With vacancies in the roster of registered nurses increasing, and the number of graduating nurses dropping, there is a clear need to improve not only recruitment, but retention and success rates in nursing programs. This study surveyed directors and former students of associate degree nursing programs in Massachusetts on their perception of factors affecting attrition and retention of students in these programs, as well as on what measures assist nursing students to pass the registered nurse licensing examination. It is anticipated that the results will be useful in developing steps to limit attrition and promote retention in nursing programs. The annual reports of nursing directors to the state Board of Registration in Nursing were reviewed. In a pilot study, the state's 15 community college nursing directors were surveyed on nursing student attrition and retention. A random sample of 115 nursing program students, provided by the directors of two rural schools and two urban schools, was surveyed by questionnaire. This group included (1) those who left or failed a nursing program; (2) those who succeeded in a nursing program and in passing the licensing examination; and, (3) those who succeeded in the nursing program but failed the licensing examination. Frequency tables were used to tally responses and determine rank order. What percentage of the total sample chose a particular response and the weight each response was assigned by respondents is also given. The questionnaire responses of the nursing program directors and the former nursing students on attrition, retention and success on the national examination were compared, as were also the responses from the rural and urban area schools. The three major reasons for attrition are (1) family responsibilities and the stress of juggling home life and school; (2) failure in nursing courses; (3) inadequate finances. Peer study groups, positive and caring faculty, concerned advising, completing non-nursing courses prior to taking the nursing curriculum, and an orientation that informs students about the nurse's role and teaches time and stress management, were considered critical to retention. Recommendations for nursing education, practice, and research, based on the conclusions from this study, are offered.

Sickle cell disease (SCD) is a genetic disorder which affects thousands of Black Americans. SCD is found predominantly in people of African descent. The disease is characterized by repeated and unpredictable painful episodes capable of disabling its victims. People with this disease need to make adjustments in order to cope with this life-long chronically disabling illness. No studies have examined self-efficacy, uncertainty, and self-management in adult clients with SCD. A cross-sectional, descriptive correlational study was conducted to examine the relationships among self-efficacy, uncertainty, and self-management in adults with SCD. A convenience sample of eighty-five subjects from three institutions completed the study. Data were collected using the Mishel Uncertainty in Illness Scale (MUIS), Appraisal of Self-Care Agency (ASA) Scale, and two subscales of the Self-Efficacy in Cancer Management Scale. Data were likewise obtained on demographic characteristics, frequency of crises, pain intensity associated with crises, and use of home remedies and their effectiveness. Descriptive statistics were used to describe characteristics of the sample. Pearson Product Moment Correlations and Regression analyses were used to examine three hypotheses and one research question. The mean age of the sample was 32 years (SD = 9) with a range from 19 to 54. Subjects tended to be single, unemployed, and on disability. The study also revealed that a majority (58%) of subjects had a college education. Results indicated a significant low negative correlation between self-care and uncertainty ($r = {-}.24,\ p < .05$) and a significant low positive correlation between self-care and self-efficacy ($r = .25,\ p < .05$). Stepwise regression analyses were performed between uncertainty, self-efficacy, and self-management as the dependent variables with several demographic variables as independent variables. Education accounted for 16% of variability in uncertainty; effectiveness of home remedies accounted for 19% of variability in self-efficacy; and use of home remedies accounted for 14% of variability in self-management. Limitations of the study, contributions to nursing science, and recommendations for further research are presented.

This dissertation explores the extent to which present day nursing education reflects its tradition-bound subservient roots. The purpose of this study was to identify behavioral phenomena which influence the perpetuation of sex-role socialization from teacher to student in the traditional milieu of nursing education. Using feminist and nursing literature as a theoretical base, the review of the literature revealed a dismal portrait of self perceived inferiority, oppression, and male domination of nurse educators in the academic environment. In contrast, the researcher found nurse educators do not succumb to environmental pressures. They do not conform to the feminine traits as defined in the review of the literature but are enthusiastic, confident, dedicated women who do not perpetuate the monastic military milieu or the rites of initiation in nursing. Nor do they socialize students into the doctor-nurse game or perpetuate the learned feminine traits of submission, passivity, conformity, and dependence. Through in-depth interviews containing 107 open-ended questions, 42 nurse educators in Massachusetts and California described their personal experience with sex-role socialization as a woman, as a student nurse, and as a teacher. Crosstabulation contingency tables compared question responses in cell categories by (1) individual response, (2) state, (3) academic agency, (4) type of nursing program from which they graduated, and (5) type of nursing program within which they are currently teaching. Computation of means, t-tests, and Chi Square demonstrated no significant statistical difference in this nurse educator population for the five categories. The type of school they graduated from or the type of program they are currently teaching do not matter. After maturation, these 42 nurse educators present the same profile of a dynamic, competent, hard-working professional, concerned for the influence she has on students and on the nursing profession. This study has determined that these women are positive role-models and cycle-breakers, encouraging students to be assertive, creative practitioners. This dissertation found that oppressive forces of sex-role socialization are not perpetuated by these 42 nurse educators but by others in the health care system. Implications for further research suggest that other members in the health care system be interviewed to ascertain who is responsible for perpetuating the feminine behaviors encountered in clinical agencies.

Nursings' lack of full professional status based on the criteria of autonomy coupled with the need for a more independent practitioner in today's complex health care system was the basis for this study. A comparison of senior nursing students from different educational programs was undertaken to determine if type of educational preparation was a predictor of professional autonomy. Schutzenhofer's (1988) Nursing Activity Scale (NAS) was used to measure and compare the level of professional autonomy of 306 senior nursing students who were within four weeks of graduation from nine nursing programs across Massachusetts. Further comparisons of students' professed autonomy as a function of demographic variables and students' perceptions of their level of participation in learning were compared. Thirty-six senior level nursing faculty were surveyed for identification of possible relationships between student and faculty scores on these variables. The majority of students surveyed (85%) scored in the high range of the autonomy scale, and the level of nursing education was not a predictor of the students' autonomy level. Variables that correlated with student autonomy levels were marriage, plans for earning an advanced nursing degree and perceived level of participation in learning. However, significant differences were found in student reported autonomy between schools at the associate degree level. Schools at the baccalaureate degree level did not differ significantly from each other. No clear relationship was found between student and faculty scores. More baccalaureate degree students reported their programs as having a more theoretical than practical focus, while the associate degree students perceived a more practical focus to their programs. Seventy-five percent of students from both programs planned to earn advanced nursing degrees. These findings have implications for nursing education. Increased opportunities for students to participate more fully in their educational process may facilitate the internalization of professional autonomy in nursing students. Such opportunities may ultimately provide the health care system with practitioners who possess the professional characteristics necessary for a more autonomous, successful practice.

<p> Nursing programs have embraced distance learning in their curricula, but discussion is ongoing about course assignments and grading criteria to increase examination scores in nursing distance learning courses. Because course examinations are a predictor of success on the postgraduate licensing examination (NCLEX-RN), the purpose of this study was to determine whether differences existed in student examination scores between nursing distance learning courses with and without points aligned to assignments. The theoretical framework was Knowles&rsquo;s theory of andragogy, which highlights adults&rsquo; motivation and self-direction to succeed. The quantitative causal comparative study included a convenience sample of 164 students to compare archival data of 4 examination scores between 2 nursing distance-learning courses. Data analysis included an independent-groups one-tailed <i> t</i> test. No significant differences were found between the 2 courses, suggesting that students do not achieve higher examination scores with course points aligned with course assignments. Nursing administrators and faculty in nursing programs with a distance learning component will benefit from the findings of this study. Findings may be used to draft, revise, and implement assignment criteria and point alignment for nursing distance learning courses. Social change will occur when nursing distance learning faculty use problem-solving and critical thinking assignments, including case studies, discussion boards, group assignments, concept mapping and NCLEX-RN style testing in each nursing distance learning course. Because point alignment to course assignments do not significantly improve examination scores, implementation of problem-solving and critical thinking assignments is necessary to promote student learning and examination success.</p>

<p> This study took place at a Wake Technical Community College, a multi-campus institution in Raleigh, North Carolina. An evaluation of the return on investment in high fidelity simulation used by an associate degree of nursing program was conducted with valid and reliable instruments. The study demonstrated that comparable student outcomes are attainable when traditional clinical study is replaced with high fidelity simulation curriculum. Limited clinical practice space justifies the spread of simulation in college health science programs. North Carolina Administrative Code permits community colleges to replace 25% of traditional clinical with simulation. The lack of research on the cost effectiveness of high fidelity simulation has been cited as a barrier to its diffusion. Sound research demonstrating performance-based and patient-centric outcomes can provide governing bodies with evidence supporting the diffusion of high fidelity education.</p>

<p> The purpose of this study was to increase the knowledge level and change self-reported behavioral intent among a sample of healthcare providers regarding safe sleep messaging. From 1995 through 2015 in New York City, an average of one infant died every week from unsafe sleeping conditions. One agency in New York City experienced four unsafe sleep infant deaths within two months in 2010. In 2011, the city provided case managers with training on infant safety. Before this training, up to six sleep-related infant deaths were reported annually. The following year, one sleep-related infant death occurred. None occurred during the second year subsequent to the training. Current literature demonstrates healthcare providers have considerable influence on safe sleep messaging. This current study utilized a similar educational training designed for healthcare providers working in an urban health facility.</p><p> A single group pre/post-test quasi-experimental design was delivered to 23 participants. The design incorporated an online educational intervention in order to increase healthcare provider&rsquo;s knowledge level and change their self-reported behavioral intent to educate parents and caregivers on the importance of safe sleep practices. Data were gathered at pre-test and post-test to assess changes.</p><p> Final analysis, using a repeated measures general linear model, was carried out on data from the twenty-three participants who returned completed pre- and post-class surveys. There was a statistically significant change in the overall 13-item composite score reflecting knowledge level and change the self-reported behavioral intent from pretest (M=6.13, SD=2.78) to post-test (M=8.78, SD=3.79) at the p &lt;.001 level. These findings support current literature recommendations for healthcare providers to incorporate the safe sleep message into their practice. Nonetheless, supplementary research is needed to conclude whether these results coincide with communities elsewhere and to examine the issues regarding knowledge and behavioral intent regarding safe sleep messaging.</p>

<p> In recent years, an unprecedented level of interest has grown around the prospect of sending humans to Mars for the exploration and eventual settlement of that planet. With the signing of the 2010 NASA Authorization Act, this goal became the official policy of the United States and consequently, has become the long-term objective of NASA's human spaceflight activities.</p><p> A review of past Mars mission planning efforts, however, reveals that while numerous analyses have studied the challenges of transporting people to the red planet, relatively little analyses have been performed in characterizing the challenges of sustaining humans upon arrival. In light of this observation, this thesis develops HabNet &ndash; an integrated Habitation, Environmental Control and Life Support (ECLS), In-Situ Resource Utilization (ISRU), and Supportability analysis framework &ndash; and applies it to three different Mars mission scenarios to analyze the impacts of different system architectures on the costs of deploying and sustaining a continuous human presence on the surface of Mars.</p><p> Through these case studies, a number of new insights on the mass-optimality of Mars surface system architectures are derived. The most significant of these is the finding that ECLS architecture mass-optimality is strongly dependent on the cost of ISRU &ndash; where open-loop ECLS architectures become mass-optimal when the cost of ISRU is low, and ECLS architectures with higher levels of resource recycling become mass-optimal when the cost of ISRU is high. For the Martian surface, the relative abundance of resources equates to a low cost of ISRU, which results in an open-loop ECLS system supplemented with ISRU becoming an attractive, if not dominant surface system architecture, over a range of mission scenarios and ISRU performance levels.</p><p> This result, along with the others made in this thesis, demonstrates the large potential of integrated system analyses in uncovering previously unseen trends within the Mars mission architecture tradespace. By integrating multiple traditionally disparate spaceflight disciplines into a unified analysis framework, this thesis attempts to make the first steps towards codifying the human spaceflight mission architecting process, with the ultimate goal of enabling the efficient evaluation of the architectural decisions that will shape humanity's expansion into the cosmos. (Copies available exclusively from MIT Libraries, libraries.mit.edu/docs - docs@mit.edu)</p>

<p> Nurse education leaders have a fiduciary responsibility of keep nursing curricula current with the latest technologies in healthcare. Nurse educators and nursing students are the end users who can provide the necessary feedback about the use of technology in nursing academia and clinical settings. This single case study with embedded units of analysis (the end users) was about the lived experience of the end users&rsquo; use of personal mobile devices and associated technology in the pursuit of their academic objectives. This qualitative study investigated what issues, if any, were related to the use (or non-use) of personal mobile devices (PMDs) in the nursing classroom and clinical settings. Other research questions for the end users were if institutional policies, protocols, and practices supported the technological aspects of nursing academia as well as any recommendations for improvements. The small, purposive sample population came from the Upstate Region of South Carolina. The researcher facilitated semi-structured interviews with nurse educators and focus group discussions with nursing students to identify any unforeseen and/or unanticipated concerns in the use of PMDs in nursing academia and clinical practices. The Model Measurement Questionnaire (MMQ) was incorporated into the data collection process which had multiple uses. Data analysis was framed around the Theory of Planned Behavior (TPB) and based on a triangulation of data collected from the end users through field notes, MMQ results, and observations. The most significant outcome of this study was the identification of a psychosocial phenomenon not found in current literature. A secondary objective of this case study was to suggest a basic and repeatable process for qualitative assessment of current technology from the lived experiences of nurse educators and nursing students.</p><p>

<p> Incivility has infiltrated our institutions of higher learning as well as the world of nursing. All too familiar in nursing is the phrase &ldquo;eating their young,&rdquo; which aptly describes how nurses treat other nurses, even though they should be nurturing and caring professionals. The investigator explored nursing and health science students&rsquo; perceptions of student and faculty uncivil behaviors within the academic environment, seeking the levels and frequency of the problem. Bandura&rsquo;s social learning theory presents a sound theoretical framework for this dissertation. The research methodology consisted of a quantitative descriptive approach. The Incivility in Higher Education-Revised (IHE-R) Survey was used to compare nursing and health science student perceptions of the level and frequency of student and faculty incivility. Descriptive statistics and independent t tests were used to compare the different student perceptions. The study results indicated that perceptions of student behavioral levels were between <i>somewhat </i> and <i>moderately</i> uncivil. Student perceptions of faculty behavioral levels were found to be more <i>moderate</i>. Review of the frequency levels reflected students&rsquo; frequencies to be <i> never</i> as compared with faculty, which indicated a frequency of <i> sometimes</i>. These results indicated that students perceived incivility to not be problematic within their individual programs, although it found faculty behavior levels were more uncivil even when similar behaviors were demonstrated by students. In general, these results were atypical than other results as incivility is found to be a rising problem. Further study is needed to confirm these results. </p><p>