A large number of patients do not follow medical advice for reasons generally unclear to the health care provider. Significant morbidity and mortality can be outcomes of noncompliance. The purpose of this naturalistic inquiry was to study and clarify from the patient's perspective, issues identified as influencing the ability to comply with provider recommendations. Data collection and analysis occurred simultaneously as a fluid process of organizing and synthesizing qualitative material into categories or themes that emerged to illuminate a phenomenon. Seventy-six percent of participants described themselves as 100% compliant though they did not take medications as prescribed or failed to follow through with other recommendations, such as lifestyle changes. Participants listed positive perceptions when the provider: related to them, listened, addressed concerns, and included them in the plan of care. The provider behavior of listening was important to patients but was not the only aspect identified with a potential influence on compliance levels. Unexpected study findings included connections between symptomatology and medications, control issues between patient and provider, and the patient's perceptions of office personnel attitudes.

Disparity in access to health care and preventive services places a heavier burden of morbidity on those with limited access and resources. Underserved populations with decreased access to appropriate health screening and therapeutic interventions often present with increased risks for peripheral arterial disease. Some patients with peripheral arterial disease are asymptomatic and may defer treatment while others present with occlusive disease requiring immediate therapy. Delaying diagnosis and treatment reduces quality of life and functional status. The prevalence of peripheral arterial disease has been extensively studied in the elderly population but the prevalence in the high-risk underserved population is unknown. The purpose of this study was to identify the prevalence of peripheral arterial disease in an underserved, high-risk, predominantly African American population and to determine if providers using an electronic blood pressure machine could accurately measure the ankle-brachial index. The sample population of forty adult residents at a homeless shelter in northeast Florida was screened for peripheral arterial disease. Inclusion criteria consisted of a diagnosis of hypertension, hyperlipidemia, diabetes or a history of smoking. The ankle-brachial index was assessed using the vascular Doppler method and an electronic blood pressure machine though the latter was found to be an insensitive screening tool. The ankle-brachial index, the San Diego Claudication Questionnaire and a physical assessment were used in this crosssectional study to determine the prevalence of peripheral arterial disease. An abnormal ankle-brachial index value (≤ 0.90), indicating a high suspicion of peripheral arterial disease, was assessed in 22.5% of the sample population, all of whom were found to have a history of smoking crack cocaine.

Since the results of the Women's Health Initiative (WHI) study were published in 2002, millions of women and their healthcare practitioners have had to re-examine decisions about the use of hormone replacement therapy. This level one descriptive study explored the characteristics of menopausal women who could not tolerate estrogen withdrawal and continued taking hormone replacement therapy despite findings of risk published in the Women's Health Initiative. The sample included the medical records of 1,195 patients in a single-physician OB-GYN practice in northeast Florida. All records of women with a birth date in 1954 or prior and a visit to the practice for gynecological care between July 2002 and March 1, 2004 were reviewed to collect data about demographics, past medical history, and hormone replacement therapy (HRT) use. A significant portion of women (77.2%) had discontinued HRT. Of the women remaining on HRT, 54.7% changed either the dose or type of hormones taken. Only 59.5% of these women remained on the same estrogen dose both before and after the WHI results were published in 2002. Interestingly, there were 29 women (4%) who initiated HR T use after July 2002. The women who remained on HR T after WHI were more likely to be younger, Caucasian (72. 7% ), non-smokers (82.3% ), and taking medication for other conditions (68.5%). The older the woman, the less likely she was to have continued HRT. Younger women were more likely to have changed HRT drug and/or dose post-WHI.

Preloading student satisfaction and success factors into an online graduate nursing education program orientation course strengthens the potential for student retention and success. Major components of withdrawal from universities include personal reasons and support system issues. Support system issues often relate to a difference in the students’ anticipatory expectations and the realities of the educational program. Student perspectives on program expectations may be related to their experiences in a face-to-face undergraduate program format and an online graduate program format. Another conflict between student anticipatory expectations and program realities may be related to the level of learning and understanding required of graduate education compared to undergraduate education. A 100% online graduate nursing orientation and guidance program was developed to orient newly admitted students to the expectations of graduate nursing study, the requirements of this specific MSN program, and how to use the learning management system (Desire2Learn). Students were taught the basic structure of courses (including discussions, quizzes, and dropbox assignments). Access to peer support, faculty advisor, and university resources were provided within the course using the same architecture as the program courses. Students were encouraged to introduce themselves to other students. Opportunities were provided for more experienced students to share experiences and bits of wisdom gained from their studies. New students were encouraged to ask questions of fellow students and their advisor and to establish study groups. Ongoing discussion boards were provided for continuous student interaction and peer support throughout their time in the program. Students gained a realistic perception of the program, online graduate study expectations, and helped them to form a realistic understanding of the need to maintain a work-school-life balance. Students reported decreased anxiety and increased comfort with graduate online education, increased self confidence, and feelings of support, which prepared them for success.

Providing comfort is a fundamental nursing responsibility. Unrelieved postoperative pain has adverse physiologic and psychologic effects that contribute to prolonged hospital admissions and significant discomfort to patients. Opioids are standard methods of postoperative analgesia for many surgical procedures. Unfortunately, the use of opioids is associated with side effects such as nausea and vomiting, urinary retention, ileus and respiratory depression. These side effects, with the added problem of inadequate pain control, result in patient dissatisfaction with surgical procedures. Paravertebral nerve block (PVB) is a regional anesthetic technique that has been shown to result in opioid sparing in many procedures including breast and hernia surgery. This study investigated the possibility of improved postoperative pain and nausea management when combining paravertebral nerve blocks with general anesthesia (GA) , compared to general anesthesia alone, for laparoscopic Nissen fundoplication surgery. The convenience sample consisted of 29 patients receiving surgery at the Mayo Clinic, Jacksonville, Florida. There was significant correlation between the type of anesthesia and pain at 12 hours postoperatively, indicating that those who received PVB had less pain than those receiving GA alone, at that time. Although there was no significant correlation between type of anesthesia and nausea, only one patient vomited and others had minimum to moderate nausea, postoperatively. The information attained from this research will be beneficial to nurses providing pain management for patient comfort in the outpatient surgery center.

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.

AIM: Proper advisement of students about their programs of study requires knowledge of the applicants and confidence that the recommended curricula will lead to success via graduation and certification. . BACKGROUND: Two important strategies to deliver master of science in nursing (MSN) curricula include online and face-to-face (F2F) formats. . METHOD: A nonexperimental, descriptive study of archival data was used to examine and compare the characteristics of F2F and online MSN applicants, admitted students, and graduates as well as family nurse practitioner (FNP) certification pass rates at one eastern Tennessee college of nursing. Administration and FNP concentrations were studied. . RESULTS: The average applicant grade point average (GPA) was higher for the F2F format but no difference in the average admission GPA was found between formats. The online students had more years of RN experience than the F2F students. . CONCLUSION: No significant difference was found between graduating GPAs or FNP certification pass rates.

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