Our Research

Published and ongoing research and scholarly works related to understanding and improving Diversity, Equity and Inclusion from ECU College of Nursing faculty and students.

Published works

Brown, S., Beck, M., & Elhammoumi, C. (2017). Addressing Cultural Diversity and Inclusion in a College of Nursing. Journal of Best Practices in Health Professions Diversity, 10(2), 141-144.

East Carolina University (ECU) College of Nursing (CON) is committed to promoting an environment that values diversity and inclusion as part of the fabric of its organizational culture. More than a decade ago, the college established the Diversity Advisory Council (DAC), which comprises faculty, staff, and students and serves as an advisory group to the dean. Since that time, the group has influenced and embodied the CON’s approach to its guiding principles, which state that “all people should be treated with respect, dignity, and compassion; Caring relationships are the core of nursing practice; Students should be prepared to actively participate in a global community; and Nursing practice and education should occur in a diverse and inclusive environment” (ECU College of Nursing, n.d., para. 3) These value statements form a belief system that is foundational to our educational programs. The DAC has worked to improve understanding of culture, diversity, and inclusiveness both within and beyond the walls of the classroom.

Larson, K. L., Matthews, H. F., Moye, J.P, Congema, M. R., Hoffman, S. J., Murrieta, K. M. & Johnson, L. A. (2021). Four Kinds of Hard: An Understanding of Cancer and Death among Latino Community Leaders.. Global Qualitative Nursing Research, 8, 1-11. https://doi.org/10.1177/23333936211003557

Early integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.

Lee, J. G., LePrevost, C., Harwell, E. L., Bloss, J. E., Cofie, L. E., Wiggins, M., & Firnhaber, G. C. (2020). Coronavirus pandemic highlights critical gaps in rural internet access for migrant and seasonal farmworkers: A call for partnership with medical libraries. Journal of the Medical Library Association, 108(4), 651–655. https://doi.org/10.5195/jmla.2020.1045

Migrant and seasonal farmworkers, who are essential workers in the coronavirus global public health emergency, face unique risks to their health as well as longstanding health inequities. This commentary highlights these risks and argues that Internet access represents an underappreciated but critical part of the public health response. The authors first discuss the unique risk farmworkers face. We note the importance of Internet access in the time of physical distancing, the fact that many health outreach workers are no longer visiting camps, the need for telemedicine infrastructure, and the role of Internet access in providing connections to families in communities of origin. We describe existing efforts that have been implemented in North Carolina to raise awareness among public health and health promotion practitioners and researchers. The current coronavirus pandemic demands the attention of medical libraries, public health practitioners, and policy makers to address the digital divide for farmworkers and their families.

Michels, S., & Kovar, C. L. (2020). Transgender and gender-expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families. Journal of Child and Adolescent Psychiatric Nursing: Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 33(3), 157–162. https://doi.org/10.1111/jcap.12290

Society’s blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. We envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self-harm, and suicidal ideation in our transgender and gender-expansive youth. Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.

Peery, A. I., Julian, P., Avery, J., & Henry, S. L. (2013). Diversity must start somewhere: the experience of one college of nursing. Journal of Cultural Diversity, 20(3), 120–124.

The concept of diversity varies widely in its definition, conceptualization and connotations. Addressing issues of diversity within a college of nursing is necessary if the cultures of our academic units are to change and become more inclusive. The article provides an overview of how this CON began to address changing its culture to one of a more inclusive nature and across all groups represented within the college, not bound only by ethnicity and gender. The process described in this article may provide an example for others to follow.

Jairath, N. N., Benetato, B. B., O’Brien, S. L., & Griffin Agazio, J. B. (2021). Just-in-time qualitative research: Methodologic guidelines based on the COVID-19 pandemic experience. Nursing Research, 70, 215-221. https://doi.org/10.1097/NNR.0000000000000504

This article presents methodological guidelines for just-in-time qualitative research based on our current, pandemic-relevant research. Public health measures taken to slow disease spread during the current COVID-19 pandemic and future public health crises may slow the pace of research and make its implementation all the more challenging. However, just-in-time qualitative research advances our understanding of the human experience and response to the COVID-19 and major public health crises. It also complements existing behavioral theory and research. The guidelines presented may assist researchers to initiate necessary qualitative research more rapidly, with fewer logistic challenges, and with methodological rigor. They may also help expand research on groups experiencing collateral effects of the pandemic and major public health crisis. Lastly, the guidelines may support the development of more robust data for alternate analysis at a later date.

Sitzman, K., Carpenter, T. S., Cherry, K. (2020). Student Perceptions Related to Immediate Workplace Usefulness of RN to BSN Program Content. Nurse Educator, 45, 265-268. https://doi.org/10.1097/NNE.0000000000000775

Despite a national directive for associate degree in nursing (ADN) nurses to complete BSN degrees, there is limited research related to student perceptions of the value added by BSN education. The purpose was to explore perceptions of immediate workplace usefulness of RN-to-BSN content for ADNs. Results clarified content that students found useful and provided insight into specific benefits that employers might expect to see when ADNs complete BSN-level education.

Sitzman, K. L., & Craven, I. (2021). Caring During COVID-19: Ten Insights Inspired by Nurse Narratives. American Nurse Journal, 16(4). https://www.myamericannurse.com/caring-during-covid19/

Healthcare environments have been preparing, shifting, transforming, and emergently responding to the COVID-19 pandemic since March 2020. Nurses have provided care during uncertainty, long hours, constantly shifting work environments, and expanded or new professional roles. Work-related stress—and distress—have been reported in the media and on social networking sites. Formal knowledge development is underway to better understand nursing challenges during this ongoing global crisis.

Abel, W., Scanlan, L., Horne, C. E., & Crane, P. (2021). Factors associated with Myocardial Infarction Reoccurrence. Journal of Cardiovascular Nursing. https://doi.org/10.1097/JCN.0000000000000796

As recurrent myocardial infarctions (MIRs) constitute almost a third of the annual incidence of myocardial infarction, identifying the traditional and novel variables related to MIR is important. The aim of this study was to examine modifiable cardiac risks, adiposity, symptoms associated with inflammation (fatigue, depression, sleep) and inflammatory cytokines, and MIR by sex and race. The sample included 57% male and 30% Black participants, and the mean (SD) age was 65 (12) years. An MIR was not associated with race despite White participants reporting better sleep (t₁₄₆ = −3.25, P = .002), lower body mass index (t₁₅₄ = −3.49, P = .001), and fewer modifiable risk factors (t₁₅₂ = −2.05, P = .04). An MIR was associated with being male, higher hsCRP and tumor necrosis factor-α levels (P < .001), and higher inflammatory symptoms of fatigue (P = .04), depression (P = .01), and poor sleep (P < .001). Further examination of biomarkers to understand the mechanisms associated with inflammatory symptoms of fatigue, depression, and poor sleep and MIR is needed.

Drew, M. L., & Reis, P. (2020). Black Lives Matter: A Message and Resources for Midwives. Journal of Midwifery & Women’s Health, 65(4), 451–458. https://doi.org/10.1111/jmwh.13155

This editorial features an adaptation of the essay, “A Message to Midwives,” that was written by Dr. Michelle Drew, Chair of the American College of Nurse-Midwives (ACNM) Black Midwives Caucus for Reproductive Justice and Birth Equity, on behalf of the Caucus (ACNM Connect Town Hall, June 2, 2020). In her composition, written after the tragic murder of George Floyd in Minneapolis, Minnesota, Dr. Drew poignantly speaks to Black birth workers and white allies about the enduring pain and angst of being Black in America, and she explains why we, as Black midwives, are not okay. The editorial reflects the authors’ sentiments and reflections as midwives of color when it was completed on June 27, 2020; therefore, the perpetually evolving landscape of racism and race relations in the United States may not be fully captured in this publication

Lichtman, R., Woo, J., Reis, P. J., Klima, C., & Perlman, D. (2021), Ensuring Racial Equity in Midwifery Education Programs: Beginning Steps for Midwifery Education. Journal of Midwifery & Women’s Health, 66(2), 145-147. https://doi.org/10.1111/jmwh.13192

The purpose of this commentary is to describe a beginning step that the Directors of Midwifery Education (DOME) took toward ensuring racial equity in midwifery education programs: the gathering of data. We will discuss barriers identified in the most basic components of ensuring equity and advocate for a concerted effort among stakeholders in midwifery education, DOME, ACNM, the Accreditation Commission for Midwifery Education (ACME), and AMCB, to address critical barriers.

Ongoing research, scholarly work and projects

APRN Academic Clinical Practice Collaborative and APRN RURAL Scholars Program

PI: Dr. Pamela Reis

CON Collaborators: Michael Urton, Sharona Johnson, Carol King

Consistent with the ECU College of Nursing mission, the APRN Rural and Underserved Roadmap to Advance Leadership (RURAL) Scholars Program provides excellence in the education of advanced practice nurses in the primary care of rural and underserved communities

Contact Dr. Pamela Reis (reisp@ecu.edu) for more information.

Impacts of the Covid 19 Pandemic on Palliative Care Research in Rural Latino Communities in North Carolina

Holly F. Mathews, Professor, Department of Anthropology, East Carolina University, Kim L. Larson, Professor, College of Nursing, East Carolina University, Michelle Estrada, Past-Chair, Wayne County Latino Council, Maria Paz Carpenter, Palliative Care Lay Advisor.

Latinos with cancer who live in emergent communities lack access to palliative care services. The Covid 19 pandemic complicated the delivery of a participatory action research project focused on a palliative care intervention. Major challenges included participant recruitment and retention, while addressing Latino fears and distrust of the health care system. Between January and August of 2020, 15 Latino community leaders in North Carolina were trained as palliative care lay advisors (PCLAs). Following training, PCLAs were matched with Latinos with cancer to make home visits and share information on symptom management and advanced care planning. The pandemic caused a major delay in participant recruitment and intervention by PCLAs. The responsibilities and roles of these community leaders shifted to prioritize the safety of family and community over project engagement. Efforts to overcome these challenges included revised protocols, expanded recruitment area, and addition of an oncology nurse to screen participants. Monthly online discussions and eventual in person meetings with PCLAs reinvigorated engagement. Online sessions addressed community needs for Spanish-language information on risks, safety, and vaccines. In the wake of a pandemic, flexibility and enhanced community collaboration are crucial for meeting project goals while protecting the health and safety of vulnerable communities.

Contact Dr. Kim Larson (larsonk@ecu.edu) for more information.

Addressing migrant and seasonal farmworker health disparities with information resources

PI: Joseph Lee (HHP)
Co-PI: Gina Firnaber

The objective of this project is to improve infrastructure and reduce health literacy barriers among migrant and seasonal farmworkers in North Carolina (NC). This proposal is driven by a central hypothesis that improving NLM information resources designed for farmworkers; equipping migrant health providers, outreach workers, and their associated clinics with NLM resources; and, enhancing health literacy among farmworker and their families can make the right information available at the right time to farmworkers and their families.

Contact. Dr. Joseph Lee (leejose14@ecu.edu) or Dr. Gina Firnhaber (firnhaberg@ecu.edu) for more information.

A Community-based Palliative Care Model for Latinos with Advanced Cancer

PI: Kim Larson

Conventional palliative care models have failed Latinos with cancer; only 2% are referred to palliative care. The severe shortage of palliative care providers in eastern NC is compounded for Latinos by rurality, economic disadvantage, discrimination, language differences, and lack of access. Rural-dwelling Latinos with advanced cancer (AC) have no known theory-based, culturally-relevant, community palliative care program. Thus, our interdisciplinary team and community partners propose a novel palliative care intervention: Latino Palliative Care Lay Advisors (PCLA). Our proposal extend previous pilot work with local Latino palliative care advocates who described conversations about advance care planning as “planting seeds.” To develop and test our PCLA intervention for Latinos with AC and their caregiver, we will use both the Ethnocultural Gerontological Nursing Model and an action-oriented, mixed method design. From three rural counties in eastern NC, we will recruit both a purposive sample of 15 Latino natural leaders and a convenience sample of 75-90 Latinos with AC and their caregiver. Each PCLA will be partnered with a designated team nurse during training and delivery of the intervention to ensure fidelity with palliative care best practices. Team members are well-positioned to carry out this project due to their broad experience with Latinos in the US, Mexico, and Central America: They are bilingual, engender trust, and advocate for human rights. Through education and outreach, this project brings together members of the community and the health care system to deliver the highest quality care and optimize QOL for a vulnerable population.

Contact Dr. Kim Larson (larsonk@ecu.edu) for more information.