Nursing-Dissertations

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A convergent parallel mixed method study on the experience of coping during high-risk pregnancy and prescribed bed rest
(5/14/2019) Boyd, Ellen; Freysteinson, Wyona M.
Antepartum bed rest and hospitalization are frequently prescribed for high-risk women experiencing pregnancy complications. Bed rest may result in problems for the high-risk mother including isolation, boredom, anxiety, depression and separation from their families. The aim of this study is to analyze the coping behaviors of high-risk pregnant women hospitalized and prescribed bed rest. Also, to describe the lived experience of high-risk pregnant women hospitalized and prescribed bed rest. A convergent parallel mixed method design was used to analyze the coping behaviors of 40 high-risk pregnant women. A secondary analysis of data from the Brief Cope Scale (Carver, 1997) was used for the quantitative portion. Transcripts from the same 40 high-risk mothers were reviewed as a secondary analysis using a Step-by-Step Simple Thematic Analysis (Nowell Norris, White & Moules, 2017). The most frequently identified maternal coping behaviors were emotional support, positive reframing, religion, acceptance, instrumental support and planning. The less frequently used coping behaviors were self-distraction, humor, substance use, self-blame, denial and behavioral disengagement. The overreaching theme from the qualitative analysis was Coping in High-Risk Pregnancy. Seven themes were identified from the transcripts: Family Burdens, Fearfully Waiting, Leaning on Faith, Hope, Acceptance, Knowledge Seeking and Support Enhances Maternal Coping. Quantitative and qualitative data were triangulated to identify those behaviors that were convergent or divergent in this mixed method design. By identifying adaptive coping behaviors of high-risk hospitalized mothers antepartum care may be improved.
A descriptive phenomenological study of nursing student experiences of clinical data use in clinical rotations
(11/9/2017) Straughn, Marcia; Liu, Fuqin, 1977-; Lee, Mikyoung; Zeigler, Vicki
Clinical learning experiences are important opportunities for nursing students in that they gather and synthesize data of patients’ conditions, provide appropriate nursing interventions, and evaluate patient outcomes, applying their knowledge and skills learned from the classroom in real practice. In order to ensure quality clinical learning for nursing students, it is vital to hear the voices of nursing students on how they experience clinical learning, particularly with regards to clinical data use. This qualitative, exploratory approach was conducted, using descriptive phenomenology as the philosophical framework, through in-depth interviews with eighteen junior and senior baccalaureate nursing students at a large, public university in Texas. The interview data were analyzed according to Colaizzi’s method of descriptive phenomenological data analysis. Theme 1: Help Wanted was revealed in descriptions of needing or wanting help with using clinical data. Theme 2: Making Sense, included descriptions about ways that clinical data make sense and ways that clinical data assisted students in making sense in both clinical and classroom. Theme 3: Recognizing Usefulness emerged from descriptions of how clinical data was used or could be used. Participant descriptions of how clinical data in clinical rotations was related to communication illuminated Theme 4: Engaging in Communication. Descriptions of the impact of the assigned nurse on student experiences with using clinical data in clinical rotations resulted in the emergence of Theme 5: Nurse as Key Player. Lastly, Theme 6: Emotionally Charged, emerged from descriptions about emotional experiences related to experiences of clinical data use in clinical rotations. The thematic findings were reduced according to Colaizzi’s method, resulting in an exhaustive statement of description, and a descriptive statement of identification of the phenomenon of interest. The findings may be used to assist nurse educators in developing effective ways to help students use clinical data for effective clinical learning. Suggestions to achieve this aim include improved orientation for educators and nursing staff and emotional support for students. Policy development to address barriers to effective clinical learning and the development of the future nursing workforce remains an important strategy for supporting nursing students and their preparation for entry into professional nursing practice.
A phenomenological exploration of the lived experience of concurrent AND-BSN program graduates in the Southwestern U.S.
(December 2023) Nelson, J. Michelle 1973-; Moore, Brenda; Kubin, Laura; Merritt, Linda
In 2010, the Institute of Medicine released a policy brief advocating for increased opportunities for nurses to obtain higher levels of education for increasingly complex patient care demands. Nursing programs in the United States responded by adding options for associate degree graduates to obtain baccalaureate degrees, including the innovative partnership pathway, which allows students to complete the associate degree and baccalaureate degree requirements concurrently. This pathway continues to expand in popularity and has proven to be a valuable option that allows students to take advantage of cost-effective and time-efficient associate degree programs while also gaining the additional knowledge offered by the baccalaureate degree. A review of the nursing literature revealed information regarding implementation strategies for concurrent enrollment programs and general descriptions of the challenges and strengths of these programs. However, a gap was identified in the existing literature describing the student perspective. This study aimed to address this gap and explore the lived experience of concurrent enrollment ADN-BSN graduates for the purpose of identifying the rewards, complexities, barriers, and challenges of the pathway for students. A descriptive phenomenological approach was used to gather data from graduates of a large concurrent enrollment ADN-BSN program in the Southwestern United States. Colaizzi’s seven-step data analysis method was used to analyze data. Six themes were identified, including “Choosing the concurrent enrollment program option,” “Managing time,” “Financial considerations,” “BSN curricular attributes,” “Belonging and engagement,” and “Feelings about the program.” Information obtained from the study validated findings in the current literature and added to the overall understanding of the student experience. Analysis of the findings suggests that the concurrent enrollment pathway is a valuable option for students seeking the BSN degree and that there are important implications from the data for nursing educators and the nursing profession in general.
A phenomenological study of parents of autistic children’s experiences with safety
(4/26/2019) Celia, Tania; Freysteinson, Wyona M.
Autism is a complex problem with a significant global burden with increasing prevalence. Autism is a complex disorder with varying presentations. Autistic children are most often cared for by parents who, at the time their child is diagnosed, are overwhelmed and have limited knowledge of autism and the potential safety issues that exist. Safety may not be an immediate consideration while they learn to cope with the diagnosis and what it means for them and their family. It is unknown if healthcare providers are communicating enough about safety issues specific to autism to give these parents appropriate anticipatory guidance during check-ups. A review of the literature reveals limited recommendations for the education of parents of autistic children about how to manage safety concerns specific to autism or what safety issues to anticipate once their child has been diagnosed with autism. During this phenomenological study, parents of autistic children were interviewed. The study explored the safety issues they have experienced with their child and where they obtained information about safety specific to autism. Ricoeur's hermeneutic phenomenology method was used to interpret the data. Two underlying structures which demonstrated the trajectory of the experience were: lost/ finding our way and battle-ready/battle weary. The phenomenological themes within battle weary included: living with fear, living with uncertainty, and living with disappointment. The participants provided recommendations for other parents and healthcare providers to help keep autistic children safe. This study illustrates the unique perspective of parents of autistic children concerning safety.
A phenomenological study on nurses' perceptions of participating in a root cause analysis process
(May 2023) Abreu, Tamu M 06/27/1979-; Freysteinson, PhD, Wyona; Paula Clutter; Rebecca Aulbach
The purpose of this study was to explore registered nurses' experiences of participating in a Root Cause Analysis (RCA) meeting because of their involvement in an adverse event. An RCA is the most common strategy used by organizations for adverse event investigations and nursing healthcare professionals directly involved in an adverse event may be asked to participate in the RCA. Semi-structured audio-taped interviews were held with 13 registered nurses who participated in an RCA. Ricoeur's hermeneutic phenomenology guided data analysis. Two structural elements represented the world of the nurses: 1) Learning about an RCA, and 2) Being on the other side of the RCA table. Three phenomenological themes emerged: 1) anticipatory and embodied fear, 2) To speak or not to speak, and 3) the aftermath. Nurses want to participate in RCA meetings, but desire education, and preparation on what to expect before, during, and after the RCA. Healthcare organizations must create safe and collaborative environments to empower nurses to speak up and have their voices heard during the RCA process. However, leaders must provide support for them throughout the process.
A randomized controlled trial evaluating the effectiveness of an online educational intervention on interprofessional team collaboration
(10/28/2021) Garey, Amanda Kay; Landrum, Peggy
The purpose of this study was to examine the effectiveness of an online interprofessional education competency (IPEC) online educational module intervention on the level of interprofessional team collaboration (ITC) on three subscales, as measured with the Assessment of Interprofessional Team Collaboration Scale (AITCS-II) in interprofessional healthcare providers. A two-group randomized controlled trial, with repeated measures design was used for this study. This study was conducted from October 2020 to June 2021. A computer-based randomized generator assigned 161 subjects to the intervention (n = 75) or control group (n = 86). The intervention group participated in an IPEC focused module and the control group participated in a routine family-centered care module. Data collection for both the intervention group and control group occurred at three time points: at baseline, immediately after completion, and at 1 month after completion of the module. The intervention group had statistically significant differences in all three subscales of the validated AITCS-II tool immediate post-intervention in partnership (p < .001), coordination (p < .001), and cooperation (p < .001) in comparison to the control group. The control group was not statistically significant at any time period. The intervention module was effective in increasing the level of collaboration within healthcare teams. This study supports assessing teams for their level v of interprofessional collaboration, providing insight into strengths and weaknesses of interprofessional teams, and integrating Interprofessional Education Collaborative (IPEC) related education is impactful. Study outcomes can assist organizations in building strategic plans to meet professional development goals and quality outcomes. The study findings have the potential to motivate healthcare leaders and researchers to replicate similar studies and seek further evidence to translate research into practice.
A retrospective study to identify unique contributors to falls in hospitalized adult hematology patients
(1/10/2020) Mbango, Catherine; Toms, Robin
A fall may be defined as an event that results in a person coming to rest inadvertently on a lower level surface or an unplanned descent to the floor with or without injury. Fall prevention is a concept associated with hindering a fall from happening through advance care planning or action. The body of knowledge on falls, risk factors, consequences, and prevention originates from studies of older persons who have experienced a fall. The medical community has made several efforts toward fall risk assessment with an emphasis on prevention of the reoccurrence of falls, but this approach could potentially skew attention away from initial fall prevention efforts. The purpose of this retrospective case-control study was to identify unique contributors to falls in hospitalized adult cancer patients with a hematologic diagnosis. Falls in this population are a great safety concern for nurses and other healthcare providers. Patients with hematologic disorders are at an increased risk of sustaining an injury due to their low platelet counts resulting from chemotherapy and radiation treatments. Patient falls, and patient falls with injury are healthcare outcome measures that are currently being used to evaluate the quality of hospital nursing care, and are an integral part of the National Database of Nursing Quality Indicators (NDNQI). The Centers for Medicare and Medicaid Services no longer reimburses hospitals for in-hospital falls with injury, therefore, placing a greater burden on nursing staff to ensure patient safety through the development of nurse-driven fall prevention strategies, and the implementation of risk reduction plans of care. A total of 94 electronic medical records, which served as the primary sources of data were reviewed in this study and data on ten independent variables and one dependent variable were analyzed. Simple logistic regression between continuous variables and one dependent variable, and cross-tabulation between categorical variables and the dependent variable was used to analyze study results. Stepwise logistic regression was utilized for the final analysis of data. The relationship between fall incident and fall risk assessment score on admission was significant, X2 (1) = 6.153, p<.013, Cramer’s V = .256. Additional research is planned for generalizability.
Abused women's perceptions of health before and after seeking help at a Police Department
(1999-08) Malecha, Ann; McFarlane, Judith; Young, Anne; Watson, Mary
This study describes how intimate partner violence (IPV) affects abused women's health and their perceptions of health before and after seeking help at a police department regarding the IPV in their lives. A descriptive, longitudinal, repeated-measures design was employed to examine the hypothesis that there would be a change over time in the health perceptions of abused women who go to a police department with the intent to file assault charges (helpseeking) against an intimate partner. A consecutive sample of 90 abused women attempting to file charges and meeting study criteria was obtained during a 35-day period. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used to assess the women's health perceptions for the 3-months prior to seeking help and was readministered at three and six months following helpseeking. Mean scores were calculated for each of the eight SF-36 scales at the three separate time intervals and a multivariate approach one-way repeated-measures analysis of variance (ANOVA) tested the hypothesis. Internal consistency reliability of the SF-36 was estimated by calculation of Cronbach's alpha for the eight scales of the instrument. Of the 90 abused women who were interviewed at time of helpseeking, 87 were available at three months (97%) and 83 were available at six months for a 92% final retention rate. The data analysis revealed this sample of abused women reported poor physical and mental scores on the SF-36 at time of helpseeking. Over time, perceptions of health did significantly improve for the scales of Bodily Pain (F2,81 = 27.58, p < .0005), Vitality (F2,81 = 13.21, p < .0005), Social Functioning (F2,81 = 8.17, p = .001), Emotional Role Performance (F 2,81 = 16.85, p < .0005), and Mental Health (F2,81 = 25.33, p < .0005). For these five scales, perceptions of health improved significantly both at three and six months after helpseeking. Adequate reliability of the SF-36 with the abused women was demonstrated.
Access to a home monitor and hypertension among Mexican American women: A randomized controlled trial
(2009-12) DeLeon, Evangeline; McFarlane, Judith M.; Malecha, Ann; Cesario, Sandra
Hypertension is widespread and often uncontrolled and untreated among Mexican-American women leading to possible morbidity and mortality associated with cardiovascular disease. Recent studies indicate that home blood pressure measurements improve blood pressure control rates. However, few studies have evaluated self blood pressure management in racial and ethnic minorities with hypertension. No studies were identified that examined access to a home monitor and subsequent blood pressure measurements among Mexican-American women diagnosed and treated for hypertension. This research evaluated the effects of access to a home blood pressure monitor and subsequent blood pressure measurements among Mexican-American women diagnosed and treated for hypertension. toward lowering blood pressure among Mexican-American women diagnosed with hypertension and prescribed at least one antihypertensive medication. This 2-group randomly assigned study recruited 63 women attending a primary health center. Participants were randomized to four 1-hour weekly education sessions and a wrist blood pressure monitor (n=32) or four 1-hour education session only (n=31). Additionally, all women were offered four weeks of education on the combination of diet, exercise and medications to control hypertension. The two-way mixed ANOVA with repeated measures was used to test the hypotheses that there would be a lower systolic and diastolic blood pressure over time in Mexican-American women who had access to a home monitor and education than those who had education only. The statistical analysis indicated no significant differences in the diastolic or systolic blood pressures between Mexican-American women who were given a wrist home blood pressure monitor and instructions on use and who attend weekly 1-hour education sessions for 4 weeks compared to Mexican-American women who attend the education sessions only. A significant difference was evident among the diastolic and systolic blood pressure through all 5 sessions in the intervention (monitor/education) and control (education only) group.
Acquired color vision deficiency in people taking digoxin
(1979-05) LeSage, Joan Marie; Gudmundsen, Anne; Mahon, Patricia; Stair, Jean; Rubal, B.J.; Hines, John
Acupressure and its use for dysmenorrhea
(1993-12) Mahoney, Debbie; Drapo, Peggy; Hamilton, Patti; Kashka, Maisie
The purpose of this study was to determine the effect of acupressure applied to the Ho-ku acupuncture point (on the hand between the index finger and thumb) on dysmenorrhea and attitudes towards menstruation. Sixty menstruating women were randomly assigned to a control group and an experimental group. The 33 item Menstrual Attitude Questionnaire (MAQ) was administered to all subjects upon admission to the study and at the completion of the study. Twelve women in the experimental group and twenty women in the control group completed the study. Subjects in both groups were given diaries to record data related to their next three menstrual cycles. All subjects recorded analgesic use and pre-analgesic and post-analgesic pain ratings using the 0 to 5 Present Pain Intensity (PPI) Scale from the McGill Pain Questionnaire (MPQ). Subjects in the experimental group used the acupressure technique initially. Analgesics were taken only if a satisfactory level of comfort was not achieved. Repeated measures analysis of variance was used to analyze the monthly averages of pre-treatment and post-treatment pain scores of the subjects in both groups. Treatment consisted of analgesics in the control group and acupressure in the experimental group. A significant group difference (F=.039) and test difference (F=.001) were demonstrated. Repeated measures analysis of variance of the pre-analgesic and post-analgesic pain scores of both groups demonstrated only a significant test difference (F=.000). Analysis of covariance of the post-test MAQ scores of both groups was performed using the pre-test MAQ scores as a covariate. No significance was demonstrated when pre-test differences were controlled. The conclusion of this study were: 1) there were significant differences in the two groups on both the pre-treatment and post-treatment pain ratings regardless of the month, 2) subjects in both groups experienced significant pain reduction whether they used analgesics or acupressure, 3) subjects in both groups experienced significant pain reduction after analgesic use, and 4) no change in menstrual attitudes was demonstrated as a result of participation in the study.
Adaptation experiences of internationally educated Filipino nurses employed in the United States
(2014-01-01) Beriones, Gloria Lamela; Young, Anne; Cesario, Sandra; Symes, Lene
The nursing shortage is a global issue and countries throughout world, the United States (U.S.) more than others, are consistently challenged to meet their nursing needs. Recruitment of internationally educated (IE) Filipino nurses is one strategy used to fill gaps in the U.S. nursing workforce. Filipino nurses constitute over half of IE nurses in the U.S. This study described the adaptation process of IE Filipino nurses employed in the U.S. Hermeneutic phenomenology as espoused by Heidegger provided the philosophical underpinnings. Using the Philippine Nurses Association of Metropolitan Houston, 17 IE registered nurses were recruited through purposeful and snowball sampling methods. A demographic form and a semi-structured interview guide were used for data collection. Demographic data were analyzed using descriptive statistics. Interview transcripts were analyzed using a hermeneutic phenomenological approach incorporating the concept of hermeneutic circle. The three phases of adaptation were identified (a) Pre-arrival Dreams and Motivations, Followed by Reality; (b) the Transitional Phase, and (c) Adaptation. Pre-arrival Dreams and Motivations, Followed by Reality reflected aspirations prior to leaving the Philippines and the actualities of initiating U.S. practice. During the Transitional Phase nurses faced intrinsic and extrinsic barriers to adaptation as well as intrinsic and extrinsic factors facilitating adaptation. Intrinsic barriers consisted of being shy and timid, sensitive, and lonely. Extrinsic barriers included language and communication, variations in nursing practice and technology, cultural differences, fear of healthcare lawsuits, and facing discrimination. Intrinsic adaptation facilitators included quest for life-long learning, determination to succeed, strong faith in God, and love of family. Extrinsic adaptation factors related to support of management, preceptor, educator, co-workers, family, and friends; a thorough orientation and value of preceptor; interdisciplinary teamwork and partnership; utilization of evidence-based practice; and the impact of NCLEX-RN on practice. Adaptation strategies involved observing and listening to preceptors, educators, and co-workers; asking questions and hands-on practice; being a team player, and having a positive attitude, embracing the value of lifelong learning; building relationships and finding meaning in nursing practice; capitalizing on personality traits; and self-reflection. During the Adaptation phase nurses found a balance between overcoming barriers and positively contributing to U.S. nursing practice.
The adaptive response of cardiovascular-pulmonary patients to nursing measures as reflected by mixed venous oxygen saturation measurements
(1987-05) Kernicki, Jeanette; Adamson, Carolyn; Sanchez, Kathryn; Ragsdale, Diane; Throckmorton, Terry; Hart, Mary Rose
In a group of 54 cardiovascular-pulmonary patients with fiberoptic pulmonary artery catheters, the effect of position and preoxygenation on mixed venous oxygen saturation and select hemodynamic parameters was examined. A convenience sample was randomly assigned by a coin flip to experimental or control groups. Hemodynamic parameters were compared with the mixed venous oxygen saturation before and after the experimental group subjects were turned from supine, right, and left positions. Measurements were recorded for the control group in the supine position. The second variable was preoxygenation prior to bagging and endotracheal suctioning. The experimental group received three breaths of 100% oxygen prior to suctioning, the control group were administered 50%-60% oxygen. Measurement of mixed venous oxygen saturations were taken at 5-, 10-, 15-, minute intervals post suctioning. Repeated measure ANOVA data revealed a statistically significant difference at p (LESSTHEQ) .05 level between the supine, right, and left positions. The data supported the first hypothesis that subjects who are turned from supine, to right, and left positions will demonstrate a lower mixed venous oxygen saturation than subjects in the supine position. Data did not substantiate the second hypothesis: subjects who receive three breaths of 100% oxygen prior to suctioning will demonstrate a higher mixed venous oxygen saturation at 5-, 10-, 15-minute intervals as opposed to those receiving 50%-60% oxygen. The Pearson r correlated positively with mixed venous oxygen saturation and select hemodynamic parameters supporting the third hypothesis: changes in mixed venous oxygen saturation will be associated with changes in other physiologic parameters.
Adolescent maternal competence and a postpartum home-based nursing intervention
(1992-05) Babineaux, Jeannine Utzman; Britt, Robin; Stocks, Judith; Newman, Mickie
A 2-by-2 repeated measures design was used to determine the effectiveness of a postpartum home-based nursing intervention on adolescent maternal competence. Competence was operationalized as the score of Scale 5 of the Postpartum Self-Evaluation Questionnaire (PSQ), Confidence in Ability to Cope with the Tasks of Motherhood, and the total score of the Home Observation for Measurement of the Environment Inventory (0-3 Years) (HOME). A second purpose was to determine the relationship between maternal competence and selected intervening variables. A convenience sample of 50 adolescent mothers, 13-19 years, participated by completing the PSQ and the HOME at 2 and 6 weeks postpartum. At 2 weeks postpartum the intervention group (n = 25) received an assessment of physical and psychological postpartum health status with interpretation of results from the nurse-client interaction using the Verbal Postpartum Nursing Assessment/Intervention Guide. At the same visit, the intervention group received information about and demonstration of infant interactive capabilities using the modified Brazelton Neonatal Assessment Scale. Demographic information at 2 weeks postpartum was used to describe the sample. Scores (M = 43.78, SD = 6.59; M = 45.12, SD = 6.09) of self-reported measures of maternal competence (Scale 5, PSQ) were significantly related to perception of labor and delivery experience at 2 and 6 weeks postpartum (r =.4063, p $\leq$.01; r =.2793, p $\leq$.05), support from family and friends at 6 weeks postpartum (r =.5321, p $\leq$.01), and experience with care of children at 6 weeks postpartum (R =.29, p $<$.05). Scores (M = 21.08, SD = 3.3; M = 24.4, SD = 4.5) of objective measures of maternal competence (HOME) were significantly related to perception of labor and delivery experience at 2 and 6 weeks postpartum (r =.4283, p $\leq$.01; r =.3948, p $\leq$.05), relationship with father of the baby at 2 weeks postpartum (r =.3378, p $\leq$.05), and maternal age at 6 weeks postpartum (r =.3599, p $\leq$.05). Results of the two-way ANOVA with repeated measures indicated no significant differences in maternal competence of the two groups as measured by Scale 5 of the PSQ or by the total score of the HOME. However, a significant difference existed within treatment group in the latter ANOVA. The Dunnett test for multiple comparison to a control group showed no significant difference between mean scores of intervention and comparison groups. Findings did not demonstrate that the postpartum home-based nursing intervention had any effect on maternal competence. However, various intervening variables were related to maternal competence.
Adult life crises, sexism, and moral reasoning in female nurses
(1983-12-30) Bell, Carolyn; Bush, Helen; Tanner, William; Kobler, Turner; Mahon, Patricia; Johnson, Margie
The question whether female nurses utilize the same pattern of decision making across personal, professional and moral conflict situations was major in this study. The association of sexist attitudes with decision patterns and changes in pattern across adult life crisis points were of concern. Under the descriptive survey design, the sample of five American born, female nurses who were employed full time for at least 1 year in the same hospital were interviewed by the researcher to determine previous decisions and the circumstances of the decisions. The Sexist Attitudes Toward Women Scale (SATWS) (Benson & Vincent, 1980) and the Judgments About Nursing Decisions Test (JAND) (Ketefian, 1981) were administered. Analysis of the interview data was phenomenological. Descriptive statistics of the SATWS and JAND were computed. Comparison of the Patterns of Decisions revealed that (a) personal and professional patterns differed in 4 of 5 subjects; (b) some of the subjects changed decision patterns at adult life crisis points; (c) the two subjects with extreme scores were least sexist, most autonomous, and higher in moral reasoning compared with most sexist, least autonomous, and lower in moral reasoning; and (d) only one of the five was rated at the Post Conventional level of Kohlberg's (1981b) stages of moral reasoning. No other consistent associations were found. An incidental finding in discussing the JAND to determine the pattern of decision making was that the subjects consistently added or sought further information. This is consistent with Gilligan (1982) who found women qualitatively different from men in moral reasoning, suggesting that use of Kohlberg's theory is gender biased. Further study of female nurses and other female-dominated professions is needed to clarify the development of moral reasoning in women and the relationship of the moral development to professionalism of women.
Age, trust, life events, boundaries, and social skills: A path analysis
(1990-08) Scott, Anne; Hamilton, Patti; Jennings, Glen; Drapo, Peggy; Kashka, Maisie; Beard, Margaret
The problem examined in this study was how much variance is explained in a model of boundaries (flexible, open, and closed), including three antecedents, age, life events, and trust, and one consequence, social skills. The purpose was to test six hypotheses purporting the relationship and predictive power of the variables in the recursive model. This exploratory descriptive study used a path analysis design with a survey technique to test a theoretical model designed by the researcher. The non-random convenience sample of 145 adults 18 to 77 was demographically diverse. The four instruments used in data collection were the General Opinion Survey, the Schedule of Recent Experience, the Social Skills Inventory, and the Scott Boundary Measurement Tool for Adults. The reliability of all instruments was greater than.70. Data was analyzed using hierarchical multiple regression. An alpha of.10 was used as the criteria for retaining beta weights. In the final model, 17.4% (p =.0000) of the variance of social skills was explained by age and open boundaries. Of this, 4.18% was explained by age and 13.27% was explained by open boundaries. Trust explained 1.96% (p =.093) of the variance of open boundaries and 2.14% ($p$ =.079) of the variance of closed boundaries. Age and life events were correlated at $-$.478 (p $<$.001). Flexible boundaries had a curvilinear relationship with social skills and did not have a significant relationship with any of the variables in the model. Of the six hypotheses, two were partially supported and four were rejected. This study implied that nurses should avoid generalizing older people as less trusting, less flexible, or less open. The study reinforced that trust is a prerequisite for open relationships and open boundaries are a prerequisite for social skills. Because life events were not predictive of boundaries, it can be concluded that it is not the number of life events but rather the meaning of the events that cause people to respond either with openness, closedness, or flexibility. Although the social skills of the older client may be poorer, the elderly person is not intentionally closing their boundaries. Neither trust nor life events were predictive of good social skills.
Aging among baby boomers
(2000-12) Walker, Charles Alan; Davis, Gail; Kashka, Maisie; Garrison, Deborah
The purpose of this study was to explore aging as it is experienced and expressed by healthy, middle-aged Baby Boomers (N = 225). This exploration involved instrument development and model testing. Age was a delimiting factor. Only people born during the baby boom (i.e., June 1, 1946 to December 31, 1964) were eligible to participate. At the time of data collection, subjects ranged in age from 35 to 53 years. Simple procedures facilitated data analysis. Psychometric estimates helped to establish reliability, validity, and utility of the Readiness for Aging Profile, a researcher-developed instrument. Furthermore, this study provides the first documented, conjoint use of P. G. Reed's (1991) Self-Transcendence Scale and J. B. Younger's (1993) Mastery of Stress Inventory, two extant measures often cited independently in the nursing literature. Factors that denote and explain aging readiness arose from factor and correlational analyses. Readiness for aging was characterized by (a) doing what's possible about aging, (b) embodying changes in appearance and ability, and (c) fearlessly facing the uncertainties of old age. Married women were inclined to do what is possible by maintaining a healthy lifestyle, meeting challenges boldly, and preparing adequately for old age. Women viewed their aging with experiential intensity; however, men denied or failed to recognize aging's immediacy. Despite the known fact that women live longer and exhibit a higher incidence of chronic illness, middle-aged men were more likely to fear the uncertainties of old age, such as physical disability, poverty, and social isolation. Members of ethnic minorities tended to incorporate physical evidences of age into a revised self image. The fit of C. A. Walker's (1995) transformative aging model to Baby Boomer data was evaluated against explicit hypotheses. High socioeconomic status, femaleness, marital growing older was a function of doing what's possible (r = .63). Taken together (a) mastery of stress, (b) female gender, (c) fearlessness, and (d) general optimism about life transitions explained 33% of the self-transcendence experienced by aging Boomers. Contrary to prior assumptions about intra-cohort differences among middle-aged Baby Boomers (Coward, 1996; Light, 1988; Morgan, 1998), chronological age was not a salient harbinger of aging readiness, mastery, or transcendence. Self-transcendence was authenticated as a “developmental fluidity” that unites the youthful-self (past) and the aging-self (present). The knowledge gained about Boomer aging has implications for theory and practice in several disciplines, including gerontology, human development, and nursing.
AIDS knowledge, attitudes, and behaviors in active duty Army personnel: Instrument validation
(1989-12) Brown, Betty; Beard, Margaret; Hamilton, Patti; Harrington, Linda; Kaplan, Leah; Marshall, David
The problem of the study was a lack of valid and reliable instruments for the measurement of AIDS-related knowledge, attitudes, and behaviors. The purpose of the study was to develop a valid and reliable instrument for the measurement of AIDS-related knowledge, attitudes, and behaviors among sectors of active duty Army personnel. An instrument validational study was conducted in which the AIDS Awareness Questionnaire (AAQ) and the Information and Opinion Questionnaire (IOQ) were administered in sets to a volunteer sample of 860 active duty Army personnel in two contrasting groups. Group 1, the routine HIV/AIDS briefing group, consisted of 680 subjects: 609 males and 71 females, ranging in age from 17 to 49 years. Group 2, the group screened for sexually transmitted diseases (STDs), consisted of 180 subjects: 161 males and 19 females, ranging in age from 18 to 45. Results indicated a positive correlation between knowledge and attitudes on the AIDS Awareness Questionnaire and Information and Opinion Questionnaire; and a significant negative correlation between preventive behaviors and inclusion in the STD group. Three patterns of AIDS-related knowledge, attitudes, and behaviors were profiled based on rank, age, gender, race, marital status, and hours of prevention education attended. Significant predictors with the highest predictive values for inclusion in the STD group are AIDS-related attitudes and behaviors, a black ethnic background, and being a participant in age group 1 (17 to 24 years). Items of the AIDS Awareness Questionnaire that discriminated between the contrasting groups were: shaking hands risk, contact with blood, contact with perspiration, insect bites, sharing IV drug needles, unprotected oral sex, screen pregnant women, cure soon, helplessness, news exaggerates, behavioral assessment, public protection, sex less romantic, uncomfortable, number of sexual partners, partner's number of partners, IV drug partner, sex just met, and alcohol prior to sex. It was concluded that the AIDS Awareness Questionnaire is related to but not a duplicate of the Information and Opinion Questionnaire. The AIDS Awareness Questionnaire has established a degree of validity for measuring AIDS-related knowledge, attitudes, and behaviors among sectors of U.S. Army personnel based on items that discriminate between the contrasting groups.
An educational intervention to improve registered nurses' data quality in the electronic health records
(9/5/2018) Dragan, Elena; Malecha, Ann
An analysis of Oncology nurses' statements regarding the association of pain and suffering with requests for assistance in dying
(1993-08) Thorpe, Deborah Moorehead; Fehir, John; McFarlane, Judith; Young, Anne
Fear of prolonged pain and suffering is among the reasons most frequently cited as justifying requests for Physician Assisted Dying (PAD). Unfortunately, pain is significantly undertreated and many suffer needlessly (Marks and Sachar, 1973; Melzack, 1990), leading some to consider such desperate choices as PAD. The purpose of this exploratory study was to analyze the statements of oncology nurses in response to a survey about PAD to determine the context within which judgements are made and from which interventions are derived. The study was designed to address: (1) the concerns identified in responses to a vignette in which "profound suffering" is a prominent feature, (2) the concerns identified in response to a question about the degree to which physical pain can be managed, and (3) concerns about the degree to which pain is actually relieved. The technique of content analysis was used to study the written comments supplied by the respondents who were invited to elaborate on their answers to the vignette and pain questions. The sample was derived from a survey sent to 2,000 randomly selected oncology nurses. The survey instrument was the Nurses' Attitudes Regarding Physician Assisted Dying (NARPAD) Questionnaire. Of the 1210 surveys returned, 486 responded with narrative comments, including 64 (13%) hospice nurses. The comments were transcribed and read several times to identify key concepts which were coded and categorized. The categories were collapsed into three major themes that emerged for each question. The predominant theme in response to the vignette on suffering was beliefs. While a majority indicated acceptance of PAD in the context of suffering, their comments revealed many concerns about the process and the need to explore alternatives--especially to relieve pain and suffering. The predominant theme in response to both pain questions was barriers. Nurses indicated that effective pain control is possible but described numerous barriers. Discrepancies in provider knowledge and attitudes as well as access to expert pain care for all patients were identified as the primary barriers.

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