<p> The purpose of this study was to determine the effectiveness of advance healthcare planning education among independent community-dwelling older adults, ages 60 and over, on their understanding of the advance healthcare planning presentation, including advance healthcare directive and physician's orders for life-sustaining treatments. Data were collected via a demographic survey, an attitudes toward end of life survey, and a pretest and posttest related to the educational presentation. The results indicated a statistically significant overall improvement from pretest to posttest, <i>p</i> = .001. Many older adults do not like to discuss end of life due to a lack of knowledge of health, fear, or guilt. The discussion of the advance directive and physician orders for life-sustaining treatment (POLST) should be addressed in the community setting before the patient is critically ill in the hospital. </p>

<p> Obesity is an increased body weight in relation to height when compared to some standard of acceptable or desirable weight using Body Mass Index (BMI). Obesity can affect a woman's life at any stage of her life cycle. It has been proven that certain groups, ethnicity, and race are more affected with obesity than others. Non-Hispanic Blacks have the highest age adjusted rate of obesity at 49.5%, Mexican Americans 40.4%, and Hispanics 39.1 %, while non-Hispanic Whites are 34.3%. To better understand why people from less affluent neighborhoods, especially African Americans and Hispanics within the society have a higher prevalence for obesity, this project studied the barriers to healthy weight in low-income women of reproductive age in Los Angeles.</p><p> This directed project investigated barriers to healthy weight; such as (a) scarcity or uneven distribution of supermarkets that carry a variety of food items; (b) concentration of convenience and liquor stores in a particular area, especially in low-income neighborhoods; (c) more fast food locations in some areas; (d) media promotion of high density food; (e) the percentage of Americans eating out instead of preparing their own food at home; (f) the implication of eating high-energy dense food instead of fruits and vegetables; (g) poverty and limitation when choosing what to buy; (h) why order super-size meals? (to get their money's worth); (i) sedentary; and (j) reduced physical activities. The project also reflected on the physiological changes due to obesity and its impact on women, such as body image disturbance, low back pain, and risk for osteoarthritis. It also investigated the psychological implications, including depression and eating disorders. Obese individuals may suffer from low self-esteem while having a difficult time fitting in to a social class. The impact of obesity on women and their offsprings; reproductive complications such as type 2 diabetes, pregnancy induced hypertension, cardiovascular diseases and certain cancer was investigated.</p>

<p> With family-centered care being a key element of nursing, it has become evident that critical times should include family. In this project, emergency department (ED) staff was educated on family presence during resuscitation events and its importance and then given a policy and procedure to put into practice. The aim of project was to determine the effectiveness of these methods in changing the culture of this ED.</p><p> A one-time postintervention survey was utilized to learn whether nurses were making this policy their practice. Prior to the intervention, family would be asked to wait outside until resuscitation events had ended. After the intervention, 13 of the 19 responses indicated that family was included in resuscitation events. In the remaining 6 cases, no family members arrived at the hospital in time. This project demonstrated the effectiveness of education and a well-directed policy in changing practice.</p>

<p> The overarching purpose of this dissertation project was to design a collaborative center for integrative reviews and evidence summaries (CCIRES) to advance the state of the art and science of nursing knowledge and narrow the education-practice-research gap. The CCIRES program was created as a web-based platform embedded in the Kaiser Permanente Southern California infrastructure. The specific purpose of this project was to implement CCIRES via that infrastructure, and evaluate the implementation, structures, processes, and usability of CCIRES. The Diffusion of Innovations was the theoretical framework, as supported by the Model of Diffusion in Service Organizations and the Colorado Patient-Centered Interprofessional Evidence-Based Practice Model. These theoretical perspectives and models informed the structures and processes for the design, implementation, and evaluation of the CCIRES innovation. The literature captured the history of the education-practice-research gap and the use of translational research to support evidence-based nursing practice. A rigorous methodology involving formative and summative evaluation structured data collection and analyses. Four expert members of CCIRES comprised the sample targeted for voluntary participation in the SWOT web-based survey and construction of a logic model providing the data outcomes. NVIVO was the qualitative software program chosen for SWOT data storage and management. The SWOT analysis identified nine individual themes, with three themes spanning all categories and four themes populating four separate categories. These data results allowed deep examination of the essential core functions needed to achieve CCIRES' goals and succeed as a program. Group consensus during a webinar meeting was the data analysis technique for the construction of the 2012 CCIRES logic model. CCIRES members analyzed the alignment of multiple model components to understand the gaps, commonalities, and interrelated elements needed for a successful academic-service partnership program. Secondary outcomes included increased membership, website design, increased evidence review competencies, development of resources, and tool testing. CCIRES' goal of narrowing the education-practice-research gap facilitates the delivery of meaningful knowledge into the caring hands of professional nurses. CCIRES next bold step is to partner with other influential groups seeking to increase the breadth, depth, and rigor of the evidence. By heeding this call to action, CCIRES can translate, diffuse, and disseminate 21^st Century nursing knowledge that has meaning for the two people who seek it and need it most&mdash;the nurse and the patient.</p>

<p> Major advances in health information technologies, safety and quality initiatives, and health policy changes have fueled the development and implementation of the Electronic Health Record (EHR). Any discipline's work and contribution to patient care exist in the EHR only as they are coded. Thus, coding nursing's knowledge, work and contribution to patient care in meaningful ways requires nurses to have a language that defines nursing concepts and works consistently and reliably. Currently the American Nurses Association (ANA) recognizes twelve (12) nursing languages being used in the EHR. Over the last forty years many research efforts have validated these nursing languages and mapped the languages to each other and to other clinical terminologies. Although these nursing languages exist and are in use, they were developed and are used primarily for describing nursing care to individual clients and occasionally extended to families and groups. Nursing languages describing the care of populations has not been well researched. Thus, the purpose of this study was to identify the descriptors and names nurse case managers used to refer to subpopulations, the data elements they used to assess subpopulations, the descriptors and names did nurse case managers use to refer to interventions for the subpopulation, and the descriptors and names used to refer to outcomes of the interventions. </p><p> The study was designed to investigate language used by nurses doing population based care. Participants were nurse case managers who were members of the Case Management Society of New England. A questionnaire was distributed in both online and written formats; 19 participants answered questions based on a case study about subscribers of an insurance company with diabetes mellitus. A tentative folk taxonomy was generated from responses to the questionnaire. Although the tentative folk taxonomy requires further investigation, it identified ten categories labeled utilization, cost, disease-related, treatment-related, people factors, living factors, education, support/coach/care coordination, and type of interactions. Thirty-nine subcategories were associated with the five categories and gave more specificity to the language in the categories. Further investigation of the folk taxonomy with different samples is needed to validate the categories and subcategories followed by additional research with different diseases and conditions.</p>

<p> The Institute of Medicine (IOM) report <i>To err is human: Building a safer health system</i> raised the very important concern of patient safety. The ultimate goal of this report was to provide a call-for-action that promoted patient safety at the point-of-delivery (Kohn, Corrigan, &amp; Donaldson, 2000). Registered Nurses (RNs) represent the largest discipline providing and coordinating patient care redesign. The aim of creating safe and quality care would not be possible without the presence of competent nurses. Conversely, new graduate nurses are prone to errors due to lack of transitional support from academics to practice. With the growing shortage of experienced RNs nationally, there is a need to evaluate and promote programs to assist in the transition, retention, and recruitment of competent new nurses. Structured residency programs offer a means to increase the competency of newly graduated RNs. This study performed secondary data analysis of the Versant 18-Week Residency Program to provide evidence of the success of this approach in assisting new nurses in their transition from academia to practice.</p>

<p> This descriptive study was designed to examine the relationship between nursing faculty attitudes toward culturally diverse patients and transcultural self-efficacy (perceived confidence in performing transcultural nursing skills). Nursing faculty are the educators of the largest group of health care providers. As such, they can have the greatest impact on student development of cultural competence and the provision of culturally competent care which promotes positive patient outcomes. The Cultural Attitude Scale, the Transcultural Self-Efficay Tool, the Social Desirability Scale and a demographic information sheet were completed by a sample of nursing faculty (N = 65) from a large northeastern public college system. Psychometric evaluation of the instruments indicated reliability. Significant findings were that the older, longer licensed faculty had a more positive attitude toward the White and Asian patient and faculty who received their basic nursing education in the U.S. had a more negative attitude toward the Black patient. A decline in mean scores of attitude over the last 20 years indicated a more negative attitude toward culturally diverse patients. There was no difference in transcultural self-efficacy scores for faculty with formal and/or informal education in transcultural nursing and those with no formal or informal education in transcultural nursing. Recommendations for future research include investigating the variables separately, conducting qualitative and mixed method studies with faculty and instrument refinement and development.</p>

<p> Hypertension (HTN) prevalence in African Americans contribute to higher rates of disabilities and deaths from stroke, myocardial infarction, and end stage renal disease than all other racial groups in the United States. The major reason documented for these poor health outcomes is related to lower HTN control rates among African Americans compared to other racial/ethnic groups. Though overall HTN awareness, pharmacological treatments and control have significantly improved for all populations, studies found that rates of HTN control and adherence with anti-hypertensive medications are lower for African Americans compared to other subgroups. </p><p> Study Aims: The primary aim was to determine whether hypertension knowledge, expectation of care, and social support are predictors of adherence to prescribed medications while controlling for socioeconomic factors in the context of hypertension among African Americans. </p><p> Methods: A cross sectional quantitative approach was used. A secondary data analysis was conducted with 387 hypertensive African Americans. The Morisky Medication Adherence scale was used to measure adherence, internal consistency was established, (r=.61). The Roy Adaptation Model (RAM) was used to link HTN knowledge, expectations of care, social support, and socioeconomic factors with adherence to medications to provide an understanding of the process of adaptation. Logistic regressions were used to determine the relationships among the variables. </p><p> Results: The sample (N=387) was primarily female (76%) and men (24%). On average, participants scored high in knowledge about hypertension; mean knowledge score was .91 (SD = .09). Controlling for patient covariates, hypertension knowledge was not found to be a predictor of adherence to prescribed medications (p=.469). Expectation of care was found to be a predictor of adherence to prescribed medications (p=.008); social support was found to be a predictor of adherence to medications (p=.006). </p><p> Conclusion and Implications: This study supports findings regarding expectations of care, social support, and adherence to medication in African American patients with hypertension. The findings are useful for planning patient management initiatives specific to chronic disease such as hypertension. </p>

<p> Skin breakdown occurs when one or more layers of the skin have been disrupted (McLane et al., 2004; National Pressure Ulcer Advisory Panel, 2007). While some literature uses the terms skin breakdown and pressure ulcer interchangeably, these are actually two distinct conditions and pressure ulcers are encompassed in the definition of skin breakdown (Kuller, 2001; Lund, 1999; Suddaby et al., 2006). The consequences of skin breakdown in the pediatric population can include increased cost of treatment, infection, increased morbidity and mortality as well as psychological consequences from resulting alopecia or scarring (Schindler, 2010; Willock &amp; Maylor, 2004). Development of skin breakdown has also been associated with increased morbidity, increased length of stay, and higher costs of care (McCord et al., 2004). </p><p> Prevention of skin breakdown can be accomplished by the use of barriers and specialty surfaces. Barrier protection is achieved by the use of preparations, such as zinc oxide, petrolatum-containing compounds, and alcohol-free barrier films, and also by the application of transparent film and hydrogel dressings (Atherton, 2004; Atherton, 2005; Baharestani, 2007; Campbell et al., 2000; Lund et al., 2001). Surfaces can be useful in the prevention of skin breakdown by aiding in the distribution of pressure and decreasing moisture, and can also be used to aid in temperature control for some patients (Norton, Coutts, &amp; Sibbald, 2011). The PICO format question used to guide this project is: For patients in Pediatric Intensive Care Units, is barrier protection or use of specialty surfaces more effective at preventing skin breakdown? </p>

<p> <b>Purpose:</b> The goal of this study was to gain a better understanding of the process undertaken by the informal caregivers of head and neck cancer (HNC), with an eye toward theory development. Although the development of a theory was beyond the scope of this project, it was meant to be a first step toward understanding the important categories and concepts that are part of this process. </p><p> <b>Methods:</b> This study used grounded theory methods and was conducted at a large urban National Cancer Institute (NCI)-designated cancer center in the Mid-Atlantic region of the US. Constant comparative analysis and theoretical sampling were used to gather and analyze data from six caregivers of HNC patients. Audio-recorded and transcribed, de-identified raw data were analyzed using Atlas ti Software&trade;. </p><p> <b>Results:</b> The caregiving process was described in terms that yielded a core category and two other categories. Subcategories were identified as well as dimensions of some of the subcategories. The core category was entitled Managing Change and the two other categories were entitled Types of Change and Strategies for Managing Change. Types of Change encompassed the subcategories of Changes in Life Patterns, Witnessing Physical Changes, Relationship Changes, and Increased Uncertainty. Strategies for Managing Change included the subcategories of Controlling Life Pattern Changes, Utilizing the Quality of the Relationship, and Managing Stress. Key findings included the identification of many different types of change, variation in types and amounts of change over time, utilization of quality of the relationship between patient and caregiver as an important strategy for caregivers, and caregivers&rsquo; use of a variety of strategies to manage change. </p><p> <b>Conclusions:</b> This study has attempted to broaden the understanding of the role of a caregiver of a patient with HNC using grounded theory methods. This work is the first step in developing a theory of caregiving related to this population which may also be applied to a broader population of caregivers. </p>