The purpose of this study was to (a) describe the physiological and behavioural responses of premature infants to a tissue-damaging stimulus and (b) determine how severity of illness and behavioural state influenced these responses. A convenience ample of 124 premature infants between 32 and 34 weeks gestational age was obtained from one neonatal unit in a Montreal teaching hospital. Physiological (heart rate, oxygen saturation, intracranial pressure) and behavioural (facial expression and cry) data were collected during the baseline, warming, stick and squeeze phases of a routine heelstick procedure. Behavioural state and severity of illness were assessed using instruments by Prechtl (1974) and Georgieff, Mills and Bhatt (1989). Demographic data were collected from the medical record. Data analysis was performed utilizing repeated measures multivariate analysis of variance (RM MANOVA), multivariate analysis of variance (MANOVA) and repeated measures multivariate analysis of covariance (RM MANOVA). There were significant differences in physiological and behavioural parameters between baseline and stick including: (a) an increase in maximum heart rate, (b) a decrease in minimum oxygen saturation, (c) an increase in intracranial pressure and (d) an increase in the proportion of all facial actions. For those infants who cried during both the stick and squeeze phase, the fundamental frequency, harmonic structure and peak spectral energy were significantly increased during the stick as compared to the squeeze. Behavioural state was found to modify the facial expression variables and severity of illness modified the acoustic cry variables. An interaction between behavioural state and severity of illness influenced maximum heart rate. There was no significant relationship between physiological and behavioural outcomes. Both categories of outcomes provide important but different information about the premature infant's response to a tissue-damaging stimulus. A multidimen

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<p> Medication errors are a major concern for patient safety, and cost the health care system billions of dollars each year. There is evidence that Barcode Medication Administration Technology decreases medication errors. However, little is known about the factors that affect Barcode Medication Administration Technology Acceptance by Nurses. The purpose of this research was to investigate the relationships between caring, role conflict and role ambiguity, organizational commitment and barcode medication administration technology acceptance by nurses.</p><p> A quantitative non-experimental correlational design was utilized for this study, in addition to two qualitative questions. Eighty-six nurses completed four questionnaires measuring the study variables. Two of the four hypotheses were supported. There was a negative correlation between role conflict and role ambiguity and technology acceptance, indicating that nurses in this study who experienced less role conflict and role ambiguity were more likely to accept BCMA technology. There was also a positive correlation between organizational commitment and technology acceptance, indicating that nurses in this study that were highly committed to their organization were more accepting of BCMA technology. The qualitative findings indicated that nurses experienced some frustration when aspects of the technology malfunctioned, making the medication administration process time consuming. However, nurses verbalized that BCMA technology made their role of medication administration safer and more efficient. </p><p> This study's findings can assist administrators, nurse educators and informatics directors in providing adequate training, support, resources and environment for promoting BCMA technology acceptance by nurses. This will help to promote patient safety and technology acceptance and may result in less turnover due to nurse role conflict and role ambiguity.</p>

Background A gap exists within healthcare between identifying and treating adverse psychological outcomes to abortion. Meanwhile, 30% of women worldwide experience significant emotional distress after abortion. Specifically, younger women are at the highest risk for developing mental health problems after abortion. No empirical data for interventions to relieve psychological distress after abortion were found. Goal: This thesis provides a framework to identify and treat psychological distress after legal, induced, voluntary abortion. It proposes a first of a kind evidence-based and patient-centered intervention to relieve psychological distress after abortion among university students. The thesis proposes a theory and conceptual model to understand negative psychological responses to abortion. Population-specific evidence and preference for services support the theory. Methods The United Kingdom Medical Research Guidelines were used to develop the intervention. Two phases of the five-phase method were used. First, the Pre-Clinical Phase developed: (a) the theoretical and (b) evidential basis for target symptoms of the intervention. Next, using these results, the Modeling Phase established (c) the design, (d) patient preferences, and (e) feasibility for delivering the intervention. The thesis is formatted as three manuscripts. ResultsThe Pre-Clinical Phase applied psychological stress theory to guide the intervention. It also generated evidence from a cross sectional study of N=151 participants who identified target symptoms. Participants who preferred treatment for distress after abortion demonstrated severe psychological stress (Impact of Event Scores of >26) and moderate perinatal grief (Perinatal Grief scores > 60) focused on the pregnancy and abortion. The Modeling Phase designed the intervention based on patient preferences for a group treatment addressing unanticipated guilt, enhanced coping skills, and education of psychological distress reactions after abortion. Significance and Conclusions The thesis is a series of studies that were used to develop a targeted and acceptable intervention for university students who had an abortion, reported distress afterward, and preferred treatment to relieve it if such treatment was available. The thesis provides a mechanism within nursing to understand, identify, and treat psychological distress after abortion that is population-focused, and currently does not exist. The intervention can be tested for efficacy and replicated on larger samples. Effective interventions after abortion have the potential to reduce psychiatric morbidity and mortality after abortion within a university student population. / Découvert Il existe dans le domaine médical une lacune entre la science et la pratique pour comprendre, identifier et traiter les conséquences psychologiques après un avortement. En effet, 30% des femmes du monde qui ont choisi un avortement subissent des conséquences psychologiques significatives. C'est surtout évident parmi les jeunes femmes que l'on trouve les risques les plus élevés pour ces problèmes psychologiques. Les données empiriques pour les interventions qui adressent ce problème n'ont pas été découvertes. ObjectifCette thèse a comme but de fournir une base de connaissance et pratique pour traiter les problèmes psychologiques, qui existent après un avortement. L'intervention proposée, unique en son genre, est basée sur les éléments de preuves recueillis des étudiantes universitaires qui ont éprouvé des effets négatifs après un avortement et qui accepteraient un traitement pour leur désordre. Cette thèse propose une théorie et un modèle pour mieux comprendre les mauvais effets psychologiques après un avortement. L'évidence accumulée et les préférences des clients, concentres sur la population du groupe de contrôle, soutient la thèse.MéthodesThe United Kingdom Medical Research Guideline a fourni la méthode pour l'élaboration des interventions. Parmi les cinq phases proposés dans ce guide, les deux premiers ont été utilisés: la phase préclinique et la phase modèle. La phase préclinique développe (a) une théorie pour la détresse après un avortement et (b) les symptômes ciblés pour l'intervention. Avec cette évidence comme base, la deuxième phase a été élaborée : (c) plan de l'intervention ; (d) les préférences du client pour une intervention spécifique et (e) la faisabilité et l'application du traitement. RésultatsLa phase préclinique, a déterminé une théorie du désordre psychologique comme base de l'intervention. En plus, une étude descriptive d'un groupe (N=151) de participants fournit l'évidence des symptômes ciblés. Les participants qui cherchaient un traitement, avaient démontré une sévère détresse psychologique (Impact de Grands Nombres d'Evénement >26 et deuil périnatal modéré >60), spécifique à la grossesse et l'avortement. L'évidence ramassée dans la phase préclinique a été utilisé pour déterminer une intervention appropriée. Parmi ces interventions préférées parmi des clients étaient : le service d'une thérapie en groupe pour la culpabilité non anticipée, le succès des compétences, et l'enseignement sur les effets psychologiques après un avortement. Signification et conclusionLa thèse actuelle représente une série d'études utilisée pour développer une intervention ciblée et acceptée par les étudiants universitaires qui, après avoir subi un avortement, ont éprouvé des conséquences psychologiques négatives et qui cherchaient un traitement médical. Cette thèse pourvoit une base de connaissance cohérente dans la profession d'infirmière à comprendre, identifier, et traiter la détresse psychologique après un avortement. Cette connaissance, concentrée dans la population, n'existe pas encore. L'intervention développée pourrait être examinée pour l'efficacité et répliquée parmi les groupes plus nombreux. Les interventions efficaces, qui réduisent la détresse après un avortement pourraient aussi réduire la portée de morbidité psychiatrique et mortalité après l'avortement dans la population du niveau universitaire.

Background An admission to the intensive care unit causes major physical and psychological stress for children. Pain contributes significantly to this distressing experience. To optimize pain relief, a sound pain assessment tool is essential. Although this need is recognized, only a few pain assessment instruments have been thoroughly tested with this population using a rigorous scientific approach, and none have been shown to be superior to the other. Recent studies using near-infrared spectroscopy (NIRS) in term and premature infants indicate that nociceptive stimuli cause haemodynamic changes in specific cortical regions. This suggests a new avenue for assessing and quantifying pain processing in critically ill infants that could be more sensitive and specific to the nociceptive response. Aims In this series of studies we examined regional cerebral and systemic haemodynamic changes, as well as behavioural reactions in critically ill infants with congenital heart defect (CHD) during chest drain removal following open heart surgery. Specifically, we examined changes within subjects, as well as individual factors (age, sex, medication) affecting the change and associations between cerebral haemodynamic changes, systemic physiological changes, and Face Legs Activity Cry Consolability (FLACC) pain scores. Subjects Critically ill infants less than 12 months of age admitted to a cardiac intensive care unit after cardiac surgery for CHB comprised the sample. Outcome measures Changes in cerebrovascular haemoglobin concentrations (NIRS), as well as heart rate (ECG), systemic arterial oxygen saturation (pulse oximetry), and mean arterial blood pressure (arterial line) were recorded during three distinct epochs (Baseline, Tactile stimulation, and Chest-drain removal). Behavioural manifestations were also captured through video and were subsequently rated for pain with the FLACC scale. Design Descriptive correlational design. Results We studied 32 infants with CHD and obtained FLACC pain scores in 20 of these infants. Cerebral deoxygenated haemoglobin concentrations significantly increased across the epochs (p&lt;.01). Physiological systemic responses were not found to be associated with the cerebral haemodynamic parameters. Mean FLACC pain scores significantly increased across the epochs (p &lt; .001) with a mean score of 7/10 during the noxious procedure, despite administration of an analgesic agent (morphine). Sex of patients was found to be a determining factor in the cerebral haemodynamic responses and pain FLACC scores. Pharmacological treatments, age and weight of patients were significantly associated with cerebral and systemic haemodynamic responses, as well as the FLACC pain scores. The administration of a sedating agent (midazolam) had a significant dampening effect on the pain behaviours as assessed by the FLACC scale.ConclusionsUsing a multidimensional pain measurement approach, we demonstrated that significant cerebral, physiological and behavioural activity was present in response to a noxious procedure in critically ill infants despite the administration of analgesic treatment. Although pain behaviours were significantly dampened by the sedating agent, the cerebral response was still evident. Thus, assessment of cerebral haemodynamics in the context of pain seems to be an important addition when a sedating agent is administered. Our data suggest that NIRS is a potentially useful technique for assessing pain evoked cerebral activation in critically ill infants. / Introduction Une admission à l'unité des soins intensifs est une source de stress physique et psychologique chez l'enfant. La douleur contribue grandement à cette expérience affligeante. Pour optimiser le soulagement de la douleur, un bon outil de mesure est essentiel. Malgré que ce besoin soit reconnu, très peu d'instruments ont subi des tests scientifiques rigoureux auprès de cette population et aucun outil ne s'est démarqué des autres. Des études récentes utilisant la spectroscopie par infrarouge (SPIR) chez les nouveau-nés à terme et prématurés ont indiqué que des stimuli nociceptifs causent des changements hémodynamiques dans des régions cérébrales spécifiques. Cette approche semble prometteuse auprès des jeunes enfants gravement malades. Objectifs Nous avons examiné les changements hémodynamiques cérébraux et systémiques, ainsi que les réactions comportementales reliés au retrait d'un drain thoracique chez de jeunes enfants ayant subi une chirurgie à cœur ouvert pour une cardiopathie congénitale. Spécifiquement, nous avons exploré et comparé les changements de chaque enfant, ainsi que les facteurs individuels (âge, sexe, médication) affectant ces changements. De plus, les associations entre les changements hémodynamiques cérébraux et physiologiques, ainsi que les scores de douleur selon l'échelle Face Legs Activity Cry Consolability (FLACC) furent étudiées. Échantillon L'échantillon comprenait de jeunes enfants gravement malades âgés de moins de 12 mois admis à l'unité des soins intensifs cardiaques. Mesure des paramètres Les changements de concentrations en oxygène de l'hémoglobine (SPIR), ainsi que le rythme cardiaque (ECG), la saturation artérielle en oxygène (oxymétrie pulsatile), et la pression artérielle moyenne (ligne artérielle) furent recueillis pendant trois périodes distinctes (mesures initiales, stimulation tactile et retrait drain thoracique). Les manifestations comportementales furent obtenues par vidéo et évaluées, subséquemment, pour la douleur à l'aide de l'échelle FLACC. Devis Devis descriptif corrélationnel. Résults Nous avons étudié 32 enfants avec cardiopathie congénitale et avons obtenu des scores de douleur FLACC auprès de 20 de ces enfants. La concentration cérébrale de désoxygénation de l'hémoglobine a significativement augmenté entre les trois périodes (p&lt;.01). Les réponses physiologiques systémiques ne furent pas associées aux paramètres hémodynamiques cérébraux. Les scores de douleur FLACC moyens ont significativement augmentés entre les périodes (p &lt; .001), dont la moyenne était de 7/10 en réponse à la procédure douloureuse, malgré l'administration d'un agent analgésique (morphine). Le sexe des participants fut un facteur déterminant de la réponse hémodynamique cérébrale ainsi que pour les scores de douleur FLACC. L'administration de traitements pharmacologiques, l'âge et le poids des enfants furent associés de façon significative aux changements hémodynamiques cérébraux et systémiques, ainsi que ceux des scores de douleur FLACC. L'administration d'un agent sédatif (midazolam) a eu un effet atténuant significatif sur les comportements de douleur tels que mesurés par l'échelle FLACC. Conclusions Nous avons démontré, à l'aide d'une approche multidimensionnelle, que des manifestations cérébrales, physiologiques et comportementales significatives étaient présentes en réponse à une procédure nociceptive chez le jeune enfant gravement malade, et ce, malgré l'administration d'un traitement analgésique. Les comportements communiquant une douleur furent significativement atténués par l'administration d'un agent sédatif. Par conséquent, l'évaluation de l'activité hémodynamique cérébrale lors de situation douloureuse s'avère être un important ajout lorsque des médicaments sédatifs sont administrés. Il semble que la SPIR soit une technique potentielle pour évaluer l'activation cérébrale évoquée par une stimulation nociceptive chez le jeune enfant gravement malade.

<p> This study examines how healthcare related stress in graduate nursing students impact satisfaction attainment. The factors examined in this study included demographic characteristics such as age, years in practice and employment status. Other factors examined include general health, perceived stress, salary, vacation, scheduled hours, flexibility, benefits and opportunities for advancement.</p><p> The tool used in this study was a demographic survey combined with a 67-item questionnaire developed by the researcher. The questionnaire was adapted from the Perceived Stress Scale (PSS 10), The General Health Survey (GHQ 28) and The McCloskey/Mueller Satisfaction Scale (MMSS). Forty-five participants took part in this study. Each participant was currently a graduate nursing student.</p><p> The study revealed that graduate nurses in the Los Angeles metropolitan area were less satisfied overall with diminished perceptions of health and increased stress particularly at 6-10 years of experience. The findings also suggest that work- related stress prevention programs would promote satisfaction attainment among nursing staff and potentially improve organizational outcomes. </p>

<p> The Hispanic American population has a higher risk for chronic diseases, including diabetes mellitus type II (DMII), hypertension, and hyperlipidemia. Many population-specific risk factors are modifiable but distinctly related to culture (e.g., language, diet, healthcare practices, gender roles). Thirty participants recruited at a Los Angeles County hospital clinic completed a survey on partner involvement in care and partner knowledge level that were subsequently compared with participants' laboratory values (glycated hemoglobin and low-density lipoprotein [LDL]) and blood pressure.</p><p> Three significant correlations were found: Perceived consistent DMII-appropriate meal consumption was correlated with lower LDL levels; increased appointment attendance was associated with decreased LDL level; and there was a positive correlation between partner involvement and partner appointment attendance. The data supported the need for more research in the areas of partner support and education for improved outcomes of diabetics, especially those with strong cultural views and gender role delineations.</p>

<p> The purpose of this project was to assess nursing students' knowledge of breastfeeding guidelines and benefits. A nonexperimental, descriptive design was used with a convenience sample of 40 students enrolled in a nursing program at a southern California university. Participants took a modified Breastfeeding Knowledge Questionnaire. The questionnaire consisted of 17 knowledge items covering the benefits and guidelines of breastfeeding. Descriptive and inferential statistics were used to analyze student knowledge and to test for differences in knowledge levels.</p><p> Of a possible 17 points, the mean knowledge score was 14.08 &plusmn; 1.56. There was a significant difference between male and female students' knowledge scores (<i>p</i> = .023). More than one third of the students scored below 80%. Improving breastfeeding education in nursing curricula is necessary to prepare future nurses with essential knowledge about breastfeeding. </p>

<p> Falls in the geriatric population present a significant preventable problem in the United States. Reducing the number of falls in the geriatric population is important not only for the quality of life for senior citizens but also for cost containment in the current healthcare system in the United States. One well-documented risk factor for falls is polypharmacy. Many seniors take multiple medications on a daily basis, including blood pressure medications. Nurse practitioners and other primary caregivers can help keep seniors safe by seeking methods to reduce fall risk factors. One such method is encouraging participation in balance-specific exercise programs. These programs not only have the potential to reduce falls by improving strength and balance, but also to reduce extrinsic fall risk factors such as medication usage.</p>

<p> Obesity has arisen as a major cause of morbidity and mortality in today' s society. The aim of this study was to assess potential barriers encountered by obese women seeking medical care. It was hypothesized that overweight or obese women will be likely to have a negative self-esteem and that a negative self-esteem associated with being overweight will decrease healthcare utilization. A convenience sample of 50 women over the age of 18 were surveyed upon entering a health care clinic. Self-report of height and weight was collected to calculate a body mass index (BMI) score. Furthermore, a self-report of healthcare utilization was obtained along with demographic data and a quantified self-esteem score. Results showed a significant Pearson's negative correlation between BMI and the self-esteem score (<i>r</i> = -0.395; <i>p</i> = 0.01) and a significant difference based on a <i>t-</i>test between self-esteem based on employment status (<i> p</i> = 0.021). Other demographic variables (age, income, education, marital status, and race) had no significant impact on BMI, self-esteem or number of office visits. There was no significant difference between obese and non-obese women on the number or type of office visits, and no significant difference between average self-esteem score and number of medical office visits. Assessing self-esteem in those with higher BMIs may be a helpful tool in assisting providers to identify barriers of seeking healthcare in obese women.</p>