Medicine and Health Sciences Commons^™

Perinatal Palliative Care: Assessment Of Practice Barriers, Clinician Perspectives And Confidence, Charlotte Wool

Nursing Theses and Dissertations

Perinatal palliative care (PPC) is an emerging model of care that provides supportive services to families anticipating fetal or neonatal demise. Clinician reported practice barriers, their perspectives of PPC and confidence in caring for patients requiring PPC are unknown. The aim of this research is to fill a gap in understanding clinician perspectives, perceived practice barriers and reported confidence to providing PPC. A cross sectional survey design using the Perinatal Palliative Care Perceptions and Barriers Scale© was administered using a Web-based tool. Recruitment was completed via email invitation and list serves. Participants included physicians (n = 66) and advance practice …

The Influence Of Time Perspective On Physical Activity Intentions And Behaviors Among Adolescents Residing In Central Appalachia., Tauna Gulley

Electronic Theses and Dissertations

Obesity and inactivity are prevalent among central Appalachian adolescents. Appalachian residents have been labeled "fatalistic," a time perspective unsupportive of health-promoting behaviors such as regular participation in physical activity. The theory of planned behavior has been used extensively to explain the physical activity behaviors of adolescents. Constructs within the theory of planned behavior include attitudes toward the behavior, subjective norms, perceived behavioral control, and intention to perform the behavior. The purpose of this study was to determine the time perspective of central Appalachian adolescents and examine the relationship between time perspective and the constructs within the theory of planned behavior. …

Horizontal Violence In The Nursing Work Environment: Beyond Oppressed Group Behavior, Therese M. Mendez

University of New Orleans Theses and Dissertations

The United States has been experiencing a nursing shortage since the mid-1990s. The shortage is expected to deepen as the provisions of the 2010 Patient Protection and Affordable Care Act are enacted. Horizontal violence is a negative phenomenon in the nursing workplace that contributes to difficulty in recruiting and retaining nurses in hospitals. Horizontal violence has been described as a form of mistreatment, spoken or unspoken, that is threatening, humiliating, disrespectful or accusatory towards a peer. The effects of this nurse on nurse aggression can be devastating for the nurse involved and also for the patients under the nurse's care. …

Knowledge Of The Effects Of Alcohol On Fetal Development Among Women Of Childbearing Age., Mary Bales

Undergraduate Honors Theses

While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development …

Rn Transition To Practice Program In The Primary Care And School Settings: Development, Implementation, And Evaluation, Maria-Idalia O. Lens

Doctor of Nursing Practice (DNP) Projects

New graduate registered nurses (RN) are facing a difficult time finding jobs since the economy of the United States has declined. Since then the California Institute of Nursing and Health Care, along with funding from the Betty Moore Foundation, have developed RN transition programs. These programs were developed to increase skills, confidence, and experience among new RN graduates to promote their transition into the nursing workforce. The programs also were designed to retain newly licensed nurses in the nursing profession while engaging competencies that could be transferred to both acute and outpatient care settings. In addition, the programs are intended …

Motherhood And Childbirth Experiences Among Newcomer Women In Canada: A Critical Ethnographic Study, Fatmeh Ahmad Alzoubi

Electronic Thesis and Dissertation Repository

Statement of the Problem: Motherhood and childbirth are very sensitive experiences and have a strong impact on family functioning, social identity, and cohesiveness. Although motherhood and childbirth have been discussed extensively in the scholarly and popular literature, much of this work has been conducted from a North American perspective, with little attention to how motherhood and childbirth are experienced by newcomer women from diverse racial and cultural backgrounds.

Methodology and Theoretical Orientation: A critical ethnographic study using in-depth interviews with 16 newcomer women was utilized to explore newcomer women’s experiences and understandings of motherhood and childbirth in the aftermath of …

Development Of An Evidence-Based Clinical Practice Guideline On Linear Growth Measurement Of Children, Jan Foote, L. Brady, A. Burke, J. Cook, M. Dutcher, K. Gradoville, J. Groos, K. Kinkade, R. Meeks, P. Mohr, D. Schultheis, B. S. Walker, K. Phillips

Jan M. Foote

Growth is an important indicator of child health; however, measurements are frequently inaccurate and unreliable. This article reviews the literature on linear growth measurement error and describes methods used to develop and evaluate an evidence-based clinical practice guideline on the measurement of recumbent length and stature of infants, children, and adolescents. Systematic methods were used to identify evidence to answer clinical questions about growth measurement. A multidisciplinary team critically appraised and synthesized the evidence to develop clinical practice recommendations using an evidence-based practice rating scheme. The guideline was prospectively evaluated through internal and external reviews and a pilot study to …

Pyloric Channel Stricture Secondary To High-Dose Ibuprofen Therapy In A Patient With Cystic Fibrosis, E. Bell, R. Grothe, V. Zivkovich, Jan Foote, J. Wellendorf

Jan M. Foote

OBJECTIVE: To describe a case of pyloric channel stricture secondary to high-dose ibuprofen therapy in a pediatric patient with cystic fibrosis. CASE SUMMARY: A 12-year-old white girl started taking high-dose ibuprofen to treat the pulmonary manifestations of cystic fibrosis. The peak plasma concentration at dose initiation was within the accepted therapeutic range. Approximately one month later, the patient developed emesis and intolerance of solid foods, which persisted for several months and resulted in a weight loss of seven kilograms. The patient was referred to a pediatric gastroenterologist, who performed an upper endoscopy and subsequently diagnosed a pyloric channel stricture. The …

Getting A Healthy Start. Feeding Issues In The First Year Of Life, Jan Foote

Jan M. Foote

No abstract provided.

Four Distinct Generations Of Workers Makes Leadership Challenging, Joyce K. Kutin

Joyce K Kutin RN, MSN, MOL

The Bureau of Labor Statistics for the year 2000 stated that Baby Boomers (age thirty-six through fifty-four) represented fifty percent of the United States labor force while Generation X (age twenty to thirty-five) represented some thirty-three percent, a significant decline in workforce. This demographic, time bomb indicates the urgency for many organizations in developed countries to prepare for and cope with the imminent retirement of their aging workforce.

Impact Of Multiple Children On Parental Supervision Practices, Parental Developmental Competence, And Unintentional Injury Risk, Jennifer L. Taylor

Dissertations

Unintentional injury is the leading cause of childhood mortality and morbidity in the United States. The effects of injury on children, families and society encompass physical, mental, emotional, and financial consequences. The highest injury rates are among preschool age children, especially preschool children who have siblings. Child injury prevention strategies can reduce the rates of childhood unintentional injuries and minimize the burdens to children, families, and society created by these injuries. To design and implement effective child injury prevention strategies, further investigation is needed to understand the relationship between the variables influencing the occurrence of child injuries. The specific aim …

Chest Tube Dressings: A Comparison Of Different Methods, Susan Kathleen Blackburn Jones

Dissertations

This study is an experimental design with randomization comparing the use of standard gauze dressings (SGD) to transparent adhesive dressings (TAD) to cover chest tube insertion sites in post-operative patients who have undergone cardio-thoracic surgery. The study was conducted in a 400 bed, tertiary non-academic teaching hospital in the Midwestern United States. Seventy-nine patients were enrolled in the study; 39 received TAD and 40 received SGD. The non-inferiority margin was set at 15% in keeping with current recommendations (Kaul & Diamond, 2006). The TAD was found to be not inferior to the SGD with regards to the proportional differences in …

Sleep Loss And Its Health Impact Among Family Caregivers Of Persons With A Primary Malignant Brain Tumor, Jean Pawl

Nursing Dissertations (PhD)

Sleep impairments for caregivers are multifactorial. Assumptions are that caregivers of those with primary malignant brain tumors (PMBT) are similar to caregivers of persons with dementia as cognitive impairments are present at diagnosis. The shorter trajectory of PMBTs and rapid deterioration of recipients’ health may influence sleep in caregivers of persons with a PMBT. The purposes of this study were to use a sleep impairment model to characterize caregiver sleep using objective and subjective measures, and to examine sleep loss effects on psychosocial and physiologic health outcomes.

A secondary data analysis using baseline data from a larger study of mind-body …

Development And Description Of The Incivility In Nursing Education (Ine) Survey, Cynthia Clark, Judy Farnsworth, R. Landrum

R. Eric Landrum

Incivility in nursing education is a challenging problem and difficult to measure. This paper describes both the development and description of the Incivility in Nursing Education (INE) survey. The INE includes eight demographic items, six quantitative items, and four open-ended questions. It measures nursing students' and faculty’s perceptions of and experience with academic incivility. The INE was initially tested in a 2004 pilot study using a convenience sample of 356 nursing students and faculty and re-tested in a 2006 study with another convenience sample of 504 nursing faculty and students. Revisions were made to the INE based on findings from …

The Determinants Of A Nurse's Discretionary Decision To Respond To Situations That Place Patients At Risk For Safety Events But Requires A Response That Is Beyond The Scope Of Nursing Practice, Kathy Baker

Theses and Dissertations

A nurse’s contribution to patient safety in regards to early detection of issues in the clinical setting is undisputed (Redman, 2008). If these patient situations require a response that is beyond the scope of nursing practice, in most instances nurses are not sanctioned to intervene without physician consultation (Gaba, 2000). The evidence in the nursing literature does suggest that some nurses exercise professional discretion and are, at times, making the decision to initiate interventions independently (Benner, Hooper-Kyriakidis, & Stannard, 1999; Hutchinson, 1990; Tiffany, Cruise, & Cruise, 1988). The focus of this inquiry was to examine the determinants of a nurse’s …

Introducing Integrative Medicine At The Bedside To Patients With Post-Traumatic Headache Pain, Melissa E. Allard

Theses and Graduate Projects

The use of integrative medicine is growing, and the nursing profession has a responsibility to meet the changing needs of patients. This paper describes a model of nursing for delivering integrative medicine practices at the bedside to persons suffering with post-traumatic headache pain related to traumatic brain injury (TBI) and is grounded in Katherine Kolcaba's Comfort Theory. A patient is best served when the holistic principles of integrative medicine are facilitated by a nurse who is centered and able to introduce these modalities with positive intention. The goal of the practice model is to provide the foundation for nursing to …

Response To And Recovery From Endotracheal Suctioning In Preterm Infants Using Routine Versus Four-Handed Care, Sharon Cone

Theses and Dissertations

Neonatal Intensive Care Units have experienced profound advances in technology and treatment modalities over the last two decades. Infants born at the edge of viability are now surviving despite prolonged hospitalizations. These infants born preterm are prone to a high degree of stress from life sustaining and routine interventions. Much focus has been directed toward addressing noxious environmental factors such as noise, light, and infectious disease; however, little has been done to examine the stress experienced by the professional caregiver who work in these environments. Environmental press theory, which focuses on the interplay between human beings and their surroundings, is …

Facilitating The Staff Nurse's Role In Creating A Culture Of Care On An Obstetrical Care Unit, Laura Struve Hanson

Theses and Graduate Projects

The art of caring is foundational to the nursing profession, but too often nurses prioritize care for others above care for themselves. Nurse self-care and peer care are integral in the creation of a unit culture of care. This project introduces a new nursing practice model based on Jean Watson's caring theory and Caritas Processes to guide staff nurses on an obstetrical unit in creating a culture of care for self and peers. The practice model relies on nurse courage, intentional collaboration, and creativity to uniquely integrate the Caritas Processes into professional practice. This progression fosters the emergence of holistic …

Advancing A Culture Of Safety Through The Creation Of A Unit-Based Safety Team, Lynda K. Carr

Theses and Graduate Projects

Hospitals are challenged to create a strong culture of safety within their organization to eliminate harm to patients. This paper describes a project to advance a culture of safety on a cardiovascular acute care unit at an urban hospital through the creation of a unit-based safety team. Based on the premise that patient safety is a local phenomenon, the rationale for the project is to aim interventions at the unit level where they will have the greatest impact. Four key steps in creating an effective unit-based safety team are highlighted: team member selection, team development, enacting interventions, and evaluating interventions …

Caring For A Preterm Infant During The First Six Months Post Nicu Discharge: A Mother’S Perspective, Lois Phillips-Pula

Theses and Dissertations

Overview There are numerous studies in the current literature focusing on the intense emotions experienced by parents, following the birth of a preterm infant, (i.e., born prior to 37 weeks gestational age [GA]). Research findings have helped us understand the fear and anxiety they feel while attempting to navigate the neonatal intensive care unit (NICU) environment. What happens in those early weeks and months at home after discharge, however, is surprisingly absent from the literature. It is well known that preterm infants are readmitted to the hospital during the first few months after discharge at a rate of 10% - …

Implementing Evidence-Based Practices: Considerations For The Hospice Setting, S. Sanders, Melissa Lehan Mackin, J. Reyes, Keela Herr, M. Titler, P. Fine, C. Forcucci

Melissa Lehan Mackin

No abstract provided.

Emergency Contraception In Iowa Pharmacies Before And After Over-The-Counter Approval, Melissa Lehan Mackin, M. Clark

Melissa Lehan Mackin

ABSTRACT Objectives: To compare availability of emergency contraception in Iowa pharmacies, before and after the U.S. Food and Drug Administration (FDA) approved over-the-counter sales and identify reasons why over-the-counter, emergency contraception might still not be available in some Iowa pharmacies. Design and Sample: Secondary analysis of data collected for an existing, descriptive study. A total of 906 pharmacies were identified; 405 (56.8%) pharmacies participated before, and 308 (43.2%) after the FDA policy change. Measures: Data collected via a scripted telephone survey. Results: After the FDA changed its policy and allowed over-the-counter sales of emergency contraception, the percentage of Iowa pharmacies …

Research Participation By Older Adults At End Of Life: Barriers And Solutions, Melissa Lehan Mackin, Keela Herr, K. Bergen-Jackson, P. Fine, C. Forcucci, S. Sanders

Melissa Lehan Mackin

The purpose of this article is to elaborate on barriers to research participation by older adults at end of life. We focus on the hospice setting and classify barriers to research participation into six domains: societal attitudes toward death, research procedures, health care organizations, agency staff, patients' families and caregivers, and patient characteristics. We characterize particular participation issues, uncertainties in participation for individuals with advanced illness, and infringements on patient self-determination, as well as potential solutions to these research challenges. Our observation of the complex palliative context includes the realization that a singular change will not have large enough impact …

The Keys To Creative Caring., Melissa Lehan Mackin, S. Baumler, B. Bezoni, D. Keiffer

Melissa Lehan Mackin

No abstract provided.

Engaging Racial Autoethnography As A Teaching Tool For Womanist Inquiry, Janette Taylor, Melissa Lehan Mackin, A. Oldenburg

Melissa Lehan Mackin

Racial autobiography, self-narratives on how one learned about the idea of race, has been underutilized as a tool to familiarize and orient students in the process of critical inquiry for nursing research. The aims of this article are to explore how racial autoethnography: (1) repositions students to effect an epistemological change, (2) challenges dominant ideology, and (3) functions as a link between the student and critical theories for use in nursing research. Students engage in and share reflective narrative about a variety of instructional materials used in the course. Reflective narratives are presented in a framework that addresses white racial …

Fall Prevention Practices In Adult Medical-Surgical Nursing Units Described By Nurse Managers, L. Shever, M. Titler, Melissa Lehan Mackin, A. Kueny

Melissa Lehan Mackin

The purpose of this article was to describe nursing practices (e.g., assessment, interventions) around fall prevention, as perceived by nurse managers in adult, medical-surgical nursing units. One hundred forty nurse managers from 51 hospitals from across the United States participated. Descriptive frequencies are used to describe nurse manager responses. The most commonly used fall risk assessment tool was the Morse Fall Risk Assessment Tool (40%). The most common fall prevention interventions included bed alarms (90%), rounds (70%), sitters (68%), and relocating the patient closer to the nurses' station (56%). Twenty-nine percent of nurse managers identified physical restraints as an intervention …

Faculty Empowerment Of Students To Foster Civility In Nursing Education: A Merging Of Two Conceptual Models, Cynthia Clark, Bonnie Kenaley

Bonnie Kenaley

Academic incivility negatively impacts faculty and student well-being, weakens professional relationships, and impedes effective teaching and learning. This article addresses the prevalent concern of student incivility and provides useful strategies for faculty to empower students. Two conceptual models, Fostering Civility in Nursing Education and an Empowerment Model, were merged to illustrate how the concepts of civility and empowerment can be combined to foster civility in nursing education. Empowerment domains of motivation, psychic comfort, problem-solving, and self-direction are explored as influential factors promoting constructive reciprocal engagement and civility and, ultimately, enhancing professionalism in a complex and ever-changing health system.

A Bridge To One World: An Indigenous Wisdom-Based Approach To Designing A Transcultural Patient Family Advisory Council, Julie Lundberg

Theses and Graduate Projects

As health care organizations face increasing challenges to accommodate diverse patient populations amid growing concerns of persistent health disparities, there is urgent need to better understand and listen to diverse, unique patient experiences. This paper describes the design and implementation of a transcultural Patient Family Advisory Council (PFAC) as a concrete step towards ensuring that the voices of culturally diverse patients and families are effectively engaged to improve the patient experience at a large, Midwestern healthcare organization. Storytelling, ritual and dialogue provide a wisdom-based approach to the design of a Bridge to One World practice model grounded in Leininger's Culture …

Care Of Self: How Reiki Is Used By Nurses To Reduce Stress On An Acute Care Unit, Leann Olson

Theses and Graduate Projects

As the nursing shortage escalates and patient acuity levels continue to rise, nurses can expect to experience increased stress and burnout. Indeed, studies show that job dissatisfaction among nurses today is widespread. Finding ways to reduce the stress, improve job satisfaction, and retention is important not only for nurses, nursing units, and organizations, but also for patients. This paper describes a nursing practice model that was developed to reduce stress and burnout among nurses in an acute care unit of a large urban hospital. The model uses the energy therapy of Reiki and is guided by Martha Rogers' Science of …

Creating A Healing Environment In The Intensive Care Unit, Elissa Egbers

Theses and Graduate Projects

The intensive care unit (ICU) can be a very stressful environment. Patients are critically ill and require constant monitoring. Indeed, high tech care in the ICU environment includes multiple factors that may impair the patient's ability to sleep and rest. The purpose of this paper is to describe a practice model that is conducive to patient healing in an intensive care unit in a large urban hospital. This practice model is significant to patients, families, and nursing staff and is based on Florence Nightingale's Environmental Model of Nursing and her thirteen canons. This paper describes the potential implementation of the …