<p> Heart failure patients who visit the Emergency Department often because of chronic nature of their illness require a specific plan of care. Successful engagement requires that nurses identify and act on factors to facilitate transition across the care continuum. This study was undertaken to examine the relationship of three major quality care indicators: social support, perception of nurse caring, and patient satisfaction among patients with heart failure admitted to the emergency department. The study further explored the association of these indicators with demographic and illness variables of the study participants.</p><p> The Quality Caring nursing framework was used as the theoretical framework for the study. A total of 115 adult participants, 71 males and 44 females who were admitted in the emergency department of two public hospitals in the mid-Atlantic region of the United States were recruited. Data were collected using a survey package consisting of four instruments: the Medical Outcomes Study (MOS) Social Support Survey measuring perceived social support, the Caring Assessment Tool (CAT) measuring nurse caring, and the Consumer Emergency Care Satisfaction Scale (CESS) measuring satisfaction with care in the emergency department.</p><p> Although the major study hypotheses that high levels of social support would be associated with caring and with patient satisfaction were not supported, there were significant associations found between aspects of social support, caring measure and the demographic and illness measures such as marital status and the number the number of household members. Also, those who were employed perceived more social support than those who were unemployed and those who were retired had a significantly higher perception of caring.</p><p> These findings challenge nurse clinicians, educators, and administrators to further investigate the roles of social support, caring and patient satisfaction in multiple aspects of chronic illness.</p>

<p>The current study sought to examine certified child life specialists&rsquo; perspectives on supporting siblings of infants in the neonatal intensive care unit (NICU). The intent of the study was to identify the types of support available, barriers to offering support, the individuals who offers support and the effectiveness of interventions by certified child life specialists with siblings of infants in the NICU. Sixty-eight certified child life specialists were surveyed regarding their work supporting siblings of infants in the neonatal intensive care unit. Results support previous literature suggesting that there are many barriers to offering support to siblings in the hospital, including: staff availability, space constraints, funding, and visitation policies. In addition, results demonstrated that provided supports still vary widely from hospital to hospital and certified child life specialists are the individuals who are most likely to offer support when it is available. Furthermore, the certified child life specialists surveyed view their interventions with siblings of infants in the NICU as effective or very effective. In conclusion, these findings support the need to increase the presence of certified child life specialists in the NICU in order to adequately meet the psychosocial needs of siblings. </p><p> <i>Keywords</i>: certified child life specialists, child life interventions, siblings, neonatal intensive care unit, NICU </p>

<p> The hospitalization of one's infant is a stressful situation that can lead to decreased bonding and poor health outcomes. This longitudinal comparative design study examined the effects of neonatal palliative care (PC) consultation on stress levels and satisfaction scores of parents of neonatal intensive care unit (NICU) infants. Clinical data was abstracted from the medical record. Demographic data, stress scores, and satisfaction reports were obtained via self-report.</p><p> Mean stress scores indicated most parents experienced moderate stress due to NICU hospitalization. Some parents met diagnostic criteria for acute stress disorder. While all parents expressed satisfaction with care received; PC parents were extremely satisfied with care. No statistically significant differences in stress or satisfaction scores were noted between parents who received PC consultation and those who did not. Study conclusions validate previous research regarding NICU parent stress and show that additional quantitative and qualitative research regarding NICU palliative care is warranted. </p>

<p> Exploring a large data set, hypertonicity of the lower extremities has been incidentally identified as occurring in one out of every five infants, whether term or preterm. This retrospective, longitudinal, descriptive, quantitative study examined data from 463 functionally and structurally normal infants and identified infants that were considered to be hypertonic at either hospital discharge and at one month of corrected gestational age to determine what their motor capabilities were at 13 months of age. Understanding the correlation will assist in determining whether early intervention is indicated for these infants. Multiple statistical analyses revealed no correlation between hypertonicity as a young infant and the Bayley-II motor function score at 13 months of age. The Roy Adaptation model was used as the conceptual framework of the study and ordinal regression was utilized to analyze the data.</p>

<p>Over 40% of Americans are at risk for developing cancer during their lifetime. Technological advances have resulted in improved survival rates. The uncertainty associated with the diagnosis of cancer may give rise to psychological distress. Psychological distress is a multifaceted, complex concept that has shown to interfere with the patient's quality of life, treatment regimens, and treatment outcomes. The purpose of this study was to explore the factors that influence psychological distress in patients with cancer. Influencing factors of psychological distress include medical treatments, personal concerns, family relationships, social support, spirituality, uncertainty and professional support. The theoretical framework that guided this study was derived from the Theory of Uncertainty, Chaos Theory, and review of the literature. The sample consisted of 150 patients diagnosed with non-metastatic cancer living in the suburbs of a major Northeastern United States city. Data was collected using three instruments that measured the degree of psychological distress and the influencing factors: the Distress Thermometer, Mishel's Uncertainty Scale and the Distress Inventory for Cancer-Version 2. The results of this study revealed that significant relationships exist between psychological distress and personal concerns, finances, and uncertainty. In this study the influencing factor of personal concerns was shown to mediate the other factors. Studies have shown that nurses do not routinely screen for psychological distress. Nurses involved in the care of oncology patients can utilize the results of this study to recognize the impact of cancer beyond the clinical manifestations. In addition, nurses can use the results to develop a collaborative plan of care to address the psychological distress that patients with cancer may be experiencing. </p>

<p> <b>Purpose:</b> It is imperative to assure that health care organizations provide excellent care and create value by improving quality while eliminating unnecessary costs. Lean management is a continuous improvement management plan that uses work flow design to produce improvements in quality, safety, cost and productivity; it has been used in manufacturing, service and, more recently, healthcare industries. This study developed and tested an instrument to measure frontline nurse caregivers' perception of the penetration of lean management in hospitals that report using lean strategies. </p><p> <b>Methods:</b> The study consisted of three phases. In Phase 1, using the Delphi technique, an on-line survey of experts (<i>n</i>=10) and a review of the literature identified the domains and subdomains of lean management. Ideas from each domain were formed into items on the Frontline Improvement Thinking (FIT) instrument. The experts also assessed content validity. In Phase 2, nurses assessed the instrument's format, on-line usability of the instrument and content validity. In Phase 3, the instrument was administered to frontline nurses working on units in hospitals that reported using lean methods. Their responses (<i>n</i>= 212) provided the data for assessing the instrument's psychometric properties. </p><p> <b>Results:</b> Exploratory factor analysis yielded a scale with 75 items in 12 factors. Three domains were identified: organizational, unit and individual areas of improvement. The 4-factor, 29-item,<i> FIT Unit </i>had the highest reliability (&amp;alpha;=.86-0.94; inter-item correlation range=.26-0.63). The 2-factor, 10-item <i>FIT Organization</i> was also acceptable (&amp;alpha;=.87 and 0.79, inter-item correlation range=.30-0.72. The <i>FIT Individual</i> had less than desired reliability on one factor (&amp;alpha;=.66) but had acceptable reliability on the other six factors (0.75-0.94; inter-item correlation range =.25-0.89). Test-retest reliability estimates were acceptable for the organization and unit based on Pearson's R correlations (0.53-0.77). </p><p> <b>Conclusion:</b> In the early stage of development, the FIT instrument proved helpful in describing diffusion of lean management. Sample size and quality proved to be problems, however. Nurses from hospitals with a history of lean quality improvement did not participate in the study and some of the hospitals studied were in the very early phases of lean management. Recommendations include continuing work on measure development by increasing the sample of lean-thinking nurses.</p>

<p> PRN psychotropic medication administration is a common practice used by psychiatric RNs in acute inpatient mental health settings to manage anxiety and agitation in patients, and as a result, there are high incidences of PRN psychotropic medication administration (Mugoya &amp; Kampfe, 2010). There is limited documentation indicating that therapeutic non-pharmacological interventions are utilized prior to PRN psychotropic medication administration (Curtis et al., 2007). The purpose of this scholarly project was to determine what non-pharmacological interventions are used by mental health RNs prior to or in lieu of administering PRN psychotropic medication to manage anxiety and agitation in adult psychiatric hospitalized patients. Another aim of this project was to determine what factors influence mental health RNs' decisions to administer PRN psychotropic medications. A descriptive study was conducted. Two survey-type self-reporting tools were used. Twenty RNs completed Nursing Surveys. Thirteen RNs completed both Nursing Surveys and Nursing Intervention Tracking Forms. Findings from this study revealed that non-pharmacological interventions successfully resolved problems over 1/3 of the time and may prevent the use of PRN psychotropic medications. In cases where PRN psychotropic medication was not administered, distraction was the non-pharmacological intervention most often used. The most common factor influencing RNs' decisions to administer PRN psychotropic medications was a high level of anxiety persistent after non-pharmacological interventions were used. This study reinforces the importance of RNs using non-pharmacological interventions to manage patients exhibiting signs or symptoms of anxiety or agitation.</p>

<p> Although there are ample studies confirming that memory self-efficacy (MSE) declines with age, less is known about what factors account for the variation in MSE among older adults. The purpose of this study was to examine the relationship between MSE, diagnostic and clinical characteristics, and subsequent episodic memory performance in older adults. A nonprobability sample of 200 cognitively normal and older adults with mild cognitive impairment (MCI) participating in a longitudinal population-based study investigating the incidence, prevalence and risk factors for MCI completed a questionnaire about self-referent beliefs of MSE. Bandura's (1989) selfefficacy theory and the Integration Model (Whittemore, 2005) informed the descriptive study. Pearson product-moment correlations, a general linear model and a multiple linear regression analysis were conducted. The difference in MSE ratings between the cognitively normal group and the MCI group tested as a whole was significant when adjusting for age, gender and educational attainment (p &lt; .001; ES= 0.585). The overall regression model explained 17 % of the variance of MSE (p &lt; .001) and included age, gender, educational attainment, APOE 4 genotype, family history of dementia, cognitive diagnosis and depressive symptoms. After controlling for age and the other variables of interest, cognitive classification and depression were significant predictors of MSE. Higher MSE ratings were correlated with better episodic memory performance for both groups (r = .273, p &lt; .001). Memory training that capitalizes on the benefits accruing from higher MSE is needed for cognitively normal older adults and older adults with MCI.</p>

Thesis (Ph.D.)--University of California, San Francisco, 2007. / Source: Dissertation Abstracts International, Volume: 68-07, Section: B, page: 4393. Adviser: Catherine A. Chesla.

Thèse (D.Ps.)--Université de Sherbrooke (Canada), 2008. / Titre de l'écran-titre (visionné le 1 février 2007). In ProQuest dissertations and theses. Publié aussi en version papier.