The purpose of this study was (1) To develop strategies that can be used to identify pain in elderly nursing home residents; (2) to explore a pain assessment model that includes age, cognition, communication, depression, function, and pain; (3) to understand the distribution of pain among groups defined by age, gender, cognition, communication, depression, function and pain; (4) to predict pain based on measurements of variables in the model; (5) to evaluate the usefulness of functional status as a predictor for pain. The design was descriptive and correlational. The setting was a 200 bed nursing home in western Massachusetts. Subjects were 111 nursing home residents (mean age 78), who were Caucasian, and predominantly female (77.5%). They were impaired in cognition (54%), communication (61%), and function (82%). They experienced moderate to severe depression (28%) and moderate to severe pain (42%). The instrument was the Minimum Data for Nursing Home Resident Assessment and Care Screening (MDS 2.0).

Agitated behavior is a widespread problem that adversely affects the health of nursing home residents and increases the cost of their care. Agitated nursing home residents are more likely to be physically or chemically restrained, to fall and to have a lower quality of life. Current strategies to reduce agitated behavior tend to be costly. This dissertation research examined a relatively inexpensive intervention to reduce the agitated behavior of cognitively impaired nursing home residents. The specific aim was to compare the effect of calming music or hand massage or a combination of calming music and hand massage on the level and type of agitated behavior over time. This four group, repeated measures design used the Progressively Lowered Stress Threshold model (Hall & Buckwalter, 1987) to test the effect of exposure to calming music and hand massage on agitation. This model proposes that in the context of agitation, the stress response can be altered and functionally adaptive behavior achieved by modifying environmental demands and controlling for factors that correlate with the perception of stress. Power calculations indicated that a sample size of 68 would be adequate to detect significant results. Subjects were randomly assigned to one of four intervention groups: (1) calming music, (2)hand massage, (3) calming music and hand massage simultaneously, or (4) control. Level of agitation was assessed during each of four ten minute observation periods, immediately before the intervention, during the intervention, immediately after the intervention, and at 60 minutes. Each of the experimental interventions produced a reduction in agitation that was greater than that achieved in the absence of any intervention. The benefit was sustained and increased over time. The level of increased benefit over tune was similar in each of the experimental intervention groups. When syndromes of agitated behaviors were examined separately, there were differential levels of reduction of physically aggressive, physically non-aggressive and verbally agitated behaviors. Results of this study provide information on an easily administered intervention that can improve the quality of life for nursing home residents and potentially decrease the cost of their care.

The primary aim of the thesis was to report new cost-effectiveness evidence in the clinical area of heart disease. Following a review of published empirical work, this was achieved by undertaking three new cost-effectiveness studies: one in nurse-led secondary prevention clinics for coronary heart disease in primary care, one on cardiac resynchronisation therapy with or without an implantable cardioverter defibrillator in chronic heart failure, and the final one on a new drug therapy, nebivolol, compared with standard treatment in elderly patients with heart failure. The second aim of the thesis concerned the application of modelling methodology, with the intent being the provision of general recommendations in using Markov modelling approaches in economic evaluation conducted in the heart disease area. The focus was on extrapolation of cost-effectiveness of an intervention beyond a trial both in terms of the time horizon of the analysis and in relation to the population involved. Fundamental issues in parametric distribution functions and Markov modelling approaches have been revisited, with detailed consideration of which parametric distribution functions should be employed when extrapolating beyond a trial and how they could be adopted into model-based analyses. The need for further methodology investigations in this area is discussed in conclusion.

Purpose <br>The purpose of this study was to provide an understanding of the self-perceived physiological and psychosocial needs of persons living in communities which have been exposed to environmental contamination, and to provide an understanding of how forensic nurses can be utilized in these communities. <br>Background <br>This study was conducted to provide an opportunity for forensic nurses to advance their profession by finding ways that they can move beyond their traditional roles. Dixon and Dixon's Integrative Environmental Health Model was the theoretical framework. <br>Research Design <br>This cross-sectional triangulated study used quantitative and qualitative methods. The Community Environmental Health and Rights Assessment Tool (CEHRAT) was used to elicit quantifiable responses. One-on-one qualitative interviews were then conducted. <br>Participants and Data Collection and Analysis <br>Questionnaires were completed by 198 participants (109 from Ellenville, New York, and 89 from South Plainfield, New Jersey). For the qualitative phase, six residents were interviewed. <br>All persons who completed the questionnaire received a $5 gift card and an environmental resource pamphlet. The quantitative data was analyzed using SPSS. The qualitative data was managed with Weft QDA. <br>Results <br>The majority of participants in each community were `Somewhat satisfied' with the environmental information they receive (32.4% for Ellenville and 53.5% for South Plainfield). Two-thirds of the respondents in both communities said they know little or nothing about environmental contamination in their community. Over ninety-six percent of respondents indicated that they would trust nurses to provide environmental information if the nurses were experienced in such matters. Over ninety-eight percent of respondents stated they would trust forensic nurses. Eighty-five percent of respondents wanted educational information so they could protect themselves from contamination. The qualitative data revealed themes that buttressed the quantitative results: a lack of knowledge; the negative impact of politics, economics, and personal finances on remediating contamination; the need for outside help; and the belief that nurses can help affected communities by providing education, treatment, and investigation. <br>Conclusions <br>Forensic nurses can benefit communities that have been environmentally contaminated. In addition to advancing their profession, forensic nurses can be catalysts for change. / School of Nursing / Nursing / PhD / Dissertation

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.P.H.)--University of Michigan, 1936.

Thesis (Ph. D.)--Teachers College, Columbia University, 1968. / Typescript; issued also on microfilm. Sponsor: M. Frances Frazier. Dissertation Committee: Vivian P. Gourevitch. Includes bibliographical references (leaves 148-153).

Thesis (M.S.P.H.)--University of Michigan, 1936.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.P.H.)--University of Michigan, 1936.