This investigation determined the difference in the incidence of spinal headache in 33 patients placed in 30 degrees (°) head-up position versus 33 patients who remained flat for four hours following the administration of spinal anesthesia. An experimental design was used. The two randomly assigned groups presented for elective postpartum tubal ligation under spinal anesthesia. Group A was placed flat and group B had the head of their beds elevated 30° postoperatively. Strict procedural protocol was adhered to prior to and during the administration of the spinal anesthetic. To determine if the patients had any symptoms consistent with spinal headache, patients were visited postoperatively in the hospital and were contacted again on the seventh to ninth postoperative day. Pain in the frontal and/or occipital area which was aggravated by sitting up and relieved by lying down was used as the criteria for spinal headache. The data were analyzed using the Fisher Exact Test. There was no statistically significant difference in the incidence of headache between the postpartum tubal ligation patients who were placed flat postoperatively and those who had the head of their bed elevated 30° (p = 1). The null hypothesis was therefore supported at p > .05. The findings support relaxing restrictions placed on patient's positioning following spinal anesthesia.

The study examined whether adaptive maternal behaviors correlated with a positive self-concept measurement. The adaptive behaviors observed were those which the literature suggested indicate a positive response to the changes of the puerperium. The study aimed at assisting the nurse in assessing the self-concept level of clients. The researcher also hoped to contribute to the continued development of nursing theories and the application of the theories to the arena of clinical practice.

The purpose of this study was to determine the relationship between specific oral contraceptive use and cervical intraepithelial neoplasia (CIN), and to determine if duration of use and content of oral contraceptives were related to CIN. The hypotheses tested in this study were: (1) norgestrel-containing oral contraceptives are associated with more severe levels of CIN, and (2) longer duration of oral contraceptive use is associated with more severe CIN. Data was collected from 52 clinical records of clients who attended a colposcopy clinic during a four month period. Clients included in the study were utilizing one of five specific oral contraceptives for a minimum of six continuous months. During their initial clinic visit, all clients were interviewed by the colposcopy clinic nurse who recorded information concerning duration and type of oral contraceptive use on part one of an investigator-designed data collection form. From the data collection forms completed by the nurse, the investigator determined clinical record eligibility for inclusion in the study. The investigator utilized part two of the data collection form to record age, race and colposcopic diagnosis from the client clinical record. The majority of study clients were black and younger than 26 years of age. The duration of oral contraceptive use ranged from six to 96 months. OrthoNovum 1/50 (ON 1/50) was the most frequently used, and LoOvral was the least frequently use, oral contraceptive. Mild/moderate dysplasia was the most frequent CIN diagnosis and carcinoma in situ (CIS) was the least frequent. Condyloma was the second most frequent CIN diagnosis. OrthoNovum 1/35 (ON 1/35) users had the highest frequency of mild dysplasia, and the highest Estimate of Relative Risk (ERR) of mind/moderate dysplasia. Users of <= 35 mcg. estrogen oral contraceptives had a higher percentage and ERR of mild/moderate dysplasia than users of 50 mcg. Estrogen oral contraceptives. ON 1/35 and Loestrin users had no severe dysplasia/CIS diagnoses. ON 1.50 and Ovral users (50 mcg. Estrogen oral contraceptives) had a higher percentage and ERR of severe dysplasia/CIS and condyloma than users of <= 35 mcg. estrogen oral contraceptives. Loestrin users had the highest overall percentage and ERR of condyloma, and LoOvral users had the lowest overall percentage and ERR of condyloma. Of those clients with 12 or more months of oral contraceptive use, the 50 mcg. estrogen oral contraceptive users had the highest percentage of condyloma. Of the study clients with 12 months or less oral contraceptive use, the 50 mcg. estrogen oral contraceptive users had the lowest percentage of condyloma. For all durations of oral contraceptive use, 50 mcg. estrogen users had the highest percentage of severe dysplasia/CIS. Users of oral contraceptives for 12 months or less had a higher percentage and ERR of severe dysplasia/CIS and condyloma than users of oral contraceptives for more than 12 months. Users of norgestrel-containing oral contraceptives had a higher percentage and ERR of severe dysplasia/CIS and a lower percentage of condyloma and mild/moderate dysplasia than other oral contraceptive users in the study. Fisher’s exact one-tail test and Analysis of variance (ANOVA) showed a statistically significant difference in the incidence of dysplasia between <=35 mcg. estrogen and 50 mcg. estrogen oral contraceptive users. Fisher’s exact one-tail test also showed statistically significant differences in the incidence of dysplasia between ON 1/35 and Ovral users. Differences in the incidence of condyloma between norgestrel-containing oral contraceptives and other oral contraceptive users were not statistically significant with Fisher’s exact one-tail test. The investigator concluded that there were differences between specific oral contraceptives and the associated incidence of CIN. The investigator also concluded that these differences were not associated with duration of oral contraceptive use.

Medical advances in disease management has improved quality of life for women with cystic fibrosis (CF) and now enables them to consider pregnancy. The purpose of the study was to examine women's perceptions of how the demands of having CF influenced their ability to care for their children and continue to meet their own health needs. The study design was grounded theory methodology with a complementarity research technique to incorporate qualitative and quantitative data collection. Participants were 12 women recruited over the Internet and through an adult CF newsletter who completed questionnaires for demands of illness (DOlI) and self care of CF. A severity of illness measure (Nll-I-CSCF) based on medical records was completed by participant's health care providers. Participant interviews were conducted following receipt and preliminary analysis of study instruments. Semi-structured telephone interviews incorporated information from questionnaires. A data matrix containing information from questionnaires and the participant interview was compiled for each participant. Within and across data matrix analysis elucidated patterns which were further condensed into categories. A theoretical model emerged that reflected social, medical, and economic themes of how women worked to sustain and maintain family life and a chronic illness entering the twenty first century. The findings also provided recommendations for health care providers working with mothers with CF.

<p> Background: Quality end-of-life care is provided by a special type of nurse. The very nature of hospice work puts it at a higher level of complexity, which includes the ability to cope with death and dying on a daily basis. In 2014, the NHPCO estimated 1.6 to 1.7 million patients received hospice services. </p><p> Purpose: The purpose of this research was to discover the essence and meaning of the lived experience of the hospice care nurse as primary provider of end-of-life care. Prior to this research, little was known about the hospice care nurses in the United States. </p><p> Philosophical Underpinning: This qualitative research was underpinned by constructivism and the philosophy of Husserl known as descriptive phenomenology. </p><p> Methods: Moustakas&rsquo; (1994) method was used to discover the lived experiences of 12 hospice care nurses who have at least 2 years of experience as the primary provider of end-of-life care. The semi-structured interviews were transcribed verbatim to capture the true essence and meaning of the hospice nurses experience providing care to patients and families on a daily basis. </p><p> Results: The four strong themes that emerged from this research are <i> Feeling Attachment, Managing Workload, Lacking Support,</i> and <i> Providing Education.</i> These themes clearly describe the essence and meaning of the lived experience of the hospice care nurses. </p><p> Conclusion: To this researcher&rsquo;s knowledge, this is the first qualitative research about the lived experience of the hospice care nurse as primary provider of end-of-life care in the United States. It is my hope that this research will draw attention to the dynamics surrounding hospice nursing and the educational needs of health care providers and the general population.</p>

<p> Major areas of concern within the US healthcare system today include the quality and cost of healthcare. Open colorectal surgery patients have a higher prevalence of prolonged length of hospital stay (LOS) than most other types of surgery patients and are likely to be discharged to home care or other healthcare settings (DHCS), both of which contribute to increased costs. The ability to predict which patients are at risk for these outcomes early after open colorectal surgery could prompt nursing interventions aimed at improving quality of care and reducing healthcare costs. Radwin and Fawcett&rsquo;s Refined Quality Health Outcomes Model served as the conceptual framework for this study. </p><p> In this retrospective cross sectional study of adult open colorectal surgery patients (N=789), nursing documentation in the electronic health record (EHR) was reused to examine the relationships among patient acuity, LOS, and discharge disposition (DD). At the large Midwest healthcare system where this study took place, a patient acuity software system generated real-time patient acuity scores from discrete nursing assessment data fields in the EHR. This information was being used by unit nurse managers to guide nurse staffing decisions.</p><p> Patient data were stratified by three discharge diagnostic-related groups (DRG) for colorectal surgeries, DRG 329, 330, and 331, to provide some control for comorbidities and post-operative complications. Multiple regression analysis for each DRG examined how patient acuity and select patient characteristics predicted prolonged LOS. Findings included that having a high patient acuity score on Day 2 or 3 after open colorectal surgery was a significant predictor of prolonged LOS for subjects in each DRG (DRG 329: <i>B</i>=1.985, <i> p</i>&lt;0.05; DRG 330: <i>B</i>=1.956, <i>p</i>&lt;0.01; DRG 331: <i>B</i>=0.967, p&lt;0.01). Logistic regression analysis results also indicated that high patient acuity scores on Day 2 or 3 after surgery significantly predicted DHCS for each DRG (DRG 329: OR=3.65, 95% CI [1.39, 9.59], <i>p</i>&lt;0.05; DRG 330: OR=2.86, 95% CI [1.58, 5.16], <i>p</i>&lt;0.01; DRG 331: OR=8.62, 95% CI [2.04, 39.48], <i> p</i>&lt;0.05). </p><p> Implications for nursing include the need for further research to examine the use of patient acuity information to support evidence-based clinical decision making to improve healthcare quality and contain costs.</p>

<p> Bridging the gap between classroom learning and nursing practice is an ongoing concern in nursing education. Multiple studies have found that students who are provided the knowledge, skills and modeling behavior, in addition to an expectation of efficacy, have an increase in their confidence of acquired skills and thus an increase in self-confidence and competence. However, patients in acute care settings have increasingly complex medical problems, which often leave nursing students with minimal hands-on care for their assigned patient. The purpose of this study was to examine the effect of deliberate practice, using a repeated simulated clinical experience, on student self-confidence and competency. A quantitative method with a descriptive, non-experimental, pre-test-posttest study provided information about the effect of a repeated simulated clinical experience on student self-confidence and competence. A convenience sample of 26 nursing students from a university located in central Pennsylvania enrolled in their junior year medical-surgical course participated. Self-confidence was measured using the National League for Nursing (NLN) <i> Self-Confidence in Learning with Simulation</i> self-reporting instrument prior to experiencing the simulation and then immediately following the initial and repeated simulation. Competence with nursing skills using simulation was measured using the <i>Creighton Competency Evaluation Instrument</i> (CCEI) for both the initial simulation and the repeated simulation. Parametric statistics and a multivariate analysis of variance (MANOVA) indicated a statistical significance for overall improvement in competence following the repeated scenario, <i>p</i> = 0.001. There was no statistical significance in improvement of student self-confidence. The findings of this study suggest that repetition of a simulation scenario promoted an increase in overall competence and support incorporating deliberate practice of simulation scenarios.</p>

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

A review of literature from the fields of nursing, medicine, sociology, law and psychology from the late 1980's to the present reveals extensive discussion and debate of male circumcision. This investigation was an attempt to determine factors which may influence parental decision making regarding routine newborn circumcision and to determine parental attitudes toward circumcision. The issue has been debated for decades; with proponents and opponents alike arguing their position with passion. In 1999 the American Academy of Pediatrics (APA) updated their current policy on routine newborn circumcision. The APA does not recommend routine newborn circumcision, instead declares circumcision to be a decision best left to parents. The policy further states the decision regarding circumcision should be made after parents receive accurate and impartial information from their healthcare provider. Using a questionnaire asking both demographic and nondemographic questions a sample of parents of male children aged birth to thirty-six months were invited to participate in the research. One hundred-one participants returned the completed questionnaire. Data collected shows that although not statistically significant, there does seem to be a trend between decision making regarding circumcision and advice from healthcare providers. This is reflected by the fact that of the participants who had their son circumcised 58% did so without advice from any healthcare provider with an increase to nearly 80% after discussion with a healthcare provider. Data was unable to show any significant effect by demographic variables on parental decision making regarding circumcision / A Thesis submitted to the College of Nursing In partial fulfillment of the requirements for the degree of Master of Science in Nursing. / Degree Awarded: Fall Semester 2006. / Date of Defense: October 24, 2006. / Influence, Parental Attitudes, Circumcision, Healthcare Professional / Includes bibliographical references. / James Whyte IV, Professor Directing Thesis; Susan Porterfield, Committee Member; Sally Karioth, Committee Member.