With increased advances in technology, the overall survival rates in the Neonatal Intensive Care Unit (NICU) for premature infants at lower gestational ages, has also increased. Although premature infants survive at lower gestational ages, they are often discharged to home with unresolved medical issues. While the birth of a new baby for parents is a joyous occasion, they often have difficulty coping and transitioning into a parental role. Premature infants also have ongoing complications such as difficulty with feeding, developmental delays in growth, and long-term eye and respiratory complications. As a result of chronic health sequelae, premature infants require extensive utilization of hospital and community health resources. In addition, hospitals must coordinate between community resources, while preparing parents for specialized discharge teaching. Furthermore, individuals living in rural and underserved areas face unique challenges and barriers to access healthcare resources. An interpretive phenomenology study was conducted to bring insight and develop an understanding into how families perceive discharge readiness, accessing health care resources, and ability to cope at home after discharge from a Level III NICU located in Appalachia. Ten parents total were enrolled in the study and consisted of three couples, three married mothers, and two single mothers. Interviews were conducted over a period of six months and transcript analysis revealed development of major and minor themes. The studies overarching theme was Adapting to a New Family Roles, Finding Normalcy, which described parents experience of being prepared for discharge and their transition to home. Three major themes related to discharge readiness from detailed analysis included; 1) Riding out the storm, 2) Righting the ship, and 3) Safe port, finding solid ground. Subthemes that supported development of the major these were 1a) having the carpet pulled out from under me, 1b) things I lost, 1c) feel like an outsider, 1d) sink or swim, 2a) quest for knowledge, 2b) caring for me, care for my baby, 2c) customized learning, 3a) getting to know baby, 3b) becoming the expert, 3c) ongoing emotions, and 3d) adjusted parental role. Practice and research implications for discharge readiness include providing customized support for parents as they adjust to a new normal for their family, identify necessary resources, and become self-reliant once home.

Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of depressive symptoms on the association between sleep disturbance and QoL in patients and family caregivers; and 3) provide evidence of the psychometric priorities of the Zarit Burden Interview (ZBI) as a measure of caregiving burden in caregivers of patients with HF. The three specific aims were addressed using secondary analyses of cross-sectional data available from 143 patients with HF and their primary family caregivers. To accomplish Specific Aim One, multilevel dyadic analysis, actor-partner interdependence model was used for 78 patient- caregiver dyads. Individuals’ sleep disturbance predicted their own poor QoL. Caregivers’ sleep disturbance predicted patients’ mental aspect of QoL. For Specific Aim Two, a series of multiple regressions was used to examine the mediation effect in patients and caregivers separately. Depressive symptoms significantly mediated the relationship between sleep disturbance and mental aspect of QoL in patients. The mediation effect was similar in caregivers. For Specific Aim Three, the internal consistency and convergent and construct validity of the ZBI in 124 family caregivers of patients with HF were examined. The results showed that the ZBI is a reliable and valid measure of caregiving burden in this population. This dissertation has fulfilled important gaps in the evidence base for the QoL outcome in patients with HF and caregivers. The findings from this dissertation provided evidence of the importance of monitoring sleep disturbance for better QoL in both patients and caregivers and the importance of assessing caregivers’ sleep disturbance for improving patients’ QoL. It also provided evidence of the importance of managing depressive symptoms when targeting sleep disturbance to improve QoL in both patients and caregivers.

Many babies are delivered by using the standard lithotomy birthing position. However, evidence shows several benefits to an upright birthing position. The purpose of this study is to discover birthing positions that lead to more positive outcomes in laboring women delivering in hospitals. This research was conducted by examining previous studies conducted on a similar topic. However, the studies found mainly focused on the benefits of squatting positions and the implementation of devices that helps achieve an upright position. All findings support an upright birthing position provides a more optimal position for birthing a child due to the force of a more natural pelvic expansion and gravity. One of the barriers of this area of study includes the lack of pregnant mothers willing to participate in a study skewing the reliability of many studies. In conclusion, the articles analyzed provide pertinent information that supports the intervention of nurses and midwives providing patient education to explore birthing options outside of standard practice that could lead to more positive outcomes.

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to guide the project include rural health theory, novice to expert, and from limbo to legitimacy frameworks. Global outcomes include increased quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of institutional and community stakeholders (n = 10) to develop primary products including the residency program, curriculum modules, and the secondary products necessary to implement and evaluate the project. Implementation will consist of a pilot followed by expansion throughout the rural health network. Evaluation will involve the CAH dashboard to monitor patient outcomes, Misener NP job satisfaction scale, and employee turnover rates. The project expands understanding of the on-boarding needs of rural NPs. The results of this project will serve as a guide to publish outcome data and collaborate with higher education to develop programs to award academic credit for paid clinical experiences leading to academic degrees.

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.

Introduction & Background: Female athletes are at risk for developing eating disorders, they feel the need to engage in dieting, fasting, vomiting, and diet pills. These actions impact 35-57% of female athletes. An eating disorder can be defined as a variety of mental conditions that are characterized by an imbalance in eating and a weakness in physical or mental health. The female athlete triad is three components including osteoporosis, eating disorders, and amenorrhea (absence of menstrual cycle). Purpose Statement & Research Question: For female athletes around the ages of 18-23, what is the risk of eating disorders compared to their involvement in a competitive sport within the years they are participating in their sport? Literature Review: Sources were pulled from the CINAHL database, these articles are under 5 years of age. Findings: Female athletes develop low body weights. Approximately 4.3% of female athletes struggle with the female triad. The demands of athletes cause extensive stress and unhealthy eating patterns. About 62% of female athletes develop eating disorders. Conclusion & Nursing Implications: Nurses should be educated on how to identify symptoms, educate on risks associated with energy deficiency, and refer athletes to resources. It is important for nurses, coaches, and families to work to promote the health and well-being of athletes, and to prioritize prevention and early intervention when it comes to eating disorders. Key search terms: Search terms include “female athletes”, “the female triad”, “eating disorders”, “eating disorders in sports”, “coaches' role in the female triad”, and “risk for injuries”.

The purpose of this literature review was to identify differentiating risk factors in women for postpartum depression and postpartum psychosis. By understanding differentiating risk factors health care professionals, and nurses in particular, can be alert to women who are at higher risk for postpartum depression or postpartum psychosis. This information allows for early nursing intervention and the development of appropriate treatment plans. Fifteen peer-reviewed, English language research articles published between 2000 and 2015 were analyzed for the purpose of this literature review. Study results were inconclusive for the intention of this review, but do provide valuable information on independent risk factors for both disorders. A history of depression and significant life stressors are strong predictors for postpartum depression. Whereas a history of bipolar disorder is strongly associated with the development of postpartum psychosis. Further research is needed to examine the role of genetics in both postpartum depression and postpartum psychosis and to further evaluate risk factors for postpartum psychosis, specifically in women with no history of bipolar disorder. Moreover, additional research needs to be conducted within the United States due to a lack of generalizability of studies conducted in other nations.

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The Rural Expansion Program for At-risk Communities to Promote Health Outcomes through the Integration of Mental health and Enabling services in an Existing Primary Care School-Based Setting (REACH ME) program was established to increase access to mental health services at two existing school-based health centers (SBHC) in rural Hancock County, TN. These SBHCs are among the most unique in the nation, holding designations as federally funded qualified health centers - proving primary care services in a geographically isolated, rural, and medically underserved area. The aim of the project is increasing the number of patients receiving mental health and enabling services for not only the children and adolescents of Hancock County, but also adults who use the clinic for primary care services. This project employs a secondary data analysis to determine if there is an increase in the use of mental health services by patients using a school-based health center for care. Variables include number of visits, screening employed, and mental health diagnosis. Data gathered by health center staff and input into Excel will be used. Data collection is ongoing and is expected to be completed in February 2024. Early results indicate an increase in mental health and enabling services from initiation of the project. There were identified facilitators and barriers that impacted the project. Significance for this project is two-fold, identified facilitators and barriers to initiating integrated mental health services in the SBHC setting and increasing early screening, identification, referral and treatment of rural populations with mental health problems.

Trauma informed care nursing education is crucial. Trauma informed care is a method of providing health care which understands the likelihood of past and present traumatic events in patients and families. The experience of past or present trauma often led to chronic diseases, substance abuse disorder, fragmented health care, fears surrounding health care, chronic stress, and other negative health consequences. The purpose of this project is to increase licensed nurses’ awareness and ability to practice trauma informed care in clinical practice, as well as promote policy initiation within the health care facilities. Method planning integrated the Knowledge to Action Cycle. A two hour, Delphi reviewed, evidenced based educational session was developed for licensed nurses in two health care facilities. After the educational session is completed, an anonymous survey will be distributed to determine the licensed nurses’ awareness of trauma informed care. A second anonymous survey will be sent four weeks later to assess changes in clinical practice based on trauma informed care education. One educational session for eleven licensed nurses working in a psychiatric facility has been completed. Two preliminary themes emerged from the first survey. The first theme was more intentional focus on integrating trauma informed care principles into practice. The second theme was an increased need for self-care. Two more educational sessions are planned for licensed nurses in an acute care hospital. Keywords: trauma informed care, nursing, education, KTA Cycle, health care, policy