Browsing by Subject "Nursing"

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    Characterization of the peripheral artery disease symptom experience
    (2013-08) Schorr, Erica Nicole
    Background: Claudication is the most commonly recognized symptom of PAD. It is classically described as an aching, cramping, painful, or tired feeling in the buttock or leg muscles. However, classic claudication is only reported in 7.5% to 33% of patients with PAD. Symptoms beyond classic claudication have been reported and suspected as being part of the symptom experience, but have not been validated as directly relating to changes in calf tissue oxygenation during exercise and subsequent recovery. Objective: The purpose of this study was to characterize the symptom experience of individuals diagnosed with PAD. Specific aims were to: (a) understand the symptom experience of individuals with PAD through in-depth qualitative interviews, and (b) simultaneously evaluate calf tissue oxygenation and self-reported symptoms experienced during treadmill exercise and throughout recovery. Method: Adults experiencing lower extremity symptoms during exercise due to underlying PAD were asked to participate. They were asked to: (a) complete a semi-structured interview to report their symptoms and describe their symptom experience in detail; (b) use a numeric rating scale (NRS) (0 to 5) to rate their symptoms during exercise and recovery; (c) provide descriptions of their symptom(s) during exercise and recovery; and (d) wear a near-infrared spectroscopy device to obtain information on tissue oxygenation during the exercise and recovery phases. Data were analyzed using content analysis, exploration of individual graphical trajectories, grouping trajectories, and multilevel modeling to examine the relationship between self-reported symptoms and calf tissue oxygenation. Results: A total of 40 participants were enrolled in this study. Participants were predominately Caucasian males. The average age of participants was 67.55 years (SD 9.18). Six themes emerged from 27 participant interviews: symptom descriptors, maintaining equilibrium, temporal fluctuations, the role of exercise, the perceived impact on QOL, and disease presence and treatment. During interviews, participants provided 24 symptom descriptors in 10 lower extremity locations. During treadmill exercise, participants provided 22 symptom descriptors in eight lower extremity locations. Under static and dynamic conditions, classic and `atypical' descriptors were used to describe discomfort in typical and `atypical' lower extremity locations. During three successive bouts of treadmill exercise, the largest drop in calf tissue oxygenation occurred between the start of exercise and the onset of symptom(s). During recovery, calf tissue re-saturation occurred steadily between maximum discomfort (i.e., a rating of 5 out of 5) and full symptom recovery. Individual changes in tissue oxygenation were related to total exercise time, baseline calf tissue oxygenation, exercise and recovery ratings, disease severity, and body-mass index. Conclusions: This study provides a preliminary understanding of the relationship between subjective symptom reporting and calf tissue oxygenation with a variety of PAD risk factors and individual characteristics. Continued research is necessary to validate `atypical' participant symptom reporting and broaden the currently accepted PAD symptom locations and descriptors. Despite the under-reporting of `atypical' symptoms compared to classic claudication, they do exist and they are no less important for the early detection, diagnosis, and treatment of PAD to minimize the impact of this painful, debilitating, and deadly disease.
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    Cultivating Student-Staff Connections in Middle School: An Integrative Theory of Creating Space as a Holistic Approach to Promoting Adolescent Health and Wellbeing
    (2019-01) Fredkove, Windy
    Connection with a caring adult in the school setting contributes to healthy youth development, yet little is known about the nuanced patterns and processes leading to student-staff connectedness (SSC). The purpose of this constructivist grounded theory study was to explore the process through which school staff members connect with students in middle school settings and identify the factors influencing that process. Data was collected and analyzed over a nearly two-year period using semi-structured interviews and observations with 24 staff members in varying roles from two middle schools situated within a large, metropolitan school district in the Midwest. Line-by-line, focused and theoretically-sensitive axial coding, constant comparison, theoretical sampling, extensive memoing and reflexive journaling were used to analyze data. The integrative theory of Creating Space is the core, overarching process within which the SSC process takes place. Creating Space and the SSC process describe what staff members do. The how is characterized by (a) the higher-level awareness process of seeing within, beyond and between; (b) two translational processes described as embracing our shared humanness, and equilibrating with empathy; and (c) a praxis-level process of demonstrating relational artistry. The multi-dimensional space that is created by school staff members offers numerous potential connection-catalysts that may spark a students-staff connection. Nurses, teachers and other allied staff working with adolescents in schools have an opportunity to encourage healthy youth development, promote human thriving, and contribute to equity and social justice by Creating Space within which meaningful connections can flourish.
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    Developing a Predictive Model for Hospital-Acquired Catheter-Associated Urinary Tract Infections Using Electronic Health Records and Nurse Staffing Data
    (2016-08) Park, Jung In
    There are a number of clinical guidelines and studies about hospital-acquired catheter-associated urinary tract infections (CAUTIs), but the rate of CAUTI occurrence is still rising. Hospitals are focusing on preventing hospital-acquired CAUTI, as the Centers for Medicare and Medicaid Services (CMS) does not provide payment for hospital-acquired infections anymore. There is a need to explore additional factors associated with hospital-acquired CAUTI and develop a predictive model to detect patients at high risk. This study developed a predictive model for hospital-acquired CAUTIs using electronic health records (EHRs) and nurse staffing data from multiple data sources. Research using large amounts of data could provide additional knowledge about hospital-acquired CAUTI. The first aim of the study was to create a quality, de-identified dataset combining multiple data sources for machine learning tasks. To address the first aim of the study, three datasets were combined into a single dataset. After integrating the datasets, data were cleaned and prepared for analysis. The second aim of the study was to develop and evaluate predictive models to find the best predictive model for hospital-acquired CAUTI. For the second aim of the study, three predictive models were created using the following data mining method: decision trees (DT), logistic regression (LR), and support vector machine (SVM). The models were evaluated and DT model was determined as the best predictive model for hospital-acquired CAUTI. The findings from this study have presented factors associated with hospital-acquired CAUTI. The study results demonstrated that female gender, old adult (≥56), Charlson comorbidity index score ≥ 3, longer length of stay, glucose lab result > 200 mg/dl, present of rationale for continued use of catheter, higher percent of direct care RNs with associate’s degree in nursing, less total nursing hours per patient day, and lower percent of direct care RNs with specialty nursing certification was related to CAUTI occurrence. Implications for future research include the use of different analytic software to investigate detailed results for LR model, adding more factors associated with CAUTI in modeling, using a larger sample with more patients with CAUTI, and patient outcomes research using nursing-sensitive indicators. This study has important implications for nursing practice. According to the study results, nurse specialty certification, nurse’s education at the baccalaureate level or higher, and more nursing hours per patient day were associated with better patient outcomes. Therefore, considerable efforts are needed to promote possession of nurse specialty certification and higher level of nursing education, as well as enough supply of nursing workforce.
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    Discovering Hidden Patterns in Anesthesia Data Associated with Unanticipated Intensive Care Unit Admissions
    (2017-04) Peterson, Jessica
    Unanticipated intensive care unit admissions (UIA) are a metric of quality anesthesia care since they have been associated with intraoperative incidents and nearly four times as likely to die within 30 days of surgery compared to patients that were not admitted to the intensive care unit unexpectedly. Patient age, American Society of Anesthesiology Classification, type of procedure, tachycardia, hypotension, and cardiovascular and neuromuscular blocking drugs administered in the operating room have all been associated with patient UIA. Intraoperative anesthesia data is generated in real-time and can be used to identify patterns in patient care associated with UIA. Knowledge about patterns in intraoperative medication administration and hemodynamic data is important to develop interventions that can be used to prevent intraoperative deterioration. Patterns were defined as two or more characteristics in the line graphs. This data visualization study discovered, labeled, and tested patterns in intraoperative hemodynamic management for association with patient UIA. Data from 68 adult, inpatient, elective surgical patients were matched to 34 patients with UIA in the University of Minnesota, Academic Health Center, Clinical Data Repository. A prototype line graph was evaluated to identify salient (obvious) patterns in intraoperative hemodynamic management for the data set. Line graphs for patients with and without UIA were created and visualized. Patterns in intraoperative hemodynamic management were discovered using data visualization with line graphs and operationally defined. Odds ratios were used to test categorical patterns and one-way analysis of variance was used to test continuous numeric patterns for association with patient UIA. Seven patterns were significantly associated with patient UIA (p < .05).
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    Effects of high-fidelity human patient simulation on self-efficacy, motivation and learning of first semester associate degree nursing students.
    (2009-06) Kuznar, Kathleen A.
    One of the newest methodologies in nursing education is high-fidelity human patient simulation (HPS). Many nursing educators have embraced the method as it offers a strategy to facilitate cognitive, affective, and psychomotor outcomes. Despite their popularity, however, HPS systems are costly and, in an era of cost containment and tuition increases, research must be employed to determine its effectiveness and guide its utilization. The purpose of this study is to determine how associate degree nursing students' self-efficacy, motivation, and learning in the simulated environment compare to nursing educational experiences without simulation. The mixed-method, quasi-experimental design was chosen for the study with a sample of first-semester associate degree nursing students at 2 technical colleges, 54 in the experimental group and 30 in the comparison group. Results indicated measures of self-efficacy and motivation increased throughout the semester for both groups. The simulation group had a statistically significant increase in general self-efficacy but no significant increase in nursing-specific academic and clinical self-efficacy. In contrast, the comparison groups had a significant increase in nursing academic self-efficacy but not in clinical or more general self-efficacy. Motivation measures were relatively consistent between the groups with only the measure of extrinsic motivation declining for the experimental group. When comparing the two groups on differences between pretest and posttest measures of self-efficacy and motivation, there were no significant differences. The experimental group scored significantly higher on the posttest knowledge examination. Results of interviews (n = 16) revealed specific themes, some unique to the simulation group and some common to members of both groups. The simulation students reported the importance of comprehensive skill practice, risk-free practice, group participation, and debriefing and instructor feedback. They were often able to identify a specific learning experience in the simulation lab that had impact on their practice. Technical skill knowledge was highly important for both groups. Students in both groups related the importance of a variety of courses in the first semester curriculum as increasing their nursing knowledge, self-efficacy and motivation. Simulation was found to be an acceptable learning strategy for novice associate degree nursing students.
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    Enablers and barriers to factors contributing to bone health among early adolescent Somali girls living in Minnesota.
    (2010-12) Benbenek, Mary Mescher
    Purpose: This descriptive qualitative study aimed to (a) gain a better understanding of the socio-cultural and environmental factors that shape lifestyle practices contributing to bone health including the dietary intake of foods high in calcium and vitamin D, sunlight exposure, and physical activity, and (b) to identify enablers and barriers to these lifestyle practices among early adolescent Somali girls who live in urban and more rural areas of Minnesota. Theoretical/Conceptual Framework: Urie Bronfenbrenner's socio-ecological theory informed the framework used to guide this study. This theory recognizes the complex relationships between the individuals and their numerous environments and considers the individual's development within and across different levels of these environments. This theory was chosen because it acknowledges the social, cultural, historical, and environmental influences on development and behaviors over time. Subjects: Four cohorts of 6 to 12 girls of Somali ethnicity, ages 11 -14 years, were recruited from two Minnesota communities, Minneapolis and Owatonna. Thirty-nine girls participated. Of the 39 participants, 26 participated in all 3 sessions; 10 participated in only 2 sessions, and 3 girls participated in the first session only. Methods: A series of three focus groups was conducted with each cohort of girls, a younger cohort and an older cohort from each community, to gather information about enablers and barriers related to diet, dress, activity, and sunlight exposure relative to bone health. The focus groups were conducted according to guidelines published by Krueger and Casey (2000). Results: Descriptive content analysis was utilized to summarize information derived from the within and across cohort analysis of the focus group data and to identify enablers and barriers to factors contributing to bone health. Cultural tradition, age/developmental stage, acculturation, and environment emerged as key concepts that shaped lifestyle practices and contributed to enablers and barriers to bone health among study participants. Conclusion: Cultural tradition, developmental stage, acculturation and environment emerged as major contributors to factors shaping, enabling, and acting as barriers to bone health among Somali girls, ages 11 to 14 years, living in Minnesota. These findings must be considered when designing and implementing bone health promotion strategies within these communities.
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    Entry Into Nursing And Academic Nursing: Career Trajectories Of Nursing Faculty Members
    (2013-11) Dickerson, Christopher
    The United States is in a long term shortage of nurses affecting all areas of the profession, including academic nursing. The shortage of faculty members in nursing restricts entry of new nurses thus continuing the shortage profession-wide. If the broader shortage is to be addressed, the shortage of academic nurses needs to be examined. As part of this research, an integrated model of career choice and progression was proposed based on a landscape where each career is a mountain within the range of careers. Choice of career is often restricted due to social norms, not unlike travel and vision in a mountain setting. Career progression often involves educational attainment that, when consolidated in degrees or licenses, establishes floors, like mountain plateaus, where further attainment is not required. Finally, bridges from those plateaus allow individuals to changes careers and return without loss of rights due to the consolidated educational attainment. This model was the theoretical guide in a descriptive phenomenological study examining initial career choice and progression to academic practice in professors of nursing. Interviews were conducted with ten nursing faculty members at a large, Midwestern university teaching in programs leading to initial nursing licensure. The interviews were digitally recorded and transcribed for content analysis during which themes emerged detailing the career trajectory. Four overarching themes emerged, three containing additional subthemes. The initial pursuit of nursing, theme number one, found participants were typically late deciders in pursuing a career in nursing and had loose initial ties to the profession. Redirection and transitioning to nursing, theme two, contained several sub-themes including those discussing the influence of the participant's teachers, dissatisfaction with early nursing roles, and transitioning to academia. Continuing in academia, theme three, included thoughts on interacting with students, the desire to continue learning, and maintaining a clinical role. Finally, financial considerations, theme four, brought discussions of income differentials between academic and clinical nurses with equal education, non-academic support, and the costs of the necessary degrees. Important aspects of the theoretical model found validation in the results and appropriate recommendations for academic policy changes are made based on the results.
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    Factors affecting treatment choice in HER2 positive metastatic breast cancer.
    (2009-03) Gallagher, Eva
    Women with HER2 positive breast cancer have decreased overall survival and may have a poorer response to treatment. Evidence suggests that disparities exist in treatment and outcomes in individuals with diverse racial and ethnic backgrounds, the elderly, individuals that are obese, hormone receptor positive, those with comorbid conditions, those treated in various regions of the country, and in different treatment settings. Trastuzumab (Herceptin®) is an anti-HER2 monoclonal antibody and was the first targeted therapy developed for the treatment of HER2 positive metastatic breast cancer. With its approval by the U.S. Federal Drug Administration in 1998, trastuzumab became the standard of care for treatment of HER2 positive MBC. This study examined differences in treatment, specifically trastuzumab use, and outcomes in these various groups treated for HER2 positive metastatic breast cancer. A conceptual framework guided by the fourth version of Andersen's health service utilization model was developed to better understand treatment patterns in these various groups. A prospective observational database called RegistHER was the source of the data. The first outcome evaluated was whether the frequency of use of optimal therapy (antibody) varied by group. Using logistic regression, this study showed no difference in use of optimal treatment in participants based on region of the country, race, obesity status or comorbid conditions. Differences in these groups might be seen given larger sample sizes. There were differences seen in individuals treated in different settings, the elderly, and those in that are ER/PR positive. Although women who are hormone receptor positive are eligible for treatment with hormones, consideration should be given to concurrent or sequential treatment with antibody therapy in those women that are HER2 positive. The second outcome evaluated was the time to start of treatment (in days). Logistic regression showed no variables were significant for this outcome indicating that race, age, obesity status, treatment setting, region of the country, hormone receptor status, the presence of cardiac disease and comorbid conditions did not affect time to start of treatment in this sample of patients from the RegistHER database. The third outcome evaluated was time to progression of disease. Using Cox regression, those who were ER/PR positive had a reduced risk of having progressive disease than their ER/PR negative counterparts. Not surprisingly, those with ER/PR positive disease did better than those that were ER/PR negative since those that have HR negative disease typically have a poorer prognosis than their HR positive counterparts. An unplanned sub-analysis showed that when you look at just those that are HR positive and compare those who got antibody to those that did not get antibody, both groups progressed at about the same rate. RegistHER, a registry with the largest cohort of HER2 positive MBC patients followed to date, is important because it provides a unique opportunity to characterize treatment patterns in this subset of individuals with breast cancer. In this evaluation of the database, important information regarding use of optimal treatment and time to progressive disease for women with HER2- positive breast cancer was described. Given the findings, this additional data may guide clinical decision-making for healthcare providers and their HER2 positive breast cancer patients and ultimately improve outcomes.
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    Factors associated with sleep wake disturbances in adult survivors of childhood brain tumors.
    (2010-02) Gapstur, Roxanna
    Sleep disturbances impact physical and mental health in brain tumor survivors, leading to sub-optimal participation in life activities. Technological advances in cancer treatments have improved five-year survival rates for childhood brain tumors to nearly 75%. With growing numbers of brain tumor survivors, mitigation of serious late sequelae from cancer treatments becomes increasingly important. This study evaluated factors associated with sleep quality in adult survivors of childhood brain tumors and a population-based comparison group. The Cancer-Related Factors Affecting Sleep model developed by Vena et al. (2004) provided a conceptual framework for this study. Participants were recruited from the University of Minnesota and St. Jude Children's Research Hospital clinical treatment databases. The comparison group was recruited from a national mailing database service. The first aim evaluated differences in global and component sleep quality between survivors and the comparison group. Using multiple variable linear regression and logistic regression, no differences in global sleep quality were detected between survivors and the comparison group. However, survivors were two and a half times more likely than the comparison group to have longer sleep latency, taking on average 33 minutes to fall asleep after going to bed. Females in both groups reported worse sleep quality, including more daytime dysfunction, and risk of poor sleep (PSQI global scores > 10). The second aim evaluated cancer treatment effects on sleep quality among brain tumor survivors. Tumor location and surgery were not significant predictors of sleep however, radiation to the hypothalamus approached significance among survivors for longer sleep latency. Exploratory analyses identified radiation to the hypothalamus and age at diagnosis < 5 as predictors of lower vigor subscale scores on the POMS. No treatment variables predicted abnormal BSI scores among the survivors. The third aim evaluated a path model proposing post-treatment variables including obesity, depression, and fatigue as mediators of global sleep quality. In addition, gender, age, radiation to the hypothalamus and age at diagnosis < 5 were included in the model as exogenous variables. Obesity and depression were not strong predictors of global sleep quality however, gender and age at diagnosis < 5 predicted higher fatigue subscale scores. Fatigue itself significantly predicted higher (worse) global sleep quality scores within the model. This study revealed new and surprising information about sleep latency in brain tumor survivors. It also confirmed known associations with sleep and gender and a strong relationship between fatigue and sleep quality. Given these findings, future studies can begin to focus on identifying additional factors impacting sleep in these survivors.
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    Factors impacting school nurse care coordination for children with special healthcare needs.
    (2011-11) Choromanski, Lynn Marie
    Background: Children with special healthcare needs (CSHCN) compose a significant potion of pediatric clients. Approximately 14.2 million U.S. children have special healthcare needs. CSHCN are integrated into the school system to the level their disability allows. School nurses are responsible for the healthcare needs of these children while in school. Purpose: The purpose of the study was to explore the factors which impact school nursing care coordination of CSHCN. Six specific study aims were identified to support the research purpose. Methods: The design of this research was a qualitative descriptive study. Data were gathered during semi-structured interview with 27 school nurses from one Midwestern state. Participants described their experience with care coordination for CSHCN in their schools. Results: A total of 19 separate themes across the six study aims were identified. From the 19 themes identified there were four overarching factors which could encapsulate all 19 themes. Factors which impact school nurses' provision of care coordination for CSHCN are: school nurses need to establish relationships with a team; information needs to be collected and shared; each child has individualized plans to meet overarching educational goals; and sufficient time is needed. Conclusions: The school nurse participants in this study provided insights into the care coordination efforts they make on behalf of the CSHCN in their schools. Little research has been conducted about factors contributing to care coordination for CSHCN by school nurses. This study fills a gap in knowledge about school nursing and raises questions for future research about the understanding, contributing factors and barriers to effective care coordination by school nurses for CSHCN.
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    Fatigue and disease trajectories in chronic liver disease patients: the role of gender and coexistent symptoms.
    (2010-08) Jorgensen, Roberta Ann
    BACKGROUND: Fatigue is a common symptom in chronic liver disease, significantly impacting multiple aspects of quality of life. Although fatigue severity correlates poorly with traditional markers of liver disease activity, greater fatigue has been associated with an increased risk for early death, providing evidence of its prognostic significance (Jones, 2006). Gender differences exist in fatigue reporting yet little is know about gender differences in liver disease. Fatigue in liver disease has been associated with symptoms of sleep disturbance and daytime somnolence yet the relationship of these other symptoms with underlying disease is not well studied. The purpose of this study was to investigate the interrelatedness of fatigue and disease trajectories in patients with chronic liver disease. The intent of this analysis was to explore whether the general level and rate of change over time differs by gender and the presence at baseline of other symptoms. METHOD: A secondary analysis was done of data collected on 150 primary sclerosing cholangitis (PSC) patients who participated in a treatment trial over a 5-year period. Patients completed yearly fatigue questionnaires and quality of life assessments, which included symptom questions, and were assessed on severity of their liver disease by calculation of risk scores. Linear mixed-effect models were used to examine patterns of fatigue and disease, their covariation over time, and the predictive effect of gender and coexistent symptoms. RESULTS: Fatigue increases only slightly over time; yet liver disease severity exhibits an accelerated rate of progression. Female gender, insomnia, concentration difficulty, and itching predict significantly greater fatigue levels. Itching and disease duration were related to disease severity. Although women suffer great fatigue morbidity they do not suffer worse disease. Levels and patterns of fatigue and disease severity do not covary over time, indicating that they are separate processes. CONCLUSIONS: Fatigue levels in liver disease patients remain stable with little increase over time; however disease progresses at an increasing rate of change. Women and those with insomnia, concentration difficulty and itching are more likely to have greater fatigue but not worse disease. No evidence was found of an association between fatigue and disease levels or related patterns of change over time.
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    Fatigue, physical performance, and carnitine levels in children and adolescents receiving chemotherapy.
    (2009-04) Hooke, Mary Catherine
    Fatigue in childhood cancer is a pervasive and distressing symptom that has a physical component described as a "lack of energy". Fatigue, physical performance, and a micronutrient, carnitine, all relate to physical energy and may be influenced by chemotherapy. The purpose of this pilot study is to examine the relationship between the physical performance and carnitine plasma levels and fatigue in child and adolescent cohorts receiving chemotherapy. The study included 30 patients, ages 6 to 17, who were newly diagnosed with cancer and receiving chemotherapy. There were 20 males and 10 females; the child cohort had 16 subjects ages 6 to12. The 14 subjects in the adolescent cohort were ages 13 to 17. Standardized instruments were administered in the 1st and 3rd cycle of chemotherapy between day 15 and 29. Instruments included physical performance tests (Timed Up and Down Stairs [TUDS] and 6-Minute Walk test [6MWT]), carnitine plasma levels, and self-reported Childhood Fatigue Scale or Fatigue Scale for Adolescents. In the child cohort, physical performance measures appeared to improve (TUDS, p = 0.09 and 6MWT, p = 0.09) and free carnitine plasma levels decreased (p = 0.01) between cycles 1 and 3. Fatigue scores also tended to improve (p = 0.05). In the adolescent cohort, there was a suggestion that fatigue decreased (p = 0.15) but other variables evidenced little change. Spearman's rank-order correlation was used to examine relationships between the change in variables from cycle 1 to 3. In 6 to 12 year olds, when time on the TUDS decreased, fatigue tended to decrease (p = 0.11), and when 6MWT distance increased, fatigue decreased (p=0.01). In 13 to 17 year olds, correlations between changes in the physical performance variables and fatigue were slight and not significant. Fatigue may decrease early in treatment as disease symptoms resolve. Fatigue in the 6-12 age group was related to physical performance, which is consistent with previous studies that define fatigue in children as primarily a physical sensation. Adolescent fatigue was not related to physical performance which supports the concept that, in adolescents, fatigue is more complex and includes mental and emotional components.
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    From nursing sisters to a sisterhood of nurses: German nurses and transnational professionalization, 1836-1918.
    (2009-08) Soine, Aeleah HeaRan
    Between the 1830s and World War I, German nurses engaged in collaborative efforts with American and British nurses for the purpose of transforming their work into a respectable profession for women. This dissertation reasserts the importance of German nurses in the development of a profession, not only because they were actively involved in the movement, but also because many transnationally-influential nursing ideologies and organizational models originated in Germany. Through archived collections of personal letters, organizational records and publications, government transcripts, and speeches by German nurses, my project brings together artificially-separated national nursing traditions at key moments in their shared history of nursing professionalization. As such, the writings and activities of these German women offer illuminating evidence of the historical intersections among professional class formation, gender relations, and organizational development as they occurred simultaneously on a local, national, and transnational scale.
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    High risk medication regimens and medication related predictors of hospital readmission in elderly home care patients.
    (2010-10) Dierich, Mary Therese Jancaric
    Adverse drug events are a primary cause of hospitalization in the elderly. Nearly 70% of the $177.4 billion dollars spent on drug related morbidity and mortality in the U.S. is due to hospitalizations. Polypharmacy, inappropriate medications or medication regimen complexity have all been implicated as precursors to adverse drug events and as indicators of high risk medication regimens. Understanding the relationship between medication regimens and readmission is important when evaluating potential errors in administration, risk-benefit ratios, and readmission risk. However, due to definitional and measurement issues, the high risk medication regimen remains an elusive concept. This study characterizes medication regimens, defines high risk medication regimens, and determines if high risk medication regimens predict re-hospitalization in home healthcare clients over age 65. An exploratory, secondary analysis of OASIS data and medication records from 15 home care agencies was used to characterize medication use in 911 older adults discharged from the hospital to their first episode of home care in 2004. Conceptual and operational definitions of polypharmacy, potentially inappropriate medications, medication regimen complexity, and high risk medication regimens were developed. Logistic regression and structural equation modeling were used to examine the relationship between comorbidity, a variety of risk factors supported by the literature, high risk medication regimens (defined by polypharmacy, potentially inappropriate medication regimens, and medication regimen complexity) and re-hospitalization to determine if high risk medication regimens predicted rehospitalization in these subjects. Factor analysis revealed that high risk medication regimens are composed of polypharmacy, potentially inappropriate medication regimens, and medication regimen complexity, and that a model using this concept rather than individual medication variables proved to be the most predictive and parsimonious model. The model accounted for 10% of variance in re-hospitalization in this sample. Additionally, high risk medication regimens appear to have as much influence as comorbidity on hospital readmission. Future research should include high risk medication regimens as a predictor of readmission and previously completed studies may need to be re-evaluated in light of these findings. Both the findings and the methodology will be useful in examining predictive potential of high risk medications regimens in other settings.
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    Homelessness, housing, and health geography: the impact of housing on the health of chronically Ill homeless adults.
    (2011-08) Petroskas, Dawn
    Interventions are needed to reduce the health disparities that exist in homeless populations. Housing, often viewed as an outcome to be achieved, has become increasingly recognized as an innovative health care intervention. Through the lens of health geography, this study sought to understand how housing is health care for formerly long-term homeless adults with chronic illnesses. The study (a) explores how the places of homelessness impact disease management, (b) identifies the processes by which the home becomes a therapeutic landscape, (c) explicates the place effects of housing on health, and (d) uncovers nursing‟s „place‟ on supportive housing teams. A sample of formerly homeless adults (n=16) was interviewed. Nursing (n=2) and non-nursing (n=9) service providers participated in focus groups. Findings reveal that homeless adults face extreme environmental, spatial, and social conditions, demanding creative strategies to manage illness. Closing the door on homelessness and making the home into a therapeutic landscape involves: negotiating home space with old and new social networks, finding a place that meets needs and desires, setting up a personal home, and enjoying home‟s sensual pleasures. The home affords a sense of normalcy and a desire to care for one‟s health. It also gives one the ability to care for health. Home essentials for health include: water, shelter, a private bathroom and shower, one‟s own bed for sleep and recovery, kitchen amenities, an electrical outlet, four walls, space and place for medications, an address and telephone, a place for pets, and a safe neighborhood. Nurses can be figurative stepping-stones out of homelessness and into health care. As care navigators, they assume some of the burden of disease management and triage, which is important for those newly housed and entering care for the first time. Providing care work on the street and in the home gives nurses an intimate knowledge of how „place‟ impacts a person‟s health narrative. These narratives are shared to advocate for client needs and encourage moral and political action. It is hoped that findings spur research on housing‟s effect on chronic illnesses; support homeless, housing, and health care policy; and guide nurses in place-based care work.
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    Interview with M. Isabel Harris
    (University of Minnesota, 1999-02-22) Harris, Isabel; Pflaum, Ann M.
    Ann Pflaum interviews Isabel Harris, former dean of the School of Nursing.
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    Left ventricular assist device therapy: family caregivers' stress, perceived burden and quality of life.
    (2011-04) Petty, Michael Glenn
    Background: Individuals implanted with left ventricular assist devices (LVADs) as bridge to transplant or as destination therapy expect to be discharged home. Responsibility for providing care to those patients has fallen almost exclusively to family caregivers. Yet there is a paucity of research on the experience of family caregivers of LVAD patients. This study assessed the burden and quality of life (QOL) of caregivers over a period of up to 6 months. The influence of stress and select demographic variables on those outcomes was also evaluated. Methods: Subjects recruited from a single LVAD center in the upper Midwest were required to be > 18 years old, the identified primary caregiver of an LVAD patient, and able to read and write English. Each was asked to complete a questionnaire at baseline and again at 2, 6, 14 and 22 weeks after the baseline measure. Measures included demographics, the Caregiver Distress Scale, the Caregiver Involvement Instrument, the Caregiver Burden Assessment, the Cantril Ladder scale, the CES-D, and the SF-12. Results: A total of 46 subjects provided data for analysis. The average caregiver was a 58 year old Caucasian female spouse of a bridge-to-transplant patient with a HeartMate II living with the patient and one other adult with an average income of $40,000-$59,999. Stress was mildly to moderately elevated over the entire period. Baseline burden was measured at levels that warranted intervention in up to 41% of participants, but decreased steadily over time (p=.04). Sixty to eighty-five percent of subjects reported below average quality of life that was largely static across the study. Stress was negatively correlated with QOL. (p=.004) Conclusions: Interventions to reduce stress are most likely to improve caregiver quality of life.
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    The lived experience of Type 2 diabetes in urban-based American Indian adolescents.
    (2011-05) Martin, Lisa C.
    This qualitative nursing research study used a hermeneutic phenomenological perspective to discover meaning in urban-based American Indian adolescents' experiences living with Type 2 diabetes. The aim of this study was to understand what it meant for urban-based American Indian adolescents to live with and experience Type 2 diabetes. The study used phenomenologic unstructured interviews to describe and represent the adolescent's voice and experiences of living with the disease in an urban community. The study was guided by Max Van Manen's methodology for phenomenological research. This method entailed turning to the phenomenon of interest, then, inquiring and investigating the experience as it was lived rather than as it was conceptualized. The study reflected and analyzed essential themes that characterized the phenomenon of living with Type 2 diabetes and presented the phenomenon through the art of writing and re-writing. Data collection involved in-depth, in-person interviews with analysis of the resulting transcripts. Adolescents in this study described connections with the American Indian culture, past and present family members, and the pragmatic details of living each day with the disease. Essential themes of the adolescents' experiences were found in the lifeworld areas of relationality and temporality, followed by incidental themes in the areas of corporeality and spatiality. The study findings illuminated the participants' personal meanings and validated the phenomenological research process. A preliminary conceptual model based on the lifeworld categories for understanding adolescents' experiences was proposed and had implications for education, research, and practice, supporting continued inquiry.
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    Low income women‟s expectations, needs, and desires for social support in the postpartum period: a feasibility study.
    (2012-02) Uban, Nicolle Marie
    The postpartum period represents a significant transition in women's lives. This critical period of adjustment is characterized by physical, emotional and psychological stressors that impact women's experiences, adaptation and health and wellness. Common stressors in the puerperal period include: the transition to motherhood and associated role change and role stress; physical stressors such as hormonal fluctuations, altered sleep, and pain; and, psychological stressors including interpersonal relationship challenges, self esteem and self confidence issues, and postpartum depression (PPD). Social support has been identified as a factor contributing to women's experiences in the postpartum period (Beck, 2001; Dennis, 2003). Lack of social support is also a predictor of functional status problems in the puerperal period (McVeigh, 1997). There is a body of noteworthy literature examining the association between social support interventions provided by health professionals, and negative affect in the new mother (Armstrong, Fraser, Dadds et al., 1999; O'Hara, Stuart, Gorman, & Wenzel, 2000). Critical gaps in maternal support needs have been identified in the literature and indicate that high risk populations of women might benefit from targeted social support services and interventions (Armstrong, Fraser, Dadds et al., 1999; Dennis, 2003; Shaw, Levitt, Wong et al., 2006). The purpose of this feasibility study was to examine and describe low-income postpartum women's perceptions, expectations, and desires for social support and the feasibility and acceptability of a postpartum doula as a vehicle for social support services in the postpartum period. This study utilized focus groups, a social support survey and a socio-demographic survey for data collection. The final sample included a total of 30 participants. First, a pilot test with one participant was conducted to trial the focus group questions and user-friendliness of the social support and demographic surveys. This was followed by three focus groups: Group 1 with nine participants; Group 2 had fifteen participants; and Group 3 had five participants. Recruitment of participants was conducted by a community doula program in the Upper Midwest that has an established priority to serve low-income women.Four categories emerged during the content analysis process identifying types of support that were most important to participants in the postpartum period and areas where they experienced gaps in support: (1) Functional support; (2) Physical support; (3) Educational/Informational support; and, (4) Emotional support/Presence. The findings from the social support survey confirmed this information, as well as identified deficits in the availability of individuals within their support networks to provide much needed support. Participants in this study had experience with birth doulas and expressed interest in postpartum doula care as a desirable method for providing individualized support to meet their needs and to fill deficits in their existing support systems. The findings from both the focus group analysis and the social support survey reiterate the importance of a broader social support network in low-income postpartum women's lives. This study adds to the existing body of research by laying out the foundational pieces for designing an effective intervention targeted to meet postpartum women's expectations, needs, and desires for social support in the postpartum period. Furthermore, the information from this study provides those providing support to new mothers with necessary information to expand current practices in the maternity care model to include targeted postpartum doula support interventions that may ultimately influence maternal outcomes. Additional research is indicated in order to determine the effectiveness of targeted, individualized, in-home social support interventions for women in the postpartum period.