2018 Acknowledgements: Graduate of the Medical University of South Carolina!

July 24th 2018 PhD in Nursing Dissertation Defense

ACKNOWLEDGEMENTS

No one reaches their goals in life without the help and support of others. I am no exception. As I reach this milestone in my career, I want to thank God through whom all things are possible. I want to honor some members of my family who have finished their work here but whose lives have profoundly influenced mine. The original family nurse, Helen Bounds Deese and her husband Owen Lafayette Deese, wonderful grandparents that epitomized unconditional love. My mother Myra Helen Deese Bland White whose toughness taught me to never quit; and my mother-in-law Martha Bramlett Hiott, a gentile southern woman whose love, guidance, quiet strength and faithfulness instilled in me the confidence to succeed. Lastly, I would like to honor my dad, Dr. Maynard Bland, whose work ethic and devotion to medicine intrigued me from a young age igniting my passion for nursing.

Thank you, Steve Hiott, my husband of forty-two years whose love, stability and unwavering support of my dreams is undeserved but appreciated; you kept me going long after I felt like giving up. Thank you to my children, Wesley Celeste, Carrie, Jordan, Steven, Nathan, Ian, and CeJay for supporting a dream that was not yours, a dream that was demanding of my time and difficult to understand. Your faith in my success was humbling; it often propelled me forward in my darkest moments of doubt. You all are and will always be my greatest accomplishments in this lifetime. And thank you to my grandchildren, Noah, Faith, Wyatt and Emme Kate, watching you grow, explore and discover this world with unbridled enthusiasm fed my spirit with hope and joy sustaining me during this arduous journey.

I am grateful to my cohort: Candace, Carley, Crystal, Donna, JoAnna, Kim, Lana, Monica, Pat, Patty, and Solange; other MUSC shining stars who inspired me, Julie, May, Fay, Felicia, Toshua, Michelle, Jennifer, Michael, Lori, Novelette, Marvesh, and Dru. I admire and appreciate the lessons we learned together; you all have a special place in my heart. All our starting points were different, all our aspirations were different but for this moment in time I learned personal and professional wisdom that I will always value.

I am so appreciative to the MUSC College of Nursing staff you often do not realize how instrumental a simple email can be to change a student’s outlook for the day. Thank you, Yolanda Long, your presence was a comfort and your assistance invaluable. I want to express my gratitude to the research staff Toni Mauney, Leslie Bell, Erica Ellington, and Stephanie Oppenheimer who guided me when I did not know what I did not know. And to the writing center, thank you.

The passion and keen insight shared by each professor has inspired me. I am still in awe of my original advisor Dr. Marilyn Laken. Your sense of hard work and fair play emboldened me. My chair, Shannon Phillips, has modeled a level of professionalism and scientific thinking that I can only hope to attain. Elaine Amella, I hung on your every word and email; your steady guidance and patience will always be remembered. Dr. Martina Mueller and Mary, I so appreciate your encouragement of my rudimentary statistical analyses. And thank you, Dr. Rushton for feeling this study had merit.

For each faculty member that taught me and pushed me to excellence, thank you: Dr. Stuart and Dr. Gilden, amazing role models, Dr. Pope, Dr. Newman, Dr. Anderson, Dr. Cartmell, Dr. Gregoski, Dr. Jenkins, Dr. Kellechi, Dr. Magwood, Dr. Nemeth, Dr. Dumas and the late Dr. Spruill. I am honored to have learned from the best.

So long...

It has been so long...

So long since ...

I had a moment to think...
A moment to reflect...
Time to savor.

So long since...

I have felt like I was moving forward
I wasn't overwhelmed
The house was clean

So long since...

I didn't have a list
I checked things off my list
I felt in control...

And Lord knows this is hard for me.

I am in dissertation now ...
But it feels as though I am at the bottom of Mount Everest.
The mountain looms in front of me, but I cannot move.
I need a site for my study,
It's a good study but I need a site.




I am at a new job, a different university...
It's a good university but new is hard.
I am new to them,
They are new to me,
And I long for the comfort of familiar surroundings.
I push far too hard for perfection,
So much so that missing the mark has me discouraged.
Leaving me to question everything...

And somewhere on the outskirts of my life is me,
the person.
The daughter, the wife, the mother with children and grand children.
Who is absent.
There is no reasonable way to rationalize this.
Absent from their lives to attend to the lives and needs of others,
Absent to attend to work, and to address things that are necessary to make a living.
But worldly obligations no less,
Am I making a living but missing a life?




Farther along still my soul wonders,
God am I where I am supposed to be?
Doing what I am supposed to be doing?
Living the life that I am supposed to be living?
Am I?

I fear I am too tired, too confused and too hurt at this moment to know.

So what do we do when we cannot know, cannot be sure.
What do we do?

Sit and breathe sister,

Kind words from a friend.

She is right. I need to drop it all for a while.
It will be there tomorrow, or the next day,
Responsibilities always are.

Will it clear my head to push them to the periphery of my life, my mind, my heart for a while?

Well I guess we shall see.

D

Ask yourself...

That is a good question...

Serendipity...

Are you ready for a little serendipity?

The other day as I contemplated yet another change in my life, my daughter reminded me about a poem I had given her. The story goes like this...

When I was pregnant with Carrie we discovered that she was breech. My original birth plan had involved a natural labor in a local birthing facility. This was potentially going to change our birthing plans significantly and I was facing a possible C-section.

While on vacation, I received encouragement from the Lord in the form of a poem on a card. I bought the card and framed it. Our baby Carrie turned around and was delivered in the birthing center, the rest is history... For years the poem served as a reminder that God's ways are perfect, that He is good, He is constant, active and present in our lives and His compassion is unfailing... I of course passed this framed poem on to Carrie when the time came.

During a recent conversation with Carrie, as I lamented life's ever constant changes, Carrie reminded me about the poem, "God Sends His Best to Those Who Leave the Choices Up to Him by Perry Tanksley (1985).

How serendipitous that long ago God used a baby girl to increase my faith. Now years later the same sweet girl is doing it again...

*sigh*

Is there anything more beautiful and reassuring than that? 

What do you want to be when you grow up... Why I Love Nursing

All those years ago, little did I know what nursing would come to mean to me... I had wanted to be a nurse to help people ever since I was a child in my dad's doctor's office. Years later as I glance back over the path I have taken, I am quite amazed. Never did I realize all the places nursing could take me, all the people I would meet and all the awe inspiring moments and opportunities that would arise...

Bedside nursing:
I wanted to help people and this I was able to do. How blessed I have been to be at the bedside of patients who are ill, tired, alone and in need to comfort and rest. There are not words to describe the feeling of fulfillment... Hearing an elderly man thank God for me in prayer as I left the room, praying with a heart broken woman who's child had been rushed to another hospital, observing a young father of another faith blessing and praying over his newborn son, and most unnerving and yet exhilarating, responding with that rush of adrenaline and the steady Hand of God to an emergency. The stories, the people, the sense of humility and awe that I was able to be present in these moments of utter vulnerability is something I will never forget.

Ambulatory Care Nursing:
Then I moved from acute care into the ambulatory care environment to work in pediatrics. Never did I think I would love any nursing environment as much as labor and delivery but working with children is one of the greatest pleasures in the world. I love to listen to their thoughts on what makes the world go round. Those little brains are fascinating. In pediatrics I learned to carefully craft explanations. A 'shot' is a 'poke' and when I take your blood pressure, I am going to 'give your arm a hug'. Stickers can brighten any day and 'fix' any boo boo, as can bandaids. Bubbles, well, these glistening orbs of air are essential distractions. Oh, and don't forget that prize...

Nursing Education:
For years I was at the bedside and never dreamed of being anywhere else. Then I moved into education. I was excited to prepare nurses to do what I had cherished for so long. I was blessed to be part of students educational journey. I enjoyed watching their eagerness and passion. Eventually we would part ways as they continued their passage into nursing on their own, only now as colleagues. Hopefully, I taught them something. I know every student taught me something and I was honored to be a part of their lives.

Nursing Quality Improvement:
Somewhere along the line, I moved into quality improvement and research. It was exciting. Lean Six Sigma (LSS) was hard at first, a definite learning curve, but then it made sense. Begin by looking for a broken process, then define, measure, analyze, improve and control (DMAIC). What is the voice of the customer (VOC)... what is the voice of the process (VOP).  What are my inputs and outputs... What once was hard, now is second nature. Once LSS is embraced you understand why so many process improvements often fail, the true root cause of the problem is never truly investigated. We just think we know what will solve the problem and act. LSS involves using specific tools... SIPOCs, Fishbones, and matrices to drill down to the process to identify barriers. I love it!

Research:
Alright, it is confession time. Those who knew me when can attest that during my undergraduate school days, I hated research. Really, seriously... I find this so funny now. At first I missed my patients, then I realized that I am still caring for patients, only now my focus is on improving patient care with a pen, paper and a computer. It also involves finding gaps and barriers, so I am a detective of sorts, very intriguing...

Reinvention:
This by far is one of the greatest things about nursing, the ability to move into new areas of interest and reinvent yourself... how cool is that! Along the way you meet new people, learn new things and explore new settings. This is a great way to keep yourself engaged and relevant.

Faith:
None of these adventures would have ever been possible without the God's direction, His Holy Spirit and plan, plain and simple, "Whether you turn to the right or to the left, your ears will hear a voice behind you saying, 'This is the way; walk in it..." Isaiah 30:21

A Meaningful Life...

While working on my research proposal a few weeks ago, I found this... 

How beautiful.

How true.

Some times as I grasp for the stars and contemplate my grand plans to take over the world... 

It is wonderful to get a reminder of what is real.

"Yes, everything up till now has already been enough for a meaningful life..."

I am blessed.

The Medical University of South Carolina...A student's journey

Okay, it is official, I am the worst ever at blogging about this Phd journey! But here's a little update...

I love, love, love my school, the Medical University of South Carolina (MUSC). It is located in one of the most beautiful and historic cities in the United States, Charleston, S.C. MUSC is #1 in the nation in online PhD nursing programs. This is exciting. However, they did not get to this point by luck. MUSC's doctoral program is carefully crafted to build nursing scientists. When I started I really had no idea what I was getting into. However, at that time I received some of the best advice from upper classmen, "Trust the process." How right they were.

Obtaining a PhD is a process. Once you grasp this you will be a happier student. The groundwork has to be laid. This is where MUSC excels in opening the 'toolboxes' to incrementally supply you with the skills needed to become a scientist. What are the tools?

First, the foundation is laid:

The theory behind nursing research is explored. What has nursing's role in research been in the past and where is it going in the future? I am such a nerd, so I loved this class. Finally, I understood what all those nursing theorists were trying to accomplish and why.

Research classes were combined with statistics and guidance in how to research and write. What is quantitative research? What is your research question? What is an integrative review or a meta analysis?  And of course my favorite, what is a p value? Better yet z scores, really?

Little did I know at that time that finding the gaps in knowledge in your area of passion is key to discovering a viable research topic.

As a full-time student, with full-time work, this introduction into nursing research was mind boggling. I felt as if I was barely hanging on and not sure I was retaining any of the necessary information. Later, studies of vulnerable populations, qualitative research, manuscript writing and publication essentials and yet more statistics kept me writing, writing, writing, computing, questioning and critiquing. Ethics, leadership, policy and measurement pushed me one step closer to where I needed to be. Still, I was certain there was no way I was retaining any of this, and as so many times before in my life my goal most days was simple, survive to see the next semester ;-)

Well, to make a long story short, in April I defended my research proposal. I am officially a PhD candidate!!! I am out of my mind excited. I still have a ton to do, but I am getting there. By this time next year...or sooner, it is my hope to have completed my PhD. All the sleepless nights, obsessive thoughts, BBQ fritos, and coffee are finally bearing fruit. So I have my own statistical formula to offer:

(Exponential Reading + Herculean Research) x Persuasive Writing

(Sleepless Nights + Obsessive Thoughts) + (BBQ Fritos + Coffee) x Time

= Compelling Dissertation Proposal

And the coolest part, all the 'stuff' I was certain that I would not remember is there in the recesses of my mind. This information emerges when I least expect it and I find myself reading an entire study without skipping the statistical analyses or find myself planning a study of my own....Muhahaha

Lastly, the best part of all, is that through all these years of doubt, sweat, tears and laughter, I have accumulated friends, mentors and colleagues that I so appreciate. No one ever reaches a long sought goal without help from others. I have an amazing committee for which I am immensely grateful. I have amazing classmates, friends, colleagues and a precious, long suffering family. And I have my faith in the One who made this all possible.

So to all potential nursing students out there... whether you are going for your ADN, BSN, MSN, DNP or PhD, don't focus on the hardships, the doubts, the school loans, the distractions, these can stop us all in our tracks. Focus on the dream, the still small voice that compels you to move forward. On your way, don't forget to embrace each step, each stumble, each triumph because in the end, it is worth it.

This may just work!

As I forge ahead on my dissertation journey, one thing is for sure, it takes meticulous planning and organization. Something that despite appearances, I am not good at! In that vein, I want to share with you something that I just signed up for and have started to use to plan my dissertation steps. It is similar to a pert chart but more intuitive and colorful. Also, it is online and free.

The web site is called Tom's Planner. The planner is set up like a Gnatt chart. The website has a demo that you can play with to see if this format works for you. I am excited. Particularly, with research each step takes a great deal of planning. It is almost like a domino effect, miss a deadline and it will throw everything else off. This will allow me to set due dates for each step and plan ahead. Interestingly, they have templates for dissertations.

I posted a picture of what I have so far... Hmmm, looks like I have a lot of planning to do!

:-D

Surviving a doctoral program...

Organizational Helps:

Apps for the busy student...

Evernote and Dropbox for note taking and storage!

I am always trying to find more ways to be organized. When I ran across these two applications, my heart almost skipped a beat. Anyone with lots of ideas, notes, projects and segments to their lives are sure to love these; I know I do!

Evernote has a phone and tablet app so I am able to jot down ideas anywhere, anytime and when I open my laptop, there they are! Evernote is comprised of 'notebooks' that you label and yes, they look just like notebooks. I have several notebooks to keep various areas of my life compartmentalized and can place links and notes in them. If you are all over the place or an idea person, try it, you are sure to love it! 

Dropbox is just that, a box out in the wild blue yonder that holds whatever I need it to. It holds articles and such, or can store pictures. Many students use it to hold articles that they are reading so they can access them on mobile devices. You can also 'share' articles within groups or with other students. There are many uses for Dropbox and though I don't use mine a lot it is nice to have the versatility it offers.

Scrivener for document composition and writing!

Oh, how I wish I had found this before now but I just downloaded and am excited to have it in time for my dissertation, yay! This app is almost indescribable. I am very picky and demanding of apps that I actually pay for. This one delivers. It is specially designed for writers who write a lot. Novelists or researchers are sure to appreciate this robust writing tool. This application is for Macs or PCs. It can house my documents and the articles or links I am referencing. It also has notecards and a corkboard to keep me on track. Best of all, it exports to Word or anywhere else you need.

Index card is for your portable devices.

Index card enables one to take notes or create index cards for studying and then sending the cards to Scrivener. So for those times you don't want to take your laptop but you would like to create some notes for an article, this is the perfect solution.

Wunderlist for your lists.

Yes, I have a calendar but I am a list maker. Seriously, I need my lists to keep me on track. I also like to categorize them to the different compartments of my life. I know what you're thinking...but you just said you have Evernote for that. Yes, I do but Wunderlist is for the short lists, my to-do lists...and it syncs between all my devices. That is invaluable to me. I am looking for a calendar that does the same thing. I love awsome Awesome Cal but it isn't for the laptop. So on the calendar front, I'm still looking :-(

Endnote is a must!

Well, there is just no way in the world I would have survived this doctoral program thus far without Endnote. I know some people use Refworks and I'm sure it is a great tool also. Endnote definitely has a learning curve but it is well worth it. The school I attend provides this program while you are a student, but I already have plans to purchase it after I finish. If you are a researcher/writer you will need a high performance program such as this to organize your references.

I use the online version. The Cite While You Write feature magically inserts the reference at the end of the sentence when I go to tools, then Endnote and type in the author name. It also creates the bibliography page as it inserts each citation. Recently, I also installed it on my hard drive. They both sync, which is great. This version can change your document style from APA to MLA or AMA. I am sure a wizard who pitied poor doctorate students created this magnificent application.

Scapple for mind maps!

I'm sure this is hard to believe but I can be a bit scattered...I know, what a surprise. This is why I like mind mapping tools. They just follow my thoughts. My favorite, favorite, favorite is scapple. Why? Because it literally just follows my thoughts and I get to link things together the way I want. This app has been instrumental in allowing me to map out my plan of study and my research. Another app that is great for this is X Mind. I like X Mind but it is a more organized tool. It offers great templates and while you can rearrange them somewhat, I found the openness of Scapple works better for me.

Ok, where can you find these apps? Where you can find most anything, Google and the app store! I would encourage you to google these apps and read other reviews, which is what I did. I looked at screen shot after screen shot and tried to determine if these were going to be helpful. I, also, read other peoples comments and ratings on the app sites. This helped me choose what was likely to work best for me. Good luck!

D

Synthesis and survival...

Whew... Sitting here this morning, being lazy, is amazing. It is not something that I do often. It has been nice to recuperate and rest from my first semester in post-graduate school. It's funny, someone asked, do you like it, another queried is it hard? Yes and yes. It is the most amazing experience.

There have been sleepless nights and fatigued days filled with too much junk food. The emotional high that only an A can produce and the gut wrenching feeling in the pit of the stomach of anything that is not an A. After all, in a PhD program nothing less than a B is passing, no C's are allowed. This has required me to try to organize myself even more.

I thrive on organization and am uncomfortable when I must run headlong into work and school without a plan. Thus, this first semester was a bit of a struggle. I had been out of school for a couple of years and allowed myself to sit and vegetate in front of the TV. I had the classes I taught organized, even new ones I had picked up, so there was time to relax. If I had only known what was to come, I would have read and studied ahead. So during this winter break, I am trying to consume text after text. Fall semester I felt I started behind and was trying to keep my head above water the whole time, this I do not want to repeat!

One of the goals in any graduate or PhD program is to prepare the student for research and writing.  The student is taught to read material and reflect upon it, add several other readings which substantiate the material or bring in alternate view points and then synthesize the information. Many who read this will think, 'duh', however for those embarking upon a journey into graduate and post graduate education this thought process may seem new. A lot depends on previous schooling. I was fortunate that my graduate school was pretty rigorous. Consequently, I was used to this. However, as you can see this takes time. Time to read, time to think, time to read more and then time to mull over all the information and formulate your own original thoughts about it. So my plan during break is to do a great deal of preliminary reading so I can begin to reflect upon it. Reflection is crucial. Once in graduate school you are no longer looking for 'right' answers so much as you are proposing original thoughts about current topics.

I am hoping to chronicle this journey. Goodness knows I have done a very poor job thus far. It is fascinating on so many levels. For those considering furthering your nursing education, I hope to offer insight and a crude map to assist you in your journey. In many ways the map is not unique. Yet it is my hope that these individual experiences can support you in your goal and enlighten you as you too prepare to further your education.

Postscript: I found this today. Wrote it and never posted as this spring semester consistently seemed to get the best of me.What was true then, is true now, so I'm posting with more to come later :-)

Finding the answers...

Though I haven't yet posted the news, I recently was accepted to the PhD in nursing program at the Medical University of South Carolina (MUSC). Whoooohooooo!!!

For months I have been so excited I could hardly stand it. Because, as a self admitted nerd, nothing smells quite as alluring as the pages of a textbook. Nothing is quite as inspiring as meeting new people with original ideas and grand dreams and then mingling with these idealists to study, question and dare to improve upon our little corner of the world. This, in addition to the joy of procuring new knowledge and exercising the opportunity to test oneself, is so fulfilling. Why, could there be anything else so exhilarating?

So what's up with this... the nervous tension, the pressure I am feeling. After all isn't this what I wanted? What I have dreamed of...? 

It could be that teaching pediatics first summer session was exhausting. It could be that I am drained of all creative thought after teaching a new class the week I came back from residency. It could be that I feel behind on a grant I am completing. And it could be that looking at my student loans undid me. Or it could be that I am questioning my sanity to be starting a PhD program at age 55. Yes, there I said it. I admit to it. I worry about my age.

I sure could use a Book Of Answers about right now. However, after compiling a list of all my questions ... what in the world, whats wrong with me? How do I know if I am to do this? How do I know I am not crazy? How do I know anything? The answer revealed itself when I realized ...

If I don't do this, I will forever regret it for the rest of my life...
 and regret is an awful life partner...
 and so that is enough...

Life, after all, is a grand adventure, one we must traverse with a great deal of faith. We cannot know tomorrow but we must still give our all today and everyday, or life becomes meaningless and mundane.

So, it is not about how long or short my life will be but how fully engaged I am in the process of consuming authenically the time and resources that have been given me. God said it best, "To whom much is given, much is required..." While I may not have immense wealth, I do have passion for the profession I love. And so I am off to school once more...

That old lab coat...

Often when students first begin nursing, the concepts can be rather difficult. I always try and encourage students because nursing is hard, very hard. Benner's work addresses the levels of nursing expertise and the arduous path one must take to become a nurse as she describes the novice, the advanced beginner, the competent nurse, the proficient nurse and the expert nurse (1984).

I love using word pictures to help explain ideas and concepts. So with students I equate this quest for knowledge and experience to having a brand new lab coat. Now, most people would think that a new lab coat would be nice. However, the truth of the matter is that a new lab coat is often stiff and uncomfortable. It takes wearing and washing the lab coat to 'break it in', much like a new pair of shoes, for the lab coat to become an accepted and desired part of nursing attire. The more this item of clothing is worn the more it is stained with experience! Of course, it will be washed but traces of the stain and the experiences that contributed to the stain remain.

So it is with nursing. In the beginning, the student is inexperienced and the tasks are new and difficult. The material seems heavy and cumbersome, combining this heavy material with stiff new tasks make wearing this coat hard. Then it begins, the change is almost in perceivable at first. You get the lab coat dirty in the process of caring for a patient, you wash it, but the next time you see a similar patient you realize you are familiar with the experience, you have a stain of knowledge in this area of nursing. Aha!

Over time the more the lab coat is worn, used, stained, washed... the more comfortable this coat becomes. The more experiences we stain the coat with, the more comfortable we too become. Time passes, knowledge expands... and that lab coat becomes drab but suddenly it is comfortable.

Now be forewarned, should I move to a new area of nursing, alas, it is as if I have purchased a brand new lab coat in some respects. I must wear it, wash it and gain experience in it also; only using the lab coat will produce the stain of experience...

So ladies and gentlemen, buy your lab coat, wear it, wash it and in due time it will become comfortable and familiar to you. And remember one day, before you realize it, you will find that slipping it on is like rejoining an old friend and you will feel proud and confident ... I promise.

But your lab coat, well it's going to look really nasty...

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.