professor of Nursing at Hope College. The theoretical foundation for this research is based on social-exchange theory with input from relevant nursing theorists, constructs, and conceptual structures (Reed, 1992; Watson, 2008; Paterson & Zderad, 1988; Nightingale, 1865/1969; Leininger, 2002; Burkhart & Hogan, 2008). Spirituality is viewed as a resource influencing health and as essential to holistic care. In addition, spirituality has been identified as having multiple dimensions and different connotations for various existential, philosophical and religious orientations. Spirituality is a universal phenomenon derived out of our human experiences, is subjectively defined, and is our link in our relations to the world. It connects humans with a universal order, provides harmony and congruence, and reintegrates the individual which has been artificially divided into mind, body, and spirit by science.

The provision of spiritual care or comfort in the event of spiritual distress or pain has been shown to be of benefit in the research in strengthening the individual’s spirituality and facilitating improved health and well being. Although spirituality and spiritual care have been shown to be important, the definitions of these concepts are inconsistent in the research and concept literature. In addition, how nurse practitioners in primary care who work with patients with chronic disease define spirituality, identify spiritual distress, or provide spiritual care to improve the health of their patients has had limited attention in the research literature. There is also no research found on the impact of spiritual care provided by nurse practitioners on patient health.

Attributes of spirituality that are found in the literature are related to connections and existential concepts. The intrapersonal connection contains ideas of existential well being and connection to self, gaining a deeper understanding of self through human experience and personal reflection. This allows for healing, growth, liberation, strength, coping, hope and purpose to develop. Interpersonal connections with others and to the surrounding environment allow individual consciousness to gain awareness of the rhythms and patterns of the surrounding world and develop harmonious relationships that have external dimensions to self. This process is mediated through the spirit, frequently using presence in connecting with others. Connection to the sacred, holy, God/Supreme Being, purpose, or transcendence is often mediated through our connections to self and others.

Meaning, purpose and fulfillment in life have also been described as being a part of spirituality, with potential teleological undertones. This is especially true with life events, crisis, or illness. Spirituality in this sense is said to provide a framework in response to these concerns and enables the development of awareness of meaning and purpose in life.

Spiritual care is an interpersonal phenomenon and a part of person-centered care focused on the individual and based on our human experiences. It supports the use of all the resources of the receiver of care when faced with illness, doubts, anxieties, crisis and questions. The provision of spiritual care is the process of supporting the discernment of another who is seeking meaning and purpose in life as well as balance and health as defined by individual reality. The provider of spiritual care thus enables the receiver of such care to use inner resources when meeting life’s challenges or crises. Nurse practitioners in primary care are in a position to help increase this inner resource in their face to face encounters with patients.

Hope students have been able to participate in this research with pertinent literature reviews and the development of definitions and concept analyses of spirituality and spiritual care. In this manner they have increased their knowledge of what is involved in a concept analysis, improved their literature search skills, and differentiate the types of research methodologies utilized to study this phenomenon in the nursing, health care and related literature.

Coping, Acculturation and Birth Outcomes among Hispanic Immigrants and Mexican-Americans are being studied by Paulette Chaponniere, BSN, MPH, PhDc, associate professor of Nursing at Hope College. The nursing theoretical base for this prospective quantitative study is Betty Neuman's Systems Model. "The focus of this model is the concern with the stability of the client system as it encounters stressors in the environment. The goal of any intervention is to keep the client system stable using preventive measures." (Neuman, B., 1996, 67)

How an individual copes will determine whether stress has a deleterious effect on health outcomes. Stress affects birth outcomes. Preterm labor as well as low birth weight cannot be predicted on medical factors only, and recent investigations highlight the impact of psychosocial factors, in particular stress. Despite socioeconomic disadvantages, Latina women have similar birth outcomes as Caucasian women. This phenomenon has been named the "Latina paradox." Immigrant Hispanic women have better birth outcomes than US-born Latinas. Most research has focused on cultural and social explanations for this paradox: lifestyle (behavioral risk factors), acculturation and social support. In order to understand this paradox further, three buffers of stress will be examined in this interdisciplinary descriptive prospective study: social support, coping style, and optimism to examine the association between these buffers and birth outcomes among 113 pregnant Mexican and Mexican American women living in Western Michigan.

Preliminary analysis of data in fall 2007 from 50 subjects has revealed a trend between acculturation and birth weights; a significant correlation between acculturation and age. Interviewing of pregnant women will continue until the full sample is obtained.

Through participation in the study, students (nine students summer 2006 - fall 2007) have gained first hand experience with the quantitative research process, increased their comfort and skill with interviewing techniques and writing of field notes, and increased their knowledge about aspects of the Mexican and Mexican American culture. This research study is funded by a grant awarded to Hope College from the Howard Hughes Medical Institute ($ 10,000 in 2006 and $ 3,342 in 2007) as well as a grant from Kappa Epsilon Chapter of Sigma Theta Tau International, Honor Society of Nursing.

Research to Explore Hopelessness' Effect on Heart Attack Recovery Posted December 2, 2003 HOLLAND - A federal grant is supporting a Hope College nursing professor's research into the way that hopelessness and depression may affect the recovery of patients who have suffered a heart attack. Susan Dunn, assistant professor of nursing, is studying whether or not increased levels of hopelessness and depression have a negative effect on how heart attack patients recover. She is exploring in particular whether or not they stay with their exercise rehabilitation programs and their physical functioning in the months after leaving the hospital. Her goal is to provide health care professionals with information that will help them serve patients more effectively. "That's the ultimate hope-that we as nurses could identify patients who are at risk and that we could intervene," she said. Her two-year project has received $50,000 in support through the National Institute of Nursing Research, part of the National Institutes of Health. She is conducting her investigation in conjunction with a large-scale research project based at Michigan State University: "Patient Decision Support and Coaching Project: Heart After Hospital Recovery Planner" (HARP). The multidisciplinary HARP study involves a team of more than a dozen researchers, and is headed by Dr. Margaret Holmes-Rovner, who is section chief and professor of health services research in the College of Human Medicine at MSU. Dunn began working with the team while pursuing doctoral coursework at the university in 2001. Earlier studies, Dunn said, have found that hopelessness and depression can lead to heart trouble, but the role of both in the aftermath of a heart attack is less well understood. She is also interested in considering whether or not hopelessness is distinct from depression in its effects. "Some of the literature indicates that the two overlap," she said. "Other research seems to indicate that depression and hopelessness are two different variables." Dunn is following the progress of some 550 people who have suffered heart attacks, all selected from among patients treated at four hospitals on the east side of the state. She has already started analysis of baseline data, and has found that the heart attack patients are significantly more depressed and also feel more hopeless than the average population. As the project continues through the spring of 2005, she'll measure whether or not the emotions correlate to ongoing heart trouble. If so, she hopes her work will serve as a foundation for developing strategies to prevent hopelessness and depression in heart attack patients and to promote their physical recovery. Although she has been involved in the HARP study for two years, Dunn's interest in the topic goes back much farther. "My background is cardiovascular nursing," she said. "I've worked with cardiovascular patients for 15 years. I've always been interested in the psychological response to their illness and also how psychological states might even contribute to heart disease." Dunn has been a member of the Hope faculty since 1997. She teaches courses in research in nursing, and has been using her project as an example of the process. "I incorporate what I'm doing into what I'm teaching," she said. "It gives us a chance to talk about a real project that is currently happening, and to see how it's evolving."

The meanings of mental health care of Midwestern Dutch Americans are being studied by Tamara George, RN, PhD, associate professor of Nursing at Hope College. The theoretical base for this qualitative study is Leininger’s Theory of Culture Care Diversity and Universality. Leininger’s Sunrise Model and ethnonursing method were used to identify the meanings and experiences of mental health care of Dutch Americans to advance transcultural nursing knowledge and to help nurses give culturally congruent mental health care. Preliminary analysis of data from 74 extensive interviews with healthy Dutch Americans reflects strong care values of religion, family, and frugality which influence their health care needs and their perception of care. Many of the informants lacked knowledge about the current mental health care system and described stigma associated with the need for mental health care. Secondary data analysis is in progress, as is an article for a juried nursing journal describing study results.
Eight Hope College nursing students (now graduates) and a former nursing faculty member, Kay Wallace, assisted with this study. One student, Sarah DeHaan, completed a preliminary literature review and seven students (Shannon Wixson, Mary Byrn, Dee Ann Maynard, Ashley Connelly, Tara Patton, Julie Visser, and Diana Frazier) and Professor Wallace conducted in-depth interviews with Dutch American adults. Through participation in the study the students gained first hand experience with the qualitative research process, increased their comfort and skill with interviewing techniques, and increased their knowledge about aspects of the Dutch American culture. This research study is funded by an “Excellence in Research Award” of $10,000 from the Blue Cross Blue Shield of Michigan Foundation which was awarded to Dr. George for unrestricted clinical research, and by grants from Kappa Epsilon Chapter of Sigma Theta Tau International, Honor Society of Nursing, and the International Association for Human Caring.