<p> Background: Cardiovascular disease (CVD) is the leading cause of death among all major racial and ethnic groups in the United States (US) and worldwide. Filipinos are the second largest Asian immigrant group in the US. Healthful lifestyle behaviors are cardioprotective factors, but have been under-, overestimated, or not studied among Asian American subgroups. </p><p> Objective: The purpose of this dissertation was to describe the cardiovascular health, cardiovascular mortality, cardiometabolic and lifestyle health behaviors, acculturation, and predictors associated with CVD in the Filipino American population. </p><p> Methods: A systematic review of the literature was conducted which focused on the cardiovascular mortality, disease and clinical and behavioral risks of Filipinos in the US. Two secondary analyses of the 2011-2012 California Health Interview Survey dataset were conducted which focused on the cardiovascular health, CVD, acculturation, metabolic and lifestyle health behavior of Filipino Americans (n = 555). </p><p> Results: The systematic review suggested that Filipino Americans are at high risk for developing cardiovascular disease, for having CVD-related clinical health risks, for engaging in unhealthy CVD lifestyle behaviors, and dying from CVD, as compared to White, non-Hispanic and other Asian Americans in general and by gender. The prevalence of CVD was 7.4% among Filipinos in California. Hypertension, diabetes, physical inactivity, being overweight/obese, and inadequate consumption of fruits and vegetables were prevalent among Filipinos. Multivariate logistic regression analysis indicated that only hypertension was a significant predictor of CVD, controlling for the effects of age, gender, being born in the US, and diabetes. When taking into consideration acculturation factors in chronic diseases and health behaviors, US-born Filipinos had a significantly lower proportion of chronic diseases as compared to Filipinos not born in the US. Filipinos who lacked English proficiency reported more hypertension as compared to Filipinos who reported proficiency in English. A higher proportion of several positive health behaviors were reported among Filipinos not born in the US and those who did not speak English at home ate the recommended 35 or more servings per week of fruits and vegetables compared to their counterparts. </p><p> Conclusions: Further research is needed for culturally-appropriate interventions, education, and prevention programs which focus on health behaviors and chronic diseases, such as CVD, for Filipino Americans.</p>

<p> Nurses assume preceptor responsibilities in addition to usual nursing duties and most have minimal pedagogical preparation for the role. However, preceptors influence the competence of new staff through their instruction. The development of self-efficacy is vital to patient outcomes and safety. Using Bandura's (1997) framework of self-efficacy, ten proficient preceptors participated in an action research study that included individual interviews and focus groups related to the research question: What do proficient nurse preceptors report about the development of their preceptor self-efficacy for the purpose of recommending ongoing professional development and best practices within a hospital setting? </p><p> Preceptors identified thirteen best practices for ongoing professional development within their hospital. These practices include areas of Instruction, Preceptor Support and Professionalism. The largest number of findings were within Instruction. Preceptors are the first teachers of new hires within hospitals. Effective instruction was predicated upon the existence of role support and inculcation of professionalism within the preceptor culture. </p><p> Recommendations for practice include adoption of these best practices into ongoing professional development curricula. A monthly preceptor forum, to facilitate preceptor networking and sharing, is recommended. Future research might examine teaching strategies utilized by preceptors and the timing of these strategies when engaged in precepting. A comparative study using a self-efficacy tool for assessment could be conducted to ascertain whether the preceptor forum was building self-efficacy among the preceptors in comparison to another non-participating group of preceptors.</p>

It is widely claimed that nurses are leaving the profession in large numbers. This is often cited as a result of a decline in commitment. However, in this thesis I argue that these commonplace understandings are mistaken. Through a qualitative analysis of in-depth interviews with 28 practising and ex-nurses, I paint a complex picture of how individual nurses’ range of commitments need to be understood within the broader contexts and discourses of British nursing, workplaces and society. Participants in this study demonstrate powerful and conflicting feelings towards their work. A passionate commitment, often rooted in a concern for the welfare of others, is reinforced by the intense personal rewards that nursing offers, and a dominant occupational discourse of total commitment. This commitment demands a high level of physical and emotional endurance, a willingness to prioritise nursing over all else, and to sacrifice one’s own needs in the service of others. However, these positive feelings are often accompanied by intense negative feelings of frustration, fear and powerlessness centring on participants’ inability to fulfil their working commitments, and to balance them with other commitments in their lives. This thesis centres on the premise that nursing involves a life on the boundaries, a place of uncertainty and conflict as well as of challenge and opportunity. Nurses frequently find themselves caught on the boundaries between conflicting ideas and commitments, trying to fulfil expectations that are mutually exclusive. At the same time, they are faced with the task of negotiating their own boundaries in order to function in a world of limitless demands. Within a working role that has no clear boundaries they must seek to establish the nature and scope of their responsibilities in order to function. In an occupation that demands limitless commitment, they must negotiate the boundaries between their commitment to nursing and to other roles beyond the sphere of work. They must also negotiate the boundaries of the self, determining the extent to which they are willing or able to give of themselves, balancing expectations of the super-nurse with the limits imposed by being human. These negotiations occur in an environment of constant change, of conflicting ideals and high stakes where there are often no right answers. The task is further complicated by the organisational limits to nurses’ authority, by a persistent discourse of the submissive and obedient nurse, and by the risks involved in challenging a dominant discourse of strength and coping. The complexity of nurses’ situation leads them to adopt a range of survival strategies. Some stay and endure, while others seek respite in new posts or specialities. Those who lose hope may take advantage of childbearing to slip out unnoticed. Contrary to the popular belief in a mass exodus of nurses indicating a loss of commitment, it is often those with a powerful sense of commitment to caring for others who find the strength to leave nursing and seek satisfaction in other fields of work.

<p> <i>Purpose:</i> Implement and evaluate a formal evidence-based risk screening protocol in a rural clinic setting to optimize early identification of prediabetes and T2DM in asymptomatic, non-pregnant adults age 18&ndash;44. </p><p> <i>Significance:</i> Absence of an evidence-based risk screening protocol contributed to under/overutilization in laboratory test referral and inconsistency in prescribed treatments among clinic providers. Early identification of prediabetes and initiation of appropriate treatment plans may assist in preventing T2DM and its associated complications. </p><p> <i>Methodology:</i> Quality improvement project utilizing a retrospective, randomized representative sample of charts, <i>n</i> = 30 and a convenience sample of participants, <i>n</i> = 40. The American Diabetes Association Diabetes Risk Test (ADA DRT) served as a prediabetes risk screening tool. Provider adherence to ADA DRT risk screening and laboratory test referral, type of laboratory test ordered, the relationship between demographic characteristics and the ADA DRT score, participant follow-up, and treatment ordered based on risk screening and laboratory results were analyzed using group data. </p><p> <i>Results:</i> Thirteen (35.7%) participants had laboratory values in the prediabetes or T2DM range and 100% of treatment ordered are substantiated by ADA guidelines. Using the ADA DRT tool, risk screening was completed in 100% of eligible participants; accordingly, appropriate utilization of laboratory test referral improved by 33.33%. </p><p> <i>Recommendation:</i> Incorporation of best-practices for risk screening and laboratory test referral for early identification of prediabetes is needed. APRNs are instrumental in promoting efficacious screening strategies and preventative treatment aimed at improving health outcomes. The benefits of using the ADA DRT as a prediabetes risk screening protocol in primary care should be elucidated in a prospective study.</p><p>

<p> Hypertension is a common public health problem. Lack of self-care practices and non-adherence to treatment plans are among the primary reasons for the increasing cases of the condition. The project assessed the teach-back method and the reliability of assessment tools in improving health literacy and hypertension management among adult patients with hypertension. Effective patient education is critical for the control and treatment of hypertension. A convenience sampling was used to recruit patients with hypertension (<i>N</i>=16) in a primary care facility. A quantitative descriptive pre and post study design ascertained the effectiveness of the teaching intervention. Participants received face-to-face teach-back educational sessions accompanied by American Heart Association&rsquo;s <i>Understanding and Controlling your High Blood Pressure.</i> The Healthcare Effectiveness Data and Information Set (HEDIS) guideline and the Hypertension Knowledge-Level Scale (HK-LS) were valuable in measuring outcomes before and after the intervention. There was a statistically significant improvement in median HK-LS from pre-intervention (52% IQR: 36%, 66%), to post-intervention (95% IQR: 86%, 100%, Z=-3.521, <i>p</i> &lt; .001). Also, 50% of the participants met the HEDIS BP guidelines of BP less than 140/90 at post-intervention whereas none had met the target pre-intervention. The findings indicate the teach-back method to be effective in improving hypertension knowledge and BP control in this population. Healthcare providers should employ an easy to understand patient educational tool to optimize patient understanding and ability to adhere to their hypertension regimen.</p><p>

Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains viii, 140 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 113-120).

<p> Nurse practitioners (NPs) have been undergoing a rapid transition in their entry-level degree, from Master of Science in Nursing (MSN) to Doctor of Nursing Practice (DNP). At this time, it is important to establish research evidence on the effects of doctoral education on NP practice. Therefore, a qualitative study of practicing NPs that have returned for the DNP degree was conducted. The purpose was to describe NPs' perceptions of their DNP education, and particularly its influence on their professionalism and patient care. A literature review and evidence synthesis process showed that the available body of research provides little insight into the question of how DNP education affects NP practice; therefore, qualitative description methodology was used to describe this phenomenon. The research questions that guided the study were: 1) What changes do practicing NPs describe about their clinical practice after the experience of completing a DNP?; and, 2) What are the NPs' perceptions of and concerns about the influences of their DNP educational experience on their clinical practice? Two published models and the DNP Essentials (AACN, 2006) informed and guided the data collection and analysis process. Purposive sampling and analyses continued concurrently until data saturation was achieved. Ten DNP prepared NPs were interviewed, and there was wide variation in the sample. The overarching theme <i>Growth into DNP Practice</i> summarizes the participants' perceptions of the changes that have occurred as a result of their DNP educational experience. Four major themes that support the overarching theme are: (a) <i>Broader Thinking and Work Focus</i>; (b) <i> New Knowledge and Interests</i>; (c) <i>New Opportunities</i>; and, (d) <i>"Doctor" Title an Asset</i>. Conceptual categories under each major theme are described. Participants were overwhelmingly positive about the influences of their DNP education on their practice, but the role of the DNP graduate in knowledge translation has yet to be fully operationalized. </p>

<p> National calls for a better-educated nursing workforce are proliferating. The Institute of Medicine (IOM) challenged the nursing profession by setting the goal of having 80% of the nation's nurses prepared at the baccalaureate level (BSN) or higher by 2020. This is an ambitious goal given that, nationally, only 50% of nurses have a BSN. In fact, only 40% of nurses in Michigan have a BSN, and in the rural North-Central Region of this state, only 29% (the lowest in the state) of the nurses have a BSN. The purpose of this hermeneutic phenomenological study was to understand and interpret the meaning of being an associate degree (AD) nurse, the meaning attaining a BSN has for rural registered nurses who currently have an AD, and the barriers they experience that inform their decisions to return to school (or not). The investigator interviewed 11 AD nurses from rural North-Central Michigan and analyzed interview transcripts to identify common experiences and shared meanings using methods identified by Diekelmann, Allen, and Tanner (1989). Two themes were explicated in this study: "Getting in and Getting out" and "What Difference Does it Make?" The findings in this study challenge many of the common assumptions about academic progression in nursing and provide educators, administrators, and legislators with insight about the strategies that may be most helpful for achieving the IOM goal in rural Michigan.</p>

<p> Preparing nursing students to address spiritual needs of clients is a challenge for nursing education programs. There is minimal evidence in the literature exploring the spiritual needs of clients from the perspectives of nursing students and faculty. While licensed nurses can confirm the importance of meeting the physiological and psychosocial needs of the client, nursing professional practice standards demand nurses include acknowledging the client&rsquo;s spirituality. As required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), American Association of Credentialing Nursing (AACN), and the National Council State Boards of Nursing (NCSBN), spiritual care is a requirement, not an option. By determining how nursing students are prepared to address the spiritual needs of the client in a large Midwestern baccalaureate nursing program, nursing faculty can identify effective methods of including spirituality in the nursing education curriculum. This research study used qualitative inquiry and focused on understanding experiences from nursing students and nurse educators. A grounded theory approach was utilized to assess faculty and student perceptions of preparation of senior baccalaureate nursing (BSN) students to address the spiritual needs of the clients. Two themes emerged from the faculty interviews: students need a clear definition of spirituality, and students are not prepared to address the spiritual needs of clients with a spiritual assessment tool. Three themes emerged from the student interviews: students cannot clearly define spirituality versus culture versus religion, they are not equipped to do a spiritual assessment, and there is a lack of role models by both nursing faculty and staff in the clinical setting demonstrating how to address the spiritual needs of clients. There are two sub-categories that support how to define spirituality and how to better equip students to address the spiritual needs of clients. Using a grounded theory approach, the outcomes of this study support a new theory to facilitate nurse inclusion of spirituality in the nursing curriculum. </p><p> This study provides support for integration in the nursing curriculum and inclusion of teaching strategies focusing on spirituality in the nursing curriculum. Findings from this study help minimize gaps in the literature by contributing new knowledge about spirituality in the nursing curriculum that previously had not been empirically identified.</p>

<p> The purpose of the qualitative grounded-theory study was to generate a theory to explain workplace readiness and needs of new graduates entering the intensive care unit (ICU) from the viewpoint of managers, clinical educators, preceptors, and new registered nurses (RN) graduates. The study involved 24 nurses including five managers, four educators, eight preceptors, and seven new graduates working in Florida with 1,550 beds, which includes 115 specialized ICU beds. A qualitative grounded theory developed from analyzing the responses from face-to-face interviews and identifying competencies and skills required for new graduates to enter the ICU. The following four themes emerged: (a) embracing the new ICU role, (b) overwhelming experience of performance ambiguity or anxiety, (c) adapting to the ICU, and (d) embodying the new ICU RN role. </p><p> The results of this study indicate that new ICU RN&rsquo;s have limited exposure in nursing school to the ICU and the inclusion of the novice nurse embracing the ICU theory (NNEIT) could enhance the new nurses&rsquo; transition into the ICU. Through the reduction of overwhelming experience of performance ambiguity or anxiety, the new graduate will adapt to the fast-paced ICU environment and embody the new ICU RN role. Novice nurses embodying the new role require time, preparation, and support. This study adds to a growing body of knowledge on facilitating the workplace readiness of new ICU nurses from the perspectives of the manager, educator, preceptor, and new graduate. The novice nurse embracing the ICU theory (NNEIT) will provide guidance in resolving the discourse of the competencies and skills for new nurses entering the ICU.</p>