This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, pleas

Without him I would not have been able to accomplish this dream. I also want to thank my awesome girls for their support and encouragement. Especially Kristin, she was my biggest cheerleader and she also sat through numerous “practice runs ” of my defenses. Laura was always ready with an encouraging word and an awesome edit. I am blessed to have such an excellent dissertation committee chaired by Dr. Biddle, who kept me on the path to completion. Dr. Bennett has been my rock and mentor throughout this process. Dr. Dodd-McCue, thank you for your insight and help. Dr. Hartland, thanks for the words of encouragement. I would like to thank Dr. Demetrius Porche, dean of the LSUHSC School of Nursing, for his support and encouragement. I would like to thank Dr. Diann