Betty Neuman's Systems Model (1985), the Integrated Case Management Model (2004), and the Clinical Nurse Specialist (CNS) Spheres of Influence (1998) were blended together to create the theoretical framework that guided this study. This quasi-experimental study utilized both retrospective and prospective data to investigate the efficacy of a Clinical Nurse Specialist Case Manager (CNS CM) Intervention on reducing the 7-day and 30-day readmission rates of patients diagnosed with heart failure. The overall findings of this study, following the programmatic intervention, indicate that there was a decrease in both the 7-day and 8-30-day readmission rates of patients with the primary diagnosis of heart failure (HF). The results of this study were not statistically significant, but were of clinical and of financial importance. There was a difference of 11 total readmissions that is equivalent to a savings of approximately $44,000.00, as a result of the CNS CM intervention. Of interest was the fact that both the pre-intervention and intervention patient groups were particularly similar with respect to demographic and personal health characteristics. Given the similarity of the groups, it is more plausible that the decreases seen in the readmission rates were directly related to the CNS CM intervention versus unknown, confounding variables. Although increases in case management and social work documentation as well as home health care consults were observed, these percentages are still sub-optimal. / A Thesis submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Masters of Science. / Degree Awarded: Fall Semester, 2005. / Date of Defense: October 27, 2005. / Heart Failure, Case Management / Includes bibliographical references. / Jeanne Flannery, Professor Directing Thesis; Denise Tucker, Committee Member; Sandra Faria, Committee Member.

Caregivers of the elderly who suffers from AD and dementia have significantly high psychological stress. Alzheimer's disease (AD) is a progressive degenerative disease that affects cognition, the ability to perform activities of daily living, and behavior. AD is the most common form of dementia, a group of disorders that impair mental functioning. Memory loss is one of the earliest symptoms of AD, along with a gradual decline of cognitive functions. Age is a key risk factor for AD in all racial and ethnic groups. Recent research has shown that the prevalence of AD in the African American community has graduated from a problem to an epidemic. Much of the burden of caring for patients with AD falls on family members, particularly spouses and adult children, predominantly female. Because there is a lack of knowledge and awareness in the African American community about the disease, the progression of the disease, signs and symptoms, and resources available, many caregivers caring for individuals with AD and/or dementia suffer with physical illnesses and heightened levels of stress. This study examines the relationship between the level of knowledge and the level of psychological stress among African American primary caregivers of patients who have Alzheimer's disease and/or dementia. A sample size of 50 caregivers was obtained by convenience sampling. A cross-sectional design was employed in this study. Caregivers were asked to fill out a quiz and questionnaire regarding their knowledge and feelings about caring for a person with Alzheimer's disease and/or dementia as well as some personal information about themselves. Results of the study showed that increased knowledge about dementia was associated with higher levels of stress. Overall, there was a poor level of knowledge about dementia in African American caregivers. Caregiver stress was associated with relationship to the care recipient, showing that "others" were more stressed than spouses who took care of the elderly with dementia. Caregivers' lack of knowledge about the spiraling course of the disease may put them at risk for a multitude of psychological and physical health problems. Nurses can take an active role in educating the caregivers and public about the disease and providing access to available resources. Because African Americans demonstrated low levels of knowledge about dementia in this study, efforts should focus on identifying the barriers to knowledge and their means of gaining information about dementia. / 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: November 3, 2006. / Caregiver, Alzheimer's Disease, Dementia, Psychological Stress, Knowledge, African American / Includes bibliographical references. / Sandra Faria, Professor Directing Thesis; Deborah I. Frank, Committee Member; Denise Tucker, Committee Member.

The purpose of this study was to examine the effect a debriefing had on Compassion Fatigue levels as measured by the Compassion Fatigue Self Test (CFST) in public health nurses employed by the Florida Department of Health who provided care to the victims of the hurricanes that occurred in the fall of 2004. 500 surveys were mailed to these nurses. While 120 returned the survey, 89 completed the entire survey and thus, were the sample for this study. This study also examined the effect the debriefing had on the CFST subscales of STS and burnout. A 2X2 Factorial ANOVA was used to analyze the data generated from the sample. This revealed there was no significant change in the CFST scores related to the debriefing. There was, however, a decrease in Compassion Fatigue scores overall and in the sub scale of STS from the week of the hurricanes to the time the test was administered post hurricanes, regardless of participation in debriefing. Implications for nursing practice and research are presented. / A Thesis submitted to the School of Nursing in partial fulfillment of the Requirements for the degree of Master of Science in Nursing. / Degree Awarded: Fall Semester, 2005. / Date of Defense: October 21, 2005. / Disaster relief, natural disasters, hurricanes, public health nurses, debriefing, secondary traumatic stress, burnout, compassion fatigue / Includes bibliographical references. / Deborah Frank, Professor Directing Thesis; Sandra Faria, Committee Member; Denise Tucker, Committee Member.

Health care literature and mainstream media sources have produced volumes of information regarding the current and projected effects of the nursing shortage. Little, however, has been written regarding the deleterious effects of this phenomenon, and other work-related factors, on the nurses in the trenches. Compassion Fatigue among care providers has emerged in the literature as a concept worthy of study; however, the population of hospice nurses has been virtually ignored. The present inquiry utilized descriptive and inferential statistics to accomplish a two-fold purpose. Initially, it investigated the prevalence of CF risk among Florida's hospice nurses and analyzed relationships among demographic, work-related, and personal health factors. Secondly, the study employed the use of multiple independent variables in a regression equation for the prediction of compassion fatigue risk. Findings revealed that 78% of the sampled hospice nurses were at moderate to high risk for compassion fatigue with approximately 26% in the "high risk" category. Additionally, participants from the entire sample were experiencing the overt effects of stress, manifested in hypertension (30%), depression/PTSD (22%), and headaches (28%). These effects were, no doubt, exacerbated by the fact that more than half (53%) reported stress from finances, slightly less than half were encountering five or more patient deaths per month, and almost 65% were sacrificing their own personal needs for the needs of their patients. Major factors such as trauma, anxiety, life demands, and excessive empathy (leading to blurred professional boundaries) were key determinants of CF risk in a multiple regression model that accounted for 91% of the variance in this dependent variable. With knowledge of these few variables, hospice organizations may identify nurses at risk and take measures not only to provide needed support for these individuals, but also, to seek to eliminate or reduce the contributing factors. This inquiry provided a first glimpse into the stressful world of Hospice nurses, provided a means for the identification of those at risk of compassion fatigue and an estimate of prevalence in a state where the demands on these caregivers are expected to increase exponentially. While these results appear to have prescriptive value, replication is warranted to validate the model's, as well as the study's, other descriptive findings. / A Thesis submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Master of Science in Nursing. / Degree Awarded: Spring Semester, 2005. / Date of Defense: March 21, 2005. / Maryann Abendroth, nursing, vicarious traumatization, secondary traumatic stress, compassion fatigue, secondary trauma, palliative care, burnout, nurses / Includes bibliographical references. / Jeanne Flannery, Professor Directing Thesis; Denise Tucker, Committee Member; Sandra Faria, Committee Member.

Coronary heart disease is the single leading cause of death in the United States. According to the American Heart Association, cardiovascular diseases are responsible for the lives of 41.4 % of more than 2.3 million Americans who die each year. Coronary Artery Bypass Graft (CABG) is an operation performed on individuals that have extensive blockage of their coronary arteries as a result of CAD. Although CABG restores health to the heart, arteries can again become occluded if lifestyle changes are not made. After CABG, a part of disease management by the healthcare professional is educating the patient regarding signs and symptoms of heart disease, appropriate methods for diagnosis and treatment, and any modifications that must be made in the patient's lifestyle. Before effective teaching can begin, healthcare providers must first assess the educational needs and learning styles of the patient. Patients' perceptions of that which is important information may be different from that of the healthcare members providing the education. Without proper assessment of the desired educational needs of the patient, information given to the patient by the healthcare provider may be disregarded. The purpose of this study was to compare the perceptions of cardiac patients with those of cardiac nurses concerning the patient educational needs for maintaining a healthy heart. A nonprobablility convenience sample of 38 participants was obtained from a private, community hospital in the North Florida region. Eighteen nurses employed in the Progressive Care Unit and 20 patients who had a CABG performed within the hospital were used in the study. Data were obtained with the use of demographic forms for both the nurses and patients and The Cardiac Patient Learning Needs Inventory tool. The overall findings, consistent with previous studies, indicated that the areas of medication information were important to both the patients and nurses. There was a statistically significant difference between the nurses' gender and the ranking of anatomy and physiology, psychological issues, medication information, physical activity, and other information. That meant that the female nurses rated the above categories as more important than the male nurses. A statistically significant difference was also evident between the nurses' degree related to psychological factors and physical activity. The data showed that the nurses with a BSN degree rated psychological factors and physical activity as more important than those nurses without a BSN. The only significant difference found between the patients' demographic variables and the seven subscales of the CPLNI was in patients with Diabetes Mellitus, who ranked risk factors as most important. From the data analysis, patients and nurses perceive the same areas as important and not important, which are consistent with previous studies implementing the CPLNI. There is still a need for researching the differences in the nurses' gender and perception of patients' educational needs as well as research focusing on the differences in nurses' educational background and their perceptions of patients' educational needs. Continued research on identifying patients' educational needs will benefit the patient by providing the patient with information that he or she deems important. / A Thesis submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Masters in Science. / Degree Awarded: Spring Semester, 2004. / Date of Defense: November 19, 2003. / Cardiac Patient, Patients and Nurses Perceptions / Includes bibliographical references. / Laurie Grubbs, Professor Directing Thesis; Deborah Frank, Committee Member; Denise Tucker, Committee Member.

Cardiovascular disease is the number one killer in the United States. Decades of research have indicated that controlling risk factors can reduce the incidence of this disease in the population. And, early treatment of symptoms can greatly improve outcomes in patients who develop cardiovascular disease. However, women have not had the same improvement in either incidence of the disease or decrease in morbidity and mortality. The purpose of this study was to determine the types of treatment received by patients presenting to an emergency department with chest pain in an attempt to identify any possible causes for this discrepancy. A sample of one hundred charts of patients receiving treatment at an emergency department was reviewed. The types of diagnostic testing conducted and treatments received by the patients were recorded from the record. In addition, time variables related to the testing and treatment were collected. Inclusion criteria was limited to those patients between the ages of 35 and 65 presenting to the emergency department with a chief complaint of chest pain. They must also have had a discharge diagnosis from the emergency department of ICD-9 410, acute myocardial infarction, ICD-9 411, acute coronary syndrome, ICD-9 412, old myocardial infarction, ICD-9 413, or ICD-9 414, coronary ischemia. The total number of records available was approximately 900. The hypotheses were in regards to the presence of a relationship between treatment and gender. Student's t test, t-test for Equality of the Means (with a 95% CI), and Chi-square were used to identify any possible relationship. Time variables were analyzed using an ANOVA. In the case where more than one factor was found to have an influence, a two way ANOVA was conducted. In regards to diagnostic testing and treatment, there was a significant difference in emergent coronary angiography. Women did not receive emergent coronary angiography as frequently as men (χ = 2.406, df=1, p= .007). Time variables were analyzed with significant differences in time to care (t= -2.963, df = 98, p= .005), time to oxygen (t = -3.228, df = 40.156, p=0.003), time to morphine (t = -4.624, df = 13.113, p 49 to 56 (p=.045). A two-way ANOVA indicated that gender had an effect on both time to care and time to Troponin as women in the younger age groups waited much longer than men to be seen and to have a Troponin assay collected. Based on the results, it is the responsibility of the advanced practice nurse to educated their patients about factors that increase the risk for developing CVD and ways to control these factors. This includes diet, exercise, and medication regimens. In addition, frequent monitoring of both risk factor reduction and medication adherence is necessary to identify and address potential problems. Any change in a client's state of health, especially those with CVD risk factors, must be assessed appropriately and treated promptly. / A Thesis submitted to the College of Nursing in partial fulfillment of the requirements for the degree of Master of Science. / Degree Awarded: Summer Semester, 2007. / Date of Defense: June 28, 2007. / Cardiovascular Disease, Gender Bias / Includes bibliographical references. / James Whyte IV, Professor Directing Thesis; Laurie Grubbs, Committee Member; Dianne L. Speake, Committee Member.

Ramona T. Mercer's theory of Maternal Role Attainment was the framework that guided this study conducted to compare the maternal confidence levels of the depressed and non-depressed first-time mother 4 months after delivery. A sample of 104 women completed the First-time Mother Questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Confidence Questionnaire (MCQ). Fifteen (14.4%) of the mothers were considered depressed with a score 12, or higher, on the EPDS. With the exception of age and income, the demographics of the depressed and non-depressed mothers were very similar. Both groups of mothers were also found to have similar personal and family histories for depression, support systems, and perceptions of their support and of their infants. Correlation coefficients using Spearman's rho revealed a negative association between age and maternal confidence (r = -.174). Positive correlations were found between maternal confidence and support system size (r = .241), support satisfaction (r = .319), and perception of infant temperament (r = .405). Negative associations were found between postpartum depression and support system size (r = -.112), support satisfaction (r = -.308), and infant temperament (r = -.201). An independent samples t-test was performed to test the equality mean maternal confidence levels for the populations of depressed and non-depressed first-time mothers. The depressed mother was found to be less confident in her role (t = 2.455, p = .016, df = 102). Pearson's Product-Moment Correlation Coefficient was used to provide the correlation coefficient for the variable of postpartum depression and maternal confidence(r = -.461; p = .001). Approximately 21% of the information needed to predict depression is being provided by confidence ( r = .461, r2 = .212). / A Thesis submitted to the Department of Graduate Studies in partial fulfillment of the requirements for the degree of Master of Science in Nursing. / Degree Awarded: Spring Semester, 2004. / Date of Defense: March 18, 2004. / Postpaartum Depression, Maternal Confidence, First Time Mothers / Includes bibliographical references. / Jeanne Flannery, Professor Directing Thesis; Donald R. Workman, Committee Member.

The nursing shortage is of growing concern to the nation's health care system. The problem and thus the solution are multifaceted. Many solutions exist in alleviating the nursing shortage, one of those solutions is to reduce the incidence of compassion fatigue among nurses. Compassion Fatigue can be a precursor to burnout, a phenomena that may be causing nurses to leave the profession. Compassion fatigue and burnout are a real threat to the nursing profession. During an outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto Canada in 2003, 5 nurses decided to quit their jobs. They decided to quit after "a month of putting up with long hours under unusually strenuous conditions" (CBC News Online Staff, 2003, p. 1). Strenuous conditions included working 12 hour shifts without the allotted breaks, wearing heavy protective gear that caused the nurses to break out in rashes, and fearing they might contract the potentially fatal disease or bring it home to their families. The purpose of this study was to examine the factor of compassion fatigue, and the role it plays in nurses who provide assistance during natural disasters. This study chose to examine only female middle aged nurses who provided care to victims of the 2004 Hurricane season in Florida. The rationale for choosing only female middle aged nurses lies in the fact that they comprise the majority of the current nursing population. Variables such as marital status, number of times deployed to assist victims and number of years in public health, were examined for their effect on levels of risk for compassion fatigue. This study used a subset of data from a pre-existing data set. The original study utilized a retrospective design and had participants complete a survey 3-4 months after they assisted hurricane victims. A total of 500 participants were selected at random by the Department of Health; addresses for those participants were also provided by the Department of Health. Survey packets containing a letter of introduction, letter of consent, stamped return envelope, demographic data sheet and two copies of the Compassion Fatigue Self Test (CFST) were mailed to the 500 participants. Each packet was numerically coded, to keep the participants anonymous, only the original researchers had access to the master list of participants and corresponding codes. Return of the survey served as consent for the study. For the current study only female participants age 40-60 years with complete data were included in the sample. The total number of participants who met the inclusion criteria was 55. Descriptive statistics, factorial ANOVA and simple effects were used to analyze the data. Findings indicate that the majority of the participants were non-Hispanic white, married and had no children living with them at the time they provided care to victims of the hurricanes. This was the first experience assisting victims of a hurricane for the majority of the sample, and they had also not provided assistance in other types of natural disasters. As a result, the average level of risk for compassion fatigue, both during the hurricanes and 3-4 months after, was low. Of the variables that were examined as possible moderating variables on level of risk for compassion fatigue, only years in public health proved to be significant. Results from analyses on years in public heath and compassion fatigue revealed that those with 11-20 years of experience in public health had the greatest rate of change in levels of risk for compassion fatigue experienced during the hurricanes and 3-4 months after. Those who had the most experience in public health did not experience significant levels of risk for compassion fatigue, and they also showed little change from levels experienced during the hurricanes and 3-4 months later. The factors of being middle aged and female seemed to prove beneficial in dealing with compassion stress/fatigue. / A Thesis submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Masters of Science in Nursing. / Degree Awarded: Fall Semester, 2005. / Date of Defense: October 27, 2005. / Secondary traumatic stress disorder, compassion stress, Gail Sheehy, Charles Figley, nursing shortage, burnot / Includes bibliographical references. / Deborah Frank, Professor Directing Thesis; Sally Karioth, Committee Member; Mary Beth Zeni, Committee Member.

Technology has expanded the availability of information through various routes, such as, television, music, movies, internet and magazines. These routes avail adolescents to endless learning venues about any issue that might be of interest to them. Television is a common media mode and research indicates approximately 83% of programming contains sexual content. Adolescents being impressionable believe the sexual content in the media is natural, which may lead to an altered perception of what types of behaviors are appropriate for them. This retrospective descriptive study explored whether mass media prompted individuals to become sexually active as adolescents. The sample population of 180 college age students came from a public university in the southeast United States. Factors examined in the study were age, gender, race, and amount and mode of media consumed. The Sexual Media Diet (SMD) Questionnaire, along with sexual history demographics, was administered to college students (N=180) to explore how much time and type of media they consumed as they were developing through their adolescent years. Data from the survey established an association between age of sexual initiation and gender. Results indicated females consume more sexual content from the media than males but males were initiating sexual intercourse at younger ages than females. Race could not be used as a single variable to predict the age of initiating sexual intercourse. An additional finding was the ability to predict the college age student's virgin status based on age, race, sexual media content score, protection knowledge, and sexually transmitted disease knowledge / 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, 2007. / Date of Defense: October 15, 2007. / Media, College Age, Sexually Active, Adolescent / Includes bibliographical references. / Susan Porterfield Co-, Professor Directing Thesis; Laurie Grubbs Co-, Professor Directing Thesis; Dianne Speake, Committee Member.

Health care individuals such as emergency preparedness teams, clergy, nurses, and physicians are first responders during times of disaster. These types of responders are at risk to develop compassion stress, compassion fatigue, or even burnout. Compassion stress is a result of the cumulative demands of experiencing and helping the suffering; compassion fatigue is defined as "a state of exhaustion and dysfunction, biologically, physiologically, and emotionally, as a result of prolonged exposure to compassion stress" (Figley, 1995). Burnout is a gradual process that occurs over time as the accumulation of fatigue leads to a state of exhaustion; "being physically and emotionally fed up with the job as a result of general dissatisfactions as a worker" (Figley, 2005). The symptoms of burnout include "depression, cynicism, boredom, loss of compassion and discouragement" (Figley, 1995). This purpose of this study was to determine the prevalence and effects of compassion fatigue in Emergency Department nurses following a natural disaster. The study was a descriptive exploratory study asking nurses to examine their perceptions, feelings and experiences after caring for hurricane disaster victims following the 2005 hurricane season. A total of 28 registered nurse respondents met the eligibility inclusion criteria. The instrument utilized for the study was the PROFESSIONAL QUALITY OF LIFE SCALE Compassion Satisfaction and Fatigue Subscales—Revision IV (ProQOL) developed by Figley (1996) and revised by Stamm (1997-2005). The prevalence of compassion stress, compassion fatigue and/or burnout experienced by registered nurses was analyzed using a Spearman's rho, and Kendall's tau b test was conducted. Emergency department nurses in this study showed low risk for compassion fatigue. The nurses demonstrated compassion satisfaction in the care they had provided during the aftermath of the hurricane season of 2005. Analysis showed no significant correlations between age, gender, marital status, employments status, number of years as a nurse, education level and/or previous disaster experience. There was a positive correlation between number of years as a nurse and age. This relationship demonstrated as the age went up in number of years, the level of compassion satisfaction also increased. A T-test and a Levene Test for Equality of Variances with assumed equal variance was conducted to determine if gender differences existed between male and v i female found no specific correlations between genders. Older more experienced nurses demonstrated higher levels of compassion satisfaction. Future research should be aimed at hard hit disaster areas, as this study examined an outlying region and may have underrepresented true risk to disaster areas. The risk for compassion stress/fatigue may have been attenuated due to the retrospective design and the year-long time span from disaster to the completion of data collection. Future evaluation of compassion stress/fatigue should examine the personal coping mechanisms, level of expertise, age, and experience of the nurse. Research should be aimed at discovering the link between these variables, focusing on nurses' ability to continue delivering care during times of unusually high demand. Employer programs should be developed for prevention of compassion stress/fatigue in those nurses who are most at / 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: November 1, 2006. / Compassion fatigue, Hurricane, Emergency Nurses / Includes bibliographical references. / Laurie Grubbs, Professor Directing Thesis; Sally Karioth, Committee Member; Linda Sullivan, Committee Member; Michael Barbour, Committee Member.