COMMUNICATING NURSING RESEARCH
Volume 51
TRANSFORMING HEALTH THROUGH
ADVANCES IN NURSING RESEARCH,
PRACTICE, AND EDUCATION
An annual publication of the Western Institute of Nursing containing the proceedings of the
Communicating Nursing Research Conference and WIN Assembly held April 11-14, 2018
at the Davenport Grand Hotel in Spokane, Washington.
WESTERN INSTITUTE OF NURSING
SN-4S
3455 SW US VETERANS HOSPITAL ROAD
PORTLAND, OR 97239-2941
An Affirmative Action/Equal Opportunity Employer
Spring 2018
1
, COMMUNICATING NURSING RESEARCH
issues previously published:
Volume 1: The Research Critique
Volume 2: Problem Identification and the Research Design
Volume 3: Methodological Issues in Research
Volume 4: Is the Gap Being Bridged?
Volume 5: The Many Sources of Nursing Knowledge
Volume 6: Collaboration and Competition in Nursing Research
Volume 7: Critical Issues in Access to Data
Volume 8: Nursing Research Priorities: Choice or Chance
Volume 9: Nursing Research in the Bicentennial Year
Volume 10: Optimizing Environments for Health: Nursing’s Unique Perspective
Volume 11: New Approaches to Communicating Nursing Research
Volume 12: Credibility in Nursing Science
Volume 13: Directions for the 1980’s
Volume 14: Health Policy and Research
Volume 15: Nursing Science in Perspective
Volume 16: The Image of Nursing Research: Issues and Strategies
Volume 17: Advancing Nursing Science: Qualitative and Quantitative Approaches
Volume 18: Influencing the Future of Nursing Research through Power and Politics
Volume 19: The Winds of Change: New Frontiers in Nursing Research
Volume 20: Collaboration in Nursing Research: Advancing the Science of Human Care
Volume 21: Nursing: A Socially Responsible Profession
Volume 22: Choices within Challenges
Volume 23: Nursing Research: Transcending the 20th Century
Volume 24: Partnerships: Putting It All Together
Volume 25: Silver Threads: 25 Years of Nursing Excellence
Volume 26: Scholarship in Practice
Volume 27: Research, Practice, and Education within the Health Care Agenda
Volume 28: Innovation and Collaboration: Responses to Health Care Needs
Volume 29: Advancing Nursing through Research, Practice, and Education
Volume 30: Nursing: Changing the Environment
Volume 31: Quality Research for Quality Practice
Volume 32: Nursing Research: For the Health of Our Nation
Volume 33: Building on a Legacy of Excellence in Nursing Research
Volume 34: Health Care Challenges Beyond 2001: Mapping the Journey for Research
and Practice
Volume 35: Health Disparities: Meeting the Challenge
Volume 36: Responding to Societal Imperatives through Discovery and Innovation
Volume 37: Hallmarks of Quality: Generating and Using Knowledge
Volume 38: Looking Ahead: Innovations in Nursing Science, Practice, and Education
Volume 39: Building Knowledge for Practice
Volume 40: 50 Years of Advancing Nursing in the West 1957 – 2007
Volume 41: The Circle of Nursing Knowledge: Education, Practice and Research
Volume 42: Networks in Nursing Science: Creating our Future
Volume 43: Nursing Science: Informing Practice and Driving Policy
Volume 44: Transitions: Unifying Practice, Education, and Research to Improve Health
Volume 45: Advancing Scientific Innovations in Nursing
Volume 46: Creating a Shared Future of Nursing: Research, Practice, and Education
Volume 47: Taking It Global: Research, Practice, and Education in Nursing
Volume 48: Equity and Access: Nursing Research, Practice, and Education
Volume 49: Innovations in Engagement through Research, Practice, and Education
Volume 50: 50 Years of Leadership: Continuing the Vision
The Cumulative Index of the Communicating Nursing Research Conference Proceedings,
Volumes 1 to 25, (1968-1992) was published in 1992.
COMMUNICATING NURSING RESEARCH has been published annually by the
Western Institute of Nursing. Each volume contains the addresses and abstracts of papers
presented at the annual Communicating Nursing Research Conference.
2
, FOREWORD
With my retirement planned later this year, this is the last Foreword I will write for
the Communicating Nursing Research Conference proceedings. I will complete 22 years as
the Executive Director of the Western Institute of Nursing (WIN). I have been so honored
to stand on the “shoulders of the giants” who served before me, Jo Eleanor Elliott and
Jeanne Kearns.
Looking back over 22 years, the advancements the organization have made are
striking. I became the Executive Director during a time of rapid technology growth. During
that time, we have moved from a paper operation to an electronic operation. We initiated
the first WIN webpage and upgraded it several times, most recently for use on various
electronic devices; developed a database to facilitate the work of staff and members;
instituted social media channels to better communicate with members; and started the use
of a conference application (app). We initiated the “Nursing Education Xchange: NEXus”
by which doctoral students in one of the consortium member school may take distance
education classes from another member school. In 2017, we celebrated the 60th
Anniversary of WIN and the 50th Communicating Nursing Research Conference, both a
testimony to the work of our members and the longevity of the mission and vision of the
organization.
While these advances happened on my “shift”, I have used the term “we”
deliberately. It certainly takes a strong and committed team to enact all these changes. I
have been extremely fortunate to have partnered with Presidents, Board members, and
Committee members, all of whom are wholeheartedly dedicated to the WIN vision and the
tasks to move the organization forward. The Program Committees over the past 22 years
have worked diligently to create conference programs that stimulate and educate with a
gentle Western welcome to all who attend.
The staff team over the years has not only made the work of the Board and
Committees easier, but staff members have contributed skill and advancements to their
respective jobs. The WIN staff works very hard, and none of the advances noted above
could have happened without their commitment. To echo Jeanne Kearns’ final Foreword,
each has certainly made my professional life an exceptional experience.
This organization has extraordinary members who are dedicated to their careers in
research, practice, and education, and accomplished students who are engaged in
educational programs to enhance their contributions to nursing science. My wish for all
members is that you continue to facilitate the growth of WIN and to remain committed to
the 60-year WIN vision of excellence in research, practice, and education.
WIN has been greatly enriched through its partnership with the Oregon Health &
Science University School of Nursing. The School and its deans, Carol Lindeman, Kate
Potempa, Michael Bleich, and now Susan Bakewell-Sachs, have been supportive and
nourishing in the relationship between the school and the western regional nursing
organization. We owe them a debt of gratitude.
I close with my appreciation and fondness to each and every one, within and
outside the organization, who has made my tenure here such an amazing experience. I will
miss you all.
Paula A. McNeil, RN, MS
Executive Director
Western Institute of Nursing
April 2018
3
, PREFACE
The 51st Annual Communicating Nursing Research Conference, “Transforming Health
through Advances in Nursing Research, Practice, and Education,” was held April 11-14,
2018 at the Davenport Grand Hotel in Spokane, Washington.
The keynote address was delivered by Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN,
Dean and Mary O’Neil Mundinger Professor, Columbia University School of Nursing and
Senior Vice President, Columbia University Medical Center, New York, NY. State of the
Science presentations were delivered by: Eileen Cody, BSN, RN, Representative of the
34th Legislative District, Washington State Legislature and Neuro-Rehab Nurse, Group
Health Cooperative, Seattle, WA; Usha Menon, PhD, RN, FAAN, Professor and Associate
Dean for Research & Global Advances, College of Nursing, The University of Arizona,
Tucson, AZ; and Carolyn Montoya, PhD, CPNP, FAANP, FAAN, Interim Dean, College
of Nursing, University of New Mexico, Albuquerque, NM.
Two award papers were presented:
Distinguished Research Lectureship Award: Patricia Butterfield, PhD, RN, FAAN,
Professor and Associate Dean for Research, Elson S. Floyd College of Medicine,
Washington State University, Spokane, WA;
and
Carol A. Lindeman Award for a New Researcher: Daniel T. Linnen, MS, RN-BC, PhD
Candidate, School of Nursing, University of California, San Francisco and Health Systems
Research Resident, Kaiser Permanente Northern California, Oakland, CA.
The Proceedings include the abstracts of symposium, podium, and poster presentations.
One hundred and fifty-seven papers were presented in podium sessions on a wide variety of
topics, including completed research, theoretical papers, and projects. Fifty papers were
presented in eleven symposia, and one hundred and seven papers were organized in twenty-
five other sessions. Four hundred and twenty-one posters were displayed over four poster
sessions, representing projects and research, completed or in progress. A total of two
hundred and thirteen posters were submitted from member institutions for the Research &
Information Exchange.
Awards were given to numerous WIN individual members during the 2018 conference.
Please consult the Table of Contents for the location of the aforementioned papers, the list
of awardees honored by WIN, and the name and subject indexes.
The conference was planned and organized by the WIN Program Committee, and we
extend our gratitude to the Program Committee members: Anthony McGuire, Chair, ME;
Judith Berg, AZ; Katreena Collette-Merrill, UT; Mary Ellen Dellefield, CA; Linda
Edelman, UT; Bronwyn Fields, CA; Bonnie Gance-Cleveland, CO; Lori Hendrickx, SD;
Kathryn Lee, CA; Judy Liesveld, NM; Kristin Lutz, OR; Paula Meek, CO; Usha Menon,
AZ; Annette Nasr, CA; Joanne Noone, OR; Jennifer Peterson, CA; Kristine Qureshi, HI;
Roberta Rehm, CA; Sharon Ruyak, NM; Hilaire Thompson, WA; and Catherine Van Son,
WA.
We thank all of the nurse researchers who submitted papers and participated in the 2018
conference.
Charlene A. Winters, PhD, RN
President, Western Institute of Nursing
Anthony W. McGuire, PhD, CCRN-K, ACNP-BC, FAHA
Chair, Program Committee, Western Institute of Nursing
4
Volume 51
TRANSFORMING HEALTH THROUGH
ADVANCES IN NURSING RESEARCH,
PRACTICE, AND EDUCATION
An annual publication of the Western Institute of Nursing containing the proceedings of the
Communicating Nursing Research Conference and WIN Assembly held April 11-14, 2018
at the Davenport Grand Hotel in Spokane, Washington.
WESTERN INSTITUTE OF NURSING
SN-4S
3455 SW US VETERANS HOSPITAL ROAD
PORTLAND, OR 97239-2941
An Affirmative Action/Equal Opportunity Employer
Spring 2018
1
, COMMUNICATING NURSING RESEARCH
issues previously published:
Volume 1: The Research Critique
Volume 2: Problem Identification and the Research Design
Volume 3: Methodological Issues in Research
Volume 4: Is the Gap Being Bridged?
Volume 5: The Many Sources of Nursing Knowledge
Volume 6: Collaboration and Competition in Nursing Research
Volume 7: Critical Issues in Access to Data
Volume 8: Nursing Research Priorities: Choice or Chance
Volume 9: Nursing Research in the Bicentennial Year
Volume 10: Optimizing Environments for Health: Nursing’s Unique Perspective
Volume 11: New Approaches to Communicating Nursing Research
Volume 12: Credibility in Nursing Science
Volume 13: Directions for the 1980’s
Volume 14: Health Policy and Research
Volume 15: Nursing Science in Perspective
Volume 16: The Image of Nursing Research: Issues and Strategies
Volume 17: Advancing Nursing Science: Qualitative and Quantitative Approaches
Volume 18: Influencing the Future of Nursing Research through Power and Politics
Volume 19: The Winds of Change: New Frontiers in Nursing Research
Volume 20: Collaboration in Nursing Research: Advancing the Science of Human Care
Volume 21: Nursing: A Socially Responsible Profession
Volume 22: Choices within Challenges
Volume 23: Nursing Research: Transcending the 20th Century
Volume 24: Partnerships: Putting It All Together
Volume 25: Silver Threads: 25 Years of Nursing Excellence
Volume 26: Scholarship in Practice
Volume 27: Research, Practice, and Education within the Health Care Agenda
Volume 28: Innovation and Collaboration: Responses to Health Care Needs
Volume 29: Advancing Nursing through Research, Practice, and Education
Volume 30: Nursing: Changing the Environment
Volume 31: Quality Research for Quality Practice
Volume 32: Nursing Research: For the Health of Our Nation
Volume 33: Building on a Legacy of Excellence in Nursing Research
Volume 34: Health Care Challenges Beyond 2001: Mapping the Journey for Research
and Practice
Volume 35: Health Disparities: Meeting the Challenge
Volume 36: Responding to Societal Imperatives through Discovery and Innovation
Volume 37: Hallmarks of Quality: Generating and Using Knowledge
Volume 38: Looking Ahead: Innovations in Nursing Science, Practice, and Education
Volume 39: Building Knowledge for Practice
Volume 40: 50 Years of Advancing Nursing in the West 1957 – 2007
Volume 41: The Circle of Nursing Knowledge: Education, Practice and Research
Volume 42: Networks in Nursing Science: Creating our Future
Volume 43: Nursing Science: Informing Practice and Driving Policy
Volume 44: Transitions: Unifying Practice, Education, and Research to Improve Health
Volume 45: Advancing Scientific Innovations in Nursing
Volume 46: Creating a Shared Future of Nursing: Research, Practice, and Education
Volume 47: Taking It Global: Research, Practice, and Education in Nursing
Volume 48: Equity and Access: Nursing Research, Practice, and Education
Volume 49: Innovations in Engagement through Research, Practice, and Education
Volume 50: 50 Years of Leadership: Continuing the Vision
The Cumulative Index of the Communicating Nursing Research Conference Proceedings,
Volumes 1 to 25, (1968-1992) was published in 1992.
COMMUNICATING NURSING RESEARCH has been published annually by the
Western Institute of Nursing. Each volume contains the addresses and abstracts of papers
presented at the annual Communicating Nursing Research Conference.
2
, FOREWORD
With my retirement planned later this year, this is the last Foreword I will write for
the Communicating Nursing Research Conference proceedings. I will complete 22 years as
the Executive Director of the Western Institute of Nursing (WIN). I have been so honored
to stand on the “shoulders of the giants” who served before me, Jo Eleanor Elliott and
Jeanne Kearns.
Looking back over 22 years, the advancements the organization have made are
striking. I became the Executive Director during a time of rapid technology growth. During
that time, we have moved from a paper operation to an electronic operation. We initiated
the first WIN webpage and upgraded it several times, most recently for use on various
electronic devices; developed a database to facilitate the work of staff and members;
instituted social media channels to better communicate with members; and started the use
of a conference application (app). We initiated the “Nursing Education Xchange: NEXus”
by which doctoral students in one of the consortium member school may take distance
education classes from another member school. In 2017, we celebrated the 60th
Anniversary of WIN and the 50th Communicating Nursing Research Conference, both a
testimony to the work of our members and the longevity of the mission and vision of the
organization.
While these advances happened on my “shift”, I have used the term “we”
deliberately. It certainly takes a strong and committed team to enact all these changes. I
have been extremely fortunate to have partnered with Presidents, Board members, and
Committee members, all of whom are wholeheartedly dedicated to the WIN vision and the
tasks to move the organization forward. The Program Committees over the past 22 years
have worked diligently to create conference programs that stimulate and educate with a
gentle Western welcome to all who attend.
The staff team over the years has not only made the work of the Board and
Committees easier, but staff members have contributed skill and advancements to their
respective jobs. The WIN staff works very hard, and none of the advances noted above
could have happened without their commitment. To echo Jeanne Kearns’ final Foreword,
each has certainly made my professional life an exceptional experience.
This organization has extraordinary members who are dedicated to their careers in
research, practice, and education, and accomplished students who are engaged in
educational programs to enhance their contributions to nursing science. My wish for all
members is that you continue to facilitate the growth of WIN and to remain committed to
the 60-year WIN vision of excellence in research, practice, and education.
WIN has been greatly enriched through its partnership with the Oregon Health &
Science University School of Nursing. The School and its deans, Carol Lindeman, Kate
Potempa, Michael Bleich, and now Susan Bakewell-Sachs, have been supportive and
nourishing in the relationship between the school and the western regional nursing
organization. We owe them a debt of gratitude.
I close with my appreciation and fondness to each and every one, within and
outside the organization, who has made my tenure here such an amazing experience. I will
miss you all.
Paula A. McNeil, RN, MS
Executive Director
Western Institute of Nursing
April 2018
3
, PREFACE
The 51st Annual Communicating Nursing Research Conference, “Transforming Health
through Advances in Nursing Research, Practice, and Education,” was held April 11-14,
2018 at the Davenport Grand Hotel in Spokane, Washington.
The keynote address was delivered by Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN,
Dean and Mary O’Neil Mundinger Professor, Columbia University School of Nursing and
Senior Vice President, Columbia University Medical Center, New York, NY. State of the
Science presentations were delivered by: Eileen Cody, BSN, RN, Representative of the
34th Legislative District, Washington State Legislature and Neuro-Rehab Nurse, Group
Health Cooperative, Seattle, WA; Usha Menon, PhD, RN, FAAN, Professor and Associate
Dean for Research & Global Advances, College of Nursing, The University of Arizona,
Tucson, AZ; and Carolyn Montoya, PhD, CPNP, FAANP, FAAN, Interim Dean, College
of Nursing, University of New Mexico, Albuquerque, NM.
Two award papers were presented:
Distinguished Research Lectureship Award: Patricia Butterfield, PhD, RN, FAAN,
Professor and Associate Dean for Research, Elson S. Floyd College of Medicine,
Washington State University, Spokane, WA;
and
Carol A. Lindeman Award for a New Researcher: Daniel T. Linnen, MS, RN-BC, PhD
Candidate, School of Nursing, University of California, San Francisco and Health Systems
Research Resident, Kaiser Permanente Northern California, Oakland, CA.
The Proceedings include the abstracts of symposium, podium, and poster presentations.
One hundred and fifty-seven papers were presented in podium sessions on a wide variety of
topics, including completed research, theoretical papers, and projects. Fifty papers were
presented in eleven symposia, and one hundred and seven papers were organized in twenty-
five other sessions. Four hundred and twenty-one posters were displayed over four poster
sessions, representing projects and research, completed or in progress. A total of two
hundred and thirteen posters were submitted from member institutions for the Research &
Information Exchange.
Awards were given to numerous WIN individual members during the 2018 conference.
Please consult the Table of Contents for the location of the aforementioned papers, the list
of awardees honored by WIN, and the name and subject indexes.
The conference was planned and organized by the WIN Program Committee, and we
extend our gratitude to the Program Committee members: Anthony McGuire, Chair, ME;
Judith Berg, AZ; Katreena Collette-Merrill, UT; Mary Ellen Dellefield, CA; Linda
Edelman, UT; Bronwyn Fields, CA; Bonnie Gance-Cleveland, CO; Lori Hendrickx, SD;
Kathryn Lee, CA; Judy Liesveld, NM; Kristin Lutz, OR; Paula Meek, CO; Usha Menon,
AZ; Annette Nasr, CA; Joanne Noone, OR; Jennifer Peterson, CA; Kristine Qureshi, HI;
Roberta Rehm, CA; Sharon Ruyak, NM; Hilaire Thompson, WA; and Catherine Van Son,
WA.
We thank all of the nurse researchers who submitted papers and participated in the 2018
conference.
Charlene A. Winters, PhD, RN
President, Western Institute of Nursing
Anthony W. McGuire, PhD, CCRN-K, ACNP-BC, FAHA
Chair, Program Committee, Western Institute of Nursing
4
