Heart Failure is a growing and costly problem in the United States. There have been advancements in medical therapy, but unfortunately patients continue to have frequent exacerbations and hospital readmissions. The reason for this may be inadequate Heart Failure self-care, which is the most important aspect of disease management. Literature strongly encourages self-care, but there is minimal research focusing on the use of a Heart Failure diary. The study was a one group pretest/posttest design. The intervention included individualized education, provision of the Heart Failure Diary, and weekly follow-up for a total of four weeks. The Heart Failure Diary was developed specifically for this study for recording daily self-care maintenance activities which includes weight monitoring, fluid intake, salt intake, swelling, shortness of breath, and medication adherence. In order to determine the effects of using the diary on self-care and quality of life, the Self-Care of Heart Failure Index (SCHFI) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) responses were compared pre and post intervention. The difference between the SCHFI pretest-posttest scores demonstrated a non-significant improvement in self-care maintenance, n = 14, 2.616 (12.942), SE = 3.459, p = .463, t = - .756, 95% CI [-10.089, 4.856]. The difference between the MLHFQ pretest-posttest scores demonstrated a non-significant improvement in quality of life, n = 14, -5.500 (18.851), SE = 5.038, p = .295, t = 1.092, 95% CI [-5.384, 16.384]. The effect size of the SCHFI, d = .20, and the MLHFQ, d = .29, are both small and most likely due to the small sample size. The study concluded that using the diary did not have a statistically significant effect on the self-care or quality of life of these patients with heart failure.

In the United States, obesity is on the rise while physical activity is declining. Educational funding cuts result in less time and resources for physical education in schools and youth are increasingly more sedentary with technological advances. Advance practice nurses have a role in promoting physical activity and health in this population. The purpose of this study was to examine the relationship between physical activity and self-esteem in females during late adolescence and the effect of perceived benefits and barriers to physical activity on this relationship. E-mail invitations to participate in an online survey were sent to female undergraduate students at a university in the Southeastern US. Physical activity, self-esteem, and perceived benefits and barriers were assessed using the 60-minute MVPA screening measure, the Rosenberg Self- Esteem Scale, and the Exercise Benefits/Barriers Scale respectively. A sample of 536 usable surveys was obtained. Only 22% of participants were currently meeting physical activity guidelines. Self-esteem was moderately high. The greatest barriers to exercise were time and convenience. There was no significant relationship between physical activity and self-esteem. A low, but significant negative correlation was found between self-esteem and BMI and with self-esteem and perceived barriers to exercise. Self-esteem was positively correlated with overall perception of exercise. There was a small, but significant correlation between reported physical activity and overall perception of exercise and a negative correlation with barriers to exercise.

A large number of patients do not follow medical advice for reasons generally unclear to the health care provider. Significant morbidity and mortality can be outcomes of noncompliance. The purpose of this naturalistic inquiry was to study and clarify from the patient's perspective, issues identified as influencing the ability to comply with provider recommendations. Data collection and analysis occurred simultaneously as a fluid process of organizing and synthesizing qualitative material into categories or themes that emerged to illuminate a phenomenon. Seventy-six percent of participants described themselves as 100% compliant though they did not take medications as prescribed or failed to follow through with other recommendations, such as lifestyle changes. Participants listed positive perceptions when the provider: related to them, listened, addressed concerns, and included them in the plan of care. The provider behavior of listening was important to patients but was not the only aspect identified with a potential influence on compliance levels. Unexpected study findings included connections between symptomatology and medications, control issues between patient and provider, and the patient's perceptions of office personnel attitudes.

Because of the importance of long-term memory of concepts and procedures and because of the need for the ability to retrieve data to solveproblems, the relation between the method of instruction and retentionretrieval ability of students must be examined. This study was designed to approach an analysis of the nature of this relationship. Specifically, it was conducted to answer the following question:What is the relationship between retention of algorithms for problem solving as measured ,by the Test of Logical Thinking (TOLT) by ninth grade physical science students at a college preparatory school who have beentrained in control of variables, and the ability of students to apply this process to a novel problem-solving situation in Physical Science?The population was selected from a private college preparatory school in Jacksonville, Florida, which was instructed and tested in laboratoryoriented ninth grade science classes in addition to using the TOLT Form A as an indicator, the retention and retrieval of processes were tested in problem-solving situations in the classroom and observed in the laboratory by the teacher. This teacher observation and assessment, along with the TOLT, are considered essential in attempting to understand the retention of processes by the students for future use in problem-solving.

Disparity in access to health care and preventive services places a heavier burden of morbidity on those with limited access and resources. Underserved populations with decreased access to appropriate health screening and therapeutic interventions often present with increased risks for peripheral arterial disease. Some patients with peripheral arterial disease are asymptomatic and may defer treatment while others present with occlusive disease requiring immediate therapy. Delaying diagnosis and treatment reduces quality of life and functional status. The prevalence of peripheral arterial disease has been extensively studied in the elderly population but the prevalence in the high-risk underserved population is unknown. The purpose of this study was to identify the prevalence of peripheral arterial disease in an underserved, high-risk, predominantly African American population and to determine if providers using an electronic blood pressure machine could accurately measure the ankle-brachial index. The sample population of forty adult residents at a homeless shelter in northeast Florida was screened for peripheral arterial disease. Inclusion criteria consisted of a diagnosis of hypertension, hyperlipidemia, diabetes or a history of smoking. The ankle-brachial index was assessed using the vascular Doppler method and an electronic blood pressure machine though the latter was found to be an insensitive screening tool. The ankle-brachial index, the San Diego Claudication Questionnaire and a physical assessment were used in this crosssectional study to determine the prevalence of peripheral arterial disease. An abnormal ankle-brachial index value (≤ 0.90), indicating a high suspicion of peripheral arterial disease, was assessed in 22.5% of the sample population, all of whom were found to have a history of smoking crack cocaine.

Since the results of the Women's Health Initiative (WHI) study were published in 2002, millions of women and their healthcare practitioners have had to re-examine decisions about the use of hormone replacement therapy. This level one descriptive study explored the characteristics of menopausal women who could not tolerate estrogen withdrawal and continued taking hormone replacement therapy despite findings of risk published in the Women's Health Initiative. The sample included the medical records of 1,195 patients in a single-physician OB-GYN practice in northeast Florida. All records of women with a birth date in 1954 or prior and a visit to the practice for gynecological care between July 2002 and March 1, 2004 were reviewed to collect data about demographics, past medical history, and hormone replacement therapy (HRT) use. A significant portion of women (77.2%) had discontinued HRT. Of the women remaining on HRT, 54.7% changed either the dose or type of hormones taken. Only 59.5% of these women remained on the same estrogen dose both before and after the WHI results were published in 2002. Interestingly, there were 29 women (4%) who initiated HR T use after July 2002. The women who remained on HR T after WHI were more likely to be younger, Caucasian (72. 7% ), non-smokers (82.3% ), and taking medication for other conditions (68.5%). The older the woman, the less likely she was to have continued HRT. Younger women were more likely to have changed HRT drug and/or dose post-WHI.

Providing comfort is a fundamental nursing responsibility. Unrelieved postoperative pain has adverse physiologic and psychologic effects that contribute to prolonged hospital admissions and significant discomfort to patients. Opioids are standard methods of postoperative analgesia for many surgical procedures. Unfortunately, the use of opioids is associated with side effects such as nausea and vomiting, urinary retention, ileus and respiratory depression. These side effects, with the added problem of inadequate pain control, result in patient dissatisfaction with surgical procedures. Paravertebral nerve block (PVB) is a regional anesthetic technique that has been shown to result in opioid sparing in many procedures including breast and hernia surgery. This study investigated the possibility of improved postoperative pain and nausea management when combining paravertebral nerve blocks with general anesthesia (GA) , compared to general anesthesia alone, for laparoscopic Nissen fundoplication surgery. The convenience sample consisted of 29 patients receiving surgery at the Mayo Clinic, Jacksonville, Florida. There was significant correlation between the type of anesthesia and pain at 12 hours postoperatively, indicating that those who received PVB had less pain than those receiving GA alone, at that time. Although there was no significant correlation between type of anesthesia and nausea, only one patient vomited and others had minimum to moderate nausea, postoperatively. The information attained from this research will be beneficial to nurses providing pain management for patient comfort in the outpatient surgery center.

Children develop beliefs about ideal body image and carry these perceptions into adulthood. Consequences of poor body image may include decreased self-esteem, depression, unhealthy lifestyle, and eating disorders. Understanding healthy lifestyle behaviors and the relationship between body image and these behaviors can empower individuals to engage in behaviors to improve health. Pender’s health promotion model provided the theoretical framework for this study. The purpose of this study was to identify the relationship between body image and healthy lifestyle behaviors among undergraduate university students. An email was sent to undergraduate students, providing a link to the survey that included: demographic, body dissatisfaction, and screen time questions; Prochaska’s physical activity screening measure; and a lifestyle profile by Walker, Sechrist, and Pender. A total of 1056 usable surveys were returned. The majority (71%) were satisfied with their body image, although many (60.3%) wanted to alter it. Most (65.1%) had a normal BMI. Sedentary activity was more than the recommended amount, with only 23.3% meeting physical activity guidelines. Healthy lifestyle behaviors were engaged in “sometimes” and “often, but not routinely.” Body image was correlated with healthy lifestyle behaviors. There was a moderate correlation between activity and body image, and a negative correlation between sedentary activity and healthy lifestyle behaviors.

Nurse educators believe that their graduates are well-prepared for entry level positions in nursing. In the acute healthcare setting, new graduates are placed on virtually every type of nursing unit, including critical care. Employers have developed formal orientations to familiarize new graduate nurses new with the institution and its policies and procedures and to teach the things employers believe new RNs need to know but do not, either because they were never taught the material or they have not retained it. The purposes of this project were to (a) examine the evidence relative to a disconnect between nursing education and nursing practice, (b) design a formal residency program for new graduates based on the evidence, and (c) implement and evaluate the residency program. Based on the evidence, a 16-week new nurse residency was developed in which Residents were each assigned both a Preceptor and Mentor to assist their progress. Weekly educational offerings were targeted at specific competency deficits identified by Residents, Preceptors and Mentors at the beginning of the residency program. Seven out of the original 10 Residents completed the Residency. Pre-residency, the Residents were very confident of their clinical skills and abilities and this was unchanged post-residency. The Preceptors and Mentors were much less confident of the clinical skills and abilities of the Residents pre-residency. Post-residency, the confidence level of the Preceptors and Mentors was improved, but significantly so only for the Mentors. It is imperative that nursing administrators be aware of the discrepancy between the confidence new nurses have in their own skills and the perceptions of the nurses who work side by side with them on a daily basis. Residencies for new graduate nurses are costly. Nursing administrators must make the determination if the benefits outweigh the costs. They may find the results of not having a residency are far more costly.

Standards of practice for hospital electrocardiogram monitoring were recommended in 2004 by the American Heart Association; however they are not widely followed. Many nurses monitor in a single lead regardless of diagnosis and are unable to differentiate wide QRS complex tachycardias. The purpose of this project was to evaluate the effectiveness of an interactive web-based education program combined with unit-based collaborative learning activities on both telemetry staff nurses‘ knowledge of dysrhythmias and their monitoring practices for patients at risk for wide QRS complex tachycardias. This interventional, one group before-and-after cohort study design consisted of four components: interactive web-based educational program with a pretest and posttest, unit-based collaborative activities, competency skills validation, and patient audits of electrode placement and lead selection at baseline, six weeks, and 18 weeks. There were 34 nurses who consented to participate, 16 started the program, and nine finished all the components. The pretest scores ranged from 0 – 60% with median of 36.5%. The posttest scores ranged from 47 – 93% with median of 80%. The Wilcoxon Signed Ranks test showed a significant difference between the pretest and posttest scores (p = .008). The patient audit results did not indicate significant differences in proportions of correct electrode placement and correct lead selection between baseline, 6 weeks, and 18 weeks. The program was effective in increasing nurses‘ knowledge about dysrhythmias; however, it was not effective in changing monitoring behavior. More research is needed to see if this type of program is more effective if it involves all the staff on the unit who are responsible for monitoring, and if additional strategies are used, such as unit champions and group rewards.