Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 71-02, Section: B, page: . Adviser: Sandra J. Weiss.

<p> The primary purpose of this clinical scholarly research project is to determine whether there are undiagnosed symptoms of depression among the residents in a small population Long Term Care facility (LTC). Caregivers at the LTC receive specific knowledge regarding older adult late-life depression and then apply said knowledge by surveying the LTC residents (LTCR&rsquo;s) using the Geriatric Depression Scale instrument (GDS-15). The secondary purpose is to determine whether the LTC caregivers perceive this training as beneficial. Using two-sample t-test statistical analysis, the results of this study indicate a positive correlation with the alternative hypothesis; the number of LTCRs with previously undetected depressive symptoms increased. H_a: &mu; LTCR with depression or delirium &ne; &mu; LTCR with depression or delirium. In this study, the number of LTCRs with symptoms of depression or delirium increased by 60.4 percent. The P (T&lt;=t) two-tail value is less than 0.001. In the literature, this difference is extremely statistically significant. The mean of the medical records examined minus the mean of the number of medical records with an indication of depression or delirium is 0.60. For a 95% confidence interval, this difference must fall between the ranges of 0.45 to 0.76. These data confirm the alternative hypothesis. </p><p> Additionally, the caregiver participant&rsquo;s satisfaction outcome survey results reported the training was substantially beneficial. </p><p>

<p> Factor H is a newly identified phenomenon which describes a constellation of attributes of the new graduate nurse reflecting personality traits, intellectual abilities, and clinical judgment. In a previous pilot study conducted by this researcher nurse managers and experienced Registered Nurse (RN) preceptors described characteristics demonstrated by new graduate nurses demonstrating Factor H and the new graduate nurse's ability to transition quickly and successfully into the RN role in the acute care environment. There is currently no instrument available to measure this phenomenon. The specific aim of this research was to develop and psychometrically test a scale designed to identify the presence of attributes of Factor H in the new graduate nurse. The Sims Factor H Assessment Scale (SFHAS) was developed and piloted with a sample of one hundred one new graduate nurses within three months of completing the their nursing program at one of three nursing schools in central and south central Indiana. Evidence of content validity was demonstrated through the use of the Content Validity Index conducted with a panel of four experts. Evidence of face validity was demonstrated through interviews with a group of new graduate nurses, nurse managers, and experienced RN preceptors. Principle Axis Factoring with Varimax rotation was used to demonstrate evidence of construct validity and the scale was found to have a single component which was identified as nursing personality. Evidence of criterion-related validity was demonstrated utilizing analysis of the SFHAS and the criterion scale for personality traits (NEO-FFI). Evidence of internal consistency reliability was demonstrated through analysis of inter-item correlations, Cronbach's coefficient correlations, and item-total correlations. Test re-test reliability using interclass correlation was also conducted to demonstrate stability of the scale. The SFHAS was found to be reflective of nursing personality and not general mental ability or clinical judgment. Use of the SFHAS will allow organizations to evaluate the nursing personality of the new graduate nurse for fit into the work environment. Further study is recommended to gain clarity around the attributes which support successful transition of the new graduate nurse into practice in the acute care environment, also known as Factor H.</p>

<p> The experience of anxiety and depression can have detrimental effects on the body, especially that of a developing fetus. Depression and anxiety have been linked to the experience of greater pregnancy symptoms, miscarriage, poorer birth outcomes and difficult deliveries. Despite their detrimental effects, depression and anxiety may be common during the prenatal period. A history of miscarriage may heighten normally occurring symptoms, adding a layer of difficulty to an already stressful time period.</p><p> Mind-body practices have been linked to a number of health benefits, including attenuation of psychiatric symptoms and improved pregnancy outcomes. While many of these practices have received increasing attention in popular literature, lacking are studies utilizing large, randomized clinical trials empirically validating the efficacy of these interventions.</p><p> The purpose of the original study was to examine whether miscarriage status and the engagement in mind-body practices were associated with lower levels of depression and anxiety in pregnant women. Forty-three (N=43) pregnant women in the second and third trimesters were recruited and questioned about their pregnancy, their engagement in mind-body practices (past and present) and were asked to complete the Center for Epidemiological Studies Depression Scale (CES-D) and the State Trait Anxiety Inventory (STAI). It was anticipated that women with a miscarriage history would report higher levels of anxiety and depression and that women engaging in mind-body practice, past or present, would report lower levels of depression and anxiety. When statistical analyses failed to yield significant results, this author chose to explore the process of generating new knowledge through autoethnography. This dissertation moved from an empirical study to a qualitative, autoethnographic exploration of pregnancy loss in which the themes of meaning making, personhood and the expression of feelings were explored through the literature, the author's personal experience and through participation in an online pregnancy loss support group.</p>

<p> Monitoring bodies in the District of Columbia articulated that people diagnosed with an intellectual and developmental disability (IDD) who reside in community-based group home settings are vulnerable to safety issues, poor quality of care from registered nursing services, and poor oversight. Those monitors have identified the lack of knowledge of roles and responsibilities among registered nurses (RNs) in these settings as a significant risk factor. The District of Columbia Developmental Disabilities Administration (DDA) has no formal orientation or training for RNs that encompasses the multifaceted needs of people diagnosed with IDD. This capstone project aimed to identify the effectiveness of an educational intervention and the effect of continuing education on RNs' perception of their practice in the field of IDD. After review of current literature, an educational presentation addressing all facets of entry-level registered nursing was developed. The presentation focused on the fundamentals of IDD nursing. A group of RNs working in the District of Columbia IDD community participated in an all-day educational program and completed a pre- and posttest evaluation to measure their knowledge prior to the intervention and their knowledge gain immediately after the intervention. A standard five-point Likert scale survey was delivered on the third and sixth months after educational intervention (EI). The survey asked the participants to rate the impact of the EI at three and six months post intervention to measure their perceived confidence level and actual practice changes. Eighty-seven percent of the RNs that participated in the EI and responded to the questionnaire reported that their role as an IDD nurse had changed because of participating in this training, and 93.8% reported that they would recommend this training to other RNs entering or working in this subspecialty.</p>

M.Cur. / The story of loss, after the experience of spontaneous abortion affects the women’s being as a whole. It impacts her emotional, physical, intellectual, social and spiritual dimensions. The woman finds herself robbed of her voice by her social network. She stands isolated in her new reality of loss and bereavement. This research tells the story of the women’s loss after the experience of spontaneous abortion. The objectives of the research are to • explore and describe the women’s experience after a spontaneous abortion, and • describe guidelines for the advanced psychiatric nurse practitioner according to which he/she can provide support to women after the experience of spontaneous abortion and facilitate mental health through the mobilisation of resources. The paradigmatic perspective of this study is guided by the Theory for Health Promotion in Nursing (Rand Afrikaans University, Department of Nursing Science, 2002: 2-8). A functional approach was followed, based on Botes’s model for nursing research (Botes in Rand Afrikaans University: Department of Nursing, 2002: 9-15). A qualitative, descriptive, exploratory and contextual design was used. In-depth, semi-structured, phenomenological interviews were held with seven women who fitted the sample criteria. Consent for the research was obtained from the Rand Afrikaans University as well as informed consent from the women volunteering to participate in the research. Trustworthiness was maintained by using strategies of credibility, applicability, dependability and confirmability, as described by Lincoln and Guba (1985: 289-331). Recorded interviews were transcribed and analysed using Tesch’s data analysis techniques (in Creswell, 1994: 155-136). An independent coder was utilised in coding the data, and a consensus discussion was held between the researcher and the independent coder. A central storyline was identified and themes highlighted. A literature control was undertaken to highlight similarities and differences between this and other research. The results were described in a narrative manner, which included the content as well as the processes of the women’s emotional experiences after the experience of spontaneous abortion. The impact of the loss affected her social dimension in terms of emotional processes as well as emotional expression. Participants experienced a strong need for acknowledgment of their loss and understanding of their reality of loss and bereavement. The spontaneous abortion has an impact on the women’s physical dimension. She experiences physical discomfort. The impact also effects her spiritual dimension by influencing her relationship with herself and God. The impact also touches her social dimension by robbing her of her voice through her social network’s response to the spontaneous abortion. There is also an impact on her relationship with her partner, as men and women experience and express loss differently. In the reality of loss and bereavement, the participants identified hope givers and hope stealers. Hope givers include • a strong connection with women who experienced spontaneous abortion themselves, • strengthening their relationship with God, • time as a healing faktor, • the value of sharing their stories, • the ability to find meaning after spontaneous abortion, and • the need for emotional growth. Hope stealers include • the response from people in her social network with regard to the spontaneous abortion, • experience of loss of control, • insufficient support in their interpersonal relationships and social network, • confronting the finality of the loss, and • being confronted with pregnant women en babies. Guidelines for the advanced psychiatric nurse practitioner to provide support to women after the experience of spontaneous abortion will be described to assist them in mobilising their resources to facilitate the promotion of their mental health.

<p> <b>Introduction:</b> Psychological pain is a frequently observed symptom in depression, and escape from unbearable psychological pain is often mentioned as the reason for suicide. We explored the relationship between psychological pain and two potential biomarkers: heart rate variability (HRV) and frontal EEG &alpha;-asymmetry. As both markers have successfully been used as feedback to alter mood state, knowledge about the relationship between HRV, frontal EEG, and psychological pain may be of particular interest for interventions to alleviate psychological pain. </p><p> <b>Methods:</b> Adults with a history of depression (<i>N </i> = 35) participated in six 5-minute sessions during which heart rate and EEG were recorded, while the participants sat upright with their eyes closed. In addition, participants completed the Beck scales for depression, hopelessness, and suicide ideation, and two measures of psychological pain: the Psychache Scale and the Orbach &amp; Mikulincer Mental Pain (OMMP) Questionnaire. </p><p> <b>Results:</b> Mean age of the participants was 35.0 (<i> SD</i> 11.84) and their average level of depression and hopelessness was moderate. The intraclass correlation coefficient indicated excellent agreement of neurophysiological variables across successive measurements. In separate hierarchical regression models, after controlling for depression and hopelessness, low-frequency HRV and right midfrontal delta power contributed significant variance (&Delta; <i>R </i>² = 8.8%, &beta; = -.30, <i> p</i> = .02 and &Delta;<i>R</i>² = 7.0%, &beta; = -.26, <i>p</i> = .03, respectively) to the prediction of current psychological pain on the OMMP. For worst-ever psychological pain on the OMMP, midfrontal delta power contributed significant variance (&Delta;<i>R </i>² = 20.5%, &beta; = -.45, <i>p</i> = .004), after controlling for depression. Suicidal desire moderated the relationships of low-frequency HRV and midfrontal delta power to psychological pain on the Psychache Scale. High-frequency HRV and frontal &alpha;-asymmetry did not correlate with the Psychache Scale or OMMP scores. EEG asymmetry based on fractal dimensions decreased (greater left than right complexity) with increasing current and worst-ever psychological pain on the OMMP. </p><p> <b>Conclusion:</b> Findings suggest that greater psychological pain is associated with increased sympathetic nervous system activity, rather than with reduced parasympathetic nervous system activity. Psychological pain may affect the right frontal cortex more adversely than the left frontal cortex. </p>

Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 71-02, Section: B, page: . Adviser: Kathryn A. Lee.

<p> Organizations are increasingly examining the potential benefits of integrating insights concerning emotional intelligence (EI) into their employee training and development programs to enhance their mission. Petrides&rsquo;s EI model of trait emotional self-efficacy (ESE) has been defined as a constellation of emotion-related self-perceptions and dispositions assessed through self-report. This study explored the relationship between the four factors of Petrides&rsquo;s ESE model (well-being, self-control, emotionality, and sociability) and the well-researched work outcomes of job satisfaction, counter-productive work behavior, and turnover intent. Based on existing research, the study controlled for age, gender, job tenure, and social desirability. The study relied on an archival data set drawn from a similar pilot study, and included a sample population (N = 157) of certified nurse assistants and registered nurses, selected both out of convenience and because this population is known for its affect-laden work. The study employed a 239-item survey. ESE was measured using the TEIQue long form, and psychological instruments were used to measure outcomes. Confirmatory factor analysis found a lack of fit for the four-factor model, and a new, two-factor model was found using an exploratory factor analysis. The first factor, comprised mostly of the facets well-being and self-control, was named emotional constitution. The second factor, comprised mostly of emotionality and sociability, was named emotional awareness. Data analysis included four-step hierarchical regression models to assess unique variance in each of the three outcome variables using emotional awareness and emotional constitution as predictors. Results showed that emotional awareness predicts nurse job satisfaction (&beta; = .21, <i>p</i> &lt; .05), and emotional constitution negatively predicts both nurse CWB (&beta; = &ndash;.49,<i>p</i> &lt; .01) and turnover intent (&beta; = &ndash;.31,<i>p</i> &lt; .05). No difference between groups (RNs and CNAs) on these factor dynamics was found. Implications of this study are discussed.</p><p>

<p> Heart failure patients who visit the Emergency Department often because of chronic nature of their illness require a specific plan of care. Successful engagement requires that nurses identify and act on factors to facilitate transition across the care continuum. This study was undertaken to examine the relationship of three major quality care indicators: social support, perception of nurse caring, and patient satisfaction among patients with heart failure admitted to the emergency department. The study further explored the association of these indicators with demographic and illness variables of the study participants.</p><p> The Quality Caring nursing framework was used as the theoretical framework for the study. A total of 115 adult participants, 71 males and 44 females who were admitted in the emergency department of two public hospitals in the mid-Atlantic region of the United States were recruited. Data were collected using a survey package consisting of four instruments: the Medical Outcomes Study (MOS) Social Support Survey measuring perceived social support, the Caring Assessment Tool (CAT) measuring nurse caring, and the Consumer Emergency Care Satisfaction Scale (CESS) measuring satisfaction with care in the emergency department.</p><p> Although the major study hypotheses that high levels of social support would be associated with caring and with patient satisfaction were not supported, there were significant associations found between aspects of social support, caring measure and the demographic and illness measures such as marital status and the number the number of household members. Also, those who were employed perceived more social support than those who were unemployed and those who were retired had a significantly higher perception of caring.</p><p> These findings challenge nurse clinicians, educators, and administrators to further investigate the roles of social support, caring and patient satisfaction in multiple aspects of chronic illness.</p>