Nursing (M.S.)

Despite a recent decrease in the adolescent pregnancy rate, the United States continues to lead the industrialized world in this category. The two closest countries are the United Kingdom and Japan, reporting less than one-half the pregnancy rates of the United States (Foster, 1997). It has been suggested through research that knowledge of age-appropriate sexuality and reproductive health may help delay the onset of first coitus, thereby reducing the occurrence of unplanned adolescent pregnancy (Kirby, 1997).

A descriptive design was utilized to analyze the sex knowledge of pregnant or parenting adolescents. It was hypothesized that these adolescents lacked general knowledge of human sexuality and reproductive health. Research subjects were adolescent females ranging in age from 14 to 20 years. Some of these adolescents were participants in the Parenting Program offered by the City of Erie School District and some were clients of the Family Health Council, Inc. in Erie, PA.

Results of this research indicated a high degree of misinformation or lack of information regarding human sexuality and birth control. Knowledge of general reproductive health was low, as well as well as accurate information about methods of birth control. Utilizing Orem’s (1995) theory of self-care, a self-care deficit was identified.

Literature indicates that family members suffer no adverse psychological effects from witnessing CPR efforts on a loved one (Robinson, Mackenzie-Ross, Hewson, Egleston, and Prevost, 1998). Therefore, this study was aimed at health care providers and their attitudes towards family witnessed resuscitation on an adult family member. A seven-item questionnaire was distributed to physicians and registered nurses to determine their attitudes towards family presence during resuscitation procedures.

The sample size was 38 HCPs, 12 being physicians and 26 registered nurses. Of the 38 respondents, 89.5% stated that they themselves would like to be given the opportunity to be present if the situation should arise with their loved one. In addition, of the HCPs who have been involved in situations where family members have been present during CPR efforts, 93.6% stated that this experience yielded benefits. This finding was higher than previously published research. The major benefit identified was that families were viewed as supportive to the loved one in the resuscitation room The major disadvantage was that families might interfere with resuscitation efforts. This study also found that 79.0% of the respondents felt that families have the right to be present during resuscitation. However, this study found that less than half of the HCPs felt that families may interfere with treatment, procedures may offend families, and families may be disruptive to staff members working.

This study examined the coping patterns of the spouses and adult children of Coronary Bypass Graft clients during the six to twelve months following the surgical event, to determine the patterns of adaptation used during this time frame. Data were collected in a phase II cardiac rehabilitation program from a sample size of 16 spouses and 28 adult children of 16 clients who had their first coronary bypass graft surgery. Using the Family Crisis Oriented Personal Evaluation Scale (F-COPES) by McCubbin, Larsen, and Olson (1991) subjects were asked to identify from a list of coping patterns those patterns they used to cope with the stressors associated with the surgery.

The findings of the study revealed that the spouses and adult children used a variety of coping patterns to deal with the stressors. Both groups utilized the Internal Coping Patterns and External Coping Patterns as identified on the F-COPES scale similarly or with near or equal frequency when dealing with the stressors during the recovery process. Both groups identified the use of internal resources such as having confidence in their problem-solving abilities and the ability to positively redefine the situation. External coping behaviors utilized included relying on friends, seeking information from doctors, relying on resources offered by community agencies, and turning to their religious faith to assist them in coping with the stressors of the surgery. Implications for nursing practice included the need to assess the coping patterns utilized by spouses and children during the six to twelve months following the coronary bypass graft surgery to better understand and support family coping.

A sample survey of nurses practicing in rural psychiatric settings was conducted to examine their perceptions of preparation for the family educator role. A self-rating tool was sent to nurses practicing on inpatient units of rural hospitals in southeastern Kentucky and southern West Virginia. Nurses were asked to rate themselves in response to questions pertaining to teaching set and preparation for teaching. The conceptual framework of Megenity and Megenity was used as the basis for the study and the rating tool which was developed by the investigator. Descriptive statistics were used to analyze the data collected. The results of the survey showed that while nurses felt adequate in the family teaching role, their formal educational preparation stopped at the entry level of associate degree; that they value basic education and experience equally as the most helpful preparation; and that they did not plan for the teaching event. These findings were inconsistent with the literature, which supports an advanced credential for practitioners teaching families, and the model which supports grounding in educational and teaching-learning theories, as well as planning for the teaching event.

Progress in genetics has numerous implications for both nurse practitioners and those patients at risk for the hereditary diseases breast cancer and ovarian cancer. Nurse practitioners will be challenged to order and interpret genetic tests and take into consideration the legal, ethical, social, and familial implications.

Nurse practitioners need to be prepared to provide the necessary background information to patients, so that informed decision making by the patient is possible. This project provides guidelines for evaluating family history risk for inherited breast and ovarian cancer and discusses the implications for presymptomatic testing, carrier testing, and susceptibility testing of certain familial disorders. Guidelines for ordering BRCA1 and BRCA2 testing for breast cancer and the implications of these results are explored.

Unlike traditional medical testing performed to evaluate symptoms, genetic treatment is limited. Experts disagree whether genetic testing is justified in families with strong histories of certain disorders (Cho, Sanker, &Wolpe, 1999). For this reason, someone deciding whether to undergo genetic testing must weigh the medical benefits of testing against the psychological and social risks and benefits.

A reference pamphlet for nurse practitioners in ordering the genetic test for breast cancer is implemented in this scholarly project. Testing guidelines, patient counseling, clinical application of test results, and interpretation of test results are included in the pamphlet.

During America's history as a nation, the composition of the population has changed from one that was almost totally rural to one that is now predominantly urban. The United States Census Bureau (1990) estimates that 95% of the population in 1790 was rural; today only 25% live in rural areas. In recent years, the size of the rural population has not
declined overall, but is growing more slowly than the suburban population.

The Office of Technology Assessment (OTA, 1991) found that, in general, rural residents tend to be white, native-born, and living in a family headed by a married couple. Rural residents are less likely than urban residents to be employed and to have completed high school. Rural residents have lower incomes than their urban counterparts. Nearly one in four rural citizens lives in poverty, but this rate approaches one out of every two for black families living in rural areas. The 1991 OTA study also showed most rural employment stems from agriculture. This same study found there is a recent trend of locating small manufacturing facilities and other types of light industry in rural areas to take advantage of nonunion environments. However, these companies do not pay much over minimum wage, and benefits such as health insurance are often nonexistent.

The results of this project is the development of clinical guidelines for the treatment of osteoporosis. Clinical guidelines are a tool for primary care providers to use in planning quality patient care. The guidelines are based on a review of the literature and input from experts in the treatment of osteoporosis.

Literature indicates that secondary conditions are preventable in adults with spina bifida provided they receive appropriate healthcare (Rauen & Aubert, 1992). A telephone survey about adults with spina bifida was conducted to determine the reported frequency with which they received primary and specialty care, the incidence of secondary conditions and surgical interventions they had experienced since turning the age of 21, and their level of satisfaction with their primary care provider’s ability to care for their spina bifida. The tool utilized was a researcher-developed survey and assessed if frequency of care impacted on the incidence of secondary conditions, surgical interventions, and level of satisfaction with spina bifida care.

The sample consisted of 30 male and 16 female adults with spina bifida with a mean age of 29.87. The results from this study indicated that adults with spina bifida received more consistent and frequent care if they were seen in an adult spina bifida clinic and that these patients appear to have a lowered incidence of decubitus ulcers, behavioral issues, osteomyelitis, orthopedic and urological surgical procedures, and reactive surgical procedures. This research also found that adults who received healthcare through a spina bifida clinic had a higher level of satisfaction with their primary care provider’s ability to care for their spina bifida. Because of a limited sample size, not all results were statistically significant. It is recommended that further research in this area utilize a larger sample population and a prospective study approach in order to more accurately determine the incidence of secondary conditions.

The purpose of this study was to describe the knowledge source, knowledge level and attitude of women about to hormone replacement therapy. With this information health care providers can better understand how to assist women to make informed decisions. A literature review was conducted including research on the physiologic effects of hormone replacement therapy, the risks of treatment, and the overall effect of hormone replacement therapy on mortality and life span. Published research related to women’s knowledge and attitude was extremely limited.

The sample used in this study was 30 white married women who belong to a marriage support group at a northwestern Pennsylvania church. The survey used in this study was developed by the researcher. Questions were based on the information in a review of literature. Women were asked to identify the effects of Hormone replacement therapy on physiologic systems. Of a possible 8 correct answers the range was 1 to 5 correct answers with a mean score of 3.6. They were to describe their view of Hormone replacement therapy as beneficial or risky. The study found no participant answered all knowledge questions correctly. The women with the highest scores on knowledge about Hormone replacement therapy also had the most positive attitude.

Further research should be done to verify these results in more diverse populations. Effective ways of educating health care providers and women about hormone replacement therapy need to be developed.

Hormone replacement therapy (HRT) is used by perimenopausal women to manage the symptoms associated with menopause and for potential long-term health benefits. These potential benefits include protection against osteoporosis, heart disease, colon cancer, and possibly Alzheimer’s disease (Shaywitz et al., 1999). The decision to start therapy must take into consideration the potential risks of breast and endometrial cancer, and thromboembolic disorders (Cutson & Meuleman, 2000).

The purpose of this project is to provide information to perimenopausal and postmenopausal women related to hormone replacement therapy. This information will be made available via internet and world wide web at www.velocity.net/~rrmartin. The web page was evaluated using the Model for Evaluating Printed Educational Materials by
Bernier and Yasko (1991). The content is based on a review of the literature and is presented at the eighth grade level using the McLaughlin Smog Formula (McLaughlin, 1969). The topics covered include health risks, benefits, and alternative therapies. The theoretical framework for this project is the Neuman Systems Model by Betty Neuman (1995). Based on this theory, the nurse practitioner analyzes how sociocultural, developmental, and psychological variables influence a patient’s health practices (Reed, 1993).