This study examined the effect a telephone health care information system has on emergency department patients. The research questions address the patient's acuity and the length of time between the onset of symptoms and seeking treatment.A convenience sample of 80 ambulatory emergency department patients treated over a four month period, in one emergency department of a Midwest hospital with a published telephone health care information system. The sample was divided into two groups according to the treatment. The treatment group had accessed the telephone health information system prior to emergency department visit and the control group of patients had not. The procedure for the protection of human subjects were followed.Data was collected by two instruments, a demographic questionnaire completed by the subjects, and a patient acuity scale completed by the treating emergency nurse. Acuity is scored on a 1 through 5 point scale. Subjects selected the best time interval representing the onset of symptoms and treatment. The Whitney-Mann U test was used to test differences in mean ranks. When comparing individuals who used Ask-A-Nurse, there was no significant difference between the two groups and acuity scores. There were no differences between the frequency of time interval ranges in the two groups, however a pattern indicated the subjects sought treatment sooner if the telephone health care information systems was assessed. The ability of the telephone health care information system to refer nonemergency patients to physician's offices or medical clinic and avoid overcrowded emergnecy department appears limited. Implications call for an increased method of screening and providing information to emergency patients who need health care advice. / School of Nursing

The problem of the study was to determine the status of bloodborne pathogen education for injection drug users in Indiana hospital emergency departments. The study was designed to answer the following research questions: (a) Do Indiana hospital emergency departments have written policies on bloodborne pathogen education for injection drug users? (b) To what extent do Indiana hospital emergency departments provide bloodborne pathogen education for injection drug users? and (c) What are the major barriers for Indiana hospital emergency departments in providing bloodborne pathogen education for injection drug users?A valid instrument was developed and sent to 110 Indiana hospital emergency department nurse managers. Forty-six instruments were returned for a response rate of 43.8%.The results indicated only three (7.1 %) responding hospital emergency departments had written bloodborne pathogen educational policies. Ten (20.8%) emergency departments provided some form of bloodborne pathogen education for injection drug users. Major barriers indicated for not providing patient education consisted of insufficient monetary resources, injection drug users denying a drug history, and emergency department nurses being unable to identify injection drug usage. / Department of Physiology and Health Science

The purpose of this retrospective study was to determine the effectiveness of an innovative unit-wide phosphorus football contest and nutrition education intervention directed at improving the serum phosphorus levels and calcium-phosphorus products of patients undergoing routine hemodialysis. Patients at the Clarian Health Partners dialysis center located at 2140 North Capitol Avenue in Indianapolis, Indiana participated in the "National Fosphorus League Phootball" contest, a theme game that allowed patients to join a team and compete against other teams in the dialysis center over a four month time period from September 2005 to December 2005. Additional nutrition education was also provided to all the hemodialysis patients during the months of the phosphorus football contest. Identical patient information from September 2004 to December 2004 was also collected for baseline comparison of serum phosphorus levels and calcium-phosphorus products when only routine education and instruction was provided.Pearson Chi-Square analyses and a series of three-way ANOVAs were performed on the data collected. Overall, it was determined that patients who participated in the phosphorus football contest and received Vitamin D therapy were potentially two times likely to have serum phosphorus levels and calcium-phosphorus products in the goal ranges. / Department of Family and Consumer Sciences

Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle. / School of Nursing

A case study was conducted to examine the discourse of two groups of participants learning about bariatric surgery: those who used a computer software patient education program and those who used more traditional patient-education materials. Participants were interviewed, given a multiple-choice questionnaire, and given a modified Cloze test over the content. The analysis of the interview discourse showed that participants who used the software application were able to recall and produce answers with more details, examples, and specific information than those who used other materials to learn about their surgery. The implications of these findings could indicate that the multimodal nature of the patient education software program may have been able to help mediate the complex medical information. / Access to thesis permanently restricted to Ball State community only. / Department of English

Aim of the Study The aim of this study was to determine if the nursing interventions of patient education and multidisciplinary coordination of care were able to improve pain control in the cancer patient in an acute hospital setting. Background of the Study The role of the nurse in cancer pain management has been defined as being that of an educator, coordinator of care and advocate. A nurse with adequate knowledge of pain and its application to the cancer population and functioning in the role as defined is believed to be able to overcome many of the barriers that exist in implementing adequate analgesia and improve pain management in cancer patients. Design of the Study A randomized experimental control group design was utilized. The study comprised 3 experimental groups and one control group incorporating pre and post testing. The Intervention of the Study Experimental group one: subjects received education regarding their pain management which was tailored to meet their specific needs. Experimental group two: subjects underwent a pain assessment and construction of a care plan which was communicated verbally to the treating medical and nursing team and followed up with a written report which was documented in the history and sent to the treating medical physician. Experimental group three: subjects received the combined interventions administered to groups one and two. Control group four: subjects were assessed and all information was record in the same manner as for the experimental groups. The control group received their usual care during the study and their pain scores were measured at the same time intervals as the three experimental groups. Instrumentation The Wisconsin Brief Pain Questionnaire was used for the assessment of all subjects. The McGill Pain Questionnaire was used as the outcome measure following intervention. Data Analysis A one-way analysis of variance was used to detect the differences between the intervention groups and the control group. T-Tests were used to detect the differences between the groups incorporating a Bonferroni adjustment for frequent T tests. Results The main effect demonstrated a significant difference between the treatment groups and control at a significance level of 0.002. T-Tests showed no significant difference between control and communication groups and no significant difference between education and combined groups. A significant difference was detected between education and control and between combined and control. Conclusions Nursing interventions of patient education, coordination of care and advocacy can significantly improve cancer pain management. Intervention was tailored to meet the specific patient needs based on findings from the assessment and was dependent upon an adequate knowledge base. The nursing intervention of education was the most powerful of the three intervention types and its success was in tailoring to each individual. However, it is believed that with further recognition of the role of the nurse as coordinator of care will lead to greater improvements in cancer pain management.

People diagnosed with cancer or undergoing cancer treatment experience a wide range of symptoms. One of the most common symptoms experienced by cancer patients today is cancer-related fatigue. Cancer-related fatigue is a complex condition, recognised as a multidimensional construct and thought to be associated with a cluster of symptoms rather than occurring in isolation. Cancer-related fatigue is distressing and can persist beyond the treatment phase or the disease itself. Current understanding of cancer-related fatigue and its management is limited. Further developing our knowledge of cancer-related fatigue may lead to innovative means of improving the identification, prediction and management of this troublesome symptom. To this end, this thesis aims to: I) identify factors reported to have a relationship with cancer-related fatigue; II) examine the course of cancer-related fatigue during and after radiotherapy; III) determine a method of detecting clinically meaningful change in fatigue; IV) examine whether correlates of fatigue are consistent across all fatigue dimensions or whether each dimension has its own unique pattern of correlates; and, V) develop and trial a group-based educational intervention to target cancer-related fatigue. To address Aim I in this thesis, relevant literature was reviewed to identify factors which potentially influence cancer-related fatigue. Factors identified include underlying medical factors (biomedical mechanisms, disease-related factors, treatment-related factors and comorbid conditions); physical or behavioural factors (poor nutrition, decreased activity, sleep disturbance, pain); psychological factors (anxiety and depression); and sociodemographic factors (social support, employment and education). The range of inter-related factors identified makes cancer-related fatigue a challenging condition to manage. The factors associated with cancer-related fatigue were synthesized into the Fatigue Framework to provide a clinically useful format for health professionals working with people with cancer. The Fatigue Framework was used to guide the remainder of the research into cancer-related fatigue presented in this thesis. This research consists of two main studies; a prospective longitudinal cohort study (to address Aims II, III, IV) and a randomised controlled trial (to address Aim V). The first study in this research examined the factors and effects associated with cancer-related fatigue in a radiotherapy population (n=210). Patients undergoing radiotherapy were recruited for a single-centre prospective longitudinal cohort study. Participants were assessed using a battery of assessments at three time points, at the start of radiotherapy, the end of radiotherapy and six weeks after radiotherapy completion. The results of this study were used to address Aim II, to identify the pattern of fatigue over the course of radiotherapy. The level of fatigue reported was shown to significantly increase from start to the end of radiotherapy and then significantly decrease from the end of radiotherapy to six weeks post-treatment for each subscale of the MFI. The results of this study were also used to address Aim III, to determine a method of detecting clinically meaningful change in fatigue. Whilst there are many tools used to assess cancer-related fatigue, the Multidimensional Fatigue Inventory (MFI) was the assessment chosen for use in this research study and throughout this thesis. The MFI is one of the few fatigue assessments that takes the various clinical dimensions of fatigue into account and has established reliability and validity. However, unlike other fatigue assessments, there were no published minimal clinically important difference (MCID) criteria for its use in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patients’ fatigue scores. Determination of the MCID was based on the relationship of MFI scores to four clinically relevant constructs: (1) treatment impact on fatigue, (2) health-related quality of life, (3) performance status and (4) occupational productivity. These constructs were used as external or anchor-based measures to determine a MCID for each sub-scale of the MFI. Multiple MCID criteria were identified through the first study, each from a different perspective based on the anchor-based construct used. However, a two-point reference for each MFI sub-scale was suggested as a generic MCID as it was most consistent across the anchors examined. The MCID criteria validated in this study allow better interpretation of changes in MFI sub-scale scores and allow effect size calculations for determining sample size in future studies. The MFI allows assessment of multiple dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation and mental fatigue). Minimal previous research had considered the differential effect of symptom correlates on individual dimensions of fatigue. The data of the prospective cohort study were further utilised to address Aim IV, to determine whether correlates of fatigue were consistent across all dimensions or whether each fatigue dimension had its own unique pattern of correlates. Results indicated that each dimension of fatigue was associated with a different pattern of correlates supporting the concept of multiple dimensions of fatigue. This enhanced understanding of fatigue could be used to guide the development of individually tailored interventions to target specific correlates of fatigue in affected domains, or group interventions to address all relevant fatigue correlates. Because fatigue is associated with multiple symptom correlates, it requires multi-focused symptom management. Education is a commonly recommended fatigue management strategy which can be used to target multiple symptoms simultaneously. There is a lack of information about the content and format used in education programs and the effectiveness of education in managing fatigue. The second study in this thesis addressed Aim V, to develop and trial a group-based educational intervention to target cancer-related fatigue. The study examined a group-based educational intervention (CAN-FIT) targeting cancer-related fatigue in radiotherapy patients. A pilot study of the intervention’s feasibility and acceptability indicated the intervention was acceptable to participants and its operation was feasible. Small modifications to program components were made based on participant feedback. A randomised controlled trial was then conducted to examine effectiveness of the CAN-FIT program and to ascertain the most effective timing for such an educational intervention. The study employed a factorial design and recruited 110 participants. Assessments were conducted at three time points, the start of radiotherapy, the end of radiotherapy and six weeks after the completion of radiotherapy. Results of the randomised controlled trial of CAN-FIT did not show a significant effect of the program on cancer-related fatigue levels, however the pre-radiotherapy education sessions were associated with significant increases in physical activity participation. Furthermore, the study demonstrated the delivery of education prior to radiotherapy was more effective than delivery after radiotherapy. This thesis successfully addresses its stated aims and provides a greater understanding of the concept of cancer-related fatigue. The results more clearly describe the course and correlates of fatigue and their relationship with the dimensions of fatigue. The MCID criteria for the MFI can be used in future research to evaluate outcomes and determine sample size in power calculations. The intervention trialled can be used in clinical practice to provide a low-resource intervention to improve activity levels without any subsequent change in fatigue in radiotherapy patients. Together these studies build upon current knowledge and provide directions for future research to address this difficult symptom.

Thesis (M.A.)--Georgia State University, 2007. / Title from file title page. Patricia Clark, committee chair; Elisabeth Burgess, Molly Perkins, committee members. Electronic text (72 p.) : digital, PDF file. Description based on contents viewed Nov. 8, 2009. Includes bibliographical references (p. 59-67).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.