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An Evaluation Of The Factor Structure, Reliability And Construct Validity Of The Male Role Norms Inventory-Revised For African American/Black Men, Wilfred Michael Allen

Wayne State University Dissertations

Background: In the United States, on average, men die nearly five years younger than women. Among men, the life expectancy for African American/Blacks is 72.1 years compared to 76.6 years for White/European Americans. African-American/Black men experience an earlier onset and more severe disease with higher rates of complications than White/European American men. Masculinity ideology has been identified by researchers as having an influence on health behaviors and ultimately health outcomes. Based on prior research literature, higher levels of masculinity ideology have been associated with fewer health promoting behaviors. As such, there is a need for a reliable and valid measure …

Nurse Educators' Perspectives Of Supplemental Computer-Assisted Formative Assessment In An Associate Degree Nursing Program, Jennifer Buehler Sugg

Walden Dissertations and Doctoral Studies

Despite the implementation of various strategies to improve outcomes, the pass rates for the National Council Licensure Exam for Registered Nurses (NCLEX-RN) for an associate degree nursing (ADN) program continue to decrease. This study examined the use of a supplemental computer-assisted formative assessment (SCAFA) as a strategy for NCLEX-RN success. A qualitative case study with a theoretical framework based on constructivism was designed to investigate nurse educators' perspectives of this particular strategy for successful outcomes. To explore these perspectives, data were collected from face-to-face interviews with nurse educators and from program documents from 1 ADN program in the southeastern United …

Practice Guidelines For Self-Management Of Osteoarthritis Pain In The Home-Based Settings, Oyesola Omowunmi Akintan

Walden Dissertations and Doctoral Studies

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI …

Dogs, Physical Activity, And Walking (Dogs Paw): Acceptability And Feasibility Of A Pilot Physical Activity Intervention, Elizabeth Richards

School of Nursing Faculty Publications

Background. The aims of this study were to describe the development of and investigate the feasibility and acceptability of a pilot randomized controlled physical activity intervention based on social cognitive theory which used a dog walking strategy.

Methods. Participants (n=49) were randomized into an intervention or control group. Overall, participants were middle-aged (mean=45.7±13.4 years), Caucasian, and on average considered obese with an average BMI of 30.0±5.5. Descriptive statistics were used to summarize participant characteristics and analyze the feasibility and acceptability data. Regression models were used to: 1) examine significant differences between intervention and control groups across time (baseline to post-intervention) …

Pre And Post Implementation Evaluation Of An Emergency Department Severe Sepsis Alert And Practice Protocol, Darleen Williams

Electronic Theses and Dissertations

Severe sepsis kills an estimated 1,400 people worldwide every day. This often fatal infectious process accounts for an estimated 215,000 deaths in the United States (US) annually. The main goal of this project was to evaluate the impact of the Emergency Department Severe Sepsis Alert and Practice Protocol (EDSSAPP) post implementation, on time to first antibiotic administration, length of stay, and mortality in patients admitted via the ORMC ED with severe sepsis. This study evaluated the time to first antibiotic administration, total ED and hospital length of stay (LOS) and mortality of severe sepsis patients either with a severe sepsis …

The Male Army Nurse Corps Officer Experience In The Vietnam Conflict, John P. Pelletier

MUSC Theses and Dissertations

Background: A considerable amount of research has been conducted on the wartime experiences of female nurses who served in the Vietnam conflict and as a result, much is known about their experiences and the impact that their service had on their personal and professional lives. The same, however, is not true for male nurses. Anecdotal evidence suggests that the experiences of male Army Nurse Corps (ANC) Officers may have been substantially different from that of their female colleagues, thus making the impact of the experience on them potentially different. Overall Objective: This study explores and interprets the lived experiences of …

Interaction And Cognitive Engagement In Online Discussions In Professional Development Leadership And Management Course At A Private Nursing Institution, Nimira Asif, Samina Vertejee, Sharifa Bashir Lalani

School of Nursing & Midwifery

In the Post RN BScN curriculum, one of the courses “Professional Development and Leadership (PDLM)” was offered as blended mode for the first time. In order to explore the students’ interactions and Cognitive Engagement (CE) in Online Discussion Forums (ODFs), the research team conducted a retrospective study for the first time at a private nursing institution of Karachi-Pakistan. The study was conducted by utilizing the retrospective qualitative paradigm of discourse analysis to understand student’s CE in ODFs. The study has addressed the following one main and three subsidiary research questions: How do threaded discussions (in the part of online forums) …

A Faith-Based Primary Diabetes Prevention Intervention For At-Risk Puerto Rican Adults: A Feasibility Study, Sylvia Torres-Thomas

Electronic Theses and Dissertations

Diabetes is a serious health threat that disproportionately affects Hispanics of Puerto Rican heritage. Current evidence supports diabetes prevention programs to change health behaviors in people who are at risk and thus prevent the development of type 2 diabetes. However, few interventions exist for Hispanics, and even fewer have been designed for Puerto Rican adults. A literature review of community-based diabetes prevention programs involving at-risk Hispanics was conducted using a cultural sensitivity framework to determine the state of the science and identify gaps in knowledge regarding diabetes prevention for Puerto Ricans. An integrated theoretical framework was developed using constructs from …

Incontinence And Skin Integrity In Immobile Populations, Frederick Green, Alyssa Starr

Nursing Student Work

No abstract provided.

Vcuhs Inquiry Process Diagram, Roy E. Brown, Dale Wright, Vcuhs Ebp Translation Committee

VCU Libraries Faculty and Staff Publications

This diagram outlines the nursing inquiry process when it comes to answering questions that arise in the clinical setting. The diagram shows how a nurse proceeds through the process and when the question is answered though either a evidence based practice project (EBP), a performance improvement (PI) project or when it becomes a research project.

Depressive Symptoms And Violence Exposure: Contributors To Repeat Pregnancies Among Adolescents, Cheryl Ann Anderson

Nursing Faculty Publications & Presentations - Archive

Depressive symptoms and violence exposure (VE) often cooccur and have been recognized to influence childbearing; contribution to repeat pregnancy is unclear and examined in this article. This cross-sectional, descriptive, study screened for depressive symptoms and VE among 193 adolescent mothers at a large county hospital in Southwestern United States. Repeat pregnancy and depressive symptoms characterized one-third and one-quarter of adolescents, respectively. Despite minimal disclosure of VE, repeat pregnancy was significantly influenced by child abuse and past traumatic life experiences. Assessments and interventions with adolescents should focus on frequency of repeat pregnancies and symptoms of depression and VE. Nurses and childbirth …

A Narrative Analysis Of Women's Adaptation Following Sexual Assault, Debra Hurd

Nursing Dissertations - Archive

Sexual assault against women violates every area of their lives: safety, security, physical health, and social status. Available evidence is inadequate to guide interventions to promote effective adaptation following assault. No studies have been found specifically on sexual assault of women from the perspective of the affected woman. The purpose of this study was to describe the narratives and coping strategies of women who have been sexually assaulted. The study questions and analysis were framed using Roy's Adaptation model. Narrative analysis was the research design used to examine stories of the women's experiences after sexual assault and how the women's …

Measuring The Direct Nurses' And Nurse Leaders' Perceptions Of A Healthy Work Environment Within Acute Care Settings, Penny Susette Huddleston

Nursing Dissertations - Archive

Healthy work environments (HWEs) have been described as policies, procedures, and processes designed to empower nurses to meet the organizational objectives and achieve personal satisfaction in the work environment (American Association of Critical-Care Nurses, 2005; Lake, 2007; Schmalenberg & Kramer, 2008; Shirey, 2006). Unhealthy work environments (UWEs) throughout healthcare organizations have been linked to absenteeism, ineffective delivery of healthcare to patients and families, higher stress levels, poor communication, and ineffective collaboration and teamwork among healthcare professionals (Heath, Johanson, & Blake, 2004). The American Association of Critical-Care Nurses (AACN) developed a Healthy Work Environment Assessment Tool (HWEAT) for nurses to use …

Increasing Drug Screens And Prescription Drug Monitoring Program Assessments For Patients Enrolled In Opioid Replacement Therapy, Kimberly Thompson

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Opioid use disorder is an epidemic that has a devastating impact on public health, morbidity and mortality, and the escalating economic burden of healthcare (U.S. Department of Health & Human Services, 2013). The rates of prescriptive and nonprescriptive opioid misuse are on the rise (Compton, Boyle, & Wargo, 2015). One approach in managing opioid use disorder is opioid replacement therapy (ORT). In response to increasing rates of opioid use disorder, the Drug Addiction Treatment Act of 2000 permitted "qualifying physicians" to treat opioid use disorder in an office-based setting. The FDA approved medication buprenorphine, a partial opioid agonist, is used …

The Relationship Between Faith-Based Support And Physical Activity Levels Among African American Women In Faith Communities, Sharon Taylor Johnson

Nursing Dissertations - Archive

Physical inactivity is the fourth leading risk factor for death worldwide, and is a major contributor for a number of chronic diseases such as obesity, type 2 diabetes, hypertension, and cancer in the United States (CDC, 2014; World Health Organization, 2010). This public health problem is more prevalent among African American women who have been diagnosed with chronic health conditions and live sedentary lifestyles. Therefore, identifying strategies that contribute to improving physical activity levels are warranted for this population. The purpose of this study was to examine the relationship between participation in faith-based groups and physical activity levels among African …

Promotion Of Advanced Practice Provider Compliance With The 2012 Surviving Sepsis Campaign Three-Hour Bundle Guidelines In The Emergency Department: A Multi-Component Intervention, Michael Watson

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Refer to the document.

Caring Minds, University Of Texas Health Science Center At Houston School Of Nursing

Caring Minds

No abstract provided.

An Evaluation Of The Adherence To An Indwelling Urinary Catheter Maintenance Bundle, Jessica Lynn Johnston

DNP Projects

Background: There are more than 1 million Catheter Associated Urinary Tract Infection (CAUTI) occurrences per year in the United States, with an estimated cost to treat of $400 million dollars annually (Clarke et al., 2013). Urinary Tract Infections are the most common hospital acquired infection, comprising roughly 30 - 40% of all infections occurring in acute care hospitals (Gould et al., 2009). In February of 2013, the University of Kentucky (UK) Hospital made drastic changes to the current Catheter Associated Urinary Tract Infection (CAUTI) prevention standards by instituting a CAUTI Maintenance Bundle to prevent the incidence of CAUTIs.

Purpose …

Assessment Of Migraine Management In Adolescents, Kara L. Scott

DNP Projects

Objective: The purpose of this study is to assess how providers are managing adolescent patients with migraines in Kentucky.

Methods: A cross-sectional descriptive study via a 28-item survey instrument, which is distributed electronically via member listserve to members of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM).

Results: Of the 35 survey respondents, there were 29 respondents who met criteria for participation in the survey. Respondents reported the most common presenting symptom for adolescent migraine was headache. Over half of the respondents (58.6%) initiated treatment with over-the-counter medications, with ibuprofen (65.5%) being the most commonly used. 62.1% of …

Comparing Must And The Nri Tools In The Identification Of Malnutrition In Heart Failure Patients, Cassondra D. Degener

DNP Projects

The purpose of this project was to test the performance of albumin, NRI and MUST screening tools in comparison to the standardized measure of prealbumin among HF patients admitted to the University of Kentucky Chandler Medical Center. Inclusion criteria included all HF patients with the 428 diagnostic code, admitted from January 1, - December 31, 2013, ages 18 and older, with all laboratory values available specified in the data collection tool (Appendix A). A retrospective electronic medical record (EMR) review was performed for 100 patients who met the inclusion criteria. All data were collected through the University of Kentucky’s secure …

The Efficacy Of Stemi Networks And Systems Of Coordinated Stemi Care: An Evaluation Of The Implementation Of A Stemi Network, Julianne M. Evers

DNP Projects

Purpose: The purpose of this project was to evaluate the implementation of an ST-elevation myocardial infarction (STEMI) Network into a large metropolitan healthcare system in Kentucky. The objectives of this project were to (1) determine if (and to what extent) the implementation of the STEMI Network decreased walk-in, emergency medical services (EMS), and transfer door to balloon (D2B) times at a STEMI receiving center at a metropolitan Kentucky academic hospital, (2) determine if there is a difference in treatment times for those individuals who present during working hours compared to non-working hours of the day, and (3) examine the associations …

A Culturally Appropriate Cognitive Assessment Screening For Bhutanese Refugees, Holly Milligan

Master's Theses and Capstones

Background: As the incidence of cognitive impairment continues to rise, timely and accuratediagnoses are essential. Aim: The aim of this quality improvement project was to evaluate the standard cognitiveassessment screening for Bhutanese refugees in a medical home, and compare an alternative,validated, and potentially more culturally appropriate tool. Also, an assessment of provider,nurse and interpreter satisfaction with the two tools was performed. Method: Mixed methods including qualitative observations and quantitative satisfaction surveysrelated to the implementation of a culturally appropriate cognitive assessment tool. Results: When assessed with the standard tool, all 10 people screened positive for cognitiveimpairment. However, when using the alternative …

Using Shock Index As A Predictor Of Icu Readmission: A Quality Iimprovement Project, Melissa Sykes

Master's Theses and Capstones

Background: Adverse events will occur in one-third of patients discharged from the intensivecare unit (ICU) and evidence shows that ICU readmissions increase a patient’s length of stay,
mortality, hospital costs, and nosocomial infections, as well as decrease long-term survival.Specific predictive factors that will accurately predict which patients are at risk of adverseevents requiring readmission are needed.Aim: The specific aim of this project was to identify if shock index (SI) values higher than 0.7at the time of transfer from the ICU are a useful predictor of ICU readmission.Methods: Using the Plan, Do, Study, Act (PDSA) framework, a retrospective chart review wasperformed …

Prevention Of Icu Delirium Through Implementation Of A Sleep Promotion Bundle, Victoria Bennett

Master's Theses and Capstones

Background: Intensive care unit (ICU) delirium is the prevalence of delirium in ICU patientswho do not have a history of drug/alcohol abuse, an admission for a mental status change, or anadmission to the ICU for less than 24 hours. Serious adverse outcomes have been linked to thepresence of ICU delirium resulting in overall longer hospital lengths of stay, longer duration ofmechanical ventilation, higher rates of mortality, and long-term neuropsychological deficits afterdischarge. At the site of this quality improvement project, the prevalence of ICU delirium was92.3% in a population determined to be high risk using the PRE-DELIRIC screening tool. Aim: The …

An Updated Rounds Checklist To Increase Appropriate Use Of Telemetry Monitoring, Hattie Miller

Master's Theses and Capstones

Background: Telemetry monitoring is an essential tool to monitor cardiac electrical activity. Its overuse is costly in time and resources and leads to subsequent testing and treatments that are not necessary for the patient and, in addition, healthcare staff is burdened with work that is potentially not clinically useful.

Aim: The global aim of increasing efficiency in telemetry use starts with the local improvement to facilitate nurse-physician communication of telemetry patients during

Methods: This study with pre and post data collection looked at the results of quantitative data, collected in May-July 2015, on the number of patients with telemetry and …

Chiildhood Bullying: Assessment Practices And Predictive Factors Associated With Assessing For Bullying By Health Care Providers, Vicki Hensley

Theses and Dissertations--Nursing

Childhood bullying affects over 25% of today’s youth and causes up to 160,000 missed school days per year. Bullying causes short and long term adverse effects to both mental and physical health. Many organizations encourage healthcare providers to take an active role in bullying prevention. However, there has been little research into the role of primary healthcare providers regarding childhood bullying and the effectiveness of different approaches to screening and management.

Therefore the purposes of this dissertation were to a) explore childhood bullying and the role of the healthcare provider in bullying prevention, b) develop and evaluate the psychometric properties …

Perceived Social Support And Self-Care In Patients Hospitalized With Heart Failure, Lyne Chamberlain

Electronic Theses and Dissertations

Problem: Heart failure is the most frequent cause for hospital readmissions in Medicare recipients, with an estimated annual cost of $12 billion. Heart failure hospitalizations are also an independent risk factor for increased mortality. Self-care, thought to be enhanced by perceived social support, is key to managing this syndrome, and up to 50% of readmissions are considered the result of inadequate self-care. Purpose: To evaluate perceived social support and self-care characteristics of patients hospitalized with an exacerbation of heart failure, and to compare these characteristics with a study of ambulatory patients with heart failure. In addition, to assess the relationship …

Sisters Of Mercy: The Walking Nun's Siouxland Journey And Experiences In Nursing (1890-1965), Diane L. Smith

Electronic Theses and Dissertations

Nursing history is like a kaleidoscope, with prisms of time representing the past, present, and future experiences of nursing. The existence of nursing history is unknown until it is written; similar to the shadowed image of a kaleidoscope mirror is the history of the Sisters of Mercy in Siouxland. Uncovered collections, documents, letters, pictorial archives, and oral histories provide a way to examine the work of the Sisters of Mercy in Siouxland in light of the Careful Nursing Model. On December 12, 1831, Catherine McAuley became the Foundress of the Religious Sisters of Mercy Order in Dublin, Ireland. These Sisters …

ผลของโปรแกรมการสอนแนะต่อการปฏิบัติการช่วยฟื้นคืนชีพขั้นพื้นฐาน ของมารดาที่มีบุตรป่วยด้วยโรคหัวใจพิการแต่กำเนิด, สุพีระพรรณ ธูปมงคล, นรลักขณ์ เอื้อกิจ

Journal of Nursing Research, Innovation, and Health

วัตถุประสงค์: เพื่อเปรียบเทียบการปฏิบัติการช่วยฟื้นคืนชีพขั้นพื้นฐานระหว่างกลุ่มที่ได้รับการพยาบาลตามปกติกับกลุ่มที่ได้รับการสอนแนะ\n \nรูปแบบการวิจัย: แบบกึ่งทดลอง\n\nวิธีดำเนินการวิจัย: กลุ่มตัวอย่าง คือ มารดาที่มีบุตรป่วยด้วยโรคหัวใจพิการแต่กำเนิด จำนวน 40 คน จัดเข้ากลุ่มควบคุมและกลุ่มทดลอง กลุ่มละ 20 คน โดยจับคู่ให้ทั้งสองกลุ่มมีความคล้ายกันในด้าน อายุ ระดับการศึกษา และประสบการณ์เกี่ยวกับการช่วยฟื้นคืนชีพขั้นพื้นฐาน กลุ่มควบคุมได้รับการพยาบาลตามปกติ และกลุ่มทดลองได้รับโปรแกรมการสอนแนะ เครื่องมือที่ใช้ในการวิจัย คือ โปรแกรมการสอนแนะเรื่องการช่วยฟื้นคืนชีพขั้นพื้นฐาน ผู้วิจัยสร้างขึ้นตามแนวคิดการสอนแนะของ Gracy (2001) เครื่องมือที่ใช้ในการเก็บรวบรวมข้อมูลประกอบด้วย แบบบันทึกข้อมูลส่วนบุคคล แบบประเมินการปฏิบัติการช่วยฟื้นคืนชีพขั้นพื้นฐานซึ่งพัฒนาจากแบบประเมินของสมาคมโรคหัวใจประเทศสหรัฐอเมริกา (2006) ผ่านการตรวจความตรงตามเนื้อหาจากผู้ทรงคุณวุฒิจำนวน 5 คน หาค่าความเที่ยงของการสังเกต ได้เท่ากับ .90 วิเคราะห์ข้อมูล โดยสถิติทดสอบที\n \nผลการวิจัย: 1) มารดาที่มีบุตรป่วยด้วยโรคหัวใจพิการแต่กำเนิดที่ได้รับโปรแกรมการสอนแนะมีค่าเฉลี่ยคะแนนการปฏิบัติการช่วยฟื้นคืนชีพขั้นพื้นฐานหลังการทดลองสูงกว่าก่อนการทดลองอย่างมีนัยสำคัญทางสถิติที่ระดับ .05 2) มารดาที่มีบุตรป่วยด้วยโรคหัวใจพิการแต่กำเนิดที่ได้รับโปรแกรมการสอนแนะมีค่าเฉลี่ยคะแนนการปฏิบัติการช่วยฟื้นคืนชีพขั้นพื้นฐานหลังการทดลองสูงกว่ามารดาที่ได้รับการพยาบาลตามปกติอย่างมีนัยสำคัญทางสถิติที่ระดับ .05\n\nสรุป: โปรแกรมการสอนแนะเรื่องการช่วยฟื้นคืนชีพขั้นพื้นฐานส่งผลให้มารดาที่มีบุตรป่วยด้วยโรคหัวใจพิการแต่กำเนิดปฏิบัติการช่วยฟื้นคืนชีพขั้นพื้นฐานได้ดีขึ้นและดีกว่าการพยาบาลตามปกติ\n

ปัจจัยทำนายการปรับตัวในชีวิตสมรสของสตรีตั้งครรภ์วัยรุ่น, รุ่งทิพย์ กาศักดิ์, เยาวลักษณ์ เสรีเสถียร, ยุพา จิ๋วพัฒนกุล

Journal of Nursing Research, Innovation, and Health

วัตถุประสงค์: เพื่อศึกษาความสัมพันธ์และปัจจัยทำนายการปรับตัวในชีวิตสมรสของสตรีตั้งครรภ์วัยรุ่น\n\nรูปแบบการวิจัย: การวิจัยแบบความสัมพันธ์เชิงทำนาย\n \nวิธีดำเนินการวิจัย: กลุ่มตัวอย่าง คือ สตรีตั้งครรภ์วัยรุ่น ครรภ์แรก อายุระหว่าง 10-19 ปี ที่อาศัยอยู่กับสามี มารับบริการฝากครรภ์ที่หน่วยฝากครรภ์ โรงพยาบาลศิริราช จำนวน 145 ราย รวบรวมข้อมูลโดยใช้ แบบสอบถามข้อมูลส่วนบุคคล แบบสอบถามความรู้สึกมีคุณค่าในตนเอง แบบสอบถามการรับรู้การสนับสนุนทางสังคม และแบบสอบถามการปรับตัวในชีวิตสมรส ตรวจสอบความเที่ยงของแบบสอบถามทั้งสามด้วยการหาค่าสัมประสิทธิ์อัลฟ่าของครอนบาค ได้ค่าเท่ากับ .76, .82 และ .78 ตามลำดับ วิเคราะห์ข้อมูลโดยใช้สถิติเชิงบรรยาย สถิติอีต้า สถิติสหสัมพันธ์สเปียร์แมน สถิติสัมประสิทธิ์สหสัมพันธ์ของเพียร์สัน และสถิติถดถอยพหุคูณแบบขั้นตอน\n \nผลการวิจัย: 1) สตรีตั้งครรภ์วัยรุ่นมีการปรับตัวในชีวิตสมรสอยู่ในระดับปานกลาง (x̄ = 64.86, SD = 13.36) 2) ปัจจัยที่มีความสัมพันธ์ทางบวกกับการปรับตัวในชีวิตสมรสในสตรีตั้งครรภ์วัยรุ่นอย่างมีนัยสำคัญทางสถิติที่ระดับ.05 ได้แก่ ความรู้สึกมีคุณค่าในตนเอง (r = .357) การรับรู้การสนับสนุนทางสังคม (r = .349) และความเพียงพอของรายได้ครอบครัว (η = .303) ทั้งนี้ อายุ ระดับการศึกษา และลักษณะครอบครัว ไม่มีความสัมพันธ์กับการปรับตัวในชีวิตสมรส (r = .036 , r = .012 และ η = .005 ตามลำดับ) 3) ปัจจัยทำนายการปรับตัวในชีวิตสมรสในสตรีตั้งครรภ์วัยรุ่น ได้แก่ ความรู้สึกมีคุณค่าในตนเอง ( β = .275) การรับรู้การสนับสนุนทางสังคม ( β = .264) และความเพียงพอของรายได้ครอบครัว (β = .254) โดยสามารถร่วมกันอธิบายความแปรปรวนของการปรับตัวในชีวิตสมรสในสตรีตั้งครรภ์วัยรุ่นได้ร้อยละ 26.8 (R2 =.268) ที่ระดับนัยสำคัญทางสถิติ .05\n\nสรุป: ปัจจัยทำนายการปรับตัวในชีวิตสมรสในสตรีตั้งครรภ์วัยรุ่น คือ …