Author ORCID Identifier
https:/orcid.org/0000-0002-5472-9417
Date Available
5-7-2027
Year of Publication
2025
Document Type
Doctoral Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
Nursing
Department/School/Program
Nursing
Faculty
Jean Edward
Faculty
Jean Edward
Abstract
Despite increasing survival of patients who have experienced a traumatic injury in the United States, holistic health remains poor for many years following injury. The purpose of this dissertation was to provide a path toward the development of nursing interventions to improve health related quality of life (HRQoL) after traumatic injury. The dissertation accomplishes this goal by demonstrating the impact of nursing interventions on long term outcomes of patients after traumatic injury; providing an updated systematic review of the literature regarding factors contributing to HRQoL after traumatic injury; synthesizing existing theoretical frameworks and supporting literature to create a trauma-specific theoretical model for HRQoL; testing pathways of the proposed theoretical framework for HRQoL after traumatic injury with quantitative data; determining gaps in holistic care after traumatic injury and potential acceptance of intervention through qualitative data; and providing recommendations regarding the future of HRQoL-directed nursing care after traumatic injury in the United States.
The second chapter of this dissertation is a secondary analysis of the National Trauma Data Bank, demonstrating the influence of nurse sensitive indicators on discharge disposition and, thereby, nursing care on long-term patient outcomes after injury. Catheter-associated urinary tract infections and hospital associated pressure injuries increased the likelihood of discharge to another healthcare facility by 1.4 to 2.1 times, while central line-associated bloodstream infection was not a significant predictor. This study illustrates the impact of nursing care on the recovery trajectory of patients who have been injured.
The third chapter of this dissertation includes an updated systematic review of literature and describes the development of a new theoretical model for HRQoL after polytraumatic injury. This proposed model is supported by the literature and synthesizes the response shift model and the Heo-Moser model. The proposed model suggests two categories of contributors to HRQoL: the antecedents, or nonmodifiable factors, and the mechanisms, or modifiable factors. Coping is a separate consideration which may influence the impact of antecedents and mechanisms on the resulting HRQoL following injury. Further testing is needed to confirm the model structure.
The fourth chapter of this dissertation is a mixed methods study, using a cross- sectional survey and focus groups to determine whether anxiety, depression, post-traumatic stress disorder (PTSD), coping, and social support are associated with HRQoL outcomes after trauma as suggested by the theoretical model for HRQoL after traumatic injury; determine whether preexisting mental health diagnoses predict holistic recovery trajectory following injury; and establish patient-perceived gaps in care after traumatic injury. Anxiety (p = .022), depression (p = .004), PTSD (p = .003), avoidant coping (p = .033), and social support (p = .048) were associated with worse HRQoL. Having two or more preexisting mental health conditions was predictive of worse HRQoL (p = .021), regardless of time after injury. Thematic analysis of focus groups resulted in six themes: Impacts of the Healthcare System, Mental Healthcare, Holistic Recovery, Coping, Trauma as a Unique Condition, and Support Systems. These results support the structure of the theoretical model, but further inferential testing of the model is required. Participant-described areas for improvement in care include trauma-targeted mental healthcare, improved supply of holistic support resources, and enhanced follow up standards for medical care.
This dissertation provides evidence to suggest the efficacy of nursing interventions in addressing long-term outcomes after trauma and provides a model to describe the interaction of factors which affect HRQoL. Preliminary data supports the theoretical model and provides patient perspectives on gaps in care and acceptability of intervention in HRQoL after traumatic injury. Future work should focus on systematic integration of HRQoL associated assessment and data collection, with efforts to create a protocol for targeted, nurse-led interventions to improve HRQoL in patients after traumatic injury.
Digital Object Identifier (DOI)
https://doi.org/10.13023/etd.2025.52
Funding Information
The fourth chapter of this dissertation was funded by the Society of Trauma Nurses Grant for Nursing Research and Evidence-Based Practice Projects in 2024-2025.
Recommended Citation
Silverstein, Lily A., "Exploring Pathways to Improve Health-Related Quality of Life After Traumatic Injury" (2025). Theses and Dissertations--Nursing. 73.
https://uknowledge.uky.edu/nursing_etds/73
