Loss of control is a well-documented human response to hospitalization. The purpose of this study was to construct and test a theoretical model of perceived territorial control among hospitalized adults. Territorial control was defined as the freedom or choice one has in regulating or influencing the objects, activities, and social intereactions within a particular space claimed or identified as one's own. The space of concern in this study was the patient's hospital room. The study focused not on the negative aspects of a loss of control but on the positive outcomes of having a sense of control. A three-stage, multivariate, causal-modeling design was used to estimate the impact of perceived territorial control on state anxiety and satisfaction with care in a convenience sample of 80 Hispanic and Anglo-American males and females between the ages of 18 and 79 who were in the hospital for short-term orthopedic care. Attitudinal, self-report measures were used predominantly. Instruments were constructed to index centrality of territory and territorial control perceptions. Correlational and multiple regression statistical techniques were used to estimate the theoretical model. Tests for violations of the statistical and causal assumptions were performed. Centrality of territory, assistance needs, and the powerful others locus of control significantly influenced patient territorial control perceptions. Temporal duration, internal locus of control, and chance locus of control made no significant impact on perceived territorial control. Patient territorial control perceptions significantly decreased state anxiety and significantly increased satisfaction with care. Perceived territorial control explained 24 percent of the variance in patient state anxiety and 21 percent of the variance in satisfaction with care. An unstaged, empirical test of the model increased the explained variance to 32 percent for state anxiety and 40 percent for satisfaction with care. There was a positive relationship (r = .41) between age and centrality of territory and a negative relationship (r = -.31) between age and state anxiety. The implications were related primarily to continued theory-building and the development of nursing practice theories.

This study assessed the psychological problems associated with hemodialysis and included an investigation of the differences and similarities between (1) dialysis patients' and medical staff's perceptions of patients' problems, and (2) the problems of hemodialysis patients and spinal cord injury patients. Data were collected from 31 adult hemodialysis patients, 34 dialysis medical staff and 32 spinal cord injury patients at the Miami, Florida Veterans Administration Medical Center. The scaling technique of magnitude estimation was used to measure patients' and staff's perceptions of the relative seriousness of various illness-related problems. Depression and anxiety in hemodialysis patients and spinal cord injury patients were measured by standardized self-report inventories. Among the most significant findings were that: (1) Dialysis patients judged problems concerning lifestyle changes (e.g., inability to travel and work) and loss of body function (e.g., reduced levels of physical activity) to be more serious or emotionally distressing than other problems they experienced. (2) Dialysis patients and medical staff differed significantly in their perceptions of the seriousness of most problems associated with hemodialysis; moreover, there was less agreement between patients and physicians than between patients and other types of staff (e.g., nurses and technicians). (3) There were no significant differences between dialysis patients and spinal cord injury patients in their scaled problem judgments. (4) Depression in hemodialysis patients and spinal cord injury patients was greater than for the general population, with the majority of both patient groups meeting criteria for diagnosis of clinical depression. In addition, although dialysis patients and spinal cord injury patients did not differ significantly in their total mean depression scores, dialysis patients endorsed somatic components of depression more frequently and/or with greater intensity than spinal cord injury patients did. (5) Anxiety in dialysis patients was not greater than for the general population and was significantly less than for spinal cord injury patients. (6) Depression and anxiety were positively related to most problems for hemodialysis patients, while anxiety, but not depression, was significantly associated with most problems for spinal cord injury patients. A major contribution of this study is the comparison, for the first time, of patients' and medical staff's scaled problem judgments.

It was proposed that the optimal matching of psychotherapy approach to selected patient characteristics results in improved treatment outcome. Three patient dimensions were identified as contributing specific predictive power in determining the effectiveness of several types of treatment: symptom complexity, style of psychological defense, and reactance potential. Symptom complexity level was held relatively constant by studying a sample of psychiatric inpatients, who were admitted to a teaching hospital for short-term care and treated in individual psychotherapy by psychiatric residents and psychology interns. Patient defensive style was assessed in terms of an internalization/externalization ratio, derived from patient MMPI scores, and was hypothesized to differentially affect outcome depending on the degree of patient-therapist match in terms of an internalized versus externalized focus of therapeutic approach. Patient reactance potential was assessed by the Control Wanted subscale of the FIRO-B, and was hypothesized to be optimally matched by varying levels of therapy directiveness. Therapeutic approach was assessed by scores on the Theoretical Orientation Questionnaire. Outcome was assessed by three independent sources: therapist discharge ratings of global improvement, pre- and posttreatment patient ratings on a standardized symptom index, and nurses' ratings of ward behavior at the beginning and end of treatment. These measures constituted the dependent variables in a series of multiple regression analyses, which also included a number of patient background and collateral treatment variables as potential predictors. Results indicated that, after accounting for pretreatment levels of disturbance, the match between patient defensive style and internal/external focus of therapeutic approach was a significant predictor of treatment outcome. The degree of patient-therapist match on this dimension accounted for 9% and 8% of the variability in posttreatment measures of patient symptomatology and ward behavior, respectively. Matching with respect to patient reactance potential and therapy directiveness was not seen to affect outcome, and no effects due to matching were observed for therapists' ratings. Results are discussed in terms of validity and reliability of the ratings, problems in assessment from the different vantage points of patient/therapist/observer, and biases deriving from the use of self-report instruments.

This study examined changes in adult learning, adaptation, and anxiety that occurred as the result of the adult cancer education program "I Can Cope." The study utilized a repeated measures descriptive design. A volunteer sample of 19 subjects participated in this study. Changes in each person's pre-mid-post-test scores were measured against their pre-mid-post-test scores on three instruments: (a) Course Inquiry Test; (b) Purpose in Life Test; and (c) A-State Anxiety Inventory. A comparison of scores measured whether any short-term adult learning, adaptation and change in anxiety occurred as a result of the "I Can Cope" Program. The study did demonstrate that an organized adult patient education program could foster and enhance adult learning and adaptation as well as influence anxiety of participants.

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Class of 2012 Abstract / Specific Aims: To compare and evaluate the therapies prescribed, the incidence of adverse drug events, and the time to clinical cure in transplant patients with a cytomegalovirus (CMV) infection at an academic medical center before and during the foscarnet nationwide shortage. Methods: This study was a retrospective chart review to compare CMV treatment prescribed and clinical outcomes in pediatric and adult transplant patients at an academic medical center. Transplant patients were evaluated over a 16 month time period between December 2009 and March 2011. The average dose (mg/kg) and prevalence ganciclovir, foscarnet, and cidofovir prescribed in transplant patients with CMV infection were evaluated. Additionally, the incidence of adverse drug events including acute renal dysfunction and myelosuppression were characterized. Main Results: There were 30 subjects diagnosed with CMV disease during the evalutaion period. Of all of the patients treated for CMV before the shortage, 79% received ganciclovir, 43% received foscarnet, and 21% received cidofovir. Following the shortage in September 2010, the usage of the antiviral agents changed to 100%, 25%, and 13% respectively. Overall the usage of ganciclovir increased while the usage of foscarnet decreased when there was a shortage of medication. Conclusions: The antiviral prescribing patterns changed significantly during the foscarnet shortage. The average dose and incidence of ganciclovir increased which likely contributed to serious adverse events. Due to the limited amount of patients treated for CMV and the short time frame, clinical cure could not be determined at this time. Drug shortages are a serious problem and significantly influence patient outcomes.

Class of 2009 Abstract / OBJECTIVES: To assess whether patients at University Medical Center (UMC) in Arizona who have indications for venous thromboembolism (VTE) prophylaxis receive treatment, determine whether appropriate pharmacologic VTE prophylaxis is implemented, and analyze the incidence of VTE associated with prescribed regimens. METHODS: Data were derived from a retrospective chart review on risk factors for VTE and prescription of pharmacological and non-pharmacological thromboprophylaxis. Two risk assessment models were used to evaluate adherence to treatment standards: the 2008 American College of Chest Physicians (ACCP) evidence-based consensus guidelines and the Caprini score. Clinical outcomes were evaluated with regard to proper thromboprophylaxis including assessment of appropriate time, type, intensity, and duration of treatment. RESULTS: A total of 366 patients met inclusion critera. Based on the Caprini score, 94% of patients were judged to be at risk for VTE. Of those at risk, 90% received thromboprophylaxis; however, only 35% of treated patients received proper thromboprophylaxis. Ten patients (2.7%) experienced a VTE during their hospital stay or within the following 6 months after discharge. There was not a significant difference in incidence of VTE with respect to treatment versus no treatment or proper versus improper prophylaxis (p=0.15 and 0.65, respectively); however, a favorable trend in incidence of VTE was observed for treated patients and patients treated with correct thromboprophylaxis based on risk assessment. CONCLUSIONS: Most patients at UMC who were indicated for VTE prophylaxis received treatment; however, the type, intensity, and duration of thromboprophylaxis were often inappropriate despite the existence of various guidelines.

Magister Public Health - MPH / Background: Over the past decade, South Africa has scaled-up its antiretroviral treatment (ART) programme in an effort to control the HIV epidemic. Interventions to support the rollout of ART include task shifting ART initiation to nurses at primary health care level and ensuring HIV adherence counselling at every visit by lay counsellors. Furthermore, community-based outreach teams work at the community level to follow up on patients and ensure that patients remain in care and are adhering to ART. Despite all these efforts, poor adherence to ART remains a pertinent problem. In 2016, the national adherence to ART rate among adult patients was estimated at 35% compared to 39% in Pule Sefatsa clinic in Mangaung district, Free-state Province. Aim: The aim of the study was to explore the factors that influence poor adherence to ART among patients receiving ART at Pule Sefatsa primary health care clinic in Mangaung district, South Africa. Methodology: A descriptive qualitative research approach was used. Two focus group discussions were conducted with health workers and community caregivers and 16 in-depth interviews were conducted with ART patients who are in care and those who had defaulted on their treatment. Audio recorded data obtained from these sources were transcribed verbatim and prepared for analysis. Thematic analysis was used for data analysis and the results were classified under various categories. Findings: Adherence to ART in Pule Sefatsa clinic was found to be influenced by medical related factors, socio-economic factors, health system factors and individual factors. The medical-related factor was the side effects of the medication. The socio-economic factors were stigma and discrimination, lack of family support, poverty and food insecurity. Health system factors that hindered adherence to ART were medication stock-outs, long waiting times and poor service delivery. The final group of barriers to ART adherence was related to the individuals using ART and these include patients forgetting to take treatment and feeling depressed.