Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

Spiritual dimensions are an important focus for nursing care and nurses can be catalysts for spiritual care. The purpose of this descriptive comparative analysis is to examine the spiritual care needs as perceived by terminally ill clients, non-terminally ill clients, and well adults. The theoretical framework for this study is Leininger's "Cultural Care Theory" that supports the notion that spiritual care needs to be culturally congruent.Participants were obtained from a 225-bed hospital, hospice, home care, and a wellness program in a midwestern city. Permission was obtained from the hospital President, Vice President of Nursing, the directors of Hospice and Home Care, and the community's Wellness Program. The number of participants was 76. The process for the protection of human rights was followed.Findings were that terminally ill, non-terminally ill, and well-adults all agree that receiving spiritual care that is congruent with beliefs is important. The terminally ill clients rated spiritual needs higher than both non-terminally ill and well-adults. All groups rated the same in the persons from whom it was wished to receive spiritual care. Common themes of spiritual care desired from these persons for the terminally ill group was: pray for/with me and talk to me. For the non-terminally ill group it was: give me information, The understanding, and provide emotional and spiritual support. Finally, for the well-adults it was: listen to me, talk to me, be confident, and support me.No statistical difference between groups (.940) on the SPS. On the SPC, the terminally ill group was more satisfied (5.20) with spiritual support they were receiving than the non-terminally ill group or well-adults.It was concluded that regardless of the stage of illness, the same spiritual needs are prominent, all individuals have spiritual needs, and several types of interventions are preferred. It has been demonstrated in this study that prayer is the most sought after component of spiritual care among all three groups. Second to that would be someone to talk to and someone to listen to them.Implications call for nurses to facilitate spiritual care from family, friends, minister or priest, and hospital chaplain. This could be written into the plan of care by having the client describe the type of spiritual care they want to receive. Nursing Administration needs to work with nursing staff to define spirituality and religion and what they mean to the nurse. / School of Nursing

Social support has been implicated in health outcome through the functions of neuroendocrine responses. One function of body neuroendocrine responses is sleep behavior. The purpose of this study was to test the hypothesis of a positive relationship between social support and adaptation to sleep in Taiwanese hospitalized adults. Subjects for this descriptive study included 94 Taiwanese hospitalized adults from two hospitals. Of the 94 patients, 30 had social support with the presence of a relative or friend. Subjects were required to have spent two consecutive hospitalized or post-operative nights in order to be included in the study. Data analysis showed an insignificant difference between supported and unsupported groups in terms of disturbance and effectiveness of sleep. It is recommended that more appropriate measurement of social support be used to test the conceptual framework in the future.

A descriptive study was conducted to examine the relationship between social support and adaptation to sleep by Southern Taiwan hospitalized adults. The conceptual framework for this study was based on Roy's adaptation model and social support as a beneficial factor in health and well-being. Sixty-one hospitalized adults, ages 20 to 71 years, participated in this study. Sixteen subjects (26.2%) had a supportive person stay with them. Data analysis showed that only daytime sleep items of the supplementation factor were significantly different between the supported and unsupported groups. However, all the mean values of effectiveness items in the supported group were higher than those in the unsupported group. It is recommended that a larger sample size from diverse hospitals in Taiwan be used to repeat the study.

Patients who experience multiple hospitalizations over short periods of time may be at greater risk of hospital-acquired infections (HAIs). While it is known that prior hospitalizations are associated with HAIs, there is a gap in knowledge regarding which factors of prior hospitalizations have an impact on the risk of HAIs in subsequent hospitalizations. HAIs caused by gram-negative bacteria (GNB) are of particular concern due to their propensity to develop drug resistance and the limited antibiotics available to treat them. The aims of this dissertation are to: 1) examine clinical and patient risk factors associated with acquiring at least one gram-negative hospital-acquired infection in adult patients with multiple hospitalizations; 2) systematically review the literature assessing the association between repeat gram-negative bacterial infections and changes in antibiotic susceptibility patterns; and 3) assess the association between repeat infections with three common gram-negative pathogens and risk of subsequent drug resistant infections with the same species among patients with multiple hospitalizations. A retrospective cohort study was conducted to identify risk factors from prior hospitalizations associated with incident HAIs caused by three common GNB. Of the 129,372 patients with multiple hospitalizations, 1,672 (1.3%) acquired K. pneumoniae, 1,127 (0.9%) acquired P. aeruginosa, and 262 (0.2%) acquired A. baumannii infections. In survival analyses, older age, mechanical ventilation, history of chronic diseases, and increasing days of use of antibiotics decreased the time to infection for all 3 pathogens. This study highlights potential modifiable risk factors for infection control. Patients with multiple hospitalizations are also inherently at greater risk for repeat HAIs which may result in decreased antibiotic susceptibility, making them more difficult to treat. A systematic review was conducted to evaluate if there is an association between repeat GNB HAIs and drug resistance. From 2000 to 2015, only seven studies explicitly examined repeat GNB HAIs and change in antibiotic susceptibility, five of which reported decreased susceptibility in later infections. The association between repeat GNB HAIs and risk of drug resistance among patients with multiple hospitalizations was then investigated with available electronic medical record data. The risk of a drug-resistant K. pneumoniae HAI increased by 1.14 times (95%CI: 1.04-1.24) with each prior K. pneumoniae HAI, after adjusting for potential confounders and antibiotic use. Similarly, patients with repeat P. aeruginosa infections had a 1.23 times increased risk of a subsequent drug-resistant infection (95%CI: 1.12-1.36) with each prior P. aeruginosa HAI as compared to patients with only one infection. Repeat A. baumannii infections were not analyzed due to limited sample size. The studies in this dissertation demonstrate that patients with multiple hospitalizations are a high-risk population for GNB HAIs. Prevention of GNB HAIs in this group is critical in order to reduce complications to medical care and limit transmission of infections to others in healthcare facilities and the community. Patient medical history can be used for infection risk assessment and to guide future medical care to reduce risk of infection in patients with multiple hospitalizations.

Thesis (M.Dev) --University of Limpopo, 2011

School of Nursing

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb. 15, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. Martha Markward. Vita. Includes bibliographical references.

Thesis (M.A.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 90-93).