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While there is extensive literature on parental stress associated with parenting a child with special health needs, few researchers have looked specifically at the stress associated with parenting a child fed enterally. The purpose of this study was to explore the stressors experienced by mothers of children who were being fed enterally and the coping strategies and resources available to them by employing an exploratory/descriptive design. Data were obtained during face-to-face interviews, or interviews conducted via mail, employing a list of open-ended questions about caring for an infant/child who is fed enterally and a demographic questionnaire filled out by the mothers. A convenient sample of 40 mothers of children who were being fed enterally was recruited for the study. Through content analysis of the data from this sample of mothers, the negative and positive aspects of home enteral nutrition (HEN) and the stressors and coping strategies were delineated. Mothers identified several important stressors. These included the social stigma associated with HEN, managing the equipment, negative emotions associated with the process, and physical problems. Mothers did perceive that their children were now able to receive appropriate nutrition and thus, sustain physical growth and development. Coping strategies identified by the mothers included: seeking social support, seeking assistance from health professionals, being flexible with the child’s HEN schedule, and taking the time to care for themselves. The stressors and coping strategies faced by mothers of children on HEN are multidimensional and encompass social and psychological components. By identifying the specific areas of stress that mothers of children on HEN deal with on a daily basis, nurses and other professionals can develop interventions that help to decrease the effect of the negative stressors. A better understanding of the ways mothers cope with these stressors allows for more accurate evaluations of these interventions. Appropriate interventions that lessen stress and allow for better coping will create the best possible environment for the feeding process to occur. This ultimately benefits the child by making the feeding process more pleasurable for both mother and child.

Ongoing medical advances contribute to the increasing number of patient’s today living with congenital heart disease CHD). Adolescents and young adults with CHD must have knowledge and ability to take charge of their health care decisions as they begin transition from pediatric-centered health care to adult-centered health care. The purpose of this study was to investigate the self care ability and perceived needs of adolescents with CHD. Multiple self care variables were examined and the Roy adaptation model was used to direct the study. Analysis of domains by education found statistically significant findings in the areas of maintaining health records and managing special health care needs. Also, though not statistically significant, results implied concerns with some aspects of self care ability by the adolescent Nursing implications are that the nurse can better assist the adolescent with CHD when they have more specific knowledge of their self care abilities.

Each year increasing numbers of Americans report the use of some form of complementary and alternative medicine (CAM). The purpose of this descriptive study was to examine the implementation of a health benefits package including CAM therapies for employees of a small, self-insured manufacturing company. A secondary analysis guided by a decision-making theoretical framework was performed using data from the primary study, which examined the cost impact of adding two CAM therapies (Healing Touch and guided imagery) to the health care coverage for some employees of the company. The primary hypothesis of the study was that the insurance expenditures of employees who did not participate in CAM therapies would be significantly higher than participating employees one year after the intervention. Other hypotheses included a cost comparison of insurance expenditures over six years, employee satisfaction, and a decision to continue to receive CAM therapy following completion of the study. Data files included insurance expenditure payouts for all employees from 1995 to 2000 following termination of the study intervention and surveys completed by the study participants (N = 41) during the year of intervention. Overall statistical analysis did not support two research hypotheses that addressed the insurance expenditures in the four years prior to the study and in the year following the study. Mean expenditures for the non-participant group of employees continued to be significantly higher than for the study participants. An examination of employee satisfaction for the study participants revealed statistically significant support for the use of Healing Touch and guided imagery. Significant decreases in pain, stress and increase in emotional well-being (decreased anxiety and depression) were reported by the study participants following therapy. Findings in this study did not support the addition of CAM therapies to a health benefits package. However, the conclusions drawn do not negate the importance of continued research to understand the roles of energy healing, mind-body interventions and other CAM therapies in managing health-related conditions and to explore cost of CAM therapy to employers and employees.

Adolescents constitute the largest group of rape victims. Physiologic theory suggests that injuries may be different in adolescents when compared to adults; however, little is known about genital injuries that adolescents sustain following rape. Previous investigators reported a racial difference in injury prevalence among adult rape victims, with higher injury prevalence among White victims as compared to Black victims. A possible racial difference has not been studied in an adolescent sample. The present study examined the associations among injuries, age, race/ethnicity, and skin color in two groups of female rape victims: adolescents and young adults. The study involved a retrospective review of 234 medical records of women aged 14-29 years old. Over half of the sample was White (56%) and 42.7% was Black. Demographic and injury data were retrieved from medical records and color was quantified through digital image analysis of photographs taken during the examinations. Overall injury prevalence was 62.8%. A series of nested logistic regression and zero-inflated Poisson regression models were conducted. Age was significantly associated with overall injury frequency (Z=6.19, p

This descriptive exploratory study evaluated health status indicators in children of itinerant carnival and migrant farmworkers, aged birth to 12 years. Health status outcomes (immunization records, well-child examinations (WCE), dental health status, growth parameters, and health-related quality of life measured by the PedsQL™4.0) were compared between the two groups and to national averages to identify health disparities. 150 children were recruited, (65 carnival, 85 migrant farmworker) including siblings. One index child per family (n = 97) was used in data analysis. Children who presented with complete immunization records showed a significant difference (carnival < migrant). Adherence to immunization schedule was met by 93% of carnival children, 90% of migrant children. Children had a significant difference in regularly scheduled WCE (carnival < migrant). Itinerant children had significantly worse oral health indicators than NHANES 2002. Significant differences were found among groups in dental health in 2 to 5 year olds: decayed filled teeth (carnival < migrant) and filled teeth (carnival < migrant). Ages 6 to 11 were comparable to NHANES and each other. Twice as many itinerant children were overweight than NHANES; twice as many migrant children were overweight than carnival children. There was a significant difference in overweight infants and toddlers (carnival 5x> migrant). Itinerant sample PedsQL™4.0 scores were less than but comparable to geographically stable published literature. There was a significant difference in parent-proxy physical and school subscales (geographically stable > itinerant). Carnival and migrant scores were similar. There was significant difference only in parent-proxy subscales, social (carnival > migrant) and school (carnival < migrant). Both samples had highly commendable rates of recommended childhood immunizations and were not a problem for these families. However validation of carnival children’s immunizations was limited due to lack of records. Overweight was a major health concern for both groups. Both groups’ dental health was worse than national values, but HRQOL was not different than published values. Data gathered show that migrant families have been successful in locating and securing access to health care and have made it a priority for their young children. Carnival children show evidence of difficulty accessing WCE and dental care.

Accurately recognizing symptoms of Acute Coronary Syndrome (ACS) presents a challenge to Emergency Department (ED) nurses and physicians. Due to the variety of clinical presentations in patients, ACS is frequently missed diagnosed. Studies demonstrate that many patients present with atypical symptoms and presentation varies based on gender. There is, however, a paucity of studies on the presentation of ACS in the elderly. With the older American population growing at exponential rates, it is imperative that studies are conducted to better comprehend ACS clinical presentation in the elderly. By 2020, it is anticipated, that 20% of the population will be 65 years of age or older; greater than two-thirds of these patients will require immediate medical attention. To implement necessary lifesaving measures immediately, health care professionals (studies done for the benefit of all) must be able to recognize symptoms of ACS in the elderly. Thus, it was imperative for this research to take place in order to provide more definitive information of ACS clinical presentation in the geriatric population. Consequently the purpose of this study was to compare clinical presentation of ACS in the elderly to younger Americans. Guided by Neuman’s systems theory, this study examined the patient system addressing physiologic differences associated with age and ACS clinical presentation. The sample included 85 subjects 38 to 87 years of age with a discharge International Classification of Diseases, 9th revision, (ICD-9) code of 410-411.1 (excluding 411.0) during the specified time frame. Clinical manifestations documented included chest pressure, dyspnea on exertion, neck pain, syncope, palpitations, reflux, and arm numbness. Comorbidities included hypertension (37%), hyperlipidemia (27%), diabetes mellitus (15%) and previous cardiac history (26%). Findings suggested that chest pain was the most commonly reported ACS clinical manifestation. The chief complaint was not different by age group (÷2 = 6.984; phi= .363; p=.727). There were no significant statistical differences in clinical presentation by age. Further studies are needed to ascertain clinical manifestations of ACS with regard to age.

Cigarette smoking is the leading cause of preventable death in the United States and extensive scientific evidence has been reviewed to determine its causation of multiple diseases. Nicotine dependence is recognized as a determinant in the maintenance of smoking and the inability to quit. Hard core smokers have been suggested as having increased nicotine dependence and little probability of quitting. Inequalities in cigarette smoking prevalence exist, with smokers more likely to be poor and less educated. Higher socioeconomic status is associated with higher quit rates. Evidence of a social gradient in nicotine dependence has been demonstrated among smokers residing in the United Kingdom. A secondary data analysis using the 1999-2002 National Health and Nutrition Examination Survey data, a cross sectional health survey of a nationally representative sample of the noninstitutionalized U.S. population. The first two objectives included characterization of variables associated with smoking status (hard core, non-hard core and former smoker) and examining the relationship between current smokers and nicotine dependence, based on serum cotinine and time to first cigarette. Respondents were age 26 and older. The last objective included examining the existence of a social gradient in nicotine dependence in an American population and determining if this was associated with race/ethnicity and gender. Our results supported the existence of hard core smokers. Factors associated with nicotine dependence among all current smokers included male gender, younger age, and race. Hard core smoking was associated with having greater nicotine dependence, as measured by time to first cigarette or serum cotinine levels. A social gradient in the American population as a whole was not observed. A reverse social gradient was observed in non-Hispanic black males and females. Findings were intriguing and challenging to interpret. Social determinants experienced by advantaged blacks, such as increased stress and decreased control, possibly contribute to the positive relationship between nicotine dependence and socioeconomic status

The purpose of this qualitative phenomenological study was to discover the structure of the lived experience of adult women diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) using Parse’s theoretical framework and qualitative methodology. Nursing research related to the experiences of adult women is important and adds to nursing knowledge. Knowledge gained through this research is key in understanding and supporting these women as they go through life’s journey. Four women diagnosed with ADHD were interviewed. Analysis of data revealed 11 themes: forgiving self and accepting failures while feeling guilty, hurting while not understanding with empathy arising with situational knowing, having dignity during imperfection, wishing for more but accepting the now, being chained while wanting to run free, controlling while uncontrolled, maintaining tranquility during chaos, realizing limiting while striving for success, accepting the bad and celebrating the good, and understanding the past while creating knowledge of now.

Adherence to health recommendations continues to be a significant and multidimensional problem. Although self-efficacy, health beliefs and social support have been identified as significant predictors of diet adherence among cardiac patients, few studies addressed motivation and problem-solving skills as predictors of diet adherence among cardiac patients. Thus, the purpose of this secondary analysis study was to determine the relationships between perception of adherence to diet regimen, motivation and problem-solving skills in cardiac rehabilitation patients. Additionally, factors that influence the relationships between perception of adherence to diet regimen, motivation and problem-solving skills were explored, specifically, the influence of age, gender, marital status, education, depressed mood and co-morbidity. The design of this study was descriptive cross-sectional. The Social Problem-Solving conceptual model for health behavior change (Ewart, 1990) guided this study. A sample comprised of 259 patients (161 men and 98 women) who entered a cardiac rehabilitation program and had a cardiac event was used. Consecutive subjects were recruited during the subject’s 8th week in a cardiac rehabilitation program. Data were collected using face-to-face interviews. Standardized instruments were used to measure perception of adherence to diet regimen, motivation, problem-solving skills, depressed mood and co-morbidity. Findings indicated that motivation and problem-solving skills were significant predictors of perception of adherence to diet regimen even when controlling for the effects of age, gender, marital status, education, depressed mood and co-morbidity. Also, perception of adherence to diet regimen was negatively associated with depressed mood. Age, gender, marital status, education and co-morbidity were not predictors of perception of adherence to diet regimen. Motivation was the greatest significant predictor of perception of adherence to diet regimen (β = .26). Motivation explained 9% of the variance in perception of adherence to diet regimen, 5% of the variance in perception of adherence to diet regimen was accounted for by problem-solving skills. Study findings suggest that the use of interventions to enhance motivation and problem-solving skills among patients with cardiac events are likely to assist patients to improve their diet adherence.

The purpose of this study was to examine the effects, in the first 6 months of caring, of emotional support and physical help on the health of first-time caregivers of persons with stroke. This study was a secondary analysis of data collected during baseline, 3-month, and 6-month telephone interviews for a large NIH study. Only the control group for the NIH study was used (n = 40) and a descriptive-correlational designwas employed. The data were analyzed using non-parametric statistics. Caregivers' perceived health and their receipt of emotional support and physical help did not change significantly over time. A significant, positive relationship was found to exist between emotional support and caregiver health at 6 months. Nurses can help preserve the stability of caregivers’ health during the initial 6 months of caring and beyond by assisting them to establish and maintain an accessible network of emotional and physical support from family, friends, and formal services.

This study examined satisfaction levels of geriatric patients with the medication information they received during a recent hospitalization and identified potential effects of living situation and changes in medications on those levels. A non-randomized convenience sample of 36 geriatric patients was recruited from two hospital sites for this descriptive study. A post-discharge telephone call at 1-7 days was used to obtain both participant demographic data and to administer the Satisfaction with Information about Medications Scale (SIMS). Low overall mean satisfaction levels were seen in the total SIMS score and in both sub-scales. Mean satisfaction levels were significantly higher in those with changes in medications during hospitalization. Approximately 17% of the variance in the total SIMS scores can be attributed to changes in medications during hospitalization. Higher scores were seen in the Action and Usage subscale with changes in medications but were not demonstrated in the Potential Problem subscale.

Few studies have specifically analyzed the effect spirituality may have on caregivers of persons with stroke. The purpose of this qualitative study was to explore expressions of spirituality caregivers of persons with stroke relayed on a web-based discussion group. A sample of 20 caregivers from northern Ohio and southern Michigan was included in this study. Norwood’s eclectic approach for qualitative data was used to analyze the data in this secondary analysis. Data extraction revealed four themes, which were drawn to Friedemann’s framework of systemic organization, and included the following: (1) feeling the presence of a Greater Power, (2) practicing rituals, (3) being one with nature, and (4) interacting with family and friends. These findings can be used to design nterventions to support caregivers and to increase awareness of the importance of addressing spirituality in client encounters.

This descriptive study examined reasons, reported by caregivers (n=40), of why persons with stroke use health care services [provider and emergency department visits and hospital readmissions], during the first 6 months home from a rehabilitation facility in Ohio or Michigan. Additionally, differences for these reasons in months 1-3 and 4-6 were described. Orem’s self-care deficit nursing theory provided the conceptual basis. Service use was categorized according to wellness and problem-oriented reasons. A total of 336 services were used in the first 6 months and, of these, 67% more services were used in months 1-3. Most problem-oriented visits during both time periods were for laboratory work and tests and cardio/pulmonary reasons and the majority of wellnessoriented visits were for unspecified follow-up and check-ups or general follow-up with the primary care provider. There were higher numbers of visits made for cardio/pulmonary, neurological, and vision reasons in the first 3 months and lesser numbers for gastro/metabolic and infectious reasons during the second 3 months. Nurses need to be aware of these findings and provide needed education and follow-up with caregivers who influence self-care and health care service use among care recipients.

Caregivers of persons with stroke participated in a bimonthy interview process for a year-long NIH study. The current study described that lived experience for these caregivers. Phenomenology was used as a conceptual framework and method of data collection. Data were gathered from telephone interviews with 14 participants (n=3 men, n=11 women) from the control group of the NIH study. Most subjects were white Americans, aged 33 to 74 years, caring for their spouses. Using Colaizzi's (1978) method for data analysis allowed the following themes to emerge from the interviews: (a) looking forward to talking with someone; (b) feeling helped and staying connected; (c) being busy caregiving and taking care of business; (d) helping others; and (e) being ambivalent or negative about the interview process. Orem's (2001) self-care deficit nursing theory was used to reflect upon the themes to suggest research and interventions to help caregivers develop their dependent care agencies.

Unintentional traumatic injuries often cause pain in those who are injured. As health care professionals, the care provided to traumatically injured children needs to be both timely and specific to children and their unique needs. Using Neuman’s Systems Theory, this study looked at the documented pain assessment practices and pain interventions of emergency medical personnel caring for pediatric trauma victims in a Midwestern county. A retrospective chart review was performed during a 3 year period, including the charts of 696 children between the ages of 1day and 16 years who were traumatically injured and were transported by a county emergency medical system. Overall findings indicated a lack of documentation of pain assessment and interventions to decrease pain, demonstrating a need for additional education and emphasis on the importance of pain assessment, interventions, and documentation to optimize care for traumatically injured children.

Problem: Breastfeeding has long been recognized as the preferred method of feeding in the first year of life (American Academy of Pediatrics, 1997). Extensive research confirms the nutritional, economic, biomedical, immunological, and psychological advantages of breast milk. Despite the clear benefits of breastfeeding to mother and infant, breastfeeding rates today continue to remain below the recommended levels in the United States (US), most notably among low-income mothers. Research has shown that breastfeeding self-efficacy is one predictive factor affecting breastfeeding duration. Theoretical Framework: Dennis’s (1999) Breastfeeding Self-Efficacy Theory, was the basis for this study. Using this theory, the Breastfeeding Self-Efficacy Intervention Program (BSEIP) was developed. The intervention consisted of a one-hour program delivered during the last trimester of pregnancy. The BSEIP consisted of measures to increase breastfeeding self-efficacy, including education, practice, and demonstration of breastfeeding techniques. Social support and practical advice were provided in the first two-weeks of the postpartum period. Methods: A quasi-Experimental design was used to test the effect of the BSEIP on duration of breastfeeding. A convenience sample of 36 low-income predominately non-Hispanic White women was recruited from two prenatal clinics on the outskirts of a large metropolitan area. All women indicated their intent to breastfeed their infant. Women were assigned by prenatal clinic to either receive or not receive the BSEIP. Data were collected using the Breastfeeding Self-Efficacy Scale (BSES) and a demographic profile. Women were contacted by telephone at two and six weeks postpartum to determine if they were still breastfeeding and to complete the BSES.. Results: Women who received the BSEIP had greater breastfeeding self-efficacy at two and six weeks postpartum than women who did not receive the intervention; women who received the intervention also increased their self-efficacy scores over time. The mean duration of breastfeeding between the two Groups was also statistically significant: Women who received the intervention breastfed for an average of 28.82 days compared to 11.86 days for women who did not receive the intervention. Implications: The results of this study suggest that the one-hour BSEIP during the last trimester of the prenatal period may increase the duration of breastfeeding in low-income women who intend to breastfeed. This study supports the literature which found that prenatal education and postpartum support are important to the outcome of breastfeeding.

Heelstick is the most common painful procedure in hospitalized premature infants and may be associated with impaired physiological, neurologic and immunologic functioning. The purpose was to examine Kangaroo Care (KC) effect on heelstick pain as measured by the Premature Infant Pain Profile (PIPP) and heart rate variability (HRV) indices. Twenty-eight preterm infants 30-32 weeks gestational age were tested in a cross-over design. Fourteen were randomized to group A (incubator heelstick [IH] on day1; KC heelstick [KCH] on day2) and 14 to group B (KCH on day1; IH on day2). The first 18 were tested in an 80-minute protocol and the last 10 in a 30-minute protocol. During the Heel Stick phase, in the 30-min protocol subgroup, PIPP scores were lower in KCH (range 4.00-10.60) than IH (range 9.75-14.33) and the difference between KCH and IH were > 2 points (considered clinically important). Repeated-measures analysis showed that PIPP was lower in KCH than IH at 0.5 minute after the stick in the Total Sample, p < .05. Infants had an average of 27% less pain in KCH than IH and KC had a large effect on reducing pain. During the Recovery phase, KCH infants had less pain at three time points (p < .05-.001) in the 30-minute protocol subgroup and at 2 time points (p < .05) in the Total Sample. Pain was 21%-25% less in KCH than IH, and KC had medium effect on reducing pain. In KCH compared to IH, low frequency (LF, sympathetic activity) and high frequency power (HF, parasympathetic activity) were higher during Baseline (p < .05-.01); LF was higher during Heel Stick (p < .001); and LF/HF ratio (balance of sympathetic-parasympathetic activity) was lower during Recovery (p < .001). Infants had better balanced autonomic activity in KCH than IH during their response to heelstick. Infants also had a shorter duration of bradycardia, higher SaO2, less decrement in SaO2 from Baseline to Heel Stick, and shorter or no oxygen desaturation in KCH than IH. In conclusion, KC reduced bio-behavioral and autonomic pain responses in preterm infants undergoing heelstick pain during the first 2-9 days of life.

This study describes the lived experiences of patients with end stage renal disease (ESRD) on hemodialysis treatments. A qualitative, phenomenological design was used. Data collection was performed using unstructured interviews in the dialysis center or in patient’s homes. Single interviews with 5 patients receiving hemodialysis treatments in a free standing dialysis center were tape recorded with permission from the informants, transcribed verbatim, and analyzed with the assistance of Van Manen’s phenomenological methods. The overall theme of “acceptance” and three subthemes “positive outlook,” “family life,” and “involvement in care.” found this study support Roy’s Adaptation Model. All participants had learned to cope, and incorporate strategies to control complications associated with ESRD and manage productive lives. Early identification of the individual needs and effective coping skills and strategies should be included in the care plan of all hemodialysis patients on a regular schedule.

The purpose of this study was to discover the lived experience of women with first-time myocardial infarction. Van Manen’s (1990) phenomenological method of human science guided the data collection and analysis. Watson’s (1979, 1985, 1988, 1999) nursing theory was the conceptual framework. Three themes emerged and are synthesized in an exhaustive description of the phenomenon. Exhaustive Formalized Description of Phenomenon Loss and disharmony of the old self or pre-myocardial infarction elicited the process of grief as a coping response. Integration of experiences promotes change and restoration of harmony as a new integrated self is developed and sustained. Intentional caring transactions foster the integration of experience, change, and self-healing that promotes self-knowledge and inner strength to make choices in health-illness decisions.

The purpose of this phenomenological qualitative study was to investigate the lived experience of survivors who had lost an adult loved to sudden traumatic death. This study utilized Roy’s Adaptation Model (Roy & Andrews, 1999) as the theoretical framework to guide the study. The researcher interviewed five adult female survivors. Data from the interviews were analyzed utilizing Streubert’s (1999) Phenomenological Methodology to identify five common themes. Conceptualized within Roy’s Adaptation Theory, the sudden traumatic nature of the death of a loved one as well as the last encounter with a loved one prior to death remained long-term contextual stimuli for survivors as they struggled to adapt and find closure after their loss. Survivors expressed a need to know and share the details of their loss with others so that others might begin to understand the significance of their loss. Interactions with others were contextual stimuli that influenced survivors’ abilities to adapt to their loss. Survivors’ coping processes included the search for meaning in their loss and a need to know that their loved ones were “okay”. The experience of losing a loved one to sudden traumatic death is a complex phenomenon that is unique to every individual and leaves an indelible imprint on survivors.

Educational planning is essential for successful transitions from hospital to home for persons with stroke and their caregivers. Guided by Orem’s self-care deficit nursing theory, the aims of this study were: 1) identification of the most frequent teaching needs for persons with stroke and their caregivers as perceived by physical and occupational therapists and 2) comparison of these identified needs with those of registered nurses and family caregivers. The subjects (n=113) were mostly white women prepared at the occupational therapy graduate educational level in the eastern United States. Descriptive statistics revealed demonstrating safe transfer techniques (82%) [hazards in Orem’s terms] was the top teaching need identified by physical and occupational therapists. Caregivers were concerned with preventing falls (71%) [hazards], and nurses’ focused on understanding the disease process (82%) [normalcy]. Educational interventions designed by healthcare teams and focused on optimal self-care outcomes promote well-being for caregivers and their care recipients.

A critical goal of nursing education is to prepare a future generation of practitioners who can influence outcomes in a complex and changing health care environment. The empowerment of nurses has been associated with positive organizational and health care outcomes. Educational culture, as a major socializing control, has the potential to affect the empowerment of nursing students and their future nursing practice. The purpose of this study was to examine relationships between students’ perceptions of organizational culture in their baccalaureate nursing program and the students’ self-perceived empowerment. The sample consisted of 231 senior baccalaureate nursing students from 4 public institutions in Northeast Ohio. The Organization Culture Inventory (Cooke & Lafferty, 1983, 1986, 1987, 1989) and the Short Vincenz Empowerment Scale (Vincenz, 1990) were used to measure organizational culture and empowerment, respectively. Findings indicate that, overall, students perceived their baccalaureate nursing program as having a moderately high constructive culture and a moderately low defensive culture. Students also described themselves as having moderately high empowerment. A weak positive relationship was found between students’ perception of a constructive organizational culture of their baccalaureate nursing program and their empowerment. A weak inverse relationship was found between students’ perception of a defensive culture in their baccalaureate nursing program and their empowerment. Together, the two organizational culture variables explained 7.7% of the variance in student empowerment. An important measurement finding of this study was that two organizational culture concepts, passive-defensive and aggressive-defensive cultures, could not be differentiated in this sample. Although factors other than culture may account more for student empowerment in baccalaureate nursing programs, this study provides support for the existence of an emerging new generation of empowered nurses who have the potential to make a positive impact on the nursing profession and patient care.

Background: It China, more than 20 million people were diagnosed with diabetes in 2000 and it was estimated there would be 42.3 million people with diabetes by 2030 (Wild, Roglic, Green, Sicree, & King, 2004). Diabetes mellitus self-management (DMSM) is considered the cornerstone for controlling diabetes and preventing diabetic complications. To develop effective interventions to promote DMSM in China, it is critical to identify the factors influencing DMSM relevant to this population. The purposes of this study were to test a hypothesized model describing the effects of individual and environmental factors on DMSM in patients with type 2 diabetes in China, and to test if the estimated effects are the same between two subgroups, patients treated with insulin vs. patients treated without insulin. The individual factors included diabetes knowledge, beliefs of treatment effectiveness, and diabetes self-efficacy. Environmental factors included social support from family members and provider-patient communication. Methods: A cross-sectional survey research design was used in this study. The study was conducted at a major hospital in Beijing China. A convenience sample of 201 Chinese adult patients with type 2 diabetes mellitus who attended the outpatient department of the Endocrinology unit at the hospital from September 2004 to November 2004 was obtained for this study. Data were collected using a self-reported questionnaire. Structural equation modeling (SEM) analysis was conducted to test the hypothesized model, and examine and explore the relationships between and among the individual and environmental factors and DMSM. Findings: The initial hypothesized model did not fit the observed data. Based on statistical findings and theoretical soundness, the model was modified. The final model had a good fit to the data. The key findings were that belief in treatment effectiveness and diabetes self-efficacy were key proximal factors affecting DMSM. Knowledge and the environmental factors indirectly affected DMSM through belief in treatment effectiveness and self-efficacy. The findings based on the multi-group SEM analysis indicated that patient-provider communication was a more important factor affecting DMSM for the insulin-treated subgroup, while family support was more important for the non-insulin treated subgroup. Conclusions: The good fit of the final model indicated that significant determinants of DMSM described in American studies were also important predictors of DMSM in Chinese with diabetes. The model illustrated that individual and environmental factors affected DMSM both directly and indirectly. Understanding the complex relationships between and among the individual and environmental factors and DMSM helps the practitioner to design intervention programs promoting DMSM using a more comprehensive approach. The practitioner should also be aware of the differences between the subgroups when developing intervention programs.

The purpose of this study was to discover the lived experience of family members of those who suffer from chronic mental illness. Van Manen’s method of phenomenology was used for data collection and analysis. Five participants described their experience of being a family member of one who suffers from chronic mental illness. The nursing framework used to conceptualize this study was Friedemann’s Systemic Organization (1995). Five essential themes emerged to reveal their lived experience: (a) participants experienced unmet needs, stigma ,and incongruence within the environment; (b) coping with multiple stressors that stemmed from the unpredictable overwhelming symptomatology and behaviors; (c) the effects of system change on the family system; when a family member suffers from mental illness.(d) a lack of control over changes occurring within the system; and (e) spirituality provided strength, faith, courage, and resilience that facilitated the ability of family members to endure and reach a level of acceptance of the mental illness.

This study explored the use of therapeutic touch as a prophylactic intervention to minimize the pain experienced by infants receiving multiple immunization injections. The history, philosophy, and practice of the modality and its physiological effects on the body’s energy field were discussed in a review of the literature. Seventeen infants, from a small rural immunization clinic, participated in the study. Each of the infants received multiple immunization injections, ranging from two to four injections, with the goal of preventing communicable diseases. One group of infants received therapeutic touch and one group, who served as the control, did not receive therapeutic touch. The treatment of therapeutic touch was provided by the researcher and observed by clinic nurses who were unaware of which group, either treatment or control, that the infants were assigned to. The infant’s pain response was recorded utilizing the PAIN (Pain Assessment in Neonates) scale. Scores were compared using t-tests. The results of the analysis were not significant, potentially due to numerous factors discussed under limitations of the study, although there was a statistical significance within the treatment group, when the pre- and post-treatment heart rates and oxygenation saturation levels were analyzed.

Little is known about the effect of early motherhood on an enlisted career in terms of individual health and organizational mission readiness. This research was guided by the 1999 Social Determinants of Health Model by Marmot and Wilkinson. The aims of the study were to answer: Are there differences between young enlisted women with and without preschool children on the following variables: marital status, family of origin socioeconomic status, minority status, type of work, perceived availability of military resources, multiple role strain, stress-related symptoms, health status, and career aspiration. 2) Among these variables, what are the best predictors of: a) multiple role strain, b) stress-related symptoms, c) mental health status, d) physical health status and e) career aspiration. Study participants included 100 junior enlisted women (17-24 year olds). A cross-sectional descriptive design was used. Chi-Square and t-tests indicated no differences between the women with and without preschool children on multiple role strain (frequency and severity), stress related symptoms, mental and physical health, and career aspiration. The only differences were in marital status, rank, and age with the women with children being older, of higher rank and mostly married. In all the women, multiple regression analysis indicated that higher severity of multiple role strain scores (10.4% of variance explained) is related to low perceived availability of military resources ratings. Higher stress-related symptoms scores were related to higher frequency of multiple role strain scores (39.9% variance explained) as well as lower career aspiration (3.8% of variance explained). Lower mental health scores were related to high stress related symptoms scores (27.9% of variance explained), lower career aspiration (4.1% of variance explained), being nonwhite (3.9% of variance explained), and high frequency of multiple role strain (4.0% of variance explained). High career aspiration scores were related to higher perceived availability of military resources ratings (16.8% of variance explained), decreased family of origin socioeconomic status (4.5% of variance explained), and increased mental health status (3.3% of variance explained).

The purpose of this study was to explore the experiences of women recovering from crack cocaine addiction with a secondary purpose to explore how the addiction affected their ability for self-care. The psychophenomenological study examined the recovering African-American woman’s ability to meet her requisites utilizing Orem’s (1995) Self-care deficit theory of nursing as a framework. Five African-American women, 18 to 45 years of age, addicted to crack cocaine and in recovery six months to two years, were selected as a convenience sample from women enrolled in the aftercare phase of a recovery program. Participation was strictly voluntary and confidentiality was maintained at all times. After obtaining the informed consent from each participant, a self-administered biographical questionnaire was completed, followed by an audio taped interview consisting of three questions. Van Kaam’s (1966, 1987) Psychophenomenological Method was used for data analysis.

The purpose of this qualitative phenomenological study was to explore the experience of receiving TT in clients with osteoarthritis of the knee. The clients experienced helicy in their energy field and they expressed it as physically decreasing the perception of pain, improving quality of sleep, being more relaxed, improving attitudes, and promoting the perception of peacefulness as well as increased energy. The clients expressed this as demonstrated by the many statements quoted in this study.

The purpose of this study was to gain further insight into what young female caregivers of persons with stroke were talking about on a web-based discussion group in the first year of caring. Narrative email discussion data were gathered as part of a larger study on the experience of caring. The sample for a secondary analysis of these data included three wives who were primary caregivers for their husbands. Researchers clustered these narrative data (entries = 214) into codes using Friedemann’s framework of systemic organization. Data were further analyzed by this investigator allowing themes to emerge and drawing them to the framework’s process dimensions of system maintenance and coherence, as well as congruence. There were four themes: giving and receiving supporting, being social, preserving family, and becoming frustrated. The findings from this study provide nurses with information about what was important to these female caregivers. Advanced practice nurses can incorporate strategies into the plan of care based on this information.

The purpose of this descriptive study using Roy’s adaptation model was to explore the sexual awareness, body image, and self-esteem in individuals who have ostomies. The sample consisted of 18 participants in two ostomy support groups from northwest Ohio. The variables studied included sexual awareness, body image, and self-esteem. Data were analyzed using three measurement tools, the Sexual Awareness Scale (Snell, 1991), the Grindler Body Attitudes Scale (Grindler-Katonah, 1991), and the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Data revealed that there were no statistically significant findings but in this sample, men seemed to have greater perceptions of body image, self-esteem, and sexual awareness. Future studies should include larger samples, broader geographical locations or inpatient settings to gain more significant and sensitive findings. Findings from the study could be used by nurses to devise better care plans for individuals to better adapt to their ostomies.

Despite the beneficial effects of exercise on physical and psychosocial health, few older adults engage and maintain regular exercise, and correlates of regular exercise have only been established in healthy older adults. This study was a secondary analysis of a clinical trial of exercise, “The Effects of Low Intensity Exercise on the Functional Health of Acutely Ill Elderly”, to identify predictors of regular exercise among elderly adults recovering from a hospitalization and who were dependent in some activities of daily living. The 77 experimental subjects completed the study and were involved in a 12-week daily muscle strengthening program. Indicators of regular exercise were weekly frequency and duration of exercise, and correlates of exercise were physical performance (muscle strength, gait), psychological factors (depressive symptoms, self-efficacy for mobility) social support, and experience with exercise within the last 6 months. The controls were comorbidity and gender. Of the experimental subjects, 77.9% exercised at least 3 times per week—a frequency known to benefit health. The mean exercise frequency was 51 sessions (4.25 sessions/week), and 70.1% exercised at a duration known to be associated with health benefits (20 minutes/week). The mean exercise duration was 1166.76 minutes (97.23 minutes/week or 22.88 minutes/session). In logistic regression analysis, 16% of the variance in exercising at a frequency known to benefit health was significantly explained by muscle strength, self-efficacy and previous exercise experience, but only self-efficacy was a significant predictor (OR=1.05; 95% CI = 1.00-1.11). Depressive symptoms and muscle strength explained 13% of the variance in exercising at a duration known to benefit health, and only depressive symptoms was a significant predictor (OR=.73; 95% CI = 0.56-0.94). Physical performance factors did not predict exercise behavior, suggesting that physical capability is not a factor in exercise behavior. Although physical performance factors must be present to do exercise, depressive symptoms and self-efficacy for mobility are more important in the decision of older adults to exercise. Interventions to enhance exercise behavior may be most effective if they reduce depression and increase the confidence of the older adult in their ability to exercise. Self-efficacy and depressive symptoms most strongly predicted exercise behaviors.

Patients with heart failure (HF) are frequently hospitalized due to excessive sodium intake. A behavior promotion model, The Common Sense Model of Illness Representation, was used to determine predictors of self-efficacy for low sodium diet behaviors (Diet SE). When this model was used in non-HF illnesses, the level of threat imposed by implicit illness representation (knowledge about the meaning of an illness [illness beliefs] and symptoms of illness severity [objective cues]) prompted coping through self care behaviors. In addition to the direct threat imposed by an implicit representation, the emotional response to the representation prompted coping. Hypotheses: In patients with HF, (1) accuracy of HF beliefs strengthens Diet SE; (2) greater number of objective HF cues strengthens Diet SE; (3) accuracy of HF beliefs strengthens Diet SE when HF is asymptomatic or mild; (4) depression lessens Diet SE; (5) a combination of HF beliefs, objective HF cues, and depression together predict Diet SE; and (6) when controlling for prespecified control variables, the relationships in hypothesis 5 hold. In 219 patients, more were Caucasian, elderly, married, educated, and non-depressed. Overall, patients had inaccurate HF beliefs and mild objective cues of HF severity. Accurate HF beliefs (all patients and those with mild HF) and number of objective cues did not predict Diet SE (Hypothesis [Ho] 1, 2, and 3). Higher depression predicted less strength in resisting relapse and total Diet SE (Ho 4). When combining predictor variables (Ho 5), the model predicted resisting relapse for Diet SE, but not reducing salt, behavioral skills, or total Diet SE. Age, someone to confide in, and diabetes were associated with Diet SE. After adjusting for these variables, the original combination model relationship with resisting relapse for Diet SE was lost due to the effect of someone to confide in but retained when age and diabetes were entered (Ho 6). Since HF beliefs and cues of severity did not create enough threat to promote Diet SE, nurses must assess patient education protocols, especially if symptoms provide the rationale for self-care adherence. Assessment of depression is needed so that diagnosis and treatment are promoted.

A male spousal caregiver providing care to his wife with stroke was enrolled in Caring-Web, a web-based support intervention study. This caregiver’s electronic messages posted on Caretalk, the discussion group on Caring-Web, were collected over the first year of caring. These data entries (n=213) were coded, using an established coding rubric based on Friedemann’s framework of systemic organization. The themes that emerged were drawn to this framework’s concepts. The themes during this year were that of the male caregiver: 1) providing support, 2) offering solutions, and 3) taking control. Friedemann’s system maintenance process dimension was the area that captured most of his experience. This indicated that this caregiver spent a significant amount of his energy in creating control and stability within his environment in order to maintain congruence or balance in his life. These findings can be used to identify and design interventions for caregivers that impact the quality of their lives.

The purpose of this phenomenological study was to explore the lived experiences of family members who participated in the end of life decision making process for a loved one who was terminally ill and died using Watson’s (2003) theory of human caring. The emerging themes were as follows: Theme One: The importance of time and loving kindness in establishing authentic care to promote comfort and healing. Theme Two: Creating a healing environment by assisting with basic needs in a considerate, consistent, caring manner, while viewing the family member’s loved one as whole and complete regardless of illness or disease. Theme Three: The importance of respecting family members by acknowledging, honoring and supporting their decisions and concerns to develop a helping-trusting relationship. Theme four: Creating a healing environment for family members during denial, preparation, and letting go to potentiate beauty, comfort, and peace.

Coronary artery disease is the most frequent cause of death among women in the United States. This may be due to differences in presentation of women with acute coronary syndrome. A convenience sample of 136 women who presented to an emergency department and were eventually diagnosed with ACS were reviewed for signs and symptoms at presentation, time to ECG and first cardiac medication. This study found that the majority of women (54.4%) presented with chest pain, however, a large number (45.6%) presented with other symptoms; sob, syncope weakness and falls. Presenting with non-chest pain symptoms was found to result in increased times to first diagnostic test and to first cardiac medication. The results are discussed in terms of Orem’s Self Care Deficit Theory of Nursing. Future studies should utilize larger sample sizes and multiple settings to validate findings and investigate outcomes in female patients who present with non-chest pain symptoms.

This comparative-descriptive study was conducted to identify the perceived learning needs of patients following their first myocardial infarction (MI) and to examine the teaching effectiveness of the Cardiac Rehab In-patient Education Program at meeting these needs. Gender differences in learning needs and whether men’s or women’s needs were more effectively met by the education were also explored. Roy’s Adaptation theory was used as a framework for the study. A sample of 23 MI subjects completed a CPLNI questionnaire in the hospital to identify their learning needs. Subjects also completed a CHD Teaching Evaluation form in the hospital and 2 weeks after discharge to determine teaching effectiveness at meeting the identified learning needs. Three areas of concern were ranked as important to learn by subjects including Physical activity recommendations, Dietary information and Anatomy and Physiology. Women ranked Dietary information most important to learn, however, men ranked physical activity. There was no significant difference in learning needs based on gender. The in-patient education program was effective at meeting the learning needs regarding physical activity. The in-patient education did not meet one gender’s learning needs more effectively than the other’s. In-patient education should be implemented after patients’ perceived learning needs are identified to provide them substantial information before returning home with the diagnosis of heart disease.

The purpose of this study was to determine the frequency of over-the-counter and prescription medications with anticholinergic side effects being used in a sample of 193 older adults with memory problems seen an outpatient setting between October 1999 and April 2004. Medications with anticholinergic side effects are contraindicated in this population because they can worsen memory impairment, increasing memory deficits, confusion. Using data from a retrospective chart review, this study was a secondary analysis of the medications that adults (>50 years of age) were taking at their initial clinic visit. Mintzer and Burn’s (2000) list was used to identify drugs posing an anticholinergic danger. Findings revealed that 10.3% of these adults were consuming one or more medications with anticholinergic side effects. These finding demonstrate a need for continued and perhaps, increased education for medical personal and healthcare consumers concerning the dangers of medications with anticholinergics side effects.

This qualitative study describes the lived experience of five mothers who care for their child with severe cerebral palsy. The phenomenon was elicited utilizing Roy (Roy & Andrews, 1999) adaptation model of nursing as the theoretical framework and phenomenology implementing Colaizzi’s (1978) method of data analysis. The themes identified capture the collective experiences of these women. The study examines an altered mothering role that begins with the diagnosis of the child with severe cerebral palsy and the adaptation necessary to care for the child. It describes how the mothers bonded and communicated with their child. Mothers also described how they dealt with multiple burdens, adapted with and without support and the altered family relationships that resulted. There is a description of the intense emotional responses of these mothers to the experience, and the positive aspects of this parenting experience.

The purpose of this study was to evaluate effectiveness of a nurse-directed smoking cessation intervention for hospitalized adult smokers using a quasi-experimental, prospective, longitudinal design. Pender’s revised health promotion model was the conceptual framework. Sixty-eight inpatients were assigned to either a control or an intervention group. The control group received smoking cessation literature. The intervention group received smoking cessation literature and a nursing intervention. The intervention group was randomized to a one or four telephone call subgroup for post discharge nurse follow-up. Fifty-five participants completed the study. Smokers receiving the nurse-directed intervention were more likely to be tobacco-abstinent at 3 months (n = 17, 55%) than smokers in the control group (n = 5, 21%). Tobacco abstinence between the one and four telephone call groups was not significant; however, additional telephone calls appeared to delay smoking relapse. Smoking relapse was higher for participants who lived with another smoker.

The mission for faculty in university and college settings is generally three-part and encompasses teaching, research, and service. Nurse faculty have struggled to balance work and understand the changing views of scholarship. A number of factors affect faculty commitment to the academic organization, and can influence behavior and attitude in the workplace. No research was found that explored the effect of organizational climate, role ambiguity, role conflict, and nurse faculty work role balance on faculty organizational commitment and turnover intention. The purpose of this study was to examine how organizational commitment and turnover intention are influenced by organizational climate, role ambiguity, role conflict and nurse faculty work role balance in departments/colleges of nursing in Carnegie Doctoral/Research Universities – Extensive, public and private, not-for-profit institutions. The research was based on Meyer and Allen’s Multidimensional Model of Organizational Commitment (Allen & Meyer, 1990). The sample was comprised of full-time tenure track, doctorally prepared nurse faculty. Forty-five schools of nursing and 316 full-time tenure track, doctorally prepared nurse faculty participated in the study. This non-experimental descriptive correlational study was conducted using an e-mailed approach. Zoomerang ™, a survey software package, was used for confidential and secure electronic data collection. Pearson correlation, analysis of variance, and logistical regression were computed to analyze the relationships and evaluate the predictive quality of organizational climate, nurse faculty work role balance, role ambiguity, role conflict, and organizational commitment on turnover intention. Path analysis was completed to test the fit of the correlation matrix against the causal model. Role ambiguity and role conflict scores were affected by low, moderate, and high levels of the research, teaching, and service components of work role balance. Significant negative relationships (p ≤ .05) were reported for role ambiguity, role conflict, and the organizational climate subscales of consideration, intimacy, and production emphasis. Positive significant relationships (p ≤ .05) were found between role ambiguity, role conflict and the organizational subscale of disengagement. Role ambiguity and role conflict were also significantly (p ≤ .05) negatively correlated with affective, continuance, and normative organizational commitment. Organizational climate subscales of consideration, intimacy, and production emphasis were positively related to affective, continuance, and normative organizational commitment (p ≤ .05) and negatively related to turnover intention. Organizational climate subscale disengagement was positively related to turnover intention (p ≤ .05). Nurse faculty intention to leave the job was predicted by role ambiguity; affective, continuance, and normative organizational commitment; and the organizational climate subscales of intimacy and disengagement. Findings indicate that work role balance does not influence the organizational commitment of nurse faculty at Carnegie Doctoral/Research Universities – Extensive, but that role ambiguity, role conflict, and organizational climate are related to all dimensions of organizational commitment and turnover intention. The results of this study reveal that many nurse faculty are experiencing role ambiguity, role conflict, and disengagement from their organization, which can lead to a decrease in organizational commitment and an increase in turnover intention, particularly for younger nurse faculty. These findings have implications for the recruitment and retention of nurse faculty. Efforts should be made by university deans and nurse faculty to match institutional and individual goals, and open discussions should take place between administrators and faculty about role expectations, criteria for tenure and promotion, and other institutional rewards.

The purpose of this study was to analyze the relationships among alcohol consumption and two psychological variables (depression, and conduct disorder) in women who are drinkers who had been involved in an alcohol-related motor vehicle crash (ARMVC). Wilsnack’s theoretical model of causes and consequences of problem drinking among women was used to guide the analyses. The sample included 43 participants, 18 to 45 years old, with a mean age of 28.84 years (SD = 7.10). The sample was derived from a brief intervention study that was conducted to test the effect of brief intervention to reduce alcohol consumption. Data were collected using a Health Screening Survey, which included instruments to assess for conduct disorder before and after age 15 and depression both in the previous year and in over a life time. Alcohol consumption was calculated using the Timeline FollowBack method (TLFB). Multiple regression analyses were conducted to assess the relationship among the psychological factors of interest and the average number of drinks per drinking day. Results showed that the combination of conduct disorder before and after age 15, depression over a life time and in the last year, and age were significantly predicted almost 26% of the variance in the average number of drinks per drinking day, (F [5, 37] = 2.65, p < .05). Subsequent regression included three predictive variables at a time to find the best regression model. Results indicated that the best fit regression model that significantly explained approximately 25% of the variance in the average number of drinks per drinking day included depression over a life time, conduct disorder after age 15, and age. Depression over a life time significantly contributed the most to the variance to the average number of drinks per drinking day (37%) followed by age and conduct disorder after age 15. Younger women with a history of conduct disorder and depression consumed more alcohol than their older counterparts. Although more work is needed, when young women screen positive for depression or conduct disorder, alcohol screening is also important.

The Effect of Music on Power, Pain, Depression, and Disability: A Clinical Trial Abstract by SANDRA L. SIEDLECKI The experience of chronic non-malignant pain (CNMP) is one of the most frequently encountered problems affecting both men and women during their working years, and is frequently associated with physical, emotional, and behavioral manifestations that affect all aspects of an individual’s life. The pathophysiology of CNMP syndromes is poorly understood, and the effectiveness of analgesics may be limited by their side effects. The addition of complementary modalities, such as music, may enhance the effects of analgesics, decrease emotional and behavioral manifestations, such as pain, depression, and disability, promote beliefs of personal power, and thus result in improved quality of life for individuals who suffer from CNMP. Research indicates that music is effective for decreasing acute and chronic pain. However, the effect of music on power, pain, depression, and disability associated with CNMP has not been previously studied nor have the effects of different types of music been compared. This randomized controlled trial was designed to test the effect of listening to music on levels of power, pain, depression, and disability. A second aim was to compare the effects of researcher-provided relaxing music choices with subject-preferred music, selected daily based on self-assessment. Using Rogers’ science of unitary human beings and Barrett’s theory of power, this was a test of a research model, which posited that music would have a direct effect on power, pain, depression, and disability through environmental field patterning and an indirect effect through enhanced feelings of power. Univariate and multivariate analysis found that the two music groups had significantly higher levels of power and lower levels of pain, depression, and disability than the no music control group; and there were no significant differences on any of the dependent variables between groups who used researcher-provided relaxing music and those who used self-selected preferred music based on daily self-assessment. Thus, the direct effect of music posited in the research model was supported. In addition, these findings also supported the indirect effect; music increased power, and power predicted posttest levels of pain, depression, and disability.

Adult caregivers of persons with stroke [n=12] from northwest Ohio and southeast Michigan were enrolled for 48 weeks in a study that examined the experience of caring after discharge home. A secondary analysis was used to examine questions asked by male and female caregivers in a Web-based support group. Narrative content analysis of a combined total of 816 email entries, with 95 questions asked by the subjects during their participation in the Web-based discussions, resulted in emerged themes that were drawn to Friedemann’s framework of systematic organization. A difference between the themes expressed in the questions asked by male versus female caregivers was revealed. Coherence, in Friedemann’s terms, emerged as the most prevalent theme for the female caregivers, and system maintenance was the predominant theme expressed by the male caregivers. There were no notable changes in the themes expressed by the male or female caregivers over time.

This study sought to establish the utility of heart rate variability measurement as a tool to assess pain in low birth weight premature infants. It used a repeated measures design with secondary analysis and paired samples. Subjects were a subset of 10 infants who were less than 28 weeks gestational age. Heart rate increased significantly following a heel stick and remained unchanged following an axillary temperature measurement. There was a significant increase in heart rate during what is thought to be pain that did not occur following a presumably non-painful stimulus. Heart rate was shown to be a sensitive indicator of pain in this sample of infants. No support was found for the use of heart rate variability as a pain measure in this age group and post-conception age range.

The care of frail, elderly parents is becoming an issue of rising concern as the number of aged people in the population increases. It is estimated that over 22 million people currently provide support to elderly family and friends in this country. Caregivers often provide services at great physical, emotional, and financial cost to themselves. Evidence indicates that the majority of informal caregivers are daughters caring for their parents. Abundant research is available on family caregiving, however, the greatest focus has been on the concepts of caregiver burden and strain. Little investigation into the needs of daughters as a specific group has been conducted. The purpose of this study was to examine the lived experience of daughters who care for their frail, elderly parents in the parents’ home. The philosophical underpinnings and nature of phenomenological research were examined as the context for application of van Manen’s design. Data were collected from interviews with seven daughters who were currently in the caregiving role. Support for the themes was gleaned from artistic sources. Ten essential themes were elicited. These themes were that caring for frail, elderly parents in the parents’ home is: (1) being torn between worlds; (2) embracing the wholeness of commitment; (3) a crucible of individual human effort; (4) a means of self-discovery; (5) a thread that can weave a family together or cause it to pull apart; (6) an experience of reciprocity; (7) a doorway to intimacy; (8) the attempt to maintain the autonomy of the parent; (9) grieving the decline of the parent; and (10) making the best use of the time left with a parent. The ten themes were used to compose a narrative of the daughters’ experiences of caring for their frail, elderly parent in the parent’s home. The findings were examined in light of Bowlby’s Attachment Theory and Kristen Swanson’s Theory of Caring. Congruence of the findings with Attachment Theory and partial congruence with the Theory of Caring were found. Implications for research, practice, and education were discussed.

Each year thousands of adolescents suffer burn injuries. Many bear permanent reminders of this trauma such as scars, amputations, and functional limitations. Developmental theories suggest that physical changes can profoundly affect an adolescent as they progress through the complex stage of adolescence. The purpose of this study was to gain an understanding of the experience of adolescents with burn injuries following hospitalization. The hermeneutic phenomenological research design of Max van Manen was chosen to explore this phenomenon. This design explores meanings of everyday experiences from the perspective of the individual. Several data sources were used to illuminate the meanings of this phenomenon: 1) personal experiences with the phenomenon, 2) experiential descriptions of those experiencing the phenomenon, 3) experiential descriptions of the phenomenon in literature, art, and other artistic forms, and 4) idiomatic phrases and etymological sources of words used to describe the phenomenon. Eight adolescents were interviewed however only six were fully analyzed, as two adolescents were unable to reveal the meanings of their experiences. Four common themes were uncovered from the interviews. The lived experience of adolescents with burn injuries is 1) an arduous journey of struggles as each individual freely chooses a unique path to a new way of being, 2) making difficult choices as cherished values are re-examined, 3) creating new images to transform the way of being normal, and 4) becoming empowered while rejoicing in accomplishments and abilities. Two participants contributed creative works which also reflected the themes identified in the interviews. Non-narrative data such as creative and literary works further illuminated the meaning of this phenomenon. A second review of the literature found the experiences of adolescents with chronic illness similar to the adolescents with burn injuries. The findings of this study were congruent with Rosemarie R. Parse's, Human Becoming School of Thought (1998). The results of this study may be of interest to nurses, teachers, counselors, coaches, physical therapists, occupational therapists, youth counselors and others interacting with adolescents who have sustained a burn injury.

The purpose of this study was to identify the variables that influence the frequency of personal respiratory protection (PRP) use by workers in swine confinement buildings (SCBs). The study was designed to answer four research questions: 1). What is the validity and reliability of the Personal Respiratory Protection Survey (PRPS)? 2). How frequently do workers in SCBs wear PRP? 3). How do demographics, occupational histories, and self-reported respiratory health histories influence the use of PRP in SCBs? and 4). What are the relationships of the constructs (benefits, barriers, susceptibility, severity, norms) to the use of PRP by workers in SCBs? The investigator developed an instrument that included a questionnaire to elicit demographic information, occupational and respiratory histories, and frequency of PRP use among SCB workers. In addition, the instrument included the PRPS that contained five Likert scales developed to measure five constructs theorized to influence the frequency of PRP use by SCB workers. To establish the instrument’s content validity a two-phase process included a critique by a group of eight experts and a pilot test with six SCB workers. Data for the study were collected from 503 SCB workers attending the 2003 World Pork Expo in Des Moines, Iowa. Principle component analysis (PCA) and varimax rotation were used to establish construct validity and resulted in the identification of eight factors (i.e., benefits, norms, severity, susceptibility, personal barriers, knowledge barriers, external barriers, and habit barriers). Cronbach alpha values for the factors ranged from .58 to .91. Descriptive analysis found that 36.3% of the workers never used and 21.2% seldom used PRP at the worksite during the past year. Stepwise hierarchical regression was used to predict the frequency of PRP use with 38.9 % of the total variance explained by the study’s variables. Twelve percent of the variance was explained by a combination of the demographic, occupational history, and respiratory history variables. An additional 27% of the variance was explained by six of the theoretical constructs: knowledge deficit barriers, external barriers, norms, severity, benefits, and personal barriers. recommendations are shared for future research along with implications for theory and practice.

The purpose of this study was to explore the impact of maternal perceived stress in high-risk pregnancy on participation in health promoting self-care. Orem’s self-care deficit theory of nursing was the theoretical framework. A secondary analysis from a convenience sample of 69 women experiencing a high-risk pregnancy was conducted. The correlation between the Perceived Stress Scale by Cohen and associates (1983) and the Health Promoting Lifestyle Profile II by Walker and associates (1987, 1997) was negative. The findings indicated that women in the third trimester of a high-risk pregnancy with higher perceived stress levels were less likely to be involved in health promoting self-care behaviors, specifically in the areas of spiritual growth, interpersonal relations, and stress management. These findings suggest that nursing can be beneficial to decrease stress for the high-risk pregnant woman by implementing interventions, which offer support, stress management, and an opportunity for spiritual growth.

The relationship between perceived life changes related to caring and feelings of depression in caregivers of persons with stroke was examined. A convenience sample of caregivers (n = 29) who were receiving ongoing support completed two questionnaires: Bakas Caregiving Outcomes Scale (BCOS) and Center for Epidemiologic Studies Depression Scale (CES-D). Subjects were primarily white, middle-aged spouses who had been caring for the person with stroke for about a year. The mean score on the BCOS was 55.79, indicating an overall change for the worst due to the caregiving role. The item addressing time for social activities with friends resulted in the lowest score. The mean score on the CES-D was 33.86, indicating a risk for clinical depression. Correlational analysis found that as perceived life changes decreased (changed for the worst), feelings of depression increased. Interventions aimed at decreasing the negative perceived life changes related to caring need further exploration.

The lived spiritual experience of 5 Christian persons was studied using Colaizzi’s (1978) phenomenological method for analysis. Six main themes with sub themes emerged from significant statements made by the participants. The main themes included: An initial sense of disintegration; a sense of peace is sought; this sense of peace is interrupted by worries for the future; prayer support comes in many ways; life experiences are seen as lessons to be learned; and the experience results in a total trust in God. Results were integrated into an exhaustive description of the experience of spirituality for the five Christians during a life-threatening illness. Orem’s (2001) self-care deficit theory was used to illustrate the connection between the Christian beliefs and values to the state of well-being. Implications for nursing practice and further research were made.