Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Sandra J. Mixer, PhD, RN, CTN-A

Committee Members

Sandra J. Mixer, Pamela J. Embler, Jennifer L. Smith, Meredith Troutman-Jordan


As the U.S. older adult population increases and diversifies, healthcare providers need innovative, cost-effective, and culturally congruent approaches to gerontological nursing care. Decades of multidisciplinary evidence demonstrate that spirituality enhances older adult holistic health. However, although research about spirituality and nursing has become more culturally diverse, little is known about spirituality-health linkages of rural Appalachian older adults (RAOAs). This knowledge gap is significant because Appalachia leads the country in mortality related to chronic comorbidities such as heart disease, cancer, and depression. Given age, poverty, limited transportation, and health provider shortage areas, RAOAs experience severe health disparities. Moreover, spirituality is an integral part of Appalachian culture. Therefore, this dissertation sought to identify, describe, and systematically analyze the influences of spiritual engagement (SE) on health and well-being of RAOAs in East Tennessee. The results of a systematic literature review laid the groundwork for an ethnonursing study conducted in three rural counties. Leininger’s Culture Care Theory of Diversity and Universality guided data collection and analysis. Major findings included that RAOAs use the word “faith” and that for RAOAs (a) relationship with God is personal; (b) faith beliefs and practices influence health, illness, death, and dying; and (c) nurses can “Open the Door” for spiritual care. Additionally, faith decreased worry, improved coping, facilitated a sense of peace, and deepened thankfulness and joy. Faith assessment and spiritual care recommendations contribute to culturally congruent care for RAOAs and may be transferable to care for other older adults.

Available for download on Wednesday, May 15, 2024

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