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The purpose of the study was to determine how participation in a three and one-half hour continuing professional education program (CPE) influenced the nursing practice of 51 nurses three months later. The study sample was 45 staff nurses and six nurse managers.Four variables were measured using questionnaires before, immediately after, and three months after the CPE program. The variables measured were (a)"the characteristics of continuing professional education program, (b) the characteristics of individual professional, (c) the nature of the proposed change, and (d) the social system in which the professional must implement the behavior change" (Cervero, 1985, p.87). Qualitative data were collected using open-ended statements to ascertain how the content of the CPE program was useful in practice. Nurse managers were surveyed to ascertain their judgements about autonomy and empowerment levels of the nurses.Findings revealed significant positive relationship between behavior change, autonomy, and the variables the nature of the proposed change, empowerment, and the motivational levels of the 51 nurses. Characteristics of the social system and the CPE program were not found to be significantly related to behavior change. No significant differences were found between motivation levels of participants from before the CPE to three months later.Responses to the open-ended statements revealed four themes: the importance nurses placed on meeting the needs of patients, nurses were flexible and accepted change, nurses had positive perceptions about nursing, and nurses felt frustrated and inadequate. Judgements revealed in the responses of the nurse managers before and three months after the CPE program have significant implications for nurse managers when attempting to change nursing practice. / Department of Educational Leadership

Overall survival for pediatric patients with acute lymphoblastic leukemia (A.L.L.) treated with contemporary therapy now exceeds 85%; however, approximately 20% will experience relapse. Since A.L.L. is the most common malignancy in children, relapsed patients comprise a large proportion of the total number of children with cancer. The prognosis for long-term survival following relapse is generally poor; thus, relapsed A.L.L. is a significant contributor to cancer-related mortality in children. Poor adherence to oral medication is a substantial problem in contemporary health care and may contribute to unexplained relapses in children with A.L.L. Therapy for pediatric A.L.L. includes a prolonged “maintenance” phase that requires daily 6- mercaptopurine (6MP), a self- or parent/caregiver-administered oral chemotherapy agent given for approximately two years. 6MP has been shown to be a critical component of the curative regimen for A.L.L.; thus, children with A.L.L. who fail to adhere to oral 6MP chemotherapy as prescribed may be at increased risk of leukemia relapse. This study used extant questionnaire data from a cohort of children with A.L.L enrolled on a Children’s Oncology Group study (AALL03N1) to determine the prevalence of self/parent-reported non-adherence to oral 6MP during the maintenance phase of A.L.L. therapy, and to identify sociodemographic and behavioral predictors of non-adherence to oral 6MP. Twenty-two percent of children in the cohort were non-adherent to oral chemotherapy, defined as missing more than one dose of 6MP for non-medical reasons over the 112-day observation period. The risk of non-adherence was significantly increased for those who failed to perceive the severity of the child’s illness (Odds ratio [OR] 1.89, 95% Confidence Interval [CI] 1.00-3.55, P=0.049) or the benefits of treatment with oral 6MP (OR 1.78, 95%CI 1.07-2.94, P=0.025). Vulnerable subgroups included Hispanic ethnicity (OR 2.25, 95%CI 1.30-3.90, P=0.004) and older age (OR 1.07 per year, 95%CI 1.02-1.12, P=0.005). Study findings suggest that even occasional reports of missed 6MP doses may herald a significant adherence problem; that patients and their parents may need ongoing reminders regarding the subclinical and asymptomatic nature of leukemia in remission; and that frequent review with families regarding the purpose, function, and proper administration of oral 6MP is imperative.

The study was designed to compare and contrast responses of two groups of nurses to situational case studies relative to death and dying, with particular emphasis on euthanasia. One group of nurses was comprised of selected faculty of the 33 member universities of the Nurse Faculty Research Development in the Midwest. The second group of study participants was selected staff nurses of hospitals utilized by each of the universities in the Nurse Faculty Research Development in the Midwest. Special consideration was given to demographic data relative to age, highest level of education attained, marital status, number of classroom hours spent in the study of death, dying, and euthanasia during the basic nursing program, and present work assignment.The population of the study consisted of a total of 184 academic and staff nurses. Ninety of the nurses participating in the study were faculty members of institutions of higher education, and 94 nurses were staff nurses in hospitals utilized by the institutions of higher education.A search of the literature revealed no instrument dealing with euthanasia as it related to the nurse. An opinionnaire was designed specifically for the study because of a lack of an instrument in the area of euthanasia.The data collected from the opinionnaires were developed into a series of tables. The tables were designed to illustrate the number and percentage of academic and staff nurses responding to each situation in the opinionnaire. A comparison was made of the responses of the academic and staff nurses to determine similarities or dissimilarities in the response patterns.Conclusions based upon the review of the literature and findings of the study were:1. Staff nurses have more formal education relating to euthanasia than academic nurses.2. The number of classroom hours spent in the study of death and dying during basic nursing education has increased within the past ten years.3. Staff and academic nurses support the right of parents to make determinations regarding procedures utilized with infants that result in euthanasia.4. The greater number of nurses do not support the conclusion that the removal of life-support systems would be murder.5. A consensus of opinion does not exist between academic and staff nurses regarding the authority of a physician to determine which individual would have priority in the use of a hemodialysis machine. 6. There is an absence of agreement among academic and staff nurses regarding the allocation of scarce resources such as blood. 7. A majority of both academic and staff nurses agree that orders which would result in passive euthanasia could be followed, whereas few academic or staff nurses would follow an order which would result in active euthanasia.

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Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1987. / Bibliography: leaves [226]-233. / Microfiche. / xiii, 233 leaves, bound ill. 29 cm

The purpose of this study was to investigate the construct validity of the Index of Work Satisfaction developed by Slavitt and others (1978) to measure job satisfaction for nurses. Based upon need satisfaction theories, the scale contained seven subscales which were believed to explain job satisfaction. A global satisfaction level item was added in an attempt to obtain a separate measure of the dependent variable. A review of the literature revealed that a valid tool for measuring nurses' job satisfaction does not presently exist. The instrument was modified, pilot-tested for reliability and after a second phase of modification, was administered to a volunteer sample of 177 staff nurses representing several hospital and community work settings. Multiple regression and discriminant function analyses were performed on the data, and the results of these analyses were interpreted in terms of the construct validity of the job satisfaction scale. Results indicated that the scale is highly reliable, and that three of the subscales explained approximately 30 percent of the variance in the scores on the global satisfaction measure of job satisfaction. High intercorrelation of the subscales with each other and with the total scores hindered the interpretation of the variance in the total scores explained by each of the significant variables. The results of the analyses suggest that the high reliability of this version of the tool makes it a psychometrically useful measurement of job satisfaction for nurses, to the extent that job satisfaction is comprised of the seven components contained in the scale. Regarding its construct validity, there is conclusive evidence that the linear additive model of job satisfaction on which the instrument is based does not allow a complete view of the construct. Whether the three significant predictors of the total score, Professional Status, Administration, and Interaction, are part of one broader construct, or whether they interact in some unique way, could not be determined because of the multicollinearity problem. A major difficulty throughout the study was the lack of a reliable alternate measure of the criterion. The global satisfaction item responses did not correlate highly with the total test scores, and this self-report, Likert-type item would be subject to the same response bias as the questionnaire itself. Apart from the demonstration that the Professional Status, Administration, and Interaction components appear to contribute to the measurement of the construct, the study failed to gather evidence in support of the construct validity of the modified Slavitt scale. It can be concluded, therefore, that the scale 'reliably measures some aspects of job satisfaction for nurses, but one cannot state with confidence that it actually measures the complex attitude which comprises the construct "job satisfaction." Recommendations have been made for appropriate use of the tool and for further construct validation studies. / Applied Science, Faculty of / Nursing, School of / Graduate

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