The purpose of this study was to investigate the relationship among autonomy, control over nursing practice, and selected sociodemographic characteristics of nursing staff, the degree of institutional bureaucratization, and quality of resident care in two nursing homes. A significant difference was found in the IRA/Keogh benefit for both RNs and LPNs. Significant positive relationships were found between autonomy and control over nursing practice; years since completion of basic education and age of the nurse; and total benefits the nurse received and their salary. A significant difference between RNs and LPNs was found in their sence of autonomy, with RNs scoring higher than LPNs. An inverse relationship was identified between the institution's bureaucracy and the variables autonomy and control over nursing practice. No significant differences were found between the nursing homes with regard to urinary incontinence and the level of nursing autonomy, control over nursing practice, and degree of institutional bureaucratization.

The purpose of this study was to provide a secondary analysis of Derenowski's inductively generated conceptualization of wellness motivation, specifically the category identifying barriers. The sample consisted of 29 individuals who were attempting to initiate and sustain programs of cardiac risk factor modification. Descriptions of perceived barriers to initiating health behavior change were generated from the data using grounded theory methodology. Categories identified within perceived barriers to initiating health behavior change included: personal control, life stress, social relationships, physical capability, and resources. The descriptions of perceived barriers to health behavior change generated from the data provide an understanding and theoretical basis for nursing assessment and the development of interventions designed to assist individuals in continued growth and the emergence of positive health patterns.

The relationship between hospital length of stay (LOS) and Nurse Case Management (NCM), defined as the coordination of care along a continuum of hospital and community, was investigated. Three groups of discharged patients in the Diagnostic Related Groups (DRGs) of the Respiratory and Circulatory Medical Diagnostic Categories (MDCs) were described and compared: those who had NCM pre-hospitalization (n = 43), those who had NCM initiated during hospitalization or shortly afterward (n = 22), and those who had no NCM (n = 50). The NCM pre-hospitalization group was older and more likely to live alone. The non-NCM group had more admissions to Critical care. The NCM pre-hospitalization group entered the hospital with lower acuities. The NCM initiated during hospitalization group had significantly higher LOS than the other two groups. There was no significant relationship between LOS and the number and duration of NCM visits. The findings suggest that (1) NCM subjects were at higher risk due to age and living situation and (2) NCM may be associated with reduced LOS on subsequent admissions.

This descriptive correlational study investigated the relationships between sleep and depression before and after hemodialysis in patients on chronic hemodialysis. Thirty-nine adult patients were tested using the Beck Depression Inventory and the Visual Analog Sleep Scale before and after the first dialysis of the week. Results of testing indicated no significant differences between the quality of sleep before and after hemodialysis treatments. Depression was shown to be present on a mild-moderate level both before and after hemodialysis. Comparison of this study group with other groups tested using the Visual Analog Sleep Scale revealed that this group reports sleep comparable to insomniacs and hospitalized adults. The study has shown that sleep of the chronic hemodialysis patient is not perceived by the individuals to be normal.

This exploratory study was designed to describe, analyze and understand from the perspective of a primary caregiver husband, what it is like to care for a wife with middle stage Alzheimer's Disease. Using the ethnographic approach, three spouses with wives suffering from Alzheimer's Disease were interviewed and two spouses were observed in their home during one dinnertime period. Analysis of data yielded five domains of meaning: lifestyle change concerns, helplessness/powerlessness, care for own, concerns for future and coping. Two cultural themes emerged as "alone" and "hopeless". Implications for nursing practice include increasing the awareness and understanding among health care professionals of the desperate nature of the caregiver' s burden. Additionally, the caregiver's coping skills need to be maintained and enhanced as they "care for their own" and attempt to keep themselves mentally and physically healthy.

This study explored the quality of life of adult Bone Marrow Transplantation (BMT) survivors and processes involved in maintaining or enhancing life quality were identified. Grounded theory methodology was used to explore quality of life from the survivor's perspective. Five adults, 87 to 578 days post BMT, were selected using theoretical sampling and interviewed. A theory of Navigating Survival emerged from data analysis as a series of coping processes employed by BMT survivors to manage quality of life disruptions. BMT survivors identified disruptions in quality of life during the rapid decision-making period; after discharge when limitations on physical activity must be managed; and as activities resume but fears of recurrence became stronger. Coping mechanisms used varied but were directed toward three areas: adapting to transplant, searching for meaning, and discovering a difference. Identifying unique quality of life aspects will enable oncology nurses to design interventions to enhance life quality of BMT survivors.

Many patients experience psychological distress following a myocardial infarction (MI). Emotional problems can interfere with a return to family, social and work-related activities, and are associated with poor cardiac prognosis. Although many psychosocial intervention programs designed for this population have been evaluated, little is known about which components of the interventions are effective. The major aim of the present secondary analysis was to identify the types of patient-nurse interactions associated with a reduction in psychological distress in post-MI patients who participated in the Montreal Heart Attack Readjustment Trial (M-HART) randomized controlled study of home-based psychosocial nursing interventions. / The sample for the present study included 431 patients (36.2% female) in the treatment group who received at least two home nursing visits over a two-month period. The types of concerns experienced by patients (those related to symptoms, treatment, uncertainty, interpersonal roles, and work/finance) and the types of nursing approaches undertaken during the first two home visits (cognitive, educational, emotionally supportive including reassurance/encouragement, listening and providing advice, and managerial) were examined in relationship to short-term changes in distress. These relationships were examined in the sample as a whole and also in subgroup analyses where gender and baseline level of depressive symptoms were taken into account. / In the sample as a whole, reassurance/encouragement and listening were related to a reduction in distress, but mainly for patients who had physical symptoms and treatment-related concerns. The provision of advice for psychologically-related concerns such as fears was not associated with better outcomes. However, nursing approaches that were more directive (educational, cognitive and advice) appeared to have been linked to better outcomes in men, but less so in women, while listening was associated with reductions in distress in women, but not in men. Reductions in distress after the two visits was less common in patients with higher baseline levels of depressive symptoms, and those who presented psychologically-related concerns. Finally, patients who showed short-term reductions in distress had lower death rates, lower readmission rates, and a lower risk of reporting depressive symptoms at one year. / These results highlight the importance of determining the types of intervention approaches that may be most effective in men and in women, and identifying patients who are more and less likely to benefit from psychosocial interventions such as those provided in M-HART. It is also particularly notable that post-MI patients whose short-term psychological distress is reduced by individualized psychosocial interventions appear to have improved cardiac prognosis and reduced depressive symptoms in the longer term.

<p> A quantitative, descriptive research study was conducted to discover the factors that affect advanced nurse practitioner (ANP) job satisfaction in Alaska. ANPs have proven to be a cost-effective solution for addressing the national healthcare provider shortage. In order to recruit and retain ANPs, health care administrators and employers must understand the factors influencing job satisfaction. </p><p> The Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and a researcher-developed demographic questionnaire were mailed to 555 Alaska ANPs who met inclusion criteria. Data collected were input into SPSS 21 and scored as directed by Misener and Cox (2001). The overall mean Summed Satisfaction score was calculated along with the overall mean Ranked Satisfaction (RS) score and the overall mean RS score for each factor. Instrument reliability was tested with an overall Cronbach's alpha of 0.97. The five MNPJSS items contributing to high ANP job satisfaction scores were determined along with the five items contributing to lower scores. Descriptive statistics were used to describe the demographics of the sample population. </p><p> Research revealed that participants were minimally satisfied to satisfied with their job. They were most satisfied with their ability to practice autonomously, with a significant correlation between self-employed ANPs in independent practice and job satisfaction. They were least satisfied with their intrapractice partnership and collegiality. Additional research is needed to further enhance healthcare administrator and employer ability to improve Alaska ANP job satisfaction. </p>

<p> <u>Background:</u> Diabetes was recently declared the fifth leading cause of death in minority groups with minorities constituting 25% of all adult patients with diabetes in the United States (USDHHS, 2012). A 2007&ndash;2009 National Survey of people, aged 20 or older, diagnosed with diabetes demonstrated a prevalence rate of 7.1% for non&ndash;Hispanic whites, 8.4% for Asian Americans, 12.6% for non&ndash;Hispanics black, and 11.8% for Hispanics (CDC, 2010). </p><p> <b>Problem:</b> Decreasing avoidable risk factors for diabetes complications through effective culturally competent diabetes education can diminish diabetes related complications. Yet, culturally appropriate approaches for minority groups infrequently have been investigated (ADA, 2009). </p><p> <b>Research question:</b> Does Latino pastor delivered diabetes education increase diabetes knowledge in a Latino population? </p><p> <b>Research Design and Method:</b> This study used a two&ndash;group pretest posttest quasi&ndash;experimental design. A convenience sample of Latino patients volunteering from two different churches were recruited, n=40 non-intervention group n=42 intervention group. Outcome measurement included The Diabetes Knowledge Questionnaire (DKQ&ndash;24) level measured before and after the intervention. The nonintervention group had standard passive booklet distribution. The intervention group also had standard booklet distribution and active participation of a respected community leader. </p><p> <b>Results:</b> One hundred thirteen Latino volunteers completed the diabetes survey. Eighty&ndash;two respondents (non&ndash;intervention n=40, intervention n=42) were met the criteria of completing the surveys correctly. The independent&ndash;samples t&ndash;test comparing the mean scores of the non&ndash;intervention and intervention groups found a significant difference between the mean scores (t= -37.584; df= 65.547; p &lt;0.00). The mean score of the posttest for the non&ndash;intervention group (m= 5.92) was significantly lower than that of the intervention group (m=19.14). </p><p> <b>Importance:</b> The significant findings from this study with the pastor as the health educator, underscores the potential force that lives within a community, and the need for health care professionals to engage and utilize the trusted community leaders to disseminate important health information.</p>

The diagnosis and management of cancer evokes profound questions about one's understanding of the self, the world, and one's purpose in life. The stress and coping literature suggest that the process of meaning-making provides a suitable framework to study such existential questions, as well as an ideal method of intervention. Through a series of manuscripts, this thesis examines the construct of meaning-making within the specific domain of cancer, describes the development of a meaning-making intervention, and assesses the impact of meaning-making coping on psychological adjustment to cancer. The recent proliferation of studies on the concept of meaning that includes the adult cancer experience has been conceptualized and operationalized in a variety of ways. To better understand and use the meaning-making concept within the cancer experience, a systematic review of the literature was conducted to synthesize the current level of knowledge and determine where research should be directed. This review of the empirical and qualitative findings suggested that the successful ability to construct a sense of meaning in illness may lead to positive psychological outcomes. Thus a novel meaning-making intervention (MMI) for cancer patients was developed, and its applicability as well as its effects on psychological adjustment to cancer were explored in a pilot study with a heterogeneous group of patients. Significant improvements in self esteem and self-efficacy were reported in a small, uncontrolled sample and encouraged the need for further confirmatory testing. Guided by the pilot study results, a randomized controlled trial tested the effect of the MMI on levels of self-esteem, optimism, and self-efficacy in a homogeneous sample of newly diagnosed breast or colorectal cancer patients. After controlling for baseline differences on each outcome variable, participants in the experimental group (n=35) who received the MMI were found to have significantly improved percep