PDF of the Book of Proceedings

 Dear Colleagues: Welcome to the 22nd Annual Scientific Sessions! This year’s theme, “Celebrating Diversity in Nursing Science” focuses on valuing different approaches to nursing research and the importance of research dissemination and translation among diverse professional, clinical, and societal levels. The conference begins on Wednesday with Dr. Margaret Heitkemper discussing “Merging Biological and Behavioral Methods: A Model for Symptom Management.” We are delighted to have Dr. Heitkemper and look forward to an invigorating opening address. Wednesday continues with panels discussing economic analyses, research funding, publishing, and pilot studies. We are also pleased to have Dr. Joan Austin from NINR who will host a dialogue on Building Nursing Research Wednesday afternoon. We continue our pace into Thursday morning with a panel on Nursing Research in a Clinical Setting. Additional featured speakers and selected papers contribute to a particularly strong program throughout our time in Providence. Special poster sessions featuring Magnet Organizations, peer‐reviewed research, and student presentations highlight morning, afternoon and evening sessions. Our Mentor/Mentee plenary session at the close of the conference provides a great opportunity for individuals of all experience levels to network and exchange ideas — don’t miss it! The Conference Planning Committee, chaired by ENRS President‐Elect Dr. Nancy Redeker has developed a wonderful program full of progressive education, networking opportunities, and a showcase of the best work being done throughout the Northeast and beyond. As in years past, our Abstract Review Committee deserves kudos for all their efforts in reviewing exceptional submissions that clearly demonstrate that we are building nursing science. At ENRS, we are fortunate to have a strong foundation of support from collegial institutions. The Scientific Sessions would not thrive without the generous support of our sponsors: Columbia University, The Council for the Advancement of Nursing Science, Hunter‐Bellevue, Lippincott, Williams & Wilkins, Massachusetts General Hospital, New York University, Penn State University, Sigma Theta Tau, the State of Rhode Island, University of Connecticut, University of Massachusetts‐Amherst, University of Pennsylvania, University of Pittsburgh, University of Rhode Island, University of Rochester, Villanova University and Yale University. Our exhibit hall is also filled with excellent institutions and companies showcasing products, services, and opportunities for education. I encourage you to visit with each of these organizations. The ENRS Business Meeting is being held on Thursday afternoon at 12:30 pm. Members can hear about Board and Committee initiatives, see a snapshot of how the Society’s resources are utilized, and discuss activities for Board consideration. We are also recognizing and honoring our award recipients during this luncheon. We have a busy schedule! Thank you for coming to Providence to share your knowledge and experience and to participate in the 22nd Annual Scientific Sessions. Welcome, and enjoy your time over the next three days. Sincerely, Judith Erlen, PhD, RN, FAAN President, Eastern Nursing Research Society Table of Contents Conference Objectives & Highlights ................................................................ 4 Continuing Education....................................................................................... 5 Conference Sponsors & Exhibitors .................................................................. 6 Conference Schedule .................................................................................... 7‐20 Scientific Session Abstracts – A Series ......................................................... 21‐42 Scientific Session Abstracts – B Series ......................................................... 43‐64 Scientific Session Abstracts – C Series ......................................................... 65‐82 Scientific Session Abstracts – D Series ........................................................ 83‐102 Scientific Session Abstracts – E Series ....................................................... 103‐122 Scientific Session Abstracts – F Series ....................................................... 123‐141 Poster Abstracts – Session I ...................................................................... 142‐178 Poster Abstracts – Session II ..................................................................... 179‐213 Poster Abstracts – Session III .................................................................... 214‐251 Magnet Poster Abstracts .......................................................................... 252‐258 Early Doctoral Poster Abstracts ................................................................ 259‐318 BS, MS Poster Abstracts ............................................................................ 319‐344 Awards & Recognition .................................................................................. 345 Conference Planning Committee & Abstract Review Committee ................ 346 Advertisements ………………………………........................................................ 349‐351 2011 Save the Date! ..................................................................................... 352 Conference Objectives 1. Appreciate the diversity in theoretical, substantive and methodological approaches to enhancing health through nursing science. 2. Evaluate the implications of nursing research relative to enhancing health in diverse populations and settings. 3. Promote dissemination and translation of nursing research at professional, community, clinical and societal levels. 4. Utilize scientific evidence to support nursing practice. Conference Highlights 
Opening Keynote Speaker, Dr. Margaret Heitkemper will present “Merging Biological and Behavioral Methods: A Model for Symptom Management Research” 
Focus on diversity in nursing science as presented in numerous podium, poster, and symposium presentations 
Wednesday afternoon research development sessions for novice to expert nurse scientists led by renowned nurse scientists 
Wednesday afternoon special topics sessions on cost effectiveness research and the role of pilot studies in treatment development 
Thursday morning panel on role of the clinical nurse research 
NEW THIS YEAR! Friday afternoon session with focus on building mentor‐mentee relationships 
Awards for doctoral and BS/MS presentations 
Symposia presentations by the Aging, Family/Community‐Based interventions, and Nursing Theory Research Interest Groups 
Magnet Hospital poster presentations 
Opportunities to network with colleagues from academic and clinical settings Page 4
Continuing Education ALLEGRA Learning Solutions, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. To receive a continuing education certificate, please follow these important steps: 1. Sign the daily attendance sheet first thing every morning for the day you attend the conference. This list will be kept at the registration desk. 2. An electronic evaluation will be sent to those who have signed in on the daily attendance sheets following the conference. 3. Fill out the evaluation indicating every session you have attended as well as the overall evaluation of the conference. 4. Submit your evaluation electronically in order to receive your certificate. 5. Your certificate will be mailed to you once the evaluations have been compiled. Continuing Education Contact Hours Wednesday, March 24 = 4.5 Thursday, March 25 = 7 Friday, March 26 = 4.5 Total = 16 Contact Hours * * Total for attendance at all three conference days Note: No certificate will be issued to any attendee who does not sign the daily attendance sheet. Page 5
Sponsors & Exhibitors ENRS thanks our Sponsors and Exhibitors for their support of the 22nd Annual Scientific Sessions. Sustaining Partners Columbia University College of Nursing • University of Pennsylvania School of Nursing University of Pittsburgh School of Nursing Supporting Partners Massachusetts General Hospital • Sigma Theta Tau International Delta Upsilon Chapter At‐Large University of Rochester School of Nursing • Yale University School of Nursing Partner University of Rhode Island College of Nursing 2010 Sponsors The Council for the Advancement of Nursing Science • Hunter‐Bellevue School of Nursing New York University College of Nursing • The Pennsylvania State University School of Nursing State of Rhode Island • University of Connecticut School of Nursing • University of Massachusetts‐Amherst School of Nursing • Villanova University College of Nursing Wolters‐Kluwer Health‐Lippincott, Williams & Wilkins 2010 Exhibitors American Nurses Foundation • Columbia University College of Nursing • The Council for the Advancement of Nursing Science • Wolters‐Kluwer Health‐Lippincott, Williams & Wilkins Massachusetts General Hospital • Medatrax • The Miriam Hospital National Institute of Nursing Research • New York University College of Nursing • Northeastern University School of Nursing Rutgers University College of Nursing • Sigma Theta Tau International Sigma Theta Tau International Delta Upsilon Chapter At‐Large • University of Connecticut School of Nursing University of Massachusetts‐Amherst School of Nursing • University of Massachusetts‐Boston College of Nursing & Health Sciences • University of Pennsylvania School of Nursing • University of Pittsburgh School of Nursing • University of Rhode Island College of Nursing • University of Rochester School of Nursing • Yale University School of Nursing 2010 Collaborating Organizations American Nurses Foundation • National Institute of Nursing • Research Sigma Theta Tau International Page 6
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CONFERENCE SCHEDULE
WEDNESDAY, MARCH 24, 2010 8:00 AM – 7:00 PM REGISTRATION OPEN Narragansett Lobby Lobby Level 8:00 AM – 4:30 PM EXHIBITOR SET‐UP Narragansett A Lobby Level 1:00 PM – 2:30 PM OPENING GENERAL SESSION Narragansett B & C Merging Biological and Behavioral Methods: Lobby Level A Model for Symptom Management Margaret M. Heitkemper, PhD, RN, FAAN 2:45 PM – 3:45 PM Incorporating Economic Analyses into Nursing Narragansett B & C Research: An Extension of Comparative Lobby Level Effectiveness Research Patricia Stone, PhD 2:45 PM – 3:45 PM FUNDING PANEL Providence Ballroom Karen Huss, PhD, RN, APRN‐BC, FAAN, FAAAAI Third Floor Margarete Lieb Zalon, PhD, RN, ACNS‐BC Lori Melichar, PhD, MA 3:45 PM – 4:15 PM AFTERNOON REFRESHMENT BREAK Narragansett Lobby Lobby Level 4:15 PM – 5:15 PM Role of Pilot Studies in Treatment Development Bristol/Kent Lawrence Scahill, MSN, PhD Third Floor 4:15 PM – 5:15 PM PUBLISHING PANEL Providence Ballroom Third Floor Cheryl Beck, DNSc, CNM, FAAN Katie Weigner, EdD, RN 4:15 PM – 5:15 PM NINR Dialogue: Building Nursing Research Newport/Washington Joan K. Austin, DNS, RN, FAAN Third Floor 4:45 PM – 5:15 PM EARLY DOCTORAL POSTER PRESENTER SET‐UP Narragansett Pre‐Function Lobby Level 5:15 PM – 6:45 PM EARLY DOCTORAL POSTERS, EXPOSITION AND Narragansett Ballroom & OPENING RECEPTION Pre‐Function Area Lobby Level Page 7
THURSDAY, MARCH 25, 2010 6:30 AM – 7:00 AM EXHIBITOR SET‐UP Narragansett Ballroom Lobby Level 6:30 AM – 7:00 AM MAGNET POSTER SESSION PRESENTER SET‐UP Narragansett Pre‐Function Lobby Level 7:00 AM – 7:00 PM REGISTRATION OPEN Narragansett Lobby Lobby Level 7:00 AM – 8:00 AM CONTINENTAL BREAKFAST Narragansett Lobby Lobby Level 7:00 AM – 8:30 AM MAGNET POSTER SESSION PRESENTATIONS Narragansett Pre‐Function Lobby Level 7:00 AM – 8:30 AM EXPOSITION Narragansett Ballroom Lobby Level 7:30 AM – 8:30 AM Nursing Research in a Clinical Setting: Narragansett B & C Infrastructure and Implementation Lobby Level Wendy C. Budin, PhD, RN‐BC Diane L. Carroll, PhD, ACNS‐BC, FAAN Susan Gennaro, DSN, RN, FAAN Jane Bliss‐Holtz, DNSc, RN‐BC Dorothy A. Jones, EdD, RNC, FAAN Theresa Wursmer, PhD, MPH, RN, CNNA 8:45 AM – 10:15 AM SCIENTIFIC SERIES A PAPER SESSION A1: Providence I & IV Contemporary Issues and Innovative Solutions in Nursing Education Third Floor 
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Adjunct Faculty Development: Reported Needs and Innovative Solutions Maryann O. Forbes, PhD, RN, Adelphi University Developing Critical‐Thinking Skills from Clinical Assignments: A Pilot Study on Nursing Students’ Self‐Reported Perceptions Gail M. Marchigiano, MSN, Saint Joseph's College of Maine Evaluating Preceptors’ and Preceptees’ Satisfaction Concerning Preceptorship and the Preceptor‐Preceptee Relationship Kristiina E. Hyrkas, RN, MNSc, LicNSc, PhD, Maine Medical Center Professional Nurse Transition: Descriptions of the Accelerated Baccalaureate Nurse Joyce A. Wright, PhD, RN, CNL, Seton Hall University Page 8
__________________________________________________________________________________________________________ PAPER SESSION A2: Providence II & III Pain Management in Acute and Critical Illness Third Floor 
Extracting Pain Management Data from Electronic Medical Records: Comparing Methods from Three Hospitals Joanne G. Samuels, PhD, RN, University of New Hampshire 
Nurses’ Perceptions of Pain Management in Older Adults Theresa M. Gropelli, PhD, RN, Indiana University of Pennsylvania 
From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating the Implementation of the Emergency Severity Index Ellen Robin Rich, PhD, RN, FNP, Good Samaritan Hospital Medical Center 
Examining the Diagnostic Accuracy of the Hendrich Fall Risk Models and the Morse Fall Scale Cheryl A. Reilly, PhD, RN, Baystate Medical Center PAPER SESSION A3: Ethical Issues in Nursing and Healthcare Research Newport/Washington Third Floor 
The Development and Testing of an Observational Tool to Measure the Process and Quality of Informed Consent for Clinical Research Elizabeth Gross Cohn, RN, ACNP, Columbia University 
Barriers to Nurse Practitioners Recommending Clinical Trials Connie Ulrich, PhD, RN, FAAN, University of Pennsylvania 
Informed Consent For Clinical Research: A Concept Analysis Elizabeth Gross Cohn, RN, ACNP, DNSc, Columbia University 
Assessing and Addressing System Wide Deficits in End‐of‐Life Care: The Prison Study Susan J. Loeb, PhD, RN, The Pennsylvania State University SYMPOSIUM A4: Bristol/Kent Synthesizing Evidence through Systematic Review: A Fundamental Third Floor Component of Evidence‐Based Practice •
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Synthesizing Evidence through Systematic Review: A Fundamental Component of Evidence‐Based Practice Cheryl Holly, EdD, RN, UMDNJ School of Nursing A Comprehensive Systematic Review of Relocation Stress Following In‐House Transfer out of Critical/Intensive Care Susan Salmond, EdD, RN, UMDNJ School of Nursing A Systematic Review of Evidence on Determining the Impact of Magnet Designation on Nursing and Patient Outcomes. Is the Investment Worth It? Susan Salmond, EdD, RN, UMDNJ School of Nursing A Systematic Review of Nurses’ Inter‐Shift Handoff Reports in Acute Care Hospitals Cheryl Holly, EdD RN, UMDNJ School of Nursing Page 9
__________________________________________________________________________________________________________ RIG SYMPOSIUM A5: Waterplace II & III Are We Prepared to Abandon Theory — Or Do We Do Something With It? Second Floor •
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A Concept Synthesis of Geropalliative Care Susan M. Lee, PhD, RN, NP‐C, Massachusetts General Hospital Live Case Studies in Nursing Theory: See One, Do One, Teach One Olga F. Jarrín, MS, RN, PhD(c), University of Connecticut Phenomenological Research and Middle‐Range Theory: A Basis for Developing Nursing Practice Aimed at Facilitating Self‐Healing Danny Willis, DNS, APRN‐BC, Boston College Roy Adaptation Model‐Based Research 1970‐2009: A Meta‐Analysis of a Subset of Studies to Examine Effectiveness of Theory in Practice Callista Roy, PhD, RN, FAAN, Boston College The Maze of Research, Theories, Evidence, Competencies.... Will We Lose Our Way? Nancy M. Dluhy, PhD, RN, University of Massachusetts Dartmouth 9:00 AM – 5:00 PM NINR ONE ON ONE SESSIONS Stateside Room Lobby Level 9:45 AM – 10:15 AM POSTER SESSION I Narragansett Lobby PRESENTER SET‐UP Lobby Level 10:15 AM – 10:45 AM REFRESHMENT BREAK Narragansett A & Pre‐Function Area Lobby Level 10:15 PM – 10:45 AM POSTER SESSION I PRESENTATIONS Narragansett Lobby Lobby Level 10:45 AM – 12:15 PM SCIENTIFIC SERIES B PAPER SESSION B1: Providence I & IV Contemporary Nursing Workforce Issues Third Floor • Nurses’ and Nursing Assistants’ Reports of Missed Care and Delegation Nancy Phoenix Bittner, PhD, RN, CCRN, Regis College • Nurse Burnout and Quality of Care: Cross‐national Investigation in Six Countries Lusine Poghosyan, PhD, MPH, RN, Northeastern University • Do Magnet Recognized Hospitals Provide Better Care? Marie‐Claire Rosenberg, PhD, RN, New York University • The Type of Nurse Matters: The Effects of Nurse Staffing Levels, Non‐RNs, and Contract Nurses on Length of Stay Pat W. Stone, PhD, FAAN, Columbia University Center for Health Policy Page 10
__________________________________________________________________________________________________________ PAPER SESSION B2: Providence II & III Innovative Approaches to Improving Quality and Safety in Healthcare Third Floor • The Relationships of Workforce, Leadership, Empowerment, and Role Preparation to Intent‐to‐Stay in the Organization Among Traditional and Accelerated BSN Graduates Carolyn L. Davidson, RN, PhD, CCRN, APRN, Lehigh Valley Health Network • High‐Quality Nursing: The Perspective of Hospital‐Based Nurses Daniel D. Cline, MSN, CRNP, New York University • Deficiencies in Nurses’ ECG Monitoring Knowledge: Preliminary Results of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial Marjorie Funk, PhD, RN, FAHA, FAAN, Yale University • A Description of Correlates and Factors Contributing to Medication Errors in Acute Care Nurses Kathleen F. Sellers, PhD, RN, SUNY Institute of Technology PAPER SESSION B3: Nursing Research and Disparities in Health and Health Outcomes Newport/Washington Third Floor • Related Support Services Needs Indentified by African American Breast Cancer Survivors Sharon M. Mills‐Wisneski, PhD, RN, Oakland University • The Effect of a Structured Writing Intervention in Black Women Living with HIV Rosanna F. DeMarco, PhD, PHCNSBC, ACRN, FAAN, Boston College • Making Ends Meet: Community Health Work Among an Urban Minority, 1912‐1922 Margo Brooks Carthon, PhD, RN, APRN, University of Pennsylvania RIG SYMPOSIUM B4: Bristol/Kent Third Floor Family Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality • Studying Clinical Phenomenon in Diverse Family Structures Katherine Patterson Kelly, PhD, RN, PCNS‐BC, Children’s National Medical Center • Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Susan DeSanto‐Madeya, PhD, RN, CNS, University of Massachusetts‐Boston • Challenges and Strategies in the Design and Conduct of End‐of‐Life Research with Individuals with Advanced Cancer and their Caregivers Susan DeSanto‐Madeya, PhD, RN, CNS, University of Massachusetts‐Boston • Identifying, Recruiting, and Retaining Women with Postpartum Depression for Research June Horowitz, PhD, RN, CNS, FAAN, Boston College • Strategies to Address Challenges in Research with Individuals and Families Experiencing Very Sensitive Issues Helene Moriarty, PhD, RN, PMHCNS‐BC, Veterans Affairs Medical Center • Challenges in Measuring Perceptions of Community Support and Services for Older Adults Veronica Rempusheski, PhD, RN, FAAN, University of Delaware Page 11
_________________________________________________________________________________________________________ RIG SYMPOSIUM B5: Facilitating Translational Aging Research in the Northeast Waterplace II & III Second Floor • Facilitating Translational Aging Research in the Northeast Meg Bourbonniere, PhD, RN, Dartmouth‐Hitchcock Medical Center • Heart Failure Symptom Monitoring, Awareness & Response Training: A Novel Method to Educate Heart Failure Patients Corrine Jurgens, PhD, RN, ANP‐BC, FAHA, Stony Brook University • A Study of the Impact of a Structured Geriatric Program on a Medical Unit Deborah D’Avolio, PhD, APRN‐BC, Massachusetts General Hospital • It’s About Time: Barriers to Use of Non‐pharmacological Interventions in the Nursing Home Ann Kolanowski, PhD, RN, FAAN, The Pennsylvania State University • Strengthening Networking to Enhance Translational Research in Aging in the Northeast Meg Bourbonniere, PhD, RN, Dartmouth‐Hitchcock Medical Center 12:30 PM – 1:45 PM BUSINESS MEETING & DISTINGUISHED Narragansett B & C CONTRIBUTIONS TO NURSING RESEARCH Lobby Level AWARD WINNER PRESENTATION LUNCHEON 2:00 PM – 3:30 PM SCIENTIFIC SERIES C PAPER SESSION C1: Providence I & IV Contemporary Issues in Nursing Research with Special Populations Third Floor • Healthcare Experiences of Women with Visual Impairment: A Secondary Analysis of Qualitative Data Nancy C. Sharts‐Hopko, PhD, RN, FAAN, Villanova University • A Transformation Process: Health Teaching by Nurses to Adults with Intellectual/Developmental Disabilities Ginny Focht‐New, PhD, PMH‐CNS, BC, CDDN, Widener University • Nursing Care Experiences of People with Disabilities During Hospitalization Suzanne C. Smeltzer, RN, EdD, FAAN, Villanova University • The Effect on an Educational Intervention on Reducing Denture and Dental Plaque in Nursing Home Residents with Dementia Rita A. Jablonski, PhD, CRNP, The Pennsylvania State University Page 12
_________________________________________________________________________________________________________ PAPER SESSION C2: Providence II & III Nursing Research in Diverse Populations, Communities and Environments Third Floor • The Meaning of Confianza (Confidence) in the Context of Health for Mexicans in an Urban Community: A Focused Ethnography Rick Zoucha, PhD, PMHCNS‐BC, CTN, Duquesne University • A Study Using the 2007 HINTS database: Are Low Social Capital and/or High Fatalism Significant Barriers to Colorectal Cancer Screening by Colonoscopy? Julio A. Toro, PhD(c), University of Massachusetts‐Boston • Enhancing Health of Teenage Boys: An Evidence‐Based Newark NJ Best Men Adolescent Family Life Intervention to Reduce Risky Behaviors, Promote Abstinence, Good Values and Parent‐Teen Communication Kathleen A. Sternas, PhD, RN, Seton Hall University • Evaluating Baseline Employee Cultural Sensitivity at an Academic Community Hospital Lynn M. Deitrick, RN, PhD, Lehigh Valley Health Network PAPER SESSION C3: Newport/Washington Improving Health Literacy and Health with Innovative Technologies Third Floor • The Relationship Between Health Literacy, Health Knowledge and Adherence to Treatment in Patients with Rheumatoid Arthritis Patricia Quinlan, DNSc(c), MPA, RN, CPHQ, Columbia University • Experiences of Cancer Survivors with Healthcare Providers in the Context of the Internet as a Source of Health Information Maria C. Dolce, PhD, RN, NEA‐BC, FACHE, New York University • Effects of Parent‐Focused Media Intervention on Body Mass Index, Waist Circumference, Self‐Perception, Family Eating Habits, and Family Activity Habits in Overweight, Hispanic School‐Aged Children Rita Marie John, DNP, EdD, CPNP, Columbia University PAPER SESSION C4: Bristol/Kent Special Topics in Nursing Research: Violence and Incarceration Third Floor • Predictors of Retention for the First Re‐entry Year and for Subsequent Reenrollment in a Follow‐up Study of Research Participants Enrolled while Incarcerated Lorie S. Goshin, RN, MSN, Columbia University • Predictors of Self‐Efficacy and Self‐Rated Health for Older Male Inmate Susan J. Loeb, PhD, RN, The Pennsylvania State University • Women’s Health Needs Immediately Post‐Incarceration: A Feasibility Study Alison M. Colbert, PhD, APRN, BC, Duquesne University • The Importance of Family to Youth Living in Violent Environments Catherine C. McDonald, PhD(c), RN, University of Pennsylvania Page 13
_________________________________________________________________________________________________________ SYMPOSIUM C5: Waterplace II & III Global Health Nursing: Perspectives from Sub Saharan Africa Second Floor • An Integrative Summary of Global Nursing Initiatives in Sub‐Saharan Africa Inge B. Corless, PhD, RN, FAAN, MGH Institute of Health Professions • Global Health Nursing: Perspectives from Sub‐Saharan Africa Stephanie Ahmed, DNP, RN, ANP, Brigham and Women's Hospital • Global Health Nursing: Philosophical Approaches and an Analysis of Factors Related to Nurse Migration Patrice Nicholas, DNSc, MPH, MS, RN, ANP, FAAN, MGH Institute of Health Professions 3:45 PM – 5:15 PM SCIENTIFIC SERIES D PAPER SESSION D1: Enhancing Global Health through Nursing Research Providence I & IV Third Floor • Subsequent Childbirth after a Previous Traumatic Birth: Results from a Diverse Sample from 5 Countries Cheryl Tatano Beck, DNSc, CNM, FAAN, University of Connecticut • Globally‐Based Diversity Research: A Model for Multinational Research Collaboratives Betty Rambur, PhD, RN, University of Vermont • Determinants of Nonadherence to Pediatric Follow‐up Guidelines of HIV‐exposed Infants in Rwanda Patricia J. Moreland, RN, MSN, CPNP, Columbia University • A Chinese Version of Self‐efficacy and Outcome Expectations for Osteoporosis Medication Adherence Scales: Reliability and validity assessment in Chinese Immigrants Bing‐Bing Qi, PhD, RN, Villanova University PAPER SESSION D2: Providence II & III Women’s Health Across the Life Course Third Floor • Non‐coital Behaviors and Disease Risk Among Urban Adolescent Females Carol Roye, EdD, RN, CPNP, Hunter‐Bellevue School of Nursing • Daily Spiritual Experiences (DSEs) and Quality of Life of Young Adult Women: Exploring the Impact of Intimate Partner Violence (IPV) Carolyn J. Nickerson, EdD, RN, CNE, Duquesne University • The Experience of Planned Home Birth: The Development of Mutual Trust and Autonomy Judith Lothian, PhD, RN, LCCE, Seton Hall University • Exploring Latent Cancer/Cardiac Risk Clusters in Alcohol, Smoking, and Obesity in Postmenopausal Women Thomas L. Hardie, EdD, PMHCNS‐BC, Widener University Page 14
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PAPER SESSION D3: Newport/Washington Health Promotion and Disease Prevention I Special Populations Third Floor • Nurses with Disabilities: A Diverse Group of Outsiders Leslie J. Neal‐Boylan, PhD, CRRN, APRN‐Bc, Yale University • The Relationship of Vision Status to Employment Status and to Activities of Daily Life Among Adult Women Respondents to the 2006‐2008 National Health Interview Survey Nancy C. Sharts‐Hopko, PhD, RN, FAAN, Villanova University • Post‐Deployment Health Assessment in United States Service Members after Iraq Deployment Sean T. Collins, PhD, University of Massachusetts • The Effect of Psychiatric Symptom Severity on Return to Work and Bed Days in the Year following Minor Injury Sara F. Jacoby, MSN, MPH, University of Pennsylvania PAPER SESSION D4: Bristol/Kent Sleep and Sleep Disorders: Focus on Special Populations Third Floor • Is CPAP Use Influenced by Disease‐ and Treatment‐Specific Cognitive Perceptions? Amy M. Sawyer, PhD, RN, University of Pennsylvania • Gender Differences in Response to CPAP Treatment in Obstructive Sleep Apnea Lichuan Ye, PhD, RN, Boston College • Caffeine Consumption by School‐Aged Children: Effects on Sleep Duration and Body Weight Eileen R. Chasens, DSN, University of Pittsburgh • Sleep Problems in Veterans Receiving Platinum‐Based Chemotherapy for Lung Cancer Grace E. Dean, PhD, RN, University at Buffalo SYMPOSIUM D5: Waterplace II & III Integrating Research, Evidence‐Based Practice & Performance Second Floor Improvement to Sustain Evidence‐Based Practice Change in a Pediatric Hospital • Integrative Summary Katherine Patterson Kelly, PhD, RN, Children’s National Medical Center • Family Presence During Trauma Activations and Medical Resuscitations in a Pediatric Emergency Department: An Evidence‐Based Practice Demonstration Project Jennifer Kingsnorth, MSN, RN, Children’s National Medical Center • Implementing and Sustaining Evidence‐based Nursing Practice to Reduce Pediatric Cardiopulmonary Arrest Simmy Randhawa, MS, MBA, RN, NE‐BC, CPN, Children’s National Medical Center • Improving the Quality of Pediatric Pain Assessment using Automated Electronic Health Records (EHR) Outcomes Reports Amrita Naipaul, MSN, RN, PCCNP, Children’s National Medical Center Page 15
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5:00 PM – 5:30 PM BS/MS POSTER SESSION PRESENTER SET‐UP 5:30 PM – 6:30 PM BS/MS POSTER SESSION PRESENTATIONS & Narragansett Ballroom EXPOSITION & Pre‐Function Area Lobby Level FRIDAY, MARCH 26, 2010 6:00 AM – 7:00 AM EXHIBITOR SET‐UP 7:00 AM – 2:00 PM REGISTRATION OPEN 7:00 AM – 8:00 AM CONTINENTAL BREAKFAST 7:00 AM – 8:00 AM RIG’S BREAKFAST 7:00 AM – 8:00 AM BREAKFAST FOR DEANS, DIRECTORS & NURSE EXECUTIVES 7:00 AM – 8:00 AM EXPOSITION 8:00 AM – 9:30 AM PAPER SESSION E1: SCIENTIFIC SERIES E Narragansett Ballroom Lobby Level Narragansett Lobby Lobby Level Narragansett Lobby Lobby Level Narragansett C Lobby Level Blackstone Third Floor Narragansett Ballroom Lobby Level Providence I & IV Nursing Research with Children, Adolescents and Families: Third Floor Current Issues and Emerging Themes • 17‐Year Outcome of Preterm Infants with Diverse Perinatal Morbidities Mary C. Sullivan, PhD, RN, University of Rhode Island • A Partnership Between Nurse Practitioner and High School Students to Assess Risk Factors for Diabetes in Children in the Community Terri H. Lipman, PhD, CRNP, FAAN, University of Pennsylvania • Partnering with Parents of Technology Dependent Children: A Hybrid Concept Analysis Michele A. Mendes, PhD, RN, CPN, Boston College • Social‐Emotional Development of Teenagers Who Experienced the Loss of their Mother: A Phenomenological Study Donna Hallas, PhD, PNP‐BC, CPNP, New York University Page 16
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PAPER SESSION E2: Providence II & III Promoting Health Across the Life Course: Focus on Special Populations Third Floor • Factors Associated with Exclusive Breastfeeding 2‐4 Weeks Following Discharge from a Large Urban Academic Medical Center Striving for Baby‐Friendly Designation Wendy C. Budin, PhD, RN‐BC, FACCE, NYU Langone Medical Center • Predictors of Physical Inactivity in Men and Women with Type 2 Diabetes Margaret McKeever McCarthy, MS, FNP, BC, New York University • CARE Intervention for Depressed Mothers and Their Infants: Outcomes from the Randomized Clinical Trial June Andrews Horowitz, PhD, RN, PMH, CNS‐BC, FAAN, Boston College • Biomarkers of Inflammation May be Associated with Cognitive Function in Heart Failure Ponrathi Athilingam, PhD, RN, ACNP, University of Rochester PAPER SESSION E3: Newport/Washington Innovative Models of Health Care Delivery: Recent Advances and Third Floor Emerging Themes • Hospital to Homecare Transitions: Patients, Informal Caregivers and Clinicians Perspectives Janice B. Foust, PhD, RN, University of Massachusetts‐Boston • Multicomponent Home Care Intervention for Heart Failure Patients: An Academic/Clinical Partnership Colleen Delaney, PhD, RN, AHN‐BC, University of Connecticut • A Concept Analysis of Home and its Meaning in the Lives of Three Older Women Catharina Gillsjö, PhD(c), FNP, RN, University of Skövde • Assessing the Cost‐effectiveness of a Preconception Counseling Program for Teens with Diabetes: READY‐Girls Andrea F. Rodgers Fischl, PhD, MPH, CRNP, University of Pittsburgh PAPER SESSION E4: Bristol/Kent Methods and Measures in Nursing Research: Recent Innovative Advances Third Floor • Impact of a Campus Campaign on College Students’ Environmental Literacy and Locus of Control Veronica D. Feeg, PhD, RN, FAAN, Molloy College • Quality Assurance Assessment of Intervention Delivery Karen Wickersham, BSN, RN, University of Pittsburgh • Measuring Patient‐Provider Trust in a Primary Care Population: Further Support for the Health Care Relationship (HCR) Trust Scale Carol Bova, PhD, RN, ANP, University of Massachusetts‐Worcester Page 17
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SYMPOSIUM E5: Waterplace II & III Qualitative Event Analysis: Introduction and Methodological Adaptations Second Floor in Clinical Research • Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh • Discovering and Defining Events in Qualitative Event Analysis (QEA) Rebecca Trotta, MSN, RN, University of Pennsylvania • Measuring the Nurse‐Patient Communication Event in the ICU: Contribution of Qualitative Event Analysis Techniques Jill Radtke, BSN, RN, University of Pittsburgh • Qualitative Event Analysis Using Qualitative Secondary Analysis Judith Tate, MSN, RN, University of Pittsburgh • Qualitative Event Analysis: Introduction and Use in Clinical Research Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh 9:00 AM – 9:30 AM POSTER SESSION II PRESENTER SET‐UP Narragansett Lobby Lobby Level 9:30 AM – 10:00 AM POSTER SESSION II PRESENTATIONS Narragansett Lobby Lobby Level 10:00 AM – 11:30 AM SCIENTIFIC SERIES F PAPER SESSION F1: Providence I & IV Third Floor
Qualitative Approaches and Nursing Research • The Lived Experience of the Living Liver Donor: A Phenomenological Study Frances White, MS, RN, Lahey Clinic • Making the Right Decision: Parents’ Making Decisions for Their Children with Cancer Janet L. Stewart, PhD, RN, University of Pittsburgh • Tradition Fulfillment and Families of Children Who are Maternally Bereaved Margaret P. Shepard, PhD, RN, Molloy College PAPER SESSION F2: Providence II & III Nursing Research and Evidence‐Based Practice Third Floor • The Development of a Family Visitation Practice Guideline for the Post Anesthesia Care Unit Kathleen DeLeskey, DNP, RN, Lawrence Memorial/Regis College • Outcomes of Translating an Evidence‐Based, Patient‐Centered Protocol for Nurses Shift Handoffs in a Magnet Community Hospital Marlene A. Dufault, PhD, RN, University of Rhode Island • A Compass for Caring: The Essence and Experience of an Integrative Metaparadigm of Nursing Olga Jarrín, MS, RN, PhD(c), University of Connecticut • Looking is Not Seeing and Listening is Not Hearing Linda Honan Pellico, PhD, APRN, Yale University Page 18
_____________________________________________________________________________________________________________________ PAPER SESSION F3: Newport/Washington Contemporary Issues in Adult Health: Focus on Nursing Interventions Third Floor • An Exploration of Racial Differences and Predictors of Weight Maintenance after a Behavioral Weight Loss Trial Melanie W. Turk, PhD, RN, Duquesne University • Substandard Quality of ECG Monitoring in Current Clinical Practice: Preliminary Results of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial Marjorie Funk, PhD, RN, FAHA, FAAN, Yale University • ST‐Map Electrocardiographic (ECG) Software Improves Nurses’ Use of and Attitude toward Ischemia Monitoring and the Quality of Patient Care Marjorie Funk, PhD, RN, FAHA, FAAN, Yale University • End‐of‐Life Care is Improving in the Nursing Home Setting: A Pilot Study to Explore Next of Kin’s Perspectives on End‐Of‐Life Care Jill M. Terrien, PhD, APN, BC, University of Massachusetts‐Worcester State University SYMPOSIUM F4: Bristol/Kent Evidence‐Based Practice Improvement: Merging Two Paradigms Third Floor • The Evidence‐Based Practice Improvement (EBPI) Model: Merging Two Paradigms Rona F. Levin, PhD, RN, Pace University • An Evidence‐Based Practice Improvement Project to Implement Best Practices in the Administration of Propofol in the Critical Care Setting Fay Wright, MS, RN, Northern Westchester Hospital • Evidence Based Medication Management for Cognitively Impaired and Non‐Adherent Patients in Home Care Kathryn H. Bowles, PhD, RN, FAAN, University of Pennsylvania • Improving Pain Management in Long Term Home Health Care Patients: An Evidence‐Based Practice Improvement Project Rona F. Levin, PhD, RN, Pace University SYMPOSIUM F5: Waterplace II & III Supporting Family Caregivers through End‐of Life Transitions: Opened Second Floor Doors and Missed Opportunities • Supporting Family Caregivers through End‐of‐Life Transitions: Opened Doors and Missed Opportunities Janice Penrod, PhD, RN, The Pennsylvania State University • Unraveling the Influence of the Culture of Care Peggy Shipley, PhD(c), RN, The Pennsylvania State University • Understanding the Influence of the Culture of Care on Models of Care Delivery and Related Nursing Roles Brenda Baney, BS, The Pennsylvania State University • Opened Doors and Missed Opportunities for Enhanced End‐of‐Life Care Pamela Spigelmyer, PhD(c), RN, The Pennsylvania Page 19
_____________________________________________________________________________________________________________________ 11:00 AM – 11:30 AM POSTER SESSION III PRESENTER SET‐UP Narragansett Lobby Lobby Level 11:30 AM – 12:00 PM POSTER SESSION III PRESENTATIONS Narragansett Lobby Lobby Level 11:30 AM – 12:00 PM REFRESHMENT BREAK Narragansett A & Pre‐Function Area Lobby Level 12:00 PM – 1:00 PM EXHIBITOR MOVE‐OUT Narragansett A 12:00 PM – 1:30 PM MENTOR/MENTEE SESSION • Suzanne Smeltzer, RN, EdD, FAAN • Jean Johnson, PhD, RN, FAAN • Marilynn Sommers, PhD, RN, FAAN • Charlotte Thomas‐Hawkins, PhD, RN, CNN
Narragansett B & C Page 20
Paper Session A1: Contemporary Issues and Innovative Solutions in Nursing Education Adjunct Faculty Development: Reported Needs and Innovative Solutions Maryann O Forbes, PhD, RN, Adelphi University, Garden City, NY ~ Mary T Hickey, EdD, WHNP‐C, New York University, Merrick, NY ~ Jane White, PhD, APRN, BC, Adelphi University, Garden City, NY Purpose: Hiring and retaining qualified adjunct faculty are necessary but also a challenge for schools of nursing. Some literature has addressed the link between retention and satisfaction and related this to this unique groups’ need for role development. The study’s purpose was to determine the needs and problems of adjunct faculty related to their teaching role. The ultimate aim was to develop strategies to meet these needs, increase their job satisfaction, and promote retention. Theoretical Framework: Classic role theory as described by both Goffman (1959) and in the seminal work of Mead (1934) on Symbolic Interaction was used to undergird this study. Methods: A three‐ part researcher developed survey was sent to 130 adjunct faculty members with a return rate of 50 % (N‐65). The survey elicited information on demographics, clinical expertise and teaching experience and views of the usefulness of aspects of orientation to their role. Ten open ended questions elicited their frustrations and obstacles to the teaching role and the strategies they used to overcome these. Themes were developed from the responses using content analysis. Results: Four themes emerged: role expectations, inconsistencies leading to role ambiguity, the need for resources: materials, technology help and people, and a more adequate orientation with written guidelines. Major obstacles to teaching were a lack of resources, both materials and persons, and a lack of full time faculty oversight, availability and assistance with their role. When asked about the most significant obstacles, most cited the limited contact with faculty and inconsistent messages. Conclusions & Implications: Based on the findings, several initiatives were implemented including a stronger formal orientation, more oversight and involvement by full time faculty in newly defined roles as course coordinators and targeted efforts to include adjuncts in the school’s faculty activities and meetings. Page 21
Paper Session A1: Contemporary Issues and Innovative Solutions in Nursing Education Developing Critical‐Thinking Skills from Clinical Assignments: A Pilot Study on Nursing Students' Self‐Reported Perceptions Gail M Marchigiano, MSN, Saint Joseph's College of Maine, Standish, ME ~ Nina Eduljee, PhD, Saint Joseph's College of Maine, Standish, ME ~ Kimberly Harvey, MPH, Maine Medical Center, Portland, ME Purpose: The development of clinical assignments in nursing education provides opportunities for students to develop critical‐thinking skills vital to the effective delivery of patient care. The purpose of this study was to explore (a) students’ perceived levels of confidence for using thinking skills when devising a written care plan and a journal and (b) whether students’ perspectives differed between the two formats in relation to promoting and using their thinking abilities. Theoretical Framework: This study is based on the theoretical framework of critical thinking identified in the Delphi Report (Facione, 1990), within the nursing process framework as conceptualized by Wilkinson (1991). Methods: A descriptive, cross‐sectional design was used. A sample of N=51 undergraduate nursing majors in an adult nursing course completed surveys, indicating their confidence in using seven thinking skills for nursing care. Results: Results indicate that students experienced significantly more confidence when implementing the journal format for analyzing information (p < .000), making connections (p < .000), determining relevance (p < .000), selecting appropriate information (p < .000), applying relevant knowledge (p < .000), and evaluating outcomes (p < .01). Perceived confidence in setting priorities was not statistically significant, nor were there correlations to factors such as GPA, hours worked, and the time to complete a specific type of assignment when implementing the two assignment formats, although a positive significant correlation surfaced between GPA and students who work while at college. Conclusions and Implications: Nurse Educators have the opportunity to develop teaching learning strategies to help students critically think, think about their thinking, and use cognitive and metacognitive skills for sound nursing practice. This study has implications for nurse educators who attempt to develop effective pedagogical strategies for enhancing students’ thinking skills. Page 22
Paper Session A1: Contemporary Issues and Innovative Solutions in Nursing Education Evaluating Preceptors’ and Preceptees’ Satisfaction Concerning Preceptorship and the Preceptor‐Preceptee Relationship Kristina E. Hyrkas, RN, MNSc, LicNSc, PhD, Maine Medical Center, Portland , MN ~ Gail Kolbe, RN, MS, BS, BSN, Maine Medical Center, Portland , MN ~ Deborah Linscott, RN, MS, BSN, Maine Medical Center, Portland, MN Purpose: The purpose of this study was to investigate: (1) the preceptor and preceptee relationship and satisfaction, (2) preceptors’ perceptions of benefits, rewards, and commitment to their role, (3) job satisfaction among preceptors and preceptees, and (4) preceptees’ nursing performance. Design: Descriptive, cross‐sectional study. Sample: A convenience sample of 353 nurses, both the preceptors and preceptees from 15 specialty units. Methods: Five validated instruments were used. The data was collected in September and October 2008 with a response rate of 48 percent. Data analysis consisted of descriptive statistics. Results: Overall, the preceptors’ and preceptees’ satisfaction regarding the job and preceptorship experiences were high. The preceptors evaluated the preceptorship relationship slightly higher than the preceptees. Both the preceptors and preceptees reported that the preceptorship experience had strongly encouraged learning. However, the preceptors’ evaluations regarding the feedback and asked question were significantly higher compared to the preceptees evaluations. The preceptees felt most satisfied due to the welcome into the role by their preceptor and nursing staff on their clinical unit. However, they were least satisfied to the extent that the teaching and guidance had met their needs. The preceptees had engaged during their preceptorship in a variety of nursing activities and they evaluated that they had performed well. The best performed skills were the communications/interpersonal relations. The weakest skills were with teaching and collaboration. The preceptors’ scores regarding perceptions of the benefits and rewards and support were high and they were moderately strongly committed to their role. Conclusions and Implications: The findings support the most recent literature arguing that there is a need for a new preceptorship model. It is necessary to create a model that provides preceptors and preceptees a clear path towards fulfillment within preceptorship; that promotes collaboration and support from within the organization, that captures passion from the onset of preceptorship and facilitate the continuation of knowledge and experience from generation to generation. Preceptor programs that are aligned with such a preceptorship model are an important investment for both the health care organizations as well as for the profession. Regular surveys are proposed as a means of evaluating the success of preceptorship programs. Page 23
Paper Session A1: Contemporary Issues and Innovative Solutions in Nursing Education Professional Nurse Transition: Descriptions of the Accelerated Baccalaureate Nurse Joyce A Wright, PhD, RN, CNL, Seton Hall University, Holmdel, NJ Professional Nurse Transition: Descriptions of the Accelerated Baccalaureate Nurse Purpose: The purpose of this study was to describe the experience of professional role transition for 22 accelerated nurses who had practiced nursing for approximately one year. Background: In response to the projected nursing shortage, accelerated nursing programs have proliferated to attract non‐nursing college graduates. These students tend to be highly motivated with experience and success in other careers. As this student population grows, there is little research on post‐program outcomes for this new nurse graduate. Method: Unstructured, audio‐taped focus groups were conducted and participants were asked three questions: 1) How would you describe professional nursing? 2) What specific curriculum or clinical strategy utilized by the University facilitated your professional transition? 3) What would you recommend, in curriculum or clinical, to enhance your professional transition? The researcher used a qualitative descriptive design and content analysis to analyze the data. Results: From this analysis, professionalism was described as a dedication to the nursing profession, often through demeanor, with the nurse viewed as an expert clinician. To the second question, novice nurses described the importance of dynamic clinical faculty, seen as those who demonstrated skills and mentored students to critically analyze patient situations. Lastly, subjects stated additional student clinical and lab time would have enhanced their professional transition. Conclusions and Implications: The implications for nursing education reveal the importance of curriculum strategies, and the critical role of clinical faculty. A curriculum that synchronizes content to ensure a common theoretical thread, and a full‐day clinical component, to immerse into the day to day workings of the nursing unit were considered beneficial. Clinical faculty also had a significant impact on professional transition. Participants cited qualities such as being a motivator and mentor as building student self‐confidence. These research findings will add to the minimal body of nursing knowledge through the integration of educational and clinical strategies to augment professional transition in this one year program. Page 24
Paper Session A2: Pain Management in Acute and Critical Illness Extracting Pain Management Data from Electronic Medical Records: Comparing Methods from Three Hospitals Joanne G Samuels, PhD, RN, University of New Hampshire, Portsmouth, NH Purpose: Much of what is known about translational science in pain management is derived from research conducted using the medical record. With over 70% of acute care hospitals employing some component of an electronic medical record (EMR), different approaches in extracting pain management documentation (PMD) research data are needed. The purpose of this paper is to describe methodological issues arising from extracting PMD from community hospitals using the nursing EMR. Theoretical Framework: Donabedian theorizes a contributory relationship between structure, or the tools practitioners use (EMR system and fields), and processes or activities performed (PMD). Outcomes (PMD quality) emerge as a result. Methods: After IRB approval, an attempt was made to describe the pain trajectory and PMD quality of 150 post surgical patients across 3 acute care facilities. Nursing and medical data were requested and extracted from the patient’s history and physical, discharge summary, pre, during and post operative care notes, nursing flow sheets, progress notes, and medication administration records. Care plan documentation was not included in the data collection. A second rater checked the accuracy of the data extraction. Data extraction hours were documented. Results: Each acute care facility required a different approach to extract data. Each facility had different EMR data sources and a combination of paper records. Inconsistencies, omitted and duplicated documentation in pain management assessments, interventions and reassessments were identified within and across hospitals. No hospital could generate a report incorporating all PMD computer fields. Data extraction averaged 1 ¼ hour for each record. Conclusions and implications: Inconsistencies pose measurement threats. Benchmarking of PMD is hindered without the use of consistent data collection instruments. Significant researcher time is required for EMR training and data extraction. Work to standardize PMD across propriety computer systems is needed if PMD quality is to be evaluated or used for research purposes. Page 25
Paper Session A2: Pain Management in Acute and Critical Illness Nurses' Perceptions of Pain Management in Older Adults Theresa M Gropelli, PhD, RN, Indiana University of Pennsylvania, Duncansville, PA ~ Janine Sharer, MSN, RN, St Margaret, Cabot, PA Nurses’ Perceptions of Pain Management in Older Adults Purpose The purpose of this study was to determine nurses’ perceptions regarding pain management for older adults. Background Pain is a serious issue facing residents in nursing care facilities today. The lack of pain control can affect the resident’s quality of life and general well being. Ineffective pain management can be disabling in the older adult. Methods: Using a grounded theory methodology, sixteen nurses from a long term care facility were interviewed about their perceptions of pain management in older adults. A set of questions guided a focused interview with nurses. The questions explored perceptions by the nurses regarding pain management in the older adult. Interviews were audio taped and transcribed verbatim for analysis. As data collection and analysis occurred, initial analysis lead to more focused questions as the study continues. Data were coded during a line‐by‐line analysis reading the interviews by using open coding. Data were then analyzed using axial coding in which categories were examined according to coding paradigm, and relationships between categories were identified. Next, selective coding was used to identify core categories. These core categories emerged and were linked together with subcategories to eventually form a grounded theory that reflected the meaning of the data collected. Results The finding showed that the major categories from that data included perceptions about the residents and families, beliefs about older adults, lack of education, inability to recognize an individualized plan of care, and failure to effectively communicate with the entire health care team. An introductory theory of the nurses’ own perceptions caused barriers to effective pain management in the older adult emerged from the data. Conclusion and Implications This study demonstrated the important Implications for Practices related to ongoing education, effective communication, individualized plan of care, and recognizing perceptions and beliefs. Page 26
Paper Session A2: Pain Management in Acute and Critical Illness From Triage to Treatment of Severe Abdominal Pain in the ED: Evaluating the Implementation of the Emergency Severity Index Ellen Robin Rich, PhD, RN, FNP, Good Samaritan Hospital MedicaCenter and Molloy College, Huntington, NY ~ Eileen Swailes, RN, Good Samaritan Hospital Medical Center, West Islip , NY Purpose: Pain is the most common reason for patient presentation at the emergency department. The Emergency Severity Index (ESI) triage system is a well documented, reliable and valid algorithm that streamlines the triage management process. The purpose of this study is to compare a previously used four‐level triage system with the five‐level ESI by examining the time from triage to treatment order and to treatment administration for patients complaining of severe abdominal pain (8 or more out of 10) in a 431‐bed community hospital. Methods: Data were extracted retrospectively from 684 electronic medical records at three five‐month intervals. Times to treatment order and administration for ESI stages were compared using the general Analysis of Covariance (AOCV). Linear regression was run to determine which factors, if any, had a relationship with the time from triage to treatment order or from triage to treatment administration. Results: Although some demographic factors influenced time to treatment, implementation of the ESI had no effect on the overall time from triage to treatment order or to treatment administration in this sample. On further analysis, it was noted that in the Pre‐ESI period, 68% of patients complaining of severe abdominal pain were classified using the four‐level triage scale as “urgent” (similar to ESI level 2, the appropriate category for the patient with severe pain) with 32% assigned to “urgent stable” category, which most closely corresponds to ESI level 3. Following implementation of the ESI triage system only 10% of patients complaining of severe abdominal pain were triaged to ESI level 2, with 90% assigned to ESI level 3. Patients classified to ESI level 2 received treatment significantly more quickly than those assigned to ESI level 3. Conclusions/Implications: Patients with severe abdominal pain assigned to the appropriate ESI triage level did receive treatment in a timelier manner. Further investigation is needed to assess factors influencing the shift in triage patterns after implementation of the ESI system. Page 27
Paper Session A2: Pain Management in Acute and Critical Illness Examining the Diagnostic Accuracy of the Hendrich Fall Risk Models and the Morse Fall Scale Cheryl A Reilly, PhD, RN, Baystate Medical Center, Ware, MA ~ Mary M Brunton, MSN, RN, BC, Baystate Medical Center, Springfield, MA ~ Christine A Gryglik, MS, APRN, BC, Baystate Medical Center, Springfield, MA ~ Deborah Morsi, PhD, RN, Baystate Medical Center, Springfield, MA Purpose: Patient falls are common adverse events in acute care facilities. The Hendrich Fall Risk Models (HFRM) and the Morse Fall Scale (MFS) are recommended for identifying high risk patients yet few validation studies have been completed. The aims of this study were to evaluate the diagnostic accuracy of the HFRM, HFRM II, and MFS and to compare the fall rates using the HFRM and the HFRMII. Theoretical Framework: The Outcomes Model for Health Care Research served as the framework for this study. This model extends the work of Donabedian as it considers the interactions among the inputs, processes, and outcomes at the level of the client, provider, and setting. Methods: A retrospective case‐control design was used to evaluate the tools. A retrospective cohort design was used to compare fall rates. The study was conducted in a large urban academic medical center. A random sample of 100 in‐patients who fell were matched with a control, resulting in a purposive sample of 200 patients. All hospitalized patients were included in the analysis of fall rates. Estimates of sensitivity, specificity, and accuracy were determined. Point estimates were used to compare fall rates using the HFRM and HFRM II. Results: For the HFRM, sensitivity ranged from .58 to .74, specificity from .42 to .60, and accuracy from 53% to 65%. For the HFRM II, sensitivity ranged from .42 to .76, specificity from .50 to .58, and accuracy from 50.54% to 65%. For the MFS, sensitivity ranged from .76 to .82, specificity from .27 to .34, and accuracy from 54.5% to 55%. The mean fall rate per 1,000 patient days was 2.27 (SD=0.27) using the HFRM and 2.79 (SD = 0.47) using the HFRM II. The difference was 0.52 (95% CI = 0.29, 0.74) suggesting a statistically significant difference in fall rates. Conclusions & Implications: Although some studies support the diagnostic accuracy of the HFRMs and the MFS, these findings suggest there may be difficulties with their translation into practice in acute care settings. Low estimates of total predictive accuracy of the HFRM, HFRM II, and MFS suggest these models are little better than chance alone at detecting true fallers. The accurate identification of high risk patients is central to the initiation of fall prevention strategies and ultimately the avoidance of falls and related injuries. Health care organizations need to evaluate their fall risk assessment tools to ensure they are accurately identifying high risk patients, otherwise patient safety may be compromised. Page 28
Paper Session A3: Ethical Issues in Nursing and Healthcare Research The Development and Testing of an Observational Tool to Measure the Process and Quality of Informed Consent for Clinical Research Elizabeth Gross Cohn, RN, ACNP, Columbia University, New York, NY ~ Haomiao Jia, PhD , Columbia University, New York, NY ~ Elaine L. Larson, RN, PhD, Columbia University, New York, NY Purpose: The informed consent of research participants is a basic legal and ethical mandate, but studies have revealed that this process fails to achieve this intended goal. The purpose of this study was to develop and pilot‐
test an observational instrument to measure the process and quality of the informed consent encounter, including both its informational and communication components. Theoretical Framework: The Process‐Quality Informed Consent (P‐QIC) instrument was developed using a modification of Dillman’s (2007) methodology. Methods: P‐QIC was pilot tested for psychometric properties. Sixty‐three participants rated a set of DVDs depicting four consent encounters that differed by level of communication and/or informational content. Results: Convergent validity by intraclass correlation was 0.97; the instrument was able to reliably discern differences between four purposefully varied scenarios (discriminant validity) p = 0.05; internal consistency was .98 and test‐retest by from r = .630 to r = .998, which varied with the scenario. Interrater reliability was performed on live consent encounters with at Columbia University Medical Center. Conclusions: A standardized observational tool for the evaluation of the informed consent process may help investigators to better understand current practice and to design interventions to improve it. One such tool (the P‐QIC) was developed and was shown to be promising in initial psychometric testing. The DVDs and the tool are made available for use by investigators interested in further testing. Page 29
Paper Session A3: Ethical Issues in Nursing and Healthcare Research Barriers to Nurse Practitioners Recommending Clinical Trials Connie Ulrich, PhD, RN, University of Pennsylvania, Philadelphia, PA ~ Christine Grady, PhD, RN, Center for Bioethics, Bethesda, MD ~ Deborah Watkins‐Bruner, PhD, RN, University of Pennsylvania, Philadelphia, PA ~ Quiping Zhou, PhD, RN, George Mason University, Fairfax, VA Purpose: Difficulty in recruiting subjects to participate in research remains an ongoing concern for biomedical researchers, hampering the completion of the trial, translation of research into practice and ultimately effective treatments for human diseases. The objective of this research was to understand nurse practitioners’ perspectives and roles in recommending cancer clinical trials to eligible patients and the resources required to keep NPs informed and up to date, and able to refer patients for appropriate trials. Theoretical Framework: The proposed study was informed by Albrecht’s model of physician‐patient communication and extensive literature review, clinical practice, and research with cancer patients. Methods: We developed and conducted a cross‐sectional mailed survey, and randomly recruited 173 NPs from the state of Pennsylvania (56.5% response rate). The survey included individual socio‐demographic, cancer research recommendation, and ethics‐related variables. Descriptive statistics and logistic regression were used to analyze the data. Results: A majority of NPs (85%) report needing more information and education about clinical research, 36% did not feel comfortable discussing the option of entering a cancer clinical trial for treatment, and 64% reported ethical concerns as a barrier to recruitment. One third of NPs reported that cancer clinical research is not useful to their practice (34.9%) because of the difficulty of translating research results to clinical practice (53%). NPs who were willing to bring up clinical trials to patients were 2.7 times more likely to be familiar with published research (OR=2.67; 95% CI=1.36‐5.23), whereas NPs who were NOT willing to bring up clinical trials to patients were 2.8 times more likely to think published research not useful (OR=2.83; 95% CI=1.18‐6.83). Conclusions and Implications: Nurses at all levels are an enormous untapped resource that may assist to improve clinical trials recruitment. To increase clinical trial recommendations from NPs, effective dissemination strategies need to be developed and implemented. Page 30
Paper Session A3: Ethical Issues in Nursing and Healthcare Research Informed Consent For Clinical Research: A Concept Analysis Elizabeth Gross Cohn, RN, ACNP, DNSc, Columbia University, New York, NY ~ Elaine L. Larson, RN, PhD, Columbia University, New York, NY Purpose: To clarify the concept of informed consent for clinical research. Concept clarification will provide a common language for interdisciplinary dialogue, facilitate the development and testing of instruments, and guide strategies for improvement. Background: Current evidence demonstrates that despite signed consent forms, many research subjects do not comprehend the research in which they have agreed to participate. Failure to achieve comprehension, especially in marginalized populations, can leave participants with feelings of exploitation, and fear that the health care community is not being honest with them. Past practices have left a legacy of mistrust, exacerbating racial and ethnic disparities in research. Improvement efforts have been thwarted because there is a lack of clarity about the concept of informed consent. Theoretical Framework: Walker and Avant’s methodology for concept analysis was used to delineate and clarify the concept. Method: A review of the literature from May 1997 to May 2009, using PubMed and CINAHL were undertaken as part of this analysis. In addition we identified usages, attributes, antecedents and consequences and empirical referents. Results: Informed consent for clinical research was found to be composed of two complementary components. We designed a model illustrating the concept of comprehension for informed consent which includes: (1) the essential informational elements of consent regulated by statute, and (2) the communication between the researcher obtaining consent and the potential participant. Conclusion: A more comprehensive model of informed consent may enhance the design of strategies to improve the process. Our model recognizes the two‐dimensional components of informed consent and offers a framework on which to build a better process. Page 31
Paper Session A3: Ethical Issues in Nursing and Healthcare Research Assessing and Addressing System Wide Deficits in End‐of‐Life Care: The Prison Study Susan J. Loeb, PhD, RN, The Pennsylvania State University, University Park, PA ~ Janice Penrod, PhD, RN, The Pennsylvania State University, University Park, PA Purpose: To compare and contrast the current status of EOL care in contextually diverse prison communities; evaluate the infusion of modified approaches to EOL care using an intervention toolkit to meet the prioritized needs identified by stakeholders in diverse correctional facilities; and identify resource utilization data that are most appropriate for determining cost effectiveness of modified approaches to EOL care. Background: Prisons are complex, restrictive organizations that care for highly vulnerable individuals. Geriatric inmates (age > 50) are the fastest‐growing age‐cohort in prisons. They are living with and dying from chronic illnesses. Prisons are harsh contexts and inmates’ particularly fear dying alone there. We have good science on what to do in terms of end‐of‐life (EOL) care—we now need to better infuse this knowledge into complex organizations such as prisons so that wherever people die, they die comfortably and with dignity. Methods: Participatory Action Research will involve both qualitative and quantitative strategies. Data will be managed using Atlas.ti and SAS, respectively. Analytic techniques will include content, thematic, qualitative outcome, and cost effectiveness analyses. Together with Nursing and Health Economics researchers, a large multi‐disciplinary team of co‐researchers from state prisons will collaborate, interpret data, prioritize issues/needs, tailor EOL strategies that fit with organizational constraints, and interpret outcomes. Results: Our findings will include a description of values, beliefs, and perceptions of system wide needs across six state prisons. A generalist toolkit of EOL resources will be created to enable prisons to meet EOL care needs. Next, a master plan of strategic implementation will be developed and applied. Finally, the cost‐effectiveness of the medical and behavioral interventions will be determined. Conclusions: Improving EOL care for inmates who are suffering from advanced chronic illnesses will lay the crucial groundwork needed for future research aimed at infusing generalist EOL strategies into other complex organizations. Page 32
Symposium A4: Synthesizing Evidence through Systematic Review: A Fundamental Component of Evidence‐Based Practice Integrative Summary of Symposium Cheryl Holly, EdD RN, UMDNJ School of Nursing, Danbury, CT The aim of this symposium is to present the systematic review as a form of research fundamental to evidence based practice (EBP). The nature and conduct of systematic review is changing and in recent years significant progress has been made toward broadening the scope of what evidence may be included. The assumption of EBP is that there are things we need to know to conduct our practice professionally and safely, but there are substantial gaps in available knowledge. Systematic review involves the pooling of diverse forms of evidence in such as way as to effectively determine what interventions, activities or phenomena it is that the evidence supports. A pluralistic approach is presented involving synthesis of quantitative and qualitative research findings, economic analysis; and opinion, experience and expertise when other forms of evidence are not available. The systematic review is presented as an analysis of all available forms of evidence, and a judgment of its feasibility, appropriateness, meaningfulness and effectives that involves a series of complex steps. Systematic reviews occupy the highest position in the hierarchy of evidence as they systematically search, find and summarize available evidence that answers a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion or text. Following a discussion of the systematic review process, three systematic reviews will be presented. Page 33
Symposium A4: Synthesizing Evidence through Systematic Review: A Fundamental Component of Evidence‐Based Practice A Comprehensive Systematic Review of Relocation Stress Following In‐House Transfer out of Critical/Intensive Care Susan Salmond, EdD, RN, UMDNJ School of Nursing, Newark, NJ Objective: To conduct a mixed methods systematic review regarding relocation stress and the effectiveness of strategies for decreasing transfer anxiety in patients and their families upon transfer from an intensive care unit to a non‐intensive care unit. Background: The relocation from an ICU to a general nursing unit where staffing decreases from 1:1 to 1:8‐9 is considered to be stressful for staff, patients and family. Method: The review included quantitative and qualitative studies about adult intensive care patients, family members, intensive care nurses and ward/unit nurses caring for transferred. The search strategy sought to find both published and unpublished papers. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms to describe the article. A second extensive search was then undertaken using identified key words and index terms. Each paper was assessed by two independent reviewers for quality prior to inclusion in the review. Results: 23 were included in the review consisting of 14 qualitative studies, 8 quantitative studies and 1 clinical practice guideline. Three syntheses were developed: response to transfer, meaning of transfer, and strategies to facilitate successful transfer. Quantitative data could not be pooled and is presented in the narrative table. Conclusion and Implications: Transfer to the general unit was not a traumatic or negative experience but viewed positively as a sign of recovery although the positive emotions coexisted with uncertainty or fear. The most negative experience was related to lack of observation and care on the general unit where nurses many times were unaware or unresponsive to patients. functional deficits. Patients were consequently challenged to do more for themselves and depending on their level of success experienced growing confidence or frustration and embarrassment. Page 34
Symposium A4: Synthesizing Evidence through Systematic Review: A Fundamental Component of Evidence‐Based Practice A Systematic Review of Evidence on Determining the Impact of Magnet Designation on Nursing and Patient Outcomes. Is the Investment Worth It?" Susan Salmond, EdD, RN, UMDNJ School of Nursing, Newark, NJ Objective: The objective was to examine the available evidence on the impact of Magnet designation on patient and nurse outcomes. Background: Magnet designation has become a coveted symbol of quality, which requires commitment to nurturing a culture of excellence, careful allocation of resources, diligence to align and sustain systems to support patient care and professional development. The cost is significant and can conservatively be estimated at $100,000.00 per year for both the 2‐3 year preparation period and to sustain Magnet status. Method: This review considered any quantitative or qualitative study comparing organizational, nurse, patient or economic outcomes in Magnet designated hospitals with a comparison to a non‐Magnet facility. The search strategy aimed to find both published and unpublished papers. An initial search of the Joanna Briggs Institute and Cochrane Library databases was conducted, followed by searching on the key words from the preliminary search. Next, the reference lists from all retrieved papers were reviewed to identify papers not already identified. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion. Results: A total of 17 papers were included in the review. All were descriptive comparative studies with the majority using a cross sectional survey approach. Comparison across studies using the same instrument was limited. Majority of studies investigated professional nurse practice environment, nurse burnout, nurse satisfaction, perception of quality care, and intent to leave. Limited studies found related to patient outcomes, and no studies met criteria for inclusion for economic review. Conclusion and Implications: There is evidence to support the positive effect of Magnet designation on the professional nurse practice environment (PNPE). Stronger PNPE and Magnet status are associated with lower levels of nurse burnout, higher levels of nursing satisfaction, higher perceptions of quality of care, and decreased intent to leave. Page 35
Symposium A4: Synthesizing Evidence through Systematic Review: A Fundamental Component of Evidence‐Based Practice A Systematic Review of Nurses’ Inter‐Shift Handoff Reports in Acute Care Hospitals Cheryl Holly, EdD RN, UMDNJ School of Nursing, Newark, NJ Purpose: To appraise and synthesize the best available qualitative evidence pertaining to the nursing handoff report at the time of shift change. Background: Communication theories proliferate to explain the process of transmitting information from one person to another. Some of these theories focus on social aspects of communication; others focus on content, still others on human interaction. A nursing handoff is a multifaceted process involving all these aspects of communication as information is transmitted from one nurse to another in support of reassignment of patient care responsibilities. In acute care hospitals, this transfer of information is a frequent occurrence. Methods: The review considered qualitative studies that drew on the experiences of nurses at the time of inter‐
shift nursing handoff in acute care hospitals. An initial search of the Joanna Briggs Institute for Evidence‐Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical Inquiry/Find Systematic Review database was conducted, followed by an analysis of keywords contained in the title, abstract and index terms. Following this, an extensive three stage search was conducted. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant world wide websites and search engines. Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review. Results: A total of 21 papers were included. Three syntheses about the process of handoffs at the time of inter‐
shift nurses' reports in acute care hospitals were derived: 1) An embedded hierarchy exists that influences the conduct of inter‐shift nursing handoffs; 2) Participating in inter‐shift nursing handoffs are a way of becoming acculturated into the nursing unit’s norms, expectations and rituals; 3) The nurse is the gatekeeper of information handed off that is used for subsequent care decisions. Conclusion and Implications: There is evidence to support that the current process of inter‐shift nurses' reports serves several purposes in addition to transfer of information, including the development of group solidarity. It is apparent from this review that the nurse is the gatekeeper for the flow of information regarding patient care and chooses what information to impart and act upon. A consistent guideline is a prerequisite to formulating an optimal shift report given the findings of this review that the quality of information transferred is unpredictable.
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RIG Symposium A5: Are We Prepared to Abandon Theory ‐ Or Do Something With It? Theory RIG: Are We Prepared to Abandon Theory ‐‐ Or Do Something With It? Nancy M. Dluhy, PhD, RN, University of Massachusetts ‐ Dartmouth, Portsmouth, RI ~ Stacey Barone, PhD, RN, Boston College, Wm. F. Connell School of Nursing, Chestnut Hill, MA ~ Debra Hanna, RN, PhD, CNRC, Molloy College, New York, NY ~ Olga Jarrin, MS, PhD(c), RN, University of Connecticut School of Nursing, Windham, CT Susan Lee, PhD, RN, Massachusetts General Hospital, Boston, MA ~ Callista Roy, PhD, RN, FAAN, Boston College William F. Connell School of Nursing, Chestnut Hill, MA ~ Danny G Willis, PhD, RN, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA The contemporary climate within multidisciplinary health care professions positions evidence‐based practice as privileged knowledge. While EBP provides useful, specific knowledge, the trend to overshadow and devalue all other knowledge should raise a concern within the nursing discipline. As the conference objectives suggest, scientific evidence supports nursing practice but does not define nursing practice. This symposium provides a perspective on the internal and external forces influencing knowledge development and use in nursing. The presentation is framed by the question; does the current health care environment heighten the need for integrating theories to guide the practice of nursing and embed pieces of scientific evidence into a coherent whole? Moving beyond philosophical arguments, three papers provide compelling evidence for the value of theory through unique research studies, an educational application and a meta‐analysis of a subset of 350 studies based on the Roy Adaptation Model. These examples offer beginning strategies that bridge the theory‐practice gap, maintain the core values of the discipline and enhance healthcare within a multi‐disciplinary environment. Page 37
RIG Symposium A5: Are We Prepared to Abandon Theory ‐ Or Do Something With It? A Concept Synthesis of Geropalliative Care Susan M. Lee, PhD, RN, NP‐C, Massachusetts General Hospital, Boston MA, Duxbury, MA Previous work in geriatric palliative nursing has been predominately atheoretical. Additionally, little pertinent evidence for this area of practice has been found to date. Existing models of palliative care are also inadequate for this geriatric population since the needs of elders are confounded by a variety of phenomena relating to aging. Nursing in this specialized practice therefore continues to draw on a mix of theory, ethics and the values that guide the nurse to “do the right thing.” Concept synthesis was used to generate new knowledge leading to a mid‐
range theory of geropalliative nursing. Nine critical attributes of geropalliative care were drawn from inductive observations of nursing praxis. This effort provides a glimpse into future development of mid‐range theories appropriate to a specific context of nursing practice. Page 38
RIG Symposium A5: Are We Prepared to Abandon Theory ‐ Or Do Something With It? Live Case Studies in Nursing Theory: See One, Do One, Teach One Olga F Jarrín, MS, RN, PhD(c), University of Connecticut, Windham, CT A novel, collaborative learning technique for teaching nursing theory through “live” case studies highlights the abstract and invisible aspects of professional nursing practice. Nursing impacts the health of individuals, families, groups and populations through situated caring. Because of the integral (unitary) nature of human beings; physical, mental or spiritual aspects of health may be impacted by care (or lack of care) in any dimension of their experience. For example, physical health may be impacted by physical, psychological, spiritual, environmental, social or cultural conditions or events. One of the primary reasons given for the elimination of nursing theories from educational programs is the complexity of contemporary nursing practice that transcends the scope of traditional nursing theories. Drawing from methods of concept analysis, “model” and “contrary” version of a case study in pain management are dramatically portrayed, utilizing a think‐aloud approach, followed by a critique of the nursing care process. The live case study method demonstrates how multiple ways of knowing, including theories of nursing, can frame and guide nursing actions and interventions. This approach can be utilized in nursing theory courses, simulation lab experiences, didactic teaching, and for staff development or continuing education. Page 39
RIG Symposium A5: Are We Prepared to Abandon Theory ‐ Or Do Something With It? Phenomenological Research and Middle‐range Theory: A Basis for Developing Nursing Practice Aimed at Facilitating Self‐Healing Danny Willis, DNS, APRN‐BC , Boston College, William F. Connell School of Nursing, Chestnut Hill, MA Giorgi’s descriptive phenomenological research method is a good fit for nursing science aimed at understanding and describing phenomena of concern in nursing practice. One of the unique features of data analysis following Giorgi’s method is to explicitly interpret findings within a disciplinary perspective (i.e., nursing, psychology, etc). This paper examines the use of Reed’s Middle Range Theory of Self‐Transcendence and Barrett’s Theory of Power, both grounded in the Science of Unitary Human Beings, to give explanatory power to findings from a descriptive phenomenological study of 6th‐8th grade boys’ experiences of being bullied at school. Page 40
RIG Symposium A5: Are We Prepared to Abandon Theory ‐ Or Do Something With It? Roy Adaptation Model‐based Research 1970‐2009: A Meta‐Analysis of a Subset of Studies to Examine Effectiveness of Theory in Practice Callista Roy, PhD, RN, FAAN, Boston College, William F. Connell School of Nursing, Chestnut Hill, MA Stacey Barone, PhD, RN, Boston College, William. F. Connell School of Nursing, Chestnut Hill, MA Debra Hanna, PhD, RN, Molloy College, New York, NY ~ Pamela Senesac, PhD, SM, RN, University of Massachusetts ‐ Medical School, Framingham , MA Theory‐based practice is central to the recognition of nursing as a scholarly discipline with a social mandate. Nursing knowledge must be developed using scholarly approaches and be translated for use in nursing practice. This report is based on an on‐going critique and synthesis of 40 years of Roy Adaptation Model‐based research that includes 350 studies. The purpose of the secondary analysis to be reported is to select a subset of studies that meet the criteria for metaanalysis and evaluate them for effectiveness of theory in practice. Studies that met the criteria for critical analysis and pre‐established levels of explicit or implicit linkages to the model are included (Barone, et al., 2008). The subset is selected and data extraction made based on criteria recommended by Polit & Beck. The effect size of the subset of studies will be calculated. Meta‐synthesis of qualitative studies as recommended by Sandelowski and Barroso will be added as appropriate. The sample is described along with description of the research design with focus on interventions and measurement of outcomes. Because the studies are based on one conceptual model, the synthesis of findings can be discussed in terms of common elements of the Roy Adaptation Model, the four adaptive modes, influencing factors and central coping strategies, as well as the generic propositions of the model. Issues and recommendations for practice and for future research will be derived. Page 41
RIG Symposium A5: Are We Prepared to Abandon Theory ‐ Or Do Something With It? The Maze of Research, Theories, Evidence, Competencies....Will We Lose Our Way? Nancy M. Dluhy, PhD, RN, University of Massachusetts ‐ Dartmouth, Portsmouth, RI A visual representation provides a means to capture the impact of contemporary political, economic, and social trends in health care on knowledge generation in nursing. Pluralistic worldviews emphasizing multidisciplinary approaches to knowledge generation provide a new challenge to theoretical approaches in nursing science. Prescriptive guidelines such as Best Practice and Nurse of the Future Competencies have the potential to obscure theoretical knowledge within a rule‐based structure. These trends challenge the traditional view of a practice science as a theory‐research‐practice triad. The question is raised: If not theory then what? One answer begins by deconstructing theory within evidence‐based practice and making visible the challenge of integrating discreet evidence pieces into a coherent whole for practice. Page 42
Paper Session B1: Contemporary Nursing Workforce Issues Nurses’ and Nursing Assistants’ Reports of Missed Care And Delegation Nancy Phoenix Bittner, PhD, RN, CCRN, Regis College, Mansfield, MA Gayle Gravlin, EdD, RN, NEA‐BC, Lahey Clinic Medical Center, Burlington, MA Purpose: The purpose of this study was to measure nurses (RN) and nursing assistants (NA) reports of missed routine nursing care. Theoretical Framework: Clinical Decision Making was used as a theoretical framework for this study. Method: Quantitative design using the MISSCARE Survey‐2 and a delegation assessment to identify the relationship of delegation effectiveness to missed care on 16 medical‐surgical units in 3 acute care hospitals in the northeast. This quantitative study was a follow up to a previous qualitative study conducted by these researchers, exploring delegation and critical thinking in which frequent instances of routine care omissions were reported. With IRB approval, questionnaires were distributed to 568 RN’s and 232 NA’s. The response rate for each group was 42%. At the same time, a unit characteristic survey was distributed to Nurse Managers, 100% of whom responded. Results‐RN and NA reports of missed care were widespread, confirming earlier study findings. The most prevalent care omissions were turning, ambulating, feeding, mouth care, and toileting. Reasons cited by both groups were an unexpected rise in volume or acuity, heavy admission or discharge activity and inadequate support staff. Disturbing findings not previously noted were that 88% of the Nurse Managers stated omissions had been reported to them, with 67% reporting the frequent occurrence of omissions. Prime factors affecting successful delegation indicated by both groups were communication, NA competency, attitude and workload. Of interest was the report by 43% of RN’s and 60% of NA’s that they had not received any delegation education, either in nursing school or by an employer. Conclusion & Implications: An honest assessment and analysis of point of care delivery system failures and ineffective processes that do not support the work of frontline nursing staff is essential. Workforce development must include delegation education, competency training of support staff, communication and teamwork training. In addition, emphasis must be placed on educating the nursing workforce regarding new requirements that link nursing quality outcomes to hospital reimbursement. Page 43
Paper Session B1: Contemporary Nursing Workforce Issues Nurse Burnout and Quality of Care: Cross‐national Investigation in Six Countries Lusine Poghosyan, PhD, MPH, RN, Northeastern University, Boston, MA Linda H Aiken, PhD, University of Pennsylvania, Philadelphia, PA Sean Clarke, RN, PhD, FAAN, University of Toronto and University Health Network, Toronto, Ontario Purpose: Burnout is a common issue among nurses internationally, and it may influence patient care. This study explored the impact of nurse burnout on quality of patient care. Theoretical Framework: The conceptual framework that guided this study was adapted from the frameworks of Aiken et al. (1997); Lake (1999); Cordes and Doughtery (1993); and from the existing body of evidence. Methods (Design, Sample, Setting, Measures, Analysis): The study utilized a secondary analysis of data from the International Hospital Outcomes study. The data collection was conducted in six countries from 1998‐2005; 54,264 hospital nurses participated in the study from the U.S, Canada, the U.K., Germany, New Zealand, and Japan. Burnout was measured by the subscales of the Maslach Burnout Inventory: Emotional Exhaustion, Personal Accomplishment, and Depersonalization. Quality care was measured with a single item asking nurses to rate patient care during the last shift on a 4‐point scale from excellent to poor, which was later dichotomized to allow estimation of the odds of reporting suboptimal as opposed to optimal care. Multiple logistic regression models were estimated and controlled for demographic and job characteristics, job satisfaction, and nurse practice environments. Results: Nurse burnout was associated with nurses’ perceptions of quality of care independently of job characteristics, job dissatisfaction, and ratings of working conditions. Emotional Exhaustion subscale was a significant predictor. Every unit increase in this subscale was associated with a 4 to 8 percent rise in the odds of suboptimal quality of care. The effects were relatively similar across countries. Among U.S. nurses for every unit increase in this subscale the odds of suboptimal quality care increased by 5 percent keeping other variables in the model constant. Higher Depersonalization and lower Personal Accomplishment scores were also significant predictors. The odds of reporting suboptimal care by nurses in the U.K. increased by 6 percent with each unit increase on the Depersonalization subscale. Conclusions & Implications: Reducing nurse burnout should be a priority because of its potential impact on quality of care. Page 44
Paper Session B1: Contemporary Nursing Workforce Issues Do Magnet Recognized Hospitals Provide Better Care? Marie‐Claire Rosenberg, PhD, RN, New York University, New York, NY Ann Barry Flood, PhD, Dartmouth College, Lebanon, New Hampshire Research Purpose: To investigate whether hospitals with Magnet status have better patient outcomes. Background: In the early 1980s, during a nursing shortage in the US, a group of hospitals was noted for their ability to consistently attract and retain a high‐quality nursing workforce. The original research of these 41 hospitals became the foundation for the Magnet Recognition process. Each year since 1994, the American Nurses Credentialing Center (ANCC) evaluates tens of applicant US hospitals to determine whether they will become newly designated. We investigated whether patients in Magnet designated hospitals had better nursing‐sensitive outcomes and general outcomes compared to non‐Magnet hospitals. Methods: Using a cross‐sectional, multi‐level design of fee‐for‐service Medicare beneficiaries 65 years or older who were hospitalized for initial treatment of Hip Fracture (HF) or Acute Myocardial Infarction (AMI) in all US non‐federal hospitals in 2002‐2004, we merged data from the ANCC on Magnet status, from the American Hospital Association on hospital characteristics, and Medicare (using Part A, enrollment and death records). In 2004 there were 101 healthcare organizations in 45 states recognized as Magnet among 4522 hospitals. 969,905 HF and 657,814 AMI patients were included in our study. Using multi‐level regression models, we examined the association between receiving care in a Magnet hospital and better outcomes, using four nursing‐sensitive outcomes and two general outcomes. Models adjusted for patient and other hospital characteristics. Results: For HF patients, only one outcome was statistically significant at p<.001; they were less likely (Odds Ratio 0.72, 95% Confidence Interval: 0.54, 0.96) to experience a decubitus ulcer in Magnet hospitals. None of the tests based on nursing or general outcomes showed care in Magnet hospitals was statistically significantly different for AMI patients. Conclusions: This study did not provide much support for the hypothesis that patients receive better care in Magnet hospitals. There are several limitations that may have limited our ability to test this association, in particular how to measure and evaluate nursing care in hospitals, e.g., what cohorts to use and what outcomes to measure. Further research is needed to comprehensively measure how nursing care in general and more specifically nursing care provided within hospitals recognized for their excellent nursing care, impacts patient outcomes. Page 45
Paper Session B1: Contemporary Nursing Workforce Issues The Type of Nurse Matters: The Effects of Nurse Staffing Levels, Non‐RNs, and Contract Nurses on Length of Stay Pat W Stone, PhD, FAAN, Columbia University Center for Health Policy, New York, NY Background: The impact of various types of nursing personnel on patient outcomes remains uncertain. Theoretical Framework: This study was guided by the theory of human capital. Methods: Four years of panel data (2002‐2006) from all general acute care units and intensive care units (ICUs) in Department of Veterans Affairs (VA) hospitals. Using average patient length of stay (LOS) as the outcome, fixed effects, multivariate regressions controlling for known confounding variables were estimated with robust standard errors clustered by unit. A cost‐benefit calculation was computed. Results: 161 ICUs (7,148 monthly observations) and 266 acute care units (11,637 monthly observations). The mean nursing hours per patient day (HPPD) and LOS varied by unit (HPPD: ICU 18.2 vs acute care 7.9; LOS: ICU 3.0 days vs acute care 4.9 days). A one hour increase in HPPD was associated with LOS reductions of 1.6% (95% CI 1.3‐1.9, p<0.001) in ICUs and 3.1% (95% CI 2.6‐3.5,p<0.001) in acute care units. Both were approximately linear across the entire range of staffing levels. Increasing the HPPD by 1 hour per day would save $350 per ICU and $160 per acute care. An increase in contract nurses from 0% to 10% of nurse staffing was associated with 3.3% (95% CI 0.8‐5.8, p<.0.001) and 3.1% (95% CI 2.1‐4.1, p<0.001) longer LOS for ICUs and acute care units, respectively. We also found that failure to control for unobserved heterogeneity results in a doubling of the estimated HPPD effect. Conclusions: Hospitals should minimize the use of contract nurses while maintaining nurse staffing levels. Page 46
Paper Session B2: Innovative Approaches to Improving Quality and Safety in Healthcare The Relationships of Workforce, Leadership, Empowerment, and Role Preparation to Intent‐to‐Stay in the Organization Among Traditional and Accelerated BSN Graduates Carolyn L. Davidson, RN, PhD, CCRN, APRN, Lehigh Valley Health Network, Allentown, PA Purpose: The primary purpose of this study was to explore the predictors of intent‐to‐stay in the organization beyond the initial two years of employment, for traditional BSN and accelerated BSN graduates who are currently working in acute care settings. Theoretical Framework: This researcher applied, “A Theory for Nursing” (King, 1981) in development of a practice theory for intent‐to‐stay (ITS) in the organization for novice nurses. An extensive literature review identified a collective set of predictors (workforce, leadership, empowerment) referred to as professional socialization that when interacting dynamically with BSN role preparation evolved into a model predictive of intent‐to‐stay in the organization for novice nurses. Methods: The descriptive correlational and comparative design included university‐based traditional (n = 87) and accelerated (n = 85) graduates with at least 12 months, but less than 24 months experience. The data were collected by mailed survey consisting of four research instruments (Professional Practice Environment Scale, Empowering Leadership Questionnaire, Conditions of Work Effectiveness Questionnaire, Anticipated Turnover Scale and a demographic data form). The statistical methods employed to analyze and interpret the data included descriptive statistics, stepwise multiple regression, and independent t‐test. Results: Traditional BSN graduates indicated workforce predicted ITS in the organization (R2 = .44, p < .001) while the accelerated graduates indicated empowerment predicted ITS in the organization (R2 = .31, p < .001). The predictor variables of workforce, leadership, and empowerment were strongly and significantly correlated to ITS. Leadership failed to enter into the multiple regression equation for both traditional and accelerated BSN graduates. Additional analyses of demographic variables yielded a significant correlation of ITS and working at a Magnet® organization, otherwise no significant correlations were found. Conclusions: The knowledge of intent‐to‐stay for novice nurses has been advanced through this study of traditional and accelerated BSN nurses with less than two years experience, and therefore, future research will need to examine other predictors of intent‐to‐stay. Page 47
Paper Session B2: Innovative Approaches to Improving Quality and Safety in Healthcare High‐Quality Nursing: The Perspective of Hospital‐Based Nurses Daniel D Cline, MSN, CRNP, New York University College of Nursing, New York, NY ~ Christine T Kovner, PhD, RN, FAAN, New York University College of Nursing, New York, NY ~ Marie‐Claire Rosenberg, PhD, RN, New York University College of Nursing, New York, NY Purpose: The purpose of this study is to explore hospital‐based registered nurses (RNs) perceptions of high‐quality nursing care. This study contributes to ongoing work intended to define and measure what quality nursing care is and how it ultimately impacts patients. Background: The practice of nursing in the hospital setting is complex and diverse, and integrates intimate human interactions with scientific knowledge. Therefore, it is essential that nursing quality indicators measure both the science and the art of nursing. Methods: This study used qualitative data gathered from a nationally representative sample of early career RNs in a cross‐sectional questionnaire exploring hospital‐based RNs’ knowledge of Quality Improvement. Following the quantitative section of the questionnaire, participants were asked to respond to the following open‐ended statement: Please tell us what you think high‐quality nursing care is. A total of 171 narrative responses were included in the sample analyzed for this paper. Krippendorff's technique for qualitative content analysis, by means of dendograms to cluster data, was used to identify themes. Results: Three themes emerged as integral to high‐quality nursing care. RN Presence, which expresses the significance of RNs being with, or spending time with patients at the bedside; Developing Relationships, which describes essential interpersonal aspects of high‐quality care such as trust, advocating for patients, and focusing on patients’ needs; and finally, Facilitating the Flow of Knowledge and Information, which describes the importance of evidence‐based practice, individual RN knowledge and competence, and interdisciplinary teamwork and communication in relation to the delivery of high‐
quality nursing care. Conclusion and Implications: This study supports the growing body of evidence related to quality nursing care that describes the importance of RNs spending time with patients, as well as the importance of nurse‐patient relationships. It adds new knowledge by demonstrating that RNs’ perceive evidence‐based practice, RN knowledge, and teamwork and communication as integral aspects of high‐quality nursing care in the hospital setting. Development of future nurse quality measures should not only focus on patient outcomes (e.g. patient falls), but also on nursing processes of care. This would more fully capture the complexity of nursing care, both the science and the art, occurring in the hospital setting. Page 48
Paper Session B2: Innovative Approaches to Improving Quality and Safety in Healthcare Deficiencies in Nurses’ ECG Monitoring Knowledge: Preliminary Results of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial Marjorie Funk, PhD, RN, FAHA, FAAN, Yale‐New Haven Hospital, New Haven, CT ~ Barbara Drew, PhD, RN, FAHA, FAAN, UCSF School of Nursing, San Francisco, CA ~ Meghan Fashjian, MSN, APRN, Yale University School of Nursing, New Haven, CT ~ Kristopher Fennie, PhD, Yale University School of Nursing, New Haven, CT ~ Jeanine May, MSN, MPH, APRN, Yale University School of Nursing, New Haven, CT ~ Kimberly Stephens, MPH, RN, UCSF School of Nursing, San Francisco, CA Catherine Winkler, PhD, RN, Yale University School of Nursing, Newtown, CT Despite major advances in electrocardiographic (ECG) monitoring technology, monitoring practices are inconsistent and often inadequate. It is unclear whether this is partly due to knowledge deficits of nurses. Purpose: To evaluate nurses’ knowledge related to ECG monitoring and determine if any characteristics of the nurses predict ECG monitoring knowledge. Theoretical Framework: Knowledge transfer (Lavis et al., 2003) is the organizing framework guiding our PULSE Trial, a multi‐site randomized clinical trial evaluating the effect of implementing American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods: This descriptive study is the initial phase of the PULSE Trial. We examined baseline knowledge of nurses working in units with cardiac patients in 17 hospitals (15 in the US, 1 in Canada, 1 in Hong Kong) 9/08‐6/09. Nurses completed an online demographic form and 20‐item knowledge test that covered essentials of ECG monitoring and arrhythmia, ischemia, and QT interval monitoring. The test was developed by the investigators, pilot tested on 124 nurses, and revised based on an item analysis. Scores can range from 0 to 100, with higher scores indicating greater knowledge. Results: The sample of 1,739 nurses was 89% female, 72% white, with a mean age of 38.3±11.1 years. About 74% had a bachelor’s degree or higher. Participants worked on a cardiac unit for 8.9±8.8 years and 46% practiced in a critical care unit. Test scores ranged from 6 to 90, with a mean of 48.2±11.9. Of the 4 subsections, essentials of ECG monitoring had the highest mean score (52.1±16.4) and ischemia monitoring had the lowest (35.6±22.5). Mixed modeling treating hospital as a random effect revealed that the following predicted higher scores: older age (p=.043), male gender (p<.001), white race (p=.022), education at a bachelor’s level or higher (p=.009), longer time working as a nurse (p=.022), longer time working on a cardiac unit (p<.001), working in a critical care unit (p<.001), and having had a rhythm interpretation course (p=.005). Conclusions: Test scores, especially related to ischemia monitoring, indicated that nurses’ knowledge about ECG monitoring can be improved. Education should particularly target less experienced nurses. The online ECG monitoring education program in the next phase of the PULSE Trial may improve knowledge and, ultimately, the quality of ECG monitoring and patient outcomes. Page 49
Paper Session B2: Innovative Approaches to Improving Quality and Safety in Healthcare A Description of Correlates and Factors Contributing to Medication Errors in Acute Care Nurses Kathleen F. Sellers, PhD, RN, SUNY Institute of Technology, Cobleskill, NY Connie Jastremski, RN, MS, Bassett Healthcare, Cooperstown, NY Purpose: Medication errors in hospitals are common and can occur from procurement of the drug, to documentation of administration (IOM, 2006). Correlates and factors contributing to errors remain unknown, making it difficult to systematically address the problem. Internal data at a rural health network reflects that nurses play a significant role in medication errors that occur on the inpatient units – 41%/6 months – through incorrect transcription/verification of an order, incorrect administration of the medication, and/or inaccurate documentation. Theoretical Framework: Guided by Benner’s (1982) theory of Novice to Expert this descriptive study attempted to understand factors associated with specific clinician demographics and medication errors. Methods: Utilizing a non‐experimental, comparative‐correlational design a study was conducted of 96 incident reports of medication errors that involved 73 nurses occurring on the acute care units over the 6 month time frame of January 1, 2007 – June 30, 2007. Descriptive statistics were used for the analysis. Results: (N= 96 errors, 73 nurses) indicate the average age of nurses, RNs (65), LPNs (8) was 43 years. The mean years experience was 9 years, with nurses being in their current role an average of 5 years. This is not consistent with Benner’s framework and dispels the assumption that medication errors are made by the population of new graduates. Few reported errors occurred in early summer months when new graduates were orienting to their roles. The majority of errors, were made in the first 5 hours of the shift, the first day a nurse returned to work suggesting unfamiliarity with patients is a contributing factor. Productivity (NCH/PCH) averaged at 119%. A high percentage of errors are related to 1‐time orders suggesting that there was a systems problem related to a 5‐day Medication Administration Record (MAR); placement of single dose MAR labels on the back of MAR's for one‐time orders. A daily MAR with a special section for 1‐time orders is being trialed. Conclusions and Implications: Specific practice and education interventions for experienced nurses are being developed. These findings are important to informing administrative and education standards and initiatives, and speak to the need for larger collaborative studies focusing on the causes and correlates that contribute to medication errors thus enhancing patient safety in diverse populations. Page 50
Paper Session B3: Nursing Research and Disparities in Health and Health Outcomes Related Support Services Needs Indentified by African American Breast Cancer Survivors Sharon M. Mills‐Wisneski, PhD, RN, Oakland University, Ann Arbor, MI Developing an intervention that is culturally relevant remains a challenge for health care professionals. The evidence has shown that most of the attention in the literature, regarding related cancer supportive care, is available primarily during the acute treatment phase. However, little research has been done to identify which support services provided during cancer treatment would be beneficial to African American(AA) breast cancer survivors, post‐treatment. Purpose: The purpose of this study was to identify those related support services that African American women(AA) have used or might have used, during acute cancer treatment and those support services that the participants indicated that they would like to have continued to use post‐treatment. Theoretical Framework: The concept of survivorship, consisting of three phases: acute, extended, and permanent, as proposed by Mullen(1985),was used to differentiate the social and cultural contexts and preceptions of breast cancer in AA breast cancer survivors. Specifically, the concept of the extended phase of survivorship was used to guide the research design and process. Methods: The participants consisted of AA women (N=42), 26 to 80 years of age, 2 to 10 years post‐
treatment, who were members of the Sisters Network (Michigan and Ohio chapters) or members of the Minority Women's Health Registry, who completed a mailed survey that consisted of an instrument, that assesses breast cancer related service needs (Chesler, Weigers, and Zebrack, et al., 1996), but which has been primarily used in white, long‐term breast cancer survivors. Results: Overall, the participants were able to identify those support services that were useful during cancer treatment, as well as those support services that they would like to have continued. Conclusions and Implications: The findings provide a foundation for target interventions to improve the quality of life for African American breast cancer survivors in the extended phase of survivorship. Keywords: Cancer survivorship, health disparities, culture/cultural competence, and women's health. Page 51
Paper Session B3: Nursing Research and Disparities in Health and Health Outcomes The Effect of a Structured Writing Intervention in Black Women Living with HIV Rosanna F DeMarco, PhD, PHCNS‐BC, ACRN, FAAN, Boston College, William F. Connell School of Nursing, Quincy, MA Purpose: The HIV epidemic disproportionately affects heterosexual Black women in the United States. There are no interventions that target HIV‐positive Black women with complex co‐morbid psychological and physical conditions by using structured writing as a way to disclose emotions related to these experiences and effect change in at risk behaviors. This completed research tested the efficacy of a structured writing intervention with seropositive Black Women. Theoretical Framework: The Ecological Model (Bronfenbrenner, 1979; 2004) and the Silencing the Self Theory (Jack, 1991). Methods: Total sample of 75 Black seropositive women using a peer‐led randomized control trial pre and post test design at 6 weeks and 6 months in a community‐based setting. Outcome measures included safe sex expectancy (behaviors, intentions, attitudes), self‐advocacy, healthcare adherence, and stigma. Comparisons were made of paired 6‐session interventions, i.e., structured writing using film clips of a commissioned local film called Women’s Voices Women’s Lives© as a focal point and usual care support group. Analyses included general linear model (GLM) repeated measures (SPSS). Results: Retention was 82% in a hard to recruit and retain sample. Positive effects across time comparing intervention and usual care on selected outcomes: Decreased “silencing the self” behaviors significant for time (p=.015) and type (p=.000); decreased negative self image for time (p=.000) and type (p=.000); decreased stigma for time (p=.000) and type (p=.014); significant mean differences between intervention and usual care across time for condom use and safe sex practices. Conclusions and Implications: Although the intervention affected self advocacy in sexual relationships and safe sex expectancy, there is less than the ideal of consistent use of condoms and safe sex practices. These findings highlight the importance of addressing skill‐building combined with structured writing as a way to boost the effect disclosure of emotions with behavior change. Page 52
Paper Session B3: Nursing Research and Disparities in Health and Health Outcomes Making Ends Meet: Community Health Work Among an Urban Minority, 1912‐1922 Margo Brooks Carthon, PhD, RN, APRN, University of Pennsylvania, Philadelphia, PA Purpose of the Study: Using Philadelphia as a case study, this paper explores the cooperative activities of Black nurses who worked alongside private philanthropic associations, physicians and Black community residents to thwart the deadly effects of tuberculosis during 1912‐1922. Background: The poor health of Black Americans was a widely recognized fact during the first third of the 20th century. During this period, much of the noted excessive mortality in Blacks was linked to infectious diseases such as tuberculosis. Though Blacks were commonly believed to succumb to the disease at higher rates due to purported racially inherited defects, other factors such as poor living conditions and a lack of health care resources were equally to blame. Previous studies have examined the intersection of infectious disease, race and the provision of health services. Few however, have explored the role of Black nurses who worked actively within the anti‐TB campaign to provide health education and improve living and health conditions in the Black community. This paper explores the means through which Black nurses leveraged their racial identity to reduce distrust among black residents while also utilizing long standing social networks and institutions operating in the black community to push forward an expansive heath promotion agenda. Methodology/Primary and Secondary Sources: A social historical methodology was employed for the completion of this study. Primary archival sources were reviewed from the Barbara Bates Center for the Study of the History of Nursing, Temple Urban Archives and the University of Pennsylvania General Archives. Secondary sources included major historical work on black nurses and physicians and sociological and historical monographs detailing the lived experience of Black Philadelphians. Results & Implications: Collaborations between philanthropic associations and community residents became a defining feature of health service provision for Blacks during this period. Black nurses were central to the accomplishments of these endeavors, serving as the cornerstones for health promotion and activism. Contemporary efforts to ameliorate health disparities must include synergysistic partnerships between community members and health professionals. Page 53
RIG Symposium B4: Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Susan DeSanto‐Madeya, PhD, RN, CNS, University of Massachusetts‐Boston, Norwood, MA Helene Moriarty, PhD, RN, PMHCNS‐BC, Veterans Affairs Medical Center, Haverford, PA Research of families and communities is a challenging endeavor. As we enter into partnerships with diverse populations, it is critical that we design methodological approaches with careful consideration to the phenomena of interest and the nature of the questions posed. Furthermore, we need to consider many complex factors‐‐sociocultural, community, emotional, and economic‐‐in the conduct of this research. Presenters will describe innovative methods for family/community research that strive to balance scientific rigor with the realities of research with diverse groups in diverse settings. Five papers will discuss key issues in the design and conduct of research with families/communities experiencing sensitive issues. Strategies to address these issues in varied studies will be highlighted. The papers include: a study of parental treatment decision making in post‐separation families; research with racially diverse individuals with advanced cancer and their caregivers at end‐of‐life; an intervention to improve interaction between mothers with postpartum depression and their infants; studies of urinary symptoms in men with Parkinson’s disease and their partners; a study of families with intra‐familial abuse; research with families suffering death of a child; and a project on perceptions of communities about resources for older adults to age‐in‐place. Implications of the studies for enhancing health in diverse populations and settings will also be emphasized. The symposium will encourage an open dialogue around finding a balance between rigor and reality in research. Page 54
RIG Symposium B4: Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Challenges and Strategies in the Design and Conduct of End‐of‐Life Research with Individuals with Advanced Cancer and their Caregivers Susan DeSanto‐Madeya, PhD, RN, CNS, University of Massachusetts‐Boston, Norwood, MA Racially diverse individuals with advanced cancer and their primary caregivers have multi‐faceted and unique end‐of‐life care needs. Numerous methodological considerations need to be considered when embarking upon end‐of‐life research with this vulnerable population. Attention must be given to not only the scientific rigor of the study but also the sensitive nature of the phenomenon of interest. The design and conduct of end‐of‐life research with individuals and primary caregivers from diverse backgrounds poses many challenges. This paper identifies issues and challenges encountered in current methodological approaches to end‐of‐life research. Lessons learned from and strategies developed for a prospective, longitudinal end‐of‐life study, Coping with Cancer, are highlighted. Strategies include: using sensitivity and flexibility to introduce and explore the topic of end‐of‐life care; recruiting and retaining individual and caregiver participants; adapting, tailoring, and evaluating instruments used with diverse groups at various phases of end‐of‐life; planning for interviewer training and peer support; and addressing ethical issues in the conduct of this sensitive research. The ultimate goals of this program of research are to comprehensively describe end‐of‐life care needs and quality of end‐of‐life care for diverse individuals with advanced cancer and their caregivers, to develop and test effective interventions for optimizing care and quality of life for this diverse population, and to provide knowledge that will guide policy formation, funding decisions and capacity building. To achieve these goals, rigor and reality need to be balanced in the design and conduct of end‐of‐life research with diverse populations. Page 55
RIG Symposium B4: Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Identifying, Recruiting, and Retaining Women with Postpartum Depression for Research June Horowitz, PhD, RN, CNS, FAAN, Boston College, Milton, MA The purpose of this paper is to describe challenges and present strategies for identifying, recruiting, and retaining research participants who are experiencing postpartum depression – often an undetected population that can be difficult to locate and engage in research. The strategies presented are based on the experience of the CARE (Communicating and Relating Effectively) study, a randomized clinical trial (RCT) testing a nursing intervention aimed at improving the quality of interaction between mothers with postpartum depression (PPD) and their infants. Given that PPD often remains an unidentified clinical problem and recruiting new mothers to participate in research is challenging, funneling from a large population within the community was required to identify eligible and willing research participants. Lessons learned from the CARE study and strategies for success focus on study coordination and management, and knowledge of the population, i.e., women experiencing PPD. Exemplars from the CARE Study are highlighted as strategies relevant to successful conduct of research concerning PPD. Implications for identifying research participants with mental health problems other than PPD that often are undetected may be drawn from experience with the CARE study. Page 56
RIG Symposium B4: Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Strategies to Address Challenges in Research with Individuals and Families Experiencing Very Sensitive Issues Helene Moriarty, PhD, RN, PMHCNS‐BC, Veterans Affairs Medical Center, Haverford, PA Research of individuals and families from diverse backgrounds who are experiencing very sensitive issues poses many challenges for study participants and researchers. Methods that are culturally relevant, respectful, and appreciative of the naturalistic context are warranted. Furthermore, serious consideration must be given to balancing scientific rigor with the realities of conducting research with these populations. In this paper, key issues in the design and conduct of research with individuals and families experiencing very sensitive problems will be identified. Strategies to address these issues will be highlighted, using examples drawn from varied studies. A program of research focusing on urinary symptoms in men with Parkinson’s disease and their partners, which includes three interrelated studies, will be described. The investigators will discuss how the use of mixed methods (QUAN/qual) and group coding enabled the investigators to better capture the complexity of the experience of urinary symptoms and to better understand the impact of these symptoms on quality of life and relationships. A qualitative cross‐cultural study of families experiencing intrafamilial abuse will also be described, along with strategies to achieve sensitivity and flexibility in the data collection process. Finally, examples from a study of families suffering the sudden death of a child will be presented to illustrate strategies for recruiting and joining with these families at an extremely traumatic time in their lives. Through all these study examples, the authors will discuss how they strove to reach a balance between rigor and the realities of clinical research with these diverse groups. Page 57
RIG Symposium B4: Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Challenges in Measuring Perceptions of Community Support and Services for Older Adults Veronica Rempusheski, PhD, RN, FAAN, University of Delaware, Newark, DE Purpose: The purpose of this paper is to describe challenges and resolutions of balancing rigor and realities of a community‐based participatory research (CBPR) study of perceptions of three communities about the awareness, access and support of older adults to age‐in‐place. Theoretical Framework: Donabedian’s (1992) Structure‐Process‐Outcome model framed the study. Structure is the geography of three communities defined by postal zip code; process is the community intervention; outcomes are perceptions of older adults and community stakeholders. Methods: The design is non‐experimental intervention with methodological triangulation. Perceptions were elicited through focus groups and surveys. Focus group participants (n=59) provided contextual data about services, facilities and resources that do/do not exist in each community. Survey sample size (N=304) was estimated by % of 65+ year olds, stratified by % racial distribution per zip code total population. Survey items included the Perceptions of Community Scale (Chellappoo, 2008) (α = 0.88) and the Social Provisions Scale (Cutrona & Russell, 1987) (α = 0.93). Subjects were 75% women, 52% married; 73% Caucasian and 23% African American; 49% retired; 53% older adults (M age 75, SD 8) and 47% community stakeholders (M age 48, SD 15). Content, descriptive, psychometric and multivariate analyses were performed. Results: Four challenges emerged: layered hiring, interpretation of data collection protocol, conflicting agendas, unrealistic time commitment. We analyzed team dynamics and evaluated knowledge/readiness to engage in the research. These two strategies resulted in mutual understanding of roles, increased frequency and quality of communication among key personnel, reformatted materials, and simplified processes to maintain rigor of the study. Conclusions & Implications: Gaining an understanding of each site mission and team member role contributed to the balance in this CBPR collaboration. CBPR pre‐study planning must include an honest and realistic appraisal of time commitment and knowledge about research in order to achieve successful outcomes. Page 58
RIG Symposium B4: Family and Community‐Based Participatory Research Methods: Challenges in Balancing Rigor and Reality Studying Clinical Phenomenon in Diverse Family Structures Katherine Patterson Kelly, PhD, RN, PCNS‐BC, Children’s National Medical Center Purpose: To describe the challenges of conducting a study of parental treatment decision making (TDM) in post‐separation families and discuss potential solutions. Background: The majority of research about the family impact of childhood chronic illness has not reported the potential impact that family structural diversity may impose on outcomes. Previous reports estimate that approximately one third of all US children will be raised in a remarried or cohabitating stepfamily household before they reach 18 years of age. The complexities of these families cannot be understood from research approaches that study families based on the report of a single parent, typically the mother. Inattention to family structure in research and practice is a potentially serious oversight in families with parents from multiple households who are involved in TDM for a child with cancer. Methods: Integrative review of parent TDM literature and conduct of a qualitative study of 15 parents from 8 diverse families. Findings: Only 6 out of 86 studies reviewed included marital status as a demographic descriptor of parents. Researchers focused on how individual parents made decisions on behalf of their ill children. Analyses of both quantitative and qualitative data were limited to individual parents’ responses without reports of parental interactions even when data were obtained from both parents. In the qualitative study, parents’ involvement in TDM was grounded by a focus on the ill child and a belief in the biological parents’ imperative for TDM and was influenced by parent position, previous family dynamics and time since diagnosis. Conclusions: Research challenges included overcoming the presumption of conflict amongst the separated or divorced parents, and recruitment of all parents for each family. The genogram was found to be both a useful data collection strategy and a method to have a complete picture of the complex family structure, which helped the researcher to interact meaningfully with parents. Considerations related to analysis of the qualitative findings from an individual parent versus the family level will be discussed. Page 59
RIG Symposium B5: Facilitating Translational Aging Research in the Northeast Facilitating Translational Aging Research in the Northeast Meg Bourbonniere, PhD, RN, Dartmouth‐Hitchcock Medical Center, Lebanon, NH ~ Deborah D'Avolio, PhD, APRN‐BC, Massachusetts General Hospital, Boston, MA ~ Corrine Jurgens, PhD, RN, ANP‐BC, FAHA, Stony Brook University, Stony Brook , NY ~ Ann Kolanowski, PhD, RN, FAAN, Pennsylvania State University, University Park, PA Jennifer Hagerty Lingler, PhD, RN, University of Pittsburgh, Pittsburgh, PA The growth of the ENRS Aging Research Interest Group is due, in part, to the John A. Hartford Foundation’s “Building Academic Geriatric Nursing Capacity” program. This program has increased the number of nurse scientists in aging in the ENRS region. The dual purposes of this symposium are to highlight selected translational research conducted by Aging RIG members and stimulate discourse aimed at developing a network of nurse scientists in aging in the Northeast to support translational research and evidence‐based practice in the care of older adults. Presentations will address the barriers to implementing non‐pharmacological interventions in the nursing home setting; a Heart Failure Symptom Monitoring Awareness & Response Training program that helps patients monitor and interpret symptoms of heart failure; the impact of a structured geriatric education program on an inpatient medical unit; and a proposal for creating stronger networking ties among BAGNC scholars and fellows, Aging RIG members and nurse scientists in rural areas to enhance translational research in aging. A panel of BAGNC alumni and Aging RIG members will synthesize this work to advance networking that facilitates aging research in the Northeast to improve health and health care for an aging population. Page 60
RIG Symposium B5: Facilitating Translational Aging Research in the Northeast Heart Failure Symptom Monitoring, Awareness & Response Training: A Novel Method to Educate Heart Failure Patients Corrine Jurgens, PhD, RN, ANP‐BC FAHA, Stony Brook University, Stony Brook, NY Purpose: As a chronic illness, heart failure (HF) negatively affects quality of life with symptoms that limit activities of daily living and increase the risk of hospitalization. Self‐care is an essential component of HF management; however symptom recognition is difficult due to the nonspecific and insidious nature of early symptoms of decompensation. The purpose of this pilot study was to test the efficacy of a HF symptom training program using a multidimensional approach to provide context to symptom evaluation on HF symptom recognition and response. Theoretical Framework: The Theory of Unpleasant Symptoms and the Theory of HF Self‐Care informed this study. The Theory of Unpleasant Symptoms specifies the multidimensional nature of the symptom experience and the Theory of HF Self‐Care addresses the process needed for adequate self‐care. Methods: A pilot study was conducted using purposive sampling of patients hospitalized with decompensated HF. Randomization was based on comorbid illness scores using the Charlson index. Baseline sociodemographic data was collected by interview and chart review. The HF Somatic Perception Scale and the Self‐Care HF Index were used to assess symptom distress and self‐care at baseline and 1 month post discharge. Subsequent hospitalization and unplanned contact with health care providers was assessed by telephone interview and review of electronic medical records. Symptom training included an assessment of their symptom profile (cluster), use of a symptom graph, and a 6 minute walk test to stimulate respiratory effort. Results: The sample (N=20) was 80% male, 95% Caucasian with a mean age of 63.6 (SD 14.4). HF duration averaged 5.3 years with 65% having at least one prior hospitalization. Six patients did not complete the 1 month follow‐up due to death, transfer to a skilled nursing facility or withdrawal. There were no significant differences in symptom distress or self‐care practices at baseline. At one month post discharge, the intervention group had a 30.13 point increase in HF self‐care scores vs 8.93 in the usual care group. Two intervention patients and one usual care called HCP’s regarding HF symptoms. Hospitalizations were few (2 intervention; 1 usual care) but none were HF related. Conclusions & Implications: Self‐care scores improved in patients who received symptom training which is promising. A longer follow up time is needed to assess the long term effect of this novel way to educate HF patients Page 61
RIG Symposium B5: Facilitating Translational Aging Research in the Northeast A Study of the Impact of a Structured Geriatric Program on a Medical Unit Deborah D'Avolio, PhD, APRN‐BC, Massachusetts General Hospital, Boston, MA Purpose: This study evaluated the impact of a structured geriatric program on nursing practice in an inpatient medical unit. Background: The complexities of geriatric care in the hospital setting are well documented. Falls, pressure ulcers, disruptions in sleep and eating patterns, urinary incontinence, delirium and medication reactions can lead to increased lengths of stay and increased patient and hospital costs (Lang, Clark, Medina‐Walpole, & McCann, 2008). In addition, the Institute of Medicine Report, Retooling for an Aging America, states “the healthcare work force receives very little geriatric training and is not prepared to deliver the best possible care for older adults (Institute of Medicine, 2008). Methods: The key elements of the structured program included a variety of education methods and bedside rounds. Bedside rounds were implemented to demonstrate the assessment and intervention of geriatric syndromes. Outcome data was used to target practice changes. Data collected included geriatric assessment and intervention rounding logs, practice changes, and in‐depth qualitative interviews with geriatric program participants. Data were analyzed using descriptive statistics, and qualitative content analysis. Results: Geriatric assessment/intervention logs (n=83) were analyzed. The dominant geriatric syndromes identified were problems with falls (80%), nutrition (74%), incontinence (72%), sleep (70%), skin (68%), and confusion (54%). Conclusions & Implications: Data show the range of nursing knowledge and skills needed to improve the care of acutely ill hospitalized older adults. Page 62
RIG Symposium B5: Facilitating Translational Aging Research in the Northeast It’s About Time: Barriers to Use of Non‐pharmacological Interventions in the Nursing Home Ann Kolanowski, PhD, RN, FAAN, Penn State University, University Park, PA ~ Donna Fick, PhD, GCNS‐BC, FGSA, Penn State University, University Park, PA ~ Christine Frazer, MSN, CNS, DNSc , Penn State University, Hershey, PA ~ Janice Penrod, PhD, RN, Pennsylvania State University, University Park, PA Purpose: This qualitative study elicited nursing, recreational therapy and medical staff perceptions of barriers to the implementation of non‐pharmacological interventions for the behavioral and psychological symptoms of dementia (BPSD.) Background: BPSD are common among nursing home residents with dementia. Consensus guidelines recommend the use of non‐pharmacological interventions as the first line of treatment. These interventions do not enjoy a strong empirical basis for implementation and staff continues to rely on pharmacological interventions. Methods: Thirty‐five staff (registered nurses, licensed practical nurses, nurses’ aides, recreational therapists, activity personnel and medical directors) from 6 nursing homes located in Pennsylvania and North Carolina participated in the qualitative study. A focus group methodology was used to capture discussions that were audio‐recorded and transcribed verbatim. Data were analyzed using standard methods of content and thematic analysis. Results: Four broad themes were identified: the changing landscape, resident behaviors; reaching out to the person with dementia; and the educational needs of staff. The concept of time emerged as a key barrier to the use of non‐pharmacological interventions for BPSD. Conclusions and Implications: Successful use of non‐pharmacological interventions requires the right staff with the right education at the right time. The Vulnerability Framework is a model that helped organize these findings into a meaningful perspective. To effect change in the nursing home the findings indicate a need for: implementation of staffing patterns that allow staff the time to make a difference in the care of residents with BPSD; development of educational programs that promote staff understanding vs. control; and design of research studies that answer questions about the influence of time on the selection of interventions for BPDS. Page 63
RIG Symposium B5: Facilitating Translational Aging Research in the Northeast Strengthening Networking to Enhance Translational Research in Aging in the Northeast Meg Bourbonniere, PhD, RN, Dartmouth‐Hitchcock Medical Center, Lebanon, NH Jennifer Hagerty Lingler, PhD, RN, University of Pittsburgh, Pittsburgh, PA Purpose: This paper articulates an agenda for advancing networking that facilitates aging research and promotes the translation of research findings in the Northeastern U.S. to improve health and health care for an aging population. Background: The growth of the ENRS Aging Research Interest Group is due, in part, to the John A. Hartford Foundation’s “Building Academic Geriatric Nursing Capacity” program. This program has increased the number of nurse scientists in aging in the ENRS region. The growth, however, has been concentrated in Pennsylvania, where there are more than 30 current or former BAGNC awardees. In contrast, of the six New England states, Connecticut and Massachusetts each have 4, while Rhode Island, Vermont, New Hampshire and MN can claim only 1 BAGNC awardee among them. Nurse scientists studying aging related issues in these states and others in the ENRS region may often be isolated and could benefit from a strong network of researchers in aging to facilitate research endeavors. Moreover, this uneven regional distribution of gerontological nursing scholarship may have negative implications for translating research findings into clinical practice. Methods: A case report approach demonstrates the possibilities and limitations of networking among nurse scientists studying aging related issues in the Northeast region. Conclusion & Implications: Nurse scientists studying aging issues must: 1) identify effective means of communicating in the interim period between ENRS meetings, 2) pursue new collaborations to disseminate research findings, and 3) provide outreach to nurse researchers who are working in environments with limited infrastructure to conduct aging research. Establishing a strong foundation for regional networking among researchers in aging can improve the quality of research conducted in the region and enhance evidence‐based practice, which ultimately translates to improved outcomes for older adults across the region. Page 64
Paper Session C1: Contemporary Issues in Nursing Research with Special Populations Healthcare Experiences of Women with Visual Impairment A Secondary Analysis of Qualitative Data Nancy C. Sharts‐Hopko, PhD, RN, FAAN, Villanova University, Bryn Mawr, PA Purpose: To examine focus group transcripts in depth to address the question of how women with low vision or blindness have experienced health care. Background: Currently 19‐21 million noninstitutionalized American adults are visually impaired. The baby boomer generation tends to be inattentive to vision health risk and the number is expected to increase by as many as 500,000 per year by 2025. Little information exists about how people with visual impairment interact with the health care system and the nursing literature is curiously silent on this issue. Prior investigations of the experiences of women with disabilities in general with primary health care and health promotion services indicate that this population is poorly served. Methods: Secondary data analysis has been performed on transcripts from two focus groups (Heaton, 2004; Krueger & Casey, 2000) including 7 and 11 women having low‐vision or who are blind who had been part of an original study of reaching hard‐to‐reach women with disabilities. These focus groups were conducted at an agency serving visually impaired people in Philadelphia. Content analysis for the identification of thematic clusters was performed. Results: Findings are consistent with existing research on the health needs of women with disabilities but add specific understanding related to visual impairment. Six thematic categories were identified: health professionals’ awareness; information‐related issues; health care access issues; isolation; the need for self‐advocacy; and perception by others. Conclusions and Implications: Health professionals need to increase their sensitivity to the challenges faced by women with visual impairment. Health professions students need to be prepared to interact with people who are visually impaired and health care settings need to respond to their needs. Secondary analysis of qualitative data affords in‐depth understanding of a particular subset of participants within a larger study. Page 65
Paper Session C1: Contemporary Issues in Nursing Research with Special Populations A Transformation Process: Health Teaching by Nurses to Adults with Intellectual/Developmental Disabilities Ginny Focht‐New, PhD, PMH‐CNS, BC, CDDN, Widener University, Chester, PA Purpose: To address the following research questions: 1. What are the experiences of registered nurses who provide health teaching to adults with intellectual disabilities/developmental disabilities? 2. What health topics do registered nurses teach adults with intellectual disabilities/ developmental disabilities and how do they select these topics? 3. What teaching strategies do registered nurses use when teaching health to adults with intellectual disabilities/developmental disabilities? Background: Adults with Intellectual/Developmental Disabilities (ID/DD) have both common and complex health conditions. This diverse and vulnerable population has increased risk for morbidity and mortality. Adults are just now approaching the general population life expectancy. With recent focus on deinstitutionalization, the need for health services and resources have shifted to community settings. Based on current literature, health education has been limited in this population. In addition, nurses have not been educated to teach adults with ID/DD about health. Methods: A qualitative, descriptive study was conducted using naturalistic inquiry involving 23 registered nurses who have provided health teaching to adults with ID/DD. Data was collected through individual and focus group interviews and non‐participant observations. A constant comparative method was used to analyze data. Results: Three areas of findings emerged. The first was that nurses experienced a transformation from feeling insecure to becoming confident and passionate educators of adults with ID/DD. Secondly, these RNs taught health within a social context emphasizing 10 social approaches (e.g. building trust, establishing relationships, encouraging interactions, etc.). The third area focused on selection of health teaching topics and activities. Conclusions and Implications: The findings of this study offer implications to nursing in four areas: 1. Findings are aligned with literature discussing the developmental process of nursing educators. 2. Data supports health teaching for adults with ID/DD in a variety of community settings. 3. Learner centered education by nurses is a viable option for teaching this population. 4. Health teaching activities were exemplified. Page 66
Paper Session C1: Contemporary Issues in Nursing Research with Special Populations Nursing Care Experiences of People with Disabilities During Hospitalization Suzanne C. Smeltzer, RN, EdD, FAAN, Villanova University, Villanova, PA ~ Colleen Avery, RN, BSN, Villanova University, Villanova, PA ~ Patricia Haynor, RN, PhD, Villanova University, Villanova, PA Purpose: This study explored the experiences of people with disabilities related to hospital stays and their perceptions of nursing care. Background: A growing body of research has identified inadequate health care as a major issue for people with disabilities; however, few studies have specifically addressed nursing care. One study revealed that people with disabilities have strong negative reactions to the idea of hospitalization because of lack of awareness on the part of nursing staff about their needs during hospital stays. Further, lack of quality care by nurses has resulted in catastrophic outcomes that have included injury and even death of patients with disabilities. Methods: A descriptive qualitative study using 6 focus groups was conducted to explore the experiences of 35 people with disabilities during hospitalization and their perceptions of nursing care. After providing consent, participants were asked about their previous positive and negative experiences/encounters with nurses. Interviews were audiotaped, transcribed and validated for accuracy, and content analyzed. Two researchers read each of the transcripts repeatedly and independently identified recurring themes. They then developed consensus of themes and codes, which were used to identify examples of resulting themes. Peer review and member checks were used to ensure trustworthiness of the data. Results: Four major themes emerged: poor communication on the part of nursing staff, compromised nursing care, negative attitudes of nursing staff toward people with disabilities, and fears of people with disabilities during hospital stays. Participants identified the need for extra vigilance on their part or that of their family to protect them, particularly if they had difficulty communicating. Conclusions & Implications: Study participants recommended that nurses and nursing staff be taught how to care for people with disabilities and to interact with patients, particularly those with impaired communication. Although most participants were able to respond to the interview questions and probes, those with cognitive disabilities were less able to respond in focus groups. Thus, alternative strategies (i.e., individual interviews) are warranted to obtain data from those individuals with cognitive disabilities. Further research is needed to address those with cognitive disabilities and to improve the health care of all hospitalized patients with disabilities. Page 67
Paper Session C1: Contemporary Issues in Nursing Research with Special Populations The Effect on an Educational Intervention on Reducing Denture and Dental Plaque in Nursing Home Residents with Dementia Rita A Jablonski, PhD, CRNP, Pennsylvania State School of Nursing, Philipsburg, PA ~ Mary Jo Grap, PhD, ANP, FAAN, Virginia Commonwealth University, Richmond, VA ~ Mary Ligon, PhD, York College of Pennsylvania, York, PA ~ Cindy Munro, PhD, ANP, FAAN, Virginia Commonwealth University, Richmond, VA ~ Christine M Schubert, PhD, Virginia Commonwealth University, Richmond, VA Purpose: The purpose of this study was to measure the effect of an educational intervention for nursing assistants on denture and dental plaque found in the mouths of frail and functionally dependent nursing home elders. Theoretical Framework: The educational intervention was based on principles from both the Need‐
driven Dementia‐compromised Behavior and the Progressively Lowered Stress Threshold models. Background: As more dentate elders enter long‐term care, their risk for problems related to poor oral health (pneumonia, cardiovascular diseases, weight loss, and hyperglycem Method: The quasi‐experimental pilot study was conducted in the Alzheimer Units of two nursing homes that differed by geography, ownership, and reimbursement patterns. Thirty‐four NH residents with dementia were enrolled in the study. The majority were female (68%) and white (69%). Almost one‐third were African‐American. There were no differences between facilities in residents’ functional status, level of cognitive impairment, or baseline plaque scores. After the nursing home residents were enrolled in the study, plaque measurements for teeth and dentures were obtained using the University of Mississippi Oral Hygiene Index. The certified nursing assistants who worked in the Alzheimer Units received the intervention, a one‐hour in‐service that included strategies to provide mouth care to persons with dementia. Plaque measurements were then collected 4 weeks, 8 weeks, and 12 weeks after the educational intervention. Results: The intervention did not significantly reduce plaque on teeth or dentures [Wilks Lambda 0.95, F(3, 23)=0.43, p=0.74]. Conclusion: Plaque was not the best indicator of effective mouth care because successful plaque management in the elderly often requires professional care, thus, is more accurately a proxy indicator of long‐term access to professional oral care. Implications: We are currently developing another study that addresses the limitation of this pilot study by operationalizing oral health as the absence of gingivitis and debri on teeth and dentures. We are also developing a standardized intervention that includes more content specific to care‐resistive behaviors and provides opportunities for the nursing assistants to practice these newly learned strategies on trained elder actors. Page 68
Paper Session C2: Nursing Research in Diverse Populations, Communities and Environments The Meaning of Confianza (Confidence) in the Context of Health for Mexicans in an Urban Community: A Focused Ethnography Rick Zoucha, PhD, PMHCNS‐BC, CTN, Duquesne University School of Nursing, Pittsburgh, PA Purpose: The purpose of this study was to explore the perception and meaning of confidence or confianza in the context of health for Mexicans in an urban community. Research Questions: What are the cultural perceptions and meaning of confidence in the context of health for Mexicans? How do Mexicans describe confianza in relation to health? Does confidence in the nursing and health care professional promote or impede the sense of health as perceived by Mexicans? Background: The number of Mexican immigrants, migrants and Mexican Americans is increasing every year in the United States. Little is known about confianza in the context of health for Mexicans and Mexican Americans. Seeking to understand confianza is significant to the health of this population because confianza is a cultural belief that is influenced by care. This study was designed to expand nursing knowledge by describing the meaning of confianza in Mexicans in the context of health. Method: A qualitative focused ethnography was used for this study. The process included immersion, observation‐participation, field notes and semi‐structured interviews. A representative voluntary convenience sample of Mexican adults (ages 18‐90) informants (n=27, 20 female, 7 male) in an urban area of central Mexico was sought through the use of the snowball method until saturation of the data occurred. Results: Confianza is essential and needed in the relationship between health care professionals and individuals/families. Confianzia is mutual; overtime it strengthens and becomes anticipatory between nurse/physician and the individual seeking care. Lost confidence in the nurse may result in changes in health seeking behaviors. Expectations of care and role of nurses are different in Mexico than the United States. Conclusions and Implications: The findings suggest that individuals/families from Mexico may hold the beliefs and values of confianza about health care provider in the US. The role of nurses in Mexico is different than in the United States. New ways of advertising the role of nurses in the United States to Mexicans may decrease barriers of care and increase access for nurses in the community and health seeking behaviors. Page 69
Paper Session C2: Nursing Research in Diverse Populations, Communities and Environments A Study Using the 2007 HINTS Database: Are Low Social Capital and/or High Fatalism Significant Barriers to Colorectal Cancer Screening by Colonoscopy? Julio A Toro, PhD(c), University of Massachusetts‐Boston, Weymouth, MA Social Capital is defined as “the resources accessed by individuals and groups within a social structure.” In this study, social capital is measured by the trust the individual has on the health information received from family and/or friends. Cancer fatalism is the belief that death is inevitable if diagnosed with cancer (Powe Cancer Fatalism Model,) and is measured by constructing a scale based on the HINTS questions “When I think of cancer, I think of death,” “Cancer is an illness that when detected early can be cured,” and “There’s not much you can do to prevent cancer.” These questions were chosen to capture elements of the Powe Fatalism Scale of fear, pessimism, inevitability of death and predetermination. In this study, social capital and fatalism are analyzed along with other variables to see how they relate to colorectal screening by colonoscopy with data from the 2007 HINTS database. The sample was weighed using the jackknife method. Using STATA software, social capital and fatalism were found not to be significant as variables related to colonoscopy use. In the constrained model using logistic regression (pseudo R2 0.34), the significant variables were regular provider (OR 1.99,) avoiding seeing the doctor (OR 0.60,) family ever having cancer (OR 1.23,) cancer history (OR 1.56,) colonoscopy recommendation by provider (OR 4.02) and insurance (OR 1.47.) In the unconstrained model for Blacks (pseudo R2 0.38), the significant variables were having a regular provider (OR 2.51,) cancer history (6.30,) married or with partner (OR 2.47,) and colonoscopy recommendation (OR 8.87.) The significant variables in the unconstrained model for Whites (pseudo R2 0.33) were: having a regular provider (OR 1.89,) avoiding seeing the doctor (OR 0.55,) family ever having cancer (OR 1.26,) cancer history (OR 1.47,) married or with partner (OR 1.25,) and colonoscopy recommendation (OR 3.89.) In the unconstrained model for Hispanics (pseudo R2 0.57), the significant variables were trust in the information from doctor (OR 0.30,) male gender (OR 2.61,) family ever having cancer (OR 4.65,) and colonoscopy recommendation (OR 183.66.) Some of the implications of this study are that colonoscopy recommendation among Blacks and Hispanics is paramount, and that Hispanic women need to be targeted by outreach. Social capital does not have a significant influence on colonoscopy use. Fatalism does not seem to be a significant factor either, probably due to advances in cancer treatment. Page 70
Paper Session C2: Nursing Research in Diverse Populations, Communities and Environments Enhancing Health of Teenage Boys: An Evidence‐Based Newark NJ Best Men Adolescent Family Life Intervention to Reduce Risky Behaviors, Promote Abstinence, Good Values and Parent‐Teen Communication. Kathleen A Sternas, PhD, RN, Seton Hall University, College of Nursing, Verona, NJ ~ RoseMarie V Peterkin, MAT, Friends and Families United, East Hanover, NJ ~ Mary Ann M Scharf, EdD, RN, Seton Hall University, College of Nursing, Morris Plains, NJ ~ Janet Summerly, MSN, RN, Seton Hall University, College of Nursing, Fanwood, NJ Purpose: High rates of risky behaviors exist among Newark teenagers including drug/alcohol use,smoking, sexual activity which affect health. This presentation describes outcomes for an evidenced‐based intervention that promotes abstinence from drinking/drugs/sex, good values and parent‐teen communication, and compares outcomes of intervention and comparison boys. Theoretical Framework: Bandura's social learning and Piaget’s cognitive development theories guided the intervention which included discussions, mentoring/role modeling, health/fitness classes, cultural events, community service, recognition. Methods: Pretest post‐test design. Sample/Setting: Four intervention schools(n=86 boys)/five comparison schools(n=97 boys) participated. Participants were 6th,7th,8th grade boys. Intervention participants were randomly selected. Comparison participants were a convenience sample. Comparison and intervention schools were matched on demographic variables. Measures: AFL Core Baseline/Follow‐
up and Demographic Questionnaires. Analysis: Pearson Chi Square, Mann Whitney U statistical tests and .05 level of significance. Post‐Test Results: Significantly more intervention than comparison boys reported: admire teens (p=.012)/have friends who admire teens who remain abstinent(p=.043);important for future spouse to remain abstinent until marriage(p=.008); sex is for married people(p<.001); bright future (p=.018);plans work(p=.042). More comparison than intervention boys reported: friends drink alcohol(p=.05);no talking with parents/guardians about drinking/drugs(p=.043),sex(p=.042), saying “no” to alcohol/drugs/sex(p=.006);when break rules, parents/guardians yell/scream(p=.030). Results higher post than pretest for intervention boys: sex is for married people (p=.002). Results higher post than pretest for comparison boys: higher marijuana/drug use(p=.040);if break rules, parents/guardians make threats not kept(p=.026); no talking with parents/guardians about saying no to alcohol/drugs/sex(p=.045). Conclusions and Implications: Intervention boys have more significant outcomes related to abstinence behaviors/attitudes, good values, bright future than comparison boys. Findings suggest the intervention promotes abstinence, reduces risky behaviors, improves parent‐teen communication. Findings have implications for development of intervention programs which reduce risky behaviors, promote values, communication and abstinence attitudes/behaviors. Page 71
Paper Session C2: Nursing Research in Diverse Populations, Communities and Environments Evaluating Baseline Employee Cultural Sensitivity at an Academic Community Hospital Lynn M. Deitrick, RN, PhD, Lehigh Valley Health Network/Dept of Community Health, Allentown, PA Jay Baglia, PhD, Lehigh Valley Health Network/Dept of Family Medicine, Allentown, PA ~ Eric J. Gertner, MD, MPH, Lehigh Valley Health Network/Department of Medicine, Allentown, PA ~ Anthony Nerino, MA, Lehigh Valley Health Network/Dept of Community Health, Allentown, PA ~ Jarret R. Patton, MD, Lehigh Valley Health Network/Department of Pediatrics, Allentown, PA ~ Judith N. Sabino, MPH, Lehigh Valley Health Network/Cultural Awareness, Allentown, PA ~ Debbie Salas‐Lopez, MD, MPH, Lehigh Valley Health Network/Department of Medicine, Allentown, PA Purpose: To establish baseline measures of employee cultural sensitivity and cultural climate as part of a system‐wide cultural awareness initiative in a large regional health network. Theoretical Framework Leininger’s Culture Care Theory notes that health care occurs in a cultural context. In an increasingly diverse American society it is essential for nurses to provide culturally sensitive, quality health care for their patients. Methods: Nine thousand employees in the health network were surveyed using the Intercultural Sensitivity Scale (Chen and Starosta 2000) adapted for web‐based administration. The ISS measures attitudes about interacting with people from different cultural backgrounds. The instrument included 24 questions that comprised 5 scales, three open‐ended questions about network improvements for enhanced cultural sensitivity and two questions about preferred learning styles, and desired topics. Scale scores were generated for baseline measures, validity was assessed using Principal Components Analysis and text analysis identified four themes, community, education, language, and organization that provided insight into employee attitudes Results: A 35% response rate (n=3446) was achieved. Nurse respondents reported a preference for diversity workshops and cultural fact sheets as the desired modes of instruction, similar to preferences of general hospital staff. Nurses also indicated a preference for cultural information about attitudes about pain (75%), death and dying (71%), followed by information about religious practices (69%), dietary customs (69%) and other topics. The findings of the baseline assessment informed staff education interventions, assessed training needs, and revealed individual and/or institutional factors that impede or enhance responses to patient experiences of health care disparities. Conclusions/Implications: Results from the survey promoted the development of focused cultural education and other initiatives for nurses and staff at our hospital, resulting in a more culturally sensitive, caring work force for our hospital and our patients. Page 72
Paper Session C3: Improving Health Literacy and Health with Innovative Technologies The Relationship Between Health Literacy, Health Knowledge and Adherence to Treatment in Patients with Rheumatoid Arthritis Patricia Quinlan, DNSc(c), MPA, RN, CPHQ, Columbia School of Nursing; Hospital for Special Surger, New York, NY Abstract Researchers have postulated that deficiencies in health literacy are likely to impact health knowledge and adherence to treatment as well as disease outcomes. Study Aims: The primary aim was to determine whether health literacy is a predictor of health knowledge and/or adherence to treatment while controlling for socioeconomic factors in the context of rheumatoid arthritis. Methods: A cross‐sectional study approach was employed. English speaking patients were recruited from an urban outpatient Rheumatology setting. Pignone’s theoretical model describing relationships between health literacy, health knowledge and adherence to treatment was used to guide descriptive, bi‐variate and multivariate analyses. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA) brief version. The TOFHLA is internally consistent (r = .98) and reliable (r = .84). Health knowledge was measured using an adapted version of the Arthritis Knowledge Questionnaire, which also has established internal consistency (r = .98) and reliability (r = .84). The Morisky Medication Adherence scale, (r = .61) measured adherence. Results: The sample (N = 125) was predominately female (83%) and white (71%). Subjects ranged in age from 18 to 94 years (M = 58, SD =16). Forty‐three percent (n = 54) were college educated, all had health insurance and 26% (n = 33) reported an income of less than 50 thousand dollars per year. On average, participants had high levels of health literacy (M = 90.8, SD13.83). Health knowledge ranged from to .07‐
1.3 (M = .73, SD .26). The sample reported adherence to their medication regimen 84% of the time (SD .20). Mean health literacy was significantly (p < .05) different among participants based upon age, language, education, household income, neighborhood income and study location. Controlling for patient covariates, health literacy was found to be a predictor of health knowledge (p = .002). Health literacy was not found to be a predictor of adherence (p =.896) while controlling for health knowledge and patient covariates. Conclusion: This study reaffirms findings found elsewhere regarding health literacy and adherence in patients with chronic conditions. The study information is useful for planning patient education initiatives specific to chronic disease self‐management. Page 73
Paper Session C3: Improving Health Literacy and Health with Innovative Technologies Experiences of Cancer Survivors with Healthcare Providers in the Context of the Internet as A Source of Health Information Maria C Dolce, PhD, RN, NEA‐BC, FACHE, New York University College of Nursing, New York, NY Purpose: The aim of this qualitative study was to describe the experiences of cancer survivors and caregivers with healthcare providers in the context of the Internet as a source of health information. Background: The need for health information has propelled cancer survivors and caregivers to search for information on the Internet. Little is known about how the Internet, as a source of health information and resources, is changing the healthcare relationship in survivorship care. Methods: A secondary analysis of unanalyzed qualitative data from the 2006 Pew Internet and American Life Project (N = 1,680) was conducted to better understand how the Internet is transforming the healthcare relationship for participants of cancer‐related online communities. Krippendorff's thematic clustering technique of qualitative content analysis was used to discover recurring themes in the healthcare relationship experienced by cancer survivors and caregivers during survivorship care. Results: Content analysis of online survey responses (n = 488) revealed patterns of disenchantment associated with failed expectations related to evidence‐based practice, clinical expertise, informational support, and therapeutic interpersonal communication. Survivors and caregivers exercised power in healthcare relationships to influence and control care decisions. Exercising power included collaboration, direct confrontation, becoming expert, and endorsement. Conclusions and Implications: Through online health information and resources,, concealed failures in healthcare relationships were revealed to cancer survivors and caregivers. The Internet as a source of health information empowered cancer survivors and caregivers to influence and control care decisions during survivorship. Little is known about the experience of disenchantment. Phenomenological inquiry is needed to fully grasp the experience of disenchantment for cancer survivors. The immediacy of addressing failures in cancer survivorship care is recognized as a global issue for nursing, and requires novel nursing practice models which embrace the Internet as a source of health information. Page 74
Paper Session C3: Improving Health Literacy and Health with Innovative Technologies Effects of Parent‐focused Media Intervention on Body Mass Index, Waist Circumference, Self‐perception, Family Eating Habits, and Family Activity Habits in Overweight, Hispanic School‐aged Children Rita Marie John, Asst. Professor of Clinical Nursing, Columbia University School of Nursing, Hillsborough, NJ Purpose: The purpose was to examine the effects of a parent‐focused, low‐literacy, media‐based intervention in a primary care setting on BMI, waist circumference, self‐perception, family eating habits, and family activity habits in obese, Hispanic, school‐aged children (OHSC). Theoretical Framework: A modification of the Association for Care of Children’s Health theoretical model was the framework. Methods: A randomized controlled pilot study was conducted using 31 obese Hispanic, school‐aged children between 6‐11 years of age. A mixed methods approach was implemented in two phases. In the first phase, parent‐child dyads were randomly assigned into a control and experimental group. Pretest and post‐tests measures of BMI, waist circumference, child’s self‐perception, family eating habits, and family activity habits were taken using a mechanical scale, a stadiometer, a spring Gulick tape, Self‐
Perception Profile for Children and the Family Eating and Activity Habits Questionnaire. The qualitative component utilized focus groups of parents of OHSC to understand attitudes and feelings about the Internet and Internet support groups. Results: T test analysis revealed changes in the experimental group in BMI‐z scores, waist circumference, and family eating habits. Decreases in BMI‐z score, p = .009 and decreases in waist circumference, p = .004 was significant. There was no significant change in the total child self‐
perception score, p = .10. There was a significant result on physical appearance in the experimental group, p =.005. Regression analysis showed no relationship between BMI‐z, waist circumference, family eating and activity with age, gender, or income. The qualitative component suggested that technological knowledge and lifestyle may play a role in the use of technology. The major barrier to Internet support groups was lack of time and knowledge Conclusion and implications Nurses need to consider technological skills, language, and cultural factors in designing interventions. Primary care settings may be an appropriate place for obesity counseling. Page 75
Paper Session C4: Special Topics in Nursing Research: Violence and Incarceration Predictors of Retention for the First Re‐entry Year and for Subsequent Reenrollment in a Follow‐up Study of Research Participants Enrolled while Incarcerated Lorie S Goshin, RN, MSN, Columbia University School of Nursing, Brooklyn, NY Mary W. Byrne, PhD, CPNP, FAAN, Columbia University School of Nursing, New York, NY Purpose: This presentation explores successful long‐term follow‐up of research participants after prison release. One year reentry retention and reenrollment between two and four years later are specifically analyzed for a sample of women, children, and alternate caregivers who participated in the first longitudinal study assessing the effects of a prison nursery (“Maternal and Child Outcomes of a Prison Nursery Program”, R01 NR007782, M. Byrne, P.I). Theoretical Framework: Flaskerud and Winslow’s Vulnerable Populations Conceptual Model identifies low resource availability and increased relative risk as impairments to engagement with longitudinal research. Methods: In this secondary analysis, chi‐squares and t‐tests were used to determine relationships of retention and reenrollment to the following known barriers to longitudinal research with vulnerable populations: mother’s race/ethnicity, maternal substance abuse history, social support, parenting competence, time in prison phase of study, number of alternate contacts given at the last prison visit, and child released to an alternate caregiver. Logistic regression models were created to predict one year retention and reenrollment. Results: Eighty‐five percent of participants were retained one year after release, and 57% were reenrolled. African, Caribbean, and African‐American (Black) race (χ2=6.5, p=.01) and number of contacts (t=‐2.5, p= .02) were associated with one year retention but did not create a significant predictive model. Black race (χ2=6.8, p < .01), number of contacts (t=‐2.2, p=.03), and amount of time on the nursery (t=‐3.4, p < .01) were associated with reenrollment and created a significant predictive model, χ2 (4, N=91) = 24.9, p < .01. Black participants were 20% less likely than whites to reenroll. Each additional month on the nursery increased likelihood of joining the follow‐up study, and each additional contact almost doubled these odds. Conclusions and Implications: Participants enrolled while incarcerated can be retained and reenrolled years after initial release. Additional attention should be given to Black participants and those with limited inside contact with the research team. Special focus should also be paid to obtaining as many alternate contacts as possible. Understanding barriers to retention and re‐enrollment in research studies with this high risk population can assist in creating theoretically informed long‐term retention strategies. Page 76
Paper Session C4: Special Topics in Nursing Research: Violence and Incarceration Predictors of Self‐Efficacy and Self‐Rated Health for Older Male Inmates Susan J. Loeb, PhD, RN, The Pennsylvania State University, Philipsburg, PA Cathy Kassab, PhD, By the Numbers, State College, PA Darrell Steffensmeier, PhD, The Pennsylvania State University, University Park, PA Purpose: To examine: (1) the relationships between self‐efficacy for health management and (a) health‐
promoting behaviors, (b) health‐monitoring behaviors, and (c) self‐rated health status in older male prisoners; and (2) the variations in self‐rated health status and self‐efficacy for health management by inmate characteristics of older men in prison. Theoretical Framework: Bandura’s self‐efficacy model. Methods: A descriptive, correlational, survey was conducted with 131 male inmates (age 50 and older). The machine readable questionnaire contained: the Chronic Disease Self‐efficacy Scale; Health Promotion Activities of Older Adults Measure; Older Men’s Health Program and Screening Inventory; a composite measure of health‐monitoring behaviors; Mini‐Mental State Exam; and demographic questions. Institutional Review Board and Department of Corrections approvals and informed consents were obtained. Pearson correlations and regression analyses were computed. Results: A positive relationship was found between self‐efficacy for health management with: health‐
promoting behaviors (r=0.550; p<0.001); health‐monitoring behaviors (r=0.323; p<0.001); and self‐rated health (r=0.59; p<0.001). After controlling for race and years of incarceration, there was a positive relationship between education with self‐rated health (B=0.156; p<0.05). The regression models for self‐
rated health and self‐efficacy were re‐estimated using education, race, employment status prior to incarceration, and Test of Adult Basic Education score. Results indicate that employment status prior to incarceration was related to both self‐rated health (B=0.263; p<0.05) and self‐efficacy for health management (B=14.641; p=0.01). The overall models for self‐rated health and self‐efficacy for health management were both statistically significant (F= 2.553; df= 5, 111; p=0.032 and F=3.366; df=5, 111; p=0.007, respectively). Conclusions: Nurses are front line health care providers in prison, who are in a key position to implement interventions that promote greater inmate self‐efficacy for healthy behaviors and chronic disease management. Findings offer support for implementing a health promotion framework in prisons settings if underlying challenges inherent to prisons are acknowledged and barriers are addressed. Page 77
Paper Session C4: Special Topics in Nursing Research: Violence and Incarceration Women’s Health Needs Immediately Post‐Incarceration: A Feasibility Study Alison M. Colbert, PhD, APRN, BC, Duquesne University, Pittsburgh, PA ~ Susan M. Cohen, DSN, APRN, BC, FAAN, University of Pittsburgh, Pittsburgh, PA ~ L. Kathleen Sekula, PhD, APRN, BC, Duquesne University, Pittsburgh, PA ~ Rick Zoucha, PhD, APRN, BC, Duquesne University, Pittsburgh, PA Purpose: The purpose of this mixed methods feasibility study was to explore the healthcare needs of women immediately post‐incarceration and their willingness to participate in health care related activities after release. We also explored history of interpersonal violence (IPV), incarceration, and substance abuse as potential variables influencing health. Methods: This study was two phases: a quantitative survey and qualitative interviewing. We included women, age 18 years and older, who were incarcerated at some point in the previous 12 months. Phase 1 (quantitative) included 34 participants; Phase 2 (in‐depth interviews) included 11 participants selected based on availability. Quantitative data on subject characteristics, health status, health behaviors, and health literacy were collected. Due to sample size, a non‐parametric bootstrap with 1000 replications was used to estimate the empirical sampling distribution of Pearson correlation among the variables. Qualitative interviews were analyzed using content analysis. Results: Average age of participants was 41.2 years. Twenty‐three percent had less than a high school education, but all had adequate or marginal health literacy. The average number of incarcerations was 6.5. Ninety‐four percent reported currently having health problems and 77% were taking medications. Seventy‐nine percent reported being a victim of IPV as adult or child; 88% report history of addiction; 65% report at least one psychiatric diagnosis. Qualitative results indicated that health care is a significant issue for women at this time, and they are receptive to intervention. Barriers to health services included lack of resources and environmental obstacles (e.g living in a half‐way house). Key variables that were significantly correlated using the bootstrap method were: number of health problems and IPV; history of mental illness and number of incarcerations; and health promoting behaviors and history of IPV. Conclusions: Health and healthcare are significant issues for women as they leave jail, and this appears to be an appropriate time to intervene to support heath‐related behaviors. The unique needs of the population require an intervention that is individualized, innovative, and practical within a structured environment. Page 78
Paper Session C4: Special Topics in Nursing Research: Violence and Incarceration The Importance of Family to Youth Living in Violent Environments Catherine C. McDonald, PhD(c), RN, University of Pennsylvania, Philadelphia, PA ~ Terry Guerra, BS, MS, Achievability , Philadelphia, PA ~ Therese S. Richmond, PhD, CRNP, FAAN, University of Pennsylvania, Philadelphia, PA ~ Nicole Thomas, MBA, Philadelphia Area Research Community Coalition, Philadelphia, PA ~ Doug J. Wiebe, PhD, University of Pennsylvania, Philadelphia, PA Purpose: High violence levels in Philadelphia affect youth and pose substantial challenges for healthy development. The purpose was to test the hypothesis that healthy family functioning serves to enhance youth’s self‐esteem and to decrease the use of confrontational coping used by youth living in neighborhoods with prevalent community violence. Theoretical Framework: This study was grounded in an assets and stressors model that purports that the negative consequences of exposure to pervasive violence can be offset by internal (resiliency) and external (family) assets. Methods: This study was a community based participatory research study answering questions of importance to the community. A paper and pen cross‐sectional survey was administered to 110 youth (10‐16 yrs; 54% female) recruited from community settings and recreation centers in three Philadelphia communities. Standardized questions assessed participants’ community violence exposure (CVE), family functioning, peer self‐esteem, school self‐esteem, and use of confrontational coping (e.g. carry a weapon, stare someone down). Data were analyzed using multinomial least‐squares regression. Results: Over 97% of youth reported some exposure to CVE, with 35% reporting disproportionately high CVE. 52% of youth reported healthy family functioning. Controlling for age, gender, and CVE, healthier family functioning was associated with significantly (p<0.05) higher levels of school and peer self‐
esteem and decreased use of confrontational coping. Using the regression model to derive the mean predicted values among subgroup of our sample, youth with healthy family function had significantly higher levels of peer self‐esteem than did youth with unhealthy family function (3.4 vs. 2.9 respectively, p<0.05), and significantly higher levels of school self‐esteem as well (3.5 vs. 2.8 respectively, p<0.05). Youth from homes with healthy family functioning relied less often on confrontational coping (0.8 vs. 1.5, p<0.05). Conclusions and Implications: Families with high levels of function are protective for youth living in environments of pervasive community violence. Findings suggest that in preventing youth violence and augmenting healthy development, the family can be a point of intervention. Page 79
Symposium C5: Global Health Nursing: Perspectives from Sub Saharan Africa An Integrative Summary of Global Nursing Initiatives in Sub‐Saharan Africa Inge B. Corless, PhD, RN, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Boston, MA ~ Stephanie Ahmed, DNP, RN, ANP, Brigham and Women's Hospital, Boston, MA ~ Sheila M. Davis, DNP, RN, ANP, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Boston, MA ~ Patrice K. Nicholas, DNSc, MPH, RN, ANP, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Boston, MA ~ Egidia Rugwizangoga, BSN, RN, Brigham and Women's Hospital, Boston, MA ~ Lynda Tyer‐Viola, PhD, RN, Massachusetts General Hospital‐ Institute of Health Professions, Boston, MA In this integrative summary, the symposium will offer a comprehensive view of global nursing efforts in three countries in sub‐Saharan Africa. As global nursing efforts expand to support nursing in resource‐
limited countries, nursing initiatives aimed at limiting health disparities, addressing health challenges and exploring opportunities to advance nursing in South Africa, Rwanda, and Zambia will be discussed. The framework for this presentation is based on the Partners In Health (PIH) STAR model developed by Paul Farmer and Jim Kim which addresses the application of Service, Training, Advocacy, and Research in Rwanda and other resource‐limited settings. Our presentation will focus on an integrative review of global nursing initiatives, the World Health Organization (WHO) 2006 World Health Report: Working Together for Health, and an analysis of the challenges related to nursing in resource‐limited countries and global nurse migration as exemplars of the challenges for the nursing profession in the 21st century. The presentation will include examples of successful partnerships among our organizations and health care organizations and academic institutions in South Africa, Rwanda, and Zambia. Partnerships with the University of KwaZulu‐Natal, Sibusiso, Zambia Ministry of Health, and Partners In Health will be discussed. Page 80
Symposium C5: Global Health Nursing: Perspectives from Sub Saharan Africa Global Health Nursing: Perspectives from Sub‐Saharan Africa Stephanie Ahmed, DNP, RN, ANP, Brigham and Women's Hospital, Boston, MA ~ Inge B. Corless, PhD, RN, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Boston , MA ~ Sheila M. Davis, DNP, RN, ANP, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Boston, MA ~ Patrice K. Nicholas, DNSc, MPH, MS, RN, ANP, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Milton, MA ~ Egidia Rugwizangoga, BSN, RN, Brigham and Women's Hospital, Boston, MA ~ Lynda Tyer‐Viola, PhD, RN, Massachusetts General Hospital‐ Institute of Health Professions, Boston, MA This symposium will explore global health perspectives from our experiences in nursing and healthcare in Rwanda, South Africa, and Zambia. As nurse researchers, clinicians, and educators, we have shared our knowledge globally in these three countries and have addressed solutions to the complex issues of global nurse migration and advance a collaborative program of research with our nursing colleagues in sub‐Saharan Africa. Our program of research focused on two research projects related to adherence to TB medications (n = 149) and antiretroviral medications (n = 150) in two community‐based samples in KwaZulu‐Natal, South Africa. Instruments included: a socio‐demographic questionnaire; Appointments, Advice and Instruction; Medical Outcomes Study (MOS) Social Support Scale; MOS SF‐36; Perceived Non‐Adherence Scale (ACTG); and the HIV Sign and Symptom Check‐List (SSC‐HIVrev). Both studies utilized cross‐sectional, descriptive exploratory designs to examine the characteristics related to adherence, symptoms, social support, and quality of life. Frequencies, means, standard deviations, and Pearson correlation coefficients were calculated to describe the sample and examine the relationships among the major study variables. Multiple regression analyses were used to examine the relationships among symptoms, social support, quality of life, and adherence. The results of the two studies suggest that participants experienced numerous symptoms and reported impairments in quality of life, yet were highly adherent to their medication regimens in both samples. In our experience, we have developed sustainable initiatives that have brought nurses to the countries of Rwanda, South Africa and Zambia to advance collaborative research with our nursing colleagues in sub‐Saharan Africa. In addition, our global nursing programs have advanced clinical practice and health care in three countries in Africa. Recommendations for further research in global nursing will be discussed. Page 81
Symposium C5: Global Health Nursing: Perspectives from Sub Saharan Africa Global Health Nursing: Philosophical Approaches and an Analysis of Factors Related to Nurse Migration Patrice Nicholas, DNSc, MPH, MS, RN, ANP, FAAN, Massachusetts General Hospital‐ Institute of Health Professions, Milton, MA ~ Stephanie Ahmed, DNP, RN, ANP, Brigham and Women's Hospital, Boston, MA ~ Inge B. Corless, PhD, RN, FAAN, Massachusetts General Hospital‐Institute of Health Professions, Boston, MA The purpose of this presentation/abstract for symposium is to address the philosophical issues and analyze the concepts and challenges related to nurse migration. Responding to health needs in developed and developing countries requires a strong workforce—globally and locally. In many resource‐limited countries—particularly in sub‐Saharan Africa and Asia—challenges exist in grappling with the loss of the best‐trained health care workers as well as the burden of the HIV pandemic (WHO, 2006). Countries where HIV prevalence is particularly high may struggle with both the loss of large numbers of the working population affected by HIV disease and nursing shortages as nurses migrate to developed countries. The extent of the nursing shortage and its consequences are especially severe in the countries of Africa and Asia where inequitable distribution leads to the greatest challenges. In sub‐
Saharan Africa where eleven percent of the world’s population resides and twenty four percent of the global burden of disease exists, only 3 percent of the world’s health care workers are available to provide care to those disproportionately affected by illness (WHO, 2006). The vast majority of the shortage in sub‐Saharan Africa and Asia occurs in the nursing workforce (Kingma, 2006).Kingma (2006) addresses the push and pull factors within a theoretical framework and analyzes the concept within a lens of human rights and social justice. This paper will examine the history and global forces that contribute to nurse migration. Exploration of the push and pull factors‐‐those conditions and environments that drive nurses out of their home countries and the factors that draw them toward other countries‐‐will be analyzed. A discussion of the opportunities for solutions do exist to address the social responsibility of nursing in global health. Through the lens of social justice theory, the concepts of brain drain, brain gain, and brain circulation for sharing the global healthcare workforce will be examined and a new framework for global healthcare equity will be presented. Page 82
Paper Session D1: Enhancing Global Health through Nursing Research Subsequent Childbirth after a Previous Traumatic Birth: Results from a Diverse Sample from 5 Countries Cheryl Tatano Beck, DNSc, CNM, FAAN, University of Connecticut, Tolland, CT Sue Watson, Chairperson, Trauma and Birth Stress, St. Heliers, Auckland Purpose: The aim of this study was to describe the meaning of women’s experiences of a subsequent childbirth following a previous traumatic birth. Background: International rates of posttraumatic stress disorder following traumatic childbirth range from 1.5% to 9%. Women who have had a traumatic birth experience report fewer subsequent children and also a longer length of time to their second baby. Childbirth related PTSD impacts couples’ physical relationship, communication, conflict, emotions, support, coping, and bonding with their children. Long term effects of traumatic childbirth also extend into mothers' breastfeeding experiences. Transgenerational effects of trauma and posttraumatic stress are being reported. A positive childbirth has the potential to empower a traumatized woman and help her reclaim her life. Methods: Descriptive phenomenology was the research design used. An international sample of 35 women participated in this Internet study. Fifteen women (43%) were from the U.S., 8 (23%)from the United Kingdom, 6 (17%) from New Zealand, 5 from Australia, and 1(3%) mother from Canada. Eight of the 35 women (23%) opted for a home birth for their subsequent births. Women were asked to “Please describe in as much detail as you can remember your subsequent pregnancy, labor and delivery following your previous traumatic birth.” Colaizzi’s phenomenological data analysis approach was used to analyze the stories of the 35 women. Results: Data analysis yielded 274 significant statements which were clustered into four themes: (a) Riding the Turbulent Wave of Panic during Pregnancy, (b) Strategizing: Attempts to Reclaim Their Body and Complete the Journey to Motherhood, (c) Bringing Reverence to the Birthing Process and Empowering Women, and (d) Still Elusive: The Longed for Healing Birth Experience. Conclusion and Implications: Subsequent childbirth following a previous birth trauma has the potential to either heal or re‐traumatize women. Health care professionals need to be carefully aware of the consequences their words and actions can have in labor and delivery. During pregnancy women need permission and encouragement to grieve their prior traumatic births to help remove the burden of their invisible pain. Page 83
Paper Session D1: Enhancing Global Health through Nursing Research Globally‐Based Diversity Research: A Model for Multinational Research Collaboratives Betty Rambur, PhD, RN, University of Vermont, South Burlington, VT The most pressing health diversity issues of our times are increasingly beyond the scope of a single discipline, institution, or nation. Nurse researchers exploring phenomena that are inherently multi‐
national in scale often must navigate novel institutional, disciplinary, and interdisciplinary complexity in an environment that is not fully prepared to move beyond simple, more traditional research teams. This qualitative research proposed to provide a beginning step toward addressing this gap. The specific purpose of the study was to identify promising practices in multinational research collaboratives through exploration of successful and failed university‐based multinational research initiatives. Snowball sampling was used to identify mid to high level administrative leaders and mangers in research intensive universities who held responsibility for a broad array of research endeavors. The final sample represented sixteen cases in four continents. A constant comparative, grounded theory methodology was employed to identify themes and commonality, with the model then undergoing interactive critique in two settings: a self‐selected audience at the University of Wisconsin‐Madison, and a synchronous virtual, video audience of members of the World University Network. The final resulting conceptual framework posits five distinct types of inter‐institutional multinational research collaboratives arrayed along a range of increasing faculty risk, decreasing stability, increasing human factors with compounding interaction costs, and increasing time to research outputs Implications for nurse researchers whose explorations in diversity include multinational collaboratives, both disciplinary and interdisciplinary, are detailed as are facilitative and inhibitory institutional and disciplinary cultures and practices. Areas of awareness for graduate students, novice researchers, and their mentors are illustrated. Page 84
Paper Session D1: Enhancing Global Health through Nursing Research Determinants of Nonadherence to Pediatric Follow‐up Guidelines of HIV‐exposed Infants in Rwanda Patricia J Moreland, RN, MSN, CPNP, Columbia University School of Nursing, New York, NY Batya Elul, PhD, Mailman School of Public Health, Columbia University, New York, NY Kristine Gebbie, DrPH, Hunter‐Bellevue School of Nursing, New York, NY ~ Arlene Smalldone, DNSc, CPNP, Columbia University School of Nursing, New York, NY Purpose: In 2006 more than 2.3 million children were living with HIV/AIDS worldwide. Most of these children acquired HIV from HIV‐positive mothers. Rapid disease progression and high mortality in prenatally infected infants underlines the importance of pediatric follow‐up care. Prevention of Mother‐
to‐Child Transmission (PMTCT) programs have been unsuccessful in ensuring continued care of HIV‐
exposed infants due to high loss to follow‐up. The purpose of this study was to identify determinants of nonadherence to pediatric follow‐up care of HIV‐exposed infants in Rwanda. Theoretical Framework: Andersen’s Behavioral Model of Health Services Utilization guided this study. Methods: We analyzed 2006 survey data from 229 HIV‐positive Rwandan women collected as part of a national PMTCT program evaluation. World Health Organization guidelines were used to determine pediatric follow‐up adherence/nonadherence status. We analyzed data using descriptive statistics, univariate and multivariate logistic regression. Results: Of 229 women surveyed, 79% (n=182) reported nonadherence to pediatric follow‐up guidelines. Women who adhered differed from those who did not in terms of environment (travel time to clinic [p=0.03], visit by healthcare worker [p=0.05]); population characteristics (infant age [p=.005], prior death of a child [p=0.02]); and health behaviors (partner tested for HIV during pregnancy [p=0.03]; partner disclosed HIV status [p=0.04], newborn ingestion of single‐dose neverapine (SD‐NVP) [p=0.03], and adherence to mother/infant SD‐NVP [p=0.04]). Controlling for environment, population characteristics, and health behaviors , women were less likely to nonadhere to pediatric guidelines if they had reported death of a previous child (Odds Ratio [OR] 0.4, 95% Confidence Interval [95%CI] 0.2‐
0.9), mother/infant adherence to SD‐NVP (OR 0.41, 95%CI 0.2‐0.9) or if age of child was ≤1 month (OR 0.14, 95%CI 0.50‐0.38). Conclusions and Implications: Findings of this study may inform Rwandan national policy and programmatic guidelines. Identifying the reasons for nonadherence is an important step to reduce morbidity and mortality in HIV‐exposed infants. Page 85
Paper Session D1: Enhancing Global Health through Nursing Research A Chinese Version of Self‐efficacy and Outcome Expectations for Osteoporosis Medication Adherence Scales: Reliability and validity assessment in Chinese immigrants Bing‐Bing Qi, Phd, RN, College of Nursing, Villanova University, Villanova, PA Background: Studies have consistently revealed that Chinese, particularly recent immigrants, have low bone mineral density and are at great risk for developing osteoporosis. Several pharmacological treatments have been shown to increase BMD and decrease fractures among Asians. Despite the availability of effective treatments, many Chinese people with or at risk for osteoporosis fail to adhere to medication regimens either by ceasing to take the medication or by not following the instructions properly. Psychometrically sound instruments are needed to examine the effectiveness of interventions aimed at increasing osteoporosis medication adherence in Chinese immigrants. Theoretical Framework: According to Self‐efficacy Theory, individuals with stronger self‐efficacy and outcome expectations about medication behavior and the effectiveness of the drug are more motivated and persist longer in correctly following the recommended drug treatment program. Purpose: To test the reliability and validity of the translated Chinese version of Self‐efficacy and Outcome Expectations for Osteoporosis Medication Adherence scales (SEOMA and OEOMA). Methods: The preliminary testing was conducted with a sample of 83 older Mandarin‐speaking Chinese immigrants in an immigrant clinic in Chinatown Philadelphia. The average age of these participants was 63.4+9.6 years. This was a descriptive study involving a single face‐to‐face interview. A complete survey in Mandarin including demographic data, exercise behavior and osteoporosis medication use was administered. Results: There was strong evidence of reliability of the Chinese version of SEOMA and OEOMA based on internal consistency (Cronbach alpha=0.904 and 0.937 for SEOMA and OEOMA, respectively). Evidence of validity was based on hypothesis testing: individuals who take calcium or osteoporosis medications regularly had a higher level of self‐efficacy for medication adherence and higher outcome expectations for osteoporosis medication adherence when compared to the individuals who do not take calcium or osteoporosis medications. Conclusion: Although ongoing reliability and validity testing is needed, the Chinese version of SEOMA and OEOMA scales can be used to identify older Mandarin‐speaking immigrants with low self‐efficacy and outcome expectations for osteoporosis medication adherence and interventions can then be implemented to strengthen these expectations and improve osteoporosis preventive behaviors. Page 86
Paper Session D2: Women's Health Across the Life Course Non‐coital Behaviors and Disease Risk Among Urban Adolescent Females Carol Roye, EdD, RN, CPNP, Hunter‐Bellevue School of Nursing, Pleasantville, NY Beatrice Krauss, PhD, Hunter College, New York, NY ~ Paula Silverman, MPH, Hunter College (at the time work was done), North Andover, MA Purpose: HIV‐prevention research targeting sexual risk‐reduction has focused on coital behavior. However, non‐coital contact poses considerable risks for HIV and other sexually transmitted infections (STIs). Research suggests that ¼ ‐ 1/3 of young women report engaging in receptive anal intercourse (RAI), the sexual behavior most likely to transmit HIV. The human papillomavirus (HPV), a common STI, is an etiological factor for anal and oropharyngeal cancers, in addition to cervical cancer. There has been a dramatic increase in anal carcinoma over the last few decades. Yet, little is known about the context of noncoital behaviors. Theoretical Framework: The randomized clinical trial (RCT) from which these data were generated was based on the Social Cognitive Learning Theory, the Health Belief Model and the Extended Parallel Process Model. Methods ‐ The data come from baseline assessments for an RCT of HIV‐prevention interventions for Black and Latina female adolescents, aged 15 ‐21 years. Before participating in the intervention young women completed an extensive survey about their sexual behaviors using Audio Computer‐Assisted Self‐Interview (ACASI). Questions were asked about relationship patterns, sexual behaviors and risk‐reduction behaviors including use of condoms and hormonal contraceptives. Data were analyzed using correlations and chi‐square. Results and Findings: Over 1/3 of the sample had engaged in RAI and 90% had engaged in oral sex. Significant correlations were found between RAI, early age at first vaginal intercourse, history of STIs, sexual abuse, and pregnancy. Significantly more Latinas had engaged in RAI than Blacks. Similar correlations exist with oral sex. However, there was no correlation between ethnicity and oral sex. There was significantly less condom use during anal and oral intercourse than vaginal. Conclusions and Implications: Female adolescents who engage in noncoital behaviors were significantly more likely to report a high‐risk sexual history. Rates of condom use for noncoital behaviors were very low, placing these young women at high risk for HIV and other STIs. Nurses must counsel young women about these risks. Additionally, more research is needed to contextualize these behaviors in order to develop effective risk‐reduction interventions. Page 87
Paper Session D2: Women's Health Across the Life Course Daily Spiritual Experiences (DSEs) and Quality of Life of Young Adult Women: Exploring the Impact of Intimate Partner Violence (IPV) Carolyn J Nickerson, EdD, RN, CNE, Duquesne University, Pittsburgh, PA Alison Colbert, PhD, APRN‐BC, Duquesne University, Pittsburgh, PA Rick Zoucha, PhD, APRN, BC, CTN, Duquesne university, Pittsburgh, PA Religiousness/spirituality serve as resources for as well as barriers to healing after devastating life experiences like intimate partner violence (IPV). Relationships between daily spiritual experiences (DSE) and quality of life remain unstudied. The purpose the study was to describe DSEs of young adult women with and without IPV history, inquire into relationships between religious/spiritual variables and perceptions of QOL, and explore perceptions of the meaning of DSEs for QOL. Stuifbergen & Becker's Health Promotion/Quality of Life Model, complemented by Underwood’s model of human being/health, guided this study. Because the research questions ask both the "what and how" of daily spiritual experiences and IPV, quantitative and qualitative methods were appropriate. A concurrent embedded strategy (QUAN+qual) employed simultaneous collection of quantitative data on DSEs, quality of life, and demographic variables, and qualitative phenomenological inquiry into participants’ perceptions of significance of DSEs for QOL. Purposive sampling sought 19‐45 yo, English‐speaking female participants from community settings, half with IPV history. Statistical analysis included central tendency, variability, and selected correlational tests. The Utrecht method guided qualitative data analysis. Differences between IPV and non‐IPV groups were assessed using chi‐square and Mann Whitney‐U. Due to the relatively small sample size, non‐parametric bootstrap with 1000 replications was used to estimate the empirical sampling distribution of Pearson correlation among the variables. 63 women, 52% with IPV history, were surveyed. Women with IPV history had significantly higher mean DSEs scores, significant correlations of self‐ranking‐as‐religious/self‐ranking‐as‐spiritual, and of WHOQOL psychological and social domains and the overall QOL. Qualitative themes reflected participants’ perceptions of spirituality as related to life and QOL, and their desire to make meaning of life experiences and employ spiritual practices for self care. Results of this pilot study will guide the design of a larger methodologically similar study of DSE and other possible IPV including depression and anxiety. Page 88
Paper Session D2: Women's Health Across the Life Course The Experience of Planned Home Birth: The Development of Mutual Trust and Autonomy Judith Lothian, PhD, RN, LCCE, Seton Hall University, Brooklyn, NY Purpose: The purpose of this research is to describe the experience of planned home birth in the US. This presentation will focus on the findings related to the development of personal autonomy. Background: Although the safety of planned home birth for healthy women is well established less than 1% of US women choose a planned home birth. There is no research that describes the experience of planned home birth in the US. Methods: Ethnographic techniques of informal interview and participant observation were used to obtain rich descriptions of women’s experience of planned home birth. Twenty women representing diverse backgrounds and cared for by six different Certified Nurse Midwives were interviewed and observed in their homes. Interviews were audio‐recorded and transcribed. Guidelines to insure trustworthiness and protection of human subjects were followed. The data were analyzed using standard qualitative techniques—developing codes, categories and themes. Results: The relationship of the midwives and women became the foundation for the development of mutual trust and personal autonomy. The relationship developed slowly over the course of the pregnancy, with the midwives and women getting to know each other in ways that go beyond the typical patient/provider relationship. Mutual trust characterized the relationship. Pesonal autonomy was fostered by the midwives and reflected in the decisions that women made for themselves during pregnancy and labor. Conclusions/Implications: The personal relationship of women and their midwives and the development over time of mutual trust and autonomy provide a model for maternity care providers and women. The findings highlight the importance of the personal relationship of women with their care providers, the ways in which trust evolves and how this influences women's ability to make decisions about their care in a truly autonomous way. Page 89
Paper Session D2: Women's Health Across the Life Course Exploring Latent Cancer/Cardiac Risk Clusters in Alcohol, Smoking, and Obesity in Postmenopausal Women Thomas L Hardie, EdD, PMHCNS‐BC, Widener University, Chester, PA Carolee A Polek, RN, PhD, AOCNS, University of Delaware, Newark, DE Erlinda C Wheeler, RN, DNS, University of Delaware, Newark, DE Purpose: Alcohol use, smoking tobacco, and obesity have all been established as risks for developing cancers and heart disease. Recent finding indicate that post menopausal women having "even moderate alcohol consumption, defined as one or two drinks per day" increase their risk of developing the most common form of breast cancer by 51%. The purpose of this study is to describe current levels of known breast cancer and heart disease risks in a nationally representative sample and develop risk profiles derived by traditional clustering methods and latent class analysis (clusters). Understanding the prevalence and how these risks interact will inform targeted prevention and research. Methods: Data from the 2007 National Health Interview Survey was analyzed to assess the prevalence of drinking, smoking and being overweight/obese in women between the ages of 50 and 69 ( N=3750). K‐mean clusters and Latent class analysis (LCA) using levels of alcohol use, tobacco use and obesity were used to develop patient clusters. Results: Of drinking women, 11.4% are consuming alcohol at unhealthy levels, 18% are smoking and 65.6% are overweight/obese. A three cluster (LCA) solution was the most appropriate fitting model which provides a more comprehensive picture of the co‐morbidity in these risks. These clusters may provide demographic profiles for targeted interventions. Conclusion: Clustering either by traditional methods or LCA offers a method of comparing obese, abstinent smokers with the alcohol using, non‐smoking average weight women. Findings from this project will allow the nurse to use demographic profiles associated with risk clusters in developing targeted prevention and screening research. The advantages and disadvantages of using and selecting various clustering methods will be presented. For example, this observational study provides population level risk data but is censored. Some of the most severely impacted women may not be in the survey due to hospitalization or death. Page 90
Paper Session D3: Health Promotion and Disease Prevention in Special Populations Nurses with Disabilities: A Diverse Group of Outsiders Leslie J Neal‐Boylan, PhD, CRRN, APRN‐Bc, Yale University, Hamden, CT Purpose: Disability contributes to loss of employment due to physical and organizational barriers. There is a scarcity of literature regarding nurses with physical or sensory disabilities. This presentation will discuss preliminary research that indicates that these nurses comprise a diverse group that is undervalued by the profession. These nurses are leaving nursing or moving away from the bedside. Poor staff ratios contribute to problems with patient safety. Conceptual Framework: The “integrative model of health care working conditions on organizational climate and safety” (Stone, et al., 2005) was used in this study. The model shows that nursing workload can influence outcomes, such as patient care and safety. In addition, employee recognition and group behavior influence nurse retention and patient outcomes. Method: This presentation will report the results of 2 studies. The first was a qualitative study of 20 nurses with self‐identified physical disabilities and15 nurse recruiters. The second study used the Census Questions on Disability and the Nurse Work Instability Scale to measure risk of leaving the job in nurses with sensory disabilities. The snowball method was used to acquire a purposive sample of 80 RNs from within the contiguous United States. Results: Both studies found that nurses with disabilities are leaving nursing or are at risk of leaving. Nurses with disabilities often hide their disabilities. Hospital nurses with hearing disabilities are three times more likely to leave the job than other nurses. Nurses with a lot of difficulty hearing, seeing, or communicating are not practicing as nurses. Conclusions and Implications: Disability diversity is influencing nurse retention. Unmanageable workload and lack of supervisory or collegial support are key factors. Nurses and nurse leaders must open dialogue to develop awareness of the need to meet the needs of this diverse group to retain them in nursing to avoid losing the expertise and experience of these nurses. Page 91
Paper Session D3: Health Promotion and Disease Prevention in Special Populations The Relationship of Vision Status to Employment Status and to Activities of Daily Life Among Adult Women Respondents to the 2006‐2008 National Health Interview Survey Nancy C. Sharts‐Hopko, PhD, RN, FAAN, Villanova University, Villanova, PA Purpose: Examination of vision status as it relates to employment status and to activities of daily life among adult women participants in the 2006, 2007 and 2008 National Health Interview Survey. Nursing research has not focused on visual impairment, though recent surveys suggest that there will be a marked increase in low vision and blindness as the Boomer generation ages. Theoretical Framework: Bandura’s social cognitive theory provides a context for this research. People learn behavior in response to feedback from the environment and from others, and they identify with others whom they perceive themselves to resemble. Methods: This research was conducted using a descriptive design entailing sample analysis of an existing data base. The sample included 38,845 adult (18‐85+) women in the National Health Interview Survey Adult Samples for 2006, 2007 and 2008. The NHIS was redesigned in 2006 assuring consistency across these years. Data were collected by US Census workers during home interviews with telephone follow‐
up, using a complex probabilistic sampling design. All states and the District of Columbia are represented, and underserved minority groups were purposively over‐sampled. The National Health Interview Survey is a computer assisted personal interview that takes approximately one hour and most items are structured fixed response questions; the interview schedule can be reviewed on the NHIS website. Categorical data were subjected to chi‐square analysis. Results: Women self‐reporting low vision even with correction comprised 18.8% of the sample. Women with low‐vision including blindness are less likely to be employed and do report restrictions in activities of daily living and in social activities than women who do not report low‐vision. Conclusions and Implications: The percentage of women with low vision despite correction is substantial. Low vision is associated with restricted in labor force participation as well as limitations in activities of daily life and social interaction. Page 92
Paper Session D3: Health Promotion and Disease Prevention in Special Populations Post‐Deployment Health Assessment in United States Service Members after Iraq Deployment. Sean T. Collins, PhD, University of Massachusetts ‐ Graduate School of Nursing, Southwick, MA Purpose: The purpose of this study was to identify health and emotional‐related issues of service members after a deployment to Iraq. Theoretical Framework: The cognitive appraisal model of stress and coping guided this study. Methods: Secondary data analysis and a cross‐sectional descriptive design were used to analyze deidentified data from the Department of Defense Post Deployment Health Assessment (PDHA) database. The study sample included 510, 352 service members (49,998 females, 460,349 males) with a mean age of 29 years. The sample represented all components and branches of the US military that deployed to Iraq during a specified time frame. The magnitude of the differences / associations and mediation was examined with regression models. Cronbach alphas were calculated to estimate the reliability of the physical symptom and environmental exposure subscales, three item depressive symptom scale, PTSD symptoms, and emotional concern scales. Results: PTSD symptoms were identified in 11.8% (n = 60,200) and depressive symptoms in 26.5%, (n=123,808) of participants. Results of the study indicated that age, gender, rank, race/ethnicity, military component and branch were important predictors of emotional and health‐related concerns in this sample. Appraisal variables (danger of being killed and exposure concerns) mediated the relationship between immediate (physical and depressive symptoms) and long term outcomes (health perception, PTSD symptoms) for the majority of the analyses; supporting the study hypothesis. Of the total sample, 51.9% (n=264,777) witnessed wounded, killed or dead individuals and 22.1% (n=112,620) discharged their weapon in combat. Environmental exposures were an important source of stress, along with multiple physical symptoms that were identified. Conclusions & Implications: Results indicated that the appraisal variables (danger of being killed, environmental exposure concerns) were important for explaining stress‐related outcomes for military members deployed to Iraq. Implications for Practice: Policy and future research were identified. Page 93
Paper Session D3: Health Promotion and Disease Prevention in Special Populations The Effect of Psychiatric Symptom Severity on Return to Work and Bed Days in the Year following Minor Injury Sara F Jacoby, MSN, MPH, University of Pennsylvania, Philadelphia, PA Theimann Ackerson, MSSW, University of Pennsylvania, Philadelphia, PA Therese S. Richmond, PhD, CRNP, FAAN, University of Pennsylvania, Philadelphia, PA Purpose: To examine the contribution of psychiatric symptom severity to return to work and bed days at 1 year after minor injury. Theoretical Framework: Nagi’s theory of the disabling process which posits disability results from the complex interaction of pathological, psychological, social and environmental factors. Methods: This research is a secondary analysis of a data set derived from a longitudinal cohort study of patients with minor injury presenting to the ED at a large urban hospital. The dataset included 275 randomly selected subjects (52% men; 48% women) who were representative of the general ED population in ethnicity, marital status, income and education. CNS injury, injury requiring care in the past 2 years or resulting from domestic violence, and those with major depression or psychosis were excluded. Psychiatric symptom severity, using the Hamilton Rating Scale for Depression (HAM‐D) and Anxiety (HAM‐A) was collected within 2 weeks of the ED visit. Outcome measures were collected at 1 year after injury and included work performance (using the Functional Status Questionnaire) and bed days (days spent in bed in the prior month). Patients were categorized as having no/mild depression vs. moderate/severe depression symptoms and no/mild anxiety vs. moderate/high anxiety symptoms using the 2 weeks post‐injury data. Groups (no/low vs. moderate/high) were compared for the 1 year outcomes of worsened work status and increased bed days using logistic regression. Results: Of 235 participants for whom follow‐up data were available, 47(20%) reported more days spent in bed. Adjusting for clinical/demographic covariates, those with moderate/severe symptom severity for depression were over 3 times more likely to report more bed days at 1 year (OR 3.54, 95% CI 1.32‐9.54). Of 164 participants working pre‐injury, 76 (46%) reported worsened work‐score. Adjusting for clinical/demographic covariates, those with moderate/severe symptom severity for depression were over5 times more likely to have a worsened work performance score at 1 year (OR 5.77, CI 1.49‐22.37). Conclusions and Implications: Moderate/severe depression symptoms (but not anxiety) early after minor injury predict poor outcomes at 1 year after injury. Short standardized questionnaires such as the HAM‐D can be administered in the ED or at early follow‐up to screen for patients at higher risk for poor outcomes 1 year after injury allowing resources for intervention to be targeted to a smaller high risk group. Funding: NIH R01 MH63818 Page 94
Paper Session D4: Sleep and Sleep Disorders: Focus on Special Populations Is CPAP Use Influenced by Disease‐ and Treatment‐specific Cognitive Perceptions? Amy M. Sawyer, PhD, RN, University of Pennsylvania School of Nursing, Philadelphia, PA Anne Canamucio, MS, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA Samuel T. Kuna, MD, University of Pennsylvania School of Medicine, Philadelphia, PA Helene Moriarty, PhD, RN, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA Terri E. Weaver, PhD, RN, FAAN., University of Pennsylvania School of Nursing, Philadelphia, PA Purpose: Nonadherence to CPAP increases health risks associated with OSA. Early identification of those at risk for low CPAP use is critical to reducing untoward outcomes in OSA. The study purpose was to examine if disease‐specific cognitive perceptions influence CPAP use. Theoretical Framework: Social cognitive theory (SCT) posits that health behavior is determined by a core set of determinants that include knowledge, perceived self‐efficacy, outcome expectations, health goals and facilitators and barriers to achieving health goals or behaviors to manage one’s own health. Equating health behavior with CPAP use, measuring disease‐specific cognitive perceptions may present opportunities to identify those at risk for low treatment use and suggest intervention strategies to promote CPAP use. Methods: A prospective cohort study included 66, middle‐aged (56.7 yrs ± 10.7) subjects (34 [51.5%] Caucasians; 30 [45.4%] African Americans) with severe OSA (AHI 43.5 events/hr ± 24.6. Following full‐
night diagnostic and CPAP titration polysomnograms, CPAP was initiated. CPAP use was objectively measured following the first week and first month of treatment. Subjects completed the Self‐Efficacy Measure for Sleep Apnea questionnaire (SEMSA) that assesses perception of risk, outcome expectancies, and perception of treatment benefit (self‐efficacy), at baseline, post‐CPAP education, and post‐one week CPAP treatment. Stepwise linear and negative binomial regressions were used. Results: Average 1‐wk CPAP use was 3.99 hrs/night ± 2.48 and 3.06 hrs/night ± 4.50 at 1‐mo. No SEMSA domains measured at baseline predicted 1‐wk or 1‐mo CPAP use. Treatment self‐efficacy measured post‐education influenced 1‐wk CPAP use (1.52±0.53, p=0.006). Treatment self‐efficacy measured post‐
education and after 1 week CPAP use also influenced 1‐mo CPAP (1.40±0.52, p=0.009; 1.20±0.50, p=0.02, respectively). Conclusions: Cognitive perceptions influence CPAP use, but only within the context of knowledge of CPAP treatment and experience with the treatment. Early identification of patients not likely to use CPAP, or under‐use CPAP, is possibly most effectively timed after some exposure to the treatment. Further, effective interventions to improve CPAP use may target early cognitive perceptions of the treatment. Page 95
Paper Session D4: Sleep and Sleep Disorders: Focus on Special Populations Gender Differences in Response to CPAP Treatment in Obstructive Sleep Apnea Lichuan Ye, PhD, RN, Boston College, Chestnut Hill, MA Terri E Weaver, PhD, FAAN, RN, University of Pennsylvania, Philadelphia, PA Purpose: Gender differences have been reported in clinical manifestations of obstructive sleep apnea (OSA). It remains unclear, however, whether there is any effect of gender on the response to continuous positive airway pressure (CPAP), the primary treatment for OSA. This study first addressed this question in a large clinical sample. Theoretical Framework: Using Granger’s model of functional assessment, we assessed gender differences in a wide range of clinical outcomes representing personal disability and functional limitation. Methods: Data collected from an international multi‐center clinical trial were analyzed (138 males and 98 females). Excessive daytime sleepiness (Epworth Sleepiness Scale and Psychomotor Vigilance Task), mood disturbances (Profile of Mood States [POMS]), and functional status (Functional Outcomes of Sleep Questionnaire and SF‐36) were assessed at the study entry and after 8 weeks of active CPAP treatment. Paired t‐tests were used to test significant improvement in clinical outcomes following treatment. Analysis of covariance was used to test gender differences in the change in each clinical outcome. Results: In general, significant improvements in daytime sleepiness, mood disturbances, and functional status were observed in both genders following treatment. However, significant improvement in some measures was observed only in men but not in women, especially in the POMS anxiety and depression subscales and mental health measured by the SF‐36. Men had significantly greater improvement in the POMS Confusion‐Bewilderment (p=0.011) and Tension‐Anxiety (p=0.036), after adjusting for baseline status, average hours of CPAP use, and other pertinent demographic and clinical factors (age, body mass index, apnea hypopnea index, etc.). Conclusions and Implications: This study confirmed the effectiveness of CPAP in both men and women. We hypothesize that mood disturbances in women with OSA may be caused by different mechanisms compared to men, thus the impaired mood in women is less likely to be improved by effective treatment for OSA. This finding indicates the need of gender‐specific support targeting on mood disturbances in patients with OSA. Page 96
Paper Session D4: Sleep and Sleep Disorders: Focus on Special Populations Caffeine Consumption by School‐Aged Children: Effects on Sleep Duration and Body Weight Eileen R. Chasens, DSN, University of Pittsburgh, Pittsburgh, PA Christina J. Calamaro, PhD, University of Maryland, Baltimore, MD Kyeongra Yang, PhD, University of Pittsburgh, Pittsburgh, PA Purpose: Childhood obesity has increased in prevalence over the last thirty years. Obesity is associated with psychological distress and the development of lifetime health problems. The purpose of this study was to examine the relationship between sleep duration, caffeine, and weight in school‐aged children. Theoretic Framework: Recent evidence suggests that short sleep duration is associated with weight gain in adults; this relationship is hypothesized to also occur among school‐aged children. Children have high sleep requirements, 6 to 10 year olds are recommended to have 11.4 to 9.9 hours of sleep a night, respectively. The Institute of Medicine recommends no caffeine consumption among school‐aged children. Methods: A secondary analysis was completed from the National Sleep Foundation’s 2004 Sleep in America Poll (n=1073), a telephone survey of caregivers (72.8% mothers) of sleep habits in children. Our study analyzed a subset of 637 children ranging in age from 6 to 10 years of age. Descriptive/ inferential statistics examined relationships between sleep duration, caffeine consumption, and BMI. Results: The sample was 51% male, mean age 8.1±1.4 years. Mean BMI (kg/m2) =18.5 ± 5.1 kg/m2; 21.4% children > 95th percentile. Many children were reported to have a short sleep duration (mean 9.1± 1.1 hrs sleep/night). 30% of sample had one or more caffeinated beverage/day. Children with television in bedroom (p=.022) or who consumed caffinated beverages (p=.001) had a significantly shorter sleep duration. Results of multiple regression showed short sleep duration and caffeine consumption were significant for increased BMI (p<.05) when controlling for age and gender. Conclusion: Children did not sleep recommended hours for age. Short sleep duration and caffeine consumption were associated with obesity in children 6‐10 years. Increased BMI may be associated with interaction of caffeine consumption and short sleep duration. Page 97
Paper Session D4: Sleep and Sleep Disorders: Focus on Special Populations Sleep Problems in Veterans Receiving Platinum‐Based Chemotherapy for Lung Cancer Grace E. Dean, PhD, RN, University at Buffalo, Buffalo, NY ~ Suzanne S. Dickerson, DNS, RN, University at Buffalo, Buffalo, NY ~ Ya‐Jung Wang, RN, MSN, University at Buffalo, Buffalo, NY Purpose: Sleep problems in patients with lung cancer are under‐recognized and under‐treated. Much of the previous research has focused on self‐reported sleep measures. The purpose of this study was to evaluate sleep using both subjective and objective measures of sleep. Theoretical Framework: Spielman’s 3P (predisposing, perpetuating and precipitating factors) Model of Insomnia was used to guide this study. Methods: Participants were referred by oncologists and nurse practitioners from the Philadelphia and Buffalo VA Medical Centers and asked to participate following one cycle of platinum‐based chemotherapy. Participants were asked to complete the following: Pittsburgh Sleep Quality Index (PSQI), a sleep diary for 7‐days and wear the motionlogger actigraph (Ambulatory Monitoring, Inc.) for 7‐days. Descriptive, correlational analyses were used. Results: Among 50 participants, mean age was 64.2 years (SD=9.9, Range= 47‐84), with 98% male, and 50% African American. The majority of patients were diagnosed with NonSmall Cell Lung Cancer (73.6%) and 100% received platinum‐based chemotherapy. PSQI results revealed mean sleep latency 36 (SD=31.2), mean sleep duration 6.3 (sd=1.6) hours, and mean sleep efficiency 74.5% (sd=19.9). Motionlogger actigraphy results revealed mean sleep latency 75.7 (sd=83.2), mean sleep duration 5.2 (sd=2.2), and mean sleep efficiency 66.8% (sd=16.4). The PSQI mean global sleep quality was 9.0 (sd=4.0) with 77% of the sample scoring above the clinically significant cutoff score of five. There were no significant correlations between subjective and objective measures of sleep. Conclusions/Implications: The results of this study suggest that sleep is impaired in patients after receiving platinum‐based chemotherapy for lung cancer. Objective measures revealed longer sleep latency, shorter sleep duration and poorer sleep efficiency than subjective measures. Findings are consistent with previous cross‐sectional studies showing that sleep quality is poor in patients with lung cancer. Further studies are needed to understand the mechanisms through which chemotherapy may contribute to these impairments. Page 98
Symposium D5: Intergrating Research, Evidence‐Based Practice & Performance Improvement to Sustain Evidence‐Based Practice Change in a Pediatric Hospital Integrative Summary Katherine Patterson Kelly, PhD, RN, Children's National Medical Center, Rockville, MD Nurses use research, EBP and PI to inform practice. As clinical nurses become more involved with these methods, questions arise about how they differ. The three are distinguished by their purpose, use of theory and data, and generalizability of results; however, we contend that, at the point of care, the three processes should be closely aligned. We developed a model of Evidence‐Based Nursing (EBN) to illustrate to nursing staff how they purposefully integrate multiple sources of evidence to provide tailored care for patients and families, evaluate the care given and share the knowledge gained with others. The model integrates these three in a holistic process to be used by the nurse to plan care. We will present 3 exemplars of EBN. We will begin with a description of using PI methods to introduce a new standardized assessment, the Pediatric Early Warning Score, first at the unit level and then throughout the hospital. The second presentation covers a demonstration project to measure process outcomes during implementation of published family presence during resuscitation guidelines in a level one pediatric trauma center. In the final paper we will describe the development of an automated method to obtain pain management outcomes from the electronic health record that will provide a ready means to measure future research, EBP and PI outcomes. The symposium will end with a discussion about the benefits and challenges of closely aligning these methods to advance care of children and families, including future research. Page 99
Symposium D5: Intergrating Research, Evidence‐Based Practice & Performance Improvement to Sustain Evidence‐Based Practice Change in a Pediatric Hospital Family Presence during Trauma Activations and Medical Resuscitations in a Pediatric Emergency Department: An Evidence‐Based Practice Demonstration Project Jennifer Kingsnorth, MSN, RN, Children's National Medical Center, Washington, DC ~ Shireen Atabaki, MD MPH, Children's National Medical Center, Washington, DC ~ Kathleen Brown, MD, Children's National Medical Center, Washington, DC ~ Jacki Curreri Edens, BSN, MAT, RN, CPN, Children's National Medical Center, Washington, DC ~ Cathie Guzzetta, PhD, RN, Children's National Medical Center, Washington, DC ~ Anne Mecherikunnel, MSW LICSW, Children's National Medical Center, Washington, DC ~ Karen O'Connell, MD, Children's National Medical Center, Washington, DC Purpose: The evidence regarding family presence during resuscitation indicates that implementation of a family presence policy can allow for a positive family interaction during a time of crisis, without interference in the quality of patient care. The purpose of our demonstration project was to implement a family presence policy based on published guidelines by multiple medical and nursing organizations, and to evaluate the impact in our Level One urban pediatric trauma center. Theoretical Framework: We used Newhouse’s evidence‐based practice model to implement and evaluate the family presence policy. We adapted the 5 “A”s (Ask, Acquire, Appraise, Apply, Analyze) by adding a 6th “A”, Adopt/Adapt to measure the impact of sustainability of the practice change. Methods: ASK: Can we ensure appropriate family member behavior and uninterrupted patient care in the pediatric emergency department code room during trauma activations and medical resuscitations if national family presence guidelines are utilized? ACQUIRE/APPRAISE: We searched and appraised current literature and national guidelines regarding family screening, family preparation, and use of Family Presence Facilitators to determine the most appropriate intervention for our center. We surveyed ED staff attitudes (N=40 nurses and physicians) about family presence to determine baseline acceptance for education planning. Results: The steps of our intervention were evaluated for feasibility, patient safety and the guarantee of uninterrupted patent care. Family presence was evaluated in 106 events. Ninety‐six families were offered the option to be present, based on family present facilitator screening. All chose to be present with facilitator’s guidance during all events. One family presence event was terminated. In all cases, patient care was not interrupted. Conclusions and Implications: ADOPT/ADAPT: Study enrollment was completed December 2008 demonstrating the feasibility of a family presence intervention during trauma team activations and medical alerts in an urban pediatric emergency department, while also ensuring uninterrupted patient care. Physician and nursing staff have accepted the practice of family presence, adopting it as a standard of practice in our emergency department. This evidence based intervention can serve as a prototype to other pediatric emergency departments wanting to implement a family presence intervention.
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Symposium D5: Intergrating Research, Evidence‐Based Practice & Performance Improvement to Sustain Evidence‐Based Practice Change in a Pediatric Hospital Implementing and Sustaining Evidence‐based Nursing Practice to Reduce Pediatric Cardiopulmonary Arrest Simmy Randhawa, MS, MBA, RN, NE‐BC, CPN, Children's National Medical Center, Washington, DC ~ Jennifer DuVal, MSN, RN, CPN, Children's National Medical Center, Washington, DC ~ Lenore Hall, BSN RN CPN, Children's National Medical Center, Washington, DC ~ Renee Roberts‐Turner, MSN, ED, BS, RN, Children's National Medical Center, Washington, DC ~ Karen Woronick, BSN, RN, CCRN, Children's National Medical Center, Washington, DC Purpose: There is strong evidence to support the use of rapid response teams (RRT) to improve successful outcomes for patients through early escalation. Implementation of the Clinical Assessment Team (CAT) was successful in reducing codes outside of the critical care area; however we did not experience a reduction in the overall number of code blues because the subtle signs of deterioration in children were not consistently recognized by the bedside acute care nurse. The Pediatric Early Warning Score (PEWS) provides nurses with a mechanism for early detection using quantitative data. We will describe our process and outcomes of implementing and sustaining PEWS use at the unit and organizational level. Theoretical Framework: We used the Plan‐Do‐Check‐Act (PDCA) model for performance improvement to implement and sustain our practice change. Methods: PEWS was piloted sequentially on two acute care units using the PDCA rapid cycle process. Nurses and physicians (N= 110) were trained on the use of the instrument and associated treatment/escalation algorithms. Training processes included establishing inter‐rater reliability. Initially the measure was completed on paper; it is now part of our electronic health record. Results: Outcomes data show that post‐implementation of the PEWS, cardiopulmonary arrests were reduced by 32% at the pilot unit level and subsequently 23.4% at the organizational level. Data also indicated that bedside nurses effectively managed and escalated patient care needs without activating RRT (24.4% reduction in RRT after PEWS implementation) in certain clinical situations. Conclusions and Implications: Use of an early detection measure combined with rapid response teams improves patient outcomes. Ongoing institutional evaluations identify areas for continued improvement in the use of the PEWS. We will describe our ongoing challenges and strategies used to sustain the positive outcomes of PEWS at the unit and organizational levels. Page 101
Symposium D5: Intergrating Research, Evidence‐Based Practice & Performance Improvement to Sustain Evidence‐Based Practice Change in a Pediatric Hospital Improving the Quality of Pediatric Pain Assessment Using Automated Electronic Health Records (EHR) Outcomes Reports Amrita Naipaul, MSN, RN, PCCNP, Children's National Medical Center, Washington, DC ~ Brian Jacobs, MD, Children's National Medical Center, Washington, DC Purpose: Optimal pain management requires compliance with objective assessments, interventions, monitoring and documentation. After migration to an EHR for nursing documentation in 2008, we identified an opportunity to incorporate EHR outcomes data monitoring into a pain assessment quality improvement plan. We hypothesized that through ongoing monitoring and feedback, nursing staff would improve compliance of pain assessment‐intervention‐reassessment (AIR) cycle documentation. Theoretical Framework: We combined information technology with the plan‐do‐check‐act (PDCA) methodology of performance improvement to target improvements in nursing documentation of pain AIR cycles. We’ve named this approach iQuality. Methods: We designed an automated pain report summarizing pain data entered into the EHR. The report captures 100% of inpatient pain assessments at admission, each shift and after pain interventions. Data are aggregated and analyzed providing unit by unit comparative data and then disseminated to nurses, managers and executive leadership. The data are tracked longitudinally and reviewed by a multidisciplinary pain committee on a monthly basis where strengths and opportunities for improvements are discussed, goals developed and strategies implemented. Based on performance, unit level action plans are implemented. Results: To date pain assessment data have been collected on 5,653 patients from June 2008 through July 2009. We have demonstrated significant improvements in pain assessment at admission (p=0.01) and ongoing pain assessment (p=0.00). The reassessment of pain within 2hours post‐intervention has improved by 35.2% (p=0.05). The EHR‐derived pain data are now trended against patient satisfaction data on a monthly basis to identify any associations between these metrics. Conclusions & Implications: The use of the EHR outcomes data to accurately and reliably document pain assessment has been invaluable to inform and change practice. Sharing of these data across the organization has been effective in delineating areas of strength and opportunities for improvement. Results clearly indicate improved pain assessment. Our results demonstrate the process assists nurses to improve their compliance with the assessment of pain in children, which will ultimately decrease response time to pain intervention and enhancing the overall quality of pediatric pain management. Page 102
Paper Session E1: Nursing Research with Children, Adolescents and Families: Current Issues and Emerging Themes 17‐Year Outcome of Preterm Infants with Diverse Perinatal Morbidities Mary C Sullivan, PhD, RN, University of Rhode Island, Kingston, RI ~ Robin J Miller, PhD, RN, Women & Infants Hospital, Providence, RI ~ Michael E Msall, MD, University of Chicago, Chicago, IL ~ Suzy B Winchester, MA, Women & Infants Hospital, Providence, RI Purpose: Late adolescence is the link between what is learned in early adolescence and what happens in later health and development, thus making it a critical period. Adolescence may be particularly difficult for those born prematurely because impairments in cognition, learning, and neuropsychological processes are reported in follow‐up studies. The aim was to apply the International Classification of Functioning (ICF) to a diverse US cohort of preterm infants who were alive at age 17years. Theoretical Framework: The ICF model describes multifactorial components of health, functioning and participation as well as contextual factors. Method. We prospectively followed 180 infants classified into groups as full‐term and preterms who were healthy, or had medical, neurological or SGA perinatal morbidities. Standard measures completed in the research laboratory captured cognition, executive functioning, academic achievement, personal functioning, and social involvement with extracurricular activities. Multivariate ANOVA was used to test effects of perinatal morbidity and contextual factors of SES and gender on 17‐year outcomes. Results: Mean cognitive scores across all preterm groups exceeded 97 and were not different from full‐
term adolescents. SES substantially impacted cognitive outcomes with those of low SES scoring 17 points lower. In executive functioning, the neurologically ill preterm group was substantially challenged at age 17 years. Twenty percent of teens had repeated a grade, 19% received special educational accommodations, 6% received intense special education, and 2% had dropped out. Teens of high SES scored substantially higher in all area of academic achievement compared to low SES teens: math (25 points), reading (22 points), and spelling (17 points). Gender modified independent functioning with teen males scoring 12, 15, and 11 points lower respectively in social interaction, self‐care, and broad independence compared to females. Teen females had more extracurricular, community, and recreational participation compared to males. Conclusions & Implications: Across neonatal morbidities, male gender and social disadvantages are key determinants on adolescent cognitive, academic, and executive functioning after prematurity. Broad community interventions especially those addressing academic and social behavior in early school years have the potential to optimize long‐term outcome. (Supported by NIH NICHD 19195; NINR 03695) Page 103
Paper Session E1: Nursing Research with Children, Adolescents and Families: Current Issues and Emerging Themes A Partnership between Nurse Practitioner and High School Students to Assess Risk Factors for Diabetes in Children in the Community Terri H Lipman, PhD, CRNP, FAAN, University of Pennsylvania, Philadelphia, PA Janet Deatrick, PhD, RN, FAAN, University of Pennsylvania, Philadelphia, PA Purpose: The purpose of this four year University and community collaboration was to form a partnership to 1) screen growth and diabetes risk factors in children in an inner‐city community; 2) assess nutrition knowledge; 3) measure physical fitness; and 4) survey parents about barriers to healthy living. Background: The prevalence of obesity and type 2 diabetes in children is increasing and disproportionately effects children from minority and low socioeconomic backgrounds. Multiple interventions have been ineffective, in part, because they were not culturally relevant, nor did they consider environmental barriers. Theoretical Framework: Community Based Participatory Research Methods: Nurse practitioner students and high school students partnered to evaluate children in an after‐school program. The team assessed height, weight, waist circumference (WC) and the presence of acanthosis nigricans (AN); administered a nutrition knowledge test; and, taught children to prepare a healthy snack. Professional dancers led a dance class and children’s pre and post activity heart rates were obtained. Parents were surveyed about their children’s diet, physical activity and barriers to healthy living. Results: 233 children were evaluated (AA, 5‐13yr, x=9yr, 39% M). 33% of children had at least one of three diabetes risk factors (43% BMI > 85th%; 18% WC > 95%; 17% AN); 13% had all three risk factors. The average nutrition pre‐test score was 65%. In only 13% of children, heart rates returned to normal after rest following a dance activity. Parents reported that the greatest barriers to eating healthy were children’s refusal to eat healthy foods (62%); barriers to activity included lack of access to safe places to play (54%) and excessive screen time (31%). Conclusions and Implications: Children in this population had poor nutrition knowledge, were not fit, and 1/3 were at risk for diabetes. The key to effective interventions that target diabetes risk factors are those that are developed and executed collaboratively with the community, are culturally relevant, and focus on the barriers to healthy living that impact inner city populations. Page 104
Paper Session E1: Nursing Research with Children, Adolescents and Families: Current Issues and Emerging Themes Partnering with Parents of Technology Dependent Children: A Hybrid Concept Analysis Michele A Mendes, PhD, RN, CPN, William F. Connell School of Nursing, Boston College, Boston, MA Purpose/Background: The child health nursing literature frequently refers to the partnerships between nurses and the parents of acutely and chronically ill children. However the concept of partnering between nurses and clients lacks clarity, particularly as it applies to nurses working with parents of technology dependent children. Approach: The Hybrid Model of Concept Development (Schwartz‐Barcott & Kim, 2000) was used to combine a thorough review of the literature with fieldwork data to examine this concept. The theoretical phase of the project involved the review of relevant literature from nursing and other health professions, business and other related disciplines to develop a working definition of partnering. Fieldwork data from interviews with seven nurses and seven parents of technology dependent children were analyzed to examine the ways that parents and nurses partner to care for technology dependent children in the home. Major Findings: Nurses and parents described partnering as based on mutual respect and they reported reflection on and thoughtful planning for working together. Indirect and direct communication was used, and partnering consistently involved communication that was described as diplomatic. Participants acknowledged the importance of the parents’ control of their child’s care. Interestingly, their descriptions of nurses’ support for parents was very similar to the definitions of partnering found in dance terminology. Conclusions: The theoretical and fieldwork phases support the applicability of the concept of partnering to nursing and to the interactions between nurses and the parents of technology dependent children. The findings reveal both similarities and differences with the attributes of partnering found in concept analyses that focused on nurses partnering with adult patients. Further research is needed to explore the use of this concept in other areas of child health nursing practice. Page 105
Paper Session E1: Nursing Research with Children, Adolescents and Families: Current Issues and Emerging Themes Social‐Emotional Development of Teenagers who Experienced the Loss of their Mother: A Phenomenological Study Donna Hallas, PhD, PNP‐BC, CPNP, New York University College of Nursing, New York, NY Purpose: The purpose of this phenomenological investigation was to uncover the meaning of the loss of the mother‐daughter relationship on the social‐emotional development of adolescent girls who experienced the death of their mother in their adolescent years and to identify strategies to help adolescents with this loss. Background: Adolescent girls who experience the death of their mother suddenly loose the day to day encounters of the mother‐daughter relationship that most often characterizes their developing views on personal relationships, womanhood, and motherhood. Methods: Adult women who experienced the death of their mother during their preadolescent and adolescent years were participants in this study which examined how the loss of their mother affected their social and emotional development through their adolescent and adult years. During a one‐hour interview participants were asked to respond to questions which described their experiences with a focus on relationships and their experiences during their adolescent and young adult years after the death of their mother. Data were analyzed using Collazzi’s qualitative methodology. Consistent with Collazzi’s methodology for extracting significant statements, formulating meanings, and organizing clusters of themes, each interview was transcribed by the researcher and analyzed before another interview was scheduled. This process allowed the researcher to reflect upon and analyze data as it evolved throughout the study. Results: Major themes that emerged from these data were: ‘feelings of overwhelming loss and loneliness’; ‘unpleasant reminders, such as mother’s day’; ‘frozen in time’; ‘uncertainty about the ability to mother children’; ‘healing: knowing that she would be proud of my mothering ability’; ‘a personal sense of self’. Conclusions and Implications: Recommendations for nurses and other health care professionals to help adolescent girls who experience the loss of their mother during this critical period of social‐emotional development emerged from this phenomenological investigation and include: appropriate ways to communication with adolescents, young adults, and adults who have experienced this loss; strategies to encourage ‘moving forward’ with life experiences; and interventions to support their personal mothering experiences and abilities. Future studies in which these interventions are applied in clinical practice are recommended. Page 106
Paper Session E2: Promoting Health Across the Life Course: Focus on Special Populations Factors Associated with Exclusive Breastfeeding 2‐4 Weeks Following Discharge from a Large Urban Academic Medical Center Striving for Baby‐Friendly Designation Wendy C Budin, PhD, RN‐BC, FACCE, NYU Langone Medical Center, New York, NY Eileen DiFrisco, MA, RN, IBCLC, NYU Langone Medical Center, New York, NY Susan Gennaro, DSN, RN, FAAN, William F. Connell School of Nursing, Boston College, Boston, MA Karen Goodman, MA, RN, IBCLC, LCCE, NYU Langone Medical Center, New York, NY Barbara Holmes, BS, RD, IBCLC, CD(DONA); , NYU Langone Medical Center, New York, NY Aviva Kleinman, BS, BSN, RN‐BC, NYU Langone Medical Center, New York, NY Marge Lilienthal, MS, RN, NEA‐BC, NYU Langone Medical Center, New York, NY Background: Substantial evidence exists documenting the superiority of breastfeeding for mothers and breast milk for babies. Although the American Academy of Pediatrics and the US Healthy People 2010 initiative promote breastfeeding, current breastfeeding rates often fall short of recommendations. The care practices of the setting in which a woman gives birth may affect breastfeeding initiation and continuation. Positive breastfeeding outcomes have been reported at healthcare settings where a number of the “Ten Steps of the UNICEF‐WHO Baby Friendly Hospital Initiative (BFI)” are in place. Purpose: To determine factors associated with exclusive breastfeeding 2‐4 weeks following discharge from a large urban academic medical center striving for Baby‐Friendly recognition. Methods: A convenience sample of all mothers who were breastfeeding at discharge (either exclusively or a combination of breast/bottle) within a one month time frame were contacted by telephone or email 2‐4 weeks after discharge and invited to complete a survey containing items about their birth and early feeding experiences while in the hospital and after discharge. Mothers had the option of either responding to a telephone interview or completing the survey online using Survey Monkey. Response rates were comparable for the two methods with over 50 percent of the eligible mothers responding to the survey. Descriptive and inferential statistics were used to describe feeding behaviors and determine factors associated with exclusive breastfeeding 2‐4 weeks after discharge. Results: Data were collected from 113 mothers (mean age=34, SD=4.6). At 2‐4 weeks post‐discharge, 88% were still breastfeeding (60% exclusively). The strongest contributor to exclusive breastfeeding after discharge was breastfeeding within the 1st hour after birth. Mothers who reported breastfeeding within the 1st hour of birth (61%) were significantly more likely to be exclusively breastfeeding at 2‐4 weeks post‐discharge (chi square = 8.04, p = .005). This was true for mothers who had vaginal (61%) or cesarean births (38%). The main reason for supplementing and weaning was perception of not enough milk. Conclusions: Incorporating care practices that include elements of Baby‐Friendly (i.e. promoting breastfeeding within the first hour) may increase initiation and duration of exclusive breastfeeding after discharge. Page 107
Paper Session E2: Promoting Health Across the Life Course: Focus on Special Populations Predictors of Physical Inactivity in Men and Women with Type 2 Diabetes Margaret McKeever McCarthy, MS, FNP, BC, New York University, New York, NY ~ Deborah A Chyun, PhD, New York University, New York, NY ~ Janice A Davey, MSN, Yale University, New Haven, CT ~ Frans J Th Wackers, MD, PhD, Yale University, New Haven , CT Purpose: To examine and compare factors that predict physical inactivity in men and women with type 2 diabetes. Methods: A secondary analysis of data from a multi‐site screening trial, the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study. Men and women age 50 to 75 without a previous diagnosis of coronary artery disease (CAD) were followed over 5 years from 14 sites across the United States and Canada. Baseline assessment of sociodemographic, diabetes‐related and CAD risk factors was conducted. Physical activity (PA) levels (hours performed weekly) were assessed at 6 month intervals and were later dichotomized (none/any). Chi square and t‐tests followed by multivariate logistic regression were used to identify predictors of physical inactivity at 5 years. Results: The mean age of the subjects was 61 ± 6.6 years; 45% (n=441) were women and 14% (n=132) were Black. The average duration of diabetes was 8.4 ± 7.1 years with a mean HbA1C of 7.0 ± 1.5%; insulin was used by 22% (n=212). The mean hours of PA at baseline was 3.9 ± 5.3 hours. At baseline 24% (n=236) had no PA compared to 33% (n=318) at 5 years. In all 974 subjects, level of education (OR=0.91; 95% CI=0.87, 0.94), baseline level of PA (OR=3.3; 95% CI=2.37, 4.55), presence of peripheral neuropathy (PN) (OR=1.3; 95% CI=0.95, 1.71), HbA1C (OR=1.14; 95% CI=1.03, 1.25) and BMI (OR=1.05; 95% CI=1.02, 1.07) predicted physical inactivity at 5 years. In men, level of education (OR=0.93; 95% CI=0.88, 0.99), baseline level of PA (OR=3.56; 95% CI=2.28, 5.57), presence of PN (OR=1.54; 95% CI=1.02, 2.32), HbA1C (OR=1.17; 95% CI=1.02, 1.32), BMI (OR=1.06; 95% CI=1.02, 1.10), and level of HDL (OR=1.02; 95% CI=1.002, 1.03), were predictors of physical inactivity at 5 years. In women, level of education (OR=0.88; 95% CI= 0.82, 0.93), black ethnicity (OR=1.73; 95% CI= 1.01, 2.97), baseline level of physical activity (OR=3.38; 95% CI=2.08, 5.49), and waist circumference (OR=1.06; 95% CI=1.02, 1.09), were predictors of physical inactivity at 5 years. Conclusion: Over 5 years of follow‐up the prevalence of physical inactivity increased and differences were noted between men and women. Individuals at high‐risk of inactivity can be identified and efforts made to maintain activity levels. Page 108
Paper Session E2: Promoting Health Across the Life Course: Focus on Special Populations CARE Intervention for Depressed Mothers and Their Infants: Outcomes from the Randomized Clinical Trial June Andrews Horowitz, PhD, RN, PMH CNS‐BC, FAAN, Boston College, Wm. F. Connell School of Nursing, Milton, MA ~ Katherine Gregory, RN. PhD, Boston College, Wm. F. Connell School of Nursing, Chestnut Hill , MA ~ Christine Murphy, PhD, RN, Boston College, Wm. F. Connell School of Nursing, Chestnut Hill , MA ~ Joyce Pulcini, PhD, RN, CS, PNP, FAAN, Boston College, Wm. F. Connell School of Nursing, Chestnut Hill , MA ~ Joanne Wojcik, RN, MS PMH‐CNS, Boston College, Wm. F. Connell School of Nursing, Chestnut Hill , MA Purpose: To test the efficacy of the CARE intervention in increasing maternal‐infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum. Theoretical Framework: Postpartum depression (PPD) dysregulates maternal‐infant interaction thereby adversely affecting infants. The CARE intervention aimed to promote responsive interaction between depressed mothers and their infants by coaching mothers to interpret infants’ behavioral cues and respond sensitively and contingently. Methods: A diverse population of women was recruited from the obstetrical units of two hospitals and screened for PPD at 4 weeks postpartum. Women with scores > 9 on the Edinburgh Postnatal Depression scale (EPDS) who agreed were consented and received a diagnostic interview to confirm PPD. Eligible women were randomized to the treatment or control group for the randomized clinical trial (RCT). Data were collected during home visits at 6 weeks, and 3, 6 , 9 months; treatment mothers had additional visits at 2 and 4 months. Maternal infant interaction was videotaped and blind‐coded with the NCAST teaching scale. Results: Nurses screened 5,169 mothers; 13 % had positive PPD screens. Of those with positive screens, 125 mother/infant pairs completed all visits through the 9th month. Both treatment and control groups had significant increases in the quality of mother‐infant interaction (RANOVA: F. = 21.46; p < .001), and decreases in depression severity over time (p <.001). Conclusion and Implications; Efficacy of the CARE intervention was supported but not definitively. Notably, other studies have shown no improvement in mother‐infant interaction even when PPD severity improved. The presence of the nurse, empathic listening to mothers, focused attention paid to mothers in the videotape sessions and through symptom monitoring, assistance with referrals, and the self‐reflection involved in completing measures likely constituted an unintentional treatment for the control group. Intervention refinement and testing under varied conditions are warranted. Page 109
Paper Session E2: Promoting Health Across the Life Course: Focus on Special Populations Biomarkers of Inflammation May be Associated with Cognitive Function in Heart Failure Ponrathi Athilingam, PhD, RN, ACNP, University of Rochester, Rochester, NY ~ Leway Chen, MD, MPH, FACC, University of Rochester, Rochester, NY ~ Kathleen B King, PhD, RN, FAHA, FAAN, University of Rochester, Rochester, NY ~ Jan Moynihan, PhD, University of Rochester, Rochester, NY During the past half century, both the causes and treatment of heart failure (HF) have changed considerably; in addition to neurohormonal activation, biologically active molecules known as the cytokines are in the forefront of the research in HF to explain the progression of HF. However, it is unclear whether these cytokines are associated with cognitive dysfunction in patients with HF. A recent research indicated fourfold risk of having cognitive deficit (CD) among HF patients compared to general population. The purpose of this study was to examine the relationship between biomarkers of inflammation and cognitive function in HF. A cross sectional study enrolled 38 community dwelling adults aged 50 and above with HF. Thirty eight of these subjects were concurrently enrolled to have blood samples collected for cytokines (i.e., Tumor necrosis factor (TNF‐ ), Interleukin (IL6), and C‐
reactive protein (CRP). Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure cognitive function. Questionnaires to measure depression, co‐morbidity, disability, clinical and demographic data, and completed a six‐minute walk test. Cerebral perfusion pressure (CPP) using transcranial doppler and cardiac index (CI) using impedance cardiograph were also collected. Most participants were men (68%), Caucasian (79%), aged 50 to 89 (62 + 9 years), 62% were in NYHA class II, 38% in class III, 80% were in AHA/ACC stage C, 79% with ejection fraction <40%, and 98% were on an ACE or ARB. The MoCA identified 61% participants with mild cognitive impairment score <26 and 16% with moderate cognitive impairment score <22 with a mean score of 24.86 (SD + 2.81) compared to 2.2% on the MMSE with a mean score of 28.96 (SD + 1.9). Multiple regression analysis demonstrated no statistically significant association with cognitive function measured by MMSE and MoCA. Although not statistically significant, the cognitive function measured by MoCA was inversely related to TNF‐ , IL‐6, and CRP (r=0.24, p= 0.18). CRP and IL‐6 were highly related to each other with a Pearson r .791, p= 0.0001. An appropriately designed longitudinal study may have potential to demonstrate a significant relationship between cognitive function and biomarkers of inflammation. In turn, this may help in early recognition of cognitive dysfunction and in the design of an intervention to enhance cognitive function. Page 110
Paper Session E3: Innovative Models of Health Care Delivery: Recent Advances and Emerging Themes Hospital to Homecare Transitions: Patients, Informal Caregivers and Clinicians Perspectives Janice B. Foust, PhD, RN, University of Massachusetts‐Boston, MA Ernesto E. Henriquez, M.A., Center for Home Care Policy & Research, VNSNY, New York, NY Nancy H. Vuckovic, PhD, Intel Corporation, Beaverton, OR Purpose The transition from hospital to home is a vulnerable and stressful time, as patients resume care for themselves with the much‐needed help of their informal caregivers and homecare clinicians. This exploratory study describes the multiple perspectives of a diverse sample of patients, their informal caregivers and home health clinicians about the hospital discharge experience. Background The concerns of patients and informal caregivers as they abruptly assume responsibility for the patient’s health are poorly understood, especially within the context of diverse levels of support, knowledge and resources. Few, if any, studies have included homecare clinicians’ views about this vulnerable transition. Methods A purposive sample of New York City area homecare patients and their informal caregivers were interviewed during the first 6 weeks following hospital discharge. Qualitative interviews elicited views of discharge instructions and the discharge process from the hospital. Interviews were also conducted with nurses and physical therapists of a large, urban home health agency to explore their perspectives. Results Study participants were 40 patients, 35 informal caregivers and 15 homecare clinicians. A majority of the patient sample was female (72.5%) with a mean age of 64.8 (SD 14.7 years). Patients were identified as Black (45%), White (25%), Hispanic (7.5%) or unknown (22.5%). Informal caregivers included family, friends or neighbors. Homecare clinicians had a mean of 9.1 years of work experience (SD 7.5 years). Key findings include patients’ vague recall of details about their discharge instructions (e.g. medications, activity and follow‐up actions). Informal caregivers experienced gaps in communication when not present during discharge. Homecare clinicians were pivotal in finding, and interpreting discharge instructions to make them more useful for the patient and informal caregivers. Conclusions & Implication More effort is needed to include and prepare informal caregivers in the discharge process to ensure better understanding of discharge instructions. Clearer instructions are also needed to make them more useful and effective for the patient, informal caregiver, and facilitate implementation of the care plan at home. Home health care organizations are strategically placed to assure better transitions to avoid poor patient outcomes. Page 111
Paper Session E3: Innovative Models of Health Care Delivery: Recent Advances and Emerging Themes Multicomponent Home Care Intervention for Heart Failure Patients: An Academic/Clinical Partnership Colleen Delaney, PhD, RN, AHN‐BC, University of Connecticut, Woodbury, CT Richard Fortinsky, PhD, University of Connecticut Health Center, Center on Aging, Farmington, CT Purpose: The primary aim of this pilot study was to develop, implement, and test the initial acceptability and preliminary efficacy of a nurse‐directed multicomponent home care intervention termed the “Home care Education, Assessment, Remote‐monitoring, and Therapeutic activities” (HEART) intervention on health‐related outcomes in persons with Heart Failure (HF). Theoretical Framework: The Self‐Care for Health Promotion in Aging (S‐CHPA) model by Leenerts, Teel, & Pendleton provided the basis for the development of an intervention focused on promoting health among community‐dwelling elders with HF. Methods (Design, Sample, Setting, Measures, Analysis): A quasi‐experimental research design was used for the study. A convenience sample of 24 patients with a primary diagnosis of HF were assigned to the intervention (n = 12) or control group (n = 12) according to geographical location in a large multi‐branch Medicare‐certified home health agency. Intervention group patients received eight structured nurse education visits using evidence‐based protocols designed in previous trials to teach HF self‐management and to prevent/reduce depression, as well as a telemonitoring system. Control group patients received usual care and telemonitoring. Quality of Life (QOL) was assessed using the Minnesota Living with Heart Failure questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire‐9 at baseline and 90‐day study endpoint. Hospitalization was evaluated by calculating incidence rates. Results: Patients participating in the HEART intervention demonstrated significantly improved QOL (F = 4.96, p = .04) and significantly reduced depressive symptoms ((F = 4.33, p = .05) in comparison to control group patients’ at the study endpoint. There was a trend toward lower hospital readmission rates in the intervention group (16% vs. 25%) but this was not statistically significant. Conclusion: The nurse‐directed HEART intervention can improve QOL, reduce depression, and holds promise in reducing hospital readmissions. Page 112
Paper Session E3: Innovative Models of Health Care Delivery: Recent Advances and Emerging Themes A Concept Analysis of Home and Its Meaning in the Lives of Three Older Women Catharina Gillsjö, PhD(c), FNP, RN, University of Skövde, Sweden, Töreboda, Västra Götaland ~ Donna Schwartz‐Barcott, PhD, RN, Professor, University of Rhode Island, College of Nursing, West Greenwich, RI Purpose: Develop a scientific concept of home from the literature and its meaning in the lives of three older women. Background: For many older adults home is the center of daily life, an increasingly important place where health care is delivered, illness managed and well‐being sought. Yet, this very common concept whose meaning seems so obvious, remains theoretically and empirically underdeveloped. Methods: The Hybrid Model of Concept Development, which interfaces theoretical analysis and empirical observation, was used to develop a definition of home as a scientific concept for nursing research. This entailed a comprehensive, interdisciplinary literature review (including manual and computer searches of Proquest, Web of Science, PsychINFO, PubMed and Cinahl), semi‐structured interviews with three older women in their residences in rural Sweden, and case and cross‐case analyses. Results: Interviewees spoke of childhood, community, residential, church and heavenly homes. Feelings of comfort and security were associated with residential homes, peace and quiet with church homes, safety and pleasure with heavenly homes. The experience of home as being taken for granted, unselfconscious and unrecognized, became obvious when one woman tried to consciously establish a sense of being at home in her new residence. The final definition of home included three major components (place, relationship, experience). Home is a place to which one is attached, feels comfortable and secure and has the experience of dwelling. Conclusion: Every day assumptions about the meaning of home and home as just another health care delivery site are called into question. Discussions in medical geography of home as a therapeutic landscape with potential for positively or negatively impacting on recovery further supports the need and urgency for developing home as a scientific concept. Research needs to explore the impact of home care on the older adult´s meaning of home and its potential impact on recovery. Page 113
Paper Session E3: Innovative Models of Health Care Delivery: Recent Advances and Emerging Themes Assessing the Cost‐effectiveness of a Preconception Counseling Program for Teens with Diabetes: READY‐Girls Andrea F. Rodgers Fischl, PhD, MPH, CRNP, University of Pittsburgh, Sewickley, PA ~ Denise Charron‐
Prochownik, PhD, CPNP, FAAN, University of Pittsburgh, Pittsburgh, PA ~ William H. Herman, MD, MPH, University of Michigan, Ann Arbor, MI ~ Susan M Sereika, PhD, University of Pittsburgh, Pittsburgh, PA Purpose: The American Diabetes Association recommends preconception counseling (PC) for all women with diabetes starting at puberty. We developed an evidence‐based computer‐delivered PC program for teens called READY‐Girls (Reproductive‐health Education and Awareness of Diabetes in Youth for Girls) targeted to teen girls. There is a lack of information on the economic benefits and clinical translational costs of such programs. Therefore, we prospectively assessed the cost‐effectiveness of READY‐Girls. Theoretical Framework: Cost‐effectiveness theory. Methods: In a prospective trial, 88 adolescent girls with T1D from 2 clinical sites were randomized into an intervention (IG) group that received a CD‐ROM and book on PC or standard care (SC) group. The time to implement the intervention (resource utilization), cost (direct medical cost of the intervention) and outcomes (unplanned pregnancy) were assessed prospectively. We modeled the balance between the costs of the intervention and savings from averting adverse reproductive outcomes. For the time (resource utilization) component, descriptive analyses for the mean, median, interquartile range, and range of the nurses’ set‐up‐time, training time, and nurse counseling time for the IG group were generated. For both groups, we then calculated the incremental cost of the intervention by comparing the calculated differences in nurse time between the IG and SC groups and applying hourly cost to nurse’s time. We translated measured clinical outcomes, i.e. unintended pregnancies, by age groups for the long‐term cost‐benefit analysis. Results: The READY‐Girls program did not increase clinic time compared to the SC group. Total nurse time for the intervention was one hour. We found the direct medical costs of READY‐Girls to be low ($18 per participant), while the costs of adverse reproductive outcomes to be high ($28,000 for one unplanned pregnancy). CONCLUSION & IMPLICATIONS: If effective in preventing one unplanned pregnancy in participants, the READY‐Girls program is cost‐saving adding little time burden and cost to the teen’s diabetes management. Page 114
Paper Session E4: Methods and Meadues in Nursing Research: Recent Innovative Advances Impact of a Campus Campaign on College Students’ Environmental Literacy and Locus of Control Veronica D Feeg, PhD, RN, FAAN, Molloy College, Rockville Centre, NY ~ Deborah Upton, PhD, Molloy College, Rockville Centre, NY ~ Susan A Vitale, PhD, ANP, PNP‐C, Molloy College, Rockville Centre, NY Purpose: Most scientists agree that the Earth’s climate has changed, although significant debate exists related to how much or what we can do to alter the future. Whether or not nurses as environmental/earth advocates can intervene is predicated on whether or not we can impact the public’s level of environmental literacy and their beliefs that they can act on behalf of the health of the Earth, i.e., their “Earth /Health Locus of Control.” The purpose of this study was to assess the impact of nursing involvement in a campus campaign on the knowledge and beliefs about the health of the environment. Theoretical Framework: Based on the concepts of health locus of control, the study was designed to measure college students’ beliefs about the problem and the extent they can have any effect on the future of the environment. Methods: Using the dimensions of internal (IHLC), chance (CHLC) and powerful other (PHLC) health locus of control, this pre‐post project focused on public awareness and advocacy to assess change in knowledge and behavior following a week‐long campus campaign during “Earth Week” with significant nursing involvement. All student (n=530) responses to an emailed web‐link survey on their (a) knowledge about global climate change and the environment; and (b) beliefs about their ability to influence the problem were compared to a follow‐up survey (n=114) at the end of the semester. Results: Analysis of variance findings indicated that the campaign significantly changed the students’ IHLC scores (F=3.78, p<.05) and their knowledge (F=5.00, p<.01). There were significant differences in graduate student beliefs about chance (CHLC) (F=3.67, p<.05). Conclusions/Implications: Environmental literacy is an important goal for public health and nurses play a significant role in teaching about the health of the earth. This study suggests that beliefs can be changed to improve the quality of the environment. Page 115
Paper Session E4: Methods and Meadues in Nursing Research: Recent Innovative Advances Quality Assurance Assessment of Intervention Delivery Karen Wickersham, BSN, RN, University of Pittsburgh, Pittsburgh, PA Judith A. Erlen, PhD, RN, FAAN, University of Pittsburgh, Pittsburgh, PA Purpose: Behavioral intervention effectiveness in randomized controlled trials requires fidelity to the protocol. This study describes the quality assurance (QA) assessment of fidelity to the structured intervention protocol in an examination of nurse‐delivered telephone intervention designed to improve medication adherence. Theoretical Framework: The intervention was guided by social cognitive theory. Quality assurance methods were guided by the literature. Methods: Four nurse interventionists received extensive training prior to delivering the intervention to persons with HIV/AIDS taking anti‐retroviral therapy. Subject consent was obtained prior to the audio‐
taping of each session. QA assessment included the random selection and review of 10% of the audio‐
recorded sessions in the intervention, stratified by interventionist and intervention session. Audiotapes were reviewed, with field notes available, for completeness of intervention delivery including Percentage of Agreement (POA) addressing whether key components were covered at the randomly selected sessions. Visual analog scales were used to provide of summary scores (0 low‐5 high) of interaction characteristics of the interventionists and participants with respect to engagement, demeanor, listening skills, attentiveness, and openness during the intervention session. Results: Four nurse interventionists who held a minimum of a baccalaureate degree delivered 871 structured intervention sessions to 105 participants. Three trained graduate student researchers assessed 87 sessions. The mean POA was 92.0% (range 81.9%‐96.6%) meeting our criteria of 90% congruence with the intervention protocol. The mean interventionist interaction summary score was 4.3±0.9 and the mean participant interaction summary score was 3.9±1.1. Conclusions & Implications: Overall the interventionists successfully delivered the structured intervention with some variability in the quality of interventionist‐participant interaction. Monitoring of study implementation is critical; ongoing QA is necessary to ensure fidelity to study protocol and study results are reliable. Future directions may include assessment of significant differences between nurse and participant interactions or examine potential demographic predictors of intervention completeness. Page 116
Paper Session E4: Methods and Meadues in Nursing Research: Recent Innovative Advances Measuring Patient‐Provider Trust in a Primary Care Population: Further Support for the Health Care Relationship (HCR) Trust Scale Carol Bova, PhD, RN, ANP, University of Massachusetts ‐ Worcester, Worcester, MA ~ Walter Ettinger, MD, University of Massachusetts ‐ Memorial, Worcester, MA ~ Kristopher Fennie, PhD, MPH, Yale University School of Nursing, New Haven, CT ~ Gertrude Manchester, MD, University of Massachusetts ‐ Memorial, Worcester, MA ~ Paulette Seymour Route, PhD, RN, University of Massachusetts ‐ Worcester, Worcester, MA ~ Bruce Weinstein, MD, University of Massachusetts ‐ Memorial, Worcester, MA Purpose: The purpose of this study was to extend the previous work on the Health Care Relationship (HCR) Trust Scale by examining the psychometric properties in a random sample of primary care patients. Methods: This survey study used a modified version of the Dillman tailored design method (4 mailed contacts). Research participants were recruited by mail from an urban adult primary care clinic. A pilot study was conducted first (N = 30) and then 1,000 adults (age > 18) were randomly selected to receive the mailed survey from a population of 15,503 patients who attended the clinic between March 2007 and March 2008. The survey included demographics, clinical history, the HCR Trust Scale, The Mental Health Inventory, and the Marlow‐Crowne Short Form. Results: 431 participants returned surveys (43% response rate). The majority of respondents were female (60.1%), white (87.5%), married (56.4%), cared for by an attending MD (87.7%) and had at least one chronic health condition (69.4%). The mean age of the participants was 55.6 years (range = 19‐100). Factor analysis resulted in a single‐factor structure (explained 67% of the variance in trust). Two items were eliminated; resulting in a final 13‐item scale (HCR Trust Scale‐R). The Cronbach’s alpha for the HCR Trust Scale‐R was .96 for the entire sample and reMNd high (>.91) for all age groups, including adults over age 70. Greater trust was evident for participants who were older and had better mental health. Hispanics had significantly lower trust scores. No differences were found by gender or by the presence or number of health conditions. Trust scores did not correlate with the social desirability scale (r = .096, p =.06). Conclusion: Results of this study provide further evidence for the reliability and validity of the 13‐item HCR Trust Scale‐R for use with adult primary care patients of all ages. Page 117
Symposium E5: Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA This symposium presents Qualitative Event Analysis (QEA) as an emerging method in nursing research, and discusses novel adaptations that have enhanced its ability to address complex clinical situations. Nurse scholars will be introduced to QEA with an overview and illustrations from three studies in recent clinical research that represent cutting‐edge adaptations to its traditional application. The first presentation will describe traditional QEA using exemplars from a program of clinical research and will introduce three advancements to the method that have not been previously described. The second presentation will discuss a unique process of finding and defining events within QEA using a study of palliative care in the nursing home. The third presentation will address reframing secondary data using a QEA approach to examine events of agitation and anxiety among critically ill patients. The fourth presentation will describe the application of QEA techniques as a foundation for quantitative measurement of a structured event using research on nurse‐patient communication in the ICU. Finally, discussant commentary and group discussion aims to compare the application of QEA in each of the papers and to address overall methodologic development and challenges. The research examples illustrate the potential of QEA to address difficult clinical questions, ultimately advancing nursing science and improving quality of care in a wide variety of populations and settings. Page 118
Symposium E5: Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Discovering and Defining Events in Qualitative Event Analysis (QEA) Rebecca Trotta, MSN, RN, University of Pennsylvania School of Nursing, Philadelphia, PA Purpose: This paper describes the adaptation of QEA in the discovery and definition of critical events in a study of palliative care (PC) in the nursing home. Background: QEA is a data collection strategy that incorporates observation of an event, interviews, and document review. QEA has been used in studies where events are of a singular type and are predetermined. QEA was selected for the exemplar study for its utility in facilitating focus on critical events, yet required adaptation for two reasons. First, a variety of types of events were expected. Second, the flexibility for critical events to emerge based on individual resident experiences and theoretical conceptualization of quality of death was necessary. Method: The exact modification methods of QEA were not pre‐determined at the outset of this study. By spending time in the research setting and working closely with a QEA expert, the researcher developed key strategies for discovery of critical events. Theoretical conceptualization of quality of death within the context of PC guided definition of events for analysis. Results: Initially, the researcher simply spent time with residents, resulting in discovery and subsequent definition of regularly occurring events. These included feeding of meals and hygiene care. As discovery strategies advanced, spontaneously occurring events emerged, such as episodes of pain, hypoglycemia, and pneumonia. Conclusions: QEA was successfully adapted to facilitate discovery and definition of theoretically emergent events of various types. QEA was useful in providing focus and structure for the most pertinent clinical events in situations that otherwise lack such boundaries. This paper demonstrates that in addition to traditional applications, QEA has utility when applied to a phenomenon comprised of varying events, not all of which can be prospectively anticipated. Page 119
Symposium E5: Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Measuring the Nurse‐Patient Communication Event in the ICU: Contribution of Qualtative Event Analysis Techniques Jill Radtke, BSN, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA Grace Campbell, BSN, MSW, CRRN, CBIS, University of Pittsburgh School of Nursing, Pittsburgh, PA Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA Purpose: To describe the role of qualitative event analysis (QEA) in the measurement of communication between nurses and non‐speaking patients in the ICU and associated measurement considerations. Background: Applications of QEA in nursing research incorporate descriptions of persons, setting, connected events, conversation and behaviors during the target event. By combining observations from multiple data sources, QEA becomes particularly suitable for the analysis of complex nursing phenomena, such as nurse‐patient communication in the ICU. Methods: We describe how QEA techniques were utilized with a structured observation guide, videorecording, qualitative fieldnotes, medical record data, and discussion among coders to develop and refine observational tools to measure the nurse‐patient communication event in the ICU. Results: QEA provided the basis for structured observation of the nurse‐patient communication event. Challenges are reported from our experiences in measuring nurse talk time and symptom communication. Specifically, boundaries of the nurse‐patient communication event can be unclear. Measurement uncertainty exists in initiation, turn‐taking, and nurse‐patient waiting/deciphering behaviors. Additionally, there is a lack consensus on classification of non‐verbal communication and unilateral communication behaviors, such as self‐talk. Finally, when studying symptom communication within the nurse‐patient communication event, we discovered multiple meanings of symptom descriptors, umbrella/catch‐all terms, discrepancies between nurse documentation and observed symptom communication, and differential interpretation of non‐verbal communication, all of which were problematic in achieving inter‐rater reliability. Additionally, nurse symptom observations are difficult to judge without the nurse expressing her thought processes aloud. Conclusions & Implications: QEA techniques have been useful in the development of structured observational tools to measure nurse‐patient communication in the ICU. However, in order to achieve adequate validity and reliability with these tools, detailed documentation of methods and continued dialogue among experts is necessary. Funding: Study of Patient‐Nurse Effectiveness with Assisted Communication Strategies (SPEACS) (5R01‐HD043988) and Symptom Management, Patient‐Caregiver Communication, and Outcomes in ICU (K24‐NR010244). Page 120
Symposium E5: Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Qualitative Event Analysis Using Qualitative Secondary Analysis Judith Tate, MSN, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA Annette DeVito Dabbs, PhD, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA Purpose: This paper illustrates the adaptation of Qualitative Event Analysis (QEA) for use with Qualitative Secondary Analysis (QSA). Background: Traditionally, QEA has been used for studies employing primary observational data. However, QEA can be employed with existing datasets to explicate details of important events revealed yet not fully analyzed. To apply QEA to an existing dataset, target events should appear with sufficient frequency in the dataset, occur within a pre‐defined time frame and contain important components of the primary phenomenon investigated in the original study. Considerations for the appropriate application of QEA as a secondary data analysis strategy include methodologic congruency, data adequacy and relevance, contextual gaps, and the relationship of the secondary investigator to the primary dataset. Methods: This QSA study utilized an existing dataset obtained from a micro‐level ethnography of weaning from long term mechanical ventilation in which anxiety and agitation were discovered as important experiences of patients’ critical illness trajectory. Review of the primary dataset indicated that the original data were sufficient and related to the purpose and aims of the QSA seeking to describe clinician assessment and management of anxiety and agitation events during critical illness. Descriptions of events of anxiety or agitation were explored using data from sustained observation, longitudinal case description, clinical record review, and semi‐structured interviews with patients, ICU clinicians, and family members of patients weaning from LTMV. Results: After careful review of the primary dataset for appropriateness, QEA was adapted successfully for use with qualitative secondary data. Conclusions: This example of applying event analysis for QSA is unique in the use of a qualitative dataset to comprehensively describe psychological symptoms, behavioral signs, symptom interpretations and interventions undertaken by the clinicians to address anxiety and agitation. Considerations and recommendations when using secondary QSA data for QEA are described. Page 121
Symposium E5: Qualitative Event Analysis: Introduction and Methodological Adaptations in Clinical Research Qualitative Event Analysis: Introduction and Use in Clinical Research Mary Beth Happ, PhD, RN, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA Purpose: This paper presents a definition and overview of Qualitative Event Analysis (QEA). Its use and adaptation for patient‐oriented research will be described using exemplars from an ongoing program of nursing research in a complex clinical setting. Subsequent examples of studies using QEA will be briefly described to demonstrate the breadth and flexibility of this evolving method. Background: QEA is a qualitative research technique originating in anthropology and sociology. It is used to describe and explain social interactions and behaviors associated with an important occasion (event). QEA is a flexible, multi‐modal observational technique useful in limiting the focus of data collection, particularly in complex situations or environments. QEA serves the dual purpose of providing detailed description and explanation of an event of interest and providing insight into social interaction, norms, roles, and power structure within a target group or culture. The origins, main features, and nursing research adaptations of QEA, including new and evolving forms of QEA are presented to demonstrate the potential of QEA in addressing complex research questions. The use of mixed methods approaches within or in combination with QEA is also discussed. Although QEA has been used in nursing research for over 20 years, recent applications of QEA represent exciting methodological advancements that have not previously been described. Method: Methodological overview of QEA with contemporary research exemplars. Results: Exemplars from a study of care and communication during weaning from prolonged mechanical ventilation (R01‐NR07973) illustrate the identification of sub‐events of significance (e.g., psycho‐
behavioral events, bathing events) during QEA of ventilator weaning, which evolve into mixed methods questions and analyses. Finally, topics for the subsequent papers in this symposium are introduced as examples of methodological advancements in QEA and mixed methods research. Implications: QEA is advantageous in interpretive work and is an adaptable and evolving technique broadly useful in descriptive, exploratory clinical nursing research. Funding: National Institute for Nursing Research, Mid‐
Career Development Award K24‐ NR010244. Page 122
Paper Session F1: Qualitative Approaches and Nursing Research The Lived Experience of the Living Liver Donor: A Phenomenological Study Frances White, MS, RN, Lahey Clinic, Winchester, MA With an increased demand for a very limited number of cadaver livers available for transplantation, many patients are now depending on “living donors”. Adult‐to‐adult living donor liver transplantation (AALDLT) is becoming increasingly more accepted as an additional and alternative source of liver grafts. For many of these “living donors”, this is their first experience undergoing surgery, or even being hospitalized. Nurses have an important role assisting these patients with the physical and emotional issues surrounding the surgery. The purpose of this research was to understand a person’s experience of being a living liver donor so that nurses can assist these patients with the many physical and emotional issues which encompass the entire transplant process, from the decision to donate through the post operative course. Through this study the lived experience of the liver “living donor” was described through the entire partial liver transplant process. Institutional Review Board approval was obtained from an academic institution and a medical center in the United States. A purposive sample of 5 living donors was interviewed on an individual face‐to‐face basis; three in the home environment and two at the medical center. Participants were between four and twelve months post donation. Interviews were audio‐taped and then transcribed verbatim. Using Colaizzi’s method of data analysis, the transcriptions were analyzed and significant themes were extracted. The results revealed that the decision to donate was related to the donor’s concern for the recipient as another human being in need. Before and after the surgery, the donors had a sense that they were doing “the right thing.” Although all participants described physical challenges; none indicated regret with their decision. The themes which emanated throughout the study were: the decision to donate, the need for good support systems and dealing with unexpected issues such as exhaustion, pain and edema. In conclusion, this study reinforced the importance of educating patients about the donation experience, providing support throughout the process and incorporating Swanson’s “Five Caring Processes” of knowing, being with, doing for, enabling and maintaining belief into the care we as nurses offer our patients. Page 123
Paper Session F1: Qualitative Approaches and Nursing Research Making the Right Decision: Parents' Making Decisions for Their Children with Cancer Janet L Stewart, PhD, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA Katherine P Kelly, PhD, RN, Children's National Medical Center, Washington, DC Kimberly Pyke‐Grimm, MN, RN, Rady Children’s Hospital‐San Diego, CA Purpose: The purpose of this study was to describe the process of making major treatment decisions from the perspectives of parents of children with cancer. Background: One of the most significant challenges faced by parents of children with cancer is making major decisions with life‐altering outcomes. Although the medical decision making literature strongly suggests that participating in such decisions could have significant consequences for parents and families, these studies do not adequately address the unique perspective of parents. Methods: Grounded theory methods directed sampling and analytic decisions. We asked 15 parents of 13 children to reflect on a recent major decision related to their child's cancer, consider what factors influenced the role they assumed, and what impact participating had on themselves and their family. We collaboratively established codes, identified emerging themes, and refined data gathering techniques, with weekly conference calls and 5 face‐to‐face meetings during the study period. Analysis began following the completion of the first interview and continued simultaneously with data collection. Results: The decision making process was defined by parents’ imperative to make the right decision for their child, which they viewed as an extension of their parental responsibilities and intimate relationship with their child. This painstaking process required hard work, diligence, effective communication, self‐
examination, and heightened vigilance. In the face of inevitable uncertainty and limited evidence for the best course to follow, parents employed familiar as well as novel decision making skills. The primary impact on parents and families was intensification of the emotional toll of having a child with cancer, reflected in the interplay between conviction and lingering doubts that they had made the right decision. Conclusions & Implications: Our findings confirm that decision making is an emotionally demanding aspect of parenting a child with cancer. We plan to use these findings to develop and test the effects of a parental TDM support intervention. Page 124
Paper Session F1: Qualitative Approaches and Nursing Research Tradition Fulfillment and Families of Children who are Maternally Bereaved Margaret P Shepard, PhD, RN, Molloy College, Rockville Center, NY Margaret M Mahon, PhD, RN, FAAN, Mason University, Fairfax,, VA Laura Munts, JD, Mommys Light Lives On, Exton, PA Purpose: This report is to describe family bereavement experiences when a child is maternally bereaved. A second purpose is to report on our experience mining community based survey data and strategies used to strengthen reliability and validity. Background: The purpose of bereavement is not to “get over” a death, but to maintain attachment to internalized memories of the deceased (Worden, 2001). Contextual family processes such as parent functioning and communication mediate children’s bereavement, thus, there is initial support for a concept of family bereavement. Mommy’s Light is a private foundation that provides annual “tradition fulfillment,” as mechanisms to maintain memories of Mom thereby facilitating healthy bereavement. Traditions are often simple experiences (e.g. planting flowers, preparing a special meal) for maternally bereaved children 3‐18 years. We found no evidence in the literature for similar interventions; therefore, we planned systematic mixed methods evaluations of currently existing data to evaluate the efficacy of tradition fulfillment. Method: The sample included 169 demographically diverse families. Qualitative analyses were part of a larger investigation using seven data sources collected over 10 + years. Mixed data sources reduced incidences of omissions due to errors in data collection and transcription. Two child/family experts, one with expertise in child bereavement, conducted the content analyses; we achieved saturation, and confirmed findings with foundation personnel and follow‐up interviews with bereaved families. Results: Analyses of these data revealed that maternally bereaved children experienced sadness, isolation, and prolonged grief; bereavement adaptation was woven into the normal tasks of child development. These results confirmed findings of Mahon & Page (1995). Children described parental unawareness of their grief, at times because children masked their feelings. Some adults were not aware of their children's grief revealing compounded sources of the children’s isolation. Conclusion: Children were more likely to experience healthy bereavement over time when there was evidence of open communication specifically about Mom, and a shared worldview about the loss. Analysis of existing data yields constituent support for a concept of family bereavement and for further research to support children’s bereavement. The foundation plans to reduce incidences of missing data and errors in coding for future collection. Page 125
Paper Session F2: Nursing Research and Evidence‐Based Practice The Development of a Family Visitation Practice Guideline for the Post Anesthesia Care Unit Kathleen DeLeskey, DNP, RN, Lawrence Memorial/Regis College School of Nursing, Burlington, MA Purpose: A review of the literature revealed an apparent disconnect between practice and research findings related to family visitation in the post anesthesia care unit (PACU). There are no current practice guidelines for family visitation in the PACU. With no guidance or practice recommendations, visitation is inconsistent and can change within the same institution depending upon the nurse caring for the patient. Patient anxiety remains high and satisfaction decreases among families and patients that are not permitted to see one another immediately following surgery. As the number of patients in PACUs continues to grow, and the IOM mandate of respecting patients’ values and preferences looms, the issue of family visitation is even more critical. In a changing health care system that requires evidence based practice, the controversial subject of whether family visits should be permitted in the PACU remains anecdotal. A definitive evidence based practice guideline for family visitation will provide solid evidence and guide practitioners when they make the decisions to allow families into the PACU. Methods: A comprehensive systematic review of the literature on family visitation for critically ill patients was undertaken to discover the evidence for a visitation guideline. Twenty‐five studies met the criteria for inclusion. The findings from the literature were synthesized for the extraction of critical themes to direct the guideline. Literature on guideline development was then reviewed to identify the recommended criteria. The guideline was created using research findings from patient and family preferences, authoritative opinion, and recommendations from expert guideline developers. Results: The guideline for family visitation in the PACU recommends visitation whenever possible recognizing that nurses need support to manage patient and family needs. Flexibility allows the guideline to be used for different populations and various settings. Frequent evaluation of impact and outcomes of using the guideline are proposed. Conclusions & Implications: Patients and families prefer and experience increased satisfaction when visitation is permitted. An evidence based guideline will provide guidance and consistency for family visitation in the PACU. Page 126
Paper Session F2: Nursing Research and Evidence‐Based Practice Outcomes of Translating an Evidence‐Based, Patient‐Centered Protocol for Nurses Shift Handoffs in a Magnet Community Hospital Marlene A Dufault, PhD, RN, University of Rhode Island College of Nursing & Newport, Narragansett, RI ~ Cathy Duquette, PhD, RN, CPHQ, NEA‐BC, Newport Hospital, Newport , RI ~ Jeanne Ehmann, MS, RN, CPHQ, Newport Hospital, Newport, RI ~ Rose Hehl, BS, RN, Newport Hospital and University of Rhode Island, Newport, RI ~ Mary Lavin, MS, RNP, University of Rhode Island, College of Nursing, Kingston, RI ~ Mary Ann Moore, BS, RN, Newport Hospital, Newport, RI ~ Patricia Stout, MS, RNP, College of Nursing, University of RI, Kingston, RI ~ Cynthia Willey‐Temkin, PhD, College of Pharmacy, University of Rhode Island, Kingston, RI Purpose: With ineffective communication being the most frequently reported cause of sentinel events in hospitals, this study's purpose was to test an evidence‐based, patient‐centered protocol for nurses' end‐of‐shift “handoff” reports. Theoretical Framework: Guided by Roger's "adoption of innovations" theory, a "translating‐research‐
into‐practice" model (Collaborative Research Utilization Model) was used with Orlando's theory providing rational for the specific protocol. Methods: Repeated‐measures design was used to evaluate short and long term outcomes of cost & feasibility, nurse uptake, N=86, and effectiveness in improving patient (N=180) and nurse satisfaction (N=86) in a 148‐bed Magnet‐designated urban community hospital. A Best Practice Audit Instrument, Nurse Satisfaction Survey (NDNQI), Press‐Ganey Survey, and Satisfaction with SBARP Surveys were used to evaluate outcome variables along a 5‐point implementation trajectory. Data were analyzed using descriptive univariate statistics, change score transformations, and Fisher's exact test ( p<.05). Results: No significant changes in time nor length of interruptions, wait time, or social conversations occurred during handoffs from pre to posttest 1 (3‐months). Significant changes included: (1) Decreased number and cost of interruptions during handoffs from pre to posttest 1; (2) Improvement to 100% adherence with 80% of protocol criteria 1‐year post‐implementation; (3) Improvements in nurse satisfaction with adequacy of report time, handoff providing pertinent information, patient's condition matching report, shift‐to‐shift interpersonal relationships; (4) NDNQI scores on RN‐to‐RN interactions improved from moderate to high satisfaction at baseline, years 1 and 2; (5) Improvement in patient satisfaction from baseline to three months, to 1 year, to 2 years post‐implementation on variables of staff concern for privacy, pain control, patients included in decisions, perceived safety and security, and staff cohesion. Conclusions/Implications: Study incorporates directions established by AHRQ, TJC, and the National Quality Forum to create meaningful and sustainable clinician change to reduce missing or incorrect communication of patient information, and omissions of relevant care. Need for further study in a multi‐
site RCT. Page 127
Paper Session F2: Nursing Research and Evidence‐Based Practice A Compass for Caring: The Essence and Experience of an Integrative Metaparadigm of Nursing Olga Jarrín, MS, RN, PhD(c), University of Connecticut, Windham, CT Purpose: This presentation is framed by the question; how can an integrative metatheory of nursing be utilized to frame the development and use of evidence‐based practice in nursing? Background: The focus on evidence‐based practice and midrange theory have displaced much of the attention previously given to grand theories and conceptual models of nursing; contributing to further devaluing of alternate ways of knowing and blurring of the boundary between nursing and medicine. Approach: Through philosophical inquiry research, the major conceptual models of nursing are translated through the lens of contemporary, integral philosophy to create a comprehensive and unifying metaparadigm of nursing. Major Points & Rationale: Nursing is situated caring; influenced by the internal and external environments of both the nurse and patient/client. These environments include a) the individual’s state of mind, intention, and personal beliefs about nursing; b) their level of relevant skill, training, and experience; c) societal and professional norms, values, and worldview; and d) the practice environment, embedded in social, political, and economic systems. Nursing impacts the health of individuals, families, groups and populations through situated caring. Because of the integral (unitary) nature of individuals, families, groups and populations ‐ physical, mental or spiritual aspects of health may be impacted by care (or lack of care) in any dimension of their experience. For example, physical health may be impacted by psychological, spiritual, environmental, social or cultural conditions or events. Conclusions: An integrative understanding of nursing theory provides a holistic framework for the development and utilization of evidence‐based practice, orienting nurses toward compassionate action in complex situations. Page 128
Paper Session F2: Nursing Research and Evidence‐Based Practice Looking is Not Seeing and Listening is Not Hearing Linda Honan Pellico, PhD, APRN, Yale University School of Nursing, New Haven, CT Thomas C Duffy, DMA, Yale University School of Music, New Haven, CT The art of inspection/observation and listening/auscultation are essential skills for health‐care providers. Given that observational and auditory skills take time to perfect, the concern revolves around accelerated students’ ability to master proficiency in a timely manner. This presentation will describe the impact of music auditory training (MAT) for selected nursing students in an accelerated masters entry program on their competence in detecting of heart, lung and bowel sounds. The Looking is not seeing project uses art work in a museum and visual training as a means to develop observational and diagnostic reasoning skills. Students who participated in this experience demonstrated statistically significant improvements in their observational skills (p ≤.01) and diagnostic skills (p≤.02 to .0002) when observing photographs of patients with a variety of disease states. The findings of this project suggest that adding auditory skills training also may increase students’ ability to hear and interpret sounds of relevance to diagnostic auscultation. Thus, the listening is not hearing component was created and tested. During the first semester, a two hour MAT session with focused attention on pitch, timbre, rhythm and masking was held at a school of Music. Students who attended the music intervention demonstrated significant improvement in bowel, heart and lung sounds (p<.0001). The ability to label normal and abnormal heart sounds doubled with this two hour intervention, interpretation of normal and abnormal lung sounds improved by 50%, while bowel sounds interpretation improved three fold. This study describes an adult oriented, creative yet practical method for teaching auscultation. Given that the skill of physical examination is multisensory, curriculum that enhances the skills of observing, touching and hearing logically has potential for improved competency. This intervention will be beneficial in any educational or profession setting that requires observation and assessment and may be translated in the future to all basic nursing students. Page 129
Paper Session F3: Contemporary Issues in Adult Health: Focus on Nursing Interventions An Exploration of Racial Differences and Predictors of Weight Maintenance after a Behavioral Weight Loss Trial Melanie W Turk, PhD, RN, Duquesne University, Pittsburgh, PA ~ Lora E Burke, PhD, MPH, FAAN, University of Pittsburgh, Pittsburgh, PA ~ Linda J Ewing, PhD, RN, University of Pittsburgh, Pittsburgh, PA ~ Marilyn Hravnak, PhD, RN, CRNP, FAAN, University of Pittsburgh, Pittsburgh, PA ~ Susan M Sereika, PhD, University of Pittsburgh, Pittsburgh, PA ~ Kyeongra Yang, PhD, RN, University of Pittsburgh, Pittsburgh, PA Obesity is an important risk factor for many chronic diseases. Although treatment often results in weight loss, maintenance of lost weight is challenging. Purpose: The purpose of this study was to 1) explore possible differences in weight maintenance between black and white participants; 2) examine low‐fat diet experiences, barriers to healthy eating, self‐efficacy, social support, and stress as predictors of weight maintenance; and 3) explore race as a moderator of the relationship between potential predictors and weight maintenance. Theoretical Framework: Social Cognitive Theory and the concept of reciprocal determinism served as the theoretical foundation for the study. Methods: An ancillary study, PREFER II, was conducted 18 months after the completion of a behavioral weight loss trial, PREFER. Race was self‐identified as Black or White. We used the Tanita digital scale to weigh participants and Experiences Following a Low‐Fat Diet (ELF), Barriers to Healthy Eating (BHE), Weight Efficacy Lifestyle, and Self‐Efficacy for Exercise scales to measure selected predictors. A composite score of 2 subscales from the ELF and BHE measured social support, and 4 survey items measured stress. Hierarchical multiple linear and logistic regression were used to examine predictors of percent weight change and unsuccessful weight maintenance, defined as >5% weight gain. Results: The sample (N=107; 76% White, 24% Black) was 86% female with a mean age of 46.3 yrs (SD=6.9) and a mean body mass index of 33.0kg/m2 (SD=4.9). There were no differences between black and white participants in percent weight change (b=0.87, SE=1.45, p=.55) or unsuccessful weight maintenance (Odds Ratio=1.38, 95% Confidence Interval=0.51‐3.77, p=.53), after controlling for age, gender, income, education, and marital status. Blacks gained a mean of 5.0% (SD=6.6%) or 4.3kg (SD=5.4kg), and Whites gained a mean of 4.4% (SD=5.6%) or 3.6kg (SD=4.7kg). For the total sample, an increase in barriers to healthy eating and a greater effect of a stressful life event on eating were related to percent weight gain and unsuccessful weight maintenance, ps<.04. Racial group was not found to be a moderator of weight maintenance, ps>.10. Conclusions and Implications: A racial difference in weight maintenance was not supported in this study. Strategies are needed to help individuals cope with stressful events and overcome barriers to maintaining a healthy lifestyle in order to support weight maintenance after loss. Page 130
Paper Session F3: Contemporary Issues in Adult Health: Focus on Nursing Interventions Substandard Quality of ECG Monitoring in Current Clinical Practice: Preliminary Results of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial Marjorie Funk, PhD, RN, FAHA, FAAN, Yale University School of Nursing, New Haven, CT ~ Barbara Drew, PhD, RN, FAHA, FAAN, UCSF School of Nursing, San Francisco, CA ~ Kristopher Fennie, PhD, Yale University School of Nursing, New Haven, CT ~ Elisabeth Hurley, MSN, APRN, Yale University School of Nursing, New Haven, CT ~ Jeanine May, MSN, APRN, Yale University School of Nursing, New Haven, CT ~ Kimberly Stephens, MPH, RN, UCSF School of Nursing, San Francisco, CA ~ Chelsea Hoffmann Vaughn, MSN, APRN, California Pacific Medical Center, San Carlos, CA ~ Catherine Winkler, PhD, RN, Yale University School of Nursing, New Haven, CT Although electrocardiographic (ECG) monitoring is the cornerstone of care in hospital cardiac units, no studies have evaluated its quality. Purpose: To examine the quality of ECG monitoring by evaluating electrode placement, accuracy of rhythm interpretation, use of ischemia and QT interval monitoring, and appropriateness of monitoring. Theoretical Framework: Knowledge transfer (Lavis et al., 2003) is the organizing framework guiding our PULSE Trial, a multi‐site randomized clinical trial evaluating the effect of implementing American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods: We analyzed baseline data of the PULSE Trial. Three research nurses observed patients for electrode placement and reviewed the memory feature of the monitor and current medical records from patients on adult cardiac units in 17 hospitals (15 in the US, 1 in Canada, and 1 in Hong Kong) 7/08‐
7/09. Results: The sample of 1,821 patients had a mean age of 65±15 years and was 58% male and 80% white. Electrodes were frequently in the incorrect place: 15%‐27% of the time for limb electrodes, 76% of the time when 1 chest electrode was used, and 54%‐58% with >1 chest electrode. When the derived EASI system was used, electrode placement was wrong 78% of the time. Research nurses compared rhythm changes from the monitor with documentation by unit nurses. Of the 307 occurrences of a rhythm change, the nurses documented it correctly only 50% of the time. The practice standards specify indications for arrhythmia, ischemia, and QT interval monitoring. Of the 167 patients with an indication for ischemia monitoring, 42% were monitored continuously for ST segment changes. Only 23% of the 194 patients with an indication for QTc monitoring had a QTc value documented by nurses. Of the 442 patients with no indication for monitoring, 83% were on a monitor. Conclusions and Implications: Our findings revealed substandard ECG monitoring, including incorrect electrode placement, inaccurate rhythm interpretation, underutilization of ischemia monitoring, failure to monitor for QT interval prolongation when indicated, and over‐monitoring. The next phase of the PULSE Trial will test whether an online ECG monitoring education program based on the practice standards and strategies to implement and sustain change in practice will enhance nurses’ knowledge and the quality of ECG monitoring, ultimately leading to improved patient outcomes. Page 131
Paper Session F3: Contemporary Issues in Adult Health: Focus on Nursing Interventions ST‐Map Electrocardiographic (ECG) Software Improves Nurses’ Use of and Attitude toward Ischemia Monitoring and the Quality of Patient Care Marjorie Funk, PhD, RN, FAHA, FAAN, Yale University School of Nursing, New Haven, CT ~ Mary Jahrsdoerfer, MHA, RN, Philips Healthcare, Oyster Bay, NY ~ Prasama Sangkachand, MSN, RN, CCRN, Yale‐New Haven Hospital, Oxford, CT ~ Brenda Sarosario, BSN, RN, Yale‐New Haven Hospital, New Haven, CT Continuous ST segment ischemia monitoring is essential to identify patients with acute, but often silent, myocardial ischemia. Evidence suggests that nurses do not activate the ischemia monitoring feature on the bedside monitor because they perceive it to be difficult to use. ST‐Map ECG software was designed to make ischemia monitoring easier by incorporating graphical displays of ongoing ischemia. Purpose: To determine if nurses’ use of and attitude toward ischemia monitoring and the quality of patient care related to monitoring improve with the availability of ST‐Map. Theoretical Framework: Change theory. Methods: This one‐group pre‐/post‐intervention study of 61 staff nurses and 202 patients with acute coronary syndrome was conducted in the Cardiac ICU at Yale‐New Haven Hospital. We obtained baseline data on nurses’ use of and attitude toward ischemia monitoring and the quality of patient care. We then provided education on ischemia monitoring and ST‐Map, and the ST‐Map software was installed on all bedside monitors. Nurses used the new ST‐Map for 4 months. We then obtained follow‐
up data on the same outcomes we examined at baseline. We used the McNemar test (nurse data) and chi square and t‐test (patient data) to determine changes with the availability of ST‐Map software. Results: The sample of 61 nurses was 93% female, with a mean age of 41±10 years. Before ST‐Map was instituted 13% of the nurses had ever used ischemia monitoring vs. 90% after ST‐Map (p<.001). The most common reason for not using ischemia monitoring before ST‐Map was inadequate knowledge (62%). The most common reason for liking ischemia monitoring after ST‐Map was knowing when patient has ischemia (80%). The sample of 202 patients was 73% male, with a mean age of 62±13 years. Time to acquisition of a 12‐lead ECG in response to symptoms or ST segment changes before ST‐Map was 5‐15 minutes vs. always <5 minutes after ST‐Map (p<.001). There was no difference in time to return to cardiac catheterization lab. Conclusions and Implications: ST‐Map ischemia monitoring software was associated with more frequent use of ischemia monitoring, improved attitudes of nurses toward it, and a shorter time to the acquisition of a 12‐lead ECG in response to symptoms or ST segment changes. Additional research with larger samples is needed to examine the association of ST‐Map with patient outcomes. Evaluation of ST‐Map in other patient care settings and with broader patient populations is also indicated. Page 132
Paper Session F3: Contemporary Issues in Adult Health: Focus on Nursing Interventions End‐of‐Life Care is Improving in the Nursing Home Setting: A Pilot Study to Explore Next of Kin’s Perspectives on End‐Of‐Life Care Jill M. Terrien, PhD, APN, BC, University of Massachusetts ‐ Worcester GSN, Rochdale, MA Petra Flock, MD, MSc, University of Massachusetts ‐ Medical School, Worcester, MA Purpose: The purpose of this study was to, develop a survey tool, test the feasibility of the method (mailed survey) and to pilot test the revised survey instrument. Theoretical Framework: The conceptual model of quality end‐of‐life care (Teno et al, 2004). Methods: Review of the literature on quality end of life care, surveys of next of kin and review by content experts was used to design the initial survey. Next of kin (6) from 3 participating nursing homes (1 for profit, 1 not for profit and one affiliated with an academic medical center) were invited to participate in an interview, take the survey, assess content validity and emotional distress utilizing the think aloud method for cognitive pre‐testing. Survey was revised and mailed to next of kin of the nursing homes whose residents died 4/1/07 through 4/1/08. Demographic data, pain and symptom management, communication and Hospice utilization followed by 2 open‐ended questions was collected. Analysis included means, standard deviations, frequencies, percentages and Pearson Chi‐
Square statistics. All nursing homes had patients receiving traditional care and had Hospice services. Qualitative data was coded and analyzed for themes. Results: Overall response rate was 70% (N=164). The decedents had high symptom burden (75% pain, 72% agitation, 70% anxiety), and good to excellent control of symptoms for Hospice (92%) and traditional care (88%) groups. Participants felt they and their loved ones were well‐informed about their condition and that it information was understandable. Hospice participants were better educated about the signs and symptoms of death (p=0.08). Conclusions/Implications: The survey method was feasible with a high response rate. In this study, pain, symptom management and communication at the end‐of‐
life in nursing homes is better than nationally reported data. Page 133
Symposium F4: Evidence‐Based Practice Improvement: Merging Two Paradigms The Evidence‐Based Practice Improvement (EBPI) Model: Merging Two Paradigms Rona F. Levin, PhD, RN, Pace University, Tuckahoe, NY This symposium presents a new model, Evidence‐Based Practice Improvement (EBPI), for improving patient care, and provides examples of EBPI Projects that used this model successfully. The model merges two extant paradigms currently used for quality improvement initiatives – evidence‐based practice (EBP) and practice or performance improvement (PI). The literature expounds on the virtues of each of these approaches, yet no authors have moved beyond parallel play between them. The merged model, EBPI, may provide a more effective and practical approach to reach our quality goals (Levin, Keefer, Marren, Vetter, Lauder, & Sobolewski, 2009). The first paper describes the evolution and conceptualization of the EBPI Model. The 3 subsequent presentations demonstrate how this model was used as a framework for practice improvement in both the acute care and home care settings. The topics of the specific EBPI projects are the development of a protocol to monitor Propofol administration in an ICU, and pain and medication management in home health care settings. Page 134
Symposium F4: Evidence‐Based Practice Improvement: Merging Two Paradigms An Evidence‐Based Practice Improvement Project to Implement Best Practices in the Administration of Propofol in the Critical Care Setting Fay Wright, MS, RN, Northern Westchester Hospital, Somers, NY The purpose of this project is to decrease morbidity and length of stay in mechanically ventilated patients in the ICU who are receiving continuous infusion of propofol. Nurses noted that when propofol infusion was administered for more than three days, patients were not emerging from sedation as quickly as expected, and when they did, nurses noted profound muscle weakness. High triglyceride levels were also identified. Also, no hospital protocol existed to guide nurses’ assessment and monitoring of patients receiving propofol. The most valid evidence‐based guideline at the inception of this project (Jacobi et al., 2002) recommended accurate assessment of pain in addition to sedation level in order to keep sedation at the minimum level needed. The EBPI Model (Levin et al., 2009) served as the conceptual model for the project. The setting for the project was the ICU of a community hospital. The design included the collection of baseline data on outcome variables. Systematic search processes and critical appraisal of evidence were used to identify the highest level of evidence on which to choose instruments for measuring sedation and pain and develop a protocol for practice. Other relevant disciplines participated in protocol development. Small tests of change (PDSA cycles) were carried out to test the new tools for measuring sedation and pain levels first. Then the entire new protocol, new tools plus protocol for monitoring propofol use was tested. During each cycle both quantitative and qualitative data were reviewed to improve the process. Results demonstrated significant improvement in patient outcomes re: morbidity. Less propofol was administered and patients ICU stay was decreased. In conclusion, an EBP team developed a working knowledge of the EBPI process and made a significant improvement in patient outcomes related to decreased propofol use. Decreased propofol dose resulted in cost saving for the hospital as well. Page 135
Symposium F4: Evidence‐Based Practice Improvement: Merging Two Paradigms Evidence Based Medication Management for Cognitively Impaired and Non‐Adherent Patients in Home Care Kathryn H Bowles, PhD, RN, FAAN, University of Pennsylvania School of Nursing, Philadelphia, PA ~ Janice Foust, PhD, RN, Visiting Nurse Service of New York, Boston, MA ~ Bonnie Lauder, MIS, RN, CPHQ, Visiting Nurse Service of New York, New York, NY Purpose: To apply evidence based medication management assessments and interventions in the care of cognitively impaired and non‐adherent home care patients. Theoretical Framework: The Evidence Based Practice Improvement Model. This model merges EBP with Practice Improvement. Design. EBPI methodology including baseline measurement; gap analysis; problem statement formulation, literature review, critique, and synthesis; and application of evidence based reminder and medication management interventions in small tests of change. Sample. Home care patients age 50 and older screening positive for non‐adherent behaviors or cognitive impairment. First process improvement cycle had 5 patients the next cycle had 24. Setting. Large urban home care agency. Measures. Cognitive function was measured using the Mini‐Cog. The Symptom Bother Scale measured change in symptoms. The Morisky assessed medication adherence and the Hamdy measured medication simplification. Analysis. Frequencies and percent change were calculated to compare baseline measures to post intervention measures. Results: The Mini‐Cog was more accurate in identifying cognitively impaired patients than usual practice. There was an increase in the early involvement of caregivers and use of pillboxes with the cognitively impaired. Using a standardized practice helped nurses to organize their assessments and interventions during their initial visits. More than one visit is needed to accurately assess cognitive function & medication adherence. Evidence‐based assessments provide more specific data to enhance the OASIS assessment. Medication simplification is very complex. More support is needed at the team level during practice changes. Conclusions and Implications: Nurses requested the following at the conclusion of the project: Integrate the Mini‐Cog & Morisky screens into the electronic medical record for routine use. Enhance medication documentation to include a range of multiple interventions. Request caregivers are available at the first home visit. Further explore how medication complexity impacts practice and outcomes. Page 136
Symposium F4: Evidence‐Based Practice Improvement: Merging Two Paradigms Improving Pain Management in Long Term Home Health Care Patients: An Evidence‐Based Practice Improvement Project Rona F. Levin, PhD, RN, Pace University, Tuckahoe, NY Lorraine Ferrara, MA, RN, Visiting Nurse Service of New York, New York, NY Purpose: Improve management of chronic non‐malignant pain in the long term home health care (LTHHC) population. Theoretical Framework: The Evidence‐Based Practice Improvement (EBPI) Model, which merges the paradigms of EBP and performance improvement. Design: EBPI methods guided collection of internal data to support the practice problem and baseline data on current parameters, a gap analysis, development of a clinical question, systematic search for and synthesis of best evidence, recommendations for practice improvement, implementation and testing of new practice using PDSA cycles, and evaluation of outcomes. This project used the best evidence on chronic non‐malignant pain management to design a protocol for the visiting nurse to use in assessing the appropriateness of a LTHHC patients’ pain medication regimen and collaborating with the patient’s primary health care provider on pain management. Nurses attended educational sessions to standardize the implementation processes. A group of 5 nurses used the new protocol with their patients who met specified criteria. Two PDSA cycles with 7 patients were needed to perfect the new practice protocol. Pain was measured by patient self‐report using 0‐10 scale. Quality of Life was measured by the EQ‐5D. Sample: Seven LTHHC patients between the ages of 49 and 81. Setting: Large urban home health care agency. Analysis: Descriptive methods compared baseline and post intervention measures. Results: Mean pain rating (N=7) decreased with 5 patients experiencing a decrease in pain and 2 of those being pain free at the end of the project. Quality of Life (N==4) measures indicated an increase in overall QOL score in 3 of 4 patients with complete data. Conclusions and Implications: Implementation of a best practice protocol to assess and collaborate on pain management in LTHHC decreased patients’ pain and increased quality of life in small tests of change. This project is in the spread phase within the organization. Page 137
Symposium F5: Supporting Family Caregivers through End‐of Life Transitions: Opened Doors and Missed Opportunities Supporting Family Caregivers through End‐of‐Life Transitions: Opened Doors and Missed Opportunities Janice Penrod, PhD, RN, The Pennsylvania State University, University Park, PA This symposium presents findings from an ethnographic study of the interface between formal and informal caregivers during brief office visits across three distinct death trajectories. The over‐arching goal of the study is to better understand how nurses could enhance the quality of anticipatory, supportive end‐of‐life care. The purpose of this symposium is to build an awareness of the impact of the culture of care and model of care delivery on the recognition and response to expressions of distressed caregiving. The framework advanced in this presentation was derived through prolonged, intensive field work in three clinics serving those who face exemplar death trajectories common to life limiting conditions (i.e., ALS, lung cancer, and heart failure). Paper 1 describes the characteristics of the culture of care inherent to the clinic setting that influence the experience of end‐of‐life caregiving. Paper 2 extends an understanding of these cultural characteristics in a description of models of care and nursing roles in three distinct end‐of‐life trajectories. Paper 3 identifies how the prevalent model of care delivery influences providers’ recognition and response to family caregivers’ expressions of needs related to end‐
of‐life transitions. It is critical that nurses continue to build the science undergirding the recognition of family caregivers’ needs and establish a broader repertoire of generalist strategies for supporting family caregivers over years of end‐of‐life caregiving. Page 138
Symposium F5: Supporting Family Caregivers through End‐of Life Transitions: Opened Doors and Missed Opportunities Unraveling the Influence of the Culture of Care Peggy Shipley, PhD(c), RN, Penn State School of Nursing, University Park, PA Judith Hupcey, EdD, RN, Pennylvania State School of Nursing, University Park, PA Janice Penrod, PhD, RN, Penn State School of Nursing, University Park, PA Purpose: To explore characteristics of the culture of care that influence end‐of‐life caregiving. Background: Culture refers to a closed and coherent system of meanings that are communicated directly and indirectly (i.e., through behaviors, language, or attitudes) among members. Formal care settings, such as specialty clinics are socio‐cultural organizations or subcultures with implicit and explicit knowledge under‐girding care interactions. Preliminary research described three distinct death trajectories: the Expected death trajectory, in which the disease is explicitly described as terminal; the Mixed death trajectory, distinguished by an early focus on aggressive curative treatment followed by an abrupt shift toward comfort care; and, the Unexpected death trajectory, in which death is not anticipated; it typically occurs suddenly without supportive care. Methods: Ethnographic methods were used to examine the culture of care inherent in three specialty clinics that exemplified the death trajectories cited above. Researchers were embedded in clinics during hours of operation (ranging from half day to full day sessions each week) over one year. Observational data were supplemented by brief interviews with clinicians to produce a robust dataset through which the culture of care could be described. A team approach was used in a cyclical, iterative process of analysis progressing from item‐level analysis to pattern analysis (addressed in these papers). Results: Four patterns marked a range of cultural variation in the exemplar clinics: Role of Provider, addressing the degree of interdisciplinary collaboration; Conceptualization of the Patient System, addressing the incorporation of informal caregivers into the clinic visit; Focus of the Visit, addressing pathophysiology versus the experience of illness; and, Flow of Care, addressing the pacing of visits and communication between informal/formal caregivers. Conclusions: Each clinic manifested a distinct culture of care that reflects the perspectives of death inherent to the death trajectory. Page 139
Symposium F5: Supporting Family Caregivers through End‐of Life Transitions: Opened Doors and Missed Opportunities Understanding the Influence of the Culture of Care on Models of Care Delivery and Related Nursing Roles Brenda Baney, BS, Penn State School of Nursing, University Park, PA ~ Judith Hupcey, EdD, RN, Penn State School of Nursing, University Park, PA ~ Janice Penrod, PhD, RN, Penn State School of Nursing, University Park, PA ~ Jennifer Thurheimer, MSN, RN, Penn State School of Nursing, University Park, PA Purpose: To describe models of care and nursing roles in three distinct end‐of‐life trajectories. Background: In the expected death trajectory (e.g., ALS), the disease is explicitly described as terminal, opening opportunities for interdisciplinary support of end‐of‐life care. In contrast, the mixed‐death trajectory (e.g., lung cancer) is distinguished by numerous cycles of aggressive treatment—a battle is waged against the disease and end‐of‐life care is an abrupt shift. The unexpected death trajectory (e.g., heart failure) is focused on achieving and sustaining medical stability—death is held distant, not anticipated nor supported. The culture of care inherent to clinics serving these patient systems reflect how values shape models of care and, ultimately, nursing roles in providing supportive end‐of‐life care across complex trajectories. Methods: Ethnographic methods (as described in paper 1) were used to derive patterns of care delivery and related nursing roles. Results: Three models of care delivery were identified: Physician Dominant, Physician Cooperative, and Interdisciplinary. In the Physician‐Dominant model of care, the medical specialist assumes a solo practice that is supported by others (including nurses). This model embraces an emphasis on medical stability achieved by careful management of pathology and symptoms, with little attention to the illness experience. The Physician‐Cooperative model is more hierarchical in nature. While heavily centered on the medical model, there is greater opportunity and acceptance of multidisciplinary support for ancillary concerns that the patient or family caregiver may present. This model emphasizes treatment with greater attention to other aspects of the illness experience, opening opportunities for considering supportive end‐of‐life care during advanced illness. The Interdisciplinary model of care incorporates multiple disciplinary perspectives, dynamically shifting as necessary to meet the holistic needs of the patient system with an emphasis on quality of life. These models shape the role of nurses in each setting, ranging from a supportive role as assistant to physician to more independent nursing practice. Conclusions: The culture of care shapes delivery models that may facilitate or constrain critical nursing contributions to the quality of life for end‐of‐life family caregivers. Page 140
Symposium F5: Supporting Family Caregivers through End‐of Life Transitions: Opened Doors and Missed Opportunities Opened Doors and Missed Opportunities for Enhanced End‐of‐Life Care Pamela Spigelmyer, PhD(c), RN, Pennsylvania State School of Nursing, University Park, PA Judith Hupcey, EdD, RN, Penn State School of Nursing, University Park, PA Janice Penrod, PhD, RN, Penn State School of Nursing, University Park, PA Purpose: To identify how the model of care delivery influences providers’ recognition and response to family caregivers’ expressions of needs related to end‐of‐life transitions. Background: Palliative care/hospice philosophies embrace family caregivers as a part of the patient system. Yet often, this philosophy and the related end‐of‐life service delivery models are not infused into the care of complex chronic conditions that precede the period typically delineated as the end of life. Over the course of caring, family caregivers are sometimes embraced as co‐providers of care, extending medical care into the home setting. But, far too often, these partners‐in‐care are ignored as co‐recipients of care during the ongoing, brief medical visits. Preliminary research established markers of distressed caregiving that arose in response to transitions toward the end of life, but the extent to which these cues are recognized or prompt a response by health care providers in varied models of care delivery is not known. Methods: Ethnographic methods (as described in paper 1) were used to describe family caregivers’ expressions of end‐of‐life concerns that subsequently prompted an awareness or response by health care providers. Results: The values inherent to the culture of care manifest in the three exemplar models of care delivery influenced how family caregivers were incorporated into clinic visits. For example, in the Physician Dominant model, the caregiver had to reach out and connect with the attending physician (who was attuned to medical care of the ‘patient’) in order to call awareness to a concern or need. Even then, a supportive response was not guaranteed. Nurses practicing in the Physician Cooperative model were much more apt to be aware of expressions of need and to follow‐up on concerns. The Interdisciplinary model of care was the only model that incorporated the family caregiver consistently and purposefully. Rather than forcing the caregiver to reach out for support, team members targeted caregivers in assessment and interventions. Conclusions: Models of care delivery, especially the role of nurses, impact the provision of dynamically supportive end‐of‐life care for informal family caregivers across complex, long‐term trajectories. Page 141
Poster Session I Using Reflection to Link Course Knowledge to Clinical Practice: The RN‐BS Student Experience Marilyn E Asselin, PhD RN‐BC, University of Massachusetts ‐ Dartmouth, Coventry, RI Purpose: Explore the experience of RN‐BS students using reflective strategies to facilitate thinking about and transferring course knowledge to clinical practice. Background: Reflection, a thinking process of creating and clarifying the meaning of experiences, is viewed as promoting critical thinking leading to practice changes. There is little empirical research exploring subsequent changes in practice as a result of reflection or how insights from reflective thinking progress to actually change practice. Additionally, there is a dearth of empirical data on the use of reflection to facilitate transfer of knowledge to practice among RN‐BS students. Methods: Descriptive phenomenology was the qualitative research design used. A purposive sample of ten RN‐BS students in a leadership course at a Southeastern Massachusetts university participated in audio‐taped interviews. Students described the experience of using three reflective strategies (structured narratives, one minute papers and reflective questions) to think about and use course knowledge in practice. Colazzi’s (1978) descriptive phenomenological method guided data analysis. Results: Data were grouped into the following themes consistently reported by participants and suggestive of a linear process: 1) Facing emotional barriers, 2) Weighing the choices for reflection, 3) Making sense, 4) Percolating insights, 5) Letting go, 6) Blending insights into practice approaches and 7) Looking back and acknowledging growth. Conclusion: Participants transcended emotional reactions to clinical situations to attain a level of trust to begin the work of reflection. The choice of situations to reflect upon was based on individual needs and professional developmental levels. Skill in reflection developed over time. Students would benefit from a consistent reflection model throughout curriculum coursework. An ongoing need for assistance from practice was recognized as students attempted to blend insights into practice. Research is needed to explore ways for academic/practice collaboration to support students in actualizing reflective practice. Funded through University of Massachusetts ‐ Dartmouth Innovation in Teaching grant. Page 142
Poster Session I Content Validity Testing for the Agitation Severity Scale: Development of a Measure for Use with Acute Presentation Behavioral Management Patients Tania D. Strout, MS, BSN, RN, MN Medical Center / Boston College, Portland, ME Michael R. Baumann, MD, MN Medical Center, Portland, ME Purpose: Agitation is a condition frequently observed in behavior management patients presenting to the Emergency Department (ED). Joint Commission on the Accreditation of Health Care Organizations’ standards for the assessment and monitoring of behavioral health patients would be easier implemented with a reliable, valid agitation rating scale appropriate for use in the emergency setting. The purpose of this research was to conduct primary content validity testing for an initial version of an observation‐based, ED‐focused, agitation rating tool. Theoretical Framework: Nunnally’s Psychometric Theory provided theoretical support for the study. Methods: This project used a methodological design and was approved by both university and hospital Institutional Review Boards. A panel of eight experts from the fields of emergency medicine, emergency nursing, acute psychiatry, and psychiatry was used to examine the representativeness and clarity of twenty‐six items for potential inclusion on the agitation rating scale. The twenty‐six items considered for inclusion were previously developed utilizing focus groups of direct patient care providers and a survey of emergency department and acute psychiatry clinicians. Measures of interrater agreement, the content validity index, and factorial validity index were calculated for both representativeness and clarity on a by‐item and across‐the‐scale basis. Results: Initial evaluation of the potential scale items yielded an average content validity index of 0.725 for the representativeness of the items and of 0.725 for the clarity of the items. Eliminating four items with item‐level content validity indexes of 0.142 – 0.375 improved scale‐level content validity to 0.80 for both representativeness and clarity. Experts had difficulty consistently identifying domains for the scale items, with a factorial validity index of 0.50. Interrater agreement was good to very good for the majority of the individual items, and with k = 0.80 for the scale as a whole. Conclusions and Implications: Utilizing a panel of experts to develop and evaluate content validity, an initial version of the Agitation Severity Scale has been constructed. Additional psychometric evaluation is necessary to evaluate the reliability and validity of the newly developed instrument, as well as to refine domains for the individual items. Further development of the scale will provide nurses with a common language for discussing and monitoring agitated behavior. Page 143
Poster Session I A Narrative Inquiry of Postpartum Psychosis Within the Context of Orthodox Judaism Bobbie Posmontier, PhD, CNM, Drexel University, Newtown, PA Purpose: The purpose of this qualitative research study was to understand the meaning of postpartum psychosis (PPP) from the narrative of an Orthodox Jewish woman. Background: Postpartum Psychosis (PPP) is an emergency psychiatric condition affecting 1‐2 per thousand women after childbirth. PPP is characterized by mood lability, delusional beliefs, hallucinations, disorganized thinking, and increased risk for suicide and infanticide. Without treatment the condition may worsen and increase the risk for recurrence in subsequent pregnancies, treatment resistant psychosis and relapse. Women who have experienced PPP may suffer long‐term decreased self‐esteem and diminished mother‐infant bonding. Orthodox Jews, one of the fastest growing populations in the United States, believe that the Torah and Jewish Laws are the direct words of God handed down to Jews 4,000 years ago. Women within Orthodox Judaism are required to follow 613 Jewish laws, including bearing many children, in order to conduct their lives appropriately within the religion. Although other qualitative studies have explored the meaning of PPP to women, no qualitative studies have been conducted to explore the meaning of PPP within the context of Orthodox Judaism. Design & Methods: The design was a narrative inquiry, where one participant shared her personal story about PPP within the context of her religion and community. A semi‐structured interview was conducted in the home of the participant. Narrative analysis was based on the method proposed by C. K. Reissman. Results: The personal narrative shared by an Orthodox Jewish woman experiencing PPP highlights the challenges of the interface between a highly structured religion and the disorganizing experience of postpartum psychosis. CONCLUSIONS & IMPLICATIONS: Advanced nurse practitioners caring for Orthodox Jewish women with PPP need to understand their spiritual and cultural context in order to provide culturally relevant and effective care. Page 144
Poster Session I The Health‐Related Quality of Life in Mothers of Surviving Deaf‐Blind Adult Children with Confenital Rubella Syndrome Normadeane Armstrong, PhD, Molloy College, Mt Sinai, NY Purpose: The purpose of this study was to determine the health related quality of life (HRQOL) of mothers of surviving deaf‐blind adult children with congenital rubella syndrome (CRS) and the relationship of factors that influence it. Theoretical Framework: This study utilizes the Family Systems Theory to expand the understanding of maternal HRQOL. Methods: This study uses a cross sectional design with all of the study participants having surviving CRS children born from the 1963‐1965 epidemic. Demographic information was incorporated into a self ‐
administered questionnaire along with three established instruments: The Medical Outcomes Study 36‐
Item Short‐Form Health Survey, Caregiver Strain Index (CSI) and the Modified Barthel Index (MBI). Results: Analysis revealed that: 1). Maternal CSI scores were significantly associated with the HRQOL domains F (13, 273) = 67.175 p< .001. Mothers who experienced high levels of caregiver stress had a poorer overall quality of life than those with lower levels of stress. 2). The deaf‐blind adult child’s with CRS functional ability was significantly associated with the maternal HRQOL domains F (22, 263) = 17.03 p< .001. Mothers of adult deaf blind children with low MBI scores had poorer overall quality of life than those with higher scores.3). Communication methods were significantly associated with the HRQOL domains. Communication with Sign Language (M= 80.39, SD= 20.8) demonstrated better overall maternal HRQOL scores than those with gestures (M= 31.49, SD= 32.57), F (8, 277) = 17.471, p < .001. 4). 4). Behaviors were significantly associated with the HRQOL domains with the largest difference between adult‐ children demonstrating no apparent behavior (M= 89.77, SD= 11.7) to those presenting aggressive behavior (M= 30.95, SD= 30.37), F (7, 279) =21.130 p < .001. Conclusions and Implications: As the prevalence of children with disabilities continues to increase, so does the demand for professionals who understand the unique needs of caregivers. As these children transition to adult care, professionals must understand the impact the special needs have on the mother and by extension, the family, and be able to provide the care and resources needed to bridge the transition and support the continued care. Page 145
Poster Session I Multi‐professional Communication Preferences and Satisfaction During Patient Handoff Marge M Benham‐Hutchins, RN, PhD, Northeastern University, Boston, MA Purpose: The purpose of this study was to examine communication between healthcare providers from multiple professions during patient handoff between units. This paper will focus on provider preference and satisfaction with available communication options. Theoretical Framework: Complexity science principles guided the study design and interpretation. Methods: This exploratory study was conducted in a 355‐bed urban hospital. Handoffs originated in the 40‐bed emergency department. Three inpatient units participated: 30‐bed telemetry, 28‐bed medical, and a 26‐bed surgical unit. An investigator‐designed questionnaire was used to collect data from a convenience sample of 25 nurses, physicians, social workers, respiratory therapists and pharmacists responsible for care of the patient during 5 patient handoffs. The provider satisfaction and preference section of the instrument included Likert‐type scale, limited response and open‐ended questions. Descriptive statistics were computed for the scale and limited response questions. Thematic content analysis was used to analyze the open ended question responses. Results: The majority of participants preferred verbal communication (in person or phone). Reasons cited included speed, convenience, the ability to ask and answer questions, and concerns about the accuracy of the electronic record. In contrast, providers that did prefer the electronic record based their preference on the ability to review documentation from multiple providers in an organized, legible and systematic format. Although overall satisfaction with communication options was high a repeated suggestion for improving communication was converting all units to the same electronic charting system. In addition, multiple participants expressed the desire for better communication between providers on different units or working different shifts. Conclusions and Implications: These preliminary findings suggest that satisfaction and preference is related to the match between the method of communication, the physical infrastructure, provider workflow and available communication options. Future research is needed to identify information and communication technology that supports the information needs of providers during the provision of collaborative care across the continuum. Page 146
Poster Session I A Hermeneutic Humanbecoming Study of Contentment: A Phenomenon Foundational to Health and Quality of Life Susan A Bonis, RN MSN PhD University of Massachusetts ‐ Amherst/University of Wisconsin‐Oshkosh, Amherst, MA Purpose: The aims of this humanbecoming hermeneutic study were to identify the essence of the experience of contentment, to contribute toward knowledge about humanbecoming, and to contribute toward the knowledge base of nursing. Background: Contentment is a universally lived experience that is inexplicably intertwined with health and quality of life for all individuals. It is linked with multiple humanly lived experiences and is related to a reduced incidence of depression, loneliness, and anxiety. Methods: The source of data collection was the text of Songs of the Gorilla Nation: My Journey through Autism. Through a hermeneutic process of discoursing with penetrating engagement, interpreting with quiescent beholding, and understanding with inspiring envisaging the structure of the lived experience of contentment was illuminated in the text. Major Points/Findings: The primary finding is that contentment is a lasting sense of calm amid adversity while choosing‐relinquishing with visualizing new possibles. The structural transposition is: Contentment is enduring serenity unfolding with inspiring unburdening as cherished convictions arise from disharmony. This structural transposition is comprised of three core concepts: enduring serenity, cherished convictions, and inspiring unburdening. This answers the research question: What is the structure of the lived experience of contentment as described in the text of Songs of the Gorilla Nation: My Journey through Autism. Conclusion and implications for nursing: The findings of this study contribute toward a greater understanding of contentment as a universally lived phenomenon and provide information to nurses about how to support people in the choices they make regarding contentment in the difficult situations they live with and the choices they make that define their health and quality of life. Page 147
Poster Session I Spousal Caregiving and Early‐Onset Dementia Diane K Pastor, DNSc, MBA, RN, Molloy College, Northport, NY Purpose: This study extends Pastor’s findings and explores the specific caregiving needs of younger spouses (aged 65 years of less), and how they manage caregiving at home for a spouse with early‐onset dementia. Background: Questions were raised but reMNd unanswered in Pastor’s research (2008), which investigated decision‐making by community‐dwelling spousal caregivers (SCGs) about long‐term care decisions for their partners with Alzheimer’s disease (AD). Younger spouses dealing with early onset dementia in their affected spouse experienced different caregiving challenges. Little is known about this caregiver group. Methods: Qualitative descriptive methods will be used. Purposive sampling will identify spousal caregivers in the community who are caring for a spouse with early‐onset dementia at home. Ten participants will engage in one‐to‐one interviews with the PI in a community setting. Participants will be enrolled until saturation of the data is reached. Interviews will be audiotaped and verbatim transcriptions will be created. These files will be imported into ATLAS.ti 5.2 for data management and analysis. Codes will form the foundation for understanding both the similarities and the differences in the experiences of study participants. Results: Anticipated themes will describe the caregiving challenges and needs of younger (aged less than 65 years) community‐dwelling spousal caregivers caring for an affected spouse with early‐onset dementia. Conclusions & Implications: Identification of caregiving needs for this special population will inform the development of a tailored caregiving educational and support program to be delivered with a community partner. Further research objectives include piloting such a program, and determining its feasibility. Page 148
Poster Session I Primary Care Nursing Compared to Total Patient Care Nursing: Breast Cancer Patients’ Satisfaction with their Chemotherapy Nursing Care in an Outpatient Oncology Center. Lynda J Dimitroff, PhD, BSN, RN, CHES, Rochester General Hospital, Rochester, NY Beth DeCoste, BSN, RN, OCN, Clinician IV, Rochester General Hospital, Ontario, NY Purpose: To determine whether there was an improvement in patient satisfaction with chemotherapy nursing care when patients were assigned to a Primary Care Nurse (PCN) rather than being assigned to the current Total Patient Care (TPC) system. Theoretical Framework: Systems theory provided general guidelines for this quantitative study. Methods: Nurses in the outpatient oncology center discussed implications of nursing care delivery systems for patient satisfaction with care. Oncology Center nurses were assigned to either the TPC system in place at study onset or to a newly established PCN approach. Nursing care was based on established guidelines and working definitions of each care delivery system. Twenty‐nine women with new diagnoses of breast cancer were randomly assigned to the two systems of care. At the completion of their chemotherapy, participants completed the Chemotherapy Patient Satisfaction Questionnaire (CPSQ). SPSS (14.0) was used to compare outcomes between the two groups. Results: a)Nineteen patients were enrolled in the PCN group and 10 patients enrolled in the TPC group. However, PCN group lost three patients so final enrollment was 16 patients. b)The mean age was 53.3 years for PCN patients and 56.1 years for TPC patients. c)From the survey data, one question demonstrated statistical significance: Would you prefer to be treated in a room with other patients or in a private room? This question had a significantly higher mean score for PCN patients than for TPC patients (2.19 > 1.44, p = 0.048). d)Three questions trended towards demonstrating statistical significance. i.Do you feel anxious before arriving at the hospital for chemotherapy treatment? This question had a greater mean score for PCN patients than for TPC patients (3.13 > 2.40, p = 0.097). ii.Are you happy with the level of information you received about your condition upon diagnosis? This question had a greater mean score for PCN patients than for TPC patients (1.81 > 1.10, p = 0.077). iii.Are you happy with the chemotherapy nurses' medical knowledge of your condition? This question had a greater mean score for TPC patients than for PCN patients (1.60 > 1.06, p = 0.06). Conclusions and Implications: There was no overall significant difference in patient satisfaction between the two care delivery systems. The findings did allow the Oncology Center staff to evaluate outcomes of two processes of care delivery. Page 149
Poster Session I Employing a Health Information Technology Bundle with Continuous Intensivist Coverage Improves Mortality and Decreases Ventilator Use in Critically Ill Patients Hannah Paxton, RN, MPH, Lehigh Valley Health Network, Allentown, PA ~ Kathy Baker, RN, MPH, Lehigh Valley Health Network, Allentown, PA ~ Jeff Etchason, MD, Lehigh Valley Health Network, Allentown, PA ~ Kari Jones, PhD, Lehigh Valley Health Network, Allentown, PA ~ Matthew McCambridge, MD, Lehigh Valley Health Network, Allentown, PA ~ Elliot Sussman, MD, Lehigh Valley Health Network, Allentown, PA Purpose: To evaluate the impact of a coordinated health information technology bundle (HITB) and continuous intensivist coverage (CIC) for critically ill patients. Theoretical Framework: Little evidence exists to support implementing advanced technologies such as telemedicine to enable intensive care unit (ICU) coverage by intensivists around the clock. Methods: Observational study using historical controls and taking place in three ICUs at a 727‐bed academic community hospital. The ICUs were staffed exclusively by board‐certified intensivists both before and after HITB/CIC intervention. Included were critical care patients 18 years of age or older and admitted to an ICU bed for a medical diagnosis. The analysis included 954 control patients who received care over a period of 16 months prior to the implementation of the HITB/CIC and 959 study patients who received care during a ten month period following the implementation. The primary outcome of interest was ICU mortality. Secondary outcome measures were mechanical ventilation and vasopressor use, and ICU and hospital length of stay (LOS). Results: The observed mortality for the HITB/CIC cohort was 76% (p < 0.001) of that predicted by Acute Physiology and Chronic Health Evaluation (APACHE) Hospital Mortality. The standardized mortality ratio (SMR) was 29% lower in the HITB/CIC cohort than in the control group. The reduction in SMR was highest for those patients with middle ranges of APACHE scores (among those categories with sufficient numbers of mortalities for meaningful analysis). Overall, HITB/CIC patients also had significantly less (p = 0.001) usage of mechanical ventilation than the control group, controlling for body‐system diagnosis category and severity of illness. We found no significant differences in ICU or hospital LOS. Conclusions & Implications: The use of HITB/CIC significantly decreases mortality and ventilator usage when board‐certified intensivists care for critically ill patients. Page 150
Poster Session I Professional Advocacy by the Nurse: A Literature Review Pennie Sessler Branden, RN, MSN, CNM, Doctoral student, Villanova University, Woodbridge, CT Title: Professional Advocacy by the Nurse: An Integrative Review Nurses are considered trusted experts in regard to patient advocacy. However, they do not regularly advocate for their profession about professional issues even though some authors have noted that advocacy is a social responsibility of nurses, and part of the professional nurse role. Advocacy is an essential skill set for the translation of scientific evidence into widespread practice. Purpose: The purpose of this integrative literature review (IR) is to thoroughly examine and analyze professional advocacy as it applies to nursing. Synthesis of Review of the Literature: Professional advocacy by the nurse is poorly represented in the current literature. No literature discussed or investigated the role of the professional nurse advocate in depth. If political involvement translates to advocacy for the profession, the research presented in this IR has not supported that. There was no documented correlation between what prepared a nurse to advocate and the direct application of this knowledge. Characteristics have not been consistently identified and researched. Method: Integrative review of the literature from multiple disciplines. Results: Educational level and professional organization membership may be significant predictors of political activity and professional advocacy. Practice implications are related to licensure, scope of practice, practice venues, autonomy in practice, health policy and funding. Educational implications include the need for integration of advocacy information throughout all levels of curriculum, certification, funding and grants. Conclusions: Advocacy research must be done to explore how nurses define it, how they view it and if they are willing to become advocates for the profession. The results of advocacy awareness could directly affect how to educate nursing students, how to update practicing nurses, how to affect staff morale and feelings of empowerment, and how the profession represents itself outside the discipline. Page 151
Poster Session I Validation of Icons to Communicate Fall Risk and Tailored Interventions to Precent Patient Falls Diane L Carroll, PhD, RN, Massachusetts General Hospital, Beverly , MA ~ Patricia C Dykes, DNSC, RN, Partners HealthCare, Wellesley, MA ~ Ann C Hurley, DNSc, RN, Brigham & Women's Hospital, Boston, MA Purpose: Patient falls and fall‐related injuries are serious problems in acute care hospitals. Fall TIPS (Translating Interventions for Patient Safety) was established to link fall risk assessment, communication of fall risk, and tailored interventions. Several issues related to communication of fall risk and tailored interventions were identified through focus groups. A fall prevention tool kit was developed to promote prompt and easy communication to the health care team, patient and family. This paper reports on the development and validation of a set of icons for the fall prevention tool kit that were designed to easily communicate known fall risks and tailored interventions at the point of care. Theoretical Framework: NA Methods Using an iterative process, the research team developed a series of icons to represent areas of fall risk and associated fall prevention interventions. Revisions were made within the research team and 17 icons were agreed upon to test with the health care team including nursing assistants (NA). A total of 32 professionals and 22 NAs from 4 hospitals participated as content judges. Each judge was asked to rate the 17 icons on a content validity index (CVI) (6‐point scale) for accuracy and rank ordered clustered icons of same risk/intervention (4‐point scale) for best representation during 8 focus groups. Mean scores for each icon was computed separately for professionals and NAs. Results CVI mean scores (1 = strong representation) for icons ranged from 1.2 (professional) to 1.18 (NA) for the icon for ‘Out of bed with assist’ to 3.15 (professional) to 3.0 (NA) for the ‘History of falls). Other clusters of icons were reviewed and qualitative comments were used to refine the final icons. The team selected the icon with best CVI and the final results were 11 icons that included both fall risk and fall prevention interventions. Conclusions/Implications: Icons are used frequently in health care with little information on methods for development and validation. Our method used data collection from end‐users, collaboration, and testing with the end‐user. This iterative approach allowed for the building of icons that incorporated user feedback and the rating and ranking by end users. Icons allow for communication of fall alerts and interventions that were easily understood and actionable across all stakeholders. Page 152
Poster Session I Characteristics of Females with Acute Myocardial Infarction Mortality Lea Ann Matura, PhD, Northeastern University, Boston, MA Purpose: The purpose of this study was to determine cardiovascular differences (risk factors, myocardial infarction (MI) type, MI symptoms) and mortality after an acute MI in females. The parent study showed the female mortality rate was almost double that of the males; thirteen females (12%) and 11 males (7%) died (p=.136). Theoretical Framework: Neuman's Systems Model guided this study. Understanding those contributing factors that decrease the lines of defense will aid in interventions to strengthen those lines to prevent/decrease morbidity and mortality. Methods: The design was a secondary analysis of a comparative study. One hundred nine randomly selected female patients with a discharge diagnosis of acute MI were included. Descriptive statistics, t‐
tests and chi square described the sample and differences between groups. Results: The mean age of the females was 73 years (SD=14.54) and most (70%) were Caucasian. For the cardiovascular risk factors of family history of coronary heart disease (CHD), history of CHD, diabetes, hypercholesterolemia, smoking history, and hypertension there was a difference between those who died versus those who survived on CHD family history (p=.042). Those females that died had an average of 2.15 (SD=0.987) cardiovascular risk factors compared to those who survived who had an average of 2.75 (SD=1.214). The females that died differed on MI type, (p<0.001), and the type of MI presenting symptoms (p=0.020). Those females who survived were more likely to have presenting MI symptoms of chest pain and shortness of breath. Those females who survived were more likely to have a non ST elevation MI. Conclusions & Implications: In conclusion, those females that died differed in presenting MI symptoms, cardiovascular risk factors and MI type suggesting more investigation in how these factors influenced mortality. Understanding how these factors impact mortality can lead to improved prevention and MI treatment. Page 153
Poster Session I Importance of Accuracy in Rapid Streptococcal Testing Mary Jane S Hanson, PhD, RN, CRNP, CNS, The University of Scranton, Scranton, PA Purpose: Streptococcal (strep) pharyngitis is a bacterial infection of the throat, which, if untreated, can lead to acute rheumatic fever or peritonsillar abscesses. Classically the condition presents with sore throat, fever, exudates on the tonsils, and absence of cough. However, the physical findings are not sensitive or specific enough to make a definitive diagnosis. Currently, rapid strep tests, which can be performed in the primary care setting and yield results in 5‐7 minutes, are commonly used in diagnosis. For a rapid strep test, the throat and tonsils are swabbed to collect the specimen for testing. However, swabbing the posterior oropharynx can be uncomfortable and is often met with much resistance, especially in children. Therefore, the purpose of this study was to evaluate the accuracy of oral posterior cheek specimens in diagnosing strep pharyngitis. Research Design and Methods: This quasi‐experimental study took place in a rural primary care setting. Using a rapid strep test, 16 Caucasian participants aged 6 through 48 years, who tested positive for strep pharyngitis via a swab of their posterior pharynx and tonsils, were re‐tested using a swab of their posterior right cheek. The majority of the participants (88%) met three of the four common presenting symptoms for strep pharyngitis. Results: For all 16 participants, the cheek swab was negative for strep pharyngitis, when analyzed with the rapid strep test. Conclusions and Implications: Posterior cheek swabs were not found to be a valid or reliable indicator of strep pharyngitis in this pilot study. Therefore, it is important that nurses who collect specimens for rapid strep testing, are diligent in obtaining a swab of the throat and tonsils to assure accuracy of test Results: Additional research using larger samples, different populations, and other areas of the oral cavity are needed for further investigation. Page 154
Poster Session I Impact of Social Environmental Factors on Re‐hospitalization of Home Healthcare Elderly Patients Hong Tao, PhD(c), University of Massachusetts ‐ Boston, Madison, WI Carol Ellenbecker, Professor, University of Massachusetts ‐ Boston, Boston, MA Purpose: to explore the relationship of social environmental factors and re‐hospitalization of elderly home healthcare patients. Theoretical Framework: Orem’s self care theory formed the basis for the hypotheses affirming the existence of relationship among re‐hospitalization (represent SCD), TSCD, and SCA, and the influence of BCF and PC on SCA of home health care elderly. Methods: Medicare mandated OASIS data of elderly Medicare patients from a large Certified Home Healthcare Agency in the northeastern region of the United States was analyzed. Of the 1,312 patients comprising the sample, 257 (19.6%) were re‐hospitalized. The five concepts, TSCD, SCA, BCF, PC, and SCD, were measured by OASIＳitems. Social environmental factors in this study were defined as factors relevant to health behavior or heath care other than provided by Home Healthcare. Correlation analyses, T‐test, chi‐square, one way ANOVA, and three regression models‐‐Poison Regression Model, Ordinal Logistic Regression Model and Cox Proportional‐Hazards Regression Model, were employed to test the hypotheses. Results: Social environmental support factors were both directly and indirectly related to re‐
hospitalization (i) friends as primary caregiver contributed directly to re‐hospitalization (ii) paid help and other assistance such as: environmental support, psychosocial support, advocates or facilitates patient’s participation in appropriate medical care, or a financial/health agent, contributed to re‐hospitalization both directly and indirectly through functional ability, whereas functional ability contributed directly to re‐hospitalization. (iii) Living alone, receiving ADL and/or IADL assistance, and frequency of care‐giving contributed to re‐hospitalization indirectly through functional ability. Conclusions and Implications: Social environmental support was positively associated with functional ability and re‐hospitalization. These findings would allow home care agencies to identify those patients in need of social environmental support and providing that support may prevent unnecessary re‐
hospitalization. Helping patients keep informed of community resources, may not only help maintain patients in their homes, but also reduce the patients’ dependency on home health agency resources and reduce agency financial losses. The findings will inform regulators in the development of reimbursement strategies that avoid costly hospital readmission, and assure patient quality of care. Page 155
Poster Session I “I Didn’t Like the Way He Looked: An Ethnographic Exploration of the Decision Making Strategies of Emergency Nurses” Lisa Wolf, RN, MS, CEN, University of Massachusetts/Boston College, Hadley, MA Purpose: to explore the beliefs, behaviors, assumptions and expressions of meaning and choices in a cohort of emergency department (ED) nurses in two community hospitals as they relate to the experience and process of decision making with regard to patient acuity. Background: The triage nurse is generally the first person to interact with an ED patient, and who determines the acuity of condition. Accuracy in anticipating both the acuity and need for resources is important to the delivery of efficient, effective, patient‐centered care in the ED setting. Current literature describes factors that can influence decision making in triage; there is a gap in knowledge of the specific processes and critical thinking strategies used by nurses to assign acuity. Addressing this gap may suggest strategies to improve care delivery in this area. Materials, Methods, and Analysis: Ethnography concentrates on the in‐depth exploration of small groups of people, offering a richly descriptive report of perceptions, attitudes, meanings and interpretations of different events. The 10 participants in the study were observed in their role as clinical ED nurses in 120 initial patient encounters. Field notes were analyzed to identify themes and evaluated by two other emergency nurses for fittingness and theoretical and experiential validity. Results: Participants reported acuity to be a function of patient presentation, complaint, duration of symptoms, and body habitus. Acuity was also influenced by environmental and contextual challenges including patient volume, unit leadership, communication with patients and providers and length of time in triage. Physiologic data was not rigorously collected nor considered as a primary determinant of acuity. Conclusions & Implications: The initial determination of patient acuity appears to take into account multiple factors extraneous to the patient. This suggests knowledge base of staff and staffing adequacy should be considered to ensure safe and efficient care. Page 156
Poster Session I Practice Environment as Mediator of Nurse Stress and Burnout, and Maternal Outcomes in the Neonatal Intensive Care Unit Katheleen Hawes, PhD, RN, Women & Infants Hospital‐Brown Center for Children, Carolina, RI ~ Rosemarie Bigsby, ScD, Women & Infants Hospital‐Brown Alpert Medical School, Providence, RI ~ Abbot Laptook, MD, Women & Infants Hospital‐Brown Alpert Medical School, Providence, RI ~ Barry Lester, PhD, Women & Infants Hospital‐Brown Alpert Medical School, Providence, RI ~ Robin J. Miller, PhD, RN, Women & Infants Hospital‐Brown Center for Children, Providence, RI ~ James Padbury, MD, Women & Infants Hospital‐Brown Alpert Medical School, Providence, RI ~ Amy Salisbury, PhD, RN, Women & Infants Hospital‐Brown Alpert Medical School, Providence, RI ~ Mary C. Sullivan, PhD, RN, University of Rhode Island, Kingston, RI ~ Marybeth Taub, BSN, RN, Women & Infants Hospital, Providence, RI Purpose: The Neonatal Intensive Care Unit is stressful not only for infants and families but also for NICU healthcare providers, the majority of which are nurses. The current nursing shortage magnifies the need to understand this critical care work environment in order to improve nurse job satisfaction and improve patient outcomes. The purpose was to examine the relationships among the practice environment, nurse stress, and burnout; and maternal satisfaction in a 60 bed level III NICU. Mediation hypotheses were tested. Theoretical Framework: A role stress‐role strain framework was applied to explain the interrelationships among nurse job stress, burnout and job satisfaction. Methods: In this descriptive correlational study NICU staff nurses (n= 75) completed Demographics, the Maslach Burnout Inventory‐HSS, Expanded Nurse Stress Scale and the Professional Practice Environment Scale. Mothers of NICU infants (n=26) completed the Press Ganey NICU Satisfaction survey. Four hypotheses were tested with multivariate statistics. Results: The practice environment factors of control over practice, leadership and autonomy in clinical practice, and [total] professional practice environment mediated the effect of nurse stress on the burnout dimension of emotional exhaustion. Workload and problems with supervisors were the most significant nurse stressors. Other significant nurse stressors included: uncertainty towards treatment, conflict with physicians, problems with peer support, and patients and families. Nurse stress negatively affected NICU mothers’ satisfaction, though the effect was weak. Conclusions and Implications: Certain qualities of the practice environment, especially control over practice, contribute to and explain the effect of nurse stress on the burnout dimension of Emotional Exhaustion in nurses working in a large NICU. While several studies have examined nursing practice and patient outcomes in adult units, this is one of the first studies to examine factors of the professional practice environment in neonatal intensive care. Future study will reveal potential linkages among the NICU practice environment with infant and parent outcomes. Page 157
Poster Session I Comparing the Perception of Needs of Family Members Visiting and Nurses and Physicians Working in the ICU Janice L Hinkle, RN, PhD, CNRN, The Catholic University of America, Washington, DC Background and Purpose: Recent initiatives encourage a family presence during cardio‐pulmonary resuscitation, invasive procedures, and more open visitation policies in intensive care units (ICUs). This study investigated the perceptions of the needs of family members visiting and physicians and nurses working in six ICUs. Methods: The needs of family members visiting critically ill patients as well as the perceptions of needs of family members by nurses and physicians working in six ICUs were measured using the Critical Care Family Needs Inventory (CCFNI). Data were collected prospectively using a convenience sample of family members visiting as well as nurses and physicians working in the ICUs. Results: Of the 28 physicians who filled out the 45 item CCFNI the majority were male (82%), Caucasian (82%), and attending physicians (82%) with a median age of 40 years (range 29 to 50). The top 5 perceived needs of family members identified by the physicians were to: 1) have questions answered honestly 2) be assured that the best care possible is being given to the patient 3) feel the hospital personnel care about the patient 4) know the prognosis and 5) feel there is hope. When the 45 items in the CCFNI were listed in order of importance needs identified by family members and physicians were in agreement on 3 (7 %) of the items. There was agreement between the physicians and nurses on the order of importance of 5 (11 %) of the 45 items. Conclusions: There is great disparity between the perception of family member needs identified by physicians and nurses and even more disparity between needs identified by the family members and physicians. This is important information for nurses to consider in their working relationships with physician colleagues and in their work on visitation policies in ICUs. Page 158
Poster Session I Quality Of Life In Older Adult Cancer Survivors Kimberly A Christopher, PhD, RN, OCN College of Nursing University of Massachusetts‐Dartmouth, South Dartmouth, MA Purpose: This study is generating in‐depth data on the experience of cancer survivorship among adults sixty‐five years and older. Background: In the US more than 50% of all cancers occur in people 65 and older. With five year relative survival rates for all cancers combined at 60%, more older adults are living with cancer. Extended survival has increased clinicians’ and researchers’ interest in Quality of Life (QOL) evaluation. Although research has documented some age related differences in survivors’ QOL, very little research has actually focused on the potentially unique experiences of older adults. This exploratory study will contribute to current cancer survivorship knowledge by describing the differences, similarities, and developmentally specific responses of older adult survivors. Methods: A qualitative research approach guided by Ferrell and Dow’s (1997) QOL Model for Cancer Survivors, was selected to explore study participants’ experiences. A convenience sample of community dwelling survivors, sixty‐five years and older is being recruited from the local cancer centers and community organizations. Survivors may have any type and stage of cancer diagnosis, except non‐
melanoma skin cancer. Focus Groups Interviews (FGI) ‐ stratified by gender and age ‐ are the primary means of obtaining data on survivors’ perceptions, feelings, and opinions. Data are being analyzed according to Boystzis’ (1998) plan for thematic analysis and code development. Results: On‐going analysis suggests that there are unique aspects to older adults’ survivorship experiences. Ferrell and Dow’s QOL model will be modified or reconfigured for older adults based on the findings. Conclusion and Implications: Since life expectancy and cancer survivorship are increasing, QOL issues must be considered when planning care for older adults. Age appropriate models of QOL will inform practice, ensure excellent nursing care, and provide the bases for designing and testing interventions that improve QOL in this population. Page 159
Poster Session I Development of the Critical Care Nurses' Comfort in Withdrawing Life Support Instrument Laura Kierol Andrews, PhD, APRN, ACNP‐BC, Yale School of Nursing, Seymour, CT Cheryl Beck, DNSc, CNM, FAAN, University of Connecticut, Storrs, CT Regina Cusson, PhD, APRN, RNC, FAAN, University of Connecticut, Storrs, CT Purpose: The purpose of this study was to develop, evaluate and refine an instrument to measure critical care nurses’ level of comfort in performing the activities necessary in withdrawing life support in adult critical care settings. Background/Significance: Currently 50‐90% of deaths in critical care units are preceded by withholding or withdrawing of life support. This is a change in the trajectory of dying and death and has been cited as a major stressor to critical care nurses. The Critical Care Nurses’ Comfort in Withdrawing Life Support (CCN‐CIWLS) instrument was developed to assess this issue of transitioning to comfort‐oriented end of life care. Methods: This methodologic study recruited 429 CCNs who actively practice in adult settings and had withdrawn life support within the last year. Content validity was assessed via a panel of seven expert critical care and hospice nurses. Participants rated their level of comfort on a 5‐piont likert scale. Reliability and validity of the instrument was assessed via an exploratory factor analysis (EFA) and internal consistency measurements. Temporal stability of the CCN‐CIWLS was assessed via test‐retesting of 43 participants. Results: The EFA revealed a 9‐factor solution that explained 68% of the variance. Cronbach’s alphas calculated for the total instrument was .95. The subscales alphas were: Communication=.94, Withdrawal Procedures=.91, Human Connection=.88, and CCNs’ Psychological Self‐Care Activities=.84. Temporal stability analysis revealed a strong positive correlation (r=.63; p<.001) between testings. The participants reported being most comfortable with performing withdrawal procedures, followed by promoting human connections, communication activities and then their own psychological self‐care. Conclusions: This study provided evidence to support the reliability and validity of the CCN‐CIWLS instrument for use in assessment, intervention and outcome research. Page 160
Poster Session I Unintentional Medication Variances in Elderly Patients Anne D Swallow, RN DNP MSN, Greenwich Hospital, Greenwich, CT Purpose: To determine the number of medication variances on the patient discharge medication list through the use of a medication reconciliation process and identify whether there were differences by discharge destination, length of stay, type of patient or unit of discharge. Theoretical Framework: The Shannon‐Weaver Model of Communication guided this study. Poor communication of medical information at transition points is responsible for as many as 50% of all medication errors. Patients are particularly vulnerable upon discharge from an acute care setting. Methods: A descriptive comparative design was used to perform a retrospective chart review on a convenience sample of 159 adult patients aged 65 years and older with a medical or surgical diagnosis that were direct or emergent admissions and subsequently discharged from an acute care hospital. Results: A total of 56 (5.1%) medication variances at discharge occurred over a one‐year study period. Thirty patients (18.9%) were discharged from an acute care hospital with medication variances on the discharge medication list. Of those patients with variances, most had one (47%) or two (33%) medication variances. There was no significant difference in the number of medication variances for elderly patients age 65 and older by discharge destination, length of stay, type of patient or unit of discharge. Discussion: Medication variances occur at care transitions even with a medication reconciliation process for elderly patients within an acute care hospital. This study reported a lower incidence of medication variances for discharged elderly patients from an acute care hospital than reported in the literature prior to the mandate for medication reconciliation. Implications for Practice: There is no real gold standard for the discharge planning process and its many facets regarding the medication regime. Transitions such as discharge remain problem prone and a vulnerable point of care of elderly patients without a structured and consistent process for discharge planning. Page 161
Poster Session I Refugee Mothers Study: Raising Children with Special Needs Jean E. Beatson, EdD, MS, RN, University of Vermont, Jericho, VT Purpose: The purpose of this study was to understand and identify the perceptions of refugee mothers who have children with special needs regarding their educational and healthcare needs of their children. Background Vermont is a refugee resettlement site and as such has a yearly influx of refugees from Asia, Africa and Eastern Europe. This small study, funded by the Women’s Center at the University of Vermont, provided an initial inquiry into the experiences of refugee mothers raising their children with disabilities. Methods Design: This was a qualitative study, inductive in nature and most aligned with a grounded theory design. No hypothesis’ were formed a priori. Participants: Five Somali Bantu mothers, and one father (husband of one of the mothers) were interviewed. A Somali Bantu professional interpreter and cultural broker was used for all interviews. The father spoke English. Setting: All were interviewed privately in their homes at a time of their convenience. Data Collection. A semi‐structured open ended interview was created. All interviews were audiotaped and field notes were also taken for each interview. Tapes were transcribed by an employee of the University of Vermont. Analytic Approach: The data were coded and categorized into themes (Glesne, 1999), and organized into realist tales (VanMaanen, 1988) providing thick description using the participants own words.. Results Four predominant categories emerged from the data: helpful strategies, needs, wish that professionals would do, and the most difficult thing in raising a child with a disability. Two themes emerged from the data within the most difficult category: not understanding and managing special needs. Conclusions and Implications: This small study demonstrates that there is a great need to understand the refugee experience in raising children with special needs in this country. Word had gotten out that the research was happening and many more wished to be interviewed. Professional implications include better communication on critical topics, the role of Native healing, and understanding the help needed. Page 162
Poster Session I High Functioning Autism/Asperger's Syndrome: Family Issues Susan Ann Vitale, PhD, RN, PNP, ANP, Molloy College, Port Jefferson, NY Purpose: To understand the experience of parents and family members of a child diagnosed with High Functioning Autism/Aspergers Syndrome Background: Autism is considered a spectrum of disorders with many individuals suffering from degrees of mental retardation and significant language deficits. Aspergers Syndrome and High Functioning Autism are part of this spectrum however intellectual functioning is often normal or superior with deficiencies noted in social and communication skills. Diagnosis can be delayed as symptoms may overlap with normal or more "typical" children and various mental health conditions. Literature on family life for those involved is limited. Research Design: Qualitative Hermeneutic Phenomenology. Interviews were conducted with parents and adult family members to identify their experiences. Follow‐up provided confirmation and the opportunity to further explore expressed issues. Common themes were identified. Results: Pre‐diagnostic frustrations lead to hope for appropriate education and treatment. Information was welcomed yet not consistently sought. Feelings of isolation, stigma, and embarrassment complicated striving for stability and normalcy. Hope and positive outcomes were uncovered in the midst of daily associated stress and struggles. Family life revolved around the child’s issues. Each creatively adapted and responded to unusual challenges. Parents described unique personal efforts to enhance the child's functioning in society. Parental confidence and self awareness were recognized as a gradually perfected defense system against social expectations for a more typical child. Parents wished for a higher degree of public awareness. No personal regrets were described. Family members cherished the child’s uniquely positive traits. Parents and adult siblings worried over future hurdles anticipated. Conclusions and Implications: Health care professionals need to be provided with current information on Autistic Spectrum Disorders of a high functioning level. Increased awareness of unique family issues will augment services provided to the family. Appropriate anticipatory guidance and support is needed. Page 163
Poster Session I Electrocardiographic ST Segment Monitoring in Patients Undergoing Polysomnography Kathy J. Booker, PhD, RN, CNE, Yale University, New Haven, CT J. Steven Arnold, MD, Decatur Memorial Hospital, Decatur, IL Barbara J. Drew, PhD, FAAN, University of California‐San Francisco, San Francisco, CA Sleep disordered breathing (SDB) is a major health issue affecting an estimated 15 million Americans (Somers, et.al, 2008). Patients with SDB may be at risk for coronary heart disease (CHD). Purpose: This study was designed to evaluate ST segment changes during polysomnography and the relationship between ST changes and demographic variables, CHD risk factors, body mass index (BMI) and SDB measures. Levine’s theoretical framework guided the study. Methods: Consecutive patients referred for polysomnography over a 3 month period were invited to participate. Demographic and sleep disturbance data were collected. Twelve lead ECG monitoring was conducted overnight during polysomnographic recording. Results: The sample included fifty four patients; 52% were men. All but 8 (85%) had significant respiratory disturbance index (RDI) ≥15, mean = 23.3 ± 8.9. Forty patients (74%) had at least one CHD risk factor but only 6 patients (11%) gave histories of CHD. Twenty‐two (41%) of patients enrolled had baseline 12 lead ECG abnormalities (eg. QT prolongation, bundle branch block, atrial fibrillation). Two patients (4%) developed significant ST segment depression and/or T wave inversion. In both patients, the events were transient and occurred with high RDI but neither patient had CHD history. RDI was associated with BMI, r (52) = .427, p = .001 but not with cardiac risk factors, ST changes, or gender. Patients with a positive CHD history had more baseline ECG abnormalities on admission to the study (c2 = 10.7, df = 1, p = .001). Conclusions & Implications: While a small percentage (4%) of patients in this study developed evidence of myocardial ischemia during polysomnography, 41% had abnormal baseline ECGs. Occult ECG abnormalities in patients with sleep disordered breathing are common and cannot be detected with a single ECG lead during standard polysomnography. Further studies involving larger samples of patients are recommended. *Somers, V.K., White, D.P., Amin, R., Abraham, W.T., Costa, F., Culebras, A., Daniels, S., Floras, J.S., Hunt, C.E., Olson, L.J., Pickering, T.G., Russell, R., Woo, M., & Young, T. (2008). Sleep apnea and cardiovascular disease. Journal of the American College of Cardiology, 52(8), 686‐717. Page 164
Poster Session I Sleep Quality, Fatigue, and Depression in Fathers of Newborn Twins Elizabeth G Damato, PhD, RN, CPNP, Case Western Reserve University, Hudson, OH ~ Jennifer A Brubaker, MSN, RN, FNP‐BC, Case Western Reserve University, N. Olmsted, OH ~ Christopher Burant, PhD, Case Western Reserve University, Cleveland, OH ~ Lauren Flaherty, BSN student, Case Western Reserve University, Tyngsboro, MA ~ Nahida Gordon, PhD, Case Western Reserve University, Cleveland, OH ~ Jutarat Mesukko, BNS, MNS, PhD (c), Case Western Reserve University, Cleveland, OH ~ Jessica Vida, BSN student, Case Western Reserve University, Streetsboro, OH ~ Elise Wiesenthal, BA, Case Western Reserve University, Rochester, NY Purpose: Although mothers are typically the primary care providers for newly born infants, fathers of twins often balance employment responsibilities while actively participating in parenting tasks during the early postpartum period. Fathers of newborn twins are at particularly high risk for poor sleep quality, excessive fatigue, and depressive symptoms. Recent evidence supports significant associations between sleep quality, fatigue, and depression in mothers, yet little evidence exists regarding these factors in fathers. This analysis explored relationships among sleep quality, fatigue, and depressive symptoms in fathers of twins during the first 3 months postpartum. Theoretical Framework: Barnard’s Child Health Assessment Interaction model guided this study. In Barnard’s model, the function and development of the family unit is affected by interactions between infant, parents, and environment. Methods: A descriptive longitudinal design was used. Eighty fathers of twins were recruited from four delivery hospitals in a Midwestern metropolitan area. Standardized instruments measuring sleep quality, fatigue, and depression were administered in the home three times during the first 12 weeks after the twins’ hospital discharge. Descriptive statistics, correlational techniques, and repeated measures analyses will be employed to investigate relationships among sleep quality, fatigue, and depression, as well as the variation over time in fathers of twins. Results: Data collection is complete and data analysis is in progress. Conclusions & Implications: Inadequate sleep and fatigue adversely affect physiologic and behavioral health, interfering with parenting activities that stimulate optimal infant development. Mild to severe levels of depression have been associated with impaired parenting in fathers as well as mothers. Poor sleep quality and fatigue may explain in part the prevalence of depression observed in new fathers. Findings from this analysis will extend our understanding of postpartum paternal adjustment and can be used to develop future interventional strategies that minimize depression in families with twins. Page 165
Poster Session I The Caregiving Trajectory: A Longitudinal Exploration of the Work of Spousal Caregiving in Heart Failure Lisa Kitko, RN, PhD(c), CCRN, The Pennsylvania State University, University Park, PA Judith E Hupcey, EdD, CRNP, The Pennslyvania State University, University Park, PA Purpose: The purposes of this study are to gain a deeper understanding of the types of work manifested across 12‐18 months of spousal caregiving for heart failure (HF) and to generate a middle‐range theory of spousal caregiving explicating the phases of the caregiving experience. Background: The number of patients with HF is at epidemic proportions resulting in major clinical, social, and economic problems in the United States. Almost 6 million Americans live with HF and 670,000 new cases are diagnosed yearly. As a leading cause of morbidity and mortality, HF contributes to more than 280,000 deaths annually. Despite recent advances in therapy, mortality remains high and only half of the patients live five years after diagnosis. Methods: This study is an extension of a longitudinal study that identified the palliative care needs of HF patients and their spousal caregivers. Interview data from 46 spousal caregivers who were interviewed monthly about their experiences and needs will be included. The method of grounded theory was selected to answer the research questions. The Illness Trajectory (Weiner & Dodd, 1993) frames the study as the changes and transitions of the work of caregiving are identified and the types of work manifested over time defined. Results: The goals are to longitudinally capture the dynamic flow of the types of work across the HF trajectory and to generate a middle‐range theory of spousal caregiving for heart failure. Conclusions/Implications: Heart failure significantly impacts life for both patients and families, in particular family caregivers. These caregivers, in many instances the spouse, are integral partners in care for patients with HF; providing significant contributions to that care. Thus, the needs of these caregivers cannot be ignored. By understanding of the types of work of spousal caregiving across the HF trajectory, targeted interventions can be developed and services tailored and coordinated to meet the changing needs of both patients and caregivers. Page 166
Poster Session I Perceived Involvement in Treatment Decision‐making, Uncertainty, and Quality of Life in Patients with Head and Neck Cancer. Miho Suzuki, RN, MSN, New York University, Astoria, NY ~ Deborah A Chyun, RN, PhD, New York University, New York, NY ~ Judith Haber, RN, PhD, New York University, New York, NY ~ Marc Scott, PhD, New York University, New York, NY Purpose: To explore the relationships among perceived involvement in treatment decision‐making, uncertainty, and quality of life (QOL) in patients with head and neck cancer. Theoretical Framework: Based on Mishel’s uncertainty in illness theory, it was hypothesized that patients experience less uncertainty when they perceive that they can express their concerns to their healthcare providers and receive adequate information about symptoms and be involved in treatment decision‐making, and in turn, patients who feel less uncertainty are more likely to maintain their QOL. Methods: A prospective explanatory design. Data were collected at pre‐treatment (T1) and post‐
treatment (T2) by a questionnaire containing the Perceived Involvement in Care Scale (PICS), Mishel’s Uncertainty in Illness Scale for Adult (MUIS‐A), and Functional Assessment of Cancer Therapy ‐ Head and Neck (FACT‐H&N). A convenience sample of 52 patients newly diagnosed with head and neck cancer was recruited from multiple institutions; 39 participants completed the questionnaire at both T1 and T2. Correlation and multiple regression analyses were performed. Results: Uncertainty and QOL were significantly negatively correlated in both T1 and T2, whereas perceived involvement in treatment decision‐making was not significantly correlated with uncertainty or QOL in either T1 or T2. QOL at T1 and T2 were strongly correlated and decreased from T1 to T2. Pre‐
treatment uncertainty predicted post‐treatment quality of life. In cross‐sectional analyses, unemployment and depressed feelings were significant factors affecting QOL. Conclusions & Implications: A part of Mishel’s theory that patients who feel less uncertainty have better QOL was supported. The study suggested that intervention in maintaining employment and mental health may help patients improve QOL. Page 167
Poster Session I The Reliability and Validity of the Translated Chinese Version of Self‐Efficacy and Outcome Expectations of Exercise Scales (SEE & OEE) Bing‐Bing Qi, PhD, RN, Villanova University, Bryn Mawr, PA The purpose of the study was to test the reliability and validity of the translated Chinese version of Self‐
efficacy and Outcome Expectations of Exercise scales (SEE & OEE). Conceptual Framework: Based on Bandura’s Self‐Efficacy Theory. Methods: This study was a cross‐sectional, correlational study conducted in the Immigration Clinic in Chinatown Philadelphia. Mandarin‐speaking immigrants (n = 110) were recruited for the study. The mean age was 63.4 years old (SD+9.6). The participants completed SEE and OEE, demographic data form, and a paper‐and‐pencil survey that included assessments of frequency and duration of exercise and self‐rated health status, and Yale Physical Activity Survey (YPAS). The reliability was evaluated by measuring internal consistency. Validity testing was based on criterion‐related validity and hypothesis testing. Results: The results showed that the Cronbach Alpha was 0.899 for SEE and 0.930 for OEE, respectively. SEE was significantly correlated to the reported exercise behavior and physical activities including total time on exercise, total time on physical activity (r=0.19 p<0.05 and r=0.33, p<0.01 respectively) and total energy expenditure on physical activity (r=0.30, p<0.01). Validity of SEE and OEE was evidenced by hypothesis testing: Individuals who participated in exercise regularly had a higher level of self‐efficacy and outcome expectations for exercise when compared with individuals who did not exercise regularly (p<0.01); Individuals who have a better health status were more likely to have stronger self‐efficacy and outcome expectations (r=0.41 p<0.001 and r=0.25, p<0.05, respectively). Conclusion: The preliminary testing of the Chinese version SEE and OEE provided some evidence for the reliability and validity of these instruments. They may provide a valuable assessment of exercise self‐efficacy and outcome expectations for older Mandarin‐speaking Chinese immigrants. Page 168
Poster Session I Diabetes Disease Management in a Home Care Setting Joanne M Dalton, PhD, APRN, BC, Regis College, Weston, MA Purpose: The purpose of this project is to build upon the program evaluation project completed by Dalton, Garvey and Samia (2006) and determine which one of three different approaches to diabetes care in home healthcare improves self‐care better. Theoretical Framework: Orem's Self‐Care Deficit Theory of Nursing provides the conceptual framework for this study. The diagnosis of diabetes challenges a patient’s self‐care agency. Self‐care agency is influenced by basic conditioning factors (patient characteristics) and power components (capabilities that empower the patient to perform self‐care activities) as well as nursing systems (diabetes disease management). When self‐care agency is not adequate, a self‐care deficit occurs. In this project, three variables represent self‐care deficit: emergent care, inpatient facility admission, and glucose control. Methods: This project has a retrospective, non‐experimental, three‐group design. Group 1 (n=64) received an experimental Diabetes Disease Management Program (DDMP), Group 2 (n= 167) received diabetes services during a Diabetes Learning Collaborative (DLC) and Group 3 (n=132) received standard diabetes home care. Adult home healthcare patients (18 years and older) with Type 1 or 2 diabetes as their primary home care diagnosis were included in the project. Data were collected retrospectively from three sources: clinical records, the agency billing system, and the Outcomes Assessment Information Set (OASIS). Frequencies, measures of central tendency, chi square analysis, and Kruskal‐
Wallis tests were completed to examine differences among the three groups. Logistic regression was performed to examine the effects of the experimental DDMP, DLC, and standard diabetes care on discharge self‐care deficit. The level of significance was .05. Results: No statistically significant group differences were found regarding self‐care deficit. A significant clinical finding was that 46 % of patients (n=117) whose discharge glucose was tested did not meet the American Diabetes Association criteria. Conclusions and Recommendations: Larger samples are required to determine the best approach for home care diabetes disease management and the future use of OASIS in nursing research. Page 169
Poster Session I Catheter Ablation for Symptomatic Atrial Fibrillation Improves General Health Perception Aileen M Ferrick, RN, MSN, ACNP‐C, FHRS, NYU Medical Center, Larchmont, NY Anthony Aizer, MD, MS epidemiology, New York University School of Medicine, New York, NY Larry Chinitz, MD, FACC, New York University School of Medicine, New York, NY Deborah Chyun, RN, MSN, PhD, New York University, New York, NY Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Symptomatic episodes affect quality of life (QoL). Pharmacologic therapy is largely ineffective. Radiofrequency catheter ablation (RFCA) offers a cure and has become a popular treatment option for symptomatic AF. Anxiety related to symptoms may be a factor affecting quality of life. Hypothesis: Patients have a diminution of anxiety and improved QoL following RFCA. Methods: A longitudinal, pilot study of 51 patients undergoing RFCA for symptomatic AF was conducted. An SF‐36 and a Beck Anxiety Inventory (BAI) questionnaire were obtained at baseline and post‐RFCA at 19.51 days + 5.9. Complications and efficacy of procedure were assessed during follow‐up. Results: There were 34 males (66.7%). The average age was 57.6 yrs + 8.6. Patients with co‐morbidity include: 18 HTN, 5 DM, 3 CHF, 2 valvular heart diseases and 4 CAD. Significant improvement was seen in general health perception with pre‐RFCA mean = 67.2 + 21.8 and post‐RCFA mean = 75.2 + 20.7 (p< .014). No differences were seen in other QoL domains. There was no difference in the BAI scores. Conclusions: Immediately post‐RCFA there is a significant increase in general health perception. Other parameters of anxiety and QoL are unchanged. Assessment of QoL and anxiety following a longer period after RFCA for AF may reveal more significant changes. Page 170
Poster Session I Older Patients in Acute Care Setting (OPACS) Instrument Validation Mary P O'Connell, RN, MPA, CPHQ, Elmhurst Hospital Center, New York City, NY ~ Tita D Castor, MD, Elmhurst Hospital Center, Elmhust, NY ~ Lillie M. Shortridge‐Baggett, EdD, FAAN, FNAP, RN, Pace University/Elmhurst Hospital Center, Ardsley‐on Husdson, NY Purpose: Geriatric care competencies in healthcare are an emerging national mandate as older adults account for over half of hospital days in the United States. Little research has examined the care required by older people in the acute care setting. The Older Patients in Acute Care Setting (OPACS) instrument was developed by Australian researchers and validated at two suburban acute care settings in the United States. The purpose of this study is to validate the OPACS Instrument in a large, urban American setting with a culturally diverse group of nurses. Theoretical Framework: No specific theoretical framework was used for the instrument development and validation. Methods: The OPACS instrument is an 86 item self‐report questionnaire related to 13 areas that influence the care nurses provide to, and the attitudes and knowledge they possess about older patients in acute care settings. The subjects are a convenience sample of RNs’ working at large, urban hospital with an older adult in‐patient population. The ethnicity of participants will resemble the diverse workforce A sample of 300 is set as goal. A 10% convenience sample of nurses will be asked to re‐take the survey 3 weeks later to determine stability. Data entry will be completed electronically into an Excel database using customized scanning sheets. The data will then transferred to and analyzed using SPSS Version 17.0. Descriptive and inferential statistics will be utilized to determine the tool’s stability (Pearson’s correlation), internal consistency (Cronbach’s alpha) and difference between group means (Pearson’s correlation). Results: A total of 200 questionnaires have been collected. The data analysis is in process now. Conclusion/Implications: The overall goal is to validate an instrument that can be used to measure knowledge, belief and attitude that can be used to design models of care and educational programs for more competent delivery of services to the elderly in the acute care setting. Page 171
Poster Session I Hispanic Persons’ Narratives of Managing Multiple Chronic Illnesses Louise Reagan, MS ANP‐BC, University of Connecticut, Vernon, CT Purpose: To gain understanding of Hispanic persons' perspective of how they manage multiple chronic illnesses (CI). Background: Hispanic persons living in the United States are 1.6 times as likely to die from diabetes compared to non‐Hispanic whites. Hispanics have an increased prevalence of asthma, obesity, and COPD compared to non‐Hispanic whites. Even though commonalities exist by nature of their language, Puerto Ricans, for example, may share unique cultural and health beliefs from those of other Hispanic subcultures. Having a greater understanding of these cultural differences and how they impact CI management will provide insight for health care providers (HCP) caring for Hispanic persons. Methods: Riessman’s method of thematic analysis was used for this narrative analysis. Three English speaking Puerto Rican adults were recruited from an urban hospital based primary care clinic. All participants had at least two CI’s with one being Type 2 diabetes mellitus (T2DM). The participants were asked: Please tell me your story about how you take care of or manage your diabetes and other CI’s. All interviews were audio taped in their entirety and transcribed verbatim. Results: Nine themes were identified: 1) Life pre‐CI 2) It’s all about the diabetes 3) Impact of CI self‐
management on life 4) The not so hum‐drum of daily medication use 5) Fear of insulin and finger sticks 6) Dealing with uncertainty 7) Do this, and don’t do that or else, see you in three months 8) Treasuring social support 9) Declarations of strength. Conclusions and Implications: CI management is frightening at times, yet life goes on, notably with an optimistic outlook for these Puerto Rican persons. T2DM and its management took center stage above all other CI’s. The narratives displayed a superficiality of knowledge for all aspects of CI management. Participants expressed a need for more health and illness management education as well as more time with their HCP, yet none initiated an interaction or conversation with any member of the health care team in order to meet these needs. Participative research that empowers Puerto Rican persons to engage with their health care provider and system is needed. Page 172
Poster Session I Clinical Decision‐Making by Mid‐level Critical Care Practitioners Working in an Interdisciplinary Team Melinda Darrigo, PhD, MS, NP, CCRN‐CSC, University of Massachusetts ‐ Graduate School of Nursing/, Leominster, MA ~ Kathleen Miller , EdD, ACNP‐BC, FAANP, University of Massachusetts ‐ Graduate School of Nursing Worcester, Worcester, MA ~ Lisa Ogawa, PhD, MS, RN, University of Massachusetts ‐ Graduate School of Nursing Worcester, Worcester, MA ~ Susan Sullivan‐Bolyai , DNSc, CNS, RN, University of Massachusetts ‐ Graduate School of Nursing Worcester, MA Purpose: The purpose of this dissertation research was to describe how critical care nurse practitioners and physician assistants (mid‐level practitioners) make decisions within an interdisciplinary team. Background: Interdisciplinary teams in intensive care units across the United States include mid‐level practitioners under the direction of an intensivist to assess and manage critically ill patients. However, how clinical decision‐making by these mid‐level practitioners occurs has not been described. Methods: Focus groups were conducted. An interview guide was developed from the empirical literature to lead participant discussion. To enrich discussion, a clinical vignette was used. Three focus groups were conducted with 17 mid‐level critical care practitioners working in interdisciplinary teams. Data were recorded on an easel and were audio taped to confirm accuracy of quotes. Note‐based analysis was used to examine the data. Results: A web of complexity in decision‐making was described including an overarching theme of quality of care. The participants described three central overlapping themes: judgment, resources, and negotiation. Four interwoven subthemes: trust, communication, experience, and team structure were also described. Additionally, trust and telemedicine have not previously been reported, but were described as important concepts influencing decision‐making. Conclusions & Implications: Decision‐making by mid‐level critical care practitioners in interdisciplinary teams is a complex and dynamic process. Given these complexities, it is important to educate team members how decisions are made. The interdisciplinary model presented provides a developing framework for future research examining interdisciplinary team members decision‐making. This understanding may indirectly influence the quality of care for critically ill patients and facilitate research examining structure of interdisciplinary critical care teams. Page 173
Poster Session I Nurses’ Perceptions of Practicing with Impaired Health Care Professionals Kathleen M Fisher, PhD, CRNP, Drexel University, Philadelphia, PA ~ Frances Cornelius, PhD, MSN, RN‐BC, CNE, Drexel University, Philadelphia, PA ~ Judith Draper, MSN, GNP, BC, University of Pennsylvania, Philadelphia, PA ~ Theresa Fay‐Hillier, MSN, PMHCNS‐BC, Drexel University, Churchville, PA ~ Susan Solecki, MSN, FNP‐BC, PNP‐BC, Drexel University, Philadelphia, PA Purpose: An estimated 10% to 15% of all health care professionals will misuse drugs or alcohol at some time during their career. Nurses were surveyed on their experiences with impaired health care professionals. Framework: At a national nursing education conference, nurses were surveyed using an automated response system, better known as “clickers.” This is an underutilized data collection strategy allowing for anonymous evaluation of controversial and sensitive topics. Method: Following IRB approval, a cross sectional pilot study was employed to interactively survey a convenience sample of nurses attending a panel presentation on the “Impaired Health Professional”. Data Analysis: Descriptive statistics and bar graphs were displayed in real time as participants answered questions developed by the researchers. Results: Respondents were 208 nurses. They were largely female (93%), mostly academic faculty (63%) with at least 25 years of experience (58%). Most (75%) had experience working with impaired professionals and almost all (95%) felt accountability to report the impaired healthcare professional. A majority (67%) of the nurses also expressed feeling comfortable assisting with the rehabilitation program and monitoring process of a chemically impaired nurse returning to work. Most (91%) felt those with addictions could be in the health care professions and 86% felt they could not refuse to work with a rehabilitated peer. Conclusions & Implications: It is not surprising that a large majority (75%) of respondents had experience working with an impaired professional. Further education and rehabilitation programs are necessary for the identification, assessment, and treatment of impaired professionals. Continued research, by replicating this pilot study with a larger more diverse sample of nurses, may enlighten perceptions of addiction as a disease in which all members of the nursing community can play a positive role in the reestablishment of colleagues to the workplace. Page 174
Poster Session I Kangaroo Care Reducing Bio‐behavioral Pain Responses in Preterm Infants: A Pilot Study Xiaomei Cong, Assistant Professor, University of Connecticut, Storrs, CT Susan M Ludington, Professor, FAAN, Case Western Reserve University, Cleveland, OH Purpose: The purpose of this cross‐over pilot was to test mother Kangaroo Care (KC) effects on bio‐
behavioral responses to heel stick pain in preterm infants with 30‐32 weeks gestational age and 2‐9 days old. Theoretical Framework: KC is a promising method to blunt pain responses because some of its components including maternal touch, warmth, respiratory movement, heartbeat, and odor have been found to reduce the severity of responses to stress and pain. Method: Mother‐infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first in a two‐day test. Study 1 (80‐min study, N=18) tested the effect of 80 minutes of KC before and throughout heel stick procedure vs. undisturbed incubator care. Study 2 (30‐min study, N=10) tested 30 minutes of KC before and throughout heel stick vs. incubator care. KCH and IH began during a pre‐
measurement and continued through four data collection phases: Baseline, Heel Warming, Heel Stick, and Recovery. Infants’ facial actions, heart rate, oxygen saturation responses were measured every 30 seconds during data collection; salivary cortisol was measured at the end of Baseline and Recovery; serum cortisol was measured during Heel Stick. Results: The 80‐min study showed no differences between KCH and IH. The 30‐min study resulted in higher oxygen saturation during Heel Stick (KCH: 96.83 ± 2.13, IH: 93.71 ± 3.54, p<0.05), lower salivary cortisol at the end of Recovery when adjusted for baseline values (KCH: 0.21 ± 0.12 ug/dL, IH: 0.57 ± 0.61 ug/dL, p<0.01), and lower serum cortisol during Heel Stick (KCH: 5.63 ± 2.31 ug/dL, IH: 9.15 ± 6.59 ug/dL, p<0.05), in favor of the KCH condition. Conclusions and Implications: Results support that the use of KC, a nonpharmcological intervention, reduces bio‐behavioral pain responses in preterm infants undergoing procedural pain but need to be confirmed by definitive studies. Page 175
Poster Session I A Qualitative Study of TASO's Home‐Based HIV Counseling and Testing Program in Rural Uganda Gene Elizabeth Harkless, DNSc, ARNP, CNL, University of New Hampshire, Alton, NH Lindsay Erin Bergmann, Student, University of New Hampshire, West Chesterfield, NH Purpose: The prevalence of HIV/AIDS in Sub‐Saharan Africa remains at epidemic proportions. To ramp up testing and treatment, The AIDS Support Organization of Uganda (TASO) has recently initiated a Home‐based HIV Counseling and Testing (HBHCT) program. As this is a new program to the Mbale district, little was known about how this program is experienced by staff and clients. Therefore, this participant‐observation field study aimed to describe the experiences of HBHCT from observations and interviews with counselors, field officers, and clients. Background: Sub‐Saharan Africa has 67% of the global population living with the HIV virus and 75% of global deaths related to AIDS in 2007. In Uganda, the HIV prevalence of over 20% in the early 1990s declined to about six percent in 2000, and since then has gone down only slightly to about 5.4%. HBHCT may be helpful in reducing that prevalence rate by 40% as well as reaching 240,000 people with anti‐
retroviral treatment by 2012, both of which are Ugandan national targets. Methods: This participant‐observation field study was approved by UNH IRB and TASO before data collection began in the Mbale district of Uganda. In‐depth interviews including the encouragement of story‐telling, along with participant observations captured through extensive field notes contributed to a rich description of TASO's HBHCT work. Fifteen counselors, field officers, and clients were interviewed and twenty‐one participant observations were conducted. Results: A preliminary analysis of the data revealed common themes in the experience of HBHCT workers. Field officers were observed having difficulty with documentation that was consistent from client to client. Also, due to the variable home conditions, basic hand washing between client visits was difficult and gloves were not consistently changed between patients. Lastly, time challenges were a common theme in the interviews and observations, as missed appointments were frequent and counseling sessions were often not carried out for adequate time. This is a critical observation as the majority of all clients requested for more counseling during interviews. Conclusions and Implications: HBHCT is a complex program that has the potential to be an effective intervention in the HIV epidemic. Further study needs to focus on outcomes. Page 176
Poster Session I Emergency Department Nurse’s Experiences of Violent Acts in the Workplace Paul S MacKinnon, PhD, RN, FNP, Saint Vincent Hospital, Charlton City, MA Purpose: The purpose of this study was to examine the experiences of emergency department (ED) nurses with workplace violence. Background: Workplace violence is a major problem for emergency department nurses. Approximately 52% to 82% of emergency nurses experience physical violence and 100% experience non‐physical violence in their careers. Despite these data, there are limited studies examining workplace violence among this vulnerable group. Theoretical Framework: Levin et al.’s (2003) Ecological Occupational Model (EOHM) was used to guide this study. According to this framework, the emergency department is composed of an inter‐dynamic set of variables that includes: personal, workplace and community factors. Methods: This study used a qualitative descriptive design. Four focus groups using note‐based analysis were conducted with 27 nurses (Mean age = 44.6, SD = 10.4). Focus groups were segmented by ED type (rural, community, small urban and large urban Level 1 trauma center). Results: 96% of the participants experienced some form of work‐related violence and 75% had attended at least one violence education class. The major themes of frustration and powerlessness emerged from these data. Sub themes included professional conflict while caring for violent patients, personal detachment as an emotional survival mechanisms, and feelings of victimization. Additional factors contributing to workplace violence included: personal attributes of the nurse, workplace, and the community where the emergency department was located. Conclusions & Implications: Frustration and powerlessness are important factors that influence the violence experience of ED nurses. Conflicts with the ethical tenants of nursing practice arise when ED nurses care for violent patients. Results of this study have important implications for intervention development to reduce workplace violence. Page 177
Poster Session I Supporting Age Diversity in the Nursing: An Examination of Work Patterns in the Oldest RN Cohorts Mary Val Palumbo, DNP, APRN, GNP‐BC, University of Vermont, Burlington, VT Betty Rambur, PhD, RN, University of Vermont, Burlington, VT Purpose: Using nurse workforce data from one rural state, patterns of employment for nurses age 60‐64 and 65+ over 4 years were examined. Analysis of this sector can be used to inform nurse administrators, educators and leaders of upcoming trends in nurse workforce employment. Theoretical Framework: Principles of Human Capital (Schultz, 1981). 3. Methods ‐ Survey methodology was used to study the entire population of RNs in a small rural state in 2005, 2007 and 2009. The relicensure survey utilized the minimum data set recommended for nurse workforce assessment. Descriptive statistics analyzed demographics and employment characteristics. Sample: A total of 15,235 surveys were returned during three RN relicensure periods. The response rates were 54%, 51% and 65%. Further analysis was conducted on RNs age 65+ (796) and age 60 ‐64 (1153), for a total n=1949. Results: In the 65+ age cohort, the percent that engaged in direct patient care increased (45%; 53%; 58%) and this was not evident in the younger cohort. Shifts in employment setting were also noted. Specifically, over time a greater proportion of the oldest group were employed in hospital settings, with a smaller proportion in home health. Employment in nursing homes reMNd largely constant in both groups. Conclusions & Implications: These finding are in direct contrast to previous studies in the same setting that found nurses were employed in areas of less patient acuity as they age. It is possible that the economic recession is impacting the older generation of nurses and prompting them to work in settings such as the hospital that typically have better salary and benefits. If this trend becomes widespread, hospitals will be under increasing pressure to create a physical environment more conducive to the older worker. Implications for health policy and financing and hospital strategic planning are discussed. Page 178
Poster Session II A Pilot Study of Factors Related to Postoperative Weight Changes and Health Outcomes Among Older Coronary Artery Bypass Graft Surgery Patients Rose Ann DiMaria‐Ghalili, PhD, RN, Drexel University, Jenkintown, PA Charlene Compher, PhD, RD, FADA, University of Pennsylvania, Philadelphia, PA Eileen Sullivan‐Marx, PhD, RN, FAAN, University of Pennsylvania, Philadelphia, PA Background and Purpose: Coronary artery bypass graft (CABG) surgery is associated with unintentional post‐operative weight loss. In older adults, unintentional weight loss can lead to sarcopenia, a measurable loss of muscle mass and/or muscle strength. Therefore, this study examined the feasibility of measuring physical, biological and psychosocial factors associated with unintentional post‐operative weight loss in adults ≥ 65 years old undergoing CABG or CABG+valve surgery at preoperative and week 6 post‐discharge. Theoretical Framework: Sarcopenia and Surgical Stress Framework. Methods: Utilizing a prospective longitudinal design, data were collected for 20 community‐dwelling, English‐speaking, cognitively intact, older adults without cancer or immune compromise. Nutritional (weight, height, serum albumin, prealbumin, leptin and ghrelin, Mini‐Nutritional Assessment™[MNA], and appetite assessment) inflammatory (serum IL‐6 and hs‐CRP), physiological stress (salivary cortisol), functional status (hand‐grip strength, timed‐chair stance, Activities of daily living [ADL], Instrumental activities of daily living [IADL]), cognitive (Mini‐Mental State Examination), and depressive symptoms (Geriatric Depression Scale‐Short Form), measurements were collected at preoperative and week 6 post‐discharge. Results: The mean age of participants was 72.25 ± 5.24 yrs, 70% male (n=16, four patients lost to follow‐
up). Ninety‐three per cent lost weight (3.34 ± 1.62 kg). Inflammatory factors (hs‐CRP and IL‐6) continued to be elevated at week 6 post‐discharge (71% and 73% respectively). Muscle strength and IADL decreased and timed chair stance increased. Mid‐arm and calf circumference decreased in 67% and 47%, respectively. Overall nutrition status (MNA) slightly increased from baseline, but serum albumin and prealbumin decreased. The ADL, appetite, depression, and cognitive measurements did not change from baseline. Conclusion and Implications: In older cardiac surgery patients, early post‐operative weight loss is accompanied by a decrease in muscle function and mass, and a continued inflammatory response 6 weeks post‐discharge. Further research could examine the impact of cardiac surgery on sarcopenia in older adults. Page 179
Poster Session II Utilizing an Enhanced Oral Care Protocol to Reduce Ventilator Associated Pneumonia's Cynthia Padula, PhD, RN, The Miriam Hospital, Providence, RI Lisa J. Cuccio, RN, MSN, NE‐BC, The Miriam Hospital, Providence, RI Ventilator associated pneumonia (VAP), defined as pneumonia that develops in an intubated patient, represents the most common nosocomial infection in that patient population. Research has demonstrated that the oral cavity can become colonized with pathogens within 24 hours of intubation. Strategies to prevent this have been identified, including use of chlorhexidine (CHX). The purpose of this study is to examine the impact of .12% CHX on VAP rates in critical care patients. The Lifespan Institutional Review Board approved this research protocol. A pre‐post design is used. The sample includes all patients admitted to any of the critical care units and on mechanical ventilation at any time during the hospital stay. The setting is a 247 bed tertiary academic medical center. Data collection will extend over a 12‐month period. Six months of baseline data (February‐July 2009) was examined prior to the introduction of the enhanced oral care protocol with CHX. Nursing and respiratory therapy staff participated in a training session provided by the critical care educator before the revised protocol was introduced. Six months of data (August 2009‐January 2010) are being collected post implementation of the CHX oral care protocol. The protocol is being delivered every six hours and includes assessment of the oral cavity, toothbrushing, application of CHX with a foam swab to teeth, oral cavity, and tongue in a circular fashion over 30 seconds, and subglottic suctioning. Periodic documentation audits are being conducted to assure compliance with the protocol. Results will include examining differences in pre and post incidence rates for the critical care units. It is hypothesized the VAP rates will be reduced after introduction of an oral care protocol with CHX. For every VAP avoided, the institution will save an estimated $40‐57,000. Conclusions and implications for nursing practice will be presented and discussed. Page 180
Poster Session II Social Support and Positive Health Practices in Asian Americans in Late Adolescence: The Role of Mediating Variables Cynthia Ayres, PhD, RN, Rutgers, The State University of New Jersey, New Brunswick, NJ Purpose: To examine factors influencing the health practices of Asian American adolescents. More specifically, the purpose of this study was to examine relationships among social support (SS), optimism, acculturation, and positive health practices (PHP) in Asian American adolescents. Theoretical Framework: This study tested hypotheses based on the theoretical relationships and empirical evidence found in the existing literature. Methods: A non‐probability, convenience sample consisted of 226 Asian American late adolescent boys and girls between the ages of 18 to 24 years, attending a large university located in an urban setting. Using a correlational research design, theoretical relationships postulated between the dependent variable, PHP, and each of the independent variables of (a) SS (b) optimism, and (c) acculturation were empirically tested. Additionally, two mediational models constructed from theory and research was tested. It was predicted that 1) there would be a positive relationship between SS and PHP, 2) there would be a positive relationship between SS and optimism, 3) there would be a positive relationship between optimism and PHP, 4) when optimism was controlled for statistically, the relationship between SS and PHP would diminish and would not be statistically significant, 5) there would be a positive relationship between SS and acculturation, 6) there would be a positive relationship between acculturation and PHP, and 7) when acculturation was controlled for statistically, the relationship between SS and PHP would diminish and would not be statistically significant. Data collection is completed and currently being entered into SPSS for data analysis. Results: Still pending based on data analysis which will be conducted once data entry is complete. Conclusions: The findings of this study have the potential to add to the body of knowledge around positive health practices, the factors that promote the adoption and maintenance of healthy behaviors in Asian American adolescents, and in the development of culturally sensitive nursing interventions in this population. Knowledge gained will be important to help health professionals better understand how to encourage Asian Americans adolescents to develop health promoting behaviors, thereby fostering positive health practices. Page 181
Poster Session II The Influence of Glycemic Status in Patients with Cancer Marilyn J. Hammer, PhD, DC, RN, New York University College of Nursing, New York, NY Purpose: To describe, disseminate, and further investigate emerging evidence‐based knowledge about the deleterious impact of abnormal glycemic status in patients with cancer. Background: Abnormal glycemic levels among patients in critical care settings are a known contributor to infection and mortality rates. Research regarding the contribution of glycemic status in patients with cancer is in its nascence. Evidence is just beginning to emerge about the contribution of abnormal glycemic status to infection rates and related complications, including death, among patients with cancer; most notably within hematopoietic cell transplantation (HCT) populations. APPROACH: As a follow‐up to a recent retrospective study of HCT recipients, a prospective pilot study using a convenience sample of 75 patients newly diagnosed with any type of cancer who will receive care through the New York University Medical Center / Cancer Institute will be implemented. Data collection will include both physiologic and psychosocial measures over the course of nine months. Study analyses will include descriptive statistics and logistic regression to evaluate contributors to abnormal glycemic levels and associations between glycemic status and infection / infection‐related complications. Major Points & Rationale: Patients with cancer are susceptible to abnormal glycemic levels due to a number of factors including treatment‐related medications, nutritional imbalances, decreased physical activity, and stress. As much as 18% of patients with cancer also have a history of diabetes / pre‐
diabetes, which further impairs glucose control when going through treatments for cancer. Based on the theory of cancer immune surveillance – the immune system’s ability to detect and eliminate aberrantly forming cells – this research focuses on how abnormal glycemic levels impair immune cell function in patients with cancer, leaving them more susceptible to opportunistic infections and related complications. Additionally, impaired immune cell function can potentially leave a host susceptible to further malignancy formation. Conclusions: As further evidence emerges about associations between abnormal glycemic status and unfavorable outcomes in patients with cancer, future research endeavors need to focus on the contributors to abnormal glycemic status and interventions for better glycemic control. This research can lead to novel approaches for optimizing glycemic control for more favorable outcomes. Page 182
Poster Session II Development and Psychometric Evaluation of the Patients' Perceptions of Feeling Known by their Nurses Scale Jacqueline G. Somerville, RN, PhD, Massachusetts General Hospital, Newton, MA The importance of the nurse‐patient relationship to the overall well‐being of the person has been explored extensively by nurses. What is largely missing from knowledge developed to date is the patient’s perspective. The purpose of this study was to develop a reliable and valid measure of patients’ perceptions of feeling known by their nurses. The development of the Patients’ Perceptions of Feeling Known by their Nurses Scale (PFFKN Scale) was guided by Newman’s theoretical framework of Health as Expanding Consciousness (1994) and data from a qualitative descriptive study conducted in 2003 (Somerville). The current investigation focused on the development and psychometric evaluation of the PPFKN Scale. Four themes that emerged from the pilot qualitative, descriptive study were used to guide the development of the 85‐item scale. This scale was exposed to a panel of nurse experts to establish inter‐rater agreement and content validity, item understandability and readability. The revised scale was piloted with five participants who had experienced an inpatient, surgical admission to determine content validity, item readability and understandability. The revised 77‐item scale was then administered to 327 surgical inpatients across seven general care units at a large academic urban medical center. A sample size of 296 completed surveys was analyzed. A four‐component solution was devised using Principal Components Analysis with Varimax rotation. This four‐component solution accounted for 63.3% variance, with a total scale Cronbach’s alpha coefficient of 0.99. If an item failed to load at 0.3 on the expected component or did not make conceptual sense, the item was dropped. This process resulted in a reliable and valid 48 item PPFKN Scale with four components and a total scale Cronbach’s alpha coefficient of 0.98. This scale has the potential to assist nurses in exploring the impact of the current health care environment on the patient experience and the nurse‐patient relationship. Page 183
Poster Session II Development and Psychometric Evaluation of the Nurse‐Nursing Assistant Caregiver Reciprocity Scale (NNA‐CRS) Georgia P. Ameia Yen‐Patton, RN,MS,GNP‐BC, PhD(c), University of Massachusetts‐Lowell, Mattapoisett, MA ~ Alan Clayton‐Mathews, PhD, Associate Professor School of Urban Affairs and Pu, Northeastern University, Boston, MA ~ Jacqueline S Dowling, PhD, RN, University of Massachusett Lowell, Lowell, MA ~ Karen Devereaux Melillo, PhD, GNP, ANP‐BC, FAANP, University of Massachusett Lowell, MA The concept of intra and inter professional reciprocal caring relationships is intrinsic to the Nursing Scope and Standards of Practice (2004) and the ICN Code of ethics for nurses (Fry & Johnstone (2005) and has been identified as an area that needs to be addressed in nursing research and practice (DeMarco, 1998; Demarco, Horowitz & McLeod, 2000; Yonge & Molzahn, 2002).The purpose of this descriptive, cross‐sectional correlation survey pilot study (N=161, 3 nursing facilities) was to develop and validate the dimensions of the Nurse‐Nursing Assistant Caregiver Reciprocity Scale to be used as a tool to measure the quality of inter and intra professional relationships as perceived and expressed by nurses and nursing assistants in long term care. Lao Tzu & Confucius’s principle of reciprocity (550BC), Roger’s (1970) principle of reciprocity, Marck’s ( 1990), model of therapeutic reciprocity as a caring phenomenon, Carruth’s (1996) Model of caregiver reciprocity and DeMarco, Horowitz & McLeod’s Alliance model of intraprofessional alliances of reciprocal caring, provided the theoretical frameworks for this study. Exploratory and confirmatory factor analysis identified and supported construct validity for a 17 item, three factor model: Balance within long term care caregiving, intrinsic rewards of giving, and love and affection with Cronbach’s alphas of .80, .86 and .79. Item‐total correlations between .30 and .70 supported scale homogeneity. Orthogonal rotation was chosen for parsimony with varimax criteria and Maximum likelihood estimator. Kaiser‐Meyer‐Olkin Measure was .863. Factor loadings between .400 to .885 supported construct validity. Model fit was reasonably accepted with an AGFI of .819 and adjusted chi square between 1.0 and 3.0. Criterion‐related‐validity was supported using Kouvonen’s Social Capital Scale with Pearson r of .546. Currently the NNA‐CRS is being tested on a larger and more diverse sample (RNs, LPN, Nursing assistants) (N=approx 500) in 15 Nursing facilities in Southeastern Massachusetts. Page 184
Poster Session II Ethical and Methodological Issues in Sampling and Surveying Midlife Women on Beliefs and Behaviors Related to HIV Risk and HIV Testing Susan Lynde Hamilton, RN, MScN, CHNCS, PhD(c), University of Massachusetts ‐ Lowell, Newburyport, MA E. Andrés Houseman, ScD, The Warren Alpert Medical School of Brown University , Providence, RI Barbara Mawn, RN, PhD, University of Massachusetts –Lowell, Lowell, MA Purpose: To share ethical and methodological challenges experienced with a mailed survey study on health beliefs and behaviors related to HIV risk and HIV testing using a random sample of midlife women from 10 cities in MA. Theoretical Framework: Health Belief Model. The survey methodology is based on the work of Dillman. Methods: Cross‐sectional survey design using a newly designed Health Belief and HIV Testing (HBHT) Scale after pilot testing and psychometric testing. A sample of 150 women ages 50 to 59 was randomly selected from the 2008 annual city census for each of 10 MA cities (N=1500). Cities with the highest rates of HIV among women and/or proportion of midlife women who are Black or Hispanic were selected. A city census is done annually by the city clerk of each city/town in MA and maintained by the elections office of the Secretary of State. The data include name, date of birth, gender, occupation, U.S. citizenship status, and veteran status for each member of a household. Because the city census data are used for maintaining voting lists, no data is collected on race or ethnicity. Survey packages (2) and reminder postcard (1) were mailed using a method recommended by Dillman for multiple mailings of an anonymous survey on sensitive issues such as sexuality. Results: Survey response rate of 25% (n=383) with 23% of women from racial or ethnic minority groups, 22% with a high school diploma/GED or less education, and 24% with household income less than $30K. Mail returned as undeliverable (11%) and those who contacted the researchers and self‐identified as ineligible based on being unable to read survey (19), male (3), or HIV positive (1) were replaced in the sample. Thirty eight women (2.5%) refused, many because HIV was survey topic. Two non‐English speaking women contacted the investigators concerned the mailing was communicating either results of or needs for an HIV test and were contacted by a translator. Issues encountered related to language barriers, encouraging participation without biasing responses, and maintaining anonymity. Conclusions and Implications: Survey method yielded a random sample of women from diverse backgrounds sufficient to power study. Several ethical and methodological issues emerged with implications for future research and recommendations are made for changes to the survey method used. Lessons learned about the MA annual city census as a sampling frame for a random sample are discussed. Page 185
Poster Session II Health Insurance and Weight Status in 19 – 26 Year Olds: A Social‐Ecological Approach Jean Bernhardt, PhD(c), University of Massachusetts‐Boston, Salisbury, MA Purpose: The major purpose of this study was to examine the relationship of health insurance to weight status in 19‐26 year olds using body mass index (BMI) as the surrogate measure of body weight. It was hypothesized that having health insurance would predict lower BMIs. Theoretical Framework: The study is conceptualized within an adapted social‐ecological framework with emphasis on the interactions of individuals and their environments. Methods: This secondary data analysis includes data from 3804 young adults in the 2004 Medical Expenditure Panel Survey. Multivariate logistic regression analyses (using STATA 8.0) tested a recursive causal/path analytic model and structural equations to explain the likelihood of being obese (BMI=>30kg/m2). Youths’ race, gender, and education, along with parental education and obesity, were primary explanatory variables. Being on a restricted diet was considered a response to being obese as well as the characteristics of those with public insurance. Results: Preliminary results indicate being Black (OR 4.17), having a high school diploma or less (OR 1.56), with at least one obese parent (OR 1.80), all significantly increased the likelihood of being obese. Physical activity (OR .64) reduced the likelihood of obesity in males more than females and minorities. Private insurance was associated with lower BMIs (OR .74); however, young adults with public insurance (OR 1.35) had higher BMIs than those uninsured, suggesting unobserved differences in characteristics of young adults by type of insurance. Obese females were more likely to be on restricted diets and have public insurance. Conclusions & Implications: The influence of public and private insurance on BMI status was not as hypothesized. Unobserved differences in participant characteristics by insurance type partially explained this finding. Taken together and placed in context of recent research, the results suggest the need for preventive interventions targeting minority young adults with a parental history of obesity. Future research is needed to further clarify the relationship of health insurance to weight status in young adults with the ultimate goal of informing and guiding public and health policy decision‐making. Page 186
Poster Session II Women’s Knowledge of Cardiovascular Risk Factors, Level of Self‐Nurturance and Participation in Heart‐Healthy Behaviors. Annette Jakubisin‐Konicki, PhD, FNP‐BC, University of Massachusetts‐Worcester, Putnam, CT Purpose: The purpose of this study was to investigate knowledge of cardiovascular risk factors (CVRFs), level of self‐nurturance and the performance of heart‐healthy behaviors in women ages 35 to 55 years. Study findings support the significant need for CVRFs reduction early (in the pre‐menopausal years) through heart‐healthy behaviors such as increasing physical activity, promoting healthy eating, moderate alcohol consumption and not smoking. A current gap exists in understanding premenopausal women’s CVRFs knowledge and their participation in heart‐healthy behaviors as an important area to advance health promotional activities. Theoretical Framework: The Nemcek Wellness Model (NWM) (Nemcek, 2003) included integration of the Health Promotion Model (Pender, Murdaugh & Parsons, 2002) and the Health Belief Model (Rosenstock, 1966) as a systems approach to predicting wellness behaviors. Methods: A cross sectional survey design and venue sampling was used to recruit participants from a suburban community setting. A sample of 257 women were given survey instruments including the Heart Disease Facts Questionnaire, (HDFQ‐2), Self‐Nurturance Survey (SNS), International Physical Activity Questionnaire (IPAQ), Prime Screen Nutritional assessment, and demographic data form. Data analysis included descriptive statistics, reliability coefficients for multi‐item measures, and Non‐
Parametric statistics for normally distributed variables. Logistic regression also assessed the relationships between the heart‐healthy behaviors as binary outcomes, along with levels of knowledge of CVRFs and self‐nurturance. Results: Study participants were very knowledgeable about CVRFs. (Mean score = 19.53, possible range = 0 to 25 with higher scores indicating greater knowledge). Knowledge, however, did not predict physical activity (p = .07), diet (p = .08) or smoking status (p = .11). Self‐nurturance was moderately correlated (r = .33) with consuming a heart‐healthy diet. Conclusions & Implications: Results suggest women are becoming more knowledgeable about CVRFs. Such knowledge did not correlate with heart healthy behaviors that could also sustain heart health. Findings, however, suggest that interventions to promote self‐nurturance may improve some heart‐
healthy behaviors among pre‐menopausal women. More research is needed to identify factors that will help women translate knowledge into heart‐healthy behaviors in the community setting. Page 187
Poster Session II Incivility in Nursing Education and Its Potential Effect on Healthcare Environments Trish Suplee, PhD, CS, RNC, Rutgers University, Medford, NJ There is a perception among nursing faculty across the country that students enrolled in accelerated baccalaureate programs tend to be more challenging to teach and are often labeled as being more "uncivil" then those students enrolled in "traditional" baccalaureate programs. Although there has been research that has explored incivility among nursing students and faculty in general, there has been little research that has addressed the perceived differences between students enrolled in the two program types. Also, it is not known how students and faculty perceive "uncivil" behaviors in clinical environments. The purpose of this study is to examine the concept of incivility among students and faculty from two types of baccalaureate nursing programs. Clark's Incivility Model will be addressed. Design: Web‐based survey Sample & Setting: 683 students and faculty from BSN Programs across the U.S. completed the electronic survey Measures: The "Incivility in Nursing Education Survey" (Clark © 2005, Revised 2007) including six additional questions focusing on incivility in the clinical setting was used to collect data via Question Pro © web‐based software. Analysis: Data were analyzed using descriptive statistics, parametric and non‐
parametric tests, and multivarient analysis. Results: The results indicate that 96% of faculty, 87% of accelerated and 84% of traditional students perceive incivility as a moderate to serious problem in academia. Differences between uncivil variables and faculty/students, program type, ethnicity, generation, and area of the country have been identified and will be reported. Conclusion & Implications: Due to the recognized uncivil behaviors in nursing academia, incivility may become a major concern for the healthcare industry. In 2008, the Joint Commission released a sentinel alert focusing on behaviors that influence a culture of safety, many considered to be “uncivil.” Identifying and addressing uncivil behaviors in nursing education may be a mechanism for improving positive healthcare environments in the future. Page 188
Poster Session II Mobile Outreach for Hepatitis C and HIV in Western Massachusetts Donna M. Zucker, RN, PhD, University of Massachusetts ‐Amherst, Amherst, MA Jeungok Esther Choi, RN, MPH, PhD, University of Massachusetts‐Amherst, Amherst, MA Emily Gallagher, BA, BS, Massachusetts General Hospital, Boston, MA Purpose: The aims of this project were to locate, screen, counsel and vaccinate hard to reach cases of hepatitis C (HCV) and HIV in Western MA. Theoretical Framework: Concepts from relational theory in communication (trust, competence and similarity) and culture (empowerment and a sense of worth) were combined to support nurse/client interactions. Methods: Our team conducted comprehensive screening, counseling and vaccinations across 18 months for 202 non‐duplicated men and women in 4 locations. Data analysis on the client population was performed using SPSS v.17. Chi‐square testing was used to determine the statistical relationship between variables (p‐value of < 0.05.) Results: HCV tests were administered to 173 subjects with 29% testing positive. The highest rates of HCV (83.3%) were found in current injection drug users (IDU). There was a significant relationship between IDU and HCV + test results (χ2 (2) =20.845, p < .001). Of the 108 subjects (53.5%) who chose to be tested for HIV, all tested negative. There was a significant relationship found between the screening location and HCV test results (χ2 (3) =26.006, p < .001). 50.7% of subjects recruited from a harm‐
reduction center tested HCV + which was higher than other sites (county jail 18.4%; homeless shelter 11.8%; community corrections program 6.3%). There was a significant relationship between age group and HCV+ test results (χ2 (2) =8.086, p =.018) with 35.8% of subjects between the ages of 30‐49 years. 29.7% of subjects completed at least one vaccine series with 14.5% still in process. Conclusions and Implications: Mobile outreach has the advantage of screening, counseling and vaccinating hard to reach individuals at high risk for HCV and HIV infection. Attention to trends in community location can assist in reporting accurate prevalence to state officials to insure comprehensive testing and treatment is made available. Page 189
Poster Session II Emotional Intelligence and Nursing Performance among Nursing Students Audrey M. Beauvais, DNP, MSN, MBA, RN‐BC, Sacred Heart University, Southport, CT Noreen Brady, PhD, APRN‐BC, LPCC, Case Western Reserve University, Olmsted Township, OH Eileen R. O'Shea, DNP, RN, Fairfield University, Fairfield, CT Mary T. Quinn Griffin, PhD, RN, Case Western Reserve University, Cleveland, OH Purpose: To examine the relationship between emotional intelligence and nursing performance among nursing students. Theoretical Framework: Mayer and Salovey’s emotional intelligence model. Emotional intelligence is the ability to reason with, and about emotions. It combines feelings with thinking. Methods: A descriptive correlational design was utilized. A convenience sample of 231 undergraduate and 102 graduate student nurses was recruited at one New England University. Data were collected using the Mayer‐Salovey‐Caruso Emotional Intelligence Test, the Six Dimension Scale of Nursing Performance and a Background data sheet. This was an internet survey using an e‐mail invitation with web‐link to the background information and the 6‐D Scale. Then participants were given a web link to access the MSCEIT. Multi‐Health Systems Inc scored the MSCEIT responses. Descriptive statistics and Pearson’s correlations were computed using SPSS version 14.0. Results: There was a 26.1% response rate, 87 participants. The sample was predominately Caucasian (91%), female (93%), mean age 24 years. There were 86.2% undergraduate and 13.8% graduate students with a 3.49 mean grade point average. The mean score for emotional intelligence was 0.53, SD ± 0.06 indicating moderate emotional intelligence. The mean score for nursing performance was 3.14, SD± 0.40 indicating moderate nursing performance. There was a weak but statistically significant relationship between emotional intelligence and nursing performance. Conclusion and Implications: Emotional intelligence education ought to be included in nursing curricula. Emotional intelligence coaching can be accomplished with the inclusion of reflective learning experiences, supportive supervision, and mentorship. Research is needed to examine if these strategies can facilitate increasing nursing performance using emotional intelligence education. Nursing students’ nursing performance may be improved by preparing students to think critically along with integrating emotional intelligence into clinical practice. Emotional intelligence may enhance understanding of how best to educate nurses. Education programs can be established in healthcare settings to promote emotional intelligence in all nurses from administrators to bedside nursing staff. Recommendations for future research include studies with national random samples of nursing students and nurses from all work settings. Page 190
Poster Session II Women's Experiences with Discontinuing Hormone Therapy for Menopause Mary A Fischer, MSN, WHNP‐BC, NCMP, University of Massachusetts‐Worcester GSN, Framingham, MA Purpose: The purpose of this study is to explore women’s experiences discontinuing hormone therapy (HT) for menopause. Background: Women choosing or needing to discontinue HT may be thwarted in their attempts by a recurrence of troublesome menopause symptoms and a diminished quality of life (QoL) compounded by a lack of guidance and symptom management strategies. To develop much needed counseling and support interventions, a better understanding is needed of the factors that influence recurrent symptoms, QoL and discontinuation outcome. An in‐depth description of women’s experiences during HT discontinuation would provide this knowledge. Methods: This mixed‐methods Internet‐based study will use a Qualitative Descriptive design with embedded quantitative QoL measurements to address the research Purpose: 30‐40 women who have attempted to discontinue HT will be enrolled and stratified by discontinuation status (stopped versus resumed) to compare variations in HT discontinuation experiences, QoL and influencing factors. Qualitative interviews and quantitative questionnaires will be completed online at a protected university‐based website. Interview data will be analyzed through Qualitative Content Analysis to identify themes and develop a rich description of HT discontinuation experiences, influencing factors and the impact on QoL. Descriptive statistics from the quantitative measures will be integrated with the patterns identified through the qualitative analysis for comparison both across‐subjects and between strata. Within‐subjects comparison of the qualitative and quantitative QoL measures will be done (for the purpose of complementarity) will explore how HT discontinuation impacts on different facets of QoL. Results: This study will develop a rich description of women’s experiences discontinuing HT and the factors that may influence recurrent symptoms, QoL and HT discontinuation outcome. Conclusions: Study findings will provide a foundation for nurses to develop counseling and symptom management interventions for women discontinuing HT. Page 191
Poster Session II Hospital Room Design and health Outcomes of the Aging Adult Susan Garzon Lorenz, DrNP, NEA‐BC, Princeton Healthcare System, Warminster, PA Purpose: The purpose of this study was to determine the differences in the rate of falls and HAI in the hospitalized older adult for those admitted to private versus semi‐private rooms. In addition, this study controled for risk of social isolation to determine whether there is a difference in the rate of falls or HAI in patients at risk for social isolation who are in private or semi‐private rooms. Theoretical Framework: This study represents an addition to a growing body of research that is evaluating the effects of hospital design on the health and well‐being of patients. Maslow’s Hierarchy of Needs forms the theoretical and conceptual framework underlying this study. Maslow’s Hierarchy can be further expanded to include models that protect the patient from harm. The Situational Model of Nurse Protection is one such model. This model illustrates the effect of the environment on the vulnerability of the person. Methods: This retrospective case comparative design utilized a sample of patients cared for at the University Medical Center of Princeton in 2006. Patient records were randomly selected through the hospitals admission/discharge/transfer system. The records were then divided into two groups based on room type. Data collected included demographics, incidence of falls and HAI and risk for social isolation. Results: All patients were over 65 years old and were admitted to the hospital for a variety of diagnoses. Length of stay was between three and 10 days .There was no significant difference between the type of room and the likelihood of falling. (p =.367). The relative risk of falling in a private room was 4.01.There was no significant difference in the occurrence of HAI based on room type (p= 1.0).The risk of social isolation variable was unable to significantly affect who will fall (p=0.404) or develop a HAI (p=0.862). Conclusions and Implications: Room type may play a role in the occurrence of falls in the hospitalized older adult and that room type in and of itself does not increase the chance of acquiring an infection while in the hospital. In addition being at risk does social isolation does not affect the likelihood of having an adverse outcome. The results of this research imply that room type and or room design may have an association with health outcomes in the hospitalized older adult. Page 192
Poster Session II Social Support and the Continuum of Care for the Cardiovascular Rehabilitation Patient Claire L MacDonald, MSN, RN, Lahey Clinic Medical Center, Andover, MA Deborah L Sullivan, MS, APRN, BC, Lahey Clinic Medical Center, Woburn, MA Purpose: To identify and describe cardiovascular rehabilitation patients’ perceptions of social support. Background: An abundance of studies reinforce the inclusion of integrating social support in the continuum of care for the cardiovascular rehabilitation patient. Lack of social support has emerged as a potent risk factor commonly associated with increased morbidity and mortality in the patient with cardiovascular disease. Insufficient social network function or a low level of social support is consistently associated with the risk of dependency and a reduced level of function in patients with chronic disease (Shearer, 2009). The cardiovascular rehabilitation nurse is in a unique position to evaluate and implement measures to optimize avenues for enhanced social support. Method: The design was qualitative, descriptive, exploratory utilizing a focus group method. A convenience sample of cardiovascular rehabilitation patients enrolled in, or recently graduated from a Cardiovascular Prevention & Rehabilitation Program in the Northeast. Results: The resulting key categories included support system (personal and formal), type of support and perceptions of self. Interactions, both positive and negative, existed between the support system, the type of support that was provided and the impact or perceptions one felt (perceptions of self). Support systems were perceived as supportive when they offered encouragement, provided information and allowed for progressive independence and empowered the individual to adapt to new roles. Being made to feel controlled and powerless, being babied and acting without regard to the participants needs created a perception of negative support and promoted a more dependant identity. Conclusions and Implications: Perceived support lead to a more active role in terms of health seeking and promoting behaviors verses a more passive/helpless role in the recovery process. In applying the theoretical framework of social support (emotional, instrumental and informational support) perceived support leads to healthier identities for the new roles the cardiovascular rehabilitation patient must navigate. Nurses must design and integrate strategies to enhance social support to improve long term lifestyle changes. Identifying ways to assess the perception of social support and helping patients identify and communicate their unique needs will help to optimize outcomes. Page 193
Poster Session II Solving the Norbeck Social Support Questionnaire's (NSSQ) Quantity/Quality Conundrum Eileen Gigliotti, RN; PhD, City University of New York, New York, NY Purpose: To illustrate the problem created by the NSSQ scaling and to illustrate how measurement error can be reduced by accounting for the influence of network size using methodologically and theoretically‐
based solutions uncovered during a review of the NSSQ research literature published from 1981 to May 2009. Background: Participants list from 1 to 24 network members, specify their relationship (spouse, parent, etc.) and rate each (0‐4) on six support questions. Members’ support scores are then added resulting in widely varying scores (0 to 576). Rightly, participants with many network members all giving high quality support (3‐4) have higher scores than participants with fewer network members all giving high quality support. A problem arises though when participants list many network members but rate many of them lowly (0‐2). Because this latter group inflates their scores with low quality support, participants with both large and small networks can have the same quantity but not the same quality of support. Recognizing this, Norbeck proposed use of source and situation‐specific support as possible solutions. As well, other investigators have addressed the problem in varied ways. Despite these advances however, the majority of investigators do not account for quantity vs. quality of support which results in increased measurement error. Approach: The problem is illustrated and solutions evaluated using data collected for a larger published study. Methodological solutions include averaged scores and partial correlations/residuals; theoretical solutions include use of source and situation‐specific support. Major Points and Rationale The most widely used solution, averaged scores, is not recommended. Use of partial correlations /residuals results in greatly enhanced explained variance. As well, use of source and situation‐specific support are recommended. Conclusions: Accounting for the quality as well as the quantity of support is critical when using the NSSQ. Failure to do so increases risk of type II errors. Page 194
Poster Session II Striving to Be Normal: A Secondary Analysis of Shared Decision‐Making as Adolescents with HIV Transition to Adulthood Veronica D Feeg, PhD, RN, FAAN, Molloy College, Rockville Center, NY Susan Willis Ledlie, PhD, RN, CPNP, Molloy College, Rockville Centre, NY Purpose: This study is being conducted as a secondary analysis of transcript data collected as part of a larger evaluation project on decision‐making in teens with chronic and/or life limiting illnesses. The purpose is to explore adolescents with HIV autonomous decision‐making and striving to be normal. Background: Using the Knafl/Deitrich concepts of “normalization” as the conceptual grid against which to examine the responses and behaviors of a subset of adolescents, this study will examine focused problems such as making independent decisions about activities and engaging in health encounters with providers. Areas of normalcy include: (a) acknowledging the condition and its potential to threaten lifestyle; (b) adopting “normalcy lens” for defining child and family; (c) engaging in parenting behaviors and family routines that are consistent with “normalcy lens”; (d) interacting with others based on a self view of being normal. Methods: The source qualitative interviews were structured to assess adolescents’ experiences with parents and/or providers in decision‐making. The original interview schedule was developed to elicit thick descriptions from 35 subjects identified from a large pool of children with special needs in an ongoing evaluation project for the state of Florida structured to assess the adolescents’ shared decision making experiences with parents and/or providers. The interview schedule was developed to elicit how the disease or illness affected their relationships in dealing with their problems related to “growing up.” Two independent researchers will apply constant comparison approach on the verbatim transcripts of a subset (n=15) of the adolescents, using N‐Vivo software to identify themes corroborated with reading and re‐reading transcripts and thick transcription notes. Results/Conclusions Anticipated: Adolescents with HIV strive to be normal as they transition to adulthood with areas of similarities and differences with other teens. The transcripts will reveal themes that exemplify their struggle balancing disease demands and normal life. Page 195
Poster Session II Factors Related to Health Disparities in Hispanic Children Treated for Cancer Karrie Cummings Hendrickson, PhD, RN, Yale University School of Nursing, New Haven, CT Jane K Dixon, PhD, Yale University School of Nursing, New Haven, CT Problem and Purpose: The incidence of childhood cancer in Hispanic children in the United States is second only to that in white children. However, according to the CDC, Hispanic children diagnosed with any type of cancer are significantly more likely to die than are children belonging to other ethnic groups. While guidelines exist for treatment, there is little information about how characteristics which vary by ethnicity, including sociodemographic factors and hospital resource use, may impact the course of cancer in Hispanic children. The purpose of this descriptive study is to further our understanding of the socio‐demographic factors (age, socio‐economic status, and gender) and hospital resource use factors (length of stay, number of inpatient and outpatient visits, PICU admission) that may affect the mortality and cost of care for Hispanic children with cancer. Theoretical/Scientific Framework: This study was guided by Production Theory as applied to hospital economic function. Methods Design: A secondary analysis of hospital administrative and tumor registry data collected as part of routine patient care. Sub‐sample: 50 Hispanic children diagnosed with childhood cancer and treated by surgery, chemotherapy, and/or radiation at Yale‐New Haven Hospital between fiscal years 2000 and 2004. Full‐sample (for comparison): 456 children of various ethnicities diagnosed with cancer and treated at the hospital during the same time frame. Analysis: Univariate descriptive statistics, bivariate statistics (t‐tests and ANOVAs), and regression analyses. Results: On average, Hispanic children had more visits to the hospital (F = 20.26, p = 0.002) and the cost of their care was significantly higher (F = 0.88, p = 0.033), compared to number of visits and cost for non‐
Hispanic children. Sixteen percent of Hispanic children died within three years of diagnosis, while 8.9% non‐Hispanic children. Regression analyses revealed that chemotherapy, age group, and having a university‐based physician predicted high numbers of hospital visits, and that chemotherapy and PICU admission predicted high cost for Hispanic children. Conclusions and Implications: Disparities in care result in higher cost and more hospital visits for Hispanic children compared to those of other ethnicities. Future intervention studies targeting Hispanic children who develop cancer are needed to ensure this population has the best possible health outcomes. Page 196
Poster Session II Sleep Apnea in Children with Sickle Cell Disease: Does Adenotonsillectomy Improve Outcomes? Valerie E. Rogers, PhD, RN, University of Pennsylvania, Philadelphia, PA Jeanne Geiger‐Brown, PhD, RN, University of Maryland Baltimore, Baltimore, MD Purpose: To describe the effects of adenotonsillectomy (AT) on sleep parameters and disease severity in children with sickle cell disease (SCD) and obstructive sleep apnea (OSA). Theoretical Framework: Adenotonsillar hypertrophy is exacerbated in SCD and is, independently, the main risk factor for OSA in children. Intermittent airway obstruction in OSA leads to hypoxemia, hypercapnia and inflammation, events recognized as contributing to vaso‐occlusion in SCD. Thus, SCD increases the risk of OSA and OSA contributes to increased SCD severity. Adenotonsillectomy, the main treatment for OSA in children, should improve OSA and SCD severity. Methods: This was a medical chart review of consecutive children, aged 2‐18 years, having SCD (hemoglobin SS and SC) and referred for polysomnography (PSG) for evaluation of sleep‐disordered breathing, 2004‐2008. Fifty‐five children had PSG data, and 29 had data on health care utilization (hospitalization, emergency department, sickle cell clinic visits) for vaso‐occlusive crises (painful crises, acute chest syndrome) for 1 year pre‐PSG and 1 year post‐PSG or post‐AT. Analyses were descriptive and nonparametric. Forty‐one children (75%) had hemoglobin SS, average age was 9.5 ± 4.6 years and 24 (44%) were male. Thirty‐seven (67%) were diagnosed with OSA. Of children who underwent AT, 11 (20%) had SCD severity data and another 10 (19%) had post‐AT PSG data. Results: No significant change in SCD severity occurred from pre‐PSG to post‐AT. Respiratory parameters were abnormal in children with SS and in those with OSA. Respiratory parameters were better post‐AT than they were for OSA‐positive children without AT (e.g. % sleep time spent < SpO2 90% 1.6±4.2 vs.9.2±24.7, respectively) and blood pressure percentiles (BP%ile) were lower (systolic BP%ile 79.1±23.5 vs. 83.6±18.9; diastolic BP%ile 57.1±25.0 vs. 73.2±23.6, respectively); however, 8 of 10 children still had OSA and the periodic limb movement index was higher (4.6±3.5 vs. 3.3±5.1 per hour, respectively) in post‐AT children. Conclusions and Implications: Sleep apnea is common in children with SCD having sleep‐disordered breathing, and respiratory parameters tend to be abnormal, with serious implications for health. Adenotonsillectomy appears to improve respiratory parameters and blood pressure; however, many continue to have OSA, and SCD severity may not improve. Repeat PSG may be warranted post‐AT to document OSA cure or the need for further intervention. Page 197
Poster Session II Testing of a Self‐Management Internet Intervention for Older Men undergoing Active Surveillance [AS] for Prostate Cancer Meredith Wallace, PhD, APRN, A/GNP‐BC, Yale University School of Nursing, New Haven, CT Donald E. Bailey, PhD, RN, Duke University School of Nursing, Durham, NC Purpose: For men with early‐stage prostate cancer, active surveillance (AS) is a reasonable alternative to aggressive therapy. However, men who undergo AS live every day with the knowledge that they have cancer in their bodies. Uncertainty about the state of cancer intensifies when men are asymptomatic or experience only occasional signs that the cancer is present. Uncertainty has many negative effects including a decreased ability to cope, reduction in well‐being, impaired perception of mental health and psychological adjustment, depression, and lowered quality of life. The purpose of this pilot study is to test a self‐management intervention delivered via the internet on self‐efficacy, uncertainty and quality of life of older men undergoing AS for prostate cancer. Theoretical Framework: Mishel’s Uncertainty in Illness theory provided the framework for the study intervention. Methods: The intervention is being tested in a sample of 20 AS patients identified by a participating urologist. Baseline data on health behaviors, self‐efficacy, uncertainty and QOL will be compared to data immediately after completion and five weeks later to determine changes over time, using paired t‐tests. Pilot testing of the intervention will also provide information on the feasibility of the intervention. Results: Data collection is ongoing and should be completed by December, 2009. Data will help to prepare the internet intervention to provide education and support to help men self‐manage the uncertainty associated with AS in future studies. Conclusions and Implications: The results of this pilot will lead to a clinical trial testing the effect of the intervention in a large, national sample. The ultimate goal of this research is to help men manage the uncertainty associated with AS and improve quality of life. The study also has the potential to reduce the over‐treatment of prostate cancer in men who are clinically appropriate for this management option. Page 198
Poster Session II Conversion from Active Surveillance to Active Treatment for Prostate Cancer: A Qualitative Analysis Meredith Wallace, PhD, APRN, A/GNP‐BC, Yale University School of Nursing, New Haven, CT Purpose: The purpose of this qualitative study is to examine the reasons why men convert from active surveillance (AS) to active treatment for prostate cancer. Improved understanding of why men choose to convert from AS to active treatment will help to develop interventions to support men in AS to remain with this management option. Background: AS has been an option for prostate cancer management for many years. However, only 10.2% of clinically appropriate prostate cancer patients undergo AS. The reasons for the low selection and adherence to AS are unknown. However, it is theorized that AS is associated with a high level of uncertainty which has been found in multiple studies to negatively impact health outcomes and quality of life. In fact, AS has been shown to result in intolerable uncertainty that impacts quality of life to the extent that it is actually preferable to undergo treatment to simply "get rid of it" than to continue to live with the possibility of the cancer growing and killing. Methods: A purposive sample of approximately six to ten AS participants are being interviewed using a structured interview instrument developed by the researcher to examine reasons why participants converted from AS to active treatment. Participants are asked to describe their experiences with AS and active treatment, sources of support and information, problems, facilitators and barriers to the decision making process. Results: Four interviews have been completed and data collection continues to be ongoing until them saturation has been reached. Conclusions and Implications: Qualitative data gathered for this study are focused on reasons why men undergoing AS for prostate cancer convert to active treatment. Improved understanding of why men choose to convert from AS to active treatment will help to develop interventions to support men in AS to remain with this management option. Page 199
Poster Session II Prevention of osteoporosis in Asian immigrants: A Randomized Controlled Trial One‐year Study Bing‐Bing Qi, PhD, RN, College of Nursing, Villanova University, Villanova, PA Background: Studies have consistently demonstrated that Chinese, particularly recent immigrants have a low bone mineral density and to be at a great risk for developing osteoporosis. There is considerable evidence that the majority of Chinese of all ages have inadequate information about their risks for developing osteoporosis and are seldom involved in preventive activities. Despite the benefits of educational interventions designed for lifestyle changes, programs targeting Chinese immigrants and tailored to their culture, language and specific needs have not been developed or adequately studied. There is growing evidence of the effectiveness of self‐efficacy in changing behaviors among Asian minority populations. There is a paucity of research specifically concerned with the impact of Self‐
efficacy (SE)Theory based interventions when used with Chinese immigrants. Purpose: To evaluate the effectiveness of SE Theory based educational intervention (SEOPE) aimed at increasing the knowledge of osteoporosis and adoption of preventive behaviors designed for Chinese immigrants age 45 and above living in the US. The hypotheses for this study were that foreign‐ born, Mandarin‐speaking Asian adults randomly assigned to participate in SEOPE, in comparison to those who received no such intervention, would exhibit significant improvement at 2 weeks, 3, 9 and 12 months post‐intervention with respect to: osteoporosis‐related knowledge, SE for exercise and osteoporosis medication adherence, Outcome expectations (OEs) for exercise and osteoporosis medication adherence, exercise behavior, and adherence to osteoporosis medication. Theoretical Framework: This study used strategies hypothesized in SE theory to enhance SE and OEs as a framework for SEOPE interventions. Design: A randomized controlled trial design was employed. Eighty‐three foreign‐born Mandarin‐speaking Asians (mean age =64.08±9.48) were randomly assigned to either receive the intervention (n=42) or to an attention control (n=41). Data were collected at baseline before the intervention and then 2 weeks, 3, 9 and 12‐months after intervention in an immigration clinic in Chinatown, Philadelphia. Repeated‐measures 2X5 ANOVA were employed to detect changes over time in outcome measures. Results: Data are being analyzed. Results will be reported and recommendations for future research and practice will be made based on the results of this one‐year study. Page 200
Poster Session II Patterns of Self‐Care Decision Making in Women of African Descent with Type 2 Diabetes Living in Urban America Margaret E. Eckert‐Norton, MS, FNP‐BC, RN, CDE, NYU, New York, NY Purpose: The purpose of this study is to assist women of African descent with Type 2 diabetes, on Medicaid or uninsured to explore patterns of self care decision‐making via nursing practice. Background: Diabetes (DM) is the fifth leading cause of death in the United States. The incidence of Type 2 diabetes (T2DM) is increasing in epidemic proportions. Persons of African descent have higher rates of T2DM and its complications, and are more likely to have limited financial resources. Among persons of African descent, women have higher rates of T2DM and eye complications. Multiple large randomized control trials (RCTs) indicate that control of blood sugar decreases complication rates. Yet <36% of persons with diabetes achieve optimal blood glucose control. These RCTs often emphasize compliance and adherence. The purpose of the proposed study is to assist women of African descent with T2DM and the nursing profession to better understand patterns of self‐care decision making. The emphasis in this study is on the transformative potential of the nurse‐person relationship as described in the nursing theory, “Health as Expanding Consciousness"(HEC) of Margaret Newman. Methods: The study was conducted with the hermeneutic‐ dialectic protocol described in HEC. Two research questions are addressed: 1. What are the patterns of self‐care decision making for women of African descent related to their Type 2 diabetes within the context of their daily lives? 2. How can nursing practice better support self‐care decision making? Results: A purposive sample of 16 women of African descent was recruited. Thirteen of the 16 women had follow‐up interviews. The study represents a novel approach in that participants received copies of their interview on CDRom and were provided with portable CD players. Data analysis includes patterns of self‐care decision making for each participant, patterns of nurse‐person partnership and patterns across all data. Conclusions and Implications: Patterns of self‐care and nursing practice are unitary and transformative. Implications for theory, research, practice and education will be discussed as data analysis is completed. Page 201
Poster Session II Leave from Work or Leave from Breastfeeding?: Employment and Breastfeeding in a Sample of Black Women Deborah McCarter‐Spaulding, PhD, WHNP‐BC, RN, IBCLC, St. Anselm College, New Boston, NH Rebecca Gore, PhD, University of Massachusetts ‐ Lowell, Lowell, MA Jennifer Lucas, PhD, St. Anselm College, Manchester, NH Purpose: To determine the effect of outside employment on the duration of breastfeeding in a sample of black women in the United States. Theoretical Framework: Black women are disproportionately at risk compared to other racial/ethnic groups for discontinuing breastfeeding earlier than recommended by the American Academy of Pediatrics. Employment has been identified as a factor influencing breastfeeding duration, but little data exists on the influence of employment specifically in black women. Methods: A cohort of women self‐identified as being of African descent (black women) and planning to breastfeed were recruited during their postpartum hospitalization at a large, urban teaching hospital in New England, and followed monthly by telephone for six months postpartum or until discontinuation of breastfeeding. Employment and breastfeeding information was collected at study entry, and at each monthly follow‐up. Data were analyzed using a Cox proportional hazards model with the dependent variable being “time until weaned” in weeks. Results: A rapid drop in the risk ratio for risk of weaning was observed versus time until mothers returned to work up until about the 12th to 14th week. Using 12 weeks as a cut point, returning to work before 12 weeks resulted in a four‐fold increase in weaning when compared to nonworking mothers RR:4.0 (1.52,10.68). Returning to work after 12 weeks was not significantly different than not working with respect to weaning RR: 1.3(0.47,3.66). All models were adjusted for pre‐birth planned pattern of breastfeeding (supplementing versus exclusive breast feeding) RR:1.6 (0.9,2.8). Conclusions and Implications: Returning to work prior to 3 months seems to increase the risk of weaning with shorter time off work dramatically increasing the risk of weaning. After 3 months the risk of weaning was not found to be any greater than for a nonworking mother. Policies facilitating time off work for at least 12 weeks could contribute to longer duration of breastfeeding in black women. Page 202
Poster Session II Provider Cue‐responding Behaviors to Patient Distress During Oncology Visits Lisa Kennedy Sheldon, PhD, APRN‐BC, AOCNP, University of Massachusetts‐Boston, Boston, MA Donna L. Berry, RN, PhD, AOCN, FAAN, Cantor Center for Research in Nursing‐Dana‐Farber, Boston, MA Purpose: The purpose of this is to identify patterns of patient‐provider communication in conversations regarding socioemotional concerns during ambulatory, on treatment oncology visits. While over half of oncology patients experience distress including depression and anxiety, these problems are often underecognized by healthcare providers. How providers respond to patient concerns influences subsequent disclosure of concerns. Distancing behaviors may be used by providers to decrease patient expressions of concerns. Theoretical Framework: Crick and Dodge Model of Social Information Processing was used to guide response generation by healthcare providers. Methods: Secondary data analysis with coding of audiofiles of patient‐provider communication using Medical Interview Aural Rating Scale (MIARS). This is an exploratory study to identify patterns of patient‐
provider communication during oncology visits. A sample of 20 randomly‐selected audiofiles from an existing dataset of 590 electronic audio‐files of patient‐provider communication during actual ambulatory oncology visits collected between 2005 to 2007 was coded including 7 men and 13 women of various diagnoses and stages. The audio‐files were coded for general demographic characteristics (age, diagnosis, treatment), the identified MIARS codes, descriptive data regarding the codes, and patterns of communication between the provider and patient. MIARS codes and communication patterns were clustered into specific categories of communication such as provider‐ or patient‐initiated communication, type of communication, timing during the visit, and provider communication regarding assessment of socioemotional concerns as well as diagnosis and treatment of patient distress. Results: Preliminary results demonstrate a predominant pattern of distancing behaviors by providers that diminishes patient expressions of concerns. Conclusions & Implications Specific provider responses to patient cues of distress may enhance patient disclosure of socioemtional concerns, facilitate identification and treatment of disabling distress, and improve patient outcomes Page 203
Poster Session II Perinatal Bereavement: A Principle‐Based Concepts Analysis Kimberly Fenstermacher, MS, CRNP, PhD(c), Pennsylvania State University, College Park, PA Purpose: This presentation offers a brief history and concept analysis of the concept of perinatal bereavement. Principle‐based concepts analysis methods are used to arrive at a theoretical definition of perinatal bereavement. Background: Perinatal loss, including miscarriage, stillbirth, neonatal death, or elective termination due to fetal anomalies, is followed by a unique grieving experience often referred to as perinatal bereavement. The concept of perinatal bereavement emerged during the 1970’s, influenced by an articulation of attachment theory, social changes, and technological advances in neonatology. Yet the concept of perinatal bereavement is not well defined in the scientific literature and is often mingled with the concepts of loss, mourning, and grief both in description and measurement. This is problematic for researchers who seek to study the phenomenon of perinatal bereavement. Approach: The methods of principle‐based concepts analysis employ the following principles: Epistemologic, Pragmatic, Linguistic, and Logical. Once these principles are examined, the conceptual components (antecedents, attributes and outcomes) are delineated in order to arrive at a theoretical definition of perinatal bereavement. Major Points and Rationale: 1. Perinatal bereavement is an important phenomenon for nursing research. 2. Principle‐based concepts analysis produces a theoretical definition of perinatal bereavement based upon the state of the science to reveal the best estimate of probable truth through an integration and synthesis of scientific literature. 3. Concepts of interest, such as perinatal bereavement, must be well defined and have consistent meaning in order to be advanced. Conclusions: Perinatal bereavement is the experience of parents that begins immediately following the unexpected loss of an infant through death from miscarriage, stillbirth or the death of a neonate. It is informed by culture, faith, and tradition and is often characterized by a complex emotional response, manifested in the attribute of grief, but expressed differently and in varying intensities, over an undetermined period of time. Page 204
Poster Session II The American Nurses Foundation: Supporting the Creation of Nursing Science Margarete L. Zalon, PhD, ACNS‐BC, University of Scranton, Scranton, PA ~ Patricia R. Messmer, PhD, RN‐BC, FAAN, Children's Mercy Hospital and Clinics, Kansas City, MO ~ J. Craig Phillips, PhD, RN, PMHCNS‐BC, LLM, ARNP, ACRN, RN, University of British Columbia , Vancouver, BC, ~ Caitlin Van Brunt, BS, RN, Valley Hospital, West Milford, NJ Purpose: The aim of this historical study was to identify all ANF scholars from 1955‐2009 with data on 1) principal investigators and co‐investigators, 2) year of grant, 3) title of grant, and 4) affiliated institutions at the time of the ANF award 4) subsequent NIH grants obtained by ANF scholars and 5) grants focused on health care disparities. Background: The American Nurses Foundation (ANF) has provided national leadership in health philanthropy, developed nurse scientists and their research, grew its financial resources and infused diversity into its advancement of nursing science. The ANF has accomplished the goals envisioned by the leaders of the American Nurses Association (ANA) in establishing the foundation. Methods: The ANA/ANF archival materials at the History of Nursing Archives at Boston University and at ANA headquarters, research columns in Nursing Research, American Journal of Nursing and The American Nurse, archival program materials of the late Undine Sams, various websites and the National Institutes of Health CRISP database were used. ANF scholars provided additional information. Results: Since ANF’s inception in 1955, nearly 1000 ANF Scholars have been identified. Over 340 ANF scholars have gone on to receive federal funding for their projects with 304 receiving federal funding for research studies. Thirteen ANF scholars have served as the principal investigators of NIH‐funded research training centers. Eighty‐one studies focused on health care disparities or health care issues in minorities or disadvantaged groups with most of these being conducted in the last twenty years. Conclusions and Implications: A substantial number of ANF Scholars have gone on to receive federal research funding. Research on minorities or disadvantaged groups has increased indicating that the ANF Scholars are making important contributions in understanding the unique health care issues faced in these populations. These findings illustrate the critical importance of the ANF’s role in the development of the profession and the growth of nursing science. Page 205
Poster Session II Case Managers’ Perceptions of the Implementation of an electronic Continuity of Care Record Rebecca Schnall, RN, MPH, MBA, Columbia University School of Nursing, New York, NY Suzanne Bakken, RN, DNSc, FAAN, FACMI, Columbia University, New York, NY Purpose: The goal of this study was to explore case managers’ perceptions of factors related to implementing an electronic health record for Persons Living with HIV (PLWH). Background: HIV, affecting 1.2 million Americans, has become a chronic illness with patients requiring a constantly changing array of services. Use of health information technology can play a critical role in supporting chronic care management by providing readily available, comprehensive patient information, resulting in greater care coordination. A single electronic record provides the opportunity to improve quality of care and health outcomes by consolidating health information. Methods: We conducted focus groups of experienced community‐based HIV Medicaid managed care case managers in four boroughs of New York City. For analysis of the focus group, the PRECEDE portion of the PRECEDE‐PROCEED Model of health program planning and evaluation was used, which is composed of the Predisposing, Reinforcing, and Enabling Constructs in Evaluation. Qualitative analysis methods were used to explore themes. Peer debriefing occurred formally with an expert in informatics and HIV/AIDS care, and informally with another expert in HIV and qualitative. Methods: “Member checks” with case managers were undertaken to validate interpretation of the data. Results: Data from four focus groups (37 participants; 84% female, 43% Black 32% Hispanic) were analyzed. Three major themes of predisposing factors emerged from the data: client characteristics, confidentiality and system functionality. Two major themes of enabling factors emerged from the data: user training and computer access. Four major themes of reinforcing factors emerged from the data: work efficiency, continuity of care, information quality and communication. Conclusions and Implications: Our data revealed predisposing, enabling and reinforcing factors which were predicted to affect the implementation of an electronic record for PLWH. To enable care managers to use the system for HIV care coordination, recommendations to support predisposing and enabling factors for training and increasing access to computers were highlighted. Reinforcing factors addressed how the system would affect workflow and quality. Page 206
Poster Session II "A Frustrating Adventure": Parents' Information‐Seeking During Newborn Screening Evaluations Jane M. DeLuca, RN, CPNP, APNG, University of Rochester, Rochester, NY Margaret Kearney, RN PhD, University of Rochester, School of Nursing, Rochester, NY Purpose: This study explored patterns of parents’ information‐ seeking during the referral and evaluation of their infants for abnormal newborn screening results. Background: The recent expansion of newborn screening has increased the numbers of infants referred into the newborn screening system for evaluation of potential inborn errors of metabolism. Public knowledge of newborn screening is limited. Parents confronted with an abnormal newborn screening result often have no point of reference for understanding rare conditions and may be limited by their educational backgrounds and the scarcity of cogent information about screening, which adds additional stress to families during the diagnostic evaluation. Methods: This study employed a qualitative descriptive design. Nineteen cases (one parent or couple) were interviewed 1‐2 times during and after the newborn screening evaluation of their infants. Responses to open‐ended questions were audio taped and transcribed. Content analysis was used to identify parents’ themes of information‐ seeking during the newborn screening experience. Results: The majority of parents sought additional information outside the metabolic treatment center consultation. All parents accessed the Internet for newborn screening information with mixed results; some parents were confused by website information and others limited their internet browsing to avoid exacerbating their anxiety. Most parents were disappointed with their pediatric providers and found they lacked quality information about screening. Parents described their contact with metabolic specialists as information rich, but they were especially reassured by the calm approach of these clinicians and their sharing of clinical success stories. Conclusions & Implications: Lack of clear, accessible information on what to expect during a newborn screening referral evaluation can cause crippling uncertainty for parents. Primary care clinicians often do not have sufficient information to give families, yet they are often the first to notify families about a screening abnormality. Devising a script of essential screening information could aid these busy providers. Metabolic specialists could include sharing of clinical stories as a practice strategy to instill hope for parents that, should their child be diagnosed with an inborn error, treatment can improve outcomes. Page 207
Poster Session II Critical Interactionism: A New Approach for Theory, Research, Nursing Education, and Practice Patricia Burbank, DNSc, RN, University of Rhode Island, Kingston, RI Diane Martins, PhD, RN, University of Rhode Island, Kingston, RI Purpose: This paper describes a new perspective, critical interactionism that offers an exciting novel approach to theory development, research, nursing education, and practice. Background: Throughout their history, symbolic interactionism and critical perspective have been viewed as divergent theoretical perspectives with different philosophical underpinnings. Their underlying philosophies of science, views of self, society and human freedom are different as is their level of focus with symbolic interactionism having a micro perspective and critical perspective using a macro perspective. This micro/macro difference is reflected in the divergence of their major concepts, goals and basic tenets. Approach: An historical review of the development and philosophical origins of the theories revealed points of convergence along with areas of divergence. The two perspectives were then combined using a pragmatic/eclectic mode as described by Kim (1993). Major points and rationale: While their underlying philosophies are different, the two perspectives not necessarily contradictory. Areas of convergence may include the concepts of reference groups and looking glass self within symbolic interactionism with ideological hegemony within critical perspective. By combining symbolic interactionism and critical perspectives into “critical interactionism”, both micro and macro levels come into focus and strategies for change across individual and societal levels can be developed and applied. With respect to nursing research and scholarship, this perspective offers new opportunities for theory development and research methodologies. In nursing education, critical interactionism can give students added insight into patient and family problems at the micro level while, at the same time, giving them a lens to see and tools to address problems at the macro level in health care. In nursing practice, a critical interactionist approach can assist nurses to give high quality care at the individual level while also working at the macro level to address the manufacturers of illness. Conclusions: New research questions emerge from this combination of perspectives with new possibilities for theory development, a transformation of nursing education, and the potential for new practice strategies that can address individual client and larger system problems through empowerment of clients and nurses. Page 208
Poster Session II High School Students with Asthma: Attitudes about School Health, Absenteeism, and its Impact on Academic Achievement Susan Krenitsky‐Korn, EdD, FNP, Molly College, Long Beach, NY Purpose: Asthma accounts for one third of all days of missed instruction and is the most commonly reported reason for absence in school‐aged children, placing them at risk for academic failure and social isolation. This study examined the relationship between asthmatic and non‐asthmatic high school students’ attitudes toward school health services, absenteeism, and academic achievement and on the supposition that school nurse services play an essential part in the academic process. Theoretical Framework: The conceptual basis for the study utilized adolescent developmental and Nursing systems theory according to the Roy Adaptive Model. Methods: Students (N=59) with and without asthma, in a suburban high school purposely selected to be in the study, were given a survey and three open‐ended questions developed to measure attitudes toward school health services and absenteeism.. Data for academic scores in mathematics and English and their days absent were obtained from final school records from June prior to the study. Results: Analyses demonstrate significant differences reported for gender, curricular and extracurricular activities of children with and without asthma. Asthmatic students were significantly more absent, scored lower in mathematics and participated less in school activities than their peers. Their level of illness did not predict their days absent; increased days absent were correlated to permissive attitudes towards absenteeism and lower achievement. Positive attitudes toward school health services (F=21.41,P<.05 ) and comfort with school nurse services( t= 3.84, p< .01). (p<.05) existed. Students' attitudes about absenteeism were the best predictors of days absent and subsequent academic successes (p<.05). Conclusions: Themes and trends identified the offering of emotional support and relaxation, communication with teachers, parents, and private physicians, self‐management of asthma, and help in managing their asthma, support in helping them to participate in activities and attend their academic classes School nurse interventions were sources of physical, social, emotional and academic support. Page 209
Poster Session II What do Acute Care Nurses Document About Their Older Adult Patients with Delirium Superimposed on Dementia (DSD)? Melinda R. Steis, PhD, RN, University of Pennsylvania, Philadelphia, PA Purpose: To explore acute care nurses’ recognition and management of delirium in hospitalized older adults with dementia. Theoretical Framework: Recognition is dependent upon the observation and interpretation of patient‐
based evidence, resulting in specific and accurate labeling of the patient’s symptoms. Recognition is pivotal to management, prompting the nurse to act or not to act on this labeled phenomenon‐based or patient‐specific pattern. Methods: This study was a retrospective chart review and a secondary analysis of 113 hospitalized older adults with dementia (n=56 Dementia‐Only [DO], n=56 Delirium Superimposed on Dementia [DSD]). The unit of analysis was patient days (n=232: 116 DO, 116 DSD). Data were analyzed using Concept Analysis, Nursing Intervention Lexicon and Taxonomy and multinomial logistic regression. The Confusion Assessment Method was employed to determine the presence of delirium. Results: The two study groups, DSD and DO, were described differently by the nurses. While nurses did document their observations of patient behavior, no nurse interpreted or applied the label of delirium or acute confusion in their documentation. There were no statistically significant differences in the categories of nursing interventions documented between the DSD and the DO groups, although more nursing interventions were documented for the DSD group. Conclusions and Implications: Nurses notes revealed observations but not interpretation of phenomenon‐based or patient‐specific patterns in the care of their older adult patients with DSD. This study reinforced the significance of accurately labeling the patient phenomenon as part of the assessment process which, according to the above mentioned framework, results in more appropriate management of the patient. These findings support the integration of assessment tools into the electronic medical record to prompt nurses to fully assess their patients at risk for, and who display signs of, delirium. Page 210
Poster Session II How Ready Are Hospitals for Acutely Ill Children? Results of the Pediatric Preparedness of Emergency Departments in Connecticut (PPED‐CT) Study Sheryl LaCoursiere, PhD, RN, BC, Yale University, New Haven, CT Lei Chen, MD, Yale University, New Haven, CT Mark X. Cicero, MD, Yale University, New Haven, CT Purpose: To determine the level of pediatric disaster preparedness of emergency departments (EDs) in Connecticut regarding equipment availability and personnel training. Theoretical Framework: Quality Health Outcomes Model (Mitchell, Ferketich & Jennings, 1998). Methods and Design: Descriptive survey design. Sample: Medical and nursing directors of all twenty‐
nine EDs in Connecticut. Setting: Online Measures: Researcher‐designed survey to assess each ED’s capability for pediatric patients, as well as equipment availability, personnel training and disaster planning. Analysis: Descriptive statistics Results: Forty‐two directors responded to the survey, representing twenty‐six EDs in the state. Eighteen EDs were designated trauma centers, ranging from Levels I‐IV. Nursery capability ranged from Levels I‐
III. Pediatric‐specific equipment was available in most EDs: 92.9% of EDs each carried pediatric laryngoscopes, pediatric endotracheal tubes and Broselow resuscitation tapes, while 90.5% carried pediatric intraosseous needles. Broselow crash carts were used by 78.6% of EDs and laryngeal mask airways (LMAs) by 71.4%. Staff training was variable. Required staff education included PALS (Pediatric Advanced Life Support), 59.5% of EDs, followed by TNCC (Trauma Nursing Core Course), 42.9% and ATLS (Advanced Trauma Life Support), 14.3%. Few offered disaster‐specific training. Few EDs had pediatric triage systems: 19.0% used a specific pediatric system, while 14.3% used a mental health triage screening system. Less than sixty percent had disaster protocols: Pediatric specialty care capability was variable: Drills were also variable: 95.2% of EDs conducted mock drills, 71.4% conducted separate pediatric drills and 26.2% conducted Homeland Security Exercise and Evaluation Program (HSEEP) drills. Conclusions & Implications: In Connecticut, there is much variability in pediatric emergency preparedness. As expected, disaster preparedness is more developed in facilities with higher trauma designations. The areas for greatest improvement include personnel training and adoption of pediatric‐
specific disaster protocols and drills. The availability of equipment is a relative strength. Comparisons are needed with other states and regions to assess the generalizability of these findings nationally, and prepare for unique pediatric needs that might be encountered in emergent natural as well as terrorism‐
related disasters. Page 211
Poster Session II An Investigation of Transformative Learning Experiences during Associate Degree Nursing Education Using Narrative Methods Tamara M. Kear, PhD, MSN, RN, Villanova University, Villanova, PA This qualitative study investigates the transformative experiences of nursing students in an associate degree program using narrative analysis research methods to describe how learning is experienced during nursing education among 10 participants at a single research site. The study population is undergraduate nursing students in the final semester of study prior to graduation from an associate degree program at a small, private college. Purposive sampling was employed to allow for a variety of classroom, laboratory, clinical, faculty, and peer experiences. Data was collected through open‐ended questions via audio‐recorded interviews and analyzed according to the guidelines of narrative analysis. The phases of Transformative Learning Theory guided the analysis of the narratives. The participants describe their processes of learning through recounting stories of various academic and non‐academic experiences. The study yielded 5 narrative threads that included: 1) stories of the multi‐faceted process of learning, 2) stories of experiential learning, 3) stories of human interactions as central to defining nursing and caring, 4) stories that intertwine personal life experiences and nursing, and 5) stories of transformative learning. Results of the study indicate that students expressed the greatest learning and transformation through experiential learning. Such experiences included caring for immigrants, children in lower socioeconomic environments, and patients with a variety of medical and mental disorders in numerous settings. Other participants described personal experiences that took on new meaning or contributed to learning as a result of academic experiences. Stories offered by the participants also revealed that many of the students came into the nursing program with a personal history of mission, service and charity work. Future research studies should focus on transformative learning in international settings, the simulation laboratory, through innovative clinical experiences and via service learning projects. Page 212
Poster Session II Cultural Reform in Acute Care: Learning from Australia’s Improving the Culture of Hospitals Project Gene Harkless, DNSc, ARNP, CNL, University of New Hampshire, Alton, NH Allison Reilly, Student, University of New Hampshire, Alton, NH Purpose: To conduct a field study of the process of engaging quality improvement methods to systematically improve the cultural context of acute care of Aboriginal people of Australia. Background: Australia is faced with wide disparities between the health outcomes of their Aboriginal peoples and the majority population. Aboriginal people have shorter life‐expectancies and their major health assaults of heart disease, trauma, and cancer often require acute care hospital services. Therefore, providing culturally congruent acute care services is seen as essential to improving outcomes and reducing the health care disparities. To address this challenge, a quality improvement (QI) initiative, Improving the Culture of Hospitals, has engaged a national network of Australian hospitals working to improve the culture of hospitals for Aboriginal people. Learning about the experiences and challenges of project staff engaged in this work is the focus of this research. Methods: The six project team members consented to interviews. Semi‐structured interviews of about 30 minutes were taped and non‐verbatim notes were taken for analysis. Examples of questions asked were, “What has been your experience participating in this study?” and “What has been the most challenging aspects of the work of this project?” followed by prompts and specific follow up questions. Results: Preliminary interview analysis identified three emerging themes. The first theme is that of QI as a slow and quick process. Participants spoke of the slowness of change in the QI process in contrast to the energy that individuals bring to QI work. The second theme focused on the toolkit intervention as the bridge enhancing communication between the hospital and Aboriginal communities. Lastly, the third theme uncovered the challenge of working with big aims within a small project. Conclusions & Implications: The participants in this small research study generated informative themes as they considered the experiences and challenges in the Improving the Culture of Hospitals project. Notably, as the interviews developed it became apparent that the interviews were useful not only as a data gathering tool for this researcher but were important as reflection time for the project staff. The implication of this is that interview research may serve a dual purpose of informing the researcher as well as importantly providing a time for meaning‐making for the participants. Page 213
Poster Session III Critical Review of Ethnocentrism and Bias in a Nursing Text Book: A Pilot Case Study Katie L Love, APRN, PhD, AHN‐BC, Central Connecticut State University, Bristol, CT Purpose: To begin the process of analyzing nursing textbooks for issues of bias, mischaracterization, de‐
contextualized information, and stereotyping. Background: For nursing students from diverse backgrounds, nursing textbooks can be one of several barriers to success (Love, 2009). Nursing texts often unknowingly stereotype or reflect an ethnocentric perspective and this can lead to feelings of isolation and increased learning burdens for students in non‐
dominant groups (Bryne, 2001; Lea, 1994; McQueen, 2004). One snapshot review of nursing textbooks was done regarding culture, but no comprehensive reviews of ethnocentrism in nursing textbooks has been done to date (Papadopoulos & Lee, 2002). Methods : This pilot study used Robert Stake’s (1995) method of case study and includes a systematic review of one nursing health assessment textbook. An Intrinsic singular case gives insight into a topic and is foundational to future multi‐case studies and triangulated comparisons. Results: Four major categories arose including Mischaracterization, Missing Pieces, Exiled Groups, and Overt –Isms. Mischaracterizations are inaccuracies or stereotypes, whereas Missing Pieces is de‐
contextualized and only partially true information. Exiled Groups include the strongest examples of ethnocentrism where groups are simply absent in discussion and in perspective. Overt –Isms include examples such as outright discriminatory statements that had no useful application to nursing practice. This text had 9 Mischaracterizations, 8 Missing Pieces, 6 examples of Exiled Groups, and 3 statements of Overt –Isms. Conclusions & Implications: Faculty must become aware of even one problematic statement in a text to supplement learning, maintain safe classrooms, and facilitate discussions. Many articles have been written on singular textbook reviews and the textbook review process; however, they largely do not review text for its ethnocentrism, for its impact on students from non‐dominant groups, and do not seek to improve problematic texts. Such a review can also increase awareness for authors, editors, and publishers. Page 214
Poster Session III A Preliminary Analysis of Fatigue and Disease Severity in Children and Adolescents with Inflammatory Bowel Disease. Margaret A McCabe, DNSc, RN, PNP‐BC, Children's Hospital Boston, Hingham , MA Purpose: To begin to describe the relationship between behavioral measures of fatigue and disease severity in a convenience sample of children and adolescents (8‐18 yrs) with Inflammatory Bowel Disease (IBD). Conceptual Framework: Fatigue is a ubiquitous symptom that is poorly understood. Fatigue impacts health related quality of life in chronically ill adult patients and has been recognized as a clinical complaint of children with IBD. Evidence of the occurrence, severity and impact of fatigue on children’s daily lives is minimal. This limited body of knowledge about fatigue in children impacts the clinician’s ability to recognize and/or treat it. Methods: Preliminary demographic and descriptive data (n=20) from a longitudinal exploratory descriptive study at Children’s Hospital Boston has been analyzed. The PedsQLTM Multidimensional Fatigue Scale (Varni, et al., 2004), was used as a behavioral measure of fatigue. The Pediatric Crohn’s Disease Activity Index (PCDAI) (n=12 CD), and the Pediatric Ulcerative Colitis Activity Index (PUCAI) (n=8 UC) were used as measures of disease severity. Fourteen patients had inactive disease, 6 had active disease. Due to the small numbers a Wilcoxon rank‐sum test was used. Results: The preliminary data suggests that inactive disease may correlate with less fatigue, although the levels of fatigue overall seem to be higher than what has been reported with this measure in healthy children. Conclusions & Implications: These preliminary results suggest children with IBD experience fatigue; the intensity may vary with disease severity. Information about the relationship of fatigue to disease severity may help nurses in various roles to support children and families effectively manage their disease and its symptoms. Young IBD patients who learn to effectively manage their disease and its symptoms may make successful transitions to adulthood, optimizing their future health outcomes. Page 215
Poster Session III Skin Related Complications in Children Treated with Hip Spica Casts for Femur Fractures Rachel DiFazio, RN, MS, Children’s Hospital, Boston, Beverly, MA ~ Timothy Hresko, MD, Children’s Hospital Boston, Boston, MA ~ Travis Matheney, MD, MLA, Children’s Hospital, Boston, Boston, MA Purpose: To determine skin related complications in children under the age of 5 years treated with a hip spica cast for femur fractures. Background: Immediate closed reduction and application of a hip spica cast remains the treatment of choice for closed femur fractures in children under the age of 5 years old. Caring for a child in a hip spica cast poses several challenges to caregivers including keeping the cast clean and dry. Skin breakdown caused by moisture from urine and stool causes’ discomfort and can lead to the need for a repeat casting in the operating room or early cast removal. Additional treatment due to skin related complications is psychologically upsetting and financially costly to both the family and the healthcare system. The cost of a cast change is the OR is $795 ‐ $876. The incidence of skin related complications in this population has not been well documented. Methods: A 4 year retrospective chart review (2003‐2008) was conducted on children under the age of 5 years who sustained a femur fracture, and skin related complications were identified. Results: Out of 261 children, 209 (80%) completed spica cast treatment without any reported skin problems. Fifty two (20%) children had skin problems of varying degrees with 17(6.5%) requiring repeat casting in the OR, 27 (10%) requiring early cast removals, and 2 (0.8%) required readmission for skin care. There were 12 unplanned ER visits and 35 unplanned clinic visits for skin related complaints. Conclusion: The results indicate that spica cast treatment is associated with numerous skin related problems and additional costs. This data will serve as baseline data of complications in this age group for spica casting for femur fractures. This data is benchmark for quality improvement programs as well as alternative treatment options such as gortex cast padding or internal fixation. Page 216
Poster Session III Age and Death Rates for Asian/Pacific Islander American Women Hospitalized with Breast Cancer: Where are We Ten Years Later? Carolee A Polek, RN, PhD, AOCNS, University of Delaware, Newark, DE Thomas L Hardie, RN, EdD, PMHCNS‐BC, Widener University, Chester, PA Purpose/Objectives: Health disparities remain a persistent issue despite extensive research and interventions. This study is an extension of a study where we investigated whether differences exist in age and death rates between hospitalized Asian/Pacific Islander American (APIA) women diagnosed with breast cancer and other racial groups in 1997. The study will compare the rates ten years later to our prior work in an independent sample. Design: Secondary data analysis of a national data set. Setting: The Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Samples 1997 and 2007; discharge data generated by 1,000 hospitals representing a 20% stratified sample of the United States. Sample: All women who were hospitalized with a primary diagnosis of breast cancer, were older than 18, and did not die during hospitalization, plus all women who met the criteria stated above but died during hospitalization. Methods: Secondary data analysis. Post hoc analysis was used to identify significant differences among racial groups in the 1997 sample and will be repeated in the 2007 sample and group differences explored. Findings: Previous (from HCUP 1997) findings demonstrated significant differences in the rates of death between APIA and Caucasian and Latino women who died during hospitalization. Also, APIA women were the youngest to die. The analysis and contrast with the 2007 data is pending. Implications for Nursing: Sensitivity and awareness by nurses is essential when working with the APIA population. Not just understanding cultural influences but also understanding the barriers will enable us to not under estimate the threat of breast cancer among this population of women. APIA women will need culturally appropriate information and be offered screening during routine care. Page 217
Poster Session III Development and Administration of a Web‐based Survey to Assess the End‐of‐life Educational Needs of Health Care Professionals in Connecticut Elizabeth A Ercolano, MSN, DNSc, RN, AOCNS, Yale University, New Haven, CT ~ Alison Beale, AD, Yale University, New Haven, CT~ Sheryl LaCoursiere, PhD, RN, BC, Yale University, New Haven, CT ~ Craig Leukens, MS, Yale University, New Haven, CT ~ Tony Ma, PhD, Yale University, New Haven, CT ~ Ruth McCorkle, PhD, FAAN, Yale University, New Haven, CT ~ Thomas Quinn, MSN, APRN, Yale University, New Haven, CT ~ Dena Schulman‐Green, PhD, Yale University, New Haven, CT Purpose: National reports have identified gaps in knowledge of end‐of‐life (EOL) care, recommending improved training of health care professionals (HCPs). This state‐funded study developed and administered a web‐based survey to identify the educational needs of HCPs who provide EOL care in Connecticut in order to design educational initiatives. Theoretical Framework: Knowles’ theory of adult learning guided creation of survey items and plans for job‐related learning. Methods: A literature review identified 6 content domains to capture HCPs’ educational needs: Scientific and clinical knowledge/ skills; Communication with patients, family, and clinicians; Spiritual and cultural issues; Ethical, professional and legal principles; Organizational skills; and Attitudes, values and feelings. Twenty instruments were reviewed to identify survey items representative of content domains and disciplines. A survey of 16 items was reviewed by EOL experts. Items are rated on a 5‐point Likert scale (1=Strongly Disagree; 5= Strongly Agree). Participants included nurses, nurses’ aides, physicians, social workers, pharmacists, chaplains, funeral directors, and administrators who were >21 years and spoke English. Participants were recruited by the Internet, at professional meetings and by direct contact. The survey was available on the web and on paper for 9 months. Descriptive and correlational statistics were calculated. Results: 659 surveys were completed, 319 on the web and 340 on paper. 602 had complete data. Disciplines reported greater agreement on items related to their daily activities. Dealing with cultural and spiritual matters and having supportive resources at work were needs reported by the total sample. Older age and years in practice were positively correlated with adequate education in EOL communication and overall content of EOL care, as well as with adequate knowledge to care for the dying. Comparison of results by discipline is ongoing. Conclusions and Implications: The survey identified gaps in EOL education by discipline and demographics which can inform educational initiatives. Page 218
Poster Session III The Prevalence of Horizontal Violence in New York State: A Pilot Study Kathleen Fischer Sellers, PhD, RN, SUNY Institute of Technology, Cobleskill, NY ~ Jennifer Klimek‐
Yingling, PhDc, APRN, ANP‐BC, FNP‐BC, SUNY, Utica, NY ~ Nancy Kovach, MS, RN, Faxton‐St Lukes Hospital, New Hartford, NY ~ Linda Millenbach, RN, PhD, Maria College, Albany, NY Purpose: Determining nursing administrators’ knowledge of Horizontal Violence (HV) and the degree that they have encountered HV was the goal of this pilot study to enhance recognition of this phenomenon. Theoretical Framework: Transformational leadership theory guided the study; administrators as leaders motivate followers in new directions. Methods: This descriptive study used a convenience sample of New York Organization of Nurse Executive (NYONE ) members who completed demographic information and part one of Briles’ Sabotage Savvy Questionnaire, a validated tool via an online survey, or at the 2008 Annual Meeting. Demographics and responses to the Survey were analyzed using descriptive statistics. Analysis of variance (ANOVA) and t‐tests were used to compare groups. Results: This sample was below the mean in knowledge of, and experience with HV victimization. Knowledge of not being recognized for work was most common (33%), with untrue information exchanged being the most frequent experience (29%). A one‐way ANOVA was conducted to evaluate the relationship between race and the degree of horizontal victimization. Means were highest for Asians and African Americans; there was no significant difference between racial groups F (3,99) = .888. p =.45. A t test significantly demonstrated t (90) = 2.189, p =.03, that those working in union facilities reported higher occurrences of being a victim of being expected to do other’s work. Conclusions & Implications: While not well researched in the United States, the international scientific evidence has established the existence of HV in the nursing profession. Consistent with the theoretical literature, results suggest that HV is so ingrained in nursing’s organizational culture that it is not recognized; until a phenomenon is recognized and named little can be done to alter it. Dissemination of findings allows for increased recognition of the phenomenon. An expanded study of all practicing registered nurses in New York State has been initiated. Page 219
Poster Session III Portraits of Intuitive Decision‐Making by Multiple Sclerosis Lay Caregivers Mary K. McCurry, PhD, RNC, ANP, ACNP, University of Massachusetts‐Dartmouth, Somerset, MA Donna L. White, BA, University of Massachusetts‐Dartmouth, North Dartmouth, MA Purpose: Describe decision‐making and the use of intuitive knowing by lay caregivers of Multiple Sclerosis care recipients in the home setting. Background: Multiple sclerosis (MS) is a progressive neurological disorder that affects one out of every 700 people in the United States. The majority of individuals with MS are cared for by family members at home. Since MS does not significantly shorten the lifespan, support and assistance are often provided for many years. Caregivers make numerous and varied day‐to‐day decisions which increase in complexity and severity as the disease progresses. These decisions can be emotionally difficult, contributing to the negative impact of long‐term care giving. Previous studies have described analytical decision‐making styles of lay caregivers and identified an “uncertainty” or a “feeling” that may be indicative of an intuitive component to the lay caregiver’s decision‐making. However, the actual day‐to‐
day decision‐making process of MS lay caregivers is relatively unknown. Methods: Using a qualitative, descriptive research design, data was collected from three female and three male caregivers. Each caregiver completed two interviews. The face‐to‐face, audio‐taped interviews were transcribed verbatim and analyzed using qualitative content analysis. Results: Analysis revealed four main categories of caregiver decisions: healthcare, financial, social, and family. Caregivers described using both analytical and intuitive modes of decision‐making. Intuitive knowing was used most frequently when making healthcare decisions including triaging acute illnesses or injuries, trialing new medications, or advancing the level of assistance needed by the care recipients. Interestingly, participants did not self identify as caregivers unless they were providing assistance with ADLs. Conclusions and Implications: Lay caregivers of MS care recipients use both analytical and intuitive knowing to make complex and diverse decisions that impact all aspects of care recipient’s lives. The decision‐making processes described by caregivers are similar to those detailed in studies of novice nurses. By continuing to study and analyze portraits of caregiver decision making, nurses can deepen their understanding of the process, and develop supportive interventions resulting in improved quality‐
of‐life for both the MS caregiver and the MS care recipient. Page 220
Poster Session III Challenging Behaviors for Family Caregivers of People with Dementia (Alzheimer’s disease) Pamela C Spigelmyer, PhD(c), APRN, BC, CNS, CSN, The Pennsylvania State University, University Park, PA Purpose: Based upon an integrated review of the literature exploring problematic behavior assessment and management during caregiver‐assisted ADLs, current management and behavioral treatment strategies most beneficial for family caregivers were identified. Background: As Alzheimer’s disease progresses from mild to moderate and severe stages, behavioral problems became more prevalent causing distress for caregivers. These behaviors are the result of neurological degeneration and challenge caregivers, especially when they pose resistiveness during assisted activities of daily living (e.g. bathing, dressing and eating). While family caregivers frequently report difficulties with ADLs due to resistive and problematic behaviors in support groups, minimal literature describes this phenomenon. Approach: A critical review of the literature was retrieved from the data bases of Psych‐Info and PubMed (medline). Six identified measurement tools and specific interventions for problematic behaviors were evaluated and summarized. Major Points and Rationale: Multiple assessment tools for problematic behaviors were identified; however, standardization of behavior measurement was not evident. Of six measurement tools specific to behaviors exhibited by people with dementia, only one addressed the context of ADLs. Current interventions for family caregivers included mediation of primary and secondary stressors through psychological and educational strategies. Interventions proposed for paid caregivers to manage the behaviors increased the time needed to complete the task and contributes to role strain and role overload. No populations studies have evaluated family caregiver burden associated with behavior problems displayed during ADLs. Conclusion: Since seventy percent of people with Alzheimer’s disease are cared for by family caregivers in the home, further research is needed to describe the frequency and perceived impact of problematic behaviors displayed during caregiver assisted ADLs. Page 221
Poster Session III Changing Physical Activity Behavior Using Problem‐solving Skills and Continuous Glucose Feedback in Women with Type 2 Diabetes Nancy A. Allen, PhD, ANP, Boston College, Chestnut Hill, MA ~ Gail D'Eramo Melkus, EdD, ANP, FAAN, New York University, New York City, NY ~ Robin Whittemore, PhD, APRN, Yale University, New Haven, CT Purpose: Physical activity (PA) is a cornerstone of diabetes treatment, yet 60% of women with type 2 diabetes mellitus (T2D) do not participate in regular PA. Women are reportedly more sedentary than men and attribute this behavior to competing life demands and multiple roles. Few interventions have addressed this issue by facilitating problem‐solving skills to manage barriers to PA. The goal of this pilot study is to test the acceptability and efficacy of a self‐management intervention for women with T2D using technology and problem‐solving vs. technology and education. Methods: This 12 week study uses a pretest‐posttest experimental design to explore efficacy of a self‐
management intervention derived from Social Cognitive Theory to provide women (N=30) with counseling using continuous glucose monitoring (CGM) and PA related problem‐solving skills compared to women receiving only CGM counseling and general education. Both groups are counseled for 90 min. with CGM feedback to depict the glucose‐lowering effects of PA on glucose levels, PA education, goal setting, and a PA prescription. After 2 weeks, the intervention group receives a 90 min. session focused on problems implementing PA prescription, such as communication skills (i.e., assertiveness and refusal techniques), motivational strategies (i.e., self‐talk, managing fatigue, enjoyment, social support), and/or 3) time‐management skills; the control group receives 90 minutes of general diabetes education. Measures: intervention dose, implementation data, satisfaction data, clinical outcomes (blood pressure, HemoglobinA1c, Body Mass Index), behavioral outcomes (accelerometer data, diet), problem solving skills (diabetes problem‐solving inventory), psychosocial outcomes (PA self‐efficacy, Centers for Epidemiological Studies Depression Scale). Feasibility, intervention fidelity and acceptability will be analyzed between groups on protocol completion, satisfaction surveys, attrition forms, attendance logs and descriptive content analysis of open‐ended questions. Intervention efficacy will be compared between and within groups on pre‐ to post‐intervention measures. Findings: Of 29 women recruited, 82% are White, 17% Black and 17% Hispanic. Majority aged 52±7yrs. have poorly controlled T2D (HbA1c 8.6%±1.3). Feasibility, satisfaction, and efficacy results are forthcoming. Implication: This study addresses a significant health problem of physical inactivity in a vulnerable population of women with T2D. Page 222
Poster Session III Touch Therapies: Are they Effective in Treating Pain, Anxiety, and Fatigue? Joelle Chateauneuf, RN, University of Massachusetts ‐Boston, Boston, MA ~ Valerie Alexander, RN, University of Massachusetts ‐ Boston, Boston, MA ~ Susan Griever, RN, University of Massachusetts‐
Boston, Boston, MA ~ Peter Santana, RN, University of Massachusetts‐Boston, Boston, MA Purpose: Increasingly, patients are exploring touch therapies as part of their treatment plan, particularly to address nurse sensitive outcomes. It is important for nurses to understand the effectiveness of these therapies, to educate patients, and integrate these therapies into their practice. A systematic review of literature was conducted to critically examine the effectiveness of touch therapies on nurse sensitive outcomes related to pain, anxiety, and fatigue. Theoretical Framework: Touch therapies are guided by Rogers’ Science of Unitary Human Beings, an abstract theory based on the belief that humans are energy fields in continuous process with the environment. Methods: The data bases of PubMed, CINAHL, ProQuest, and Google Scholar were searched using key terms: touch therapies, pain, therapeutic touch, massage, and reiki. Inclusion/exclusion: studies published in the last 10 years, human adults, clinical trial, randomized controlled trial, clinical journals, and nursing journals. The search produced a total of 1,976 articles. Articles were selected based on rigor, relevance, and research that specifically examined the effects of one or more of the touch therapies explored. Once a planned maximum of 16 studies were chosen, the process of this systematic review began. Results: 16 qualitative and quantitative studies met criteria for inclusion. Research limitations included small sample sizes, lack of randomization, varied protocols for interventions and measurements, and inconsistent measurement of outcome variables. Most studies reviewed reported improvement in symptoms (pain, anxiety, fatigue) and health related quality of life; a few studies reported no change. No studies reported adverse effects related to the use of these therapies. Conclusions: Due to limitations in the study designs, no definitive conclusion about the efficacy of touch therapies could be determined; but the data suggests that patients may benefit when touch therapies are integrated into their plan of care and these therapies are relatively safe. More research is needed to answer this question and should focus on: larger sample size, randomization, consistent intervention and measurement. Meta‐analysis of existing studies could also be undertaken. As more patients explore these therapies, nurses need to be clear on the evidence. Since the majority of the results were positive with no adverse effects, it may be appropriate to use these therapies while more studies are conducted. Page 223
Poster Session III Pharmaceutical Company Influence on Nurse Practitioners Prescribing Elizabeth M. Blunt, PhD, RN, FNP‐C, Villanova University, Villanova, PA Purpose: The purpose of this study was to investigate the relationship between pharmaceutical company sponsored educational programs, promotions and gifts and the self‐reported prescribing beliefs and practices of certified nurse practitioners in three states. Theoretical Framework: Persuasion Theory Method – This correlational, descriptive study surveyed certified NPs in three states to document their prescribing beliefs and practices related to pharmaceutical company interactions. The survey was sent to 1,000 certified NPs in all specialty areas. The states of Pennsylvania, New York and Florida were used due to high numbers of certified NPs in these states, which also have urban, suburban and rural population centers. A forty‐five percent response rate was obtained. Results: Results show that 51% of NPs believe they are influenced by pharmaceutical company products, promotions, and gifts while 48% do not believe they are influenced. NPs in urban areas have more contact with pharmaceutical company representatives than their suburban or rural counterparts. Eighty percent of NPs report having changed or modified their prescribing practice after a pharmaceutical company interaction (n=313). Interestingly, that number is significantly less than the number of NPs who report believing they are influenced by these encounters 51%. Sixty percent of the respondents stated that having sample medications available in their office was very important or somewhat important in choosing which prescription drug to select for their patients. Thirty seven percent of the NPs stated they had changed or modified their prescribing practice because the patient requested a specific drug. Eighty two percent of respondents agreed or strongly agreed that pharmaceutical companies do provide an important education function. Conclusions and Implications: Nurse practitioners are influenced by pharmaceutical company interactions. This influence should be addressed in NP programs and practicing NPs need to be aware of this influence on their practice. NP organizations may want to consider position statements on pharmaceutical company‐NP interaction as many physician organizations have done. Page 224
Poster Session III A Multidisciplinary Effort to Improve Safety and Teamwork in Surgical Services Patrice M Osgood, BSN, RN, CNOR, Lahey Clinic, Burlington, MA ~ Ann M Dylis, PhD, RN, Lahey Clinic, Burlington, MA ~ Kimberly K Wheeler, MSN, RN, CNOR, Lahey Clinic, Burlington, MA In 2008, The World Health Organization (WHO) created the Surgical Safety Checklist. The premise of this international Checklist is that teamwork and collaboration during the surgical experience reduce complications and improve safety. International research on Checklist adoption has already documented statistically significant reduction of complications and improvements in surgical outcomes (Haynes et al, 2009). Purpose: The purpose of this study is to measure the perceptions of surgical staff teamwork before and after the implementation of WHO Checklist and to determine if there are differences in the perception of teamwork for total and subscale scores pre and post implementation of the Checklist based on job category, years of employment, years in profession, certification status, and age. Theoretical Framework: Donabedian’s (1982) Structure‐Process‐Outcomes Model serves as the theoretical framework. Methods: This pre‐test, post‐test prospective design uses the Teamwork and Safety Climate Survey, one version of the Safety Attitude Questionnaire (Sexton et al, 2006), to measure teamwork perceptions. This 28 item version has a six factor structure (Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition) and has shown acceptable psychometric properties in multiple studies with diverse clinical populations. Staff from the Departments of Nursing, Surgery, and Anesthesia (N= 400+), who work in the Operating Room, Post Anesthesia Care Unit, Ambulatory Surgery, and Preoperative Centers of a major medical center, have been recruited to participate in this anonymous, online hosted, and Institutional Review Board approved study. Data collection is currently underway in Phase I, prior to the implementation of WHO Checklist. The same staff members will complete the instrument three months post implementation of the WHO Checklist. Bi‐variate analysis of individual and group data, pre and post implementation of the WHO Checklist, will be used to address the aims of the study and to promote positive surgical outcomes. Results/Conclusions and Implications: NA‐Research in progress Page 225
Poster Session III Depression, Mood, and Mood Disturbance are Associated with Natural Killer Cell Activity in Spouses of Patients with Cancer Linda M. Goodfellow, PhD, RN, Duquesne University School of Nursing, Pittsburgh, PA Purpose: Spouses of patients with cancer often experience depression, loneliness, and mood disturbances due to their partner’s illness. They may also experience a reduction in immune function, specifically natural killer cell activity (NKCA). NKCA is an excellent indicator of overall health status. The purpose of this study was to determine whether depression, loneliness, mood, and mood disturbances were predictive of NKCA. Theoretical Framework: Family systems theory and concepts from the psychoneuroimmunology literature were used to guide this study. Methods: A secondary analysis was conducted on baseline data previously collected in a large intervention study. Spouses of patients with cancer (N=42) were originally recruited from an out‐patient chemotherapy unit. Instruments used to collect data included the 20 item Center for Epidemiological Studies Depression Scale (CESD), the University of California, Los Angeles Loneliness Scale (UCLA), and the Profile of Mood States (POMS). The POMS includes scores for total mood disturbance and anxiety, depression, anger, vigor, fatigue, and confusion mood scales. Linear regression analyses were used to determine whether age, gender, race, employment, education, mood, depression, or loneliness were statistically significantly associated with NKCA. Results: Demographic variables were not statistically significantly associated with NKCA and were not adjusted in the depression, mood, and loneliness models. Depression was statistically significantly associated with decreased NKCA (p=.018). Loneliness was associated with decreased NCKA, but not statistically significantly (p=.07). Increased total mood disturbance and mood scores for depression, anger, and confusion were associated with decreased NKCA (p<.04). Increased vigor scores were associated with increased NKCA (p=.015). Conclusions & Implications: Depression, mood, and mood disturbances were predictive of NKCA. Future research should examine the effects of interventions to reduce depression and improve mood on NKCA in spouses of patients with cancer. It is imperative that nurses promote health and well being and thus, help keep spouses healthy to care for their ill partners. Page 226
Poster Session III Screening and Treatment of Depression in Multiple Sclerosis: A Pilot Study of a New Care Model vs. Standard Care Brant J. Oliver, APRN, MSN, MPH, Dartmouth‐Hitchcock Medical Center, Lebanon, NH Theoretical Framework: This study is a microsystems intervention study derived from the Wagner Chronic Care Model for systems‐based health care delivery. Methods & Design: This was a randomized, 6 month, quantitative, two group, no placebo, between‐
subjects intervention pilot study. Setting: The Multiple Sclerosis Center at Dartmouth, at Dartmouth‐Hitchcock Medical Center, a rural academic medical center located in Lebanon, New Hampshire. Sample: Patients with relapsing‐remitting multiple sclerosis (RRMS) followed by the Multiple Sclerosis Center at Dartmouth. Process: Participants with a confirmed depressive disorder were then randomized consecutively to one of two groups: 1) a nurse practitioner providing depression treatment in the multiple sclerosis clinic setting at monthly intervals (new care process); or 2) referral to mental health practitioners outside of the MS clinic setting as chosen by the subject and with care provided at intervals determined by the patient and selected providers (standard care). Both groups received treatment for six months. Measures: Primary endpoint was change in Beck Depression Inventory (BDI‐II) depression severity scores. Secondary outcome was the time elapsed between screening and initial treatment visit, measured in days (access time). Analysis: Data was analyzed using between subjects t‐tests with significance defined at p<0.05. Results: A total sample of 11 RRMS participants were enrolled, 5 of which were randomized to the new care process and 4 to standard care. Baseline characteristics of the two groups were similar. Multiple sclerosis status at screening was stable for both groups with the mean extended disability status score (EDSS) ranging between 2.2 and 2.6 in the new and standard care groups respectively, and an annualized relapse rate of 0.1 for both. All participants completed the study. Treatment resulted in robust absolute treatment effects of greater than 50% reductions in BDI‐II scores that did not differ significantly between groups at 6 months. However, the new care process group exhibited a 30% greater relative reduction in BDI‐II scores (p<0.05) and an 80% faster access time to treatment (p<0.01). Conclusions & Implications: The new care process model may be more effective and efficient in treating depression in multiple sclerosis compared to standard care. A larger trial is needed to replicate this design and confirm these results. Page 227
Poster Session III Comparing Learning Outcomes ‐ Simulation Versus Traditional Methods in a Nursing Curriculum Suzanne Hetzel Campbell, PhD, WHNP, IBCLC, Fairfield University, Fairfield, CT Purpose: Nursing research provides inconsistent results when measuring the effect of simulation on students learning. This study examines the integration of simulation scenarios into the nursing curriculum. The research question was: “Do simulations used as an integrated component in the nursing curriculum enhance students’ clinical competence, learning, and self‐efficacy, when compared to traditional educational methods of the same content?” Theoretical Framework: The conceptual framework for the study was the “Framework for Simulation Learning in Nursing Education” (Daley & Campbell, 2008) and Bandura’s “Social Cognitive Theory”. Methods: A quasi‐experimental design was used with students in a BSN program during their women’s health course. The control group (N=19) received the traditional method of education, the experimental group (N= 34) received the traditional method plus eight simulation scenarios integrated into classes. The simulation scenarios occurred during class time, the rest of the class observed live via video, debriefing was done with the entire group. Measurements to compare group differences in learning included: knowledge transfer; clinical competence; and self‐efficacy. Results: T‐tests of group means on the Final Exam and final course grades demonstrated significant differences, respectively (t= ‐2.07, df=51, α p<.025), (t=‐3.77, df=51, α p< .0005). ATI test scores were difficult to interpret. Self‐efficacy was enhanced in both groups from pre‐ to post‐measurements, but there was not a statistically significant difference between groups. Finally, the generality of the clinical evaluation tools did not allow for a distinct differentiation between groups on clinical parameters. Conclusions & Implications: The effect of simulation‐based pedagogy on knowledge transfer and clinical performance will help to verify the usefulness of this method in nursing education. This study provides support for the integration of simulation into the nursing curriculum as part of the class content to enhance student learning and knowledge transfer. More research is needed to distinguish the effect on clinical competence and self‐efficacy. Page 228
Poster Session III Implementing a Relationship Caring Model in an Acute Care Setting: Implications for the Patient and the Nurse Teresa Walsh, RN, MEE, PhD, Catholic University of America ‐ School of Nursing, Silver Spring, MD Purpose/Theoretical Background: Maintaining an adequate supply of committed health care professionals who can recognize & care for the unique needs of older individuals in the acute care setting is fundamental in providing quality care. There has been a recent increased public emphasis and scrutiny on key quality caring indicators, as well as patient satisfaction. Several of the government agencies following these key measures are the Agency on Quality, Health Care and Research (AHRQ), and the Centers for Medicare & Medicaid Services (CMS). Hospitalized adults who feel “cared for” report increase patient satisfaction, while nurses who feel more competent professionally and personally are more likely to remain satisfied and retain their positions. Methods: This project was funded thru the Department of Health and Human Services Administration. It is a collaborative partnership between an academic institution and a non‐profit acute care hospital institution. After the objectives for a professional model of “Caring” were defined and operationalized, training and implementation of a “Caring” course occurred at the participating acute care institution and presently includes ongoing education with professional development. During its implementation, continued tracking of key measures was monitored on control and experimental units. Key measures of success include patient satisfaction, adverse events, nurse vacancy and retention. Initial Results: August of 2009 is the four year anniversary of this five year project. Currently, the model has been implemented throughout the entire participating institution. Ongoing education and training in the caring model is now a required part of nursing orientation for all nursing personnel. During the past 4 years, patient satisfaction scores, adverse events, pain scores, and nursing vacancy rates have been measured and monitored. Specifically, adverse events (pressure ulcers, falls & medication errors) have decreased 13% from the original baseline, patient pain scores have decreased 84% from the baseline & patient satisfaction has increased 9.7% from the baseline. Conclusions: The findings in this study indicate a positive correlation between the implementation of a caring model in diverse workplace and nurse retention, adverse events and patient satisfaction. Instituting this program at acute care settings has positive implications for patients and providers and demonstrates increased quality of care for the patients. Page 229
Poster Session III The Biopsychosocial Model: A Framework for Studying Boys with Klinefelter Syndrome Sharron M. Close, PhD(c), MS, RN, CPNP‐PC, Columbia University, New York, NY ~ Ilene Fennoy, MD, MPH, Columbia University, New York, NY ~ Nancy Reame, PhD, MSN, FAAN, Columbia University, New York, NY ~ Arlene Smaldone, DNSc, CPNP, CDE, Columbia University, New York, NY Purpose: Klinefelter Syndrome (KS) is a genetic disorder that affects 1 in 500‐700 males. The syndrome is associated with physical health problems, learning, behavioral and social interaction issues. The study of complex genetic conditions like KS calls for a theoretical framework to provide structure and order to guide scientific inquiry. Approach/Theoretical Framework: The Biopsychosocial Model (BPS) conceptualizes health as the intersection between biological, psychological and psychosocial factors. We adapted this model to explore the relationships between KS physical phenotype, reproductive hormones, and psychosocial phenomena in a sample of peri‐pubertal boys with KS. Major Points & Rationale: We are conducting a cross‐sectional study of KS boys between the ages of 8 and 17 years. The BPS Model provides the structure for our measurement of biologic variables (physical characteristics, reproductive hormones, and cardiometabolic biomarkers) and their intersections with psychological variables (learning disability, behavior and social interaction problems) and psychosocial variables (quality of life, self‐esteem self‐concept and depression). Androgen deficiency is known to be associated with physical attributes and metabolic health risks. Psychosocial features are likely to be related to this karyotype as well as the endocrine and physical health characteristics. Understanding quality of life, self‐esteem self‐concept and depression begins with examining their associations with biologic variables as well as the strength and direction of these relationships. The data analysis of our study will include descriptive statistics, Pearson correlation and linear multivariate regression models. Conclusions: The BPS Model provides a contextual and interdisciplinary approach to the study of KS. This framework allows for consideration of research questions that may be investigated using inter‐
linked theories and research philosophies from nursing, medicine, psychiatry, social science and education. Collaboration of disciplines may lead to innovative and effective interventions that will benefit individuals with KS. Page 230
Poster Session III Selected Outcomes of Academic Performance for ESL Students Enrolled in an Educational Program Across Three Universities Barbara J. Hoerst, PhD, RN, La Salle University, Philadelphia, PA Gloria Kersey‐Matusiak, PHD, RN, Holy Family University, Philadelphia, PA Mary Powell, PHD, CRNP, Thomas Jefferson University , Philadelphia, PA Purpose: The purpose of this study is to examine selected outcomes of academic performance for a cohort of ESL nursing students in relation to teaching‐learning support strategies utilized by a consortium of nursing education programs. Theoretical Framework Cummins Model on English Acquisition in ESL Students served primarily as a framework for the study’s interventions. The model asserts that the cognitive academic language proficiency (used to communicate abstract ideas) is much more difficult for ESL students to master compared to basic interpersonal communication skills (used to communicate concrete ideas). Methods: This study uses a prospective observational design to study the educational outcomes of an initial cohort of 40 full‐time ESL nursing students from three Universities. Students were recruited based on the recommendations of admission counselors and/or academic advisors and agreed to participate in the program which required attendance at group and individual meetings. Specific strategies included group and individual work on: sharing experiences with other ESL students, practicing giving and getting report, suggesting studying strategies, reviewing vocabulary and reading comprehension exercises, and analyzing of student’s strengths and weaknesses. Data analysis will focus on the following measures for overall analysis and individual rates at each of the three consortium schools: rates of retention; rates of graduation; rates of first‐time pass in the NCLEX‐RN® licensure examination. Qualitative data has also been collected related to ESL program participants’ views on classroom and clinical challenges and effective strategies to facilitate learning and optimize success. Results Data analysis is ongoing with only a few students completing program to date. The majority are expected to complete program requirements in Fall 2009 or Spring 2010 semesters. Conclusions & Implications: It is expected that data from this study will inform faculty of effective strategies that can be used to support ESL nursing students as they work to overcome linguistic challenges in their pursuit of a baccalaureate degree in nursing. This study program was funded by the Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Nursing Workforce: D19HP08209 Page 231
Poster Session III Sleep Behaviors and Sleep Quality in Children with Autism Spectrum Disorders Margaret C Souders, PhD, CRNP, University of Pennsylvania, Philadelphia, PA ~ Maja Bucan, PhD, University of Pennsylvania, Philadelphia, PA ~ Susan E Levy, MD, University of Pennsylvania, Philadelphia, PA ~ Alex T Mason, MD PhD, University of Pennsylvania, Philadelphia, PA ~ Jennifer Pinto‐Martin, PhD, University of Pennsylvania, Philadelphia, PA ~ Otto Valladares, MS, University of Pennsylvania, Philadelphia, PA ~ Terri E Weaver, PhD, RN, FAAN, University of Pennsylvania, Philadelphia, PA Purpose: (1) Compare sleep behaviors of children with Autism Spectrum Disorders (ASD) to typically developing (TD) children using the Children’s Sleep Habits Questionnaire (CSHQ); (2) Compare the sleep quality defined as mean activity, sleep latency, number of awakenings, sleep efficiency and total sleep time of children with ASD and TD cohort as measured by 10 nights of actigraphy; (3) Estimate the prevalence of sleep disturbances in the ASD and TD cohorts. Theoretical Framework: Bronfenbrenner's bioecology theory Design: Descriptive Cross‐Sectional Study Sample: Participants were randomly selected from the Regional Autism Center. ASD cohort of 59 children, ages 4‐10, 26 autism, 21 PDD‐NOS, and 12 Asperger Disorder were compared to 40 TD controls. ASD diagnosis was confirmed with the ADOS/ ASDS. Measurements and Results: CSHQ, sleep diaries and ten nights of actigraphy using Sadeh algorithm. CSHQ showed 66.1 % of parents of ASD children (62.5% autism, 76.2% PDD‐NOS, 58.3% Asperger) and 45% of parents of the controls report sleep problems. Actigrahic data showed 66.7% of children with ASD (75% autism, 52.4% PDD‐NOS, 75% Asperger) and 45.9 % of the controls had disturbed sleep. Conclusions: Prevalence estimate of 45% for mild sleep disturbances in TD cohort highlights pediatric sleep debt as a public health problem of concern. Prevalence estimate of 66% for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems these families face. The two predominant sleep disorders identified in the ASD cohort were Behavioral Insomnia of Childhood (Sleep‐
Onset Type) and Insomnia Due to Pervasive Developmental Disorders (ICSD‐2). Implications: Research for the etiology and treatment of insomnia in children with ASD is urgently needed. Further studies exploring the causal mechanisms of insomnia in children with ASD, as well as interventional studies aimed at improving their sleep through behavioral, pharmacological, and integrative modalities is warranted. Page 232
Poster Session III Effects of an Asthma Self‐Management Program on Adolescent Peer Leaders Hyekyun Rhee, PhD, RN, PNP, University of Rochester, Rochester, NY ~ Michael Belyea, PhD, Arizona State University, Phoenix, AZ ~ Judith Brasch, BS, University of Rochester, Rochester, NY ~ Lorrie Yoos, PhD, RN, PNP, University of Rochester, Rochester, NY Purpose: A peer‐assisted asthma management program capitalizing on peer dynamics pivotal to adolescents was developed and implemented at the camp setting. The main study was aimed to determine the effectiveness of the program in improving asthma outcomes in teens with asthma. For this presentation, however, we focused on investigating the extent to which the program benefited peer leaders in terms of asthma outcomes and assessing the perception of teen participants about their peer leaders. Theoretical Framework: The social cognitive theory guided the development of the intervention. Methods: Eligibility criteria for the peer leaders included (1) ages 16‐20 years (2) diagnosed with asthma (3) nomination from teachers or health care providers, and (4) grade point B or above. Fourteen peer leaders attended a 4‐week training program, led small groups of 6‐8 teens at the camp delivering an asthma self‐management program. The peer leaders completed questionnaires measuring asthma outcomes at baseline, camp and 3‐, 6‐ and 9‐months. Asthma teens (n=44) completed questionnaires evaluating their peer leaders. Mixed model ANOVA and frequency analyses were performed. Results: The peer leaders reported increasing trends in asthma knowledge (F=10.24, p< .001), self‐
efficacy (F=10.32, p< .001), quality of life (F=4.92, p< .05), asthma control (F=5.14, p=.01). On inspecting the trajectories, notable increases were found after the training session and immediately after camp, while the trends plateaued or declined at 6‐ and 9moths postcamp. The campers responded positively about their peer leaders’ quality in terms of credibility (93%‐98%), warmth (91%‐96%), perceived similarities (66%‐91%). Overall, the campers perceived that the peer leaders were effective in providing informational support (74%). Conclusion & Implications: The improvement in asthma outcomes in peer leaders highlights the beneficial effect of the training program and their experience as leaders at the camp. However, declining positive effects over time underscores the necessity of a booster program. Peer leaders were well received by their teen participants, suggesting the developmental appropriateness and the feasibility of the peer‐led asthma self‐management program for adolescents. Page 233
Poster Session III Faculty Presence in Online Courses: An Integrative Review of Best Practices Holly Evans Madison, MS, RN, Excelsior College, Manchester Center, VT Chia‐Huan Ho, PhD, Excelsior College, Albany, NY Purpose & Theoretical Framework: The academic environment has been transformed by the proliferation of online courses leaving the role of faculty in flux. Garrison, Anderson, and Archer (2000) introduced a Community of Inquiry model that identifies “three elements essential to an educational transaction – cognitive presence, social presence, and teaching presence” (p. 87). Using this model as a basis, the research question is: “What influence does faculty presence in online courses have on outcomes?” Methods: An integrative review is a research method that poses questions regarding a phenomenon of interest, with results obtained through an analysis and integration of the literature, and provides evidence for knowledge development, practice, and policy decisions. Using the Community of Inquiry model as a basis, an integrative review of the literature, covering the period 2000‐2009, was conducted using the following key phrases: online education, faculty role, cognitive, social, and teaching presence. Databases used include Academic Search Premier, CINHAL, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, PsycArticles, OVIDSP, and Sage Journals Online. A total of 1,104 articles have been identified. Further screening will reduce this pool of articles to a few dozen papers based on to‐be‐
determined review criteria. Results & Conclusions: Study in progress. Articles with a focus on faculty presence and engagement in online courses are currently being reviewed. The next phase of this study will categorize different faculty roles in online courses and compare the relationship between their roles and outcomes. Complete research findings will be presented at the conference. Implications: The results of this study can 1) identify evidence‐based best practices for faculty engagement in online education, 2) guide nursing faculty in the development of their role in online learning environments, and 3) identify directions for future research. Garrison, D.R., Anderson, T., & Archer, W. (2000). Critical inquiry in a text‐based environment: Computer conferencing in higher education. The Internet and Higher Education, 2(2‐3), 87‐105. Page 234
Poster Session III Psychometric Testing and Content Reports of the Updated Ethical Issues Scale John G Twomey, PhD, PNP, Massachusetts General Hospital‐Institute of Health Professions, Wakefield, RI Matthew K Twomey, BA, Massachusetts General Hospital‐Institute of Health Professions, Boston, MA Ethics in practice has historically been a phenomenon of interest to the nursing profession. However, data about ethical behaviors has not been reported in a systematic fashion. In 1999, the primary author participated in the construction of an ethics survey for measuring the ethical reports of registered nurses. The instrument used for this study, the Ethical Issues Scale (EIS), was later discussed in a publication that described the development of the instrument and showed the psychometric adequacy of the instrument to reliably and validly measure how nurses may portray their ethical experiences in practice (Fry & Duffy, 2001). The tool has not been used again in similar varied samples of registered nurses since the updated ANA Code of Ethics for Nurses (ANA, 2001) was published. Based on this deficit in the nursing ethics knowledge base as well as the changes in practice issues, it is proposed that the EIS be updated and retested for validity and reliability. Phase One of this study used focus group methods, expert consultants, and practicing registered nurses to revise the study (Twomey and Mahoney, 2009). The scale was reduced from 36 to 30 items. This presentation will report the results of an internet questionnaire validation project. 5000 practicing registered nurses are being sampled in a random stratified manner from databases maintained by the boards of registration of nursing in four New England states. Each invitee to the study is being sent a mailed letter that gives them the survey website. Each subject will be sent a reminder postcard with the website two weeks after the initial mailing. No links between the initial subjects and the results will be maintained. This study has been approved by the site‐responsible IRB. The survey website is maintained at the investigator’s institution and is security enabled to protect the already anonymized data. The data will be analyzed by through descriptive and regression methods Fry, S. T., & Duffy, M. E. (2001). The development and psychometric evaluation of the ethical issues scale. Journal of Nursing Scholarship, 33(3), 273‐277. Twomey, J. & Mahoney, M. March, 2009. Use of Focus Groups in a Mixed‐Methods Study to Update the Ethical Issues Scale. Poster presented at the Eastern Nursing Research Society 21st Annual Scientific Sessions, Boston, MA. Page 235
Poster Session III The Impact of Nursing Unit Design on Staff and Patients at a Magnet Hospital Mary Kennedy, MS RN, The Miriam Hospital, Providence, RI ~ Maria P Ducharme, MS, RN, CNA‐BC, The Miriam Hospital, Providence, RI ~ Cynthia Padula, PhD, The Miriam Hospital, Providence , RI ~ Nicholas Watkins, PhD, Hok, New York, NY Purpose: The purposes of this study were to (1) compare existing nursing units, with different design features, using data collected on patient and staff experiences; (2) measure the direct and indirect impacts of clinical informatics and architectural design on patient care activities, workflow, patient satisfaction, adverse events and efficiencies; and (3) use baseline results to inform design features of future nursing units. Framework Clinical informatics solutions and architectural design innovations that reflect the Institute of Medicine’s Six Quality Aims, provided the study framework . Methods: The study design was descriptive. Participants included nurse managers, registered nurses, certified nursing assistants, and patients in an acute care setting. During Phase 1, nurse managers completed a questionnaire asking them to describe the staffing, equipment and spaces on their nursing units. During Phase 2, staff filled out an internet‐based questionnaire asking them to share their perceptions and experiences while on the nursing unit. The staff’s patients were given a different questionnaire asking them to share their perceptions and experiences while on the nursing unit. Patients gave informed consent, were 18 years of age or older, and alert and oriented. During Phase 3, PDA handheld devices were used to observe staff’s work behaviors and locations. At the end of the shift, staff completed an “End of Shift” questionnaire via the Internet. This survey asked questions specific to the nursing unit on which care was provided. Inferential statistics including factor analysis and analysis of variance (ANOVA) will be used to analyze the data. Results will be presented and described. Conclusions: Implications for the design and operations of future nursing units will be discussed Page 236
Poster Session III Observation of Early Bone Mineral Density in a Cohort of Peri‐pubertal Boys with Klinefelter Syndrome: Preliminary Findings Sharron M. Close, PhD (c), MS, RN, CPNP‐PC, Columbia University, New York, NY ~ Ilene Fennoy, MD, MPH, Columbia University, New York, NY ~ Nancy Reame, PhD, MSN, FAAN, Columbia University, New York, NY ~ Arlene Smaldone, DNSc, CPNP, CDE, Columbia University, New York, NY Purpose: Early osteoporosis and bone fracture are known health risks in men with Klinefelter Syndrome (KS) due to androgen deficiency associated with testicular failure. It is unclear, however when bone mineral loss begins. The purpose of this study is to examine the relationship between bone mineral density (BMD) and serum testosterone (T) in a sample of youth with Klinefelter Syndrome (KS). Theoretical Framework: A biogenetic model guides this study. Methods: We conducted a retrospective medical record review of 15 KS boys, 12 ‐19 years of age followed at a university medical center who had undergone BMD and hormonal testing within a 12‐
month period. BMD was measured using dual‐energy Xray absorptiometry (DEXA). Serum testosterone (T) levels were measured in ng/dL by high‐pressure liquid chromatography/mass spectrometry. BMD results were converted to Z‐scores based on age, height and race. We examined the relationship between age and BMD using Spearman correlation. Results: Fifteen boys (mean age 15.4±2.6 years, 88% Caucasian and 50% on T replacement therapy) met review criteria. 50% of the subjects had BMD Z scores within 1 negative standard deviation (SD) from normal and 12% had a BMD Z score falling below ‐2.4 SD. Serum T ranged from 94 to 490 ng/dL. Serum T was below the normal range for Tanner Stage in 66%. Negative correlation (r = ‐0.59) is shown between age and BMD. Conclusion & Implications BMD lower than normal for age, height and race is seen in boys with KS much earlier than previously considered. Evaluation of BMD should be considered as a routine screening tool for KS boys. Further research is needed to determine when bone density declines and to guide potential hormonal replacement therapy. Page 237
Poster Session III Kenya Heart and Sole: The Afya Njema Project Mercy W Kamau, RN, BSN, B.Sc., University of Massachusetts‐Boston, Taunton, MA ~ Maddie Gambale, SN, University of Massachusetts‐Boston, Boston, MA ~ Lyns Hercule, SN, University of Massachusetts ‐ Boston, Boston, MA ~ Brenda Manso, SN, University of Massachusetts‐Boston, Boston, MA ~ Erica Miranda, Boston, MA ~ Eileen Stuart‐Shor, PhD, ANP., University of Massachusetts‐Boston, Boston, MA Purpose & Theoretical Framework: While infectious diseases account for the largest burden of disease in Sub‐Saharan Africa, cardiovascular diseases (CVD)/metabolic diseases are emerging as a major public health problem. The purpose of this project was to build on previous work assessing the prevalence and characterization of CVD risk factors in rural Kenya using the Chronic Disease Model. This project expanded on previous work, this time done in partnership with the Kenyan nursing students and faculty in the community to make it sustainable. Methods: A convenience sample of consecutive cases who presented to 5 rural clinics in Central Kenya were screened. The US/Kenyan student/faculty teams provided education about CVD/metabolic diseases in the native Kikuyu and Swahili dialects and screened for significant CVD/metabolic diseases using guideline concordant protocols. Those who met treatment criteria were referred to the nurse practitioners who worked in collaboration with local clinics to provide treatment. A community asset survey was carried out using social‐ecological domains in the Chronic Disease Model. Results: 717 individuals (mean age 51.2, 75% female) were screened. Mean SBP 144mmHg (SD ±27; 50 % ≥ 140 mmHg [Stage I/II HTN]), mean DBP 85mmHg (SD ±15; 37 % ³90 mmHg). Mean glucose 119mg/dL (SD ± 58; 20% ³ 140 mg/dL). Mean BMI 25 (SD ±5; 47% ³25). The community self‐reports its health status as at least fair, a high level of physical activity (manual labor), diets that are not high in fat, and a general sense of optimism. Among the 14 health problems the community identified as a priority, hypertension and diabetes were not on the list. Most individuals reported limited access to screening, treatment and medication. Conclusions: These community level data from rural central Kenya support the observation that CV risk factors are common in this area. Our data also suggest that individuals do not perceive this to be a health problem, that some risk factors (e.g. sedentary, diet high in fat, smoking) are not common and access to care is minimal. More research is needed to fully understand the risk profile of rural Kenyans with hypertension and metabolic disorders in order to develop a culturally appropriate risk reduction intervention. The next step is to continue our collaborative research with our community partners and develop a feasible, sustainable, culturally relevant risk reduction program that emphasizes community engagement and self‐management. Page 238
Poster Session III Work, Adherence and Health‐Related Quality of Life Among Workers with Cardiovascular Disease Victoria Vaughan Dickson, PhD, CRNP, NYU College of Nursing, New York, NY ~ Joshua Deal, B.A., NYU College of Nursing, NY, ~ Aileen Ferrick, MSN, APN, NYU College of Nursing, NY ~ Alexandra Howe, B.A., NYU College of Nursing, NY ~ Madeline Lloyd, MSN, APN, NYU College of Nursing, NY ~ Margaret McCarthy, MSN, APN, NYU College of Nursing, NY ~ Ana Mola, MS, APN, NYU College of Nursing, NY Purpose: To explore the relationship of job characteristics, adherence and health‐related quality of life (HRQL) among workers with cardiovascular disease (CVD). Theoretical Framework: According to NIOSH's organization of work conceptual model, job characteristics (i.e., job demands, job control, workplace support) have important health implications for America's workforce. Workers with CVD must meet the challenges of today's work processes including increased stress and intense production demands while managing the complexities of their health condition (i.e., adherence to medication, diet, exercise and symptom monitoring). Methods: In this cross‐sectional, descriptive study, a convenience sample of 75 workers with CVD (mean age 60.3 years SD 8.94; 60% female, 33.8% African American, 78.6% actively employed) were recruited from clinical and community settings. Standardized instruments were used to collect data about adherence behaviors (General Adherence Scale, alpha=.68), job characteristics (Job Content Questionnaire alpha=.67), HRQL (Macnew HRQL alpha=.90) and physical capacity (Duke Activity Scale alpha=.835). Correlational analysis methods examined the relationships between job characteristics, adherence and HRQL. Results: Hypertension was reported in 43% of the sample; 34% had coronary heart disease (prior MI, angina or heart failure). Although medication adherence was reported by most (74%); few adhered to diet (22%), exercise (21%) or symptom monitoring (31%). Psychological demands of work (increased stress and low control) were significantly correlated to adherence (r= ‐0.251, p=.036). Better adherence was reported by those who felt supported by coworkers (r=0.258, p=.031) or supervisors (r=.265, p=.033). Individuals with better adherence had higher HRQL (r=0.269, p=.014) and better physical capacity (r=.352, p=.003). High job control was also associated with HRQL (r=0.266, p=0.31). Conclusions: Generally, adherence is poor among workers with CVD. Since psychological demands of work may interfere with adherence to treatment recommendations, clinicians should assess job demands and include stress management as part of patient education and counseling. Research to develop and test interventions that foster workplace support and facilitate adherence for workers with CVD is needed. Page 239
Poster Session III Participatory Action Research: Exploring Diabetes‐Related Factors & Community Action Strategies in Nicaragua Gail D Melkus, EdD, ARNP, CDE, FAAN, New York University College of Nursing, New York, NY ~ Deborah Chyun, PhD, RN, FAHA, FAAN, New York University College of Nursing, New York, NY ~ Tammi Dekker, MSN, ARNP, Florida Atlantic University College of Nursing, Boca Raton, FL ~ Yolanda Mclean, BSN, RN, Florida Atlantic University College of Nursing, Boca Raton, FL ~ Kelley Newlin, DNSc, ARNP, CDE, New York University College of Nursing, New York , NY Purpose: To stimulate local understanding of the type 2 diabetes (T2D) epidemic on Nicaragua's Atlantic Coast, and thereby community action. Theoretical Framework: A participatory action research (PAR) model – addressing individual, social/medical, and physical environmental factors – was followed. Methods: Community members (with or at‐risk T2D), church leaders, and Ministry of Health providers (N=154) were sampled to participate in the 3‐Phase mixed‐methods study. Phase 1 involved community dialogue activities; Phase 2 focus groups; and Phase 3 quantitative data collection with measures tapping diabetes‐related factors. Qualitative data were analyzed with content analysis and quantitative data with bivariate/multivariate statistics computed. Results: Phase 1 identified diabetes as a public health challenge, limited access to diabetes care, and exceptional interest in developing church‐based diabetes education programs. Phase 2 identified individual, community, and environmental barriers to optimal healthy lifestyle behaviors and access to health‐related resources. Individual/community strengths and needs were identified to overcome barriers with church‐based strategies articulated. Phase 3 findings indicate trend toward severely uncontrolled diabetes with both limited understanding of diabetes self‐management and access to diabetes education. Implications: Stakeholders provided insight on factors contributing to the diabetes epidemic with community action strategies identified in collaboration with local churches, lay public, and Ministry of Health. Page 240
Poster Session III Patient Perceptions of Self‐Management of Insomnia in Stable Heart Failure Laura Kierol Andrews, PhD, APRN, ACNP‐BC, Yale School of Nursing, New Haven, CT ~ Jessica S. Coviello, MSN, APRN, APN‐BC, Yale, New Haven, CT ~ Elisabeth Hurley, MSN, APRN, ACNP‐BC, Yale, New Haven, CT ~ Nancy Redeker, PhD, RN, FAAN, Yale, New Haven, CT ~ Leionie Rose, MS, RN, Yale, New Haven, CT Purpose: Among the over 5 million patients with heart failure (HF) in the United States, as many as 75% report poor sleep quality. Both sleep apnea and insomnia are common and contribute to exacerbation of heart failure and decrements in quality of life and daytime function. However, there have been few systematic studies to evaluate the effects of insomnia treatment in these patients. The purpose of this study was to evaluate HF patients’ perceptions about insomnia, contributing factors, and effective treatment strategies. Theoretical Framework: The organizing frameworks were self‐management and Spielman’s “3‐p” model (predisposing, precipitating, and perpetuating factors) regarding factors contributing to insomnia. Methods: A mixed methods design with qualitative and quantitative components was utilized. A sample of ‐‐ stable, community‐residing HF patients participated in the study. We conducted structured focus groups, utilizing a structured focus group guide, based on the organizing framework to elicit their perceptions about predisposing, precipitating, and perpetuating factors for insomnia and completed the Insomnia Severity Scale, the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Multi‐Dimensional Assessment of Fatigue Scale, The Epworth Sleepiness Scale, and the Medical Outcomes Study SF‐36. Content analysis was used to evaluate themes regarding perceptions regarding insomnia and its treatment. Descriptive and non‐parametric statistics were use to analyze the quantitative data. Results: Qualitative and quantitative data analyses are in progress. We will report these data in the proposed poster presentation. Conclusions and Implications: The Results of this study will be used to inform the development of a behavioral intervention for insomnia in patients with stable HF. Future studies will be conducted to evaluate the efficacy and effectiveness of this intervention as a treatment for insomnia that may also improve daytime symptoms and function among this vulnerable group of patients. Grant #: P30NR08999 Page 241
Poster Session III Treatment Outcomes in Elderly Hypertensive Veterans with and without Cognitive Impairment (HE‐VET) Sheryl LaCoursiere, PhD, RN, BC, Yale University, New Haven, CT Cynthia Brand, MD, MPH, Yale School of Medicine, Center for Medical Informatics, New Haven, CT Richard Marottoli, MD, MPH, Yale School of Medicine, Internal Medicine ‐ Geriatrics, New Haven, CT Purpose: The specific aim is in elderly veterans with hypertension, to determine differences in receipt of hypertension treatment in those who are cognitively impaired, compared to those who are not cognitively impaired, and of those who are treated, differences in outcomes. Theoretical Framework: Quality Health Outcomes Model (Mitchell, Ferketich & Jennings, 1998). METHODS Design: nested case control study. Sample: All elderly male veterans with hypertension in New England. Setting: hospitalizations and clinic visits at VA New England Facilities. Measures: Existing electronic medical record clinical, administrative, laboratory and pharmacy data. Analysis: Descriptive statistics, logistic regression. RESULTS Preliminary assembly of a virtual cohort has yielded a sample size of 112,000 veterans over 65 in New England with a diagnosis of hypertension. Rates of hypertension treatment will be determined for veterans with and without dementia. Logistic regression (LR) will be used to determine odds of receiving hypertension treatment overall, and by modifiers of race, BMI, smoking, diabetes mellitus, hyperlipidemia, myocardial infarction, and cerebrovascular accident. Of those in both groups who receive treatment, LR will be used to determine odds of a successful outcome, or a systolic BP of 160 or less, by treatment overall, and by the same modifiers. Conclusions & Implications: Many elderly veterans with hypertension and cognitive impairment have other co‐morbid conditions in which cost of care is of great concern. As co‐morbidities increase, the veteran may be required to manage a more complex medication regimen, which in turn may have implications on overall disease outcomes. This study attempts to examine hypertension care in particularly vulnerable subsamples of veterans: the elderly, and those with cognitive impairment and cormorbidities. Control of hypertension is a priority VA performance measure, and further elucidation of the relationships of hypertension, age and dementia have the potential to identify areas where quality care can be improved. Page 242
Poster Session III Women's Experience with Cardiac Events: Implication for Early Recognition and Intervention Karen Toby Haghenbeck, PhD, FNP‐BC, RN‐BC, CCRN, Pace University, Larchmont, NY Purpose: To explicate women's experience with cardiac event and the implications their stories have for early recognition and intervention. Background: Heart disease is the leading cause of death in women in the United States more than breast or lung cancer. While the symptoms of heart disease are widely publicized, women still seem reticent to seek help. Women do not seek medical assistance early in the initial stages of cardiac problem because they think they will not be believed, are afraid of the consequences of heart disease, do not have the classic symptoms identified in men and are embarrassed to call 911. Methods: A phenomenological qualitative methodology was used to illicit the experience of seven women with heart disease. Interviews were conducted in participants homes or at a convenient location. Colaizzi's methodology was used for analysis. Results: Interviews were transcribed and analysis is almost complete. Themes identified include “It was an unforgettable experience”, “It’s a women’s thing”; “Is it real?”. Conclusion: Women present differently with symptoms of cardiac disease than their male counterparts (Thom, et al., 2006). In addition, women suffer higher mortality and morbidity from cardiac events, especially if they do not seek help within the first 4‐6 hours after onset of symptoms. The information provided will help to identify factors influencing early recognition and intervention of heart disease in women and assist in the development of educational strategies. The educational strategies can provide nurses with the information needed to help women with early recognition and intervention with the goal of decreasing the mortality and morbidity rates. Page 243
Poster Session III Partnering to Empower East Side Caregivers Mary Ann Meeker, RN, DNS, University at Buffalo, Holland, NY 1. The purpose of this study was to pilot test a family caregiver intervention and to evaluate the program quantitatively and qualitatively. 2. Inner‐city African Americans do the work of caregiving under several constraints, including health disparities affecting caregivers as well as care recipients, higher levels of poverty, lower levels for utilization of formal health care services, and a persisting legacy of discrimination. Although there were many existing web‐based resources for caregivers and some programs conducted in the suburbs, inner‐city caregivers in this community had many unmet needs. 3. Guided by principles of community based participatory research, the intervention was designed by a partnership of academic researchers and inner‐city family caregivers to be accessible and beneficial to a specific community of African American caregivers. The intervention consisted of six sessions, each comprised of an informational presentation and an opportunity for caregivers to share their own stories and receive support and guidance from each other. Topics were chosen to be relevant to all caregivers and included: insurance issues, advocacy, self‐care, care transitions, legal issues, and problem‐solving. The program was pilot‐tested at three sites and enrolled a total of 41 caregivers. Caregivers completed pre‐ and post‐tests using the Caregiver Reaction Assessment, Revised Caregiving Appraisal Scale, and Quality of Life‐Family Scale. These data were collected during telephone interviews. Total scores and sub‐scale scores were compared using paired t‐tests. Qualitative evaluation of the program was conducted through individual semi‐structured interviews. A qualitative descriptive content analysis was conducted. 4. Caregivers expressed very positive responses, indicating that they had gained a great deal of concrete and usable information related to managing care for their family members. Participants also valued the opportunity to share experiences with other caregivers and to recognize collective challenges. Documenting efficacy of the program through pre‐ and post‐ quantitative measures was hampered by difficulty contacting caregivers for data collection, and results were mixed. 5. The partnership process resulted in creation of a directly useful and meaningful program for a specific community and filled a significant gap in provision of supportive services for these caregivers. The partnership is now working to create sustainability for the program. Page 244
Poster Session III Working in a Different World ‐ A Meta‐synthesis Examining Operating Room Nursing Jennifer M. Hehl, RN, MS, CNOR, University of Connecticut, Enfield, CT Purpose: This paper is a meta‐synthesis of qualitative studies that focused on the operating room (OR) work setting and the nurses that work there. Background: OR nursing is considered the oldest of the nursing specialties and yet has not always been accepted by other nursing professionals as really being nursing. OR nursing has been viewed as having a dual nature, at times very technical and at other times as a caring nursing practice. The OR has been the setting for research that explored aspects of OR culture, nurse and physician roles, balances of power and politics, a hostile work environment and how these topics might affect patient outcomes (Beyea, 2004; Cook, Green, & Topp, 2001; Tanner & Timmons, 2000; McDonald, Waring, & Harrison, 2005). OR nurses struggle to define the work they do in concrete terms and in ways that reflect and rely on the nursing education that they must master in order to work as OR nurses (Sigurdsson, 2001). Methods: The meta‐synthesis technique of Noblit and Hare (1988) was chosen as the framework for this study. 13 studies were found to meet inclusion criteria for this meta‐synthesis. Results: The final synthesis revealed four themes; 1) Working in a Different World, 2) It is Nursing, 3) Struggle for Control, and 4) Is it Nursing? These themes revealed a setting that is defined by conflict between administration, physicians and the nurses who struggle to progress in their own profession in the shadow of a long history of servitude to surgeons. Conclusions & Implications: It is hoped that this meta‐synthesis may help guide healthcare teams to see the futility of struggling for control and instead focus their energy on finding ways to bridge the gaps of understanding and build useful and functional interdisciplinary teams. Page 245
Poster Session III Care Preferences of Individuals Living with Advanced Cardiac and Respiratory Illness Susan Lowey, MS, RN, University of Rochester School of Nursing, Rochester, NY Purpose: The purpose of this study is to describe the perspectives of people living with advanced cardiac and respiratory illnesses about care at the end of life, including their current and future goals for care, understanding about options for care at the end of life, and expectations from health care providers. Background: Much of what is known about care preferences at the end of life has been studied in patients with cancer diagnoses, often in hospice settings. Historically, fewer patients with end‐stage cardiac and respiratory illnesses have enrolled in hospice, and less is known about their goals and expectations as they move toward end of life. Methods: Two in‐depth interviews will be conducted with 20 participants who reside at home enrolled in a community home care agency. Criterion‐based sampling will be used to recruit patients with advanced heart failure and chronic obstructive pulmonary disease. Data will be analyzed using qualitative content analysis. Results: While this dissertation study is in its early stages, preliminary findings include themes of importance to patients living with chronic life‐limiting illnesses, such as the daily experience of living with burdensome symptoms, expectations and communication from health care providers, and understanding of care options with illness progression. A strong description of the range of participants’ views and self‐identified needs and preferences will be derived from the data. Conclusions and Implications: The first‐hand experiences of people living with cardiac and respiratory life‐limiting illnesses, understudied to date, are essential elements to add to the existing body of knowledge regarding end‐of‐life care. The insights gained from this study can inform future research initiatives focused on deepening theoretical perspectives and developing interventions to improve care for these patients with serious illness. Page 246
Poster Session III Instrument Development for E‐mentoring Facilitator and Constraint Factors in Nursing Theresa M Pietsch, RN, PhD(c), CRRN, Widener University, Chester, PA Purpose: The instrument, E‐mentoring Facilitators and Constraints (EFC), was developed by this researcher to identify facilitator and constraint factors to e‐mentoring in nursing regardless of behavioral intention or experience with this specific mentoring model. Theoretical Framework: Through the application of the integration of the Theories of Reasoned Action and Planned Behavior, an instrument to identify facilitator and constraint factors to e‐mentoring in nursing was constructed. Method: E‐mentoring literature and scale technique choices were reviewed. A review of the literature revealed no published instruments about facilitators and constraints to e‐mentoring. A nominal scale was chosen to identify facilitator and constraint factors. A total of 15 factors identified from the literature were analyzed by content experts. The CVI was calculated based upon the experts’ Results: To address reliability for this instrument, a test‐retest reliability procedure was contained within the scale. An open‐ended item was used to identify other potential factors. The EFC instrument was included as part of a survey that examined nurses’ attitudes toward e‐mentoring. Following approval from a mid‐sized university's Institutional Review Board, the survey was posted on the Internet through software that supports Web‐based surveys. Results: Six content experts evaluated a list of 15 facilitator and constraint factors that influence nurses’ behavior in e‐mentoring. The EFC instrument’s CVI was .83 with the 15 factors. An open‐ended item was included as the instrument’s last item. Hence, the EFC instrument had 17 items with the addition of the open‐ended item and the test re‐test item. Over a period of 11 weeks, a convenience sample of 139 RNs from 27 states in the US participated in the survey. The test‐retest reliability coefficient calculated for the EFC instrument was .99 (N =139). The 87 participant comments did not support the inclusion of any additional factors. Conclusions and Implications: With N = 139, the EFC instrument’s CVI was .83, and the test‐retest reliability coefficient was .99. Thus, a new and reliable instrument was developed to measure facilitator and constraint factors to e‐mentoring in nursing. Page 247
Poster Session III Delirium Assessment: Comparing the CAM and FAM‐CAM Nina M Flanagan, PMHCS‐BC,GNP‐BC,MS, Binghamton University, Dunmore, PA Donna Fick, PhD, RN, FGSA, Pennsylvania State University, University Park, PA Melinda Steis, PhD, RN, Pennsylvania State University, State College, PA Purpose: Previous studies have shown delirium often presents in the home prior to hospitalization in persons with dementia so developing a valid caregiver tool is crucial. The purpose of this study was to evaluate the use of the Family Confusion Assessment Method (FAM‐CAM) as an assessment for the detection of delirium superimposed on dementia (DSD) by informal caregivers/family members using an analysis of secondary data. FRAMEWORK: The Vulnerability Framework, a conceptual model that emphasizes the interactive effects of three sources of vulnerability: characteristics of the vulnerable person (state), the physical, social, family, and cultural context in which the person exists (space) and the non‐spatial, temporal flow or trajectory of change(time) was used to guide this work. Methods: This descriptive study utilized secondary data from an NIA funded prospective study (# AGO23216) which described the course of delirium in persons with dementia, the risk factors for delirium superimposed on dementia (DSD) and long‐term outcomes. The sample size for this analysis was 118 subjects. The setting was a community hospital in central Pennsylvania. Results: The sample had a mean age of 84; 59% female and 41% male. The mean Blessed Dementia Scale rating was 8. The level of agreement between the CAM and FAM‐CAM will be reported. Emerging themes for the qualitative data will be described from the categories: “coming and going of delirium symptoms at home”, “constant when sick”, “varies from day to day” “sleepiness” “timing” and “after surgery”. Implications: No valid tool for detecting delirium at home currently exists. We will discuss the significance of the FAM‐CAM for detection of delirium in the home as well as the symptoms of pre‐ hospital delirium. Future research direction and practice implications will be highlighted. Page 248
Poster Session III The Impact of Symptoms on Quality of Life for Patients with Head and Neck Cancer after Radiotherapy Canhua Xiao, MSN, University of Pennsylvania, Philadelphia, PA Purpose: To provide an integrative review of the literature on the impact of radiation‐related symptoms on quality of life (QOL) for patients with head and neck cancer after receiving radiotherapy. Background: Radiotherapy is increasingly used as an effective treatment of head and neck cancer; however, patients with head and neck cancer often experience multiple adverse effects from radiotherapy. These side effects may have significant influence on patients’ lives and thus require nursing assessment and intervention. Approach: Twenty‐four articles were reviewed, selected from a search of Pubmed, CINAHL, PsycINFO, Sociological Abstracts and the Cochrane databases within the last five years. The key words used in the literature search were: symptom, toxicity, or side effect; and quality of life, which were combined with head and neck cancer and radiotherapy. Any empirical reports addressing the impact of treatment related symptoms on quality of life for patients with head and neck cancer after radiotherapy were included in the review. Major Points: General symptoms, including early and late side effects, influence QOL for patients with head and neck cancer after radiation. The long‐term effect of symptoms on QOL may be sustained for 5 or more years. Among several specific symptoms, dysphagia is regarded as the most influential factor on QOL. Other symptoms that impact QOL negatively are mucositis, trismus, depression, and anxiety. The impact of xerostomia on QOL is inconsistent, with some studies reporting negative effect, and others observing no influence. Conclusions: Most radiation‐related symptoms have detrimental effects on QOL for patient with head and neck cancer. However, given the limited quantity and quality of the reviewed studies, more investigations should be conducted to understand the impact of these symptoms on QOL. With more scientifically based research, valuable knowledge and theory will become available for health care providers to improve the quality of care to patients with HNC. Page 249
Poster Session III Does Cultural Competency Training Matter to Health Care Providers: Are We Ready for Mandatory Training? Janice A Alves, RNC , Masters of Science ‐Nursing , Dowling College, Valley Stream, NY Purpose: This study examined 63 healthcare providers (HCPs) receptiveness towards cultural sensitivity training (CST), the amount of in‐service received, and their perception regarding the usefulness of this training for their job performance. Background: Participants in the study were nurses , medical staff and other HCPs from an emergency department in a Long Island hospital. Method : A six point Likert scale questionnaire was administered to assess the receptiveness to CST. Results: The results of the amount of training not received showed a remarkable 70% to 94% of medical staff, nurses 37% to 59%, and 65% to 77% of other HCPs. Healthcare providers reported levels of agreement varying from 58% to 76% regarding the usefulness of the CST received. HCPs reported usefulness of CST for job performance. Conclusions and Implications: The result of this study confirmed findings in the literature that indicated the need for reduction of health disparities among minorities, and the dire need for culturally competent HCPs and increased ethnic diversity of healthcare professionals. Page 250
Poster Session III Perinatal Outcomes of Hispanic Migrant Farmworkers Using the Optimality Index‐US Mary Dahl Maher, RN, CNM, MSN, University of Rochester, Rochester, NY ~ Ann Dozier, RN, PhD, University of Rochester, Rochester, NY ~ Stephen Lurie, MD, PhD, University of Rochester, Rochester, NY ~ Sarah Trafton, JD, Finger Lakes Health System Agency, Rochester, NY Purpose: Recent immigrant Hispanic women historically have had better childbirth outcomes than expected for their risk status, an outcome termed the epidemiologic paradox. This study was a pilot of The Optimality Index‐US, to compare childbearing health status, process of care, and outcomes between Hispanic migrant farmworker and resident non‐Hispanic women. Theoretical Framework: Optimality is defined as the best possible childbirth outcomes within the context of a woman’s background health status. The Optimality Index‐US (OI‐US) shifts the focus of measurement from rare adverse events to the best possible or optimal outcomes. Methods: This retrospective cross‐sectional study evaluated data from 269 parturient women between the ages of 15 and 44 years who enrolled in prenatal care between January 1, 2000, and December 31, 2005, at a federally funded community health center and gave birth in a community hospital in Western New York. All women received prenatal care from a certified nurse‐midwife or a family practice physician. The sample met inclusion criteria of first birth, cephalic (vertex) presentation, singleton pregnancy, and delivery between 37‐42 weeks gestation. Results: Significant differences were found in the PBI (Perinatal Background Index) scores between Hispanic migrant farmworker nulliparous women and non‐Hispanic local resident nulliparous women. Differences in total optimality scores (OI‐US) were not significant between the two groups. In a test of tool sensitivity using 7 items in which differences were anticipated between nulliparas and multiparas, episiotomy was significantly more common in nulliparas (p=.008). Conclusions & Implications: The Optimality Index‐US (OI‐US) is an innovative instrument that provides a method to examine the processes and outcomes of perinatal care in the United States (Murphy & Fullerton, 2001). These Hispanic women had similar childbirth outcomes despite higher background risk. This study demonstrated the use of the OI‐US in an ethnic minority population and adds further evidence of the epidemiological paradox observed in other Hispanic subgroups. Page 251
Magnet Posters — Poster # 1 Collaborating to Enhance Clinical Experiences Robin Steimling1 RN, Ann Bower1 RN, Shannon Gibble1 RN ~ Carol Hughes1 RN Bonnie Heinzleman2 RN MSN ~ Adele Spegman1 RN, PhD 1
Geisinger Medical Center, 2Jefferson University School of Nursing, Danville PA Medical‐surgical nurses have traditionally accepted the preceptor role as an expected contribution to nursing students’ education. Bedside nurses strive to facilitate quality clinical experiences for student nurses given the combined effects of growing enrollment at nursing schools, faculty shortages, and limited clinical sites. This challenge is quite complex when considered closely: Nursing students from multiple schools, at different stages of education, and with varied expectations, are often present on the same clinical area on different days or shifts within the same week and change with each new semester. In 2008, Geisinger Medical Center, a large medical center in central Pennsylvania investigated this issue in a grant‐funded project: Collaborating to Enhance Quality Clinical Educational Experiences: Facilitating Clinical Preceptors. Our team, consisting of 5 medical‐surgical nurses and 6 clinical faculty from affiliated nursing programs, worked for several months to identify issues and create best practice guidelines for students’ clinical experiences. The guidelines were presented at three interactive workshops to a combined audience of over 250 nursing staff, students, faculty, managers, and administrators. Highlighted themes included recommended skills for nurse preceptors and clinical faculty, professional behaviors, communication, and partnership in clinical learning. In addition to presenting the recommendations from the project group, the audience provided feedback and ideas for implementation of the guidelines. These suggestions included providing preceptor education specific to students’ clinical learning with an emphasis on communication skills, teamwork, and professionalism. Also important were clear accountability and recognition of staff nurses by management for their roles in working with students. This presentation summarizes our process and outcomes. Most notable, this project has increased our awareness of the essential need for collaboration between all stakeholders involved in the education of nursing students. Sustained and nurtured relationships enhance student’s clinical learning experiences, strengthen the quality of nursing practice and improve patient outcomes. Page 252
Magnet Posters — Poster # 2 Outcome Measures to Evaluate and Monitor Nursing Research Council Effectiveness Anne M. Berger, PhD, MBA, RN, CPHQ – Director, Nursing Systems Research Margaret McCabe, DNSc, RN, PNP‐BC – Director, Nursing Research / Medicine Patient Services Purpose: Magnet institutions must sustain environments that are supportive of clinical inquiry and evidence based practice in the patient care setting. This requires institutional strategies and infrastructure to promote innovative thinking leading to evidence based practice questions and projects that improve patient outcomes, and new nursing research ideas. Restructuring of our Nursing Research Council (NRC) has contributed to nursing excellence by supporting initiatives aimed at enhancing the research related knowledge and skill of every nurse independent of their level of practice and existing research knowledgebase. The council achieves this through the directed work of four subcommittees: Evidence Based Practice (EBP), Dissemination, Mentorship and Scientific Review (Nurse Scientists), and Clinical Research Nurses. The unique subgroup structure combines independent subcommittee meetings with full council meetings allowing each group to develop initiatives with the guidance and support of the larger committee. Methods: Following restructuring, outcome measures have been developed to evaluate program effectiveness and to guide continued program development. Research and scholarship metrics include: the number of attendees at NRC meetings, the number of research proposals reviewed for scientific merit, the number of IRB approved nursing research proposals, the number of EBP projects initiated/completed, the number of EBP projects resulting in practice/policy changes, the number of grants submitted/received, the number of publications/presentations/posters disseminated locally and nationally, as well as committee member satisfaction. Findings: Over the past 18 months, many successes and positive outcomes have been noted, including increased participation, increases in the quantity and quality of nursing research and EBP projects, as well as increased use of research and knowledge dissemination. This innovative council model can serve as a framework to create research capacity and to enhance research use in the clinical setting. Discussion: This model has fostered increased collaboration and rich information sharing across shared governance councils, nursing programs, as well as with our academic colleagues. It has generated new enthusiasm for nursing scholarship, thus meeting our goal to create an institutional culture of nursing scholarship that promotes a scientific basis for nursing practice across the continuum of care. Initiatives are driven by practice issues and the science of knowledge development. This committee also provides an important linkage with our academic partners, which fosters further collaborative opportunities. Page 253
Magnet Posters — Poster # 3 An Interdisciplinary Intervention to Prevent Falls in Hospitalized Adults C. DiSano, RN; C. Ruggiero, RN; M. Reppucci, DPT; M. Carpentier, RN; B. Forloney, RN; C. Hughes, RN; C. Padula, RN – The Miriam Hospital, Providence, Rhode Island Preventing falls represents a major challenge for bedside nurses, particularly with the increasing numbers of older adults in hospitals. Yet achieving positive outcomes as a result of fall prevention programs in acute care hospitals has remained elusive. Falls are caused by a variety of factors, and acutely ill older people are at higher risk of falls and falls with injury. Maintaining mobility is key in preserving independence in ADLs, yet low mobility and bed rest are common during hospitalization. Lower extremity weakness and balance as well as gait instability (Oliver et al., 2004) have been identified as important risks, and exercises that improve lower body strength and balance have been shown to reduce falls. The purpose of this study was to examine the impact of lower extremity strengthening exercises and mobility on fall rates in hospitalized patients. A nonequivalent control group design was used, with treatment (lower extremity exercises plus mobility) and control (mobility alone) nursing units. The sample (n = 225) included patients admitted to the study units during the six‐month data collection period. Exclusion criteria included strict bedrest orders and LOS less than three days. A trained research nurse reviewed medical records for potential inclusion, provided an informational letter to potential subjects, and performed an assessment of lower extremity strength. The inter‐disciplinary intervention included ambulation using a nurse‐driven mobility protocol plus tailored lower extremity strengthening exercises. Aggregate data as well as individual data for study participants related to fall rates and fall rates with injury were analyzed. Fall rates for study participants were below the established targets. Implications for nursing practice will be identified and addressed. Page 254
Magnet Posters — Poster # 4 Managers’ Views of Communication in Healthcare Settings Drs. Hartung, Miller, & Spegman Background: Current initiatives on best practices underscore the importance of healthy work environments that sustain quality care. Disruptive behaviors, such as ineffective communication and poor teamwork, can be harmful to patients and demoralizing to employees. Communication problems include withholding information, conveying inadequate information, and demonstrating demeaning or disrespectful attitudes. The unit manager is the frontline administrator in a hospital. Studies have correlated leadership style with workers’ productivity and retention; however, few studies have focused on nurse managers’ opinions about their impact on communication and the workplace (Aikens, 2002; Baird, 2000; IOM, 2004). Purpose: The purpose of this descriptive qualitative study was to examine nurse managers’ views of their communication practices as related to their leadership roles in the hospital setting. The study was initiated to provide insight into the less tangible aspects of communication and workplace health. The qualitative emergent design was chosen because the research design emerges based on the realities and viewpoints of those under study. Description, Methods & Results: Forty Operations Managers (unit nurse managers) at a north central Pennsylvania major tertiary care center with Magnet status were invited to participate. The study sample included 12 in‐depth interviews of six Operations Managers. Data collection consisted of demographic information, audiotaped interviews, transcripts of those interviews, and researchers’ field notes and memos. During analysis, 370 free nodes were marked, and more than 150 first and second‐
level codes were identified, using ATLAS.ti and NVIVO 8 software. Examples of free nodes in this study included “accessible” and “involved.” Examples of first‐level codes included “spreading yourself thin,” “cloning oneself,” and “circling back.” Examples of second‐level codes included “changes within one’s influence” and “meeting the challenges.” Conceptual relationships were mapped into positive and negative connotations, e.g., “open minded” (positive) versus “open‐mouthed” (negative). Conclusions: These findings are useful to strengthen communication practices in patient care settings. Methods of communication, as delineated, enable managers to communicate more effectively. Several workplace processes were identified that may hinder the managers’ abilities to stay connected to their staff, and thus can be obviated. More research is needed into the values and communication patterns of nurses from different generations. Page 255
Magnet Posters — Poster # 5 Impact of 12‐Hour Shifts on Nurse and Patient Safety Madelyn Alonzo, Brittany Bolton, Heather Chapman, Melanie Chiv, Barbara Davis, BS Marlene Dufault, PhD, RN, Kerry Elsdoerfer, Robin Devin, MA, PhD, Jartu Karneh, Mary Kelly, BS, Nancy Leuthavone, Mary Logan, BS, RN Elizabeth Moreira, Koren Palmisani, BS, Cynthia Willey, PhD. Purpose: To determine the impact of 12‐hour shifts on nurse and patient safety, a systematic evidence synthesis was conducted to assist in policy‐making regarding nurses work schedules for creating a safe and satisfying care environment. Theoretical Framework: Roger’s "adoption‐of‐innovations" theory and Dufault’s Collaborative Research Utilization Model guided potential policy changes. Methods: A four‐stage evidence synthesis was conducted. First, 8 nursing students guided by faculty, clinicians, librarians, and quality and information experts, searched, reviewed, & critiqued the evidence. Search strategy (1988 – 2009) included research, clinical practice guidelines, and “grey literature” from databases of Cochrane, PubMed, and CINAHL. 12 articles meeting inclusion criteria were evaluated for methodological rigor. Second, a strength‐of‐evidence summary table was constructed. Third, senior leadership students directed by the information systems specialist conducted retrospective reviews of 80 medication errors/near misses occurring during 2008‐09 in this 148‐bed Magnet community hospital. Variables examined included error location, length of shift, and between‐shift recovery time. Fourth, a hospital‐wide research roundtable was convened to discuss scientific merit, clinical applicability & feasibility, comparison of clinical findings to empirical literature, and potential for translation into best practices and policies. Results: Strength of clinical and empirical evidence was conflicting (all studies descriptive, graded at levels 4 to 7). Findings from the retrospective study revealed majority of errors occurred on first day following time off, rather than during 12‐hour shifts. Conclusions/Implications: Evidence to support policy changes related to nurses schedules is inconclusive, suggesting need for multi‐site studies to guide policy. Page 256
Magnet Posters — Poster # 6 The Lived Experience of Liver and Kidney Transplant Recipients Kristy Sands, MSN RN and Tracey Kopenhaver, MSN RN Approximately 5,000 patients undergo liver or kidney transplants each year. Most commonly, the transplanted organs are obtained from a deceased donor. Although the medical care following the transplant is increasingly refined with improved outcomes, less is understood about the patient’s experience of receiving a liver or kidney transplant from a deceased donor. The purpose of this study was to examine the holistic experience of receiving a liver or kidney transplant from a deceased donor. By understanding the transplant experience from the recipient’s point of view, nurses will be better able to anticipate patient needs and develop individualized plans of care for each recipient. The sample consisted of adult liver and kidney transplant recipients transplanted with deceased donor organs within the Geisinger Health System after January 1, 2006. Geisinger Health System is a level‐one trauma center located in rural Pennsylvania. A phenomenological approach was utilized to examine the “lived experience” of the transplant recipients. The holistic experience was described through personal interviews with transplant recipients conducted by the researchers. The data collected was analyzed using Colaizzi’s framework. Common themes related to receiving a liver or kidney transplant are presented. The implications for nursing are greater understanding of the holistic experience of receiving an organ transplant, increased awareness of recipient needs, and improved plans of care for recipients. Page 257
Magnet Posters — Poster # 7 Using NDNQI‐RN Survey Data to Identify Hospital Units Vulnerable for Bullying, Harassment and Horizontal Violence (BHHV) Wendy C. Budin, PhD, RN‐BC1, Susan L. Bowar‐Ferres, PhD, RN, NEA‐BC1, Judith Vessey, PhD, CRNP, FAAN2, Roseanna DeMarco, PhD, PHCNS‐BC, ACRN, FAAN2 (1) NYU Langone Medical Center, New York, NY; (2) William F. Connell School of Nursing, Boston College, Chestnut Hill, MA Background: Bullying, Harassment and Horizontal Violence (BHHV) is a significant problem in the nursing workforce; recipients exhibit poorer health and increased workplace disengagement, absenteeism, and turnover. All of these are associated with increased medical errors and poorer patient outcomes. By identifying strategies that allow for the rapid identification of BHHV, interventions can be initiated to reduce BHHV and its sequelae. Purpose: To demonstrate that existing NDNQI and exit survey data can be used to identify units at‐risk for negative outcomes associated with BHHV among nurses. Specific aim: To identify the subset of NDNQI‐RN Survey items that is consistent with BHHV within the nursing workforce that could then be used for screening or evaluation purposes after targeted interventions have been implemented. Methods: In Phase I, a BHHV measure was created from the NDNQI‐RN Survey questions using a modified Delphi technique. A panel of subject matter experts (N=12) with an in‐depth knowledge of the literature on BHHV participated in a multi‐phase process designed to transform individual opinions regarding the contribution of specific items into a group consensus as to those items that are consistent with bullying, harassment and horizontal violence (BHHV) on nursing units. In Phase II, the goal was to evaluate the effectiveness of using the delineated items for detecting units where BHHV is an issue. The validation sample was drawn from 1,200 RNs in 46 inpatient units at NYU Langone Medical Center. Unit data will be complied and ranked by using normalized, summed scores from the August 2009 NDNQI‐RN Survey. Content analysis of open‐ended questions from exit interview data are to be ordinally ranked by unit according to both the percentage of exiting RNs that reported information consistent with BHHV and have higher turnover. A matrix of NDNQI‐RN Survey and exit interview data will be used to identify those units that fall in the lower quartile. Turnover data and key informant panels will validate these findings. Results: The resulting BHHV indicator from the Phase I Delphi study was a measure consisting of 23 identified questions from the NDNQI‐RN Survey that were congruent or highly specific to bullying, harassment and horizontal violence. Conclusions & Practice Implications: By increasing recognition, interventions can be initiated to reduce BHHV and its sequelae, and be used to help ascertain cost savings related to decreased RN absenteeism, nurse turnover, as well as improving nursing care quality. This work also serves as a pilot study for development and further validation of an NDNQI‐RN Survey BHHV indicator. Page 258
Early Doctoral Poster Session The Effect of Therapeutic Touch on Bio‐behavioral Stressmarkers in Vascular Surgical Patients Amanda Bulette Coakley, RN, PhD, Massachusetts General Hospital, Acton, MA Mary E. Duffy, RN, PhD, FAAN, Massachusetts General Hospital, Acton, MA Background: Therapeutic Touch, a complementary modality that effect psychological distress and help patients to relax, is used by nurses to help patients manage pain and anxiety. It is unclear how TT works and if there is an impact of TT on bio‐behavioral markers such as cortisol and natural killer cells (NKCs). Preliminary evidence suggests relaxation may have positive effects on the immune system. Purpose: Yo test the effect of Therapeutic Touch (TT) on stress in patients recovering from vascular surgery. Framework: The study was grounded in a Psychoneuroimmunology framework to address how stress interferes with recovery in surgical patients. Methods: This was a between subjects intervention study with repeated measures. Sample: Twenty‐one post‐operative vascular surgical patients. Measures: Measures of level of pain, anxiety, wellbeing, ability to sleep and vital signs were done before and after a TT treatment. Levels of cortisol and natural killer cells were drawn before, immediately after a TT treatment and one hour later. Open ended questions were asked at the end of the TT treatment. Results: Compared to those who received usual care, participants who received TT had significantly lower systolic BP, better ability to sleep, lower level of pain, lower Cortisol and higher NKC levels. There was a significant correlation between pain and anxiety. Responses to open ended questions indicated TT provided relaxation and aided participants’ ability to sleep Conclusions & Implications: There is evidence that supports TT as a beneficial intervention for patients with many conditions. Future research on TT is still needed to learn more about how it functions. However, there is evidence to support incorporating TT into nursing practice as a complementary modality to help patients relax, decrease pain and provide comfort. Page 259
Early Doctoral Poster Session Vulnerability in Homeless Adolescents: A Concept Analysis Caroline Dorsen, MSN, FNP‐BC, NYU, Brooklyn, NY Purpose: The reduction of health inequities among vulnerable populations is one of the major foci of Healthy People 2010. As more attention is paid to vulnerable populations a need exists to re‐examine the conceptual definition of the term vulnerability, both in general and as it relates to specific populations that have traditionally been labeled as vulnerable. Homeless adolescents experience health disparities as compared to their housed counterparts and are considered to be among the most vulnerable of all populations. This paper will examine the meaning of the term “vulnerability” as it relates to homeless adolescents. Theoretical Framework: Rodgers (2000) evolutionary concept analysis method. Methods: The keywords “vulnerable” “vulnerability”, “homeless”, “adolescent”, “street” and “youth” were used to search Pub Med, Medline and Cinahl, for research articles published between 1980 and 2009. 20 articles, representing multiple disciplines were reviewed for antecedents, attributes, consequences and related terms. The results were categorized to explore trends across studies, methodologies and disciplines in an effort to arrive at a global definition of homeless adolescent’s vulnerability. Results: The literature was congruent across disciplines and research methodologies regarding the antecedents, attributes and consequences of vulnerability among homeless adolescents. However, differentiation between the related concepts of risk and vulnerability, as postulated by seminal nurse researchers, was not supported. Conclusions and Implications: Vulnerability in homeless adolescents is conceptualized as the result of the interplay between the common human experience of risk, the increased developmental risks of adolescence and the increased risks of life on the streets. This definition is compatible with a proposed modified version of Flaskerud and Winslow’s Vulnerable Populations Model (1998) and further understood in relation to Bronfenbrenner's Social Ecology Theory (1977). Research is needed to examine the role of self perception of vulnerability and how it relates to health outcomes in this at‐risk, and resilient, population. Page 260
Early Doctoral Poster Session COPE Intervention for Parents of Children with a Neurological Condition Lisa Duffy, PhD(c), CPNP‐PC, CNRN, Children's Hospital Boston & Boston College, Dedham, MA Purpose: to determine the preliminary efficacy and feasibility of the COPE (Creating Opportunities for Parent Empowerment) intervention with parents of children with neurological conditions. COPE teaches caregivers how to recognize and interpret behavioral cues provided by their child. Once these behaviors are recognized, parents can rely on their cognitive schema to formulate a plan on how to help their child cope with the experience. Parents will be able to improve their child’s adaptation to living with a chronic condition by anticipating problems and intervening before the child manifests significant behavioral problems. Theoretical Framework: The self‐regulation theory supports the idea that providing parents with information regarding how to respond to their child’s behavioral cues can improve the behavioral and emotional adjustment of the child to his or her condition. COPE is based on the theory of self‐regulation, which consists of three phases: 1) illness representation, 2) coping or action‐planning, and 3) the person’s evaluation of the situation. Methods: This clinical study uses a randomized repeated measures design administered at three intervals: 1) 24 hours after hospital admission in writing and by audiotape, MP3 download or Podcast 2) 3 days following discharge by telephone, and 3) 6 weeks after hospitalization in writing and by audiotape, MP3 download or Podcast. The sample will consist of both mothers and fathers of children between the ages of 2 and 6 years who have been diagnosed with a neurological condition. The proposed target sample size for this study is 88. The sample will be recruited from an inpatient neurology unit at a teaching hospital. Data collection measures include: 1) Parent Belief Scale. 2) Beck Depression Inventory, 3) Parent State‐Trait Anxiety Inventory, and 4) Behavioral Assessment System for Children. Data analysis will be conducted using multivariate analysis of co‐variance (MANCOVA). Results: Data collection is currently ongoing. Conclusions and Implications: Participants and their children may benefit from this study as evidenced by improved parental functioning and increased adaptation of the child to living with a neurological condition. Knowledge gained from this study will help to improve the lives of people with disabilities. Page 261
Early Doctoral Poster Session Parental Acceptance of Human Papillomavirus Vaccine in 9‐18 Year Old Girls Diane Reynolds, EdD(c), RN, OCN, CNE, Long Island University, Brooklyn, NY Purpose: To test a model that predicts intention to vaccinate and that includes as predictors variables from the health belief model and the theory of reasoned action. 2. Examine the relationship between parental knowledge of HPV and intention to vaccinate. 3. Test the hypothesis that parents/guardians who have received information regarding HPV from their pediatricians or health care providers will be more likely to intend to have their daughters receive HPV vaccination than parents who have not. 4. Test the hypothesis that parents/guardians who have more intrinsic religious motivation and for whom religious faith is more important will be less likely to intend to have their daughters receive HPV vaccination than parents who have more extrinsic religious motivation and for whom faith is less important. 5. Test the hypothesis that parents/guardians who have had a personal history or know of someone who has had a sexually transmitted disease (STD) or cervical cancer will be more likely to intend to have their daughters receive HPV vaccination than parents who have not. The conceptual framework for this descriptive correlational study integrates several constructs from the health belief model and the theory of reasoned action. The target number of participants for this study will be 350 parents/guardians of 9 to 18‐year old female children who will be recruited via an online survey. How do parents feel about new vaccines? by Dempsey and colleagues (2006) and Parental views on vaccination, developed by Waller and colleagues (2007) will be used to assess factors that may contribute to vaccine acceptance or refusal. Additionally, The impact of religion on the decision to vaccinate will be assessed through the use of 2 brief questionnaires, The Santa Clara Strength of Religious Faith Questionnaire, (Plante & Boccaccini, 1997) and The Intrinsic/Extrinsic Religious Orientation Scale by Feagin (1964). Exploratory factor analysis and regression analysis will be used to interpret data. Results from this study can be used to inform interventions to increase acceptance of HPV vaccination, as well as contribute to shaping public policy decisions in the United States. Page 262
Early Doctoral Poster Session Understanding the Cultural Expressions, Meanings, Beliefs, Practices, and Experiences of Mexican American Women during the Posptartum Period: An Ethnonursing Study Conceptualized within Leininger's Culture Care Theory Valera Alice Hascup, PhD (c), MSN, RNC, CTN, CCES, Somerset Medical Center and Kean University, Saddle Brook, NJ Purpose: To discover, understand and explicate the emic expressions, meanings, beliefs, practices and experiences of Mexican American women during postpartum. Background: Minimal extant research is available in the literature regarding Mexican American women and the postpartum period. The Mexican American population is the fastest growing Hispanic sub‐group with the highest birth rate. Eliminating health disparities is a goal of Healthy people 2010. It is imperative for nurses to understand the postpartum cultural context in order to deliver culturally appropriate and congruent care. Methods: Leininger's qualitative ethnonursing design is used for this study. The sample consists of 36 Mexican American women informants: 8 key informants and 16 general per Leininger's 2:1 rule. Data collection occurred within a city context at two sites: an Hispanic community center, and an Hispanic church. Initial audio‐taped interviews are 1‐2 hours in length. Additional interviews of key informants are 30 ‐60 minutes as needed. Leininger's enablers will be used to guide the study. Analysis will be according to Leininger's four phases of analysis: 1) Collecting, Describing, and Documenting Raw Data; 2) Identification and Categorization of Descriptors and Components; 3) Pattern and Contextual Analysis, and 4) Major Themes, Research Findings, Theoretical Formulations and Recommendations. Data will be managed by a qualitative software program NVivo 8. 4 Results: Pending ‐ ongoing research. 5. Conclusions and Implications: Conclusions of the study will provide data to guide the delivery of culturally congruent, beneficial, and meaningful care for new Mexican American mothers. The findings will contribute to the healthcare provider's understanding of the various practices and beliefs of these women, and how these factors influence health seeking behaviors. The findings from this study will contribute to the body of nursing knowledge regarding the postpartum period in Mexican American women. Page 263
Early Doctoral Poster Session Synthesis of Literature on Strategies for Chronic Disease Management During Disaster Kavita Radhakrishnan, BSN, RN, University of Massachusetts‐Amherst, Sutton, MA Cynthia Jacelon, PhD, RN, University of Massachusetts‐Amherst, Amherst, MA Purpose: ‐ Disasters are devastating events that can overwhelm individuals with chronic diseases and shift their priorities from routine disease management to immediate survival needs. There were fatal consequences to this shift in health management during recent disasters. This review of literature was conducted to identify strategies to help manage chronic illness during disasters. Background ‐ During several recent disasters many people with preexisting chronic diseases sought help at disaster shelters. These individuals experienced hardships due to difficulty contacting physicians, lack of medications, insufficient insurance coverage, lack of transportation, and adequate resources in shelters. Methods – The Ecological Model of Disaster Management guided the selection and synthesis of research articles focused on the management of adults with chronic diseases during disasters. Articles published between January 2000 and May 2009 were included. Research focused on mental illness, children or adolescents was excluded. Results – The sample included 5 surveys, 5 retrospective record audit, 4 qualitative studies and 1 study with correlational study design. The review yielded recommendations for disaster planning for individuals with chronic diseases. Conclusions – Integration of management strategies, informed by the literature and tailored to characteristics of the chronic disease population, can provide effective solutions for chronic disease management during disasters. Technology’s role in facilitating this management during disasters is highlighted. Implication – Being the most plentiful health care providers and adept at working with individuals with chronic disease, nurses are in an excellent position to take leading roles in disaster planning missions. Educating individuals on self‐management techniques, participating in drills, and familiarizing themselves with disaster technology are some of the ways nurses can help and support individuals with chronic diseases during disasters. Page 264
Early Doctoral Poster Session Frailty in Older Adults: An Evolutionary Concept Analysis Christine Tocchi, MSN, C‐GNP, Yale University School of Nursing, New Haven, CT Purpose: The term frailty is often used to describe a subset of older adults with complex health needs. Frailty is associated with personal suffering, disability, decreased quality of life, and increased rates of hospitalization, long‐term care needs, and healthcare costs. An emergent problem is the fragmented perspectives on the pathophysiology and multifactorial nature of frailty. Lack of consensus as to the etiology and definition of frailty has thwarted the ability to establish guidelines to describe older adults as frail and to develop potential preventative and treatment interventions. The purpose of this poster is to clarify the concept of frailty in context of older adults, review the current literature that influences frailty, propose a definition of frailty to identify frail older adults, and develop a model to explain the conceptual domains of frailty. Theoretical Framework: The evolutionary cycle of continuing development necessary to create a foundation for further inquiry and concept development. Methods: Rodgers’s evolutionary concept analysis. A comprehensive literature review was conducted using Medline, PubMed, CINAHL, Scopus, and PsychINFO databases from 1980‐2007. Keywords for the search included: “frailty”, “frail elders”, “aged”, “concept analysis”, and “conceptual framework”. After review of abstracts and reference lists the final result was a sample of 16 key citations. Results: The defining attributes of frailty are: (1) accumulation of deficits, (2) susceptibility, (3) tenuous nature, and (4) continuum. Based on these attributes the following definition is suggested: frailty is the accumulation of deficits that places older adults in a tenuous state between stability and instability and susceptible to adverse health outcomes. Conclusion and Implications: Frailty is a multi‐dimensional phenomenon that is influenced by biomedical, psychosocial, an environmental factors. The proposed definition of frailty provides a theoretical guide for developing strategies to identify, prevent, and treat frailty in nursing practice and research. Page 265
Early Doctoral Poster Session Activities of Daily Living in Community Dwelling Older Adults Shoshana Y Gladstone, BSN, RN, University of Massachusetts‐Amherst, Pelham, MA Cynthia Jacelon, PhD, RN, CRRN, University of Massachusetts‐Amherst, Amherst, MA Purpose: The goal of this study was to gather information regarding the pattern of daily activities in older adults. Background Ninety‐five per cent of older adults live independently in the community. However, little is known about their patterns of daily activities. As the number of older adults grows, an understanding of the patterns of daily activities will help healthcare planners determine how best to provide support to this population. Methods A convenience sample of community‐dwelling older adults who were at least 65 years old (5 women and 1 man) was recruited from a senior housing complex. Participants kept self‐report diaries recording activities in five categories (personal care, errands/chores, leisure, social and sleep) across 3 days. The diaries were augmented by interviews. Data were analyzed by looking for patterns across and among participants. Total time spent for each activity was recorded in minutes and time spent was averaged over three days. Participants recorded activity in the diary when changing from one activity to another anytime during the three days. Results The amount of time participants spent in each activity varied dramatically across participants. Among participants there seemed to be a connection between leisure time and social time; the more time a participant spend engaged in independent leisure activity the less time they spent engaged in social activity. Collectively participants spent the most time sleeping, followed by leisure, personal care, social interactions and finally errands or chores. Conclusion and Implications The findings of this study indicate that there are wide variations in the way older adults allocate their time and activities. Although more research and larger studies are indicated, our findings suggest that when planning support for community dwelling older adults, one size will not fit all, but baseline activity profiles must be established for each individual. Page 266
Early Doctoral Poster Session The Development of a Comprehensive Fidelity Assurance Plan for the Theoretically‐guided Written Representational Intervention To Ease Symptoms (WRITE Symptoms©) Research Study. Phensiri Dumrongpakapakorn, Doctoral Student, University of Pittsburgh, Pittsburgh, PA ~ Heidi S. Donovan, PhD, University of Pittsburgh, Pittsburgh, PA ~ Susan Heidrich, PhD, University of WI, Madison, WI ~ Judith Knapp, PhD, University of Pittsburgh, Pittsburgh, PA ~ Mi‐Kyung Song, PhD, UNC, Chapel Hill, North Carolina ~ Sandra Ward, PhD, University of Wisconsin, Madison, WI Purpose: To describe the development and preliminary evaluation of a comprehensive plan for ensuring treatment fidelity for WRITE Symptoms, a web‐based symptom management intervention based on the Representational Approach (RA) to patient education. Theoretical Framework: The RA is an intervention theory that can guide the development of specific patient education interventions that promote conceptual and behavioral change for patients coping with illness. Previous studies have reported evidence of its acceptability to patients and its efficacy in improving outcomes and omitted comprehensive fidelity assurance plans for specific representational interventions. Methods: A three‐arm RCT is underway to compare the efficacy of nurse‐delivered WRITE Symptoms vs. self‐directed WRITE Symptoms vs. care‐as‐usual for improving symptom management for women with recurrent ovarian cancer. The target sample is 480 women recruited from Gynecologic Oncology Group clinics nationwide. Methods for ensuring treatment fidelity include attention to theoretical congruence in intervention development and study design; iterative development of the intervention manual and fidelity monitoring tool; interventionist training in the theoretical model and clinical focus (ovarian cancer symptom management), and; ongoing monitoring of intervention delivery and remedial training activities. Results: Fidelity findings from ten completed interventions will be presented. Actions to address variations in intervention delivery will be discussed. Conclusions & Implications: Treatment fidelity means that an intervention is implemented as intended. By developing a comprehensive fidelity assurance plan, researchers can maximize the internal and external validity of intervention studies thereby ensuring accurate interpretation and dissemination of study findings. Page 267
Early Doctoral Poster Session Obesity Prevention in Latino Preschoolers: Using Cultural Sensitivity to Influence the Feeding Practices of Latina Mothers Mary Koslap‐Petraco, DNP(c) MS PNP‐BC CPNP, Stony Brook University School of Nursing, Hauppauge, NY Purpose: Since the number of Latino youth is increasing in the United States, there is an urgent need to develop and implement clinical and community strategies to prevent and treat obesity within this high risk gender‐ethnic group (Stovits et al., 2008. Background: Currently, there is no effective, culturally sensitive paradigm to educate Latina mothers on how to prevent overweight in their young children. The prevalence rates of obesity and obesity related morbidities for Latino male children and adolescents are higher than other major gender‐ethnic groups (Stovitz, Schwimmer, Martinez, & Story, 2008). Branner, Komaya, & Jensen (2008) found that 15.4% of Latino pediatric patients received obesity‐prevention counseling compared to 28.8% of non‐Latino. The cultural context of the parent‐child feeding interaction needs to be acknowledged when developing interventions. (Crawford, et al., 2004). Methods: The sample of 32 Latino families will be drawn from those presenting with 3‐5 year old children for primary care at a health center in Suffolk County, New York during the 4 month period of the study. A quasi‐experimental pre and post test design with a convenience sample will be used. A nutritional education teaching sheet will be given to each mother in addition to the oral teaching provided. A questionnaire will be given to each Latina mother at the initial visit and again at the follow up visit. The questionnaire will measure her nutrition practices for her child. All materials will be provided in Spanish or English. Demographic data will be evaluated by measures of central tendency. Inferential statistics will be used to determine if the nutrition education program was effective. Results: Results will be reported at the time of the presentation. Data analysis will determine the effectiveness of the teaching program. Conclusions & Implications: Nursing may have a scientifically supported paradigm to assist Latino families in preventing overweight in their children. Page 268
Early Doctoral Poster Session Evidenced Based Practice for the Prevention and Treatment of Cancer Related Infection Sylvia Kathryn Wood, DNP (c) MS ANP‐BC, Stony Brook University, Amagansett, NY Purpose: To investigate implementation of the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for the Prevention and Treatment of Cancer Related Infection in a community hematology oncology practice. Theoretical Framework Evidence‐based practice is the scientifically researched foundation to achieve consistency, efficiency, quality, and safety in clinical practice. Background In 2010, cancer is expected to be the leading cause of death worldwide. Innovations in cancer diagnosis and treatments have improved survivorship. However, cancer‐related infection remains a major obstacle in achieving effective outcomes causing significant morbidity and mortality. Current epidemiologic trends in cancer related infectious pathogens have changed dramatically over the last two decades with antimicrobial resistance a serious emerging problem. Knowledge gaps, inadequate prophylactic strategies, antibiotic therapy and improper infection control practices are prevalent. While neutropenia remains a major risk factor, other immunocompromised cancer states and their spectrum of susceptible pathogens pose equal infectious risk. The NCCN expanded the scope of guidelines beyond neutropenia for all cancer states, creating the 2008 Clinical Practice Guidelines in the Prevention and Treatment of Cancer Related Infection. Methodology Descriptive study comparing retrospective to prospective patient records (N=110) before and after implementation of NCCN guidelines. Outcome variables: types and rates of cancer‐related infection, rates of hospitalization, rates of cancer treatment delays/dose reduction and guideline adherence. Secondary outcomes: data regarding infections specific for community oncology patients, provider practice patterns, barriers to guideline use in clinical practice. Results Data collection is nearing completion and analysis will utilize descriptive statistics, T‐
tests, and ANOVA’s for interpretation. Conclusions & Implications Efforts to improve patient care with evidenced based clinical practice guidelines require identification of multiple factors contributing to barriers and successful integration into clinical practice. Ongoing‐evidenced based nursing research of guideline implementation is vital to elucidate their broader implications regarding diffusion of knowledge and guideline effectiveness to achieve quality care and improve patient outcomes in the cancer population. Page 269
Early Doctoral Poster Session Adolescent Health Literacy: An Evolving Concept Ann‐Margaret Dunn‐Navarra, RN, MS, CPNP, Columbia University, Smithtown, NY Background: Approximately 90 million Americans have inadequate levels of health literacy, and poor health literacy has been associated with a range of negative health outcomes. Few studies have assessed the relationship between child/adolescent health literacy and health knowledge, behavior, or outcomes. Literacy or reading ability is an important component of health literacy, but reading level alone does not explain the complex skills involved in becoming a health literate individual. Purpose: The objective of this concept analysis was to examine the current state of knowledge for the concept of health literacy in the adolescent population. Approach: The evolutionary view of concept analysis was applied and included a literature based analysis. The specific population studied was adolescents aged 13‐24 years. All identified published peer reviewed literature on health literacy in adolescents was included (i.e. there was no time limit). Search terms in PubMed, Medline, and Web of Science included “health literacy”, “literacy and health”, “adolescents/teens”, “chronic illness”, “health outcomes” and “literacy and teens”. Thematic analysis was performed including coding of categories to identify defining attributes of health literacy. Major Points & Rationale: Reading or functional literacy is both a related concept and antecedent of health literacy. A primary attribute of health literacy in the adolescent population is media literacy. In addition, health literacy in teens is related to the developmental stage of adolescence, and includes peer and family influences, interaction with the educational system, health risks, health care encounters, and political and social influences. Consequences of poor health literacy in teens represent a gap in the literature. Conclusions: Adolescent health literacy is an evolving concept. Interventions to improve health literacy should be tailored to the developmental stage and functional literacy level of an individual teen. Media represents a potential vehicle for the delivery of health related education and information to the adolescent population. References 1. Institute of Medicine (2008). Standardizing medications labels: Confusing patients less. Washington D.C: The National Academy Press. 2. Zarcadoolas, C., Pleasant, A., & Greer, D.S. (2005). Understanding health literacy: an expanded model. Health Promotion International, 20 (2), 195‐203. Page 270
Early Doctoral Poster Session Meaningful Activity in Long Term Care: An Evolutionary Analysis Sheila Pennell, BS, RN, University of Massachusetts‐Amherst, Northampton, MA Purpose: This poster is a report of a concept analysis to define, contextually locate, and describe meaningful activity in long term care. Background: The current population aged 65+ numbers approximately 41 million, and 1.5 million of those older adults currently live in nursing home facilities (CDC, 2009). Despite constant technical quality improvement efforts, quality of life in nursing homes remains low (Kane, 2001). Meaningful activity has the potential to guide new nursing interventions and structural improvement efforts aimed at improving quality of life in long term care. Approach: Rodgers (2000) evolutionary view for concept analysis was used to guide this investigation. Literature review was completed using CINAHL and Psychlit databases for entries prior to March 2009 (n=28). An inductive spirit was maintained, and thematic analysis was conducted using the concept analysis categories: attributes, antecedents and consequents. Major Points & Rationale: Meaningful activity is a subjective construct with dependence on residents’ perceptions. Internal and external factors contribute to residents’ access to meaningful activity. Many activities are identified in the literature as potentially meaningful, however little is known about how cognitively able residents perceive their activities in the nursing home. Conclusions: Meaningful activity is an emerging concept in the research literature. Further development is indicated, specifically in the cognitively able long term care population. Clarification of this concept creates a basis for future inquiry and theory generation. Page 271
Early Doctoral Poster Session PTSD after Vaginal Birth: A Literature Review Davya Brody, RN, BS, MFA, University of Rochester School of Nursing, Rochester, New York Purpose: The purpose of this systematic review of literature was to identify and summarize findings regarding antecedents to Posttraumatic Stress Disorder (PTSD) in women following vaginal birth. Current literature estimates that the incidence of PTSD following vaginal delivery may occur in as many as 5.6% of vaginal deliveries. PTSD can cause serious quality‐of‐life disturbances and may have a negative impact on maternal/partner relationships and maternal/infant bonding. Theoretical Framework: Psychiatric epidemiology Methods: MEDLINE, PsycINFO and CINAHL searches were performed using the following key words: PTSD”, “post traumatic stress disorder”, “posttraumatic stress”, “stress disorders”, “emotional trauma”, “anxiety”, “childbirth”, “birth” and “labor”. The inclusion/exclusion criteria included (a) primary research and analysis (b) extended beyond a single‐participant case study (c) assessed PTSD after vaginal birth (d) measured PTSD following birth according to DSM‐IV diagnostic criteria. A total of 14 research studies meeting all inclusion criteria were identified for review. Results: Six antecedents of PTSD following vaginal birth were identified. These included pain, loss of control, perception of inadequate support, obstetrical interventions or complications, a history of psychiatric mental health issues and anxiety. Conclusions and Implications: This summary of antecedents may help health care practitioners proactively identify and advocate for women who are at increased risk for developing PTSD following vaginal birth. The traumatic events most often associated with PTSD in women are: rape, sexual molestation, physical attack, and childhood physical abuse. Given the exposure of genitalia, pain and fear often associated with birth, it seems a grave oversight to fail to address the most common antecedents to PTSD in this population. More research is needed on the role of sexual abuse history in PTSD following vaginal birth and on PTSD measurement in childbearing women. Page 272
Early Doctoral Poster Session Understanding HIV Prevention in Abstinent South African Adolescent Girls Nomvuyo Mahlangu, RN, MSC, MBA, University of Rochester School of Nursing, Rochester, NY Purpose: The purpose of the present study is to gain insight into the context of sexual abstinence and identify potential determinants of abstinence. Background: South Africa is now the world’s new epicenter for the rapid increase of HIV/AIDS. Youths (15‐24) years, lead as the fastest growing HIV population. Females (15‐19) years, three to four times exceed prevalence rates for male counterparts. Mean age of sexual debut is 16 years with a range of 10‐
21 years. Sexual debut for over 50% of the young women is unprotected and uninformed. Sexual abstinence, delayed sexual debut and condom remain the critical strategies for the primary prevention of HIV infection in the 11‐ 20 years age group. Keen interest is accelerating on examining the determinants of sexual abstinence among adolescents. Methods: Formative focus groups with sexually abstinent ethnic Xhosa girls (13‐19)years will be tape recorded in Cape Town, South Africa using a structured interview guide framed within the context of the Information Motivation and Behavioral‐Skills theoretical model (Fisher& Fisher, 1992), to elicit in‐depth information from the participants to the point of data saturation. Initially, 32 girls in groups of 6‐8, will participate. Data collection will also include verbal and non‐verbal observation notes of group interactions and catch phrases. Analysis will consist of manual search for themes from the patterns and codes in the data from which generalizations, theories and constructs can be formulated. Results: Providing the information, motivation and behavior skills needed to maintain abstinence, delay sexual debut and condom use is critically needed by young South African women. Results of the focus group discussions will be used to tailor a gender‐specific intervention study to promote sexual abstinence, delay sexual debut and promote safer sex practices at sexual debut and after. Page 273
Early Doctoral Poster Session Psychosocial Interaction Behaviors Effect on Nursing Care Quality and Medical Recovery of Nonspeaking, Older ICU Patients Marci L Nilsen, RN, MSN, University of Pittsburgh, Pittsburgh, PA Purpose: The purpose of this study is (1) to describe psychosocial interaction behaviors between nurses and nonspeaking critically ill older adults in the intensive care unit (ICU) and (2) to explore the association between psychosocial interaction behaviors during nurse‐patient interaction and nursing care quality indicators and medical recovery of nonspeaking, critically ill older adults. Methods: The study is a descriptive observational design utilizing data collected on a subset of patients enrolled in the Study of Patient‐Nurse Effectiveness with Communication Strategies (SPEACS) (R01‐ HD043988; Happ, 2003‐2008). The sample will include all adults > 60 years of age (N=35) and their nurses (N=23) who participated in the parent study. Psychosocial interaction behaviors will be measured by rating videotaped interactions between nurses and patients. These procedures were adapted from de los Rios‐Castillo and Sanchez‐Sosa 2002. Data on medical recovery will be obtained from the existing SPEACS data set. Information on nursing care quality including sedation and restraint use, pain management, medication errors, and unplanned device disruption will be obtained through individual medical record reviews. Descriptive statistics will be used to describe the interaction behaviors between nurse and nonspeaking older adults. Group comparative statistics will be utilized to compare the differences between psychosocial interaction behaviors with/without the use of speech generating devices. The association of psychosocial behaviors and nursing care quality indicators will be explored through longitudinal repeated measures analysis. Finally, survival analysis and regression will be utilized to determine the impact of psychosocial interaction behaviors and frequency of interaction on medical recovery. Conclusion: Findings from this study have the potential to further define the relationship that psychosocial interaction behaviors have on nursing care quality and medical recovery. Funding‐ John A. Hartford Building Academic Geriatric Nursing Capacity Scholar. Page 274
Early Doctoral Poster Session Good Birth: A Concept Analysis Davya Brody, BS, RN, MFA, University of Rochester, Rochester, NY Purpose: The term ‘good birth’ is used often in the field of labor and delivery and is understood as a primary goal both for caregiver and patient. However, the defining attributes of a good birth remain ambiguous. The purpose of this concept analysis was to identify the defining attributes of a good birth. Theoretical Framework: Concept analysis Methods: The Walker and Avant method of concept analysis was used. Searches in MEDLINE, PUBMED, CINAHL and Cochran databases were performed using the keywords “good birth”, “positive birth experience”, “childbirth experience”, “birth experience”, “good childbirth”, “positive childbirth”, “birth”, “delivery”, “childbirth”, “good childbirth experience” and “positive childbirth experience”. A total of 15 articles, 3 books on birth and a contemporary documentary were included for review, bringing the total number of materials reviewed to 19. Recurrent themes, words and phrases were evaluated and the defining attributes of a good birth were distilled into four major categories. Results: Four defining attributes of a good birth were identified. These attributes include: Safety, support, integrity and harmony. Each of the four defining attributes must be met in order to have a good birth. Attaining these attributes is a subjective interpretation belonging to the woman giving birth. Safety refers to maintaining personal, physical and/or mental well being for the laboring woman and/or the fetus. Support references the actions of a person during childbirth that contributes to the birthing woman’s sense of mental, emotional or physical reassurance, comfort and/or well‐being. Integrity refers to the behavior of the woman giving birth as well as to the persons who care for her. This behavior must promote respect, honesty or open interaction. Harmony is the presence of at least one of an array of attributes that contribute to or result in a positive, good, spiritual and/or transformative childbirth experience and that in some way addresses the issue of congruence between expectations and outcomes for the birth. Conclusions: Promoting a good birth has the potential to improve outcomes by potentiating maternal psychological well‐being and health during delivery and beyond. The focus in the literature reviewed was on natural, low‐intervention birth. This raises an important question for future research: How do women perceive birth in our contemporary high‐intervention labor and delivery environment? Page 275
Early Doctoral Poster Session Self‐efficacy in the Clinical Setting and Self Reported Anxiety: A Quantitative Pilot Study Comparing Junior and Senior Nursing Students Elaine F. Martin, APRN, MS, FNP, PNP, University of Connecticut, South Glastonbury, CT Purpose: to measure the level of self‐efficacy in the clinical area and the state‐trait anxiety of nursing students in the junior and senior years. The quantitative research method is non experimental design using T tests. The method used was a non‐experimental correlation design using means comparison and a T‐test. The sample was obtained in a convenience sample of nursing students in the junior and senior year of a four year baccalaureate program at a major university. The sample consisted of all students in the junior class and senior class who had never had the researcher as a teacher. This constituted of approximately half of the junior and senior classes totaling about 125 students. The State‐Trait Anxiety scale is used to evaluate the “state” feelings of apprehension, tension and nervousness. The trait measures the worry that people are having “right now” and the stable individual differences in a tendency to perceive a stressful situation as dangerous. The self efficacy in the clinical area scale is used to determine the level of self efficacy in various common clinical situations. The seniors had both lower state and trait anxiety compared with the juniors with significant difference at p > .001. The seniors were less anxious than the juniors. For the self‐efficacy scale the higher the number the more confidence the students had. The senior’s were measured at a mean score of 4.1092 and the junior’s 3.7660. The T‐test is significant at p>.003. The seniors had higher confidence in clinical than the juniors and were less anxious. Educators need to be aware of nursing student’s level of anxiety and self–efficacy in the clinical area in order to retain and progress students in schools of nursing toward the goal of them becoming nurses who have confidence and low anxiety in clinical settings. Page 276
Early Doctoral Poster Session Nurses Knowledge and Practice Related to ST‐Segment Monitoring: Baseline Findings of the PULSE Trial Leonie L Rose, RN, BSc, MSN, Yale University, New Haven, CT ~ Barbara Drew, RN, PHD, FAAN, UCSF School of Nursing, San Francisco, CA ~ Kristopher Fennie, MSC, MPH, PHD, Yale School of Nursing, New Haven, CT ~ Marjorie Funk, PhD, RN, FAAN, FAHA , Yale School of Nursing, New Haven, CT ~ Jeanine May, MSN MPH APRN, Yale School of Nursing, New Haven, CT ~ Kimberly Stephens, MPH RN, UCSF School of Nursing, San Francisco, CA ~ Catherine Winkler, PhD, RN, Yale School of Nursing, New Haven, CT Purpose: Although recommended by practice standards to facilitate earlier recognition and treatment of often silent myocardial ischemia, evidence suggests that the continuous ST‐segment monitoring feature on the bedside monitor is underused. The purpose of this study is to examine nurses’ knowledge and quality of care related to ST‐segment monitoring. Theoretical Rationale The knowledge transfer framework (Lavis et al., 2003) guided this study. It proposes that message, target audience, messenger, process communication, and evaluation lead to effective knowledge transfer. Methods This study is an examination of baseline data of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial, a 5‐year multi‐site randomized clinical trial evaluating the effect of implementing American Heart Association practice standards for electrocardiographic monitoring on nurses’ knowledge, quality of care, and patient outcomes. Nurses (N=1,739) working on cardiac units at 17 hospitals completed an on‐line demographic form and knowledge test, which included 4 items on ischemia monitoring. To evaluate practice, 3 research nurses reviewed medical records (N=1,821 patients) for indications for ST‐segment monitoring and observed whether patients were being monitored for ST‐segment changes. Findings The nurse sample (mean age of 38±11 years), was 89% female with 74% having a bachelor’s degree or higher. Their mean percentage of correct answers on the knowledge pretest was 48.2±11.9% and only 35.6±22.5% on the ST‐segment monitoring section. The patient sample was 58% male with a mean age of 65±15 years. Among patients with an indication, 41% were monitored for ST‐segment changes, whereas 24% of those with no indication were monitored. ST‐
segment alarms were inappropriately silenced on 18% of patients. Conclusions/Implications There is a need for improving nurses’ knowledge and practice related to ST‐segment monitoring. The next phase of the PULSE Trial tests whether an on‐line education program improves nurses’ knowledge and practice, as well as patient outcomes. Page 277
Early Doctoral Poster Session Transit: A Columbia University‐Hunter College Initiative for Training Nurse‐Scientists in Interdisciplinary & Translational Research in the Underserved Nowai L Keleekai, RN, BSN, Columbia University, New York, NY ~ Suzanne Bakken, DNSc, RN, FAAN, Columbia University, New York, NY ~ Kristine Gebbie, DrPH, RN, Hunter Bellevue School of Nursing, New York, NY ~ Elaine Larson, PhD, RN, FAAN, CIC , Columbia University, New York, NY ~ Nancy Reame, PhD, RN, FAAN, Columbia University, New York, NY Purpose: The National Research Council (2005) has recognized the need to change the career trajectory for nurse‐scientists, with a greater emphasis on interdisciplinary research. In 2006, the AACN recommended that education for interdisciplinary research be part of doctoral and postdoctoral nursing education. Prompted by the growing complexity of health problems in underserved minority populations, and supported by a 3‐year grant from the Health Research Services Administration (HRSA) for advanced nursing education, Columbia University School of Nursing’s PhD program and Hunter College’s Master Programs have partnered together to train the next generation of nurse scientists. TRANSIT’s goal is to increase the number of nursing faculty prepared to conduct interdisciplinary, practice‐relevant research that benefits underserved urban communities. This federally‐funded program aims to reduce health disparities in the Northern Manhattan area of the City of New York, a designated Health Professional Shortage Area. Theoretical Framework: The logic model of program development and evaluation to guide programmatic decisions (formative feedback) and document effectiveness (summative feedback). Methods: With the help of community partners and an interdisciplinary advisory board, we are recruiting up to 15 minority students and 2 junior faculty interested in a research career focused on health disparities in underserved communities. TRANSIT students will be exposed to new coursework in health literacy and interdisciplinary research methods, and will work with DNP students in a summer practicum to strengthen the interface of clinical scholarship. The program takes advantage of NIH‐
funded faculty research programs which target health problems critical in the NYC minority communities such as infectious disease, obesity, diabetes, hypertension and contraception. Currently enrolled minority doctoral students play a central role in recruitment and retention activities, serving as focus group leaders, seminar speakers, and academic ambassadors for potential applicants. An evaluation plan designed to assess programmatic goals and student competency skills is in place. Results: Five TRANSIT minority fellows are enrolled. Descriptive data will be presented on program characteristics. CONCLUSIONS: Graduates will be prepared to create the evidence base to improve nursing practice and health care delivery in underserved, urban communities. Page 278
Early Doctoral Poster Session Investigating Factors that Influence Compliance in Cervical Cancer Screening in Young Adult Females Ameanthea Blamco, MSN, FNP, Old Dominion University, Virginia Beach, VA Purpose: Compliance with the Pap test, which is the main screening for cervical cancer, is underutilized despite risks and complications of infertility and death (ACOG, 2008). The goal is to identify modifying factors (race, age, marital status, contraceptive use, and Gardasil vaccination, history of sexually transmitted disease, history of smoking, education, and BMI) that may be contributors to either obtaining or not obtaining a pap. Which modifying factors (race, age, marital status, contraception use, Gardasil vaccination, history of sexually transmitted disease, history of smoking, education, and BMI) are the most predictive of annual cervical cancer screening in young adult females? Theoretical Framework: The Health Belief Model (Rosenstock, 1988) provides the framework for this study, investigation of the modifying factors and distinguishing which factors (age, contraception, BMI, marital status, education, race, age, history of sexually transmitted disease, and history of smoking) are most predicative of annual cervical cancer screening in young adult females can assist comprehending self efficacy and contribute to the likelihood that a young women will receive their annual cervical cancer screening. Methods: This causal comparative study will occur in a primary care center serving adults, adolescents, and children. Participants will include 200 female patients between the ages of 21‐27 years old, and excludes those from that population having any history of dysplasia on any Pap test and pregnancy. A chart audit will be conducted by researchers in order to collect this data. Analysis. Differences in modifying factors between those that are current on their pap smear test and those that are not current will be analyzed using Chi Square, Man Whitney U, or t‐tests. In order to determine the most significant predictors of cervical cancer screening, logistic regression will be employed. Results: Results of study are currently pending, as the research is ongoing. Conclusions and Implications: The outcome measure of current pap smear will be evaluated, as well as the effect of the modifying factors on the participants’ pap smear status. Specific potential limitation includes an exposure to additional consultation for Pap testing, due to experienced cervical abnormalities.To counter that implication, females with any history of dysplasia in any Pap test are excluded from the study. Page 279
Early Doctoral Poster Session Hope, Social Support and Self‐Esteem in Early Stage Dementia Valerie T Cotter, DrNP(c), FAANP, University of Pennsylvania/Drexel University, Philadelphia, PA Elizabeth W Gonzalez, PhD, RN, Drexel University, Philadelphia, PA Purpose: This preliminary study examines the relationship of hope, social support and self‐esteem in individuals with early stage dementia. Theoretical Framework: The investigation is framed by symbolic interaction theory. One of the core assumptions is that the self is developed, maintained, and changed through social interaction and social factors that influence and support self‐concepts throughout a lifetime. In early stage dementia, interpersonal relationships providing social support and hope are theoretically proposed to influence self‐esteem. Methods: A correlational descriptive design was used. Participants with early stage dementia were recruited from three clinical sites and from Alzheimer’s Association support groups in the Philadelphia region. Hope was measured by the Herth Hope Index, social support was measured by the Social Support Questionnaire‐Short Form, and self‐esteem was measured by the State Self‐Esteem Scale. Descriptive statistics were used to analyze demographic data and study variables. A bivariate correlational analysis was used to test for significant relationships at p=.05. Results: Thirty six individuals participated in the study. Participants were primarily female (69%) and Caucasian (83%). Their mean age was 79 years. Their mean score on the Mini‐Mental State Exam was 26 (SD 3.28). The results showed that self‐esteem was significantly correlated with hope (r=.40, p=.01) but not with social support (r=.07, p=.67). Hope and self‐esteem had a shared variance of 16%. Conclusions: Individuals with early stage dementia who have high self‐esteem reported high levels of hope. There is a need to further examine the influence of hope on self‐esteem in persons with early stage dementia. Hope as a positive factor may sustain the quality of life for persons with early stage of dementia. Page 280
Early Doctoral Poster Session A Critique of Qualitatively Derived Models of Recovery from Intimate Partner Violence Penelope W McDonald, BSN, MSN, RN, PhD Candidate, University at Buffalo, Buffalo, NY Purpose: to examine the qualitative nursing research that conceptualizes or explains the process of recovery from intimate partner violence (IPV). Background: While it is known that most women eventually leave abusive partners, little is known about the process of recovering from IPV. In order to understand this process from the viewpoint of women experiencing it, a review of qualitative nursing literature was conducted. Only nursing studies were sought, because nursing considers patients holistically, from a bio‐psycho‐sociological perspective. Methods: Databases searched included CINAHL, PsycINFO, and Medline. Search terms included IPV, trauma recovery, and violence recovery. Studies were included if subjects had left the abusive relationship, were in the process of leaving, or self‐identified as recovering from IPV; qualitative methods were used; and findings identified IPV recovery as a process, outcome, or concept. Results: Sixteen reports, comprising nine theories, were identified which contained concepts of IPV recovery. Two forms of qualitatively‐derived nursing models were identified. Three theories identified Recovery as the final stage of the trajectory of coping with a violent relationship. Five of the six remaining models were conceptual descriptions of IPV recovery as a process which occurs after leaving. The sixth model is the theory of Strengthening Capacities to limit Intrusions by Ford Gilboe and colleagues (2005), which subsumes the process of IPV recovery within a framework of family health promotion. This theory’s goal is the development of family functioning and support of health of family members consistent with that of families unaffected by violence. Through the processes of strengthening Capacities, Intrusions are limited and the goals of IPV recovery are accomplished: reintegration of the Self within a sociocultural context, and positioning the violence so it is no longer the central focus of her life. Conclusions & Implications: Taken together, these nine models comprise a thorough concept of IPV recovery, with antecedents, attributes, and consequences, and identify a theoretical framework which can guide nursing research and practice with women recovering from IPV. Page 281
Early Doctoral Poster Session Toward a Mid‐Range Theory of Nursing Presence Michelle A. McMahon, MSN, RN, University of Massachusetts‐Dartmouth, Holbrook, MA Purpose: To propose a mid‐range theory of nursing presence. Within the theoretical model, identify directed developmental opportunities to improve nurses’ use of presence as a relational skill. This poster will specifically address development opportunities for baccalaureate nursing students (BSN). Background: Presence is widely accepted as a core relational skill within the nursing profession. Practicing nurses are challenged to prioritize the humanistic aspects of nursing care as they integrate increasing numbers of technical and scientific expectations. Nurse educators are challenged to ensure that the humanistic aspects of client care are included in the BSN curriculum. Introducing and teaching presence skills early in the BSN curriculum will ensure the essential value of relational engagement with clients. Nursing literature, however, notes presence is a challenging concept for BSN students (Rankin & DeLashmutt, 2006). Articulating a mid‐range theory of presence will facilitate students’ conceptual understanding and identify directed developmental opportunities for nurse educators to teach presence skills. Approach: An extensive literature review was conducted. Materials were synthesized and the mid‐range theory and model were developed. Major Points & Rationale: Kim’s (2000) nurse‐client domain provided the perspective that guided the parameters of the theory and model. Professional nursing presence is dependent upon the combination of five variables: individual nurse characteristics, individual client characteristics, shared characteristics within the nurse‐client dyad, an environment conducive to relational work, and the nurse’s intentional decisions within the practice domain. The variables are described and the relationships among variables depicted in the model. Specific points in the nurse‐client interaction determine or influence the nurse presence intervention. Directed developmental strategies designed to teach or improve relational skills are identified for the BSN educator. Conclusion: A mid‐range theory of presence contributes to our understanding of the relational aspects of nursing practice. Identifying strategies to teach BSN students presence skills will facilitate the incorporation of the humanistic aspects of client care in the undergraduate curriculum. Page 282
Early Doctoral Poster Session The Effects of Intrinsic Motivational Factors and Professional Values on Associate Degree Nursing Students' Intent to Continue Education. Unn Hidle, RN‐C, BSN, MS, MS.Ed, PNP‐C, City University of New York, Graduate Center, New York, NY Guided by the Self‐Determination Theory (SDT), the purpose of this quantitative study is to evaluate the effects of intrinsic motivation and professional values on associate degree (AD) nursing students, enrolled in their last semester at a City University of New York (CUNY), in planning to obtain a post‐AD in nursing. The proposed study links intention to attain a higher nursing degree, intrinsic motivation, and professional values by using the SDT, an empirical human motivational theory concerned with the choices individuals make with their own free will. Considering the fact that a new proposal is to be implemented in New York State in the near future which will require a Bachelor of Science (BS) degree in nursing for maintenance of practice within ten years after obtaining a lesser degree, it is imperative that educators identify motivational factors in order to encourage nurses to achieve higher academic goals. The research finding will provide insight into how academia, the health‐care system, and nursing organizations can reinforce motivational factors and professional values for nursing students to advance their educational levels. In this quantitative research study, path analysis based on simple regression techniques will be used to answer the research questions. The sample will consist of AD nursing students attending their last semester of a nursing program in a CUNY institution. Prior to the study, the research will obtain Internal Review Board (IRB) approval from the Graduate Center, CUNY and the participating CUNY institutions. The independent variable intrinsic motivation will be measured using the Academic Motivation Scale, College Version (AMS‐C 28), a 28‐question survey using a Likert scale to explore motivational factors. Professional values will be measured using the Nursing Professional Values Scale Revised (NPVS‐R), a 26‐item questionnaire with a Likert scale to further investigate professional values held by AD nursing students. Both instruments have acceptable validity and reliability when used in other research studies. Finally, a short demographic questionnaire will be used with the instruments for further statistical analysis. Once the data is collected, statistical data analysis will be done using the most current SPSS 16.0 for Windows. Page 283
Early Doctoral Poster Session Effectiveness of a Family Level Intervention for Families of Hospitalized Older Adults with Diabetes. Kara Misto, MS, RN, University of Rhode Island, Kingston, RI Purpose: to examine the effectiveness of a family‐level intervention for families of older adults hospitalized with diabetes. Theoretical Framework: As adults live longer with more chronic illness, the management of these illnesses in the home setting becomes a family effort. However, when clients are admitted to hospital their control over illness management is removed and the role of family under recognized. The study is based in the belief that inclusion of family as a unit in planning care will have positive impacts on the client, the family and the nurse. This study will be undergirded by The Calgary Family Intervention Model (CFIM). The CFIM conceptualizes an intersection between one of three domains of family functioning (cognitive, affective and behavioral) and a specific intervention offered by the nurse. The family‐nurse relationship is characterized by reciprocity. Methods: The proposed study is a randomized control trial using a pretest/posttest design conducted on two medical‐surgical units in a community hospital. The sample will include all older adults (> age 65) admitted over a 3‐month period who have an existing diagnosis of diabetes. Clients with dementia or who are unable to communicate in English will be excluded. Study participants must have an identified family member and be community dwelling. Participants will be randomly assigned to either a control group or an experimental group. The intervention will include family support and education via web‐
based support tools, in addition to face‐to‐face support meetings. Effects on family unit outcomes will be measured via the Family Functioning, Health and Social Support Instrument (FAFHES) and effects on nurse outcomes will be measured using the Family Nursing Practice Scale (FNPS). Patient outcomes will include HbA1C and 30‐day readmission rates. Data analysis will include descriptive statistics and ANOVA. Results: The results of the study will describe differences (if any) between in the experimental and control groups on outcome variables at three levels: 1) family (perceptions of nursing care); 2) nurse (attitudes regarding working with families, appraisal of their family‐nursing practice and reciprocity in the nurse‐family relationship; and 3) patient (HbA1C and 30 day readmission rates). Conclusions: The results of this study will provide an understanding of the impact of a family intervention for families coping with chronic illness. Page 284
Early Doctoral Poster Session Older Adults’ Physical Activity and Function in Person‐Centered Care and Traditional Nursing Home Environments Ying‐Yu Chao, MS, GNP, PhD(c), University at Buffalo, SUNY, Amherst, NY Sherry H Pomeroy, PhD, RN, University at Buffalo, SUNY, Orchard Park, NY Yvonne K Scherer, EdD, RN, University at Buffalo, SUNY, Buffalo, NY Purpose: This study described and compared physical activity (PA) and function among residents living in traditional nursing home (TNH) environments versus those in a person‐centered care model of “Welcome Home” (WH) (Beechwood Health Care Inc., 2005). A sub‐sample of residents with stroke was also evaluated. Theoretical Framework: The study was conducted in the context of a larger study using social cognitive theory (Pomeroy, Scherer, & Resnick, 2006). Methods: The design was non‐randomized quasi‐experimental with a matched control group. The sample included 22 participants with 10 (45%) in TNH and 12 (55%) in WH. The mean age was 87 (SD ± 6.7) years. The Barthel Index (BI), the Physical Activity Survey for Long Term Care (PAS‐LTC) (Resnick & Galik, 2007), and the ActiGraph accelerometer were used to measure function and PA. The stroke sub‐
sample (n = 8) were in TNH (n = 3; 37%) and WH (n = 5; 63%). ANOVA and the Kruskal‐Wallis test were used to compare mean scores between groups on BI, PAS‐LTC, and ActiGraph. Results: There were no significant differences between TNH and WH in function using the BI (p = .89) or in PA on the PAS‐LTC (p = .68). There were significantly higher ActiGraph mean total activity counts (TAC) (p = .017) and mean total step counts (TSC) (p = .004) in TNH compared to WH. Those with stroke in WH had more total minutes of PA on the PAS‐LTC compared to TNH (p = .65) and higher ActiGraph TAC (p = .65). There was a significant relationship between the PAS‐LTC and ActiGraph TAC (r = .834, p < .05) and TSC (r = .747, p < .05). Conclusion: Future dissertation research will build on these findings to design and test interventions to increase PA and function for stroke survivors in rehabilitation settings in Taiwan. Page 285
Early Doctoral Poster Session The Experience of Cognitive Impairment Following Chemotherapy in Women with Breast Cancer Mary Louise Kanaskie, MS, RN‐BC, AOCN, The Pennsylvania State University, State College, PA Purpose: to understand the lived experience of cognitive impairment following chemotherapy in women with breast cancer. The research question is “What meaning do women experiencing cognitive impairment following chemotherapy for breast cancer ascribe to this phenomenon?” Background: Breast cancer is the most common cancer among women in the United States. It is estimated that nearly 182,460 new cases were diagnosed in 2008 (National Cancer Institute, 2009). Some reports indicate that a subset of women receiving chemotherapy for breast cancer experience symptoms of cognitive impairment. These symptoms often include forgetfulness, absent mindedness, and inability to focus on certain routine tasks which make it difficult to carry out normal daily activities. In addition, the emotional stress this may cause for the individual can result in additional physical and psychological problems. Methods: A phenomenological study will be conducted to uncover the meaning of the lived experience of cognitive impairment following chemotherapy in women with breast cancer. The primary data collection method will be semi‐structured individual interviews and subject diary entries. Qualitative methods of data analysis will be used to identify themes that reveal the essence of the phenomenon. Subjects will be recruited at a University Hospital Outpatient Cancer Institute. Potential subjects will be asked to complete a screening questionnaire to determine whether they have perceived cognitive changes following treatment with chemotherapy. The primary data collection method will be semi‐
structured individual interviews approximately 60 minutes in length. The PI, a doctoral nursing student working under the direction of experienced faculty researchers, will conduct the personal interviews. Three interviews plus two additional submissions (diary, audio recording or email) will produce between 24‐40 data sets. Results Findings of this research will provide a narrative description of the phenomenon that will give voice to breast cancer survivors’ experiences of cognitive impairment. Conclusions/Implications: When the impact of cognitive changes is better understood, meaningful and timely interventions to improve quality of life can be developed. Page 286
Early Doctoral Poster Session A Proposed Study of Predictors of Delirium Among Surgical ICU Patients Claire E Shaler, BSN, RN, University of Pittsburgh, Pittsburgh, PA Purpose: The primary aim of this study is to investigate Neuronal Injury (NI) predictors of delirium symptoms. The secondary aims are 1) Explore gene expression of NI in delirium, and 2) Explore neuroimaging measures of NI in delirium. Background: Delirium is defined as an acute change in mental status, inattention, disorganized thinking and altered level of consciousness. Delirium is the most common acute brain dysfunction, which occurs in up to 80% of mechanically ventilated ICU patients and up to 70% in non‐ventilated ICU patients. Recent studies have found that ICU delirium is associated with Long‐Term Cognitive Impairment (LTCI), and is an independent predictor of mortality at 6 months discharge. The pathophysiology of delirium is likely multi‐factorial, involving inter‐play among individuals’ genomic profile and critical illness. Elevated serum levels of NI biomarkers (NSE, S‐100β, and NTP) are associated with LTCI, and neuroanatomincal changes in patients with TBI, CVA, and SAH. Recent studies have identified similar neuroanatomical changes in patients following ICU delirium. Methods: This study will employ a prospective, repeated measures design, and a convenience sub‐
sample for neuroimaging studies. Patients undergoing elective thoracic, vascular or orthopedic surgery with a planned surgical ICU admission will be recruited to participate. Data collected will include: 1) Peripheral whole blood, 2) Delirium symptom assessment tools, and 3) Neuroimaging. Data will be collected preoperatively, postoperatively, every 24 hours for 7 days and at 30 days postoperatively. Analysis of primary aim will include multivariate ANOVA, Chi‐Square, and bivariate logistical regression. Implications: ICU delirium research has consisted predominantly of retrospective analysis. This prospective study will collect data crucial in: 1) Identifying NI predictors and their role in delirium symptoms, 2) Identifying candidate genes for future study, and 3) exploring the relationship between NI, neuroanatomincal changes, and delirium symptoms. Page 287
Early Doctoral Poster Session Burden of Caregivers in Caring for Stroke Survivors in the Early Poststroke Period Eeeseung Byun, MSN, RN, ACNP‐BC, University of Pennsylvania School of Nursing , Philadelphia, PA Lois K. Evans, PhD, FAAN, RN, University of Pennsylvania School of Nursing, Philadelphia, PA Purpose: This concept analysis analyzes and clarifies the burden of caregivers of stroke survivors in the early poststroke period and compares it to related concepts that have been used to describe burden of caregivers. Background The concept of burden of caregivers of stroke survivors is broad, and multiple terms have been used inconsistently. No concept analysis of caregiver burden relative to stroke survivors in any time period poststroke has been found. It is important to understand the burden of caregivers of stroke survivors in the early poststroke period if we are to prevent or decrease the sense of burden in a timely fashion, aid families in coping well in their role as informal caregivers, and facilitate better health outcomes for both caregivers and stroke survivors. Approach A literature review was performed using MEDLINE, PubMed, CINAHL, PsycINFO, and ISI Web of Knowledge databases. Rodgers’ (2000) evolutionary method of concept analysis guided the review of 28 publications to identify antecedents, attributes, and consequences of the concept. Major Points & Rationale Five antecedents (sudden onset of stroke, survival and stabilization immediately poststroke, socioeconomic characteristics of caregivers, chronic illness of caregivers, and coping capacity of caregivers), 5 attributes (functional status of stroke survivors, uncertainty about the future, knowledge about stroke and prognosis of stroke survivors, time required to care for stroke survivors, and view about the future) and 3 consequences (quality of life, physical impact, and psychological impact) were identified. Undetermined recovery status of stroke survivors in the early poststroke period may help predict subsequent burden of caregivers. Conclusions The concept of burden of caregivers of stroke survivors in the early poststroke period is complex. Clarification is needed because multiple definitions of caregiver burden have led to confusion, and the concept of caregiver burden is closely associated with other factors. Page 288
Early Doctoral Poster Session Cultural Competence and Personal Accomplishments of Foreign‐trained Nurses Nadiah Abdulaziz Baghdadi, RN, MSN, Northeastern University, Malden, MA The purpose of the study is to determine the relationship between cultural competency of foreign trained nurses and their personal accomplishments. Background and significance: The United States, along with many other countries, is experiencing a nursing shortage. Lack of qualified nurses represents a significant challenge to providing quality health care (Cowan & Norman, 2006). In response to the nursing shortage, foreign trained nurses are being recruited to work in the US. Four percent of the 2.7 million US registered nurses are foreign trained; 38% from the Philippines and 10% from India (Xu, 2005). Foreign trained nurses face significant challenges adapting to the workplace, including lack of cultural awareness and communication barriers with patients and colleagues. Theoretical Framework: Leininhger’s theory on cultural competency will guide this study. Cultural competency is defined as a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross‐cultural situations (Leinenger & McFarland, 2002). Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge, and skills along the cultural competence continuum (Cross, et. al., 1989). Methods: A cross‐sectional, correlational design will guide this study. The sample will include 300 foreign trained nurses working in the US for more than one year in an acute care setting. Data collection will take place in acute care hospitals in the Boston area. A questionnaire will be administered that includes demographic data, the Cultural Competence Assessment tool (Schum, Doorenbos, Miller & Benkert, 2003) tool and the Personal Accomplishment Subscale (Maslach, 1981). Analysis: Descriptive statistics and multiple regression will be used to examine the relationship between cultural competence and personal accomplishments. Expected Outcomes: There will be a statistically significant relationship between cultural competence and personal accomplishments. Page 289
Early Doctoral Poster Session Relationship Between Diabetes Self‐Care and Glycemic Control Among the Lebanese Population Ola Sukkarieh, RN, MPH, Northeastern University, Boston, MA Diabetes is a chronic medical illness mandating sustainable medical care and self‐management to prevent or delay complications. A large body of knowledge supports the significance of diabetes self‐
management educational programs to maximize diabetic control thereby alleviating its resulting complications. According to the CDC, the prevalence rate of diabetes mellitus in 2008 was almost 7%. Between 2000 and 2020, the WHO estimates that the prevalence of diabetes in developing countries will rise by 60%. In Lebanon, the prevalence of diabetes, according to WHO estimates in 2003, was almost 12%. Unfortunately, the literature scarcely documents the profile of diabetic patients in Lebanon. More specifically, no descriptive or interventional study documents the diabetes self‐
management status of the Lebanese population. The purpose of this study is to examine the relationship between self‐care and glycemic control in Lebanese diabetic adults. Additionally, a select group of demographic and physiological characteristics will be examined as they are thought to affect significantly the relationship between diabetes self‐care and glycemic control. A descriptive correlational design with convenience sampling (N=200) of diabetic Lebanese patients recruited from two diabetes clinics will be adopted to fulfill the purpose of the study. As a valid and reliable instrument, the Summary of Diabetes Self‐Care Activities (SDSCA) will be used to measure diabetes self‐management. The instrument is a brief, self‐report questionnaire consisting of 12 items and assessing five different aspects of diabetes regimen (general diet, specific diet, exercise, blood‐glucose testing, foot care and medication adherence). Initially, the SDSCA will be translated into Arabic using backward translation and then tested for its psychometric properties. Glycemic control will be measured by glycated hemoglobin (A1C). The results of the study will enable health care providers to tailor diabetes self‐management educational programs to best fit the needs of the Lebanese diabetic patients. Page 290
Early Doctoral Poster Session Validity and Reliability of CD4+ Gene Expression Measurement After Allogeneic Stem Cell Transplantation Jamie Oliva, MS, ANP‐BC, University of Rochester, Rochester, NY Many cancer patients who receive allogeneic stem cell transplant (SCT) experience graft‐versus‐host disease (GVHD) in which donor immune cell responses cause organ dysfunction and immune system compromise, resulting in decreased survival and quality of life. Although helper (CD4+) T‐cells are decreased after transplant, CD4+ related cytokine gene expression (GE) may cause cytokine production that activates other immune cells, contributing to GVHD. Measuring GE as a marker of immune response is key to understanding this life‐threatening disease. Purpose: I evaluated published evidence regarding measurement validity and reliability of quantitative real‐time polymerase chain reaction (RT‐PCR), to determine whether GE accurately and reproducibly represents protein production in lymphocytes, in human studies with common limitations of small‐sized cell populations and use of cryopreservation, which speeds ribonucleic acid (RNA) degradation. Theoretical Framework: Genomic and biologic theorists posit that the transcriptional events of up‐ or down‐regulation of genes are a response to environmental stimuli and result in terminal protein production. Methods: A PubMed search was performed in October 2009 with keywords of GE, RT‐PCR, cytokines, small‐sized cell populations, and preserved specimens and limited to research published from 2004 to 2009 involving human subjects. The search produced approximately 140 articles of which 12 had primary relevance. Results: The validity and reliability of RT‐PCR was strongly supported. When the amount of RNA input was known, the validity and reliability of absolute GE by RT‐PCR and the comparative cycle threshold (CT) method was also supported. When the amount of input RNA was small, unpredictable, or degraded, the comparative CT and standard curve methods successfully compensated for variance in RT‐PCR product amplification. Conclusions & Implications: When the above techniques were used and procedural errors were minimized, the validity of relative GE was supported despite variable RNA input, small‐sized cell populations, and RNA degradation due to specimen cryopreservation. Relative GE measurement by RT‐
PCR can be applied in clinical research limited by unpredictable RNA input, such as after SCT. Better understanding of the immune system events in GVHD can aid in early detection and treatment of this life‐threatening complication. Page 291
Early Doctoral Poster Session A Concept Analysis: Spirituality among African Americans and its Impact on Health Ranekka T Dean, RN, NYU College of Nursing Florence S. Downs PhD Program, New York, NY Purpose: Spirituality for many African Americans has been used as a coping mechanism and a way of dealing with various stressors that may compromise their health status. Culturally competent care for African Americans should acknowledge and/or include spirituality. This paper focuses on a concept analysis of African American spirituality and its impact on health. Methods: Qualitative and quantitative studies were selected from Medline, Pubmed, CINAHL, PsychoInfo and Web of Science using the following keywords both separately and in combination: spirituality, religion, religious beliefs, African American and health. Inclusion criteria for the analysis are from a multidisciplinary sample of research studies from 1991 to 2008 with a total of 17 articles examined. Theoretical Framework: Content analysis using the Rodgerian method (Rodgers & Knafl, 1999) revealed several antecedents, attributes and consequences of African American spirituality that were particularly salient and consistent. Results: Antecedents identified were demographics; affiliations; beliefs; and hardships. Attributes identified were connectedness; God in control; divine intervention; compassion; and salvation. Consequences identified were empowerment; emotional/mental balance; and effectual associations. Conclusions & Implications: These findings are related to previous concept analyses of African American spirituality that reinforce its prominence and need to incorporate spiritually based interventions in nursing care. Implications for practice and future research are presented. Page 292
Early Doctoral Poster Session The Role of Acculturation on Korean Female College Students’ Sexuality and Gynecology Care in United States Jin Young Seo, RN, WHNP, Doctoral Student, University at Buffalo, Buffalo, NY Purpose: to examine current sexual behaviors, contraceptives use, and access to Gynecology (GYN) care to investigate the influence of acculturation on sexuality among Korean female college students who came to United States (U.S) for studying. Also the study will describe how the level of acculturation influences on the use of contraceptives and the access of GYN service among this population. Background: Late adolescence is a very important developmental stage of life because health‐risk behaviors may be initiated such as high‐risk sexual behaviors. Also, most of risky behaviors are carried on into adulthood, thereby negatively affecting health in later life. In 2007–2008, 623,805 students from all over the world were enrolled in American colleges and universities. Among them, Koreans are the third biggest population coming to U.S. (Institute of International Education, 2009). Especially, Korean international students are moved from parental control and their own culture without appropriate sex educations. Therefore, exposure to a new culture could modify existing behaviors, norms, and belief system on sexuality. Methods: For the purpose of study, a mixed method approach will be used. For the quantitative approach, a self administered survey will be taken to examine the relationship acculturation level and sexual behaviors, contraceptives use, and access to GYN care. For the qualitative approach, ground theory method based on the personal interviews will be used to investigate the role of acculturation on sexuality among Korean female college students who came to U.S. for studying. Implications: This study will increase better understandings of female Korean students’ sexuality, contraceptives use, and current access to care for GYN services. This understanding will increase school health care providers’ abilities to interact with those students in culturally sensitive ways. Improved interaction between clinicians and students can provide a culturally appropriate program of sexual education on this population. Page 293
Early Doctoral Poster Session Implementation of Skin Cancer Screening Tool in a Primary Care Setting: A Pilot Study Holly Bradley, MS, ANP‐BC, APRN, University of Connecticut School of Nursing, Glastonbury, CT Purpose: Given the increased incidence for skin cancer, this pilot study explores the need for more extensive assessment and documentation of screening procedures. A skin cancer screening tool improved provider documentation and cued the nurse practitioner (NP) to review, examine, and educate the patient Theoretical Framework: There are no standardized guidelines for skin cancer screening within primary care. Few studies have examined NP screening practices; no published study has explored these practices in a college health setting. Methods: Two research questions were tested: RQ1: What effect does a didactic educational program have on NPs knowledge of and ability to accurately identify skin cancer? RQ2: How does a new skin cancer screening tool impact NPs documentation of skin cancer screening and patient education? A convenience sample of six NPs in a northeastern college health setting participated. Phase one: quasi‐
experimental pre‐test/post‐test design of NPs skin cancer knowledge was evaluated pre/post exposure to a didactic educational program. Phase two: review of provider documentation in patient charts pre/post implementation of an established skin cancer screening tool. Results: RQ1: Results showed a significant difference in NPs pre‐test and post‐test scores after receiving the didactic education program. (Claim). With xˉ = 33.6458, s = 85.764, n = 16, the finding is t (15) = 1.57. At a level of significance α = .10, the upper critical value = 1.34; the null hypothesis is rejected. Statistical evidence indicates the didactic increased the mean percentage of questions answered correctly. RQ2 Findings revealed a 223.4% increase in proper documentation of skin cancer, and skin cancer education. Conclusions and Implications: This pilot study demonstrated the efficacy of educating NPs in proper documentation/early detection of skin cancer among young adults. Additionally, the use of a standardized screening instrument substantially improves quality of NPs documentation, enhancing patient education. Page 294
Early Doctoral Poster Session Appraisal of Cardiovascular Risk and Preventive Measures in the Emergency Department: An Integrative Review Kimberly Terese Hall, MSN‐FNP‐BC, RN, NYU, New York, NY Purpose: An integrative review was conducted to examine what is known about appraisal of cardiovascular (CV) risk and preventive measures in the ED. Background: Cardiovascular Disease (CVD) remains the leading cause of death worldwide. Ethnic minorities and those of lower socioeconomic status suffer higher rates of morbidity and mortality related to CVD, groups that are disproportionately represented in the emergency department (ED). This puts ED providers in a unique position to recognize patients with adverse CV risk profiles and thus implement preventive measures. Methods: Electronic databases MEDLINE, PubMed, CINAHL, and Web of Science were searched; articles were also hand‐searched. Guided by Campbell & Stanley (1963) data were extracted, evaluated, and analyzed by their design, theoretical framework, sampling, participant characteristics, and intervention details. Results: A total of 12 quantitative articles comprised the final set for this review; no qualitative studies were identified and the theoretical underpinnings of ED research are limited. Preventive measures implemented in the waiting room are feasible. Behavioral interventions can be implemented in ED chest pain observation units, when perception of susceptibility to CVD is shown to be higher. The ED is an appropriate location for hypertension screening. Smoking interventions are feasible, yet very challenging. Conclusion/Implications: There is a dearth of literature examining CVD related preventive measures among the ED population. Identifying CV risk among the ED population will require a collaborative practice plus innovations in usual care. Page 295
Early Doctoral Poster Session Stigma Among Mexicans Adrian Xavier Juarez, RN, New York University, New York, NY Purpose: This paper describes the concept of stigma among women of Mexican ancestry, Mexicanas. Background: Concept of stigma has received wide attention with variability in its usage. Little attention has been paid to stigma among Mexicanas in the context of health. Methods: This study used a Rodgerian approach and was informed by Goffman’s sociological categorization of stigma: (1) abomination of body; (2) perception of character deficiency; and (3) tribal stigma. Convenience sampling procedures were followed and 19 studies retrieved using Chicano Studies, CINAHL, JSTOR, Julius, PAHO (Pan American Health Organization), PsychInfo, PubMed, and the Sociological Abstracts databases. Data analysis was a three‐phase process of reading each article to: (1) identify attributes; (2) extract the conceptual antecedents and consequences; and (3) determine relationships among conceptual elements. Results: Findings include the identification of conceptual element clusters: (1) transitions; (2) conformity; and (3) objectifying. These groups captured relationships which include at least one of Goffman’s stigma categories. The identified attributes indicate the Mexicana experiences stigma when mainstream American or native cultural norms are unmet, particularly in terms of gender. Conclusion & Implications: Findings indicate the Mexicana is at risk for experiencing stigmatization as she attempts to fulfill native and host‐country cultural norms. Page 296
Early Doctoral Poster Session Barriers to Cardiac Rehabilitation in Women with Cardiovascular Disease: An Integrative Review Margaret McKeever McCarthy, MS, RN, FNP, New York University, New York, NY Background: Although deaths rates from cardiovascular disease (CVD) have declined in recent years, it continues to be a leading cause of death for women. Of note, as women age, the prevalence of CVD increases; for women age 60‐79, almost 73% will be affected. Sedentary lifestyle is a risk factor for CVD that can be countered with entry into a cardiac rehabilitation (CR) program; unfortunately this resource is often underused. Purpose: An integrative reviewed examined the barriers to enrollment into a CR program for women with CVD. The electronic databases searched included: Pubmed, CINAHL, Medline, Web of Science, Embase, and PsychInfo. A hand search of retained studies was also conducted. Methods: Fifteen primary studies were retained for review and appraisal; ten were quantitative, three were qualitative and two were a mixed methodology. None of the studies used an intervention; descriptive data was collected via interview, survey or questionnaire. Results: Several themes emerged as major barriers to enrollment into CR. Lack of physician referral was discussed in a majority of the studies: being a woman was independently associated with a lower probability of referral and one finding revealed that African American women were also less likely to receive a referral. Transportation and insurance/financial issues were also noted as barriers to participation. Co‐morbid conditions or feeling too ill to exercise was often cited as a barrier. Lack of knowledge and personal beliefs about CR also serves as an impediment to enrollment. Conclusions and Implications: Despite methodological limitations of each study, major themes did emerge, leading to implications for future research and interventions. Larger studies completed in the United States are warranted, especially those that assess barriers for different racial/ethnic groups. Inclusion of a theoretical framework in future studies would assist in study design. Finally, given the prevalence of depression and anxiety in patients with CVD, this issue needs to be assessed as a potential barrier to enrollment. Page 297
Early Doctoral Poster Session Lateral Violence in Nursing: Reframing the Construct Patricia Molloy, MS, PMHCNS, BC, University of Rhode Island, Kingston, RI Lateral violence (LV) is a construct that has appeared with increasing frequency in the nursing literature to describe aggressive or hostile interactions that occur between nurses in the workplace. The implications of this phenomenon are diverse; for example, its negative effect on nurse recruitment and retention in an era of nursing shortages, its effect on increasing occupation‐related illness among nurses, and its influence on adverse patient outcomes. A review of the literature indicated that several terms are often used interchangeably with LV limiting conceptual clarity. This paper will present the results of a systematic literature search of the numerous concepts/constructs used to describe LV, the associated operational definitions, and the divergent theoretical frameworks posited to explain its complex etiology. The results revealed the need for a coherent, comprehensive typology that encompasses the sociohistorical, organizational, and interpersonal factors that contribute to LV to guide implementation of effective workplace strategies to address it. Additionally, the results suggested that LV has become ‘normalized’ socially for nurses in all areas of practice both nationally and internationally; therefore interventions directed solely at the individual (micro) level will not be successful if they fail to address the contextual (macro) elements of LV. Implications for future development of effective strategies to combat LV include those that are not narrowly confined to an ‘either/or’ – ‘micro/macro’ level. A multidimensional typology of violence developed by the WHO/CDC (2008) is discussed since it provides a model for understanding factors that contribute to the etiology of violence on four interactive levels: the individual, relationship, community, and society. Suggestions for adaptation of the WHO/CDC model to develop an integrated framework that is more particular to the nursing discipline are presented. Page 298
Early Doctoral Poster Session Development of a Healthcare Framework for an Amish Community Karen L McCrea, MSN, FNP‐C, State University of New York Institute of Technology, Cherry Valley, NY Purpose: to establish a collaborative relationship with an Amish community in Upstate New York, perform a comprehensive health needs assessment and work collaboratively with the community to develop a framework for care that will improve patient health outcomes. Theoretical Framework: Madeleine Leininger's Culture Care Diversity and Universality Nursing Theory will be utilized for the theoretical underpinnings of the proposed project. Initial entry into community will be established through the assistance of several key community members Methods In depth one‐
on‐one confidential interviews with community adults (over age 18) involving extensive demographic data, validated tools to evaluate health status and open ended questions to explore barriers to care Comprehensive analysis of interview data Community meetings with presentation of group data and empowerment of community to shape healthcare future through design of healthcare framework Contact (phone and in person) with outside healthcare providers to negotiate healthcare services for Amish community Results Project not yet implemented Conlusions and Implications: Conclusions, recommendations and further action will be determined through analysis of gathered data Page 299
Early Doctoral Poster Session The Process of Mothering a Child with Obesity Carol A. Bartlett‐Soto, MS, ANP, PhD(c), Adelphi University, Fresh Meadows, NY Purpose: This study will be a grounded theory study to explore the process of mothers' experiences of having an obese child. Background: One of the greatest public health challenges of the 21st century is childhood obesity. Health care reform must include initiatives and strategies to curb this escalating epidemic. In addressing this epidemic one key area that needs to be explored is the perspectives of the parents, particularly the mothers of children who are overweight. Parents play a very important role in the daily lives of a child who is obese. Parental influence has been identified as an important factor in identifying and predicting if a child will be obese and possible future co‐morbidities if they are obese. However, the literature is devoid of mothers' perspective on experiences regarding a child with obesity especially literature that is research focused. Theoretical Rationale: This grounded theory study will be conducted according to the principles of Glaser and Strauss whose work was developed from Symbolic Interactionism as posited by Mead and Cooley. Methods: Participants will be mothers with children who are obese aged 5 years through 20 years and will be recruited from outpatient settings, flyers, and snowball technique. Semi‐structured interviews will be conducted. From these transcribed interviews, categories will be developed leading to conceptualizing the process mothers experience having an obese child. Theoretical sampling will be undertaken,and interviews with others significant to the process being studied such as health care providers or fathers will be conducted. Results: The findings from this research study will generate a substantive theory concerning the process mothers' with an obese child experience, and will propose hypotheses for further research. Conclusions/Implications: This study's findings will inform health care professionals who work in both prevention and intervention settings with parents and obese children. Mothers will continue to play an important role in childhood obesity and these findings will assist mothers and health care providers in partnering. Page 300
Early Doctoral Poster Session Internet Use in Asian American College Students and the Potential of Interactive Social Networking and Virtual Worlds for Cyber Counseling of Victims Nahoko Harada, RN, MSN, Boston College School of Nursing, Brighton, MA Ann W Burgess, DNSc, FAAN, Boston College School of Nursing, Chestnut Hill, MA Purpose: To examine Internet use and knowledge between college age Asian Americans and Non‐
Asians. Theoretical Framework: Cheny Yin Cheong (1989) explains how organizational culture influences organizational behavior of individuals and groups. Background: Asian Americans are believed to be highly skilled in use of technology as part of their educational culture; however this has not been extensively studied in health care utilization. Methods: Data were analyzed from surveys completed by 1284 subjects from five universities. Variables examined: age when the student first used the Internet, Internet knowledge, and the use of Internet social networking. Statistical analysis was conducted with SPSS. 16.0 Results: 128 Asian Americans and 1156 Non‐ Asians were identified. Analysis showed that both groups started using the Internet at a similar age (11.01, SD2.4) vs. 10.74, SD3.5). On an Internet Knowledge test, Asian students had the highest percent correct answers in 14 of the 15 questions. The percentage of Asian students who use social networking (90.6%) was consistent with the average of all races of students. But when looking at the type of social networking, Asian students used two or more social network sites (31.5% v. 28.6%, p=.000). The use of virtual worlds, such as Second Life, showed significant differences between races of college age students. Asian students had the highest percentage of use at 9.4% which was four times more than Caucasians (2.3%), 50% larger than African‐American (6.%) and 3.7 times the percentage of Hispanic students (3.5%). Conclusion: One nursing implication is the potential for cyber counseling for all college students and Asian Americans in particular. These data will serve as the benchmark for the Internet as a potential means to conduct outreach in populations such as Asian American victims of domestic violence. Page 301
Early Doctoral Poster Session A Comparative Assessment of Intraocular Pressure in Prolonged Steep Trendelenburg Position vs. Supine Position Intervention Bonnie Molloy, MS, CRNA, University of Connecticut, Fairfield, CT Purpose: to provide safe anesthetic and ophthalmic care for laparoscopic procedures. Intraocular pressure (IOP) is increased during prolonged procedures performed in ST position (> 30 degrees head down). Increased peri‐orbital swelling and venous congestion potentially produce a low perfusion state in the eye, possibly contributing to the increasing incidence of postoperative visual loss (POVL) via a compartment syndrome mechanism. Theoretical Framework: Subsequent to a state mandated intervention following a case of POVL in the ST position at our institution, IOP measurements were taken during laparoscopic surgery. IOP wsa observed to rise over time. A significant number of patients had increasd IOP (4‐5 times baseline). We hypothesize that returning patients to supine position for one 5‐7 minute interval at the 60‐90 minute time point will normalize IOP. Methods: The study employed a repeated measure prospective design. An anesthesia team was credentialed in the use of a validated instrument for IOP measurement‐ Reichert Tonopenxl tonometer. Following informed consent patients having laparoscopic surgery in the ST position were enrolled. IOP was measured at start, 30 minute intervals and end of surgery. A comparative analysis of IOP was completed. Results: IOP of sustained ST group at 120 minutes ranged from 25‐54 mmHg. ( mean 31.6). At end of procedures in supine position, IOP ranged from 10‐42 mmHg. (mean 20). 90% did not return to baseline. IOP of supine intervention group ranged from 10‐24 mmHg. ( mean 19) at 120 minutes. End of case IOP's returned to normal in 75% of patients with levels being 7‐23 mmHg. (mean 14). Analysis showed statistically significant decrease in mean IOP of supine intervention group in comparison to ST group with P<.001. Conclusions: A supine intervention can minimize the impact of lengthy ST positioning on increasing IOP potentially preventing future POVL events. Page 302
Early Doctoral Poster Session Conceptual Analysis of Patient Satisfaction with Nurse Practitioner Care Frances DiAnna‐ Kinder, RN, MSN, CPNP, Widener University, Chester, PA Abstract Patient satisfaction is a concern among health care institutions measuring service rendered by a variety of health care providers. The quality of care is an important element in providing safe and effective health care to patients and Nurse Practitioners (NPs) are at the forefront of patient care due to the importance of primary care and health care reform. The concept of patient satisfaction is important to study related to care given by NPs in all settings. Policy makers and insurance companies need valid statistics to substantiate why persons seek out NPs for health care. This concept analysis used Walker and Avant’s method to explore antecedents, consequences, and attributes of patient satisfaction with NP care. Medical and nursing empirical and theoretical literature was explored. The author’s experience as a Pediatric Nurse Practitioner was taken into account in the analysis. The repeating themes in the literature were quality of care, holistic care, caring behavior, expert knowledge, technical/skill competence, and effective communication. A concept map was created depicting the antecedents, consequences, and attributes of patient satisfaction with NP care. The importance of exploring patient satisfaction with NPs has implications in graduate education and NP practice. The critical elements of patient satisfaction with NP care can be incorporated in the graduate curriculum. Creative curriculum incorporating the perceptions of patients will provide better quality of care in practice and confirm the importance of the NP as a valuable member of the health care team. Page 303
Early Doctoral Poster Session The Relationship between Social Support and Pursuit of a BS Degree Among Associate Degree Nurses Margaret J Reilly, MS, APRN, Queensborough Community College, Floral Park, NY Aikens landmark study on surgical patient mortality and educational level of nurses resurrected the call to increase the educational level of nurses in order to better address the increased complexity of patient care. Current data inform us that, nationally, greater than 65% of new nurses earn their entry to practice degree at the Associate Degree level with only 20% of these graduates actually progressing to a bachelor’s degree. This also limits the number who can then pursue graduate degrees greatly impacting the pipeline for nurse educators, and contributing to the shortage of nurses and nursing faculty. The purpose of this study is to examine some of the factors associated with associate degree nurses (ADN) and progression to a bachelor’s degree (BS) among the largest population of nurses. While there have been some suggestions as to why associate degree nurses do not pursue higher education in greater numbers, there is limited research that examines the current factors affecting the progression to higher education among this category of nurses. Identification of factors influencing pursuit of a BS degree among ADNs can assist in determining academic, institutional as well as policy intervention strategies that may increase the number of ADN’s that return to school. This study will examine what is the relationship between sources of social support and pursuit of a BS degree among ADN graduates in an urban setting. The methodology used will be a stepwise regression analysis comparing reports of sources social support among ADN graduates who have been out of school and in the workforce for at least 3 years with those ADNs who have been enrolled in an RN to BS program for at least one year. Norbeck’s Social Support tool will be used. Page 304
Early Doctoral Poster Session Concept Analysis of Power: In Relation to Sexual Decision Making and HIV Risk in African American Women Tanyka K Smith, MS, FNP‐BC, APRN, New York University, Rosedale , NY Purpose: African American (AA) women comprise 12% of the U.S. female population, yet account for 66% of new cases of HIV (CDC, 2008). The concept of power is not clearly elucidated in the literature as it relates to HIV risk among AA women. This paper presents a concept analysis of power and its significance related to HIV risk and sexual decision‐making in AA women. Method: An evolutionary method (Rodgers & Knafl, 2000) was used to clarify the expanded use of power in research. A literature search conducted using CINAHL, MEDLINE, EMBASE, PsyhInfo, and PubMed databases yielded 45 primary qualitative and quantitative studies. Results: Major findings reveal lack of congruency in defining attributes of power across disciplines or within contextual/theoretical frameworks. A new understanding of the attributes of power emerged, establishing 5 dimensions of power (personal, dyadic, group, intergroup, and hierarchical) to explicate its meaning. The antecedents, related terms, and consequences were largely harmonious. Conclusion/Implications: There is a paucity of studies that show evidence of clarity in defining attributes of power in HIV risk and sexual decision making among AA women. Further empirical studies are needed to standardize the concept of power for the development of culturally tailored HIV risk reduction interventions for AA women. Page 305
Early Doctoral Poster Session A Campaign of Experimentation Exploring the Influence of the Battlefield Super Soldier Suit within Biomedical Network Topologies: Application of Nursing's Roy Adaptation Model Alicemary Aspell Adams, MBA, BSN, RN, Naval Postgraduate School, Pacific Grove, CA Alex Bordetsky, PhD, Naval Postgraduate School, Monterey, CA In the near future, a soldier on the battlefield will be wearing a specialized battlefield “super” soldier suit (BSSS) designed to enhance and maximize soldier performance, combat survivability, communications and status surveillance. Through advances in materials, nanotechnologies and network communications, the BSSS will in part serve as ballistic protection, hazmat detection, a medication or life sustaining delivery instrument, and a health status monitor. The BSSS will be lined with hundreds of nanotechnology biosensors allowing the measurement, monitoring and assisting of the soldier’s modes of adaptation while on the battlefield. The BSSS provides an integrated interface between humanity and a broader electronic computerized network. This presentation will explore an entire campaign of experiments using the concept of adaptation of network topologies within and across varying systems scenarios; the individual, special operations team (SOT), and remote distributed monitoring team (RDMT). Understanding of the implications of BSSS will help to define the future maximization of soldier health in combat and provide opportunity for accelerating and redistributing military battlefield decision making. The Roy Adaptation Model (RAM) was selected as a framework for this campaign of experimentation. The RAM’s four Adaptive Modes: physiologic‐physical, self‐concept, role function, and interdependence modes, lend themselves to the study of human assessment, health status maintenance, treatment delivery and large scale system network monitoring in the battlefield environment. Additionally, use of a nursing theory in the assessment and maximization of warrior well being is poignantly applicable as Florence Nightingale founded the nursing profession when caring for wounded soldiers during the Crimean War. The aim of this campaign of experimentation is to identify adaptive mechanisms for maintenance of homeostasis within human and technology networks occurring within the individual soldier, SOT and RDMT. The experiments highlighted in this presentation will explore optimal and adaptive topologies for human and technology networks when monitoring and caring for battlefield soldiers wearing the BSSS. Ultimately these studies will have implications for education, policy, practice, research, and theory development within the armed forces/ department of defense, as well as civilian bioinformatics, decision/ information sciences, medicine and nursing. Page 306
Early Doctoral Poster Session Basic Knowledge in Critical Care: A Comparison between Newly Graduated and Experienced Nurses Lynn Wiles, MSN, RN, CEN, PhD Candidate, Duquesne University, Virginia Beach, VA Purpose:A comparison of the basic knowledge of newly graduated nurses and experienced nurses’ working in critical care was conducted. This pilot aimed to determine whether the methodological design proposed for my dissertation study was feasible to obtain an adequate sample size and if the assessment and demographic tools would provide the information needed to draw comparisons between the groups. Theoretical Framework: The Novice to Competent Nurse Process Model (Schoessler and Waldo, 2006) was used to guide the pilot study. Methods: This pilot study used a between group non‐experimental, descriptive design. All nurses in the critical care units at one hospital comprised the sample. The Basic Knowledge Assessment Test (BKAT‐7) and demographic tool were completed by each nurse. Experienced nurses were grouped into a single cohort and newly graduated nurses subdivided into cohorts, as described by the framework (0‐3, 4‐9, and 10‐18 months). SPSS was used to analysis the data. Results: Twenty‐three nurses participated (47%). BKAT scores ranged from 71‐95, mean 83, SD 6.64. Independent t‐tests to determine score significance between the cohorts were non‐significant at 0.05 level of significance; [t (21df) = ‐1.244, p>0.05]. A one‐way ANOVA was used to compare BKAT scores and nursing degree and found significant, F (2, 20) = 4.483, p = 0.025. Correlation coefficients were computed to determine the degree to which the variables of BKAT score and experience were related. When controlling for degree, there was a significant relationship between employment time and BKAT scores r = 0.876, p = 0.022. Conclusions: Literature asserts that experienced nurses have greater clinical knowledge and function at a higher level than do newly graduated nurses. Results of this pilot study did not support this, but did show that knowledge level was linked to nursing degree earned for this relatively inexperienced group of critical care nurses (mean experience = 4.34 years). The return rate of 47% (39% of experienced nurses; 87.5% of newly graduated nurses), while not ideal, was not unexpected when collecting data by survey. Anecdotal comments from participants stated the methodology was convenient. The demographic data collection tool was adequate to gather the information that will be needed to compare the groups. A larger, more representative sample of experienced critical care nurses will be needed to compare group differences in my dissertation study. Page 307
Early Doctoral Poster Session The Pediatric Burn Book Maryann Godshall, MSN, RN, CPN, CCRN, CNE, Doctoral Student, Duquesne University School of Nursing, Emmaus, PA Purpose: Pediatric burns are a leading cause of serious injury and death for children. Each year over 250,000 children are seriously burned which require medical attention or hospitalization. Of the over 15,000 children hospitalized, about 1,000 of them die from their burn injury. This causes children to endure lengthy treatments which cause a large economic burden on both the families and society (American Burn Association, 2003). The purpose of my dissertation study is to examine whether pediatric burn patients can learn about their burn injury through a coloring book about burns. Also, whether children can express what they have learned through drawing a picture and telling a story about their picture. Background: After several years of working with pediatric burn patients, it became apparent that most discharge teaching is primarily done with the parents. The children are often ignored or sent off to play and not made part of the burn care which involves their own bodies. A review of the pediatric literature revealed the lack of tools available to teach children at their level of understanding about their burn injuries. This is the impetus for the development of a child‐friendly story and coloring book developed by this researcher in preparation for dissertation study. The book is age‐appropriate teaching tool that may help children learn about their burns Method: Narrative inquiry or “storytelling” and interpretive phenomenology will be used in the dissertation study. The target population will be children aged five through ten who are admitted to the hospital and receiving treatment for second or third degree burns. The setting will be a 26‐bed, in‐
patient pediatric unit that is a pediatric burn center in a level one trauma center in eastern Pennsylvania. The Pediatric Burn Book authored by this researcher will serve as the learning tool. The book has pictures which the child can color and includes important facts for the child to remember about taking care of their body after a burn injury. Results: It is not yet known whether the Pediatric Burn Book will meet the needs of the children it is intended to help. Conclusions: The results of my dissertation study may help determine the effectiveness of the Pediatric Burn Book and may help guide further education efforts for children with burn injuries so they will be given a voice and not be ignored. Page 308
Early Doctoral Poster Session Opt‐Out Testing of the Adolescent Population: A Critical Analysis of Current CDC Recommendations Erin N Leech, RN, BS, MS (student), New York University, College of Nursing, New York, NY ~ Abigail A Boyer, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Karyn E Cherwinski, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Jillian Davido, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Dorothy A Kleinert, RN, BS, MS, ANP, MS, (PNP student), New York University, College of Nursing, New York, NY Purpose: to determine the most effective way to change to opt‐out testing for all high school students who reside in states that have HIV screening policies inconsistent with the current CDC recommendations. It is estimated that 25% of individuals in the United States who are infected with HIV and AIDS are unaware of their status, thus HIV and AIDS remain a major public health problem. In 2006, the CDC recommended a change in HIV testing protocol in order to capture a larger percentage of infected individuals at an earlier stage in their illness. Routine screening through opt‐out testing is now recommended over previous policies that included lengthy pre and post test counseling and written consent before an HIV test could be performed. Opt‐out testing is defined as performing HIV screening after notifying the patient that 1) the test will be performed and 2) the patient may elect to decline or defer testing. Assent is inferred unless the patient declines testing. This method of testing decreases the stigma attached to the disease as high‐risk groups are no longer singled out. Along with new testing guidelines, the 2006 recommendations place a large emphasis on capturing adolescents, ages 13‐19, since they are an increasing proportion of the infected population. Some states, including New York State, have not implemented the current CDC recommendations. Theoretical Framework: Self‐regulation theory was used to guide this investigation (Shonkoff & Phillips, 2000; Bronson, 2000). In the adolescent, self regulation involves fostering a sense of self confidence and competence. Adolescent development is based on a consistent caring environment at home (Bronson, 2000) and with health care providers. Nurse practitioners who support Opt‐out screening for HIV in adolescents are fostering self‐regulation in the adolescent population and promoting healthy life‐style behaviors. Methods: This study used a quasi experimental design. Nurse practitioners are responding to an on‐line survey that addresses adolescent health care and opt‐out testing. Results: Results from this survey will be analyzed using descriptive statistics. The mean, medium, and mode for each question will be presented and the results of a frequency distribution will be analyzed and reported. 5. Conclusions and Implications: Recommendations for changing state and local school board policies in states whose policies are inconsistent with the CDC guidelines will be presented. Page 309
Early Doctoral Poster Session Qualitative Studies on End‐of‐Life Nursing Education Stephanie M. Jeffers, MSN, RN, Doctoral Student, Media, PA It is estimated that over one million people die in hospitals, often without adequate symptom and pain management (White, et al., 2006). As technology continues to advance, there will be an increased need for nurses who are sensitive to the ethical and moral issues surrounding end‐of‐life care. Nurse educators are in a key position to influence nursing practice by teaching concepts related to death and dying in the didactic and clinical settings. An integrative review of the qualitative literature on end‐of‐life content in nursing education was conducted to determine whether end‐of‐life content is included in undergraduate nursing programs, as well as further examine experiences of nursing students with dying patients in the clinical setting. The Cumulative Index to Nursing and Allied Health (CINAHL), ProQuest, PubMed and Google Scholar were searched using key terms including “education”, “nursing student”, “death and dying”, “end‐of‐life” and “qualitative”. Inclusion criteria for journal articles included qualitative research pertaining to nursing students caring for patients at the end of life. The results of this integrative review demonstrate that there is limited qualitative research on nursing education and end‐of‐life issues. Three qualitative research designs were repeated in the studies, which include phenomenology, grounded theory and descriptive design. These studies were analyzed and critiqued for content, appropriateness of research design and trustworthiness. The results of these studies provide rich descriptions of the experiences of nursing students as they care for dying patients. Further research is needed to expand the knowledge and understanding of nursing students’ perspectives, emotions and responses to caring for dying patients and would assist nurse educators in understanding how the students process these experiences. Page 310
Early Doctoral Poster Session Functional Outcomes of 8‐12 Year Old Children Born Prematurely Michelle M. Kelly, MSN, CRNP, Villanova University, Villanova, PA Prematurity affects one in eight infants in the United States, a rate that reflects an overall increase of 20% between 1990 and 2005 (March of Dimes, June 2008). The work of children is attending and participating in school, playing and learning the social roles that will be the building blocks of adulthood. Children who fail to master basic skills early in development are more likely to be unsuccessful with tasks that build upon those skills. The purpose of this integrative review was a synthesis of the current research addressing the functional status of 8‐12 year old children born prematurely. A search of MEDLINE, PubMed, CINAHL and ProQuest databases was carried out utilizing the following search terms: preterm, premature, very low birth weight and outcome. Limits placed on the searches included: English, with abstract, appropriate age categories (CINAHL limit category 6‐12 year old, MEDLINE search category children 0‐18 years) and publication from 1995‐2009. Findings from this review support the belief that children born prematurely function differently than their term peers. Co‐morbidities such as bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity have persistent effects on children’s middle school age functional status. Children born prematurely may be smaller than their peers. They have academic and social delays that may necessitate special service support through middle childhood. The results of this integrative review highlight the need for continued research addressing the health and functional status of children born prematurely as they enter middle childhood. Page 311
Early Doctoral Poster Session Palliative Care: Missed Opportunities for Patients with End Stage Heart Failure Michele H. Caccavano, DNP(c), ANP, RN, Stony Brook University, Patchogue, New York Corrine Jurgens, PhD, NP, RN, Clinical Associate Professor, Stony Brook University, Stony Brook, NY Purpose: Heart Failure is a progressive disease with high mortality. Presently, end of life care for end stage HF patients is uncommon. Many are not referred to palliative care until late in the course of the disease, or not at all. Overlooking palliative care options may prolong suffering of the patient and family. Lack of familiarity or examination of known predictors of HF mortality may be a factor in missing opportunities to offer palliative care services to patients hospitalized with end stage HF. Therefore, the purpose of this study was to examine the frequency of referrals to palliative care of potentially appropriate patients admitted with decompensated HF in a suburban tertiary care hospital. Methods: Medical records of the first 200 patients in a suburban tertiary care center with a primary discharge diagnosis of decompensated HF, were retrospectively reviewed for the year 2008. The ADHERE criteria (systolic blood pressure<115 mmHg, urea nitrogen>43, creatinine>2.75) were used to predict in‐hospital mortality. The Seattle HF model was used to predict life expectancy, 1 year mortality, and 1 year survival using HF related lab values and clinical data. Referrals to palliative care/hospice or whether the patient expired were documented. Results: The purposive sample (n=200) was 61% male, 85% non‐hispanic white and mean age was 70.9 years (SD=15). Most were functionally compromised (NYHA Class III, 84.7%, Class IV, 12.2%). Approximately 1/3 had Health Care Proxies. ADHERE high risk criteria for in‐hospital mortality was met in 9% of the sample, but only 3.5% died in‐hospital. Seattle HF model at discharge indicated that although 10% were eligible few were referred to palliative care (1.5%). Twenty‐one patients who met criteria for referral died (3.5% died during admission, 7.5% died within one year). Implications: Timely referral of HF patients to palliative care was not offerred in most cases in one surburban tertiary care center. Familiarizing health care providers with objective criteria for evaluation of potential need for palliative care referral is needed. Page 312
Early Doctoral Poster Session Testing Cognitive Function in Clinical Research Olympia Berger, RN, FNP, Binghamton University, Binghamton, NY Carolyn S Pierce, DSN, RN, Binghamton University, Binghamton, NY Purpose: to examine the sensitivity of various neurocognative tests to assess cognitive decline in persons 65 to 85 years of age who have minor memory complaints. These finding will be used to inform a subsequent study examining the efficacy of calf muscle pump (CMP) stimulation to promote circulation in the lower extremities and thus improve cognitive function in persons with MCI. Because we will be testing this device in 3 month increments, we need to use tests of cognitive function that are discriminating of changes in cognitive function at relatively short intervals. Theoretical Framework: Our work is based in the assumption that intra‐cerebral blood pressure is vital in maintaining brain perfusion. As MCI progresses to Alzheimer’s disease (AD), the brain’s regulation of blood pressure fails. It is known that with cerebral infracts in the insular region of the brain produce hypotension and dementia. Studies also have shown that individuals with MCI who converted to AD have a greater degree of hypoperfusion in the parietal and cigulate cortex bilaterally. Hypoperfusion may account for the accumulation of amyloid‐β (Aβ) and other peptides that may be indicated in pathologic changes. Methods ‐ We are currently recruiting a convenience sample of 60 subjects 65 to 85 years of age who self‐ identify with memory concerns. We will administer a battery of tests focusing on areas of cognitive function most affected in early stages of cognitive decline at 3 month intervals for a period of one year while screening for dementia and depression. We will focus on test‐retest issues because changes in cognitive function may actually be masked by the learning that occurs in many tests of cognitive function Page 313
Early Doctoral Poster Session HEAT Initiative: Implementation of an Evidence‐Based Clinical Practice Guideline to Reduce Childhood Obesity Tashea T. Gallimore, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Jessica Oppenheimer, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Miriam Pudel, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Ana Souto, RN, BS, MS (student) , New York University, College of Nursing, New York, NY ~ Christine Verzosa, RN, BS, MS (student) , New York University, College of Nursing, New York, NY Purpose: to implement the Healthy Eating and Activity Together (HEAT) Initiative, which is a culturally sensitive evidence‐based practice guideline for Nurse Practitioners (NPs) to teach parents content and choices for obesity prevention, healthy nutrition, and activity for children. Obesity in the pediatric population is the most prevalent nutritional disease in the U.S. Members of the National Association of Pediatric Nurse Practitioners (NAPNAP), with expertise in child health and nutrition, developed the HEAT Initiative as a tool for NPs to implement and evaluate nutritional guidelines to prevent childhood obesity. Theoretical Framework: The Health Belief Model (Janz, Champion & Strecher, 2002; Strecher & Rosenstock, 1997) was used to guide this study. Parents will engage in preventative behaviors if they believe in the benefit of changing their personal values and perceptions about childhood obesity. Motivational interviewing was used to enhance this theoretical framework. Methods: The HEAT Initiative and Motivational Interviewing was used to teach parents of children 6 months to 3 years old obesity prevention strategies, healthy nutrition, and appropriate activity for their infants and toddlers. An initial HEAT Initiative assessment describing each child’s usual day was obtained. Pre and post HEAT Initiative assessment tools were used to assess the parents’ learned knowledge related to content healthy choices and behaviors. Results: The pre and post test results from the implementation of this evidence‐based HEAT Initiative will be presented. Descriptive statistics, including the mean, median, mode and the standard deviation, for each of the items on the assessment tool will be presented in histograms and bar graphs. Conclusions and Implications: Results from the implementation of the culturally appropriate HEAT Initiative has the potential to support NPs use of the best evidence‐based practice guidelines to reduce the incidence of childhood obesity. This evidence‐based initiative addresses the childhood obesity epidemic. Page 314
Early Doctoral Poster Session The Validity and Reliability of the Critical Care Pain Observation Tool: A Replication Study Kathleen M. Keane, BSN, MS, CNL, CCRN, Boston College, Boston, MA Gene Harkless, DNSc, APRN, FNP‐BC, CNL, University of New Hampshire, Durham, New Hampshire Kristiina Hyrkas, PhD, LicNS, MNSc, RN, Maine Medical Center, Portland, ME Purpose: to measure the reliability and discriminant validity of the Critical Care Pain Observation Tool. Theoretical Framework Melzack's Neuromatrix Theory of Pain Background: Critically ill patients are often not able to self report the presence of pain. Currently there is no generally accepted assessment tool for this population; the Critical Care Pain Observation Tool was developed to address the need for an instrument that assesses pain in critically ill patients. This research examined the reliability and validity of the Critical Care Pain Observation Tool via replication of the original research study that developed the tool. Methods: The design of this quantitative study was a repeated measures design with a convenience sample of twenty three post operative open heart surgery patients cared for in a 500 bed tertiary care teaching hospital. Two nurse observers used a standardized instrument, the Critical Care Pain Observation Tool, to score patient pain behaviors during rest, with repositioning and after repositioning. Data was collected and statistical calculations were conducted in MedCalc for Windows, v. 10.02.0 (MedCalc Software, Belgium) and v. 17.0 of SPSS for Windows (SPSS Inc, Chicago, Ill.) Results: Testing for interrater reliability in this study showed a range of results resulting in fair to almost perfect interrater reliability with weighted kappa scores ranging from .34 to 1.0 at each assessment period. The findings of this study suggest that the instrument’s interrater reliability is acceptable but variable. Testing for discriminant validity demonstrated a significant difference in mean scores between noxious and non noxious procedures; this finding supports the discriminant validity of the Critical Care Pain Observation Tool instrument. Conclusions/Implications: This replication study supports the reliability and discriminant validity of the Critical Care Pain Observation Tool instrument in assessing pain in open heart surgery patients. A particular strength of this study is that it adds substantive information on the interrater reliability component of this instrument. This replication study adds to two other studies that have examined this instrument and contributes to the process of translating the use of this instrument to the clinical setting. Page 315
Early Doctoral Poster Session Evaluating the Relevance of the Representational Approach to Patient Education for Physical Activity Interventions Renee M Ingel, RN, MSN, Doctoral Student, University of Pittsburgh, Pittsburgh, PA Heidi S Donovan, PhD, RN, University of Pittsburgh, Pittsburgh, PA Purpose: To review existing research on the most‐common theoretical approaches to physical activity interventions and to assess the potential relevance of the Representational Approach for improving physical activity outcomes. Background: Obesity is a national epidemic. Physical activity is one of the most effective approaches to weight loss. While progress has been made using a range of educational approaches, long‐term physical activity adherence rates remain poor. The Representational Approach (RA) to patient education has been used successfully to guide interventions targeting chronic disease and symptom management. The question is whether the RA could be used to guide health promotion education to improve physical activity. Approach: Constructs of two commonly used theoretical approaches to physical activity were examined: the Trans‐Theoretical Model (TTM) and Social Cognitive Theory (SCT). Findings related to the mediating effects of key constructs on physical activity outcomes was summarized and compared to key concepts of the RA. Major Points and Rationale: Five potential mediators were commonly evaluated in physical activity research: physical behavioral processes of change, cognitive processes of change, self‐efficacy, decisional balance, social support and enjoyment. Of the targeted variables which were examined to have an effect, behavioral processes of change and self‐efficacy received the most support. Key concepts of the Representational Approach include 1) representational assessment; 2) addressing misconceptions; 3) creating conditions for conceptual change; 4) providing new information; and 5) developing patient‐centered goals and strategies. Because the patient is actively involved in reflecting on his/her past experiences, identifying causes of previous problems, and creating specific plans for change, this approach has the potential to increase self‐efficacy and support behavioral change processes. Conclusions: Existing literature suggests long‐term physical activity outcomes are lacking and that improving physical activity is necessary for improving health. The Representational Approach could contribute to existing literature which identifies a need for self‐efficacy, behavioral changes, and changes in cognition. Page 316
Early Doctoral Poster Session Integrative Review of an Emerging Care Model: Telemedicine, Health Information Technology, and the ICU Daniel D Cline, MSN, CRNP, New York University College of Nursing, New York, NY Purpose: to examine the existing literature on the emerging eICU® care delivery model to better understand its impact on quality, reasons for organizational adoption, and the care model’s work characteristics. Background: Current challenges related to the delivery of high‐quality care, the rising cost of care, and a shortage of highly skilled clinicians has created the need for new care models. An emerging model in the critical care setting is the eICU® care model. The model integrates telemedicine, health information technology, and specialized ICU care providers ‐ critical care RNs and Intensivists. Currently, about 40 healthcare systems use the model accounting for about 10% of the adult ICU population. Methods: A literature search was conducted within the following electronic databases: Pubmed, CINAHL, Web of Science, Embase, EBSCOhost Business Source Premier, Cochrane Library, PsychINFO, Google Scholar, and ProQuest Dissertation Abstracts. After applying inclusion and exclusion criteria twelve studies remained: eight quantitative studies, three qualitative studies, and one mixed‐methods study. Results: Studies were critically appraised for findings related to the eICU® care model’s ability to impact quality care (mortality, length of stay, and complications), factors impacting organizations decision to adopt the eICU® care model (cost savings, and improvements in quality), and work characteristics of the eICU® care model (mentoring, increased monitoring, and improved communication and collaboration). All studies used risk‐adjustment and controls to try to isolate the eICU® as the only possible reason for improved patient outcomes. The studies aggregated findings indicate the eICU® care model leads to improved quality when measured by select patient outcomes. Conclusions and Implications: The limited number of peer reviewed and published studies prevent conclusive findings. However, the eICU® model has a positive effect on ICU and hospital mortality, ICU and hospital length of stay, and cost of care. The eICU® care model has the ability to change how critical care services are delivered but further research is needed. In particular, studies are needed exploring how the bedside RN uses and perceives this new care model. Page 317
Early Doctoral Poster Session Promoting Active Engagement of Undergraduate Students in Nursing Research: One case Study Rosemary Collier, RN, BS, Binghamton University, Franklin, NY Involving undergraduate students in research is a goal of many universities, and can improve student outcomes. Nursing undergraduate education has long included a didactic research component, but few programs provide an experiential opportunity. This study presents the experience of one group of undergraduate nursing students. The main focus of student activities was research to increase understanding of the experience of the pregnant smoker and of their health care providers. Each student attended training sessions on planning and facilitating focus groups, as well as analyzing results. They implemented grant objectives by note taking at the focus groups, analyzing transcripts, assisting with dissemination of research results and in‐service training of providers. On completion, they were invited to participate in their own focus group to understand how their experiences with the research project affected their overall learning as students and future practitioners in the nursing profession. The common themes related to their own clinical practice and the research: reflective practice (importance of listening skills, not being judgmental, and perception checking), learning the research process, and looking forward to making research part of their futures. This study illustrates how nursing programs that actively involve undergraduate students in research can gave them valuable experience, not only in research process, but also in first‐hand understanding of a clinical population, much like a clinical experience. Page 318
BS/MS Poster Session Coping While Caring for the Dying Child: Nurses’ Experiences Katherine A Cook, MSN, RN, CPNP, Children's Hospital Boston, South Boston, MA Purpose: To describe and understand behaviors and coping mechanisms used by nurses when caring for dying children on an inpatient cardiology unit. Resources nurses find necessary to experience an adequate grieving process will also be explored. Background: Little research has focused on how nurses grieve and cope while caring for a dying child on an acute care unit. It is well described in literature that job dissatisfaction, stress and burnout result from an inadequate grieving process. Methods: Qualitative methods using focus groups were conducted with acute care nurses who had cared for a dying child after a prolonged illness within the Cardiac Unit at a large tertiary care pediatric hospital. Chronic illness was defined as any medical condition that requires long term management of greater than six months and one or more periods of hospitalization. Data was audio taped, transcribed verbatim and categorized into domains. During the first interpretive phase, the researchers reviewed comments from the identified data source, highlighting illustrative instances in the comments, and tracking patterns and themes that appeared within and between comments. The researchers then interpreted and contextualized the data for further analyses, organization and coding. Results: Twenty two nurses participated in focus groups. Four main domains were identified, Disconnecting, Memories, Boundaries, and Labeling. Prior experiences or exposures were found to inform coping and behaviors used by nurses. Colleague support and institutional resources were critical to the coping and grieving process. Years of practice influenced the nurse’s ability to disconnect and set boundaries. Conclusions: Coping and grieving are a critical part of the practice of nurses in a cardiac acute care unit. Colleague support and adequate resources allow for an adequate grieving process. Further studies exploring the relationship of job dissatisfaction, stress and burnout from an inadequate grieving process are required. Page 319
BS/MS Poster Session Workplace Violence Among Nursing Personnel in the Geriatric Long‐Term Care Setting: A Mixed Methods Analysis. Ronica Lu, BS, Johns Hopkins University , Baltimore, MD ~ Richelle Bolyard, BA, Johns Hopkins University, Baltimore, MD ~ Elizabeth Hill, RN, PhD, Johns Hopkins University, Baltimore, MD ~ Joan Kub, PhD, APRN, BC, Johns Hopkins University, Baltimore, MD ~ Jill Messing, MSW, PhD, Arizona State University, Phoenix , AZ Purpose: To investigate: (1) the prevalence, risk factors, perpetrators and types of workplace violence (WPV), (2) underlying themes and perceived meaning of workplace violence among staff in a geriatric long‐term care (LTC) facility. Background: Workplace violence has major long‐term health and employment outcomes. WPV research has primarily focused on emergency and psychiatric units and few studies have examined WPV among nursing personnel in urban geriatric LTC settings. Methods: This analysis is an adjunct to a larger longitudinal NIOSH‐funded study of WPV that focuses on 2007 baseline data collected from nursing personnel (N=68) working in an urban LTC setting. Quantitative data (prevalence, risk factors, perpetrators and types of WPV) were analyzed using SPSS. In‐depth interviews are being conducted with seven of the personnel reporting WPV. Interviews are taped, transcribed, coded, and analyzed using NVIVO. Results: A total of 22% of nursing personnel reported experiencing threats or physical violence within the past year, while 23% reported psychological abuse. The primary source of the physical violence was patients (89%) while the primary source of psychological abuse was coworkers (44%). Qualitative analysis of the in‐depth interviews is ongoing. Conclusions & Implications: The combined quantitative and qualitative methods used in this study delineate the nature of WPV in the LTC setting. Physical and psychological experiences of violence are frequent among nursing personnel (RNs, LPNs, and assistants) in an urban LTC setting, posing safety concerns. Because of the limitations of this study, replication should occur in a wider geographical area with broader representation by gender. We also recommend screening for and WPV education as initial interventions to improve work environment safety, which are critical to the provision of high quality work and ultimately quality patient care. Page 320
BS/MS Poster Session Nursing Care of the Alcohol Misuser: A Look at Curriculum Michelle A Mollica, RN, BSN, Daemen College, Newfane, NY The prevalence of alcohol abuse and misuse is greatly disproportionate to the amount of didactic and clinical hours reported by nursing programs nationwide (Hoffman & Heinemann, 1987; Howard et. al, 1997; Rassool, 2004). As there is no recent nursing literature that re‐examines the findings of these earlier studies, it was important to survey baccalaureate schools of nursing regarding their current educational offerings of the alcohol misuser. A questionnaire was distributed via Survey Monkey to all nursing department deans or program chairs of all traditional four‐year baccalaureate nursing programs in the Northeastern States (N = 117). Twenty‐seven schools responded. The majority of responding schools include 1‐5 hours of didactic instruction related to alcohol misuse. Results also showed a deficit in clinical offerings related to the same. Compared to previous studies, a greater number of responding schools reported coverage of content areas such as treatment and rehabilitation, psychological complications, as well as self‐help related to alcohol misuse, but areas found to be lacking were public health, legal regulations, and public education. Survey findings showed there has been little change in results from studies performed 10 ‐ 20 years ago. It is evident from the findings of this survey that the tool itself provided many limitations for transferability of the results. Based on the study findings further survey development is encouraged with the intent of continuing exploration of curricular offerings related to alcohol misuse. Page 321
BS/MS Poster Session The Lived Experience of Cross‐Cultural HIV/AIDS Education in Tanzania, Africa Erin Flanagan, BS Student, The Pennsylvania State University, State College, PA Purpose: The purpose of this research was to improve understanding of the experience of volunteer educators teaching HIV/AIDS prevention in a foreign country to students not of their culture. The goal was to gain insight into issues that may impact the effectiveness of this type of educational process. Framework: The study was based on Heidegger’s philosophy of hermeneutic or interpretive phenomenology. In this philosophical view the person is considered inseparable from the object so that the person cannot exist without considering the world around them. Therefore the study focus is on the actual experiences of persons with a specific phenomenon, in this case, cross‐cultural teaching. Methods: The design of the study was application of the hermeneutic phenomenological research approach. Eight volunteer educators were interviewed over a six week period during the time they were teaching in Tanzania, Africa. Semi‐structured interviews were conducted to support in depth descriptions and then transcribed verbatim by the primary researcher. Text analysis was completed for emergent individual themes, patterns, and group themes to produce an in depth interpretation of individual and common features of the phenomenon, following the guidelines provided by Smith, Flowers and Larkin (2009). An expert in phenomenological research assisted with analysis and provided an audit to assure the quality and rigor of the process and trustworthiness of the findings. Results: The final emergent themes and the interpretation of the findings related to cross‐cultural teaching and possible impact on teaching outcomes will be discussed. Preliminary analysis suggests the experience is challenging and difficult for many. Implications: The significance of the findings, measures suggested to improve this area of research, as well as future research direction will be discussed. Page 322
BS/MS Poster Session Patient Lift Teams: A Realistic Solution to Reducing Musculoskeletal Injuries in Nurses Kelly E. Williams, BS, MS, CCRN, The Pennsylvania State University, State College, PA Purpose: Nurses have one of the highest rates of work‐related injuries among all professions, leading to devastating personal, economic, and professional consequences. With the aging of the nursing workforce and the ongoing nursing shortage, this problem is only expected to grow unless a realistic solution is established. The purpose of this presentation is to describe the impact of work‐related injuries and the effect of lift teams on the reduction of these injuries. Methods: A literature review was undertaken to explore the state of the science surrounding the use of lift teams. A total of nine articles were retrieved that addressed lift team intervention designs and the influence of lift teams on nurses’ injuries. Result: Lift team interventions were found to have a positive impact on nursing injuries. These included a decrease in lost workdays, cost savings for the institution, and an increase in both nurse and patient satisfaction. Conclusions: The evidence is clear that lift teams, when properly implemented, can reduce the incidence of musculoskeletal injuries in nursing staff. The aging of the nursing population, which is expected to lead to increased injuries in the profession, and the ineffectiveness of previously used approaches to preventing injury, present a crucial health and economic problem that is in need of immediate and focused attention. These injuries are preventable. Lift teams provide a solution to the problem by protecting nurses and thereby protecting the future quality of patient care. Page 323
BS/MS Poster Session Exploring the Utilization of Hospice and Palliative Care Services in Nursing Homes: A Systematic Review of the Literature Gail M Gregg, BSN, RN, CCRN, University of Massachusetts Lowell, Westford, MA Susan Crocker Houde, PhD, ANP‐BC, University of Massachusetts Lowell, Lowell, MA Purpose: To explore how hospice and palliative care services are utilized in U.S. nursing homes. A preliminary systematic review of the literature was conducted. Findings were limited to the critical appraisal and synthesis of six research studies. Methods: Full‐text journals at OVID were searched with limits set to articles written between 1999 and 2008. Key words selected were “hospice”, “end of life”, “palliative care”, and “nursing homes”. The search identified 107 articles from OVID. Exclusion criteria included studies of hospice and palliative care in foreign nursing homes, symptom management, and end‐of‐life care in the pediatric population. Eighty‐seven articles were excluded by title review. Nine were excluded with a focus related to nursing home management. The remaining eleven papers were reviewed. Three were not research studies. The remaining six studies are the focus of this review. Cochrane Collaboration guidelines were used to appraise the quality of the research. A search of CINAHL will be conducted to expand this preliminary systematic review and results will be reported. Results: The six studies reviewed included two randomized controlled trials, one quasi‐experimental study, one non‐experimental, retrospective cohort study, and two descriptive studies with one using a concurrent mixed‐methods design. Results support that hospice and palliative care in nursing homes promote higher satisfaction and improved quality at the end of life through expert symptom management, facilitation of communication between patients, families and caregivers, and psychosocial and spiritual support. Hospice services were underutilized for nursing home residents who were eligible. Increasing awareness and education among nursing home staff was associated with increased communication about end of life wishes among residents, families, and caregivers that resulted in an increase in the number of hospice referrals. Findings support the need for increased awareness and education of nursing home staff concerning end‐of‐life issues, including the timing and appropriateness of referral to hospice services. Implications: Further research is needed in the area of quality of life for hospice patients. Further exploration of educational needs of nursing home staff regarding hospice care is also important. The final systematic review will provide practice, policy, and research implications regarding palliative and end‐of‐life care in nursing home settings. Page 324
BS/MS Poster Session Gender‐based Differences in the Analgesic Management of Cancer Pain in Outpatient Oncology Settings Hwasoon Rim, RN, BSN, MSN, University of Pennsylvania , Philadelphia, PA Salimah Meghani, PhD, MBE, CRNP, University of Pennsylvania, Philadelphia, PA Purpose: This study investigates if there are gender‐based differences in the management of cancer pain in the outpatient oncology settings. Background: Accumulating evidence suggests that women receive less than optimal analgesia for pain treatment. However, few studies have explored differences by gender in the setting of cancer pain. Methods: A convenience sample (N=118; males=45, females=73) was recruited from outpatient medical oncology clinics in Mid‐Atlantic region. Self‐identified AA and WH, >18 years, diagnosed with solid tumors, with cancer‐related pain in one week prior to the survey were included. Pain and treatment variables were elicited using the standardized 32‐item Brief‐Pain‐Inventory (BPI‐LF). T‐test for continuous and Pearson Chi‐squared‐test for categorical variables were used to analyze data. Result: Mean age was 55.4 years (SD =/‐9.92). There were no differences by gender in baseline demographics including age (P=.789), marital‐status (p=.086), race (p=.449), education (p=.516), insurance‐status (p=.240), income (p=.747), duration of cancer pain (p=.867), and use of complementary‐alternative‐methods (p=.274). Women reported higher “pain‐average” (5.0 v.4.2, p=.032), “pain‐now” (3.8 v. 2.7, p=.009), lower pain‐relief (“pain least”=3.4 v. 2.6, p=.033), and tended to experience more trouble in “general‐activity” (p=.046) and “work‐related interference” (p=.044). Women were also likely to receive more potent analgesia (p=.048), however, the Pain Management Index was below zero for both genders indicating less than optimal cancer pain relief for both men and women in this sample (‐.2558 v. ‐.2254, p=.873). Conclusion & Implications: Our findings suggest that women are more likely to experience cancer pain and pain‐interference burden, however, both men and women experience moderate levels of cancer pain on average and were less likely to receive guideline‐recommended analgesia relative to their severity of pain. This is despite the evidence that most cancer pain can be adequately relieved using a simple three‐step WHO analgesic ladder. Page 325
BS/MS Poster Session Deactivation of Implantable Cardioverter‐Defibrillators (ICDs) at End‐of‐Life: An Exploration of Healthcare Provider Attitudes, Patient Attitudes, and Clinical Practices James Russo, RN, BSN, CCDS., Hunter‐Bellevue School of Nursing, Lake Katrine, NY Significance Terminally ill patients with Implantable Cardiac Defibrillators (ICDs) can experience a compromised quality of death when the ICD delivers painful shocks as it attempts to treat an arrhythmia. This can be averted by device deactivation. However, no formal practice protocols exist for ICD deactivation and discussions regarding deactivation often do not occur. Without discussions, patients are not able to consider this in planning their death experience. Purpose: To identify factors delaying ICD deactivation discussions. To identify ways to promote timely deactivation discussions and foster patient centered care. Methods Literature review. Results Provider knowledge deficit of ICD functions and their attitudes regarding ICD therapy in end‐of‐life care can negatively impact the timeliness of deactivation discussions. Provider reticence to discuss deactivation may occur due to feelings of discomfort with end‐of‐life discussions and value conflicts. The ICD may be viewed differently from other life sustaining measures and not seen as a priority to discuss. Providers may feel ill‐prepared, prefer expert guidance, or have the conversation initiated by others. Loss in continuity of care impacts practice: deactivation is performed most often by an industry representative rather than a provider known to the patient. Scant research on patient attitudes towards ICD deactivation exists and results are conflicting. However, a knowledge deficit of ICD function in patients is apparent. A complex psychological relationship may exist between patients and their ICDs. Deactivation discussions occur more frequently when a formal policy exists in an institution. ICD deactivation in terminal patients is more likely when an interdisciplinary approach to deactivation discussions is present. Conclusions and Implications: Patients and providers need increased knowledge of device options at end‐of‐life. Patient attitudes regarding ICD deactivation need further research. Formal ICD deactivation policies should be developed to guide providers. A comprehensive and interdisciplinary approach should be considered for deactivation discussions. Page 326
BS/MS Poster Session The Experience of Using Complementary/Alternative Medicine for the Symptoms of Distal Symmetrical Polyneuropathy Among Individuals with HIV/AIDS Meredith Lucas, BSN/MSN Candidate, BS, Emory University, Nell Hodgson Woodruff SON, Atlanta, GA Susan Bauer‐Wu, BSN RN, MS, PhD, Emory University, Atlanta, GA Ashli Owen‐Smith, PhD, Emory University, Rollins School of Public Health, Atlanta, GA The purpose of this study was to examine the perceived benefits, barriers and efficacy of complementary and alternative medicine (CAM) for managing distal symmetrical polyneuropathy (DSP) among HIV‐positive individuals in Atlanta, GA. Background Highly active antiretroviral therapy (HAART) has transformed HIV/AIDS from an acute to a chronic illness. Healthcare providers now manage long‐
term side effects seen not only with the disease but also the medication. Neuropathic pain is an under‐
recognized, under‐treated symptom of HIV/AIDS. The most common manifestation of neuropathic pain is distal symmetrical polyneuropathy (DSP). Lack of effective conventional therapies inspires many individuals to turn to alternative methods for symptom relief. CAM therapies may include, but are not limited to, the following: acupuncture, vitamins, meditation, massage, reflexology, yoga, and tai chi. In order to facilitate informed provider‐patient dialogues, healthcare providers need to understand why individuals use CAM. Methods Recruitment consisted of fliers delivered through various local HIV/AIDS listserves and posted at a multi‐site HIV/AIDS healthcare‐based organization. Eligible individuals were at least 21 years old, HIV‐positive and reported using CAM to manage their DSP on an initial screening survey. Participants were assigned to one of two focus groups, each of which lasted approximately one hour. Afterwards, participants completed a survey consisting of sociodemographic and health‐related questions. Focus groups were audio recorded and transcribed; each resulting narrative was analyzed using content analysis. Results This study is still in progress, and there are no available results to report at this time. Conclusion The forthcoming results will guide larger intervention studies investigating CAM for DSP. Participants’ shared experiences will be used to guide health education on beneficial therapies for DSP symptoms and facilitate informed provider‐patient dialogues. Page 327
BS/MS Poster Session Dying with Dignity: Hospice Nurses' Perceptions of Dignity in the Final Weeks of Life in Rural Ireland and Connecticut Laura Foran, BS Student, University of Connecticut School of Nursing, East Hartford, CT Purpose: The objective of this research was to assess the perspectives of registered nurses working in hospice care on the effectiveness of interventions to promote dignity in the final weeks of life in Connecticut and rural Ireland. Background: Hospice care focuses on providing comfort measures and dignity to patients and their families at the end of life, yet few studies actually explore the effectiveness of practices used for the promotion of dignity. Methods: A descriptive phenomenological research method was used. Participating hospices were located via the Internet using purposive sampling. A total of ten participants were interviewed from Connecticut (5) and Ireland (5). Questions related to definitions of dignity and opinions about the interventions used to promote dignity at the end of life. The taped interviews were transcribed verbatim by the researcher and the Colaizzi method was used to analyze data. Results: Participants’ definitions of dignity universally related to patient choice. Interventions identified by both groups included: communicating with patients about their wishes; appropriate pain management; aiding the patient in maintaining a sense of control; and protecting privacy. Nurses felt that these interventions adequately promoted dignity at the end of life. Though Irish nurses discussed the importance of alleviating spiritual and mental distress, few interdisciplinary teams included social workers or spiritual counselors. Connecticut nurses discussed referral to social workers and spiritual counselors, but were less likely to discuss other spiritual or mental health interventions. Conclusions/Limitations: Nurses from Ireland and Connecticut had similar definitions of dignity. Interventions were believed to be effective and were similar with the exception of Irish nurses being more likely to personally provide holistic interventions, whereas Connecticut nurses were more likely to refer to interdisciplinary team members. Several participants were from the same hospices, and homogeneity among participants in terms of gender and race may have limited results. Page 328
BS/MS Poster Session Family Perspectives on End‐of‐Life Care Rebecca Osgood, RN, MSN, Simmons College, Newton, MA Patricia White, Ph.D., ANP‐BC, Simmons College, Boston, MA Purpose: The purpose of this pilot study was to gain better understanding of family members’ perspectives regarding what the experience of a loved one’s death was like for them and what can be done to improve the dying experience for all involved. Background: End of life (EOL) is associated with a substantial burden of suffering among dying individuals and also has health and financial consequences that extend to family members and society. Family members are often asked to make decisions on behalf of a loved one who is seriously ill without having a complete understanding of his or her preferences. To avoid this situation, older adults should discuss their EOL wishes with family members and health care providers well before the onset of a serious illness, and they should designate a surrogate decision maker for health care. Methods: The Director of Nursing at a skilled nursing facility (SNF) in southern MA and a Nurse Practitioner involved in EOL care contacted 5 family members of elders who were residing at this nursing home at the time of their death 3 – 18 months prior to recruitment. Five family members agreed to participate in the study and all 5 were interviewed by the principal researcher using using face‐to‐face interviews. Results: Qualitative content analysis of the interviews revealed that positive family perspectives were highly correlated with ongoing communication from members of the healthcare team, particularly when alerting family member(s) of their loved one’s imminent death. All participants’ family members had advance directives (AD’s) that had been in place and well‐communicated prior to changes in health status, which was associated with increased family satisfaction with EOL care. All participants recommended that healthcare providers and family advocate for early EOL decision making and for active communication of these AD’s among the healthcare community. Finally, EOL care that displayed respect and dignity was universally associated with increased family satisfaction. Additional themes included participants’ descriptions of family members’ transition to the SNF and participants’ descriptions of the dying process. Conclusions and Implications: The findings of this study support that ongoing communication positively impacts family members’ perspectives on EOL care. Family members’ satisfaction with EOL care was also associated with healthcare providers’ compliance with the decedent's treatment preferences. Page 329
BS/MS Poster Session Adolescent Food Habits: Results of Prenatal Nutritional Survey Nancy J. Wise, RN, MSN, Villanova University College of Nursing , Villanova, PA Purpose: This pilot study was conducted to obtain baseline data about the food choices of pregnant adolescents, their knowledge about nutrition, current eating habits and how they feel they learn best. Framework: Pender’s Health Promotion Model served as the study’s framework. Methods: A 22‐item survey was distributed to a diverse group of pregnant adolescents between the ages of 15 and 19 who attended a teen parenting program or a prenatal clinic in Pennsylvania. A total of 49 adolescents completed the surveys. Descriptive statistics were used to describe the sample and to summarize results of the survey. Results: The results indicated that healthy eating is viewed as important by pregnant adolescents. Although they eat three or more meals a day, their snacks generally consist of unhealthy food choices. Pregnant adolescents in this sample reported not being big consumers of fast food; their evening meal typically includes meat, grains, and vegetables but is deficient in dairy products. Adolescents know about food nutrition labels but do not always use them to make healthy food choices. Most adolescents are interested in exercise and with access to a gym or someone to exercise with, they would exercise more often. Study participants feel they learn best by listening to information given to them and most of their education about nutrition comes from medical offices, clinics and school. Finally, most adolescents responded that their mothers do most of the grocery shopping and meal preparation. Most respondents participated in WIC/food stamp programs. Conclusions & Implications: Pregnant adolescents are interested in healthy eating to have healthy babies. Nurses in offices, clinics and schools are ideally positioned to provide prenatal nutrition education; families should be included in the education. Education should focus on increasing dairy products and interpreting nutrition labels. More research is needed on prenatal adolescent nutritional habits. Page 330
BS/MS Poster Session Clinical Trajectories in Mild Cognitive Impairment Margaret E Wetzel, BS(c), Yale University School of Nursing, New Haven, CT Sheila L Molony, PhD, RN, GNP‐BC, Yale University School of Nursing, New Haven, CT Purpose: The purpose of the study is to examine functional, cognitive and behavioral trajectories of community‐dwelling older adults with mild cognitive impairment (MCI) and to describe the relationship between MCI and neuropsychiatric symptoms (NS) over time. Theoretical Framework: MCI is a decline in cognition that does not meet the criteria for dementia. Up to 17% of adults over age 60 have a diagnosis of MCI, and this prevalence increases with age. MCI has been associated with an increased risk of morbidity and mortality, nursing home placement and impairment in daily function, as well as behavioral changes which can exacerbate caregiver burden. Mishel’s Uncertainty in Illness Theory supports the need for evidence‐based knowledge of illness trajectories to enhance patient/family coping. Methods: We performed a secondary analysis of longitudinal data from the University of California, San Francisco, Alzheimer’s Disease Research Center. We examined data from 360 adults over age 55 with MCI, and 71 cognitively healthy controls (NC) at baseline to determine the prevalence of NS as measured by the Neuropsychiatric Inventory. A Chi square test was used to identify significant between‐
group differences. The 403 individuals with complete one‐year follow‐up data were also included in a longitudinal analysis using ANCOVA to determine whether participants with NS have significant differences in cognition over time. Descriptive statistics and time‐series graphs will illustrate cognitive, functional, and behavioral trajectories. Results: Persons with MCI had significantly more neuropsychiatric symptoms at baseline than NC (χ2=54.4135; p< .0001). Analysis of longitudinal data is in progress. Conclusions: Individuals with MCI are more likely to exhibit NS than normal controls. This emphasizes the importance of screening for cognitive decline in the clinical setting to inform interventions that may decrease caregiver burden, patient distress, and healthcare outcomes. Longitudinal findings will inform clinical practice and the design of future prospective research studies. Page 331
BS/MS Poster Session Providing Self‐Management Support through Goal Setting and Action Plans Carol L Hodges, BSN, RN, The University of Vermont, St. Johnsbury, VT Purpose: The purpose of the study is to identify behaviors of healthcare providers and their staff in providing self‐management support for all patients with the chronic disease diagnoses of hypertension, diabetes and asthma. The self‐reported behaviors of healthcare providers and their staff in providing self‐management support will define strengths as well as gaps in resources, services and supports. The data will identify potential strategies and interventions to standardize healthcare practice while providing individualized patient care and assist in finding methods to decrease healthcare expenditures. Theoretical Framework: The tenets of the Chronic Care Model, patient centered care, proactive collaborative planning and problem solving with follow‐up support provide the framework for this study. Key components of Pender’s Health Promotion Model are also incorporated into the design. Method: This is a descriptive study based upon data obtained from a convenience sample of 68 respondents in 11 primary care practices throughout Vermont. The respondents completed the Assessment of Primary Care Resources and Supports for Chronic Disease Self Management survey developed by the Advancing Diabetes Self Management Program of The Robert Wood Johnson Foundation Diabetes Initiative. Two additional questions asking specifically about determination of long‐
term goals and identification of specific action plans were added to the survey. Data analysis will be completed using EXCEL® and descriptive statistics will be run to describe the data. Results: Pending completion January 1, 2010. Conclusions and Implications: Chronic disease accounts for the majority of healthcare dollars; it is also the largest, fastest growing and the most expensive aspect of healthcare services. Patients with chronic conditions are more likely to be successful in self‐management of their health status if there is a participatory relationship with their healthcare provider. Patient centered/patient directed action plans increase the likelihood of adherence by patients and improve patient outcomes by assisting them in accomplishing their long‐term goal. Identification of successful strategies will help the advanced nurse practitioner who is committed to utilizing innovative and effective health promotion and prevention strategies which would lead to patients incorporating behavioral changes to improve their health status. Page 332
BS/MS Poster Session Nurse Competency in End‐of‐Life Care Mohini Yalanis, BS, University of Rhode Island, Kingston, RI ~ Marlene Dufault, PhD, University of Rhode Island, Kingston, RI ~ Jeanne Ehmann , MS, RN, CPHQ, Newport Hospital, Newport, RI Purpose/ Significance: As the aging trend of the US population accelerates, providing high quality care to dying patients in the Intensive Care Unit (ICU) will become an ever‐increasing priority. Nurses who care for severely ill patients are often confronted with the challenging goal of ensuring a “good death”. The purpose of this study was to develop and test an instrument to measure self‐perceived nurse competency in caring for patients in the ICU at the end of life. A positive correlation was hypothesized between years of nursing experience and levels of expertise. The ultimate goal of the study is to evaluate the effectiveness of the hospital’s new palliative care program. Theoretical Framework: Benner’s “Novice to Expert” theory was the framework for determining the levels of proficiency in constructing the questionnaire. Ten measures of palliative care quality and a consensus statement by the American Academy of Critical Care Medicine formed the basis of the questionnaire. Methods: Twenty‐eight ICU nurses from a 129‐bed Magnet‐designated community hospital completed the 15‐item questionnaire to rate their level of proficiency on a 5‐point Likert scale. The scale was supplemented with a checklist and open‐ended questions. Content validity was established for each item by a panel of eight nursing experts in palliative care and thanatology (< .05) . Reliability using split‐
half measures is being used to determine internal consistency. Linear correlation using Pearson r determined the relationship between each item and years of nursing experience. Findings/Conclusions: The majority of nurses (most with > 10 years critical care experience) rated their care at a competent level. Results supported the hypothesis of a positive correlation between years of experience and perceived competency level in providing end‐of‐life care. Implications: The results will provide direction to the hospital’s Palliative Care Advisory Team for the development of an evidence based multidisciplinary educational program for promoting excellence in end‐of‐life care throughout the hospital. Page 333
BS/MS Poster Session Effectiveness and Efficacy of Surgical Facemasks versus N‐95 Fit‐tested Masks in Preventing the Spread of N1H1 Flu Viruses in Bedside Nurses Tracie Crisafulli, BS Student, University of Rhode Island, Kingston, RI ~ Barbara Davis, BS Student, University of Rhode Island, Kingston, RI ~ Chinmay Deshpande, BS, MS Pharmacy Student, University of Rhode Island, Kingston, RI ~ Robin Devin, PhD, University of Rhode Island, Kingston, RI ~ Kayla Diamond, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Marlene Dufault, PhD, RN, University of Rhode Island, Kingston, RI ~ Gail Jackson, BS, RN, University of Rhode Island, Kingston, RI ~ Mary Key, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Aran Kuhn, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Christina Maroun, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Amy Mello, BS Nursing Student, University of RI, Kingston, RI ~ Laura Mello, BS Nursing Student, URI, Kingston, RI ~ Marissa Mello, BS Nursing Student, URI, Kingston, RI ~ Caleigh Orzel, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Natalie Rebelo, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Kristina Stabb, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Krysten Webber, BS Nursing Student, University of Rhode Island, Kingston, RI ~ Cynthia Willey, PhD, University of Rhode Island, Kingston, RI Purpose: The effectiveness of respiratory protective devices in the face of the N1H1 pandemic influenza combined with a lack of availability of the filtering facepiece respirators and strain on mask users prompted questions about the effectiveness of surgical face masks versus the N95 filtering mask. The purpose of this evidence summary review was to assist policy makers in making informed decisions for standards of practice and feasibility regarding mask type in large‐scale outbreaks of respiratory pathogens such as N1H1. Theoretical Framework: Roger’s "adoption of innovations" theory and Dufault’s Collaborative Research Utilization Model were used to assist in evidence‐based decision‐making on the use of surgical masks versus N‐95 fit‐tested masks to prevent the spread of N1H1. Methods: A three‐stage systematic review was conducted. First, baccalaureate nursing students were guided by faculty, clinicians, and reference librarians to search, review, critique and translate evidence mask effectiveness. The search strategy (1984‐2009) included qualitative and quantitative studies, clinical practice guidelines, article reference lists, and “grey literature,” including editorials. Databases were the Cochrane Database of Systematic Reviews, PubMed, and CINAHL. Twenty‐nine articles met inclusion criteria; 14 were critiqued in depth. An evidence summary table was constructed to illustrate the strength of evidence (Lo‐Biono‐Wood & Haber). Second, graduate students provided feedback in a poster session. Third, a hospital‐wide research roundtable was convened with nursing students, staff nurses, Director of Infection Control, and the Director of Performance Evaluation and Improvement. The scientific merit, clinical applicability, usefulness, feasibility, and potential for translation into best practices and policies were discussed. Results: Most studies were graded at levels 4‐7 strength‐of‐evidence. Evidence was inconclusive on the feasibility, efficacy or effectiveness of surgical masks versus N‐95 respirator masks. Patient and provider use of masks and other personal protective equipment in the hospital environment early in an epidemic is inconclusive. Conclusions/Implications: More conclusive scientific evidence to support policy on the use of face masks is needed, including large‐scale RCT’s, meta‐analyses, & observational studies. This presents policy recommendation challenges as currently we rely heavily on expert judgment in the absence of a definitive empirical base. Page 334
BS/MS Poster Session Dietary Supplement Use among Persons with Osteoporosis Katherine H. Taylor, RN, University of Connecticut, Granby, CT Stephen J. Walsh, ScD, University of Connecticut, Storrs, CT Purpose: To describe variation in the frequency of dietary supplement use among persons with osteoporosis. Background/Framework: Persons diagnosed with osteoporosis are more likely to consume dietary supplements than those without the disease. However, published studies have not fully evaluated sources of variability in supplement use within this clinical population. Data from an existing, cross‐
sectional, national survey provide an opportunity to assess such variation. Methods: Adult respondents (> 20 yrs.) were drawn from four biennial cycles (1999‐2006) of the National Health and Nutrition Examination Survey. Osteoporosis status and supplement use were determined by self‐report in the survey’s household interview. Contingency table analyses and logistic regression modeling were applied to study data and accounted for the survey’s use of stratified, clustered sampling. Results: Among 20,311 survey respondents, 1137 reported a diagnosis of osteoporosis. In these individuals, 75.2 ± 1.3% reported using dietary supplements. Supplement use was less frequent in younger persons (< 50 yrs.) with osteoporosis than in older persons (48.0 ± 4.9% vs. 80.1 ± 1.0%, respectively) and was lower among men than women (56.5 ± 4.1% vs. 78.3 ± 1.5%). It was also less common among Non‐Hispanic Blacks with osteoporosis (55.5 ± 4.9%) than among Non‐Hispanic Whites (76.7 ± 1.6%) or Mexican‐Americans (70.8 ± 5.3%). A multivariate model simultaneously included the age, gender, and ethnicity factors. It yielded an odds ratio of 0.3 (CI: [0.2, 0.4], p < 0.001) for supplement use in younger versus older persons and of 0.4 (CI: [0.3, 0.7], p = 0.001) for supplement use in men versus women. In comparing the frequency of supplement use in Non‐Hispanic Blacks to that in Non‐
Hispanic Whites and Mexican‐Americans, the odds ratios were 0.4 (CI: [0.3, 0.7], p < 0.001) and 0.6 (CI: [0.3, 1.1], p = 0.11). Conclusions & Implications: Increased calcium consumption via dietary supplements is a routine clinical recommendation for persons with osteoporosis. Despite this, large percentages of younger persons, men, and Non‐Hispanic Blacks with the disease report taking no dietary supplements. Effective management of osteoporosis necessitates identifying barriers to supplement use, especially of calcium‐
containing supplements, within these groups. Page 335
BS/MS Poster Session Scholarly Literacy Enhancement: A Student Centered Learning Approach Implemented by a Journal Club Theresa Criscitelli, BSN, RN, CNOR, Adelphi University, Floral Park, NY Monique Thorne, BSN, RN ‐BC, Adelphi University, Northport, NY Scholarly literacy refers to the ability to read and write as a learned person. A deficiency in undergraduate and graduate students, as well as hospital‐based nurses has been well‐documented in the nursing and higher education literature. This adversely affects professional reading, writing and communicating in a scholarly style, in which the impact is significant. The authors developed and implemented a student‐centered learning approach to enhance participants’ ability to be more effective consumers of scholarly material, to promote critical thinking skills, and to encourage mentorship related to these goals. The intervention involved didactic and experiential components by establishing a professional journal club, which is a forum to enhance the process of reading, understanding, discussing, synthesizing, and writing professional articles of interest. By directly linking research to practice, the journal club helps promote evidence‐based clinical initiatives. Article selection, journal club facilitation, peer mentoring, and the evaluation process are intricate components for success. The undergraduate nurses were on site in a campus setting, and the hospital based nurses participated in a hybrid on site/web based program. Learners’ responses in both settings indicated a better understanding of the literature discussed, improved critical appraisal skills, and increased application to practice. Limitations were found in the undergraduate’s lack of experience and contextual ability. Peer mentoring and trans‐
disciplinary aspects provided co‐facilitators with increased knowledge, resources, and affective support. Page 336
BS/MS Poster Session Community Survey of Kigumo Kenya: Resources for Health and Risk for Developing Cardiovascular/Metabolic Diseases Sandra L Jones, Undergraduate, University of Massachusetts‐Boston, Boson, MA ~ Jennifer Harrison, Undergraduate, University of Massachusetts‐Boston, Boston, MA ~ Mercy Kamau, RN, BSN, University of Massachusetts‐Boston, Boston, MA ~ Natalie King, Undergraduate, University of Massachusetts‐Boston, Boston, MA ~ Brenda Manso, Undergraduate, University of Massachusetts‐
Boston, Boston, MA ~ Erica Miranda, Undergraduate, University of Massachusetts‐Boston, Boston, MA ~ Eileen Stuart‐Shor, PhD, APRN, University of Massachusetts‐Boston, Boston, MA Significance: The prevalence of cardiovascular (CV) and metabolic diseases are increasing in sub‐Saharan Africa and new initiatives are needed to address this emerging crisis. Understanding the Social Determinants of Health; “the conditions in which people are born, grow, live, work and age, including the health system”(WHO) is critical to effective solutions. This framework suggests that the distribution of resources at the community level influences the ability of individuals and the community to stay healthy and prevent illness. Purpose: This community survey was designed to assess resources for health and risk for developing CV/metabolic disease in one Kenyan community where CV/metabolic risk factors are prevalent. Methods: Using principles of community‐based participatory research we used a semi‐structured interview guide to interview stakeholders and households and assess the local food market, school and clinic. Questions included: key characteristics of the population, perceived health status and needs of the people, local factors affecting the health of the community and services currently being provided. Each student team (n=8) recorded their findings and the data were examined for problem frequency/intensity. Results: The community was primarily black, Kikuyu, rural/farming, poor (mean income <$1/day), < metabolic treating preventing on education community medications, food supportive policies promotion prevention, focus in shift a require will program reduction risk disease effective an Creating implications problems. significant be these perceive do they community, the factors prevalence Despite network. physically being for resources Positive food. healthy prevention promoting few has The Conclusions> Page 337
BS/MS Poster Session The Accuracy of Arrhythmia Interpretation by Nurses Working on Cardiac Units Sheli L Feder, RN, BSN, MSN (c), Yale University, New Haven, CT ~ Barbara Drew, RN, PhD, FAAN, University of California, San Francisco, San Francisco, CA ~ Kristopher L Fennie, PhD , Yale University, New Haven, CT ~ Marjorie L Funk, PhD, RN, FAHA, FAAN, Yale University, New Haven, CT ~ Jeanine L May, MSN, APRN, Yale University, New Haven, CT ~ Kimberly L Stephens, MPH, RN, Yale University, New Haven, CT ~ Catherine L Winkler, PhD, RN, Yale University, New Haven, CT Purpose: To determine how accurate nurses were in arrhythmia detection and identify which arrhythmias most often are misinterpreted; and 2) To compare accuracy of arrhythmia detection across different hospital units. Theoretical Framework: Knowledge Transfer Theory by Lavis et al. (2003) which provides five determinants that guide planners in the transfer of knowledge to recipients. Methods: This study used baseline data from the Practical Use of the Latest Standards of Electrocardiograph (PULSE) Trial, a 5‐year multi‐site randomized clinical trial addressing ECG monitoring in hospitals. Data were collected from 1,739 nurses and 1,821 patients. Nurses completed a 20‐item online ECG monitoring knowledge test that included 6 items related to arrhythmias. Three research nurses gathered patient data over a 5‐day period at each of 17 hospitals. They compared arrhythmias stored in the monitor’s memory with documentation by unit nurses. Results: The mean score of the pretest it it’s entirety was 48.1% and mean score of arrhythmia questions was 47.5%. There was no difference in the means by unit type. The most commonly occurring arrhythmia documented by research nurses was non‐sustained ventricular tachycardia. Nurses identified this arrhythmia correctly and documented in the chart 50.89% of the time. Asymptomatic Ventricular Tachycardia was misidentified most frequently. Nurses identified this rhythm correctly 33% of the time. Out of 294 arrhythmias noted by the research nurses, documentation was not found in the chart 32% of the time. Conclusion and Implications: Nurses performed poorly on both the pretest and in patient arrhythmia identification. A lack of arrhythmia documentation in patient charts was also found. The study elucidates the need for improving nursing education in the realm of arrhythmia interpretation in acute care settings. Page 338
BS/MS Poster Session Implementing A Technology‐Based Asthma Education Program to Evaluate Students’ Ability for Independent Medication Administration Colleen E Foley, MS Graduate Student, Molloy College, Garden City, NY This study is designed with an Asthma Education Program (AEP) utilizing SMART board technology. Children spend many hours in school, and with the difficulty of obtaining parental participation, the issue of children being able to assess their own health status and make decisions, specifically regarding self‐medication administration is investigated. Successful completion of the technology‐based AEP increased young children’s (9‐12 years old) ability to master self‐management skills for their condition. The program was implemented at three elementary schools. A total of 22 students participated in this program. Presentations and interactive post tests incorporating SMART Board and Senteo technology were utilized. Retention of information was rated throughout the study. Children’s Health Survey for Asthma (CHSA‐C) was utilized to assess the children’s ability to accurately report their condition status. The data indicates that this did in fact increase the child’s ability to understand and manage his/her care. Initial testing indicated 58% of the students had felt confident as an independent reporter of their condition. By the end of the program the number of students that felt capable of both reporting their condition and managing their medication reached 98%. The study demonstrates that young children can be taught to be effective managers of their medication and those young children can be accurate reporters of their asthma condition. An AEP is necessary to support a child becoming an independent user of asthma medication. The study demonstrates a school can be an effective setting for this type of program. Page 339
BS/MS Poster Session Production/Production Capability of the Clinical Research Nurse Liza L Behrens, RN, BS, BSN, CCRC, Geisinger Health System, Wilkes‐Barre, PA ~ Valerie Harkins, RN,BSN, CCRC, Geisinger Health System, Danville, PA ~ Debra Henninger, RN, BSN, CCRC, Geisinger Health System, Danville, PA ~ Adele Spegman, RN, PhD, Geisinger Health System, Danville, PA The clinical research nurse (CRN) role is an emerging specialty within nursing. The role supports all types of clinical research in academic and non‐academic settings, including outcome studies, clinical trials, and industry‐sponsored drug and device trials. The expertise of the CRN and the flexibility of this role make the CRN’s participation in any type of clinical research highly valuable. Many factors affect the CRN’s job performance in the current clinical practice setting. Global attention to efficiency in research highlights the need to examine influences on clinical and administrative productivity. Franklin Covey’s (2004) principle of production/production capability balance illustrates the multiple – and at times competing – demands of clinical and administrative responsibilities in a complex research environment. This model assists in the conceptualization the prerequisite requirements for sound research methods, consistent quality outcomes, and human subject protection. We use this concept to explore the influences on CRN role in any research setting to generate potential explanations for role challenges. Quality data collected in an ethical, efficient, and safe manner is a quantifiable product of the CRN role. Time and expertise, as production capabilities, directly affect the performance of clinical and administrative tasks. Furthermore, workplace relationships and resources significantly influence productivity and capability. For a CRN to balance clinical and administrative tasks, there must be a corresponding balance between time and expertise. Additionally, cultural variables within and external to the research environment impact the effectiveness with which the CRN can balance clinical and administrative tasks in relation to time and expertise. This poster presents a conceptual model of CRN production/production capability balance. We examine each component of the model along with the consequences of unbalanced relationships between task responsibilities, expertise, and time. Covey, S.R. (2004) The Seven Habits of Highly Effective People: Powerful Lessons in Personal Change. New York, NY: Free Press. Page 340
BS/MS Poster Session Let's Talk About Kidney's Coleen E. Smart, RN, BSN(c), University of Hartford, Plantsville, CT Context: Several people die everyday somewhere in the United States while waiting for a matching kidney to be donated. The number of deaths is expected to increase if this current trend continues. Registered nurses (RN's) who work on an inpatient kidney transplant unit have developed their own program to increase the number of living kidney donations through awareness. Program Design: The RN's create an opportunity to share information at health fairs by distributing "let's talk about kidney's" bracelets. Information is disseminated from the nurses and from living donors who tell their story. Written information is written in a bilingual format. The RN's also visit clients during dialysis treatment to discuss all possible donor options. Education is shared with family and friends of potential kidney recipients. Outcomes: It is hoped that through increased awareness and proper education about living donation of kidneys that more kidneys will be donated. There is an assumption that through increased awareness persons in the community will become kidney donors. With increased donation there will be less loss of life from End Stage Renal Disease (ESRD). Conclusions: RN's can independently provide an important service to the community of patients with ESRD. The coordination of conversation with potential kidney donors and living kidney donors who share their story can increase live kidney donation. Education for potential recipients and exploration of options for potential donors and recipients may expedite the number of donations and save lives. Implications: Many potential donors are thought to exist and can provide a life saving kidney donation without changing their own quality of life. It is assumed that if the public could be educated about this by RN's that many more people could receive a kidney from a family member or friend. Page 341
BS/MS Poster Session Living Well With Diabetes Joanie Cover, RN, MSN(c), University of Hartford, Winchester, CT Context: In Hartford, Connecticut, 90% of the seniors who frequent a senior center have been diagnosed with Type II diabetes. Nursing interventions to keep glycemic levels under control were needed in this population. Graduate level Registered Nurse (RN) students who provided care for two semesters in a community/public health service learning setting with these seniors creatively provided such interventions. Program Design: The RNs developed a program of education about maintaining health and wellness for senior citizens diagnosed with diabetes. The education included posters, presentations, pamphlets, demonstrations and return demonstration of skills. Further to the formal education, the seniors were involved in helping the RN's create a cookbook with the senior's own recipes. The RN's added "healthful" tips for cooking and eating. Outcomes: The seniors enthusiastically participated and disseminated the written information and cookbooks to friends and family. There were active discussion groups within the population. The seniors self‐reported positive changes in behavior, such as diet and exercise that would aid in keeping glycemic levels under control. Conclusions: Service learning with RN graduate students and senior citizens is beneficial to all those involved. The RN graduate students learned adult education theory while the seniors benefited from the education and primary health care interventions. Implications: Education about how to maintain control over glycemic levels for senior citizens can be learned in groups in the community in a service learning setting. Page 342
BS/MS Poster Session A Study of the Use of the American Academy of Pediatrics Guidelines for Screening and Treatment of High Cholesterol by Nurse Practitioners Katherine Shaw, BS, RN, New York University, New York, NY ~ Rebecca Goldstein, BS, RN, New York University, New York, NY ~ Lori Kraljevic, BS, RN, New York University, New York, NY ~ Erin Lange, BS, RN, New York University, New York, NY ~ Grace Ning, BS, RN, New York University, New York, NY ~ Maria Paini, BS, RN, New York University, New York, NY Purpose: The purpose of this investigation is to determine if the American Academy of Pediatric guidelines for screening and treatment of high cholesterol in at risk children and adolescents are being implemented by Nurse Practitioners in pediatric clinical practice settings. Hypercholesterolemia is a major health problem emerging in the pediatric population. It is believed that failure to implement strategies in this population has the potential to increase the number of adults experiencing cardiac disease early in life. The literature shows that there are numerous barriers for the implementation of clinical practice guidelines. Theoretical Framework: The evidence‐based model (Melynk & Fineout‐
Overholt, 2005) for NP practice was used to implement this study. NPs must place value on using the best available evidence for clinical decision making to provide optimal health care. Critical appraisal of practice guidelines using the Agree Tool is the first step for implementing a practice guideline. Methods: This is a quasi experimental study design. NPs who work in pediatric outpatient settings will receive an anonymous survey in which they are asked questions on the use of the American Academy of Pediatrics Committee on Nutrition practice guideline for cholesterol screening. Data obtained from the survey will be analyzed using descriptive statistics. Results: The study results will report on the current practices of NPs and their use of the American Academy of Pediatrics Committee on Nutrition practice guideline for cholesterol screening. Conclusions: The use of best practice guidelines for clinical decision making is now considered the standard of practice. However, the number of practitioners who use the guidelines remains small. Recommendations for improving the use of practice guidelines by NPs will be presented. Page 343
BS/MS Poster Session Promoting Minority Recruitment, Retention, and Diversity in Scholarship: A Journey into the Bridges to the Doctorate Experience at the University of Pennsylvania Monica Harmon, RN, MSN, MPH, University of Pennsylvania, Philadelphia, PA Carla Clements, RN, MSN, CRNP, University of Pennsylvania, Philadelphia, PA Purpose: 1.To describe lived experiences of Bridges to the Doctorate program participants. 2. To identify the merits of Bridges to the Doctorate programs in recruiting and retaining minority nurse scholars. Background: The nursing shortage continues to be a growing problem seen around the world. Doctorally prepared nurses are critical in addressing the nursing workforce and faculty shortages. Recent reports cite that other concurrent factors such as an aging nursing workforce, inability to retain nurses, an increasing demand for nurses, and an increasingly ethnically diverse population greatly widens the gap between recruitment and retention of diverse individuals into the nursing profession. In spite of concerted efforts by nursing programs to recruit other groups, according to the American Association of Colleges of Nursing in 2007 and 2008, only 21.0% and 22.32% respectively of the students enrolled in research funded doctoral programs were minority. Bridges to the Doctorate programs were developed to assist students from underrepresented groups in biomedical and behavioral research transition from their master’s level education into PhD programs. Assistance comes in the form of tuition, stipend, and socialization into the researcher role through research mentor/student participant dyads. Approach: Minority Student participants were recruited to participant in this NIH funded program. After the first general session, eight students agreed to participate in the third cohort of Bridges to the Doctorate program. This poster outlines the journey of the eight students, discusses their experiences, identifies outcomes and gives recommendations for future programs. Major Points & Rationale: 1.The nursing shortage continues to be a growing problem seen around the world. 2.A diversified nursing workforce is critical when addressing healthcare inequities. 3.Bridges to the Doctorate program assists students from underrepresented groups to transition from their master’s level education into PhD programs. 4.This poster outlines the lived experiences of a cohort of Bridges to the Doctorate program students in a university setting. Conclusion: The inclusion of Bridges to the Doctorate programs is a viable means of recruiting, retaining, and diversifying nursing scholarship. Attracting minorities to the nursing profession can alleviate the nursing workforce and faculty shortages; diversify nursing education, research and scholarship; decrease health disparities and barriers for health of the public. Page 344
2010 Award Winners Page 345
Conference Planning Committee Thank you to the 2010 Conference Planning Committee for their contributions to the success of these sessions. 2010 Conference Planning Committee Conference Chair & ENRS President Elect Nancy S. Redeker, PhD, RN, FAHA, FAAN Professor & Associate Dean for Scholarly Affairs Yale University School of Nursing Angela Creta, MS, RN, CNL, BC Magnet Coordinator, The Miriam Hospital Karen T. D’Alonzo PhD, RN, APNC Assistant Professor, College of Nursing Rutgers, The State University of New Jersey Laura L. Hayman, PhD, RN, FAAN Associate Dean for Research, Professor of Nursing College of Nursing and Health Sciences University of Massachusetts‐Boston Rita A. Jablonski, PhD, CRNP Assistant Professor, The Pennsylvania State University Harriet J. Kitzman, PhD, RN, FAAN Professor, University of Rochester Arlene Smaldone, DNSc, CPNP, CDE Assistant Professor of Nursing Columbia University School of Nursing Mary C. Sullivan, PhD, RN Professor, University of Rhode Island Connie M. Ulrich, PhD, RN, FAAN Associate Professor of Bioethics & Nursing University of Pennsylvania School of Nursing 2010 Abstract Review Committee JiYoung An Roseann Barrett Mary Benham‐Hutchins Carol Bova Betty Braxter Linda Caley Suzanne Campbell Diane Carroll Eileen Chasens Kimberly Christopher Jean Connor Joanne Dalton Victoria Dickson Patricia Dunphy Suplee Carol Elliott Elizabeth Ercolano Ginette Ferszt Kimerbly Glassman Debra Hanna Mary Jane Hanson Thomas Hardie Janice Hinkle Margaret Kearney Joseph Libonati Pamela Mahon Bette Mariani Magdalena Mateo Lea Ann Matura Robin Miller Susan Miovech Leslie Neil‐Boylan Diane Newman Patricia O’Brien‐Barry Elaine Parker Carolee Polek Carol Polifroni Karen Pounds Gail Russell Elizabeth Schlenk Dena Schulman‐Green Kristen Sethares Nancy Sharts‐Hopko Mary Lou Siefert Suzanne Smeltzer Mary Smith Susan Sullivan‐Bolyai Jean Swinney Jane Tang Allison Vorderstrasse Roberta Waite Jane White Page 346
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