Individuals in the final stages of life are often cared for by informal caregivers whose interpretation of the patient’s signs, symptoms and treatment needs and options may be incongruent with that of healthcare providers (Docherty et al., 2008). Nurses need to fully understand the scope of this disparity. The purpose of this study was to determine how Black caregivers interpreted signs, symptoms, and treatments for symptom relief during the last months of their loved one’s life. The effect on caregiver decision making was explored. This project is a secondary analysis of preexisting qualitative data. Transcripts from 5 focus groups encompassed 53 participants. All participants were Black and informal caregivers or decision makers for a loved one at their loved one’s end of life. Eighty-seven percent of caregivers were female, and a majority had a high school education. The mean age was 66. Transcripts were coded for themes independently by two researchers. To allow for the most open interpretation, no a priori set of codes was utilized. 3 main categories of signs, 4 main categories of symptoms, 4 themes of the interpretation of signs and symptoms, 4 main categories of treatments and interventions, 5 themes of the interpretation of treatments, and 3 themes describing the effect of signs, symptoms, and treatments on decision making were identified. Case examples of the caregiver interpretation process are included. Health care providers need to provide time, clear and simplified language, and additional explanation in communication. Further research combining health literacy measures and qualitative data on interpretations should be conducted.

Pediatric oncology is known to be a stressful work environment due to the difficult aspects regarding patient care. This known stress related to work and caring for pediatric oncology patients can negatively impact nurses, patients, and families. The purpose of this study is to examine: relationships between patient symptom management and nurse distress; strategies used by nurses to manage symptoms in pediatric patients with cancer; nurse perceptions of the effectiveness of non-pharmacologic or nursing interventions; and nurse distress related to managing symptoms in pediatric patients with cancer. Registered nurses (N=13) at a local children’s hospital participated in an online survey. The survey included the Nurses’ Distress and Interventions for Symptoms Survey (NDISS) and the Stressor Scale for Pediatric Oncology Nurses (SSPON). Descriptive and correlation statistics were used to analyze data. Results showed that the most commonly managed symptoms were pain (100%), nausea/vomiting (100%), hair loss (100%), fatigue (92.3%), worry (92.3%), mouth sores (84.6%), and trouble sleeping (69.2%). On average, participants reported using at least 10 strategies to manage these symptoms. The most common strategies included: active listening, encouraging family involvement, family support, and reducing sleep interruptions. Most participants felt like they managed the symptoms effectively. Overall, the most common stressors for pediatric oncology nurses were related to co-workers (71.8%) and system demands (68.9%). There was no statistically significant relationship between symptom management and nurse distress. Further research should be conducted on the relationship between nurses and significant stressors other than symptom management. Identifying these significant stressors, especially related to co-workers and system demands, would be the first step in the development of appropriate interventions, such as supportive programs, for decreasing nurses’ stress response.

Homophobia plays a significant role in the treatment of individuals who identify as lesbian, gay, bisexual, or transgender (LGBT). The purpose of this study is to explore the presence of these types of negative attitudes as they present themselves in the nursing workforce. 520 registered nurses were contacted via email to partake in a survey assessing homophobic attitudes and perceptions regarding nursing care of LGBT persons. A total of 27 registered nurses responded and the resulting data were analyzed using descriptive statistics. A majority of registered nurses were female (89.3%), greater than 40 years of age (75%), white (75%), heterosexual (96.4%), and Christian (67.9%) with a Bachelor’s degree or less (57.1%). Homophobia scores averaged 27 on a scale from 12-60, higher scores translating to greater homophobia levels. This value is on the lower end of the scale, which interprets to lower levels of homophobia among the participants. While some of these scores did show the existence of negative attitudes toward LGBT individuals among participants, further investigation is needed with a larger, more representative sample. As a result, it is difficult to determine whether LGBT relations are improving with registered nurses.

The development of anesthesia has greatly contributed to the safety of surgeries, reduced the level of invasiveness of many procedures, and provided increased comfort for patients. The delivery of anesthetics has been primarily provided by one of two unique health care providers: a trained physician who has specialized in anesthesia, or an advanced practice nurse—the certified registered nurse anesthetist (CRNA). Both providers have a similar scope of practice, are nationally certified, and often work side-by-side. However, in recent years there has been some controversy between the two providers regarding autonomy, safety, and quality of services. The purpose of this study was to utilize current research comparing the two professions to determine if there is a difference in the quality of care and cost effectiveness between these two providers. This research was focused on studies performed in the United States after 1985. Results indicated no significant differences in quality of care between providers; however, a cost difference does exist. CRNA's provide a high quality of care equivalent to their physician counterparts, but at a reduced price. They additionally offer access to care in rural areas that lack anesthesiologists. Limitations include an inability to assess the impact of doctoral level programs for nurse anesthetists (required for entry into practice beginning in 2025) and how this may affect the main components of patient care assessed in this study (quality of care and cost). Future studies should look at ways to improve the relationship between the two providers and to remove barriers to nurse anesthetists’ scope of practice in order to increase overall access to care.

Prostate cancer (PCa) has been the leading cause of cancer death in men since1930. While studies pertaining to PCa have primarily focused on the disease and the subsequent side effects of treatment, psychological distress in this group has yet to be adequately addressed. The purpose of this dissertation was to: 1) conceptualize health related quality of life (HRQL) and health seeking behavior of men by describing lifestyle, cultural and health risks associated with being male, 2) evaluate the psychometric properties of the SF-12 Health Survey (SF-12) combined with the urinary and sexual portions of the UCLA PCa Index (UCLA-PCI), 3) investigate the psychological impact, coping styles and informational needs of a group of men diagnosed with PCa who have not yet undergone treatment. Men have been observed to underutilize health care services despite the fact that they are in poorer health, have higher mortality rates and lower life expectancies than women. Restricting emotions, being oriented toward success, having limited social networks and taking health risks are often associated with being male. Because incontinence and sexual dysfunction, the two most common side effects of PCa treatments impact men's quality of life, portions of the UCLA-PCI and the SF12 were analyzed. The psychometric analysis of the SF-12/UCLA-PCI and its three subcomponents confirmed the validity of the instrument. The SF-12 component had a Cronbach's alpha of 0.87, while the urinary and sexual subscales had a Cronbach's alpha of .86 and .91 respectively. All three scales were found to have good internal consistency. KEYWORDS: prostate cancer, health related quality of life, coping styles, psychological distress.

Emergency department (ED) crowding is a patient safety concern that has been increasing for more than a decade. Increased visits have resulted in ED crowding, longer wait times, ambulance diversions, and boarding of admitted patients (Hing & Bhuiya, 2012). Numerous factors affect ED crowding. Once various extraneous issues are resolved and a bed is available for a patient, it becomes the responsibility of nurses across unit boundaries to coordinate the patient transfer. This study applies Relational Coordination Theory (RCT) as a framework to provide nurses insight into the relational aspects of their work in the transfer of ED patients to inpatient beds. Relational coordination is a mutually reinforcing process of interaction between communication and relationships that is carried out for the purpose of task interaction. It is useful for coordinating work that is highly interdependent, uncertain, and time constrained (Gittell, 2002). Nurses work during ED transfers requires task interaction as they coordinate their efforts. This study, guided by RCT, will examine relational and communication dynamics among nurses within their own units and across unit boundaries as they interact during ED transfers. A cross-sectional, descriptive design will explore the seven dimensions of Relational Coordination (RC) during ED admissions and explain nurses relational and communication dimensions that may influence ED boarding times. The results of this study provide new information and a sound theoretical model on which to base future research.

Obesity has been recognized as an increasing issue within our country. Obesity contributes to many health related issues, including type 2 diabetes mellitus. Portion size is a factor that has generated clinical research interest. The aim of this study was to determine if there was a relationship between management of diabetes measured by hemoglobin A1c and portion size selection for type 2 diabetics. In this study, subjects selected portion sizes of four different foods. Data were compared to recent A1c levels. Due to the small sample size, nonparametric statistical analysis was used. The relationship of grain portion weight selection and A1c was significant (Spearman R = .900, p = .037). This finding has potential for future investigation and patient education.

The purpose of this study was to describe the perceived barriers to obtaining psychiatric treatment at the Johnson City Community Health Center. The context of the study was a rural area in Eastern Tennessee. Five patients with confirmed DSM-IV mental health diagnoses were recruited during treatment and interviewed at the Johnson City Community Health Center after their scheduled appointments with a Mental Health Nurse Practitioner (MHNP). The semi-structured interview focused on perceived barriers to obtaining treatment, perceptions of treatment received, and perceived availability of treatment. From those interviews, two themes were identified and each of which had two sub-themes identified: Realities of Treatment with the sub-themes of Therapy-Related Realities and Logistics Realities, The Way It Is with the sub-themes of Take Care of It Myself and Don’t Want People to Know. The findings indicate that there is a duality of positive and negative aspects of treatment at Johnson City Community Health Center. Understanding the needs and perceptions of those with psychiatric diagnoses will assist all staff and mental health providers in developing programs that are better suited for those with psychiatric diagnoses receiving treatment from Johnson City Community Health Center.

The purpose of this study was to determine whether therapeutic music affects the patient’s perception of pain, postoperative day 1 after knee replacement surgery in an inpatient hospital. In addition to the patient’s pain levels, the study was an analysis of the quantity of opioids the patient was requested, the length of stay, and the physiological parameters, which included blood pressure, heart rate, respiratory rate, and oxygen saturation. Sixty knee replacement patients were randomly placed in the music group or the quiet group. The Faces Pain Scale Revised with Numeric Rating Scale was used to measure pain levels. Statistical analysis between the music group and the quiet group indicated a significant difference in patient’s pain levels (F = .298; p = .037). Study results support music decreasing patient’s perception of pain. Nurses can suggest music intervention to decrease pain with this patient population knowing evidence based practice supports the efficiency of music.

Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience.