With the continued growth in the numbers of nurse practitioners and certified nurse-midwives, more and more women will receive prenatal care from advanced practice nurses. The purpose of this research was to assess the routine screening practices of advance practice nurses providing prenatal care and to compare those practices with current guidelines. The study focused on five areas of prenatal screening: bacterial vaginosis, group B streptococcus, gestational diabetes, maternal serum markers, and fetal movement monitoring. The interaction model of client health behavior by Cheryl Cox, specifically professional-technical competencies, part of the client-professional element of the model, provided the theoretical framework for this study. The sample was obtained :from two major nursing organizations involved in prenatal care: the National Association of Nurse Practitioners in Women's Health and the American College of Nurse-Midwives. A random sample of250 members from each organization was sent a postcard explaining the study and directing them to the online survey. In four out of five screening areas, there was no significant difference in the screening practices of NPs and CNMs. Bacterial vaginosis was the only screening with a significant difference. There was inconsistency with what the advanced practice nurses state they do and current guidelines with respect to screening for group B streptococcus and maternal serum markers.

The death of a child has tremendous impact on a caregiver. Even when prognosis is poor and death appears imminent, care of the dying child typically focuses on achieving cure. Consequently, caregivers are often ill prepared to cope with the grief they experience as their child is dying. Anticipatory mourning allows caregivers time to begin grief work prior to the death of a loved one. Literature suggests that those who experience anticipatory mourning have a less complicated bereavement period. The purpose of this qualitative study is to (a) describe the presence (or absence) and role of anticipatory mourning in caregivers who recently experienced the death of a hospitalized child and to (b) determine if consistent themes exist that caregivers describe as helpful or detrimental to them during this process. An exploratory, descriptive design was used to answer questions in focused, guided, semi-structured, in-depth, tape-recorded interviews. Thematic content analysis derived themes from the interview transcripts of a sample of 11 caregivers who recently experienced the death of a hospitalized child. Caregivers' descriptions of their experiences surrounding the death of their child reveal an environment and health care team that is often ill prepared to deal with the impending death of a child. Also described are instances that reflect a compassionate process that positively affects the experience while facilitating appropriate grief work. Offered are recommendations for health care professionals that may assist caregivers in coping with the death of their child.

Lung transplant is a treatment modality for patients with end stage lung disease. Bronchiolitis obliterans syndrome (BOS) is the number one cause of morbidity and mortality in patients the first year after lung transplant. There are many risk factors which have been identified to increase the risk of BOS including acute rejection, lymphocytic bronchitis, medication non-compliance, bacterial or viral infections, older donor age, extended ischemic time, donor antigen-specific reactivity, human leukocyte antigen (HLA) mismatch, underlying disease and gastroesophageal reflux disease (GERD). Advanced practice nurses can help in the primary prevention of BOS through the assessment and treatment of pre-transplant patients with GERD. A descriptive study using retrospective chart reviews of lung transplant recipients was conducted to evaluate the relationship between pre-transplant GERD and post-transplant BOS. The incidence of pre-transplant GERD was 39%. The incidence of BOS at year one was 17% and at year two was 32%. There was not a significant relationship between pre-transplant GERD and post-transplant BOS.

This is a study of the relationship between consumer credit scoring and the resolution of a patient's account for hospital services. Accounts studied were classified as Good accounts or Bad accounts based upon their final resolution. Bad accounts were those written-off to bad debt with Good accounts being all others. The probability of predicting a patient's account being either Good or Bad was based upon a consumer credit scoring process. The null hypothesis of this study was that the consumer credit scoring process would not provide any indication about the outcome or resolution of the account. Analysis of the credit score and the outcome of the hospital account suggested the consumer credit score would indicate the patient's reliability in taking responsibility for the account. Based on the confidence given to credit scoring in consumer markets and the results of this study, the consumer credit score would have value for the health care industry.

The implantable cardioverter defibrillator (lCD) is the most effective treatment available for terminating potentially life-threatening ventricular fibrillation and ventricular tachycardia. The lCD detects and attempts to correct these arrhythmias by pacing, cardioversion, and defibrillation thereby providing lifesaving therapy to patients at risk for sudden cardiac death. Currently, 150,000 Americans receive ICDs each year. Although most lCD recipients are men, more women are now qualifying for insertion (Stutts, Cross, Conti, & Sears, 2007). Despite its established health benefits, lCD implantation is accompanied by psychological factors which merit research attention. This study investigated the experiences of women who live an lCD. The homogenous, purposeful sample consisted of 15 women who had an lCD that was implanted within the last three years and were receiving follow-up treatment at the same north Florida clinic. Data collection was accomplished through a semi-structured interview specific to the areas of pre-implantation, immediate post-implantation, and discharge home. Results were transcribed verbatim and then analyzed. Five core themes emerged from the transcripts along with multiple subcategories. The main themes included: Psychological Reactions, Physical Comfort, Procedural Issues, Body Image, and Feelings Regarding a Shock. Information obtained from this research is beneficial to nurses providing care to women with ICDs and to primary care advanced nurse practitioners in order to improve the overall health outcome and ongoing care of these women.

This pilot study examined the feasibility of computer aided instruction (CAI) as supplemental interactive nutrition education for patients requiring chronic dialysis. The CAI prototype was developed using Gagne's Model of Instructional Design and the Theory of Planned Behavior. Forty-two patients were enlisted from a chronic dialysis clinic and assigned randomly to either treatment or comparison group. All subjects completed pre- and post-test questionnaires regarding their phosphorus-rich food consumption habits. Each group received the usual phosphorus control education adjunct to the monthly lab review. The experimental group also received supplemental education by CAI. Serum phosphorus lab results were assessed for change after use of the CAI. Near significance was observed between the study group's phosphorus lab results difference means, t = 1.79, df= 40, p = .08. Comparison of pre-test and post-test data assessed changes in the dependent variables, attitude, perceived control, intent and behavior. The differences for the behavioral dependent variables means were not significant as determined by t-tests. The CAI was well accepted (m = 1.47 ± 0.95) by the subjects without respect to gender or age. Interactive CAI nutrition education was acceptable. Replication with a larger sample would allow opportunity to determine the significance of differences.

The annual rates of hospital Chief Executive Officer (CEO) turnover are important to track and evaluate for several reasons. Like other industries, the extent of hospital CEO turnover on an aggregate level is an indicator of the current instability and pace of change within the hospital industry. Sudden large changes in leadership trends can indicate broad changes in the industry, and small changes can indicate a general satisfaction with the status-quo. Since hospitals still dominate and have considerable influence over other sectors of the health care industry, the extent of hospital leadership changes, and the causes of those changes, are also potential indicators and predictors of the regulatory, structural, and financing directions for the entire health care industry. Trends in the types of hospitals with high and low CEO turnover can isolate potential problem areas, and potential characteristics of CEO stability.

The prevention of childhood obesity during the formative years is necessary because dietary patterns influenced by parents are developed early. A major obstacle to healthy feeding patterns in children is television advertising. The study tested three hypotheses. 1) Preschool children ages two to five years who watch more television are able to recognize/recall more food brands than those who view less television. 2) An increase in food brand recognition/recall in preschool children is associated with an overweight classification based on calculated Body Mass Index. 3) Children of parents who are unaware of the American Academy of Pediatrics (AAP) recommendations for television viewing per day in preschool children will exceed the recommended daily viewing time of two hours. Twenty-nine preschool children were assessed on their ability to match food brand logos with correct foods and identify specific brands from recall. Weight and\ height were measured to calculate their Body Mass Index-for age. Twenty-eight parents were asked to complete a validated survey and a one-week television diary. The results showed statistically significant differences in identifying food brands between children who had lower exposure to television (6.8±.5; 95% CI 5.95-7.55) compared to higher exposure (10.3±1.0; 95% CI 9.25-11.42). This effect was not significantly correlated with overweight status (n=5). No significant correlations were found between parent's knowledge of AAP recommendations and children's exposure to television. Impact of television advertisements on preschool children's response to food/brand logos due to daily exposure to advertising is still of critical interest and worthy of further exploration.

This study examined associations among the nutritional risks, the risk levels, and the ages of independently living elderly. The Checklist of the Nutrition Screening Initiative (NSI) was administered to a purposive sample of 1004 Northeast Florida elderly to estimate an age-profile at risk for malnutrition. Checklist nutritional scores (cumulative of ten risks) were grouped into risk levels of low (scores 0-2, 64.3%), moderate (3-5, 29.5%), and high (6 and greater, 24.2%). Within each level, Checklists were grouped by respondents' age into young-old (60-74), old-old (75-79), and fragile-old (80-102). Eight nutritional risks' distribution across risk levels was significantly greater in respondents of the high-risk level as compared to those in the moderate and low-risk levels. A significant difference was found in the distribution of age groups across levels (x2=9.742, df=4, P=.045), with a larger proportion of the fragile-old in the low risk level (53.6%) than either the old-old (42.5%) or the young-old (43.6%). Elderly at greatest risk for malnutrition are aged 74-75 years and report illness, multiple medicines, economic hardship, and reduced social contact. The distribution of the risk "multiple medicines" (x2=12.17, df=4, P=.016) was consistently significant across all risk levels and age groups.

This retrospective study determined whether percent deficit ideal body weight (IBW) was a risk factor for the prevalence, severity or healing of pressure ulcers. This study hypothesized that nursing home residents below their IBW with pressure ulcers have more severe, higher prevalence, and a slower healing rate than resident who are above their IBW. Medical record data were analyzed for all subjects that met the selection criteria from April, 1997 to April, 1998. Fifty-eight subjects aged 39 to 104 years were assigned to one of two groups (Group 1(n=28) were less than 99% of IBW; Group 2 (n=30) were greater than or equal to 99% of IBW). There was no correlation between percent deficit IBW and pressure ulcer prevalence (rs =-0.017) or between percent deficit IBW and healing rate (rs =-0.010). There was no association between percent deficit IBW and severity (x2 (N=58)=3.35;p=06). Black subjects (n=20) had a higher prevalence of pressure ulcers than white subjects ((n=38), x2 (N=58) = 4.634; ,Q =.002). Bedridden subjects (n=34) had slower healing rates than non-bedridden subjects (n=24),(t(58) = 2.38, p=.02).