Recent Submissions

  • Acquiring Situation Awareness through Hand-Off in a Critical Care Environment

    Holden, Tina; Nursing (Augusta University, 2019-12)
    Hand-off communication is associated with 80% of hospital errors. Situation awareness (SA) has been targeted as a strategy to reduce errors and enhance patient safety when providing hand-off communication. Few studies have focused on the influence of SA in hand-off communication in the intensive care unit where the risk of errors is high. The purpose of this study was to develop a substantive theory of critical care nursing hand-off. The study was guided by Endsley’s SA framework. A qualitative study design using Straussian grounded theory methods was used to develop a substantive theory related to critical care nursing hand-off. Data collection strategies included observation of 20 critical care nursing hand-offs followed by 34 semi-structured interviews and took place from 2017 to 2019 in a medical and surgical ICU at two academic tertiary care facilities. Data analysis was conducted using constant comparative analysis and was guided by Endsley’s model of SA. Results revealed that hand-off is a basic social process with a core category of handing-off awareness. The process contained four phases: interactive, reflective, maintenance, and preparatory. The interactive phase was characterized by communication between the giver and receiver of hand-off. During that phase, the 10 critical elements of hand-off were passed on to the receiver. These critical elements included the code status, past medical history, story, systems assessment, trends, changes, rationale, level of organ support, and anticipation. Handing off these elements in a way that flows with logical order affects awareness. Nursing behaviors of the giver associated with handing off awareness are linked to the critical elements. For the receiver, these behaviors include arriving prepared, reporting the critical elements, controlling flow, and making connections between the critical elements. Behaviors for the receiver include being an active listener, validating information, and asking questions within the flow of information. In the reflective phase, the resilient nurse bridges gaps in awareness. The maintenance phase is characterized by nursing actions that support hand-off information recall. In the maintenance phase, SA is maintained through artifacts. Artifacts are tools used by nurses to aid in the cognitive function of hand-off. The preparatory phase is characterized by information synthesis and organization. The four phases of hand-off are re-occurring and are influenced by individual and organizational factors. Individual factors include a nurse’s personal process, experience, socialization, and emotional intelligence. Organizational factors include unit policies, unit artifacts, and safety culture. Theory and research implications include the need for future research to further expand the framework of SA in hand-off, the use of qualitative methods to provide insight into complex areas of healthcare, and the need for educational interventions on SA hand-off. Practice implications include evaluation of current hand-off practices in the ICU and evaluation of organizational influences on hand-off. The study concludes that the theory of handing-off awareness in the ICU is a continuous process that occurs over four phases in a repetitive cycle that starts again with each shift change. The critical elements, flow, nursing behaviors, time, and external factors influence the ability of the nurse to achieve optimal SA.
  • Evaluating the Impact of High Fidelity Patient Simulation on Clinical Reasoning in Undergraduate Nursing Students

    Gee, Rebecca Mathews; Nursing (Augusta University, 2019-12)
    Introduction: Graduate nurses must enter nursing with clinical reasoning skills that will allow them to appropriately care for patients. With limited clinical sites, nurse educators are challenged to graduate clinically-competent nurses who possess clinical reasoning skills that will allow them to appropriately care for patients. The use of high fidelity patient simulation (HFPS) as an adjunct to clinical experiences may be a solution, but previous studies have shown limited evidence that HFPS improves clinical reasoning in nursing students. A variety of tools have been used to measure clinical reasoning (or one of its components). However, most of them were not specific to nursing. Without a consistent, nursing-specific tool, exploration of HFPS effects on clinical reasoning skills is challenging. The Nursing Specific Script Concordance Test (NSSCT), a validated nursing-specific tool measuring clinical reasoning, was used for this study. The purpose of this study was to examine the impact of HFPS on the clinical reasoning skills of first-semester, pre-licensure, Bachelor of Science in Nursing (BSN) students. Two specific aims were explored: 1) determine whether teaching with HFPS scenarios improved the clinical reasoning skills of pre-licensure, first semester BSN students, and 2) determine whether the NSSCT detected a significant difference in NSSCT mean scores before and after HFPS scenarios. Methods: This study used a two-group, randomized crossover design with 14 first-semester, pre-licensure, BSN students (n = 8; n = 6). Each participant took a baseline NSSCT, followed by the experimental group participating three simulation scenarios and the control group participating in the standard curriculum only. Then a second NSSCT was administered to each participant. Then, the control group participated in the three simulation scenarios while the experimental group participated in the standard curriculum only. Then, a third NSSCT was administered. NSSCT mean scores were compared between and within the groups after each administration. Results: There were no statistical differences (p = 0.494) in mean NSSCT scores in pre-licensure, first-semester, BSN, students after participating in HFPS scenarios, inferring that in this sample, HFPS did not significantly increase clinical reasoning. There were no statistical differences in mean NSSCT scores (p = 0.064) between the control group and experimental group after the second NSSCT administration, suggesting that the clinical reasoning skills were not different between students who completed the three simulation scenarios versus students who participated in the standard curriculum alone. Finally, there were no statistical differences (p = 0.596) between the control group and experimental group after all participants completed the three simulation experiences. Conclusions: The results from this study did not conclude that HFPS improved clinical reasoning in first-semester, pre-licensure, BSN students. However, due to the limitations of this study (small sample size [n = 14], test/retest reliability, and history) a replication study with modifications should be considered to fully examine the effect of HFPS on clinical reasoning in pre-licensure, BSN students.
  • Relationships among Health Literacy, Self-Care, and Hospital Readmission Status in African American Adults with Heart Failure

    Sarfo, Robert; Department of Physiological and Technological Nursing (5/22/2018)
    Approximately six million adults are diagnosed with heart failure (HF) yearly in the U.S., with one million subsequent hospitalizations. Of these, 25%-30% are readmitted within 30 to 90 days of initial discharge. Little is known about relationships among health literacy (HL), self-care and 30-day hospital readmission status in adult African Americans (AAs) with HF. The primary purpose of this study was to explore relationships among HL, baseline self-care maintenance (BSCM), and 30-day hospital readmission status in adult AAs with HF. Two secondary purposes were to determine whether BSCM mediated the relationship between HL and readmission status and whether there was a moderating effect of age, gender, education, insurance status and perceived social support (PSS), on the relationships of HL with BSCM and readmission status. Using a one-month prospective cohort design, HL, BSCM, PSS, basic conditioning factors, and 30-day readmission status were measured in participants from two large hospitals in the Central Savannah River Area in Georgia. Statistical analyses included logistic regression, Pearson product-moment correlation, chi-square tests of independence, and mediation and moderation analyses. Eighty-nine participants were enrolled in this study. Most participants (71.9%) were male, and their mean age was 53.25 years (Standard Deviation, SD = 12.74; range 25-88 years). Of the 89 participants, 28.1% experienced at least one readmission within 30 days of discharge. The following findings have p values < .05. BSCM varied significantly with HL (X2 = 6.97 (degrees of freedom, df = 2, sample size (N) = 89)). Higher PSS was significantly associated with higher BSCM (r = .29). HL was significantly correlated with age (r = -.62). The influence of age on the relationship between HL and readmission status was significant (b = .005). Elderly patients (> 65 years) scoring high on HL had a higher probability of readmission, and younger patients (< 40 years) scoring low on HL had a higher probability of readmission. Post hoc analysis showed that lower ejection fraction predicted readmissions (odds ratio = 3.1, 95% confidence interval = 1.03 - 9.05) after controlling for the other predictors. The findings provide a basis for further research to better understand the impact of HL, self-care maintenance, and other patient characteristics on readmission of AAs with HF.
  • Female Teens Step It Up with the Fitbit Zip: A Randomized Controlled Pilot Study

    Linck, Donna Teresa; Department of Physiological & Technological Nursing (5/22/2018)
    Physical inactivity is a global pandemic. Six percent of all deaths globally (approximately 3.2 million people) are the result of insufficient physical activity, and 80% of adolescents worldwide do not get the recommended levels of daily physical activity. Depression is a major cause of disability worldwide and is a significant disease of burden for most age groups. Female adolescents are more than twice as likely to experience depressive symptoms as their male counterparts. The primary purpose of this randomized controlled pilot study was to determine if the use of electronic activity monitors, specifically Fitbit Zips, and daily step goals would increase physical activity participation in female adolescents. The secondary purpose was to determine if participation in a 12-week intervention using Fitbit Zips together with step goals would reduce depressive symptoms in female adolescents. The tertiary purpose was to determine the feasibility of recruiting and retaining female adolescents (80% or more) in the study and having them adhere to the research protocol. There were no available research studies examining physical activity and depressive symptoms in female adolescents using Fitbit Zips as an intervention to increase physical activity and decrease depressive symptoms. A convenience sample of 44 female adolescents from two church youth groups in the southeastern United States participated in the study. The mean age of the participants was 16.6 years. Psychosocial variables such as self-efficacy, social support, and commitment to a plan of action were assessed. Using mixed model analysis, no significant differences (p = .678) were found between the experimental (Fitbit-E) and control groups (Fitbit-C) on average median steps per day. The Fitbit-C group had 6,088.3 (SE = 668.6) average median steps per day at baseline, but only had 2,783.7 (SE = 698) average median steps per day at posttest. The Fitbit-E group had a lesser decline with 6,279.1 (SE = 661) average median steps per day at baseline and 4,339.4 (SE = 728) average median steps per day at posttest. Both groups’ depression scores, as measured by the CES-D, decreased from pretest to posttest, indicating an improvement in depressive symptoms. However, the difference between the two groups on depression scores was not statistically significant (p = .425). Post hoc pairwise comparisons yielded statistically significant decreases in depression scores for the Fitbit-C group (p = .002) and for the Fitbit-E group (p < .001) from pretest to posttest. Additionally, 42 out of 44 participants (95%) completed final CES-D surveys, and 35 out of 44 (79.5%) had some final step count data at post-test. Therefore, it was feasible to recruit and retain 80% of the participants in this RCT pilot study, and they did adhere to the protocol. This study helps bring to light the importance of promoting physical activity and assessing for depressive symptoms in the female adolescent population. Although there were no significant differences between the experimental and control groups on depressive symptoms for the 12-week intervention period, within each group there were significant decreases in depressive symptoms. The results from this study provide the groundwork to further investigate the impact of EAMs on physical activity and depressive symptoms in female adolescents.
  • Vitamin D Moderators and Supplementation Outcomes

    Havens, Robyn Lynn; Department of Physiological and Technological Nursing (2017)
    Abstract Robyn L. Havens Vitamin D Moderators and Supplementation Outcomes (Under the direction of Dr. Elizabeth NeSmith) Vitamin D insufficiency is a global health concern affecting approximately 1 billion people, including about one third of the American population. Vitamin D insufficiency promotes the development of chronic diseases. The people most at risk for developing chronic diseases from vitamin D insufficiency are those individuals in the vulnerable populations who experience poor health outcomes. Currently, researchers and clinicians disagree as to the recommended daily allowance and therapeutic range supporting sufficient serum vitamin D concentrations. To provide data to resolve this disagreement, the objectives of this secondary analysis were to determine if age, sex, and body mass index were moderators of serum vitamin D concentration and if varying dosages of vitamin D supplementation affected serum interleukin-6 concentrations. The data records of 60 healthy male and female African American participants were examined who were aged 13-45 years, categorized as overweight or obese, and exhibited a baseline serum vitamin D concentration ≤ 50 nmol/L. The participants were randomized into four treatment groups for the original study: 1) a control group that received a placebo; (2) a group that received monthly supervised doses of 18,000 IU (equivalent to 600 IU/day); (3) a group that received monthly supervised doses of 60,000 IU (equivalent to 2,000 IU/day); and (4) a group that received monthly supervised doses of 120,000 IU (equivalent to 4,000 IU/day). After 16 weeks of vitamin D supplementation, the only statistically significant interaction found was with sex as a moderating variable despite the small sample size of men. No other significant interactions were found, including no interaction with vitamin D supplementation and interleukin-6. Despite lacking statistical significance, the data results suggested that the 2,000 or 4,000 IU/day dosages of vitamin D supplementation was needed for the overweight/obese African American participants to achieve a sufficient serum vitamin D concentration > 50 nmol/L as recommended in the 2011 Institute of Medicine report. These results also suggest that the overweight/obese, African American adolescents and adults needed much more vitamin D supplementation than the 600 IU/day recommended by National Institute of Health researchers. Lastly, the findings suggest that the national clinical guidelines published by the Endocrine Society may warrant revision to at least 2,000 IU/day to be effective for individuals in vulnerable populations. Future research is needed to further elucidate the role vitamin D plays in maintaining overall good health and the benefits of vitamin D supplementation. Keywords: vitamin D, vitamin D insufficiency, vitamin D supplementation, age, sex, body mass index, interleukin-6, vulnerable populations conceptual model
  • Early adolescents' physical activity and nutrition beliefs and behaviors in an urban cluster in the southeastern United States

    Hawks, Miranda R.; Department of Physiological and Technological Nursing (2016)
    Obesity in early adolescents is a significant public health problem that has adverse health consequences, to include increasing the risk of developing type two diabetes and hypertension. Factors such as the environment, nutrition, and physical activity contribute to obesity in early adolescents. The purpose of this ethnographic study was to explore the physical activity and nutrition beliefs and behaviors of early adolescents in an urban cluster in the southeastern part of the United States. The researcher recruited early adolescents at a community organization and collected data using three ethnographic methods: semi-structured interviewing, participant observation, and collection of artifacts. Data were analyzed using constant comparative analysis to shed light on the meaning of early adolescents’ communications about their physical activity and nutrition beliefs and behaviors. Themes that emerged from data analysis included recognizing benefits of physical activity and healthy eating, family influences, connecting with the community, peer influences, electronic media influences, and developing a sense of self. This study contributes to nursing science in three ways. First, all early adolescents recognized both physical activity and healthy eating as beneficial for promoting their health and improving the quality of their lives. Second, early adolescents described their mothers as the most influential family member for both their physical activity and healthy eating behaviors. Third, the community organization was identified as the main facilitator of early adolescents’ physical activities within their immediate environment outside their home. These findings explain three different points of entry that the nursing community can use, separately or together, for their health promotion strategies to encourage physical activity and healthy eating among early adolescents.

    Gollan, Srisuda Siera; Department of Physiological and Technological Nursing (9/15/2017)
    The objective of pre-hospital trauma care is ensuring that the most severely injured persons are transported to the facility best suited to meet their complex needs (Fitzharris, Stevenson, Middleton, & Sinclair, 2011; Hoff, Tinkoff, Lucke, & Lehr, 1992; Leach et al., 2008; Sasser et al., 2012). To support pre-hospital decision making regarding trauma triage destination determinations, the Guidelines for Field Triage of Injured Patients decision scheme (FTDS) was developed as an algorithmic decision tool (Sasser et al., 2012). The purpose of this study was to examine pre-hospital trauma triage transport decision making by EMS providers from multiple perspectives. This study used a concurrent mixed methods triangulation design (QUAL+QUANT). Mixed methods included: (1) Grounded theory methodology to describe a model of decision making used by EMS providers to make trauma triage determinations and (2) quantitative analysis of secondary data to determine how the FTDS criteria are utilized by EMS providers. The FTDS criteria were also examined relative to trauma outcomes: level of trauma team activation (TTA), patient disposition when leaving the emergency department (ED), and the injury severity score (ISS). A model of Interpreting Trauma into Action was elucidated to describe the processes used by EMS providers. Pre-hospital providers based their trauma transport decisions on the perceived patient level of injury severity. The FTDS criteria were not explicitly used in this study region, but were interwoven into practice through employer policies and other training. The convergence of these findings indicated congruence between the model and trauma outcomes. The quantitative data indicated relationships (p<.05) between 12 of the 29 FTDS criteria and trauma outcomes. Both sources of evidence supported the relationships between the model of Interpreting Trauma into Action, the FTDS criteria, and specific trauma outcomes.
  • Exploration of Two Methodologies for Measuring Clinical Judgment in Baccalaureate Nursing Students.

    Call, Marlene W.; Department of Physiological and Technological Nursing (5/8/2017)
    Introduction: Senior nursing students need a requisite level of preparedness to safely care for an acutely ill, complex patient once they graduate and become independent clinicians. This level of preparedness may be evaluated by measuring clinical judgment (CJ) with the Lasater Clinical Judgment Rubric (LCJR). The LCJR contains 11 indicators that represent the actions and behaviors necessary for demonstrating CJ. Two methods of simulation, high fidelity patient simulation (HFPS) and objective structured clinical examination (OSCE), replicate the healthcare environment so students may safely demonstrate clinical skills without harming an actual patient. The purposes of this study were to 1) explore the use of the LCJR in the OSCE setting, and 2) elicit and compare the number of LCJR indicators that occur in the HFPS and OSCE settings for senior baccalaureate nursing students. Two research questions were explored: 1) comparing the representation of indicators between the OSCE and a single HFPS and question 2) comparing the representation of indicators between the OSCE and two HFPSs. Methods: This study used a two group, randomized crossover design with 23 senior nursing students in their last semester of a Bachelor of Science in Nursing program (n = 11; n = 12). Each participant performed patient care during two HFPS scenarios and 12 OSCE stations, followed by a written debriefing. Clinical performances were video recorded for each participant. CJ was evaluated by the reviewing the video recordings and counting the number of times an LCJR indicator occurred during the HFPS and OSCE settings. Counts for each indicator in each setting were established for the OSCE by adding indicator counts for each and for the HFPS by adding each indicator for the two scenarios. Comparisons of the OSCE to individual HFPSs as well as the combined HFPS means were performed using paired t-tests with an alpha value of 0.05. Results: The mean number of times that the LCJR indicators occurred in the OSCE setting was significantly higher (p < 0.05) than in either individual HFPS setting, indicating that the OSCE setting provided more opportunities for measuring CJ than a single HFPS setting. When comparing the OSCE to the combined HFPSs setting the mean counts of LCJR Indicators 3, 4, 5, 7, and 9 were higher in the OSCE, while counts for LCJR Indicators 2, 6, and 8 were higher in the combined HFPS settings. Indicators 3, 5, and 7 count means were more than five counts higher, indicating a likely impact on the accuracy of CJ scores regarding those indicators and a more favorable environment to measure those indicators within the OSCE setting. Participants reflected on their simulation experiences by answering written questions during the debriefing sessions to measure Indicators 10 and 11. Opportunities to measure Indicator 10 were similar between the two settings, while Indicator 11 occurred more in the students’ written OSCE debriefing than in HFPS debriefing. No variability existed with Indicators 10 and 11, thus statistical significance could not be determined. Conclusions: The overall higher mean count of LCJR opportunities in the OSCE setting suggests that OSCE provides a comparable number opportunities to measure CJ of senior nursing students. While previous research has validated the use of the LCJR tool in the HFPS setting, the results of this study suggest that the LCJR may be used in the OSCE setting and be similarly suitable. The OSCE uses less faculty resources than HFPS and thus may be a more cost-effective mode for evaluating CJ. However, additional research is needed to establish the validity and feasibility of using the LCJR tool in the OSCE setting to measure CJ in senior nursing students prior to graduation.
  • Effect of mentoring relationships on professional socialzation of the pre-licensure clinical nurse leader graduate

    Gazaway, Shena Borders; Department of Physiological and Technological Nursing (5/8/2017)
    The professional socialization of a nurse begins during their education experience and continues throughout their career as they acquire new roles and responsibilities. For pre-licensure clinical nurse leader graduates (PLCNLGs), the challenge is to meld the ideals learned during their education experience with the protocols and regulations necessary to practice successfully in their first professional nursing position. While all novice nurses experience difficulty with professional socialization, PLCNLGs have an additional stressor due to the prevailing belief that a Master’s-prepared nurse should be an expert nurse clinician before assuming the title of Clinical Nurse Leader. No matter their educational program, early professional socialization helps all newly licensed nurses, identify with the profession and provide a philosophical foundation with which to build a dynamic career. Mentoring is a low-cost strategy that may help achieve early professional socialization. Mentors provide the necessary support, career lifeline, and professional guidance during the PLCNLG’s transition from student to independent clinician. A positive mentoring relationship creates a trusted partner and confidant who eases the negative feelings associated with this transition process. Nursing research is needed to establish the best mentoring strategy to support the PLCNLG’s professionalism and career trajectory since differences exist in the foundation underlying each mentoring relationship. This study used a mixed methods longitudinal design with two instruments, the Nurses Professional Values Scale-Revised (NPVS-R) and the Nurses Role Conceptions Instrument (NRCI), plus focus groups to examine the impact formal and informal mentoring relationships had on the professional socialization of PLCNLGs. Participants were recruited from the pre-licensure Clinical Nurse Leader program nursing program of a large university located in the southeastern portion of the United States. Phase I data collection took place on campus just before graduation (n=69), nine months later the participants were approached to participate in the Phase II portion of data collection. A final sample of 22 participants completed Phase II with six of them participating in the focus groups. Using a one-way ANOVA, statistically significant differences were not found between the types of mentoring (formal, informal, both, none) and NPVS-R or NRCI bureaucratic and professional role orientation. However, a significant difference was seen with the service role discrepancy and mentoring relationship. Focus group results led to the development of a conceptual model which supports the manner in which mentoring impacted the professional socialization process of PLCNLGs. The integrated quantitative and qualitative results provided evidence that participants were greatly impacted by mentoring relationships. These relationships were established on trust and with people who were willing to help them grow in their nursing role. Participants reported increased confidence, comfort, and competence in their nursing role due to the actions of their mentors. The results of this study added critical knowledge regarding the professional socialization process from the perspective of the PLCNLG. The mixed method integrated approach highlighted how mentoring impacted this socialization process when quantitative analysis did not produce statistically significant results. Nurse executives and leaders should use this research to establish goals for employing mentors and successfully cultivating best practice for pairing mentors and mentees to decrease PLCNLG employment dissatisfaction and turnover.
  • An examination of telenursing: Description of the professional role and predictors of role stress, role ambiguity and role conflict

    Schlachta-Fairchild, Loretta M.; Department of Physiological and Technological Nursing (2000-11-07)
    Telenursing is the use of telehealth technology to deliver nursing care and conduct nursing practice (Schlachta & Sparks, 1999). In response to the rapid adoption of telemedicine technology in healthcare organizations, telenursing is emerging as a new role, promoting discussion of licensure, malpractice, and credentialing issues within nursing. Rule stress associated with new nursing roles such as telenursing impacts individual patients and the larger healthcare organization ,causing turnover, burnout, loss of continuity of care and loss of operation expertise. As with many emerging technologies, nurses assume increasingly complex roles and responsibilities. As telemedicine proliferates, the role of nurses in participating in and improving the telemedicine process will take on more prominence. It is important to identify issues related to use and integration of telemedicine into nurses' roles to minimize role stress, encourage telenursing participation and position nursing practice to take advantage of telemedicine technologies. Using the portion of Role Theory, that relates to the impact of Role Set upon Role Strain, as a framework this was a descriptive research study that identified a current population of 796 telenurses in the U.S. , representing 40 states. From this population, 196 telenurses participated in a telephonic or an online, web-based survey during Summer 2000. The purposes were to 1) Describe a) telenurses' professional role(s) and characteristics and b) U.S. strategies for nursing competence and patient safety 2) Measure telenurses' work satisfaction and its components, and role stress and its components 3) Predict the relationship between the components of work satisfaction, individual and professional role characteristics, and role stress, role ambiguity and role conflict. Findings of the Telenursing Role Study indicated that the typical Y2K telenurse is 46 years old, has work 21 years in nursing and >6 months in her telenursing position. She has a 27% chance of being an advanced practice nurse, and has at least a baccalaureate degree, and likely a graduate degree. The typical telenurse is white, female, married, and has children. She works full-time in telenursing and makes just over $49,000 per year. Telenurses work in over 29 practice settings, including web portals, private companies and for telemedicine equipment vendors. They have a host of unique, new titles such as Bioengineering Clinical Nurse Specialist, Telehealth Project Director and Consumer Information Nurse. Telenurses experience less than average role stress, role ambiguity and role conflict. They also have the same work satisfaction as other hospital-based nurses. The most important factor contributing to telenurses' work satisfaction is autonomy. Findings of regression analysis were that education level and level of work satisfaction both predict role stress and role ambiguity in telenurses. Higher education levels of telenurses are associate with high role stress and role ambiguity. Higher levels of work satisfaction of telenurses are associate with lower role stress and role ambiguity. Role ambiguity, level of education and work satisfaction are significant predictors of role conflict in telenurses.
  • Self-care and Cultural Meanings of Mothering in African American Women with HIV/AIDS

    Shambley-Ebron, Donna; Department of Physiological and Technological Nursing (2003-11)
    African American women as a marginalized group in American society daily face obstacles related to race, gender, and culture. The stigma of HIV/AIDS compounds the problems and issues that African American women face as they ' manage their illness, childrearing, and other responsibilities of daily living. Within the last twenty years, HIV/AIDS has undergone a transformation, with a shift in the population most affected by HIV/AIDS. Women of color and their children have become the most rapidly growing group of people living with HIV/AIDS. This study will explore how core cultural values influence the self care activities and personal meaning of mothering among African American women who are HIV- positive. An Africana Womanist framework in conjunction with critical social theory will be used to guide and analyze this study. Knowledge generated from this research study will lead to the development of culturally appropriate theory development, and has the potential for developing empowering and liberating resistance patterns in young African American women.
  • Screening for Circadian Rhythm of Core Body Temperature in Spinal Cord Injured Patients

    Secrest, Janet A.; Department of Physiological and Technological Nursing (1987-10)
    The purpose of this study was to describe the pattern of core body temperature in spinal cord injured patients. The research question was: Is there a circadian rhythm for core body temperature in spinal cord injured patients? Subjects included 19 in patients with traumatic spinal cord transections at or above the fourth thoracic segment. Oral temperatures were monitored every four hours for a 48-hour period using an electronic thermometer. The range of individual subjects temperature ranges were 1.1 to 5.2 degrees F. The group pattern of mean temperatures from Day 1 was similar to that of Day 2.A significant difference was found between the time periods (p = .038). The higher temperatures occurred in the evening, and the lower temperatures in the morning. The finding of a circadian rhythm for core body temperature was unexpected in spinal cord injured subjects.
  • The Relationship Among Structure, Technology, Autonomy, Decision Making, Nurse Characteristics and the Decision to Call a Resuscitation Code on the Patient Who Needs Cardiopulmonary Resuscitation

    Russell, Katherine S.; Department of Physiological and Technological Nursing (1997-08)
    In this study, the relationship among nursing unit structure, technology, autonomy, decision making, nurse characteristics and the timeliness of calling a resuscitation code was explored. The conceptual framework of the study was The Structural Interaction Model for Health Care Behavior (Colgrove, 1992), a model that combined and synthesized concepts from organizational theory, quality care, and patient-centered care.The hypothesized relationships were investigated using multivariate logistic regression and multiple regression analysis. A sample of 127 registered nurses and 127 patient resuscitation events from one hospital was used in the study. Nurses' perception of nursing unit structure, technology, autonomy and decision making were measured using four instruments. Nurse characteristics were obtained from the nurse demographic tool. Data required to stage the timeliness of calling a resuscitation code (early versus not early) was obtained from the patient's hospital record. Testing of the analytical model resulted in beginning support for elements that may contribute to the timeliness of calling a resuscitation code for the patient who may need cardiopulmonary resuscitation. These relationships pointed to the impact of structural factors and professional factors on the timeliness of calling a code. The findings were nurses with a baccalaureate degree or higher were more likely to call an early code as were nurses with less than a baccalaureate degree. Moreover, nurses that practiced on a unite with a more flexible nursing unit structure
  • Cognitive Function of Individuals with End-Stage Renal Disease on Hemodialysis

    Schira, Mary G.; Department of Physiological and Technological Nursing (1997-03)
    An interrupted time series with non-equivalent dependent variables design was used to determine if there is a difference in attention and memory of adults on hemodialysis immediately before, during, and after a dialysis treatment. The study also investigated if BUN, creatinine, and carbon dioxide were predictive of cognitive function. The study sample included 52 individuals with a mean age of 45.5 years on out-patient dialysis and average of 10.6 months. The sample was 52% male; 73% of the subjects were Black, 19% were white, and 6% were Hispanic. Subjects completed two tests of attention - Trailmaking Test A and B and one memory test - the Auditory Verbal Learning Test. The test were administered immediately before, 60-90 minutes after the beginning, and immediately after a HD treatment session. Blood for BUN, Creatinine, and carbon dioxide were obtained within 5 minutes of the cognitive function testing. Testing times were separated by one week. Cognitive function test results were analyzed using Repeated Measures Analysis of Variance. Analysis revealed that there were no significant differences (p>.05) in attention or memory among the three testing times. Despite significant differences (p<.05) in BUN, creatinine, and carbon dioxide among the three testing times, there was no significant correlation between serum values and cognitive function test results. Additional findings revealed that when compared to normal reference values, subjects had significantly (p<.05) impaired attention and memory function at all three testing times. Although memory function was impaired, a pattern that indicated information retention was demonstrated. The lack of difference in attention and memory function among the three testing times indicated that attention and memory did not vary during a dialysis treatment session. Therefore, the current session was supported. The pattern of memory function demonstrated in the sample supports the assertion in the theoretical literature that repetition of information plays an important role in teaching patients on dialysis.
  • Determinants of Quality of the Caregiving Relationship

    Sauter, Maranah A.; Department of Physiological and Technological Nursing (1996-10)
    The purpose of this study was to examine selected caregiver and care receiver characteristics which may influence perceived quality of the dyadic caregiving relationship. The theoretical model evolved from reciprocity and social exchange theories and the theoretical and empirical caregiving literature. A purposive sample of 100 elderly care receivers and their family caregivers was selected for this study. Caregiving dyads were narrowed to community residing, cognitively intact care receivers, age 60 and over, and their spouse or adult daughter/daughter-inlaw caregivers. Care receivers were assisted with two or more activities of daily living three times per week or more. Approximately half of the study dyads were spouses. Caregiver characteristics included social and economic resources, physical and emotional health, and length of time as caregiver. Care receiver characteristics included social and economic resources, physical, functional, and emotional health, and length of time as care receiver. The concept of perceived reciprocity was used as a measure of quality of the caregiving relationship. Four dimensions of reciprocity were examined. These were caregiver perceived reciprocity, care receiver perceived reciprocity, intradyadic congruence of perceived reciprocity, and dyadic perceived reciprocity. Regression analyses revealed that lower caregiver depression, higher caregiver social and economic resources, and higher care receiver depression predicted caregiver perceived reciprocity. When examining dyadic perceived reciprocity, high care receiver depression was again a significant predictor of reciprocity. However, an interaction (cross-product) of both caregiver and care receiver depression showed that when both members of the dyad had low levels of depression, dyadic perceived reciprocity increased. Dyadic perceptions of reciprocity were congruent between caregivers and care receivers in the study; however, with-in dyad levels of perceived reciprocity were different. Dyadic descriptions of caregiving relationships reflected strong commitments to caregiving relationships and strong bonds of attachment. Quality of these relationships provides benefits which may help sustain caregiving. Longitudinal research is needed to determine the effects of caregiver and care receiver depression over time on quality of the caregiving relationship. Studies are also needed to investigate how quality of the caregiving relationship influences decisions to maintain or terminate caregiving.
  • Creating a New Life: The Process o f Temperance For Perinatal Cocaine Crack Users

    Pursley-Crotteau, Margaret S.; Department of Physiological and Technological Nursing (1995-03)
    Research related to cocaine crack use during pregnancy has focused on prevalence, increased maternal morbidity and mortality, neonatal outcomes, and the teratology o f cocaine use. The purpose o f this study was to explore from a feminist perspective how pregnant women with a history o f cocaine crack use participate in prenatal care. The context o f the study was an inner city hospital Psych-OB clinic within a Maternal and Infant Project. Initially, I recruited nine women for the study. All had a history o f cocaine crack use by self-report and as documented in clinical records. The women were actively participating in the prenatal clinic and in some type o f substance abuse treatment. Additional participants were selected through theoretical sampling and included women participating and not participating in substance abuse treatment. I selectively interviewed 19 women. Besides in-depth interviews, data were also collected through participant observation and document reviews. The constant comparative analysis of the data o f grounded theory was used to develop, interpret, and analyze the data. I collected and analyzed data until all categories were saturated and the core variable was identified. Staying Clean w as the psychosocial problem as identified by the women. Creating a new life was identified as the process by which the women manage to stay clean during their pregnancy. Creating a new life had three phases: drifting in, tuning in/tuning out, and drifting out. D rifting in had three stages: knowing about the pregnancy, ignoring the pregnancy, and acquiescing to the pregttancy. The second phase tuning in/tuning out had three stages which represented the striving by the women to integrate both a maternal identity and an addict identity within the treatment structure. These stages were: struggling with s e lf and others, assimilating a new identity, and accepting the adjusted self. The final phase had two strategies: buying into recovery and clutching at normalcy. This substantive theory provided a broader understanding o f the experiences o f women who are pregnant and use cocaine. Based on this theory, I explored implications for health policy in perinatal substance abuse treatment, proposed innovative models for early intervention and improved treatment programs, and suggested further research from both qualitative and quantitative perspectives.
  • A Counseling Intervention to Improve Personal Control, Affective Outcomes, and Satisfaction in Surrogate Decision Makers at End-of-Life

    Purvis, Reese J.; Department of Physiological and Technological Nursing (2006-02)
    This study investigated whether personal control, situational anxiety, situational depression, and satisfaction with end-of-life (EOL) care might be improved in surrogate decision makers who receive a cognitive-behavioral decision making intervention. The sample consisted of 38 surrogate decision makers for 38 incapacitated patients in three hospitals in a moderate sized city in the Southeastern United States. The demographic characteristics of sample included: 50% female and 50% male, 50% African-American and 50% White, and 81.6% Protestant. Although the sample was small, the demographic composition of the sample was highly consistent with the population of the community in which the study was conducted. Guided by Bandura’s Social Cognitive Theory, it was hypothesized that experimental (DMCI) group subjects would score higher on posttest measures of personal control and satisfaction with EOL care than subjects in the usual care group. It was also hypothesized that experimental group subjects would score lower on posttest measures of depression and anxiety. Pretest and posttest scores on five instruments were compared and analyzed for an experimental group, N=19 which received the DMCI versus a control group, N=19, that received only usual care. Instruments used to assess the dependent variables of personal control, affective outcomes, and satisfaction with end-of-life care were: the Pearlin Mastery Scale, the Perceived Personal Control Questionnaire, the Beck Depression Inventory, the Beck Anxiety Inventory, and the FAMCARE Scale. Data were collected over a seven month period from Summer 2004 to Spring 2005. After obtaining informed consent experimental participants completed all instruments (pretest), received three counseling sessions over approximately 14 days and then completed all instruments again (posttest). Control group members after providing informed consent also completed all instruments (pretest), received three attention- usual care contacts, and subsequently completed all instruments again (posttest). Data were analyzed using descriptive statistics, Chi-Square, Mann-Whitney Test, and 2-way ANOVA with one repeated measure. The factors were group assignment (experimental vs. control) and time (pretest vs. posttest) with time as the repeated factor. Chi-square, and Mann-Whitney tests showed the groups were comparable at pretest and that demographically the random assignment to groups was effective. The 2-way ANOVA results showed significant interaction effects in each case. The experimental group scored higher or lower posttest as predicted by the hypotheses compared to the control group.
  • Early Recognition of Patient Problems in Critical Care: An Interpretative Study

    Minick, Ptlene; Department of Physiological and Technological Nursing; American Nurses' Foundation (1992-05)
    Early recognition of patient problems is crucial in the critical care setting, however the process of early recognition remains elusive. The literature reflects growing consensus that expert clinicians routinely use “intuitive knowing” (embodied intelligence) in critical decision-making situations (Benner, 1984; Benner & Wrubel, 1989). The purpose of this study was to gain an understanding of the embedded knowledge used by critical care nurses in the early recognition of patient problems. Heideggerian hermeneutical analysis was chosen as the theoretical perspective and research method because of its usefulness in revealing contextual understanding of obscure constructs. A purposeful sampling technique was used to recruit the 30 critical care nurses as participants for this study from one of two hospitals in the North Georgia area. All 30 participants had a minimum of three years of experience in critical care nursing and were interviewed once. Eight of the participants were interviewed a second time; in addition, two key participants reviewed and confirmed the interpretation for a total of 40 interviews. Two patterns considered constitutive of the nurses’ Being were found implicitly and explicitly in every interview and were entitled: (a) the perception of early recognition: engendered through care and (b) practical knowing: embodied intelligence. Major themes that were identified were: (a) experience is requisite for early recognition, (b) communication between nurses and physicians, (c) technology: help or hindrance and (d) what sustains me in nursing. A meaningful understanding of process of early recognition of patient problems contributes to nursing science, nursing education and most importantly, to the improvement of patient care.
  • The Efficacy of a Smoking Prevention Curriculum in Fifth-Grade Children

    McGahee, Thayer W.; Department of Physiological and Technological Nursing (1998-06)
    More than 3,000 young people begin smoking each day in the United States. The age at which children begin to smoke is on a continual decline, with an estimated 60% of smokers beginning by age 13 and 90% having begun by age 20. The younger the age of smoking initiation, the less likely it is they will ever quit. The prevention of smoking needs to begin during childhood because of the early exposure to cigarette use, and the addictive nature of nicotine. The primary purpose of this quasi-experimental study was to examine the efficacy of a smoking prevention curriculum in fifth-grade children. The efficacy of this curriculum as an intervention was assessed by measuring the child’s intent to smoke by the end of their current school year. Two secondary purposes of this study were to determine (a) possible predictive variables of the child’s intention to smoke and (b) the influence of the intervention of the child’s attitudes, normative beliefs, and perceptions of refusal skills related to smoking. This study consisted of 361 fifth-grade children from public schools in the southeast. The smoking prevention curriculum used in this study was a 5-unit curriculum developed by the American Cancer Society to prevent smoking in children. It is a part of the “Do It Yourself-Making Healthy Choices” curriculum. The various internal factors addressed in this study were measured by an investigator-developed School-Age Smoking Questionnaire. It also measured the child’s intention to smoke. Parental attitudes toward smoking were measured by the Smoking Attitude Scale developed by Gordon and Haynes. Other variables were measured by an investigator-developed sociodemographic questionnaire. This study utilized the Solomon four-group design. The study was quasi-experimental in nature. Participating schools were randomly assigned to one of the four groups. Analysis of variance and t-tests for paired samples were used to analyze the differences in data from the four groups. Five research hypotheses were developed for this study. These were analyzed using ANOVA and multivariate correlation statistics. Results indicate that the smoking program was an effective intervention to decrease the intention to smoke in fifth-grade children (p = .000). The intervention was effective in changing children’s attitudes toward smoking (p = .000), but was not significantly effective in changing normative beliefs and refusal skills. Attitude and refusal skills resulted as the best overall predictors of intention to smoke in children.
  • A Study of African American Women Receiving Prenatal Care in a Housing Project

    McAllister, Lydia E.; Department of Physiological and Technological Nursing (1997-05)
    Access to prenatal care remains a problem for poor African American women. As a group, African Americans have twice the infant mortality rate and three times the mortality rate of white Americans. The purpose of this study was to explore "what happens" to pregnant African American women as they receive prenatal care. The intent of this research was to better understand the experience of pregnancy and prenatal care for African American women and the context in which it occurs. Thirteen women, aged 18 to 36 years who lived in a housing project, participated in this descriptive, qualitative study. In-depth, unstructured interviews as well as observation participation were the methods used to gather information. Interviews were transcribed and analyzed by the constant comparative method. Four themes were generated: a) Wanting to be away; b) Makin' it; c) Being alone; and d) Receiving care. Wanting to be awav described why the women were not happy or content with their living situations. The second theme, Makin' i t depicts the complexity of their lives. Being alone illustrates that they live without men, means, or money. The fourth theme, Receiving care describes the experiences of prenatal care during pregnancy. The study concludes that information about African Americans must include the context of their lives to be truly relevant. Implications for health policy, theory, and research related to African Americans are suggested.

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