Never has the world experienced such extreme desecration as with the atomic bombings of Hiroshima and Nagasaki, Japan, in August 1945. This magnitude of destruction serves as the foundation for this disaster research. Although significant quantitative research has been completed about medical effects following radiation, the literature lacks qualitative exploration from a holistic health perspective. The purpose of this study was to explore the experience of atomic bomb survivors from Hiroshima and Nagasaki. From ethnographic data and interviews with eight survivors who currently reside in the United States, a thematic structure was developed that depicts the essential elements of the atomic bomb experience. This includes the literal destruction of the bombing, which resulted in complete desecration of the environment (including the physical health, psychological health and response effort). Individual‟s perspectives of the atomic bomb experience were circumscribed within the Japanese cultural context. Two ways of being in the world followed the bombing: surviving and thriving, with resilience serving as a lever, allowing for fluid movement over time across the continuum. Individuals experiencing surviving exhibited anxiety about their personal and family members‟ health, expressed mistrust, and felt a stigma associated with being a survivor. For those who were thriving, peace activism, overcoming and forgiveness were typically displayed. Keen sensory perceptions were universal across all participants and extreme measures of care were frequently discussed. The narratives were explicated using Leininger‟s Culture Care Diversity and Universality Theory. Findings from this study add to disaster nursing literature and support the need to include disaster nursing in all levels of nursing education, emphasize the necessity of long-term psychosocial support following disasters, and discuss key public health messages

The purpose of this study was to describe the interaction that occurs between adolescent mothers and their newborns while situated together in the immediate postpartum period. The researcher sought to determine: 1) What are the interactive process (es) that occur between adolescent mothers and their newborns while situated together in the immediate postpartum period, 2) What categories emerge from the adolescents’ descriptions of the mother infant situation?, and 3) How do the emergent categories relate? Ten primiparous adolescent mothers age 17 years or less were purposively sampled to participate in this qualitative Grounded Theory study. Face to face interviews about what participants had been doing to get to know their babies were conducted either the in-patient setting or the home of each participant at their request within one week of delivery The adolescent mothers described a distinct process that begins at the moment of birth and encompassed them forming a relationship with their newborn, recognizing self-change based on that relationship, and moving forward with their baby as the central component of their life. Three core concepts, “Connecting Together,” “Taking Baby into the Inner Being,” and “Embarking Together” emerged from the rich descriptions provided by the participants to represent the theory “Becoming Tied.” The theory provides a new way of viewing the process of how adolescent mothers and their newborns relate in the immediate postpartum period.

Hurricane Katrina, a Category Four hurricane, made landfall on August 29, 2005, along the Gulf Coast of Mississippi and Louisiana. The strength and the extent of winds resulted in the worst destruction and the largest storm surge in the history of the United States. Within hours after the hurricane hit, the earthen levees in New Orleans were breached and 80% of the city became submerged in up to 20 feet of water. Health care workers and patients were stranded in hospitals, where they experienced extreme environmental conditions. The death toll was reported at, 1836 persons, and the damage was estimated at 200 billion dollars. No one in the United States was prepared for a disaster of this magnitude. The purpose of the study was to describe nurses’ experience of caring for patients in Mississippi and Louisiana during and after Hurricane Katrina. An existential phenomenological research method was used. Face-to-face, digitally recorded interviews were conducted with a purposeful, networking sample of nine Registered Nurses. Transcribed narratives were analyzed by the researcher and members of an interdisciplinary research team using a hermeneutical approach developed by Pollio and applied to nursing research by Thomas. Each interview was examined to identify themes. The experience of providing care was grounded within the context of caring. The themes that emerged were 1) Fear, 2) Ethical Conflicts, 3) Blurred Boundaries, 4) Isolation/Connection, 5) Powerlessness/Power, and 6) No Hope/Hope. Descriptions of the environment were woven throughout every narrative, and it was described as overwhelming. The nurses in this study experienced terror, chaos, danger, threat, and isolation while providing care to patients. During this ordeal, basic physiological needs were not met. The nurses experienced physical exhaustion and some became patients. The findings from this study point out the inadequacies of local, state, and national government and hospital administrators related to disaster preparedness. The findings also illuminate areas where nursing education could be improved, policies to protect nurses could be implemented, and areas needed for future research related to emergency preparedness.

The retention of healthcare personnel, especially in the profession of nursing, continues to remain a critical issue. The ability to adequately and safely staff healthcare facilities to provide inpatient and outpatient care and emergency services is dependent on maintaining a well trained and experienced professional and paraprofessional workforce. This issue is of particular importance to the enlisted members of United States Army Medical Department (AMEDD) and the United States Army Nurse Corps. This qualitative descriptive research study identified many topics influencing the retention of enlisted personnel in the AMEDD. The work environment, economic factors, personal and professional issues were identified as influencing decisions regarding reenlistment. Additionally, the findings of this study indicate that the decision to reenlist was often made as a result of the individual’s perceptions and evaluation of the importance and interactions of the topics. Finally, this study identified that retention can also include the possibility of staff returning to a previous employer. The development of a better understanding of the topics identified and described as important when making the decision to reenlist should support the AMEDD as it continues to assess and refine current reenlistment incentives as well as the identification and development of additional options to improve enlisted soldier retention.

After hurricanes Katrina and Rita, faith-based organizations were among the most trusted and efficient organizations responding in New Orleans. The primary purposes of this study are twofold: 1) to understand the experience of faith-based disaster response for those charged with organizing and executing such a massive, grassroots effort, those delivering direct service, and the survivors who seek and receive assistance; 2) to understand the impact of the disaster event and levels of hope in the lives of those who provide and receive assistance. These research purposes were achieved by using a mixed methods research design that included ethnographic participant-observer field experience, existential phenomenology interviews, and the administration of the Herth Hope Index, the Hope Visual Analogue Scale and the Impact of Event Scale – Revised. Study participants included faith-based disaster response staff and volunteers as well as the New Orleans residents they assisted. All research findings were triangulated. The qualitative contextual ground for the experience was “Divine Agency.” The figural themes were “Decision Point,” “Social Suffering,” “Stranger-to-Stranger Interactions,” “Communitas,” “Transformation,” and “Reflection.” With a possible maximum of 48, the scores for the Herth Hope Index included a mean of 42.5 for the staff, 41.5 for the volunteers and 46 for the residents. The scores on the Impact of Event Scale – Revised, among all participant groups, revealed almost all of the participants experienced significant emotional impact. The mean Impact of Event Scale – Revised score was 34.22 for the staff, 37.63 for the volunteers and 47.5 for the residents of New Orleans. Implications for nursing education and practice were identified with emphasis on the emerging nursing specialties of faith-community nursing and homeland security nursing. Future research should incorporate intervention studies treating faith-based disaster response and strategies to encourage hope as interventions. Potential areas for public policy development related to faith-based disaster response discussed include reallocation of public funds to faith-based disaster response, encrypted case management systems, and fee for service disaster response activities.

The purpose of this study was to describe the experiences of midlife women who have experienced a myocardial infarction and returned home to recover. A phenomenological research method based on the philosophy of Merleau-Ponty was used for the study. The researcher interviewed 8 women ranging in age from 45 to 65. The interviews were transcribed and analyzed using the approach of Pollio and Thomas. Most of the transcribed interviews were read and discussed in the Phenomenology Research group. A thematic structure was identified from the shared themes of the women participants. For the women in this study the experience of the myocardial infarction and the recovery must be understood within the existential grounds of body and others. Four themes were common among the women survivors including: (1) Interference, (2) Freedom/Unfreedom, (3) Knowing/Not knowing and (4) Living in fear. Findings of this study suggest women need to be better educated before leaving the hospital. Returning home post myocardial infarction is a difficult time for women and they need to be better educated by health care professionals. The women in this study felt a support group for women myocardial infarction survivors was needed.

The purpose of the study was to describe the experience of early stage breast cancer women who were living with cancer-related fatigue. Using a phenomenological approach based on the work of Merleau-Ponty, the researcher completed six interviews in which women described the experience of being tired each day. Interviews were transcribed verbatim and analyzed using a hermeneutical approach developed by Pollio and applied to nursing research by Thomas. Each interview was examined within the context of all the interviews to identify themes noted in all transcriptions. Dealing with the prevailing and profound fatigue that entrenched these women‟s lives was overwhelming. There was an overarching sense of living in the “Shadow of Death,” which served as the contextual ground. This sense of looming in the “Shadow of Death” reflected that these women survived cancer and cancer therapies; however, fatigue rendered their bodies, minds and lives changed…..an irreversible change. Living with fatigue was described by the women as “part of weaving the fabric of my life,” yet the tapestry was never complete and had many imperfections. These flawed threads in the tapestry emerged as four figural themes: “Being Alone in my Cave,” “Coming Out of the Cocoon,” “It‟s a Lost Fight” and “Who am I Now?” They described living in two worlds: one being hard and demanding, regardless of how hard they worked to overcome their fatigue; the second world served as a safe refuge, a cave, that allowed them to “peer through the window of hope” into the outside world. As fatigue improved they initiated “coming out of the cocoon,” but realized their bodies were entrapped with many losses. Losses were described as “permanent visitors” which led to feelings of loneliness and despair with their life being relegated to a non-participative role with family, friends and work. Regardless of effort, their recalcitrant body was unable to overcome the fatigue. With fortitude, they confronted a search for the “old me” to realize every fabric of their life had changed, never to return to the “old self” which left them to peer into the outside world while searching for small “windows of hope.”

Experts have identified simulation debriefing as the crucial or pivotal point to learning (Baldwin, 2007; Gaba, Howard, Fish, Smith, & Sowb, 2001), and the “heart and soul” of simulation (Rall, Manser, & Howard, 2000, p. 517). No research studies exist that support how best to perform this crucial activity, particularly as it relates to nursing clinical simulation (NCS) debriefing. My aim in this study was to explore and describe the current practice of NCS debriefing. I studied the phenomenon as it naturally occurred, a group exercise, and interaction between the educator, student, and environment. The research question was the following: How is NCS debriefing currently practiced? No data exist regarding the proposed study; therefore, a purposive sample of four individual cases was proposed as an adequate number to acquire sufficient intercollegiate variation. I chose study sites from the three geographic locations of Tennessee: West, Middle, and East. Creating individual case descriptions was the first analytical method used to begin cross case analysis. I then reduced the data using several techniques: categorical aggregation, time-ordered displays, content analysis, and pattern matching. Iterative comparison of data resulted in further reduction. The videotapes served as bases throughout the entire analytical process and were considered the primary source if any dispute or disagreement among sources occurred. After cases were analyzed individually, a cross case analysis revealed patterns or potential typologies of instructor participants. The final cross case synthesis of the emerged patterns produced seven patterns; four patterns matched those of the extant literature, (communication, time, structure, and emotion), and three new patterns emerged: accentuate the positive, higher order thinking, and experience counts. Debriefing provides students the opportunity to reflect on their experiential learning exercises and to hypothesize how they might perform differently next time. Debriefing also offers students a reality check, a way to see themselves through the eyes of the teacher or their peers, something the participants in this study (i.e., students and educators) valued and sought.

Subarachnoid hemorrhage (SAH) is a hemorrhagic stroke subtype affecting 30,000 Americans per year. The most common cause of secondary injury after SAH is cerebral vasospasm (CV). Currently, there are no biomarkers to identify risk for CV. Apolipoprotein E (apoE) is a protein with potential to alter tone of cerebral vessels by influencing intracellular calcium homeostasis. ApoE has isoform specific effects on intracellular calcium (Ca++) level, cerebral vessel tone, and potentially CV. The overall objective of this project was to describe the relationship between apoE genotype (APOE), apoE protein level, calcium level and presence of CV after SAH. This study included individuals age 18-75 with a diagnosis of severe SAH from an aneurysmal source. Daily cerebrospinal fluid samples were drawn from a drainage catheter. APOE genotyping was performed using standard restriction fragment length polymorphism techniques. The sample was dichotomized based on APOE ?4 allele presence. Daily apoE protein levels were analyzed using an enzyme linked immunoassay. Ca++ level was analyzed using potentiometry. CV was verified using cerebral angiogram, computed tomographic angiogram, or elevated transcranial dopplers the entire group were lower than normal and associated with one another. Overall and daily apoE protein levels were higher in individuals with an APOE ?4 allele but there was no association with CV. Overall Ca++ level was higher in the individuals without CV, however daily mean was not significantly different between the two CV groups. Overall and daily mean Ca++ levels were higher in individuals with an APOE ?4 allele. This project further describes the relationship between apoE, Ca++ and neurologic disease, however more work is required before either CSF apoE or Ca++ can be used as a predictor of CV.

Background: Resuscitation preferences regarding prolonged mechanical ventilation (PMV) have rarely been explored. Objectives: To determine preferences of PMV survivors and influencing factors. Methods: Subjects were 29 (57% male) survivors of PMV ( 7 days) and tracheostomy interviewed > 6 weeks after MV was initiated. Subjects were asked to: 1) indicate if they would choose MV again; 2) rate present health, pain/discomfort in ICU and from MV, perceived family financial burden and emotional/physical stress using a Likert scale (0=positive, 4=negative); 3) identify change changes that might alter this preference; and 4) complete questionnaires assessing quality of life (QoL) (SF-36), functional status (Health Assessment Questionnaire), depressive symptoms (Center for Epidemiological Studies Depression Scale) and communication (Patient Communication Survey). Results: Most (76%) would undergo PMV again. Median MV days were greater for those who would undergo MV again (98.5 vs. 70, p=NS), as were median tracheostomy days (102 vs. 64, p=NS). Those who would not undergo MV again were more likely to have depressive symptoms (p=0.051) and Medicare coverage (p=0.023). No other variables differed between groups, including age, ICU length-of-stay, QoL, functional status, or communication status. Individuals who preferred MV stated their preference would change if their health and/or the family s emotional/physical stress were worse. Those who did not prefer MV would change if family s financial burden and emotional/physical stress were reduced. Conclusions: Most patients would undergo PMV again despite substantial time on MV. Preferences were most likely to change based on present health and family s financial burden and stress.