It is widely supported that there are significant, positive relationships between the occurrence of some mental health symptoms and physical illnesses. Research indicates that the burden experienced by those with a physical and mental illness are magnified compared to individuals who do not experience an illness. More specifically, one of the burdens experienced by individuals is the monetary burden of affording the necessary health services to properly manage their illness. This study attempts to reveal a difference between mental health symptom count for individuals who do and do not experience difficulty affording health care for their physical problems. The first hypothesis states that the indication of medical problems will be associated with greater mental health symptoms. The second hypothesis states that the relationship between medical concerns and mental health symptoms will be moderated by difficulty affording health services. Lastly, the third hypothesis states that the indication of unhealthy behaviors, such as smoking and irregular exercise, will be associated with greater mental health symptoms. All data used in this study is archived data that was gathered by the Institute for Rural Health’s Mobile Health Units during free community health fairs from September 2012 to February 2014. The first hypothesis was supported because the incidence rate of mental health symptom count was increased with the presence of some physical problems. These findings supported previous research that indicated that the presence of physical illness increases the chance of developing a mental illness. The study results revealed that the second hypothesis was not supported since difficulty affording health services did not have a significant effect on the relationship between indicated physical illnesses and mental health symptom count. Previous research reports that there is monetary burden for individuals who experience a physical or mental illness when accessing appropriate health services. This research aimed to explore if that burden would significantly affect the relationship of those illnesses. Lastly, the third hypothesis was supported because mental health symptom count incidence rate was found to increase for individuals partaking in negative health behaviors, such as smoking, and decrease for individuals partaking in positive health behaviors, such as exercising.

Tobacco use is one of the most preventable sources of death and disease, and yet remains a worldwide problem. With the rising costs of healthcare, the focus of efforts to control them has honed in on lifestyle behaviors that contribute to the escalating costs. Within the scope of this scrutiny, the prevention or cessation of smoking and tobacco usage has become a global priority and a major focal point of worldwide anti-tobacco initiatives. The World Health Organization (WHO) has identified cessation interventions by health care professionals as a crucial factor in successful patient smoking cessation, and studies have shown that personal smoking behaviors by health care professionals are a barrier to effective smoking cessation interventions by those professionals (Lally et al., 2008; Radsma & Bottorff, 2009). This knowledge fueled the creation and distribution of global surveys by the WHO, the Centers for Disease Control and Prevention (CDC), and the Canadian Public Health Association (CPHA) to investigate the prevalence of smoking behaviors in health care professionals and in health care students (“Global Health Professions,” 2014; “WHO/CDC Global,” 2014). This study utilized the Global Health Professions Student Survey. The current study investigated the prevalence of smoking in nursing students of all educational levels at East Tennessee State University, with the expectation that the percentage of students who currently smoke would be substantially lower than that of students who do not smoke. The survey also investigated attitudes towards the role of health professionals in patient smoking cessation and towards personal smoking behaviors.

Transitioning to the father role can be complex and stressful and fathers may not be fully prepared to assume the father role. Since fathers have little formal preparation for becoming a father, they may need more social support resources to support their adaptations to the father role. In addition, fathers are instrumental in supporting mothers’ breastfeeding and other infant feeding decisions, but may experience difficulties with infant care tasks, such as feeding and providing care to their infant. Studies show that many fathers want to be productive and nurturing in the father role but little is known about fathers’ parenting knowledge and needs. Therefore, the purpose of this study is to describe the social support resources of fathers with infant feeding and related parent educational learning needs during the first year after birth. Cross-sectional data was obtained for this descriptive, exploratory study by using a questionnaire and semi-structured interviews. Descriptive statistics were used to analyze questionnaire findings and directed content analysis was used to analyze the qualitative data. Since there is little evidenced-based literature on social support and parenting knowledge and needs of fathers in general, the study design was descriptive, exploratory and included new and experienced fathers. The study was guided by Bandura’s Self-Efficacy Theory. The findings reported in this study originated in a larger study on social support needs of urban fathers with infants during the first year after birth. Thirty experienced and new fathers were recruited from community organizations that offer services to low-income families in a southern part of the United States. The mean age range of the fathers was 30 (SD = 5) and 60% were experienced fathers and 40% were new fathers. The majority of the fathers were single (67%), Black (90%), had some or completed high-school education (81%) and 85% reported low annual incomes of less than $20,000. Most infants were bottle-fed (73%) and all infants were between 2-12 months. Inclusion criteria included being 18 years old with an infant that was born full-term. The study was reviewed and approved by the university internal review board. Findings revealed most fathers were confident with feeding their baby, however, some fathers were not confident because they were afraid to handle their baby due to the baby’s size or felt awkward when holding the baby. When fathers had difficulties with feeding their babies, they primarily asked family and friends for advice. Other resources included the internet and healthcare professionals. Fathers reported positive and negative attitudes towards breastfeeding and reasons why breastfeeding was stopped. After the baby’s birth, fathers reported the majority of parent educational learning needs related to how to take of infant, normal infant behavior, basic, daily care, and recognizing signs and symptoms of illness. At time of interview, the majority of parent educational learning needs related to how to cope with a difficulty baby, accessing positive parenting tips and resources, being responsive to the infant, coping with being a new father, and recognizing signs of depression. Recommendations for practice and research will be provided.

Adolescents often make adult decisions regarding their lifestyle and behavior with little support from their family and community. In this study the researcher examined the difference in risk-taking behaviors between genders and the role that families and communities play in reducing risk-taking behaviors. In the study I further analyzed self-reports of numbers of development assets those students reporting participation in high-risk behaviors. Method: Data were obtained from a sample of convenience of (N=82) 12th grade students. Behaviors and attitudes were examined using the Search Institute’s Profiles of Student Life survey. Results: Chi square was used to test for significant differences in risk-taking behaviors between genders and levels of developmental assets. Males were more likely than females to participate in alcohol and substance use χ2 (1, N=82) = 63.95, p <0.05 and more likely to participate in violent risk-taking behaviors: physically hurt someone once or more in the last twelve months χ2 (1, N=82) = 22.73, p<0.05, used a weapon to get something χ2 (1, N=82) = 44.45, p<0.05, been in a group fight once or more in the last twelve months χ2 (1, N=82) = 29.33, p<0.05, carried a weapon for protection χ2 (1, N=82) = 23.78, p<0.05, and threatened physical harm to someone χ2 (1, N=82) = 46.2, p<0.05. Females were more likely to participate in sexual intercourse than males χ2 (1, N=82) = 214.08, p<0.05 and to have hit someone once or more in the last twelve months χ2 (1, N=82) = 11.53, p<0.05. In the area of risk-taking behaviors related to developmental assets, students who participated in the problem behaviors had fewer developmental assets than those not participating in the behavior. The exceptions to this were using a gun to get something from a person χ2 (1, N=82) = 72.4, p<0.05 and carrying a gun for protection χ2 (1, N=82) = 30.63, p<0.05. Conclusions: Findings from this study emphasize the need for community-based programs that enhance youth bonding with family and community. Furthermore, it reinforces the national goals aimed at reducing risk-taking behaviors such as alcohol and substance use, early sexual intercourse, and youth violence. Programs aimed at prevention and intervention that address the specific needs of males and females are recommended.

Alarming rates of suicide among production farmers have prompted researchers to investigate factors associated with depressive symptoms among this population. Aspects of farm life and farming can contribute to higher levels of depressive symptoms. Higher levels of depression can also increase an individual’s risk of injury and development of chronic disease, impacting overall quality of life. Despite the approximate 3.5 million farm women in the U.S., current research has focused on the male farmer. Men and women have different responses to stressors, and women in general have a higher prevalence of depressive symptoms. Farm women can be further subjected to stressors associated with farming as an occupation and their gendered role within the agrarian culture. The large number of farm women affected, the relationship of chronic depressive symptoms on health and quality of life, the lack of current research available, and the rising rates of suicide and depressive symptoms among farmers emphasize the need for further investigation of farm women and depressive symptoms. The overall purpose of this dissertation was to 1) explore the current state of the science of farm women and depressive symptoms and identify variables commonly associated with depressive symptoms among farm women, 2) identify variables influencing levels of depressive symptoms within farm women aged 50 and over and identify differences between those women with high depressive symptoms and those with low depressive symptoms, and 3) establish the reliability and validity of the 12-item John Henry Active Coping Scale (JHAC-12) within the sample. A systematic review of the literature revealed that there is a need for more research with strong study designs regarding farm women and depressive symptoms within the context of their environment, culture, and occupation. The review identified multidimensional factors from farm women’s lives that influence their level of depressive symptoms. Farm women’s ethnicity, the agrarian culture, family and social relations, as well as specific demographics were identified as key variables associated with an increased risk of higher depressive symptoms. Because of the identification of the multi-dimensional factors, the use of the Modified Biopsychosocial Model (MBPS) was selected as a framework for continued research as it depicts the interrelationship between the factors and their influence on farm women’s depressive symptoms. The MBPS was applied to data from 358 farm women aged 50 and older from a larger cohort study, and a secondary analysis was performed. Multivariable binary logistic regression was used to identify those variables associated with depressive symptoms among farm women. Depressive symptoms were predicted by race/ethnicity, years of education, adequacy of income for vacation, perceived health status, perceived stress score, and active coping score. Significant differences between those farm women with low CES-D score (< 16) and those with high CES-D score (≥ 16) were noted. Race/ethnicity, years of education, adequate income for vacation and retirement, reported health status of fair or better, perceived stress score, active coping score and satisfaction from farm work were all significant between groups. Women who were non-White, had less education, reported income not adequate for vacation or retirement, reported poor health, higher levels of perceived stress, lower levels of active coping and who were not satisfied with farm work were more likely to be in the high CES-D group. A principal component analysis with direct oblimin rotation in a sample population of older farm women (n=458) identified two dominant themes of the JHAC-12: “commitment to hard work” and “self-efficacy.” The instrument component structure reflects the culture of the agrarian society. In the two-component solution, 2 items were removed from the scale after revealing low values of communality (< .3). The item reduction resulted in more refined scale, increasing explained variance by 4.1% with less items. Cronbach’s of the JHAC-12 (α = .78) and JHAC-10 (α = .76) indicated high levels of reliability for both scales. Rotation of the items resulted in a simple structure with high loadings within items, no major-cross-loadings and little correlation between components (r = .29), supporting both convergent and discriminant validity in this population. The ability of the JHAC to encompass the socio-culture aspects of active coping among farm women and obtain a quantifiable result supports the JHAC as an important tool to utilize in future studies of depressive symptoms and farm women with use of the JHAC-10 in future studies of farm women decreasing the burden of the participants. Although there are limitations within each document, each section adds to the science of farm women and depression symptoms and provides directions for future research. The major gaps identified were: 1) the need for current research with stronger study designs, 2) studies of farm women across their life spans, 3) the need for focused studies among minority and migrant women, 4) an understanding of farm women and their leisure time, and 5) a broader application of the MBPS theory to include a large number of social variables shown to be associated with farm women and depressive symptoms that were not available in the dataset.

The purpose of this single case study was to describe community perspectives of a service learning (SL) partnership with a single university conferring a baccalaureate nursing degree. The longevity of the partnership extended the study purpose to explain why the partnership continued and worked well. A review of nursing literature revealed descriptive accounts of programs designed to meet needs of underserved populations and student learners. However, the review also revealed a knowledge gap in nursing education science regarding the community perspectives of successful SL partnerships. This study focused on relationships with the academe partner, interactions with students and faculty, and benefits of services rendered. Using a case study approach, the investigator sought disparate sources of information including interviews with 21 community members, the primary nursing professor, and the university administrator for rural health and community partnerships. The investigator reviewed relevant documents and made observations during nine days in the community. Triangulation of multiple data sources illuminated a relationship in which key players remained committed to mutual goals beyond immediate projects. Compelling findings were the a) immersed accessibility of the primary nursing professor who lived in the community, b) competency of community members to be expert teachers and set the agenda for the university’s involvement, and c) increased social connectedness that empowered a community to improve its health. The American Association of Critical Care Nurses Synergy Model (Hardin, 2009) was useful for understanding the synergistic relationship involving community partners, student learners, and nursing faculty. However, the broader themes of a community empowered through full integration into a partnership fit with social theories explaining interactions at the macro level as well as behaviors along a pathway of shared commitment. This case demonstrated that sustained interpersonal relationships were critical to developing the community’s integral role as full partner, and the primary nursing professor was a trusted link advocating judiciously for all parties. As SL pedagogy is integrated into nursing education with an emphasis on community-based education and health at the population level, findings of this study can assist nurse educators in the development and maintenance of successful community-academe partnerships.

Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of depressive symptoms on the association between sleep disturbance and QoL in patients and family caregivers; and 3) provide evidence of the psychometric priorities of the Zarit Burden Interview (ZBI) as a measure of caregiving burden in caregivers of patients with HF. The three specific aims were addressed using secondary analyses of cross-sectional data available from 143 patients with HF and their primary family caregivers. To accomplish Specific Aim One, multilevel dyadic analysis, actor-partner interdependence model was used for 78 patient- caregiver dyads. Individuals’ sleep disturbance predicted their own poor QoL. Caregivers’ sleep disturbance predicted patients’ mental aspect of QoL. For Specific Aim Two, a series of multiple regressions was used to examine the mediation effect in patients and caregivers separately. Depressive symptoms significantly mediated the relationship between sleep disturbance and mental aspect of QoL in patients. The mediation effect was similar in caregivers. For Specific Aim Three, the internal consistency and convergent and construct validity of the ZBI in 124 family caregivers of patients with HF were examined. The results showed that the ZBI is a reliable and valid measure of caregiving burden in this population. This dissertation has fulfilled important gaps in the evidence base for the QoL outcome in patients with HF and caregivers. The findings from this dissertation provided evidence of the importance of monitoring sleep disturbance for better QoL in both patients and caregivers and the importance of assessing caregivers’ sleep disturbance for improving patients’ QoL. It also provided evidence of the importance of managing depressive symptoms when targeting sleep disturbance to improve QoL in both patients and caregivers.

There is an on-going debate among health professionals, policy-makers and politicians, as to the optimal way of delivering sexual health services to young people. There is as yet, no consensus on their best patterns of organisation or configuration. This study uses qualitative and quantitative research methods, to explore both the views of young people accessing sexual health services, expressed through in-depth interview, and variations in client satisfaction with different characteristics of service delivery, expressed through completion of a questionnaire. The key research questions are:  How does young people’s satisfaction with sexual health services vary with the age-dedication of the service; that is, whether it serves young people only, or all ages?  How does young people’s satisfaction with sexual health services vary with the integration of the service; that is, whether family planning and genito-urinary services are offered separately, or together?  How does young people’s satisfaction with sexual health services vary with the location of the service; that is, in community or hospital based services? In the qualitative component, in-depth interviews were conducted with 25 young people recruited from a purposively selected sample of young people’s services. In the survey, a total sample of 1166 was achieved. Of these, 36% were attending an integrated contraceptive and STI service and 64% were attending a more traditional ‘separate’ service. 48% attended a service dedicated to young people and 52% an all-age service. 50% attended a hospital-based service and 50% a service located in the community. Of the total sample, 22% were male and 78% female. The analysis has been done not on a comparison of services in their entirety, but on a comparison of key features of their organisation, that is, whether they are provided separately as contraceptive and STI sessions or services, or whether these aspects of sexual health provision are integrated in sessions or services (integration); on whether they are run exclusively for young people or for all ages (dedication); and on whether they are located in the community or in a hospital setting (location). Recommendations are made for future service development and delivery and implications for policy are discussed.

Darbo tikslas - įvertinti bendruomenės slaugytojų medicinos normoje įvardintų ir atliekamų veiklų atitiktį viešosiose ir privačiose PSP įstaigose. Darbo uždaviniai: 1. Nustatyti bendruomenės slaugytojų atliekamas veiklas; 2. Atlikti bendruomenės slaugytojų veiklos darbo laiko analizę; 3. Palyginti bendruomenės slaugytojų medicinos normoje apibrėžtas veiklas su atliekamomis veiklomis kasdienėje praktikoje viešosiose ir privačiose pirminės sveikatos priežiūros įstaigose. Tyrimo metodika: tyrimas atliktas 2011 m. vasario - gruodžio mėnesiais anoniminės apklausos būdu, Kaune, atsitiktiniu atrankos būdu parinktose septyniose pirminės sveikatos priežiūros įstaigose: Tyrimo objektas: Kauno pirminės sveikatos priežiūros įstaigose dirbančių bendruomenės slaugytojų medicinos normoje įvardintų ir atliekamų veiklų atitiktis. Tyrimo populiacija: Kauno pirminėse sveikatos priežiūros įstaigose dirbančios bendruomenės slaugytojos. Tyrimo metu apklausta 100 bendruomenės slaugytojų. Tyrimo išvados: 1. Dominuojančios bendruomenės slaugytojų veiklos tiek viešosiose, tiek privačiose PSP įstaigose yra techninės slaugos procedūros bei administracinis darbas. Pagrindinės veiklos pacientų namuose, tai pat susijusios su įvairiomis slaugos procedūromis bei profilaktiniu darbu. 2. Didžiąją PSP įstaigoje laiko dalį bendruomenės slaugytojos, dirbančios viešosiose ir privačiose įstaigose, skiria administraciniam (44 proc. - viešosiose ir 52 proc.- privačiose bendros darbo trukmės) bei profilaktiniam... [toliau žr. visą tekstą] / Aim of study: to evaluate the correspondence of the community nurses activities described in the medical norm to their daily activities in public and private PHC institutions. Objectives: 1. To identify daily activities carried out by community nurses; 2. To perform the work time analysis of community nurses; 3. To compare the activities of community nurses described in the medical norm to their daily activities in different types of primary health care institutions. Methods: the cross-sectional study was performed at seven Kaunas PHC institutions, in 2011 February-December. The anonymous questionnaire was used in survey. The object of the research – the correspondence of the community nurses activities described in the medical norm to their daily activities in Kaunas. There were 100 community nurses. All completed questionnaires were suitable for further investigation and statistical analysis. An anonymous questionnaire was used, which was developed according to literature analysis and medical norm. Conclusions: In public and private primary health care (PHC) institutions dominant community nurses daily activities are associated with nursing procedures and administtrative work. The main activities at patient`s home also associated with a variety of nursing procedures and preventive work. 2. Most of the working time at public and private PHC institutions community nurses spend for administrative (44% in public and 52% - private institutions of working time) and preventive... [to full text]

There is a new trend of shifting the provision of health care from hospitals to the patient?s natural environment. We are increasingly aware of the expensive and sometimes ineffective late hospital treatment; therefore, there are stronger efforts for early diagnosis, prevention and health education from an early age. It is necessary to keep the future generations focused on their health and the health of their family members who live in the community. The initiative must originate not only in families but also in the school environment in which children find themselves almost every day. A school nurse is an expert in the field of community care working in school environment. The work load of the school nurse rests in maintaining and improving physical and mental health. The school nurse supports pupils in their responsibility for their health and she creates a system of formalized school activities, prepares and implements the school?s educational program focused on prevention. The data in the research part of the thesis was obtained through quantitative and qualitative research survey. The quantitative research was carried out using the technique of an anonymous questionnaire. The questionnaire was intended for general practitioners for children and adolescents, as well as nurses working with general practitioners for children and adolescents. The qualitative research data was collected through semi-structured interviews with the head teachers of elementary and secondary schools on the basis of which casuistries were created resulting in categorized charts. The objective of this thesis was to find out about the position of general practitioners for children and adolescents, and paediatric nurses working with general practitioners for children and adolescents on introducing the function of school nurses in the healthcare system of the Czech Republic. The research in this thesis showed a low level of awareness about the position of school nurses. The primary controversies related to the introduction of school nurses can be described as follows: the method of financing, the issues of authority of such nurses, and the way of preparing for this occupation. The main positive aspect of school nurses can be seen by the respondents in comprehensive care for pupils, prevention and better public education. School head teachers, general practitioners and nurses believe that school nurses should be placed in schools according to the number of school pupils and school head teachers assume greater use school nurses in primary schools than in secondary ones. The method of financing school nurses should be, according to the respondents, from multiple sources. This thesis may be used as a basis for further research work focused on the position of school nurses, and also as a proposal of establishing the school nurse position in the healthcare system of the Czech Republic, or as informative material for professional as well as lay public.