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Appalachia is a region of the United States that is characterized by high rates of poverty, low levels of education, elevated incidence of chronic disease, and inadequate healthcare. Compared to the national average, the area has an elevated incidence of Type 2 diabetes. Though this disease process is an issue that must be addressed by healthcare providers, these providers face many challenges and barriers to providing adequate care for this disease in the Appalachian population. Barriers to care include geography with limited transportation, an inadequate number of healthcare personnel, patient inability to afford healthcare, patient attitudes toward diabetes care, and the depressed economy of the region. This thesis will examine such barriers and provide suggestions for improving the education and care of patients with diabetes who reside in Appalachia.

Cerebral palsy, the most common cause of physical childhood disability, is a non-progressive disorder that results from an anoxic brain injury to the fetal or newborn brain. Because this disorder can cause disability, ranging from mild to severe effects on motor and cognitive functioning, the diagnosis can vary from one child to another, causing family stress due to vague and unknown predicted outcomes of the disorder. Because the diagnosis of cerebral palsy affects families in different ways depending on coping mechanisms, support systems, and the age and level of functioning of the child, among other factors, it is important to take an individualistic approach to care. Family-centered care has been shown to be beneficial in approaching the care needs of these families. To promote overall quality of life, efforts should be made to evaluate specific family member needs and include the entire family in the education, care planning, and implementation processes.

Managing pain in the pediatric oncology population can be a daunting task. Often pain in these patients is severe and often not adequately treated or assessed. Studies have found that the reason for this disconnect is due to the impulse to follow unsubstantiated fears and myths held by healthcare professionals and even by the caregivers of the patients. For this reason, many pediatric oncology patients suffer from unnecessary pain when there are both pharmacological and non-pharmacological means available to intervene. The diagnosis and treatment of childhood cancer is multidimensional; however, it can be managed based on recent research and evidence-based practice. In addition, the family, nurses, and other caregivers play a significant role in the management of pain for these young patients. It is imperative that empirical research is conducted and put into practice when appropriate in order to dissipate the burden of such a complex diagnosis. The synthesis of the existing research will help to identify risks and benefits associated with certain medications and treatments as well as identify where gaps exist and further research is necessary. Pediatric oncology patients are affected by their disease in every facet of their lives and would benefit greatly from adequately managed pain.

The purpose of this thesis is to review the overarching purpose of healthcare, examine race-related disparities in minority patient outcomes within specific fields of medical practice, and discuss whether these disparities are the result of racial discrimination within the clinical setting, or are due at least partially to genetic and environmental factors, followed by an examination of how cross-cultural education for healthcare professionals can be improved to equip medical personnel with the attitudes, knowledge, and skills necessary to provide effective care to a culturally diverse patient populace. The benefits of recruiting a culturally and linguistically diverse team of healthcare providers are also discussed. Review of literature seems to indicate that poor patient outcomes for minority groups are due at least in part to forms of discrimination in healthcare provision, and therefore academic initiatives to implement for current and future medical practitioners in order to address current racial disparities and discrimination in healthcare and improve health outcomes for minority patients are also examined.

Every day there are children in underdeveloped countries, such as Uganda, who are struggling to survive on minimal food, money, and other resources. These children do not have the opportunity to enjoy the benefits of a normal childhood because their main focus is on survival. Many of these children will die because of preventable disease and starvation that have resulted from the endless cycle of poverty and lack of education. Those who are lucky enough to survive must fight a daily battle to find the nutrients they need and to combat the diseases they may acquire. It is heartbreaking to know that the lives of so many children are being needlessly cut short due to circumstances beyond their control. If they were assisted, their self-sufficiency may increase and overall quality of life may be improved, including that of future generations. In order to better understand these concepts, this paper will focus on identifying the main health concerns affecting the children of Uganda, with a main focus on children <5 years old. The causes and effects of these health concerns will be explained to demonstrate the need for improved healthcare. This paper will also address ways to treat and prevent this growing problem including the benefits of improving healthcare.

Childbirth has the potential of being one of the most joyous and fulfilling experiences a woman goes through in her entire life. Being a mom, driving the kids to soccer practice, and sitting around the Christmas tree with the family can easily be seen as an ideal life. Conversely, the negative experiences with childbirth are rarely discussed. There is an overlooked category: moms who conceive but lose the baby in the womb. Not only are these women overlooked, but also the hospital care they receive proves inconsistent with the latest research. Nurses and doctors should be aware of the latest research showing the most effective to way to treat moms and dads who have just experienced a stillbirth. The immense responsibility of being present for the patient physically, emotionally, and spiritually should not be lost on the nurse. A woman is bringing both death and life into the world simultaneously. Whatever the cause of the premature death, the pain remains long after the tragic loss. Although the loss of a neonate is undoubtedly a delicate and uncomfortable situation, it is for these reasons this topic needs to be addressed.

In order to be a competent nurse on an American labor and delivery unit it is important to have an understanding of the pain of childbirth. This includes a thorough understanding of pain as a sensation and its manifestation during the birthing experience. An understanding of pain is useless, however, unless standardized pain assessment practices are used. The most accurate pain assessment is associated with a general understanding of cultural trends in pain perception and expression. Along with culture, other factors also influence how a woman senses and copes with the pain of labor. Anxiety is one of these influential elements and has a profound impact on the childbirth experience, which is why a well-rounded labor and delivery nurse has a diverse database of interventions for the stresses and discomforts of childbirth. This would include many of the increasingly popular alternative pain management methods. However, since pharmacological analgesics are the most frequently requested pain interventions in American labor and delivery units, nurses must thoroughly understand the method of action and potential complications of each of these medications as well.

Cyclic oral contraceptive and continuous oral contraceptives have many similarities yet a few distinct differences. One of the major differences between cyclic and continuous oral contraceptives is that cyclic oral contraceptive pills have twenty one active pills and seven inactive pills versus the new continuous oral contraceptive pills which have 28 active pills and no inactive pills. However, though cyclic and continuous oral contraceptives do have a few differences, both types of oral contraceptives affect a woman’s body in similar ways. When choosing between cyclic and continuous oral contraceptives, it is important for women to be informed about the advantages and disadvantages of both continuous and cyclic oral contraceptive pills. Also, over the years, there have been debates between religious groups regarding oral contraceptives. The two religions that have prominent views on this topic are Catholic and Protestant. A few followers from each religion will be chosen to represent the religious group as a whole regarding the topic of oral contraceptives. The Bible will also be used as a source and cited for its writing related to oral contraceptives, marriage, sex, and children.

Nursing is a popular career choice in the twenty-first century, and there are many opportunities within the profession to serve. An American nurse has the ability to utilize nursing skills in Africa and share knowledge with the locals. The American nurse may face challenges when adapting to the African culture and healthcare but also may be blessed by the work and ministering to the people. The American nurse faces specific challenges such as educational differences, lack of facilities and equipment, unique diseases, and poor sanitation. In spite of these challenges, the American missionary nurse is able to grow through this experience, develop a stronger relationship with the Lord, and be blessed by the grateful attitude of the African people.

New research has revealed that Celiac disease, an autoimmune illness affecting the small intestine, has more ties with neurological side effects than once was thought. The classic and most well known presentation of Celiac disease is gastrointestinal, including symptoms such as abdominal pains, nausea, diarrhea, and flatulence. Researchers have more recently found a correlation between Celiac disease and neurological illnesses such as epilepsy, depression, dementia, and ADHD. Physician awareness of the disease and the neurological side of the illness should be heightened in order for patients to receive earlier diagnosis and a better quality of life. Because of the difficulty to diagnose this disease when the presentation is neurological, there is indication for mass screening programs to be implemented.

Holistic nursing is care of the whole person, which addresses physical, mental, emotional, spiritual, and relational aspects of health. Historically, nursing has always integrated these aspects into providing care. Nursing developed out of religious orders and was predominantly a way to serve God by serving the poor and the sick. Florence Nightingale believed that nursing was her calling from God and her faith and spirituality influenced every aspect of her care. Nurses today are often fearful of addressing the spiritual needs of their patients, despite research that demonstrates the importance of providing care in these areas. Nurses can use interventions such as prayer, Scripture, active listening and presence, as well as referral to meet the spiritual needs of their patients.

Research in neonatal massage therapy has shown many possible benefits to the baby and family. Though there has been a growing trend towards family-centered care, along with a substantial and growing body of research, the practice of neonatal massage therapy is not routine in most NICUs. This study was conducted to evaluate neonatal intensive care nurses’ perspectives and attitudes towards neonatal massage therapy before and after evidence-based education. Willingness to discuss benefits of neonatal massage therapy significantly increased after education on neonatal massage therapy. The findings suggest that with proper training on the techniques and safety monitoring of massage therapy, nurses might be more willing to implement massage as part of a family-centered care with appropriate patients.

Nurses encounter many different populations of people every day and they must know how to treat them. Adopted children are a population that nurses encounter and there are disagreements concerning whether they are at an increased risk for developing behavioral problems as compared to biological children. It is also debated whether genetics or environment plays a more prominent role in childhood development. Most studies conclude that adopted children are at an increased risk for more behavioral problems due to the unique struggles and challenges they must overcome with genetics playing a bigger role than environment. Nurses can use this information to treat adopted children and their families more efficiently.

Obesity has become an epidemic in the United States, affecting individuals of all ages. Adolescents are particularly susceptible to obesity due to their decrease in physical activity, as well as to the greater availability of foods void of nutritional value. Adolescents’ impressionable natures and changing bodies also contribute to their increased weights. To combat the problem of obesity, many schools have implemented obesity prevention programs. Most of these programs are based on physical education and nutrition education. However, some schools have started mentorship programs, or worked with organizations that employ mentorship programs, to prevent obesity. The Lynchburg Healthy Living program was created to teach at-risk adolescents about exercise and nutrition, as well as to provide them with a role model and coach in how to live a healthy life. The study examined effects of the program on participants’ body mass index (BMI), self-reported nutrition and physical activity habits, and perceived health knowledge.

A 1998 research study lead by Dr. Andrew Wakefield linked the measles-mumps-rubella (MMR) vaccination as a probable cause to autism spectrum disorder. This publication has started a significant debate among healthcare professionals and instigated an anti-vaccination movement within the general population. This vaccination controversy was started by parents who readily accepted Wakefield’s findings as truth and frequently would choose to withdrawal the administration of vaccinations from their children’s care plans. There has also been disapproval by healthcare professionals over Wakefield’s study since numerous research teams have been unable to replicate his findings. This disagreement surrounding the MMR vaccination is likely putting millions of people, mostly children, at risk of contracting horrific diseases. Brian Deer established the fraud in Wakefield’s original study and rejected Wakefield’s null hypothesis. Deer’s seven years of investigation affirmed the countless research studies that rejected Wakefield’s null hypothesis. Deer’s analysis of Dr. Wakefield’s study demonstrates how the public and the media can be blindly misled by scientific studies. When information has reached people’s grasp, it is hard to retract false information once it has permeated millions of households, which is what needs to be accomplished regarding the truth behind the relationship between the MMR vaccination and autism. The medical world could benefit from knowing the cause of this detrimental disorder, in an effort to treat patients better and possibly someday cure them.

Hip fractures in elderly patients have very high postoperative mortality rates and the number of hip fractures in the United States is expected to increase exponentially before 2030. Early surgery is essential to improve outcomes, but patients on clopidogrel (Plavix) have a high risk for increased bleeding if surgery is performed within the usual 72 hour window. This paper presents literature and research addressing the dangers of delaying surgery versus undergoing surgery before the effects of the clopidogrel are gone. Based on articles published after 2006, most researchers advocated earlier surgical intervention than previously recommended and emphasized an individualized approached based on the clients’ comorbidities and susceptibilities to select postoperative complications.

Recently, there has been a growing controversy, especially among evangelicals, over whether the birth control pill might have an abortifacient mechanism that sometimes causes early chemical abortions. An understanding of this controversy necessitates a clear definition of abortion, abortifacient, pregnancy, implantation, and especially personhood. If a zygote (fertilized egg) is not a person, then it has no fundamental rights and there is essentially no debate concerning the possible link between birth control pills and abortion. There is strong indirect evidence of post-fertilization, or abortive, effects of hormonal birth control. If zygotes are people, and birth control pills do kill them, health professionals and the public, especially Christians, need to be informed about the situation.

Palliative care is an integral part of providing adequate care for pediatric oncology patients. Whether the cancer is terminal or treatable, palliative care helps patients live their lives to the fullest by improving quality of life. Therefore, it is important to have a system to define and measure quality of life. Once quality of life can be quantitatively measured, nurses can use pain and symptom relief, psychosocial support, and spiritual care to improve it. Pain management is essential to cancer recovery. Relief can be achieved through pharmacological or nonpharmacological methods; however, prophylactic pain relief is most beneficial. This means that the patient should be medicated or prepared to cope with the pain before experiencing the pain. Nonpharmacological methods are most valuable when adapted to the child’s locus of control and cognitive coping skills. A caring nurse-patient relationship can encourage psychosocial and spiritual wellbeing through trust, understanding, presence, and support. Psychosocial support can help patients with any fears that they may be experiencing, such as the fear of losing normalcy or the fear of dying. Spiritual care can greatly influence the child’s hope and purpose in life as well. These combined foci of palliative care can improve quality of life for pediatric oncology patients and help them to a more successful recovery.

Nurses play a vital role in the health and care of a patient. Through that care, the nurse has the ability to improve the patient’s experience or ruin it. A vital component influencing the care provided are the emotions the nurse displays toward her coworkers, patients, and patients’ family members. The emotions of a nurse may positively or negatively impact a patient. The studies that examine the impact of the nurse’s emotions on patient’s outcomes are varied and few. The communication and emotion of nurses are likely to impact their care and, from that, the patient’s outcome; however, there is little solid research on the specific effects, be they positive or negative. A connection might be found in studies of Expressed Emotion in psychiatric patients. Expressed Emotion (EE) refers to the negative emotions the patients’ family, and in newer research, that the patient’s nurses, display to psychiatric patients that can lead to relapses in their condition. Correlations between emotion and outcome are strongly evidenced in EE research. Examining the empirical research that shows the impact of EE on patient outcomes may give insight on the impact of a nurse’s attitude on patient outcomes as a whole.

Cardiac arrest is a condition in which the heart abruptly ceases to beat and stops supplying blood to the tissues and vital organs of the body. In order to survive cardiac arrest with good neurological function there must be immediate cardiopulmonary resuscitation, advanced cardiac life support, and quintessential post-cardiac arrest care. However, much emphasis and attention has been given to cardiopulmonary resuscitation and advanced cardiac life support with little consideration to post-cardiac arrest care. Unfortunately, even amidst all the interventions, hypoxic brain injury has been shown by various studies to occur after cardiac arrest. Hypoxic brain degeneration is part of an umbrella of pathologic condition known as Post-cardiac Arrest Syndrome. This is a complex pathological process that comprises post-cardiac arrest brain injury, myocardial dysfunction, systemic ischemia, and persistent precipitating pathology. Many prominent research studies have revealed the pertinent role that post-cardiac arrest care plays in enhancing patient neurological prognosis. The primary focus of post-cardiac arrest intervention is geared toward improving possible cerebral edema, post-ischemic neurodegeneration and impaired cerebrovascular auto regulation. The thesis therefore strives to analyze the effectiveness of present modalities within the chain of survival and also to unveil novel improvements in this field of study, which comprise both pharmacological and non-pharmacological interventions.

Millions of women have chosen to use oral contraceptives for various reasons. However, the question must be raised as to the awareness level of the risks and benefits associated with the use of oral contraceptives. Numerous studies have been performed to establish the effects of oral contraceptives. This thesis examines these studies to consolidate the most current findings. In order to present these studies effectively, this thesis will begin by briefly summarizing the menstrual cycle and how the use of oral contraceptives affects menstruation. Following this, a review of the risks, benefits, and ethical dilemmas will be presented. Utilizing the above research, a self-conducted, randomized, descriptive study was performed to assess how well women are informed of these findings before beginning to use oral contraceptives. The study consisted of 41 women between the ages of 18-45 at a local health clinic in eastern Virginia. The statistical findings showed that women are not being informed about the health risks and benefits associated with the use of oral contraceptives, indicating the need for an updated knowledge base on recent research studies and a revision of the current teaching methods.

Emphasis on infant pain management has recently become prominent in the medical field. Though it was once thought that infants do not feel pain or remember pain, this thinking has changed due to recent research on the subject. This research has found that infants’ underdeveloped nervous systems actually leads to increased pain rather than decreased pain as previously thought. Research has also found that there are long-term developmental risks associated with prolonged or unmanaged pain in infancy. However, this has not been applied to clinical practice. Studies show that infants are still being under-medicated, if medicated at all, for painful or invasive procedures. Infants in the neonatal intensive care unit are at a high-risk for complications related to unmanaged pain because of the frequency and abundance of invasive procedures performed on this unit. Reasons for this include lack of physician education on this subject, risk for adverse effects with opioid administration, and lack of adequate pain assessment tools for infants. There are some interventions that can be implemented to improve pain management in infants, which include non-pharmacological methods and educating medical staff on this subject.

Anencephaly is a neural tube defect that severely limits the lifespan of affected infants. While these infants have no higher brain function, they are still persons, and should be given the same moral and ethical considerations as healthy infants. With this in mind, organ donation procedures should follow the same guidelines that apply to other donors. Because a large part of nursing care for anencephalic infants is palliative care, nurses need appropriate training to care effectively for both the infant and the family, providing for physical, emotional, psychological, and spiritual needs.

Cardiac arrest is a condition in which the heart abruptly ceases to beat and stops supplying blood to the tissues and vital organs of the body. In order to survive cardiac arrest with good neurological function there must be immediate cardiopulmonary resuscitation, advanced cardiac life support, and quintessential post-cardiac arrest care. However, much emphasis and attention has been given to cardiopulmonary resuscitation and advanced cardiac life support with little consideration to post-cardiac arrest care. Unfortunately, even amidst all the interventions, hypoxic brain injury has been shown by various studies to occur after cardiac arrest. Hypoxic brain degeneration is part of an umbrella of pathologic condition known as Post-cardiac Arrest Syndrome. This is a complex pathological process that comprises post-cardiac arrest brain injury, myocardial dysfunction, systemic ischemia, and persistent precipitating pathology. Many prominent research studies have revealed the pertinent role that post-cardiac arrest care plays in enhancing patient neurological prognosis. The primary focus of post-cardiac arrest intervention is geared toward improving possible cerebral edema, post-ischemic neurodegeneration and impaired cerebrovascular auto regulation. The thesis therefore strives to analyze the effectiveness of present modalities within the chain of survival and also to unveil novel improvements in this field of study, which comprise both pharmacological and non-pharmacological interventions.

Due to the complex challenges facing schools of nursing, a research study was implemented to introduce nurse faculty at one small rural northeastern Tennessee school of nursing to the NLN Core Competencies for Nurse Educators. Utilizing Kalb's Nurse Faculty Self-Evaluation Tool as a pre- and post-intervention test, 30 nurse faculty members participated in a quasi-experimental quantitative study and focus group interview. Clinical adjunct staff members participated in a test-retest process to establish tool reliability with somewhat mixed results. The overall study demonstrated that participants did exhibit a significant increase in knowledge and ability of the NLN Core Competencies for Nurse Educators, via paired-samples t-tests. The focus group participants' data provided rich, contextual validation of the quantitative results. Implications for future research include examination of credentials required to enter nurse faculty practice, exploring the potential for continuing education programs for schools of nursing, and studying a prospective plan for accrediting bodies to develop consistent guidelines outlining development of graduate degree programs for nurse educators.

HIV has become one of the most feared diseases in the world. It has claimed millions of lives, especially in Sub-Saharan Africa. Although it is impossible to cure, studies have shown that using antiretroviral therapy (ART) can greatly improve quality of life and decrease viral load. There are four main classes of ART—NRTIs, NNRTIs, protease inhibitors, and fusion inhibitors. Although access to ART is improving, it is vital that its use is increased in Sub-Saharan Africa, where the prevalence can be as high as 33%. This thesis explores the current need of ART in Sub-Saharan Africa, as well as the existing coverage. In addition, it addresses the obstacles preventing ART distribution and use—both provider and patient-related. Provider-related obstacles include limited availability of drugs, total cost, lack of healthcare staff and facilities, lack of organization, and government regulations. Patient-related obstacles include cost, transportation, geographic proximity to healthcare facilities, side effects and hunger, pill burden, hospital-related factors, cultural beliefs, social stigma, lack of adequate counseling, and drug resistance. It is important to be proactive, assess ART delivery, consider suggestions for improvement, and tackle the HIV epidemic.

There is scarcity of documentation that seeks to define spirituality relating to holistic nursing; consequently, a literature review was formulated to define spirituality and guide nursing practice towards recognizing the importance of and implementation of spiritual care. By researching the current trends in peer-reviewed journals from the past three years and analyzing associated articles, this paper addresses the need for a comprehensive definition of spirituality. Key concepts such as belief, values, interconnectedness with self, others and God, energy, hope and transcendence will be analyzed, and the accumulated data will be complied into a framework that is easy for a nurse to understand and use. This thesis strives to validate the necessity of spiritual care through the mechanism of holistic nursing and equip nurses to assess and implement care for the ever-present spiritual needs of one’s patients.