Health Risk Appriaisal (HRA) is gaining widespread popularity as a health promotion strategy. Yet there are limited studies to date to assess the impact of HRA on health behavior, particularly among young populations. The purpose of this investigation was to determine the effectiveness of individual HRA results as a stimulus for young adults to pursue health promoting behavior. It was hypothesized that young adults exposed to the results of their personal HRA would demonstrate a significantly higher health habits change score than would young adults given the HRA, but not exposed to its results. A pretest-posttest, control group design was used for the study. Thirty-six young adult volunteers ages 23 to 38 were randomly assigned to either the control or the treatment group. An investigator-designed Personal Health Habits Questionnaire (PHHQ) and HRA were completed by all subjects at an initial group meeting. The HRA questionnaires were then submitted to the Center for Disease Control — Atlanta for computer processing. At a second meeting for experimental subjects only, individual risk appraisals were distributed and guidelines for interpretation given. Six weeks later, at a third and final group meeting, the PHHQ was completed again by all subjects. Thirty subjects completed the study. PHHQ pretest to posttest behavior change scores revealed a significant positive change in the experimental group's health behavior as compared with control subjects (Student's T Distribution, p ≤ .05). The greatest degree of positive health behavior change was seen in the areas of seatbelt usage, breakfast habits, and achievement of desirable weight for body height and frame in that order. Chi square analysis revealed that experimental subjects maintained a significantly higher proportion of positive health behavior than those who did not receive their HRA results (p ≤ .05). The generalizability of these findings is limited by the study's small sample size. However, HRA does seem to be a viable strategy for group health promotion activities in nursing practice. Replications of this investigation with larger probability samples are needed. Further study of educational and environmental interventions to enhance and sustain the impact of HRA on health behavior is also needed to develop a scientific basis for individual, group, and community nursing interventions concerned with primary prevention.

Summary The purposes of this ex post facto research study were to answer the following questions: 1. What is the length of time required for glass thermometers to register the temperature in neonates at the rectal and axillary sites? 2. Do significant differences exist between simultaneous axillary and rectal temperature recordings in neonates? 3. What is the relationship between axillary and rectal temperature recordings at specified time intervals in neonates? A sample of 30, full-term neonates was obtained from the Newborn Nursery of a large teaching hospital in the Middle Atlantic region. All participants were over 24 hours of age and weighed greater than 2,500 grams. Each subject had simultaneous axillary and rectal temperature recordings made at one minute intervals over a 12 minute period. Data analysis was performed which determined thermometer placement time, mean, range and standard deviation of temperature recordings, level of significance for the differences between axillary and rectal sites, and the correlation between rectal and axillary temperature recordings. Conclusions On the basis of the data analysis, the data from this study supported the two stated hypotheses: 1. Significant differences exist between simul- taneous axillary and rectal temperature recordings in neo- nates (p < .01). 2. There is a direct and positive correlation between axillary and rectal temperature recordings at specified time intervals in neonates (p < .01). The following conclusions were also drawn from these data: 1. The maximum placement time for rectal thermometers to register the neonate's temperatures was eight minutes. The optimum placement time for rectal thermometers was four minutes. 2. The maximum placement time for axillary ther- mometers to register the neonate's temperatures was 12 minutes. The optimum placement time for axillary thermometers was eight minutes. 3. The mean rectal maximum temperature in neonates was 99.05 plus or minus .49 degrees Fahrenheit. The mean rectal optimum temperature was 98.88 plus or minus .51 degrees Fahrenheit. 84 4. The mean axillary maximum and optimum temperatures in neonates were 98.87 plus or minus .47 degrees Fahrenheit and 98.7 plus or minus .48 degrees Fahrenheit, respectively. 5. The mean difference between maximum rectal and axillary recordings was 0.18 degrees Fahrenheit. The mean difference between optimum rectal and axillary recordings was 0.19 degrees Fahrenheit. Implications for Nursing As a result of this study, the following implications for nursing practice are implied: 1. A longer thermometer placement time for determining rectal and axillary temperature recordings in neonates may be indicated. 2. Although significant differences between simul- taneous axillary and rectal temperature recordings exist in neonates (p<.01), the small difference (i.e., 0.18 degrees Fahrenheit for maximum temperatures and 0.19 degrees Fahrenheit for optimum temperatures) between the two sites may not greatly influence nursing care of neonates. 3. In a constant environmental temperature,axillary and rectal temperature recordings may be used interchangeably in neonates (based on #2, above). Recommendations for Further Study It is recommended that this study be replicated: 1. Using a larger sample size of neonates to retest this study's hypotheses. 2. Comparing axillary and rectal temperature recordings of a clinical glass thermometer with an electronic thermometer. 3. Specifically determine if gender, age, race, or weight influence thermometer placement time in neonates. 4. Comparing neonatal temperatures in varying environmental temperatures.

<p> <b>Purpose:</b> The purpose of this clinical scholarly project was to plan and execute a sepsis education presentation on identifying sepsis and using the three hour treatment bundle from the Surviving Sepsis Campaign to treat sepsis. The target audience is non-critical care inpatient nurses in a medium sized acute care community hospital.</p><p> <b>Methods:</b> Nurses were assigned a course over HealthStream, a web-based platform, which included the presentation along with a pre-test and post-test, and a consent statement to have their score reports analyzed. A descriptive analysis of group pre-test and post-test scores, compliance with completing each component of the three hour treatment bundle, sepsis mortality, and sepsis length of stay was completed.</p><p> <b>Findings:</b> There were 586 nurses who completed the course. A total of 172 nurses consented to having their test scores analyzed. The same test was used for the pre-test and the post-test. Overall, the mean test score for the pre-test was 75% and the mean post-test score was 92.6%. Completion compliance with each of the four components of the three hour treatment bundle increased in the 90 days following the education. Unfortunately, sepsis mortality and sepsis length of stay increased in the 90 days following the education using an outcome/expected variance ratio.</p><p> <b>Conclusions:</b> This project increased the post-test scores over pre-test scores. There was a linear relationship between increased post-test scores and at least one component (initial lactate vii measurement) of the three hour treatment bundle. There were confounding factors that might contribute to increased compliance of the treatment bundles. This method of education delivery proved useful for one person to provide education to a large group of nurses over a short period of time and allowed for the nurses to complete the course when they had time to do so.</p><p> <b>Recommendations:</b> This project should be expanded to include other areas of the hospital such as wound care, surgery clinic, emergency department, and other outpatient areas. In addition, the program could be modified for critical care unit nurses to include training on the six hour treatment bundle which focuses on critical care interventions.</p>

<p> Incivility in the nursing literature is a term used to identify situations where distractions or discord invade the learning atmosphere. Nursing student incivility is an ongoing problem in nursing education and may cause disruption or conflict in the learning environment. Students deserve a learning environment free of distractions or harassment. Additionally, the instructor should be able to teach in a productive, positive learning environment.</p><p> Many researchers have examined the impact of incivility but the lived experience of male nurse educators has not been examined. This study examined incidents of incivility to study the lived experiences of male nurse educators, as well as the effect nursing student incivility has on pedagogy and job satisfaction. </p><p> A qualitative phenomenological approach was used to evaluate the data. Nine male nurse educators in the northeastern United States met the inclusion criteria for the study. Interviews were conducted and transcribed verbatim by the researcher. Codes were assigned and were analyzed into themes. Themes were used to describe and understand the lived experiences of male nurse educators who have experienced nursing student incivility.</p><p> The results of the study revealed that male nurse educators experienced many of the same uncivil events with the similar physical and emotional symptoms as found in previous studies. Intuitively, or through trial and error, the study participants implemented many of the comparable techniques to prevent or control student incivility as found in the literature. Where the study findings differed, though, was the aftermath of student incivility. Male nurse educators did not take the same ownership responsibility nor have as many physical and emotional symptoms as female nurse educators. Nursing student incivility did not impact job satisfaction or inspire any participant to leave nursing education. This study discovered that many of the male nurse educators acted as unofficial mentors to male nursing students to promote male student retention in the nursing profession.</p><p> These study findings provide a better understanding of the lived experiences of the male nurse educator who has experienced nursing student incivility. This information may be used by faculty and administrators to improve their understanding and management of nursing student incivility. The study results suggest a need for further research in the impact of a male nurse educator mentor on the retention and graduation of the male student nurse.</p>

<p> Inadequate and inconsistent nursing practices related to pain management are a significant problem facing stakeholders in the health care industry. The purpose of the research study was twofold: (a) to explore the processes used by registered nurses&rsquo; for clinical decision making regarding pain management in the acute care setting and (b) to develop a substantive theory using grounded theory by examining the emergent data from the perceptions of as many as 20 registered nurses. The study explored registered nurses&rsquo; perceptions of the process of clinical decision-making in pain management within the context of social norms of nursing care and the setting in which practice takes place. The exploration of the complex dynamics of clinical decision-making in pain management was guided by the principles of classic grounded theory. Fourteen registered nurses (<i>n</i>=14) participated in an interview process and provided their perceptions of the clinical decision-making process in pain management. Through an inductive iterative process of constant comparative analysis, patterns of conceptual relationships were revealed closing the theory-practice gap in the literature for the substantive problem of inadequate pain management and the process of clinical decision-making in pain management. The substantive theory that emerged from the data is facilitating shared understanding: registered nurses partnering through relating, referring, advocating, and bargaining with the patient, and members of the health care team to make patient-centered clinical decisions in pain management.</p>

<p> <b>Objective:</b> The purpose of this DNP Project was to investigate factors that influence the sustainability of a prior nursing physical assessment education intervention with intensive care unit (ICU) nurses working at Saint Luke&rsquo;s Hospital in Haiti.</p><p> <b>Methods:</b> A qualitative design, utilizing focus group interviews and direct observation was used. Two focus group interviews were held at St. Luke&rsquo;s Hospital. Participants were identified via purposeful sampling, with the aid of key informants, to include Haitian nursing and medical administration, ICU staff nurses, and physicians that participated in the prior nursing education intervention. An interpreter was present during the interviews. The interviews were audio taped, allowing verbatim translation and transcription into English. The transcription was analyzed to identify themes regarding factors that influenced the sustainability of the prior nursing physical assessment education.</p><p> <b>Findings:</b> The majority of themes identified in the nursing focus group interview were mirrored in the physician focus group interview and aligned with current literature. These included staffing, nursing knowledge regarding physical assessments, and continuing education. The nursing focus group indicated that ongoing communication and collaboration were factors influencing sustainability. In the physician focus group, the theme of interdisciplinary integration also emerged.</p><p> <b>Conclusion:</b> There is limited literature discussing the factors that influence sustainability of nursing education in developing countries. A program evaluation to examine these factors for the prior nursing education at St. Luke&rsquo;s Hospital had not been conducted. Findings indicate that there are numerous factors that influenced the sustainability of the prior nursing physical assessment education intervention. Although these findings are not transferable to other settings or populations, understanding means to increase sustainability may be influential in future nursing education endeavors with St. Luke&rsquo;s Hospital in Haiti.</p>

<p> This phenomenological study examined the understanding and perception of the lived experiences of 10 Menominee Native Americans living with renal disease. Nationally, the increasing incidence of diabetes and obesity and an aging population have contributed to the rise in chronic kidney disease placing the population at risk for end stage renal disease (ESRD) (National Kidney Foundation, 2012). Among all racial/ethnic groups, Native Americans (NA) have the highest rates of diabetes (12%) and obesity (39%) and the incidence of end-stage renal disease in Native Americans is twice that of Caucasians (Collier, 2013; Gao et al., 2007; Indian Health Services, 2011; Jolly et al., 2011). The primary data collections were semi-structured face-to-face interviews. The data was coded and analyzed using the modified van Kaam&rsquo;s rigorous four phase psychophenomenological method. A total of 24 descriptive expressions were categorized into 8 preliminary structural elements. Four essential structural elements emerged from the eight preliminary elements: (a) fighting for normalcy, (b) chronic emotional and physical fatigue, (c) living for someone else, and (d) predetermined tribal fate. Eight of ten participants had an understanding of a predetermined tribal fate to renal disease, but the observed or familial knowledge did not influence their lived experience or change the course of their health care decisions.</p>

<p> <b>Background:</b> Scholars increasingly argue that health and its attendant disparities and inequities are socioculturally constructed, and implore nurses to engage in social justice to identify and redress the societal conditions that negatively impact individual and public health. Few nurses understand or engage in social justice, but professional awareness and involvement may increase if a theoretical framework elucidating the process can be developed.</p><p> <b>Purpose:</b> The purpose of this study was to generate a theory of social justice specific to the discipline of nursing. The primary research question was, "What are the critical factors shaping nurse professionals' perceptions and attitudes about their role in social justice?" Related questions included, "How do nurse professionals come to know and practice social justice?" and, "What process do nurse professionals use to identify the contexts in which they will engage in social justice?"</p><p> <b>Philosophical Underpinnings:</b> This qualitative, constructivist grounded theory study was guided by the philosophical tenets of symbolic interactionism and pragmatism.</p><p> <b>Methods:</b> This study used the constructivist, grounded theory methodology articulated by Charmaz. Semi-structured interviews were conducted to collect data from nurses who engaged in social justice. Data segments from the interviews were coded, categorized, and analyzed for conceptual relationships. Theoretical sampling was used to develop and saturate the conceptual categories and themes identified from the interviews. The conceptual relationships were developed into a substantive theory to explain the role of nurse professionals' engagement in social justice. A focus group of six nurse experts in social justice was used to confirm the generated theory of the nurse professional's role in social justice.</p><p> <b>Results:</b> Emancipatory nursing praxis was the basic social process that was co-constructed from the voices of nurses engaged in social justice and the researcher's interpretation of their experiences, perceptions, and attitudes. The implementing processes&mdash;becoming, awakening, engaging, and transforming&mdash;comprised the interactive processes that concomitantly determined emancipatory nursing praxis. Two conditional contexts, relational and reflexive, framed and influenced the process. The theoretical framework of emancipatory nursing praxis provided an in-depth understanding of the process of nurse engagement in social justice.</p><p> <b>Conclusions:</b> The theoretical framework co-constructed from this study can be used to guide nursing education, research, and practice of social justice, thereby strengthening the profession's ability to identify and redress the societal conditions that negatively impact individual and public health.</p>

<p> Thirty-five years have passed since the HIV epidemic began and the stigma associated with the disease is still present today. This study examined the level of HIV stigma that exists among students attending a nursing school in an area with a high prevalence of HIV/AIDS. The study also determined if the level of stigma differed between pre-licensure and post-licensure nursing students. </p><p> Demographic data and responses from the Health Care Provider HIV/AIDS Stigma Scale (HPASS) were collected from 234 nursing students attending a large, urban university in Long Beach, California. Results indicated that participants had an overall low to low-moderate level of HIV stigma, but a moderate level of stigma was noted on the stereotyping subscale. No significant differences were found between pre-licensure and post-licensure students. However, students who personally know or knew a person living with HIV/AIDS had a significantly lower level of stigma than those who did not.</p>

<p> This retrospective study was conducted to examine the indwelling time and complication rate in routine replacement versus clinically indicated replacement of peripheral intravenous catheters in the adult intensive care population. A total of 73 patients with 286 peripheral intravenous catheters were included in the routine replacement group; 64 patients with 296 peripheral intravenous catheters were included in the clinically indicated replacement group. The device days for the clinically indicated replacement group was significantly longer than the RR group (CI: 4.2, RR: 3.35, <i>p</i> &lt; .00001). Chi square test showed no significant differences in complication rates between cohorts (<i>p</i> = 0.057, <i>z</i> = -1.91, RR 1.32, %RR 32, CI 1.00-1.76). The results suggest that clinically indicated replacement and routine replacement of peripheral intravenous catheters have equivalent incidence of complications. Adoption of clinically indicated replacement may spare patients from unwarranted pain, decrease nursing workload and increase cost savings for hospitals.</p>