Thesis (M.S.P.H.)--University of Michigan, 1942.

Made available in DSpace on 2015-05-08T14:47:49Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1545573 bytes, checksum: ee37e47fe58dc717e2321d96ae7e0a57 (MD5) Previous issue date: 2015-09-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The psychiatric nursing and mental health community is an area of knowledge that has suffered structural changes along if its historical trajectory. Such modifications are perceived both in practice and in terms of knowledge, promoting changes in the role and identity of nurses who work in this area. Therefore, the Therapy Integrative Community (TCI) to set up a technology takes care that has spread through the network of Primary Health Care (ABS) of the country and contributed to the practice of nurse become even more competent and humanized. Objective: To analyze the changes in the practices of nurses who work in ABS, from the deployment of TCI, having in view the emergence of a new type of nurse that consolidates advances to the nursing field in the mental health community. Methodology: The study is based on qualitative understanding and interpretation. It was carried out with 14 nurses who carry out wheels of TCI in the Family Health Strategy in Campina Grande - PB, Patos-PB and Santa Luzia-PB. The empirical material was produced by means of two focus groups, conducted in the month of May 2014 in Santa Luzia and Joao Pessoa, having two interviews was performed individually. The corpus was analyzed by means of the theory of discourse analysis of French line of Eni Orlandi. The study followed the precepts of resolution 466/ 2012 that involves human beings, and was approved in April 24, 2014, under CAAE 19482313.7.0000.5188. Results: We identified two Blocks Discursive: Visions of paradigmatic nurses Community therapists before training and Visions paradigmatic after training: Typology of Nurse Therapist Community, thus, respectively have been identified practices facing the Cartesian Paradigm and holistic Paradigm. The fourteen nurses interviewed, 10 were identified as being of a new type, have new meanings their practices and understood that taking care of yourself is just as important as caring for the other, by accepting suffering, demonstrating empathy with the pain alien from sensitive listening and qualified, in order to break away from the social prejudice and history, making emerge the resiliency, the autonomy, the improvement of self-esteem and empowerment of participants and themselves. Thus, they occupy their place of nurse and caregiver and they begin to see how unfinished move closer to the ideal type, whose actions are rational with respect to values, because they have mastered the art of doing therapy and therapists; learn to be therapist doing therapy to feel the resonance of the stories of the other in his own life. Build daily seeking to their completeness, as a subject that transforms and is transformed. By mastering the technique, invest all its potential to be, being called Nurses resignified and unfinished. Final Considerations: It was found that the TCI represents a light technology of care and training has contributed to the nurses develop a social practice, based on principles and ethical values, which is to return to the collective, the oppressed, those who are suffering, strengthens the mental health community, the ABS/SUS and, in addition, prints the profession a new competence and the ability to shape, break paradigms, rebuild and build new identities for themselves and for the category. / A enfermagem psiquiátrica e de saúde mental comunitária é uma área do conhecimento que tem sofrido modificações estruturais ao longo se sua trajetória histórica. Tais modificações são percebidas tanto na prática como no saber, promovendo mudanças no papel e na identidade das enfermeiras que atuam nessa área. Por conseguinte, a Terapia Comunitária Integrativa (TCI) se configura uma tecnologia leve de cuidado que tem se disseminado pela rede de Atenção Básica de Saúde (ABS) do país e contribuído para a prática da enfermeira tornar-se ainda mais competente e humanizada. Objetivo: Analisar as transformações ocorridas nas práticas das enfermeiras que atuam na ABS, a partir da implantação da TCI, tendo em vista a emergência de um novo tipo de enfermeira que consolida avanços para a enfermagem no campo da saúde mental comunitária. Metodologia: O estudo baseia-se na abordagem qualitativa do tipo compreensivo e interpretativo. Foi realizado com 14 enfermeiras que realizam rodas de TCI na Estratégia Saúde da Família de Campina Grande-PB, João Pessoa-PB, Patos-PB e Santa Luzia-PB. O material empírico foi produzido por meio de dois grupos focais, realizados no mês de maio de 2014 em Santa Luzia e João Pessoa, tendo duas entrevistas sido realizadas individualmente. O corpus documental foi analisado por meio da teoria de análise de discurso de linha francesa de Eni Orlandi. O estudo obedeceu aos preceitos da resolução 466/ 2012 que envolve seres humanos, e foi aprovado em 24 de abril de 2014, sob CAAE 19482313.7.0000.5188. Resultados: Identificaram-se dois Blocos Discursivos: Visões paradigmáticas das enfermeiras terapeutas comunitárias antes da formação e Visões paradigmáticas após a formação: Tipologia da Enfermeira Terapeuta Comunitária, assim, respectivamente identificaram-se, práticas voltadas para o Paradigma Cartesiano e o Paradigma Holístico. Das quatorze enfermeiras entrevistadas, dez foram identificadas como sendo de um novo tipo, por terem ressignificado suas práticas e entendido que cuidar de si é tão importante quanto cuidar do outro, acolhendo o sofrimento, demonstrando empatia com a dor alheia a partir de escuta sensível e qualificada, buscando romper com o preconceito social e histórico, fazendo emergir a resiliência, a autonomia, a melhoria da autoestima e o empoderamento dos participantes e de si mesmas. Assim, elas ocupam seu lugar de enfermeira e cuidadora e passam a se enxergar como inacabadas aproximam-se do ideal tipo, cujas ações são racionais com relação a valores, pois dominam a arte de fazer a terapia e serem terapeutas; aprendem a ser terapeuta fazendo terapia para sentir a ressonância das histórias dos outros em sua própria vida. Constroem-se cotidianamente buscando a sua integralidade, como sujeito que transforma e que é transformado. Ao dominar a técnica, investem todo seu potencial em Ser, sendo denominadas de Enfermeiras Ressignificadas e Inacabadas. Considerações Finais: Constatou-se que a TCI representa uma tecnologia leve de cuidado e a formação tem contribuído para as enfermeiras desenvolverem uma prática social, fundamentada em princípios e valores éticos, que ao se voltar para o coletivo, o oprimido, aquele que sofre, fortalece a saúde mental comunitária, a ABS/SUS e, além do mais, imprime à profissão uma nova competência e a possibilidade de moldar, romper paradigmas, reconstruir e construir novas identidades para si e para a categoria.

No childbirth education (CE) programs are available in the public sectors in Jordan. Many studies from Jordan recommended that pregnant women be educated about their health needs during pregnancy and childbirth. From the literature, CE programs were found to have positive effects on pregnancy and childbirth outcomes. Four focus groups with pregnant women, midwives and physicians were conducted to examine the perceptions of pregnant women, midwives and physicians regarding the content, feasibility, and challenges of implementing a CE program in Jordan. The 4 focus groups, two with pregnant women (one group with 8 primiparous women and one group with 6 multiparous women), one with 8 midwives, and one with 6 physicians were presented with the content, timing, and a description of three existing CE programs. Findings indicated that pregnant women’s sources of knowledge about pregnancy and childbirth were mainly from other females and doctors but not from midwives. Younger pregnant women reported the Internet as an important source of pregnancy and childbirth knowledge. Findings showed that women were not sure of what they wanted to learn. Midwives and physicians wanted to include warning signs, physical exercises, psychological changes, vii nutrition, breast feeding, newborn heath, sexually transmitted diseases, pain management, postpartum physiology and care, family planning, and planning of pregnancy as content in a new CE program. All participants reported the need to include husbands in CE. However, husbands were considered a potential challenge to implementing a CE program. Other challenges were cost, staff, clients’ responses, and governmental policies. Midwives and physicians thought that CE should be included in free antenatal care. All participants reported support for a new CE program. Midwives and physicians suggested implementing the new program within the facilities of the Ministry of Health (MOH). This would decrease cost and the need for staffing for the new program. They suggested that the CE program could benefit from potential support from international sponsors that affiliate with the MOH. Potential benefits of CE could potentially help gain support from the MOH decision makers and the community in Jordan.

Children develop beliefs about ideal body image and carry these perceptions into adulthood. Consequences of poor body image may include decreased self-esteem, depression, unhealthy lifestyle, and eating disorders. Understanding healthy lifestyle behaviors and the relationship between body image and these behaviors can empower individuals to engage in behaviors to improve health. Pender’s health promotion model provided the theoretical framework for this study. The purpose of this study was to identify the relationship between body image and healthy lifestyle behaviors among undergraduate university students. An email was sent to undergraduate students, providing a link to the survey that included: demographic, body dissatisfaction, and screen time questions; Prochaska’s physical activity screening measure; and a lifestyle profile by Walker, Sechrist, and Pender. A total of 1056 usable surveys were returned. The majority (71%) were satisfied with their body image, although many (60.3%) wanted to alter it. Most (65.1%) had a normal BMI. Sedentary activity was more than the recommended amount, with only 23.3% meeting physical activity guidelines. Healthy lifestyle behaviors were engaged in “sometimes” and “often, but not routinely.” Body image was correlated with healthy lifestyle behaviors. There was a moderate correlation between activity and body image, and a negative correlation between sedentary activity and healthy lifestyle behaviors.

The purpose of this study was to compare the relative priority rankings assigned by educators and practiontioners of activities performed by school nurses. It examines the factors that under lies the differences in priorities assigned.

Introduction and background Opioid use disorder (OUD) is an epidemic in the U.S. OUD affects both the mother’s and infant’s health. Substance-exposed infants suffer from decreased health outcomes relative to non-exposed infants. Purpose The aim is to identify infant health outcomes when pregnant women are prescribed medication-assisted treatment (MAT) for OUD. Among pregnant women with OUD in the U.S., is medication-assisted therapy as compared to no therapy associated with decreased negative infant health outcomes? Literature review Five studies on OUD and infant outcomes in the U.S. were reviewed. CINAHL and PubMed were searched using terms opioid use disorder, pregnancy, and neonatal abstinence syndrome (NAS). The search was limited to the last five years and full text only. Of the 815 results, five articles were selected that focused on infant outcomes and prevention of NAS. Articles were excluded if the focus was solely on the maternal outcomes, cost, or unoriginal research. One meta-analysis was included that compared two types of MAT for pregnant women with OUD. Findings MAT is correlated with a shorter hospital stay and less severe NAS symptoms in infants. Conclusion and implications Rates of NAS and OUD have increased significantly in the US. Some of the increase may be attributed to the transition to ICD-10 codes. MAT for pregnant women with OUD is associated with better health outcomes for infants. Patient-centered care could help decrease negative health outcomes for both infants and women with OUD. Future study should focus on degrees of opioid exposure and related outcomes.

Introduction and Background: Between 1999 and 2014 the number of patients in the labor and delivery that were on medication for opioid use disorder (MOUD) quadrupled. The rate of unintended pregnancies in pregnant patients of mOUD is at a tremendous high due to inconsistencies in the use of reliable contraception in this population. Purpose Statement: To reduce the number of unintended pregnancies and infants born with neonatal abstinence syndrome there is a need for prevention and required education for men and women in medication-assisted facilities. Literature Review: Twenty research studies were reviewed and evaluated. These articles were found by utilizing PubMed, CINAHL, One Search, and Google Scholar. Most articles were discovered in the following Journals: Medical, Contraceptive, Preventative Medicine, Women's Health, Addiction, and Neonatal Nursing Journals. Findings: Through this research, we found there is a need for prevention services and required education onsite at the facility where patients are receiving medication for opioid addiction (mOUD). The following articles show the lack of contraceptive education, and misinformation about reproduction while on methadone or other medication-assisted drugs. Conclusion: The accessibility of having contraceptives onsite with required education for patients who are in treatment has been proven to be more effective and can decrease the number of unintended pregnancies or infants born with Neonatal Abstinence Syndrome. To be able to give better patient care for this specific demographic it is crucial that nurses are allowed to educate clients.

Alcohol abuse has been a major burden on the society. In the fight against it a key issue the education of the primary care nurses has been ignored. This study evaluates the effect of education program on the attitudes, beliefs, and confidence levels of primary care nurses regarding alcohol abuse and its treatment. Data from the Project Mainstream educational intervention were used with permission from the investigators. Two hundred one students and faculty of nursing at Vanderbilt University participated in the intervention, which was designed to train primary care providers in the Brief Negotiated Intervention technique for early detection and treatment of alcohol problems. Participants completed questionnaires before and after the educational intervention. Analysis of the data using paired samples t-test and one way analysis of variance showed statistically significant positive change in the nurses' attitudes, beliefs, and confidence levels regarding alcohol abuse and its treatment after the educational intervention. This study has shown the importance of educational intervention in dealing with alcohol abuse.

Purpose To examine the effects of Animal Assisted Therapies with Farm Animals (AATF) with domesticated ducks on depression and anxiety. Aim The proposed study will use single-group time series design and collect survey data to explore the changes in anxiety and depression in patients exposed to AATF. The study will be guided by the Self-Efficacy Theory. The study will involve 30 patients with TBI living in The Crumley House Rehabilitation Center in Limestone, TN. Hypothesis. Engaging in AATF with domesticated ducks will be associated with decrease in anxiety and depression. Approach - Theoretical Framework. Bandura’s Self-Efficacy Theory will be used to guide this study examining AATF effects on anxiety and depression in patients with TBI. Salutogenesis, Social Support, and Self-Efficacy theories were compared in order to select the best theoretical framework for this study. Methods Time series Quasi-experimental design. The study will examine the effects of AATF on anxiety and depression among patients with traumatic brain injury (TBI). Because of the unique characteristics of the patient population (all patients have history of TBI) in this facility no other rehabilitation center can be utilized for comparison. Time series design will ensure that all of the participants will be exposed to the therapeutic intervention, it will not be affected by the conventional treatments the participants are receiving. Projected Results and Anticipated Limitations It is expected that AATF will be effective in reduction of Anxiety and Depression symptoms in the patient with TBI Limitations • Possibility of dropouts may compromise sample size and lead to lower statistical power. • AATF based intervention is impossible to conduct in blinded environment. That in turn may contribute to participant’s expectation of positive outcomes of the interventions in this study. This may be considered an example of subject bias. • AATF treatment cannot be completely standardized. Because the treatment is based on interaction with live animals, animal behavior may be different during each visit to the duck pen. Because of that there is a possibility that the study cannot be exactly replicated. • The participants may have different duration or complexity of treatments for anxiety and depression. This may present a confounding factor that we are not able to control in this study. Conclusion This is a pilot study to examine the effects of AATF with domesticated ducks. This study may serve as a basis in developing more research on this topic with expanding the methodology and sampling in the future.

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”.