Nursing (M.S.)

The goal of this research was to compare and contrast the elderly and adolescent populations’ knowledge about cholesterol and their lifestyle choices. Data for this study were gathered via a researcher-written survey that was given to elderly and adolescent sample populations in a rural area of western Pennsylvania. Each group consisted of 36 participants. The survey concerned demographics, lifestyle, and knowledge about cholesterol. Quantitative data were analyzed using descriptive statistics for demographics, level of knowledge, and lifestyle comparison.

A knowledge deficit was found in both sample populations. The elderly were able to answer only an average of 9% of the questions about cholesterol and the adolescents answered an average of 34% of these correctly.

The data also showed that the sample populations had several risk factors for developing high blood cholesterol. For example, 58% of the adolescent’s and 31% of the elderly used tobacco products. Thirty-five percent of the elderly population is overweight. The adolescent population was 8% overweight. The median time the elderly exercised four times per week was only 20 minutes whereas the adolescents exercised a median of 45 minutes six times per week. Of those that smoke and are sedentary only 6% were in the elderly population but 14% of the adolescent population fall into this category. More than 41% of the adolescents and only 14% of the elderly did not want additional education about cholesterol.

Teaching about cholesterol is recommended using an adaptation of the American Heart Association’s “Cardiovascular Risk Factor Education Program”. Smoking cessation also needs to be addressed.

This study compared a resident pet program and or visitation pet program and their effect on the loneliness experienced by nursing home residents. The sample was comprised of 52 subjects from two nursing homes in Northwestern Pennsylvania. The evaluation tool was the UCLA Loneliness Scale (version 3) by Russell. Subjects completed a 20-question questionnaire. The statistical tests were the t-test and the pearson correlation coefficient. Review of the data analysis suggested there was no significant difference in the loneliness scores and the type of pet program. An inversely related correlation was found between the loneliness scores and the number of years in the nursing home.

Hysterectomy, the removal of the uterus, is one of the most common surgical procedures performed; after cesarean delivery, it is the second most frequently performed major surgical procedure in the U.S. Approximately 75% of all hysterectomies are performed in women between the ages of 20 and 49 years. The highest overall rate is in the southern states with the lowest rates consistently in the northeastern portion of the U.S. Hysterectomy is more often performed in African-Americans than in Caucasians and is more frequently performed by male gynecologists' than female gynecologists. One in five women in the United Kingdom will have a hysterectomy by the time they reach the age of sixty-five (Chapple, 1995). Hysterectomy is often the last resort for women suffering from problems affecting the uterus. The most common problems include: uterine fibroids, cancer, abnormal uterine bleeding, pain and endometriosis. A lot of effort is made by the patient and her health care provider to avoid unnecessary surgery. Once the decision for hysterectomy is made it is important for the woman to understand the surgery and its risks as well as what is to be expected after surgery (Berek, Adashi, & Hillard, 1996).

The purpose of this study was to design a pamphlet to educate women undergoing hysterectomy about their post-operative course; in order to improve recovery and facilitate satisfaction of stay.

A retrospective study of 100 patient medical records was done to determine whether preoperative standardized screening tests could be reduced in healthy ambulatory surgical patients age 40 or older without compromising patient surgical outcome. A two way chi-square test of association was utilized to determine if there was any association between the outcome of patients’ elective ambulatory surgical procedures and the preoperative assessments which included the health history and physical examination, electrocardiogram, chest x-ray, and laboratory tests. This study found no statistically significant association between the preoperative assessments and patient surgical outcome. The results of this study indicate that preoperative tests are of little significance in predicting surgical outcome in healthy ambulatory patients. The study further indicated that the health history and physical examination should be done first and used as a tool in determining what preoperative standardized screening tests need to be performed.

The purpose of this study was to determine if women with a family history of breast cancer are adhering to the recommended guidelines for mammography use more often than women without a family history of breast cancer. Literature indicates these women are at high risk for contracting breast cancer and compliance with mammography screening is low (Center for Disease Control, 1997). An existing survey authored by Dr. Anna Miller (Miller & Champion, 1996) that examined demographics, compliance, attitudes, beliefs, influencing factors and knowledge of mammography usage was utilized. The sample consisted of 90 women from 2 sites in northwestern Pennsylvania. The results from this study indicate that women with a family history do not adhere to guidelines more than women without a family history. The compliance rate of having at least one mammogram was 80% in the group with a family history and 78% in the group without a family history of breast cancer. This is higher than what is reported in the literature. Having a health care provider recommend a mammogram was the greatest measure of adherence. The results were consistent with Dr. Miller’s study, and indicate that primary care providers are in a valuable position to influence compliance.

Sexually transmitted diseases (STDs) and their sequelae are very important problems in the adolescent population. There are 3 million adolescents that contract STDs each year (Donovan, 1997).

The purpose of this study was to determine if primary care providers are counseling adolescents about STDs. The study is a quantitative descriptive study in rural northwestern Pennsylvania. It consisted of six demographic questions and 37 yes and no questions to determine the percentage of PCPs (a) providing adequate STD counseling, (b) performing adequate risk assessments, (c) using adequate interaction skills, and (d) who indicated they cover the topics risk of contracting a STD and sexual abstinence for prevention.

Forty eight questionnaires were mailed to primary care providers, 23 were returned, and 17 were entered into the study. Fifty nine percent of the subjects counseled. Nearly the same percentage of males and females counseled. PCPs aged 41-50, in practice 11-15 years, and were nurse practitioners did the most counseling. PCPs aged 31 to 40, in practice six to 10 years, and were a pediatrician did the least amount of counseling. All primary care providers who counseled (a) performed adequate risk assessments, (b) adequately discussed the risk reduction topics, and (c) covered the risk reduction topics entitled risk of contracting an STD and sexual abstinence for prevention. All primary care providers used adequate interaction skills.

This study investigated high school students’ preferences for school-based health services. This non-experimental, quantitative design used a researcher-modified questionnaire. The survey addressed accessibility of services, availability of comprehensive medical services and health education/counseling at school, and identified students’ preferences in those services offered at school. The survey was completed by 117 students at a high school in northwestern, Pennsylvania. Thirty-eight percent stated they should have received health care and did not. Reasons included inconvenient office hours, lack of resources to pay fees, not wanting to see the family doctor, or miss school. These agreed with what is reported in the literature. Students were most interested (60% to 88%) in treatment for minor injuries, illnesses, and having routine physical examinations for sports and working papers. Interest was also high in education on health and nutrition, smoking, drug and alcohol abuse, and weight reduction. Overall, the results of this study agreed with findings in the literature. With the information generated from this study, an initial proposal for a school-based clinic was developed. It included a brief statement of the problem, the results of the needs assessment, statistics showing an increased pattern of usage of health room services, program plan and goals, expected costs, and possible funding sources.

This study investigated the research questions: How many people have an advance directive? and Do people want their primary care provider to discuss advanced directives during a routine office visit? This nonexperimental, quantitative study used a researcher designed questionnaire. The questionnaire was given to 100 members of a local wellness center who varied in sex, age, marital status and religion. Seventy-nine questionnaires were returned. Twenty-three percent of the research subjects indicated that they had advance directives, which was higher than the 15%-18% reported in the literature for random populations. But, only 43% wanted their primary care provider to discuss advance directives during a routine office visit, well below the 65%-68% reported in the literature for random populations. The results of this study, in contrast to other studies in the literature, showed that these subjects did not want their primary care provider to initiate a discussion of advance directives.

Asthma is the most common chronic childhood illness (Adams & Marano, 1995; Centers for Disease Control and Prevention, 1995). As children with asthma enter school, their teachers may become involved in helping them manage their asthma. Research literature review reveals few studies on teachers’ knowledge of asthma, or on the effectiveness of asthma education programs. The American Respiratory Alliance of Western Pennsylvania conducted an asthma education inservice program for elementary school teachers as part of their School Asthma Initiative. This study was conducted to assess the effectiveness of this inservice program. Malcolm Knowles’ Adult Learning Theory was the conceptual framework for this study. Thirty-six elementary school teachers participated in the study. Teachers’ asthma knowledge was tested using an identical Asthma IQ pretest and posttest. The teachers had a significant increase in their scores on the tests taken after the inservice program (p<0.01).

Responses to a researcher written survey revealed that although at least 60% of teachers reported having students with asthma, and almost one-half of teachers had previously had to assist a student with asthma symptoms, only two teachers had ever attended an asthma education program. Nearly all of the teachers perceived that they should have some role in assisting students to manage their asthma.

Children with asthma need proper support at school (National Institute of Health, 1997). Recognizing teachers, at least in part, as caregivers of children with asthma, and asthma, and networking in community based organizations to participate in asthma education programs, offers the nurse practitioner another opportunity for education.

The purpose of this study was to explore the relationship between nursing staff members who have positive or negative attitudes towards the change process and their support or nonsupport for the organizational strategic direction. Differences in attitudes towards the change process and degree of organizational support among nursing staff members with different licensure status were evaluated. This study also identified patterns and trends in relation to nursing staff members’ perceptions concerning factors that helped or hindered the successful change process within their organization. With this information, nursing leaders can better understand employees’ reactions to strategic change and implement steps prior to the change process to gain a more successful outcome. A literature review found little concerning nursing staff attitudes toward the process of change. However, the literature documented the rapid change taking place in healthcare institutions across the nation. The research participants in this study were forty-two nursing staff members in two rural hospitals in northwestern Pennsylvania. The research questionnaire utilized in this study consisted of a demographic section, a seven-point Likert scale that measured attitude and organizational support, one yes or no question with a comment section, and two descriptive questions with comment sections. The attitudinal and organizational support tools used were developed by Dr. Karen Gaertner of Georgetown University. The researcher designed descriptive questions were added to gain further insight into nursing staff attitudes and perceptions about successful or unsuccessful change efforts within their organization. This study concluded that there was no significant correlation between attitude and organizational support. The study did not reach a level of significance when looking at differences between or within the groups. Further research is recommended to verify these results in a larger sample, in more diverse healthcare organizations, and in other geographic locations.

Literature indicates that college students have a higher prevalence of alcohol use than their noncollege counterparts (U.S. Department of Health and Human Services, 1991). Heavy drinking causes problems for the drinker, threatens the quality and safety of the college experience for nondrinking students, and increases costs for colleges. (Harvard School of Public Health, 1995).

Colleges and universities have developed programs to combat binge drinking (five or more drinks in one sitting for men, four for women), and to heighten campus awareness of the problem (Harvard School of Public Health, 1995). Edinboro University of Pennsylvania has such a program in place. Using the Core Alcohol and Drug Survey, this study evaluated the program’s effectiveness by measurement of change in: (a) self-reported alcohol use, (b) negative consequences resulting from alcohol use, (c) student perception of other students’ use of alcohol, and (d) awareness of campus alcohol and drug policies. A comparison of pretest (N-68) and posttest (n=19) results showed percentage changes but Chi Square testing rejected a relationship between program participation and change in behavior or attitude toward the use of alcohol.

The American College of Obstetricians recommends that all postmenopausal women consider Hormonal Replacement Therapy (American College of Obstetricians and Gynecologists, 1992). Although HRT has clearly been shown to have life-prolonging benefits, women remain skeptical (Salamone, Pressma, Seeley & Cauley, 1996) and treatment remains widely underutilized by the menopausal population (Rabin, 1998).

The purpose of this study was to identify the barriers that may influence a woman’s decision regarding HRT. By studying these barriers the nurse practitioner will have a better understanding of a women’s existing concerns, and can better assist her in making an informed decision.

A non-experimental descriptive study was conducted utilizing a questionnaire consisting of 19 questions. A convenience sample of 78 menopausal women were recruited from the northwestern region of Pennsylvania. Analysis consisted of compilation of total percentages from all respondents and comparison was made between HRT users versus nonusers in regard to demographic factors, health practices, knowledge, and attitudes.

Several underlying themes were identified. Sixty-seven (86%) of the participants reported that they knew what HRT was. Current users appear convinced of the potential role of HRT in the prevention of menopausal symptoms (70%), osteoporosis (67%), and cardiovascular disease (57%). Nonusers represented the largest group in this study and showed similar awareness of the role of HRT in menopausal symptoms ((65%) and osteoporosis (54%).

Nonusers appear to be skeptical and unconvinced of the potential role of HRT. The uncertainity expressed by the nonusers in this study about fear of cancer (31%), questionable safety (29%), and just not wanting to take HRT (35%) points to a need for balanced information and the opportunity for discussion of these complex issues. All PCP’s who care for women should fully discuss the positive and negative effects of HRT and identify and address the concerns, beliefs, and attidudes that may influence a woman’s decision regarding HRT.

An estimated 1 to 5 million Americans develop a deep vein thrombosis (DVT) each year (Kurowski, 1997). Educating patients about this health-related problem is necessary to alter their health behavior and improve their potential for optimal health outcomes (Falvo, 1994). Patient education is constantly changing to meet the demands placed by today’s health care system (Bastable, 1997; Falvo, 1994; Whitman, Gliet, Graham, and Boyd, 1992). The nurse practitioner assumes a vital role in the patient education process (Close, 1988). The use of printed education materials (PEMs) is one method to facilitate the achievement of health.

Using Bernier and Yasko’s (1991) EPEM model for designing and evaluating PEMs, a patient education pamphlet was designed for use with patients diagnosed with, or who are high risk for, DVT. The purpose of the pamphlet is to supplement and reinforce oral instructions given to the patient by the health care provider. After construction, the pamphlet was submitted to a patient education committee in a northwestern Pennsylvania acute care facility for evaluation. Once the recommended changes were instituted, the PEM was relinquished to the committee for publication and distribution throughout the institution.

With patient education receiving such emphasis in today’s health care arena, multi-instructional aids are widely used to enhance the patient education process. Printed patient education materials remain the most common tool to supplement oral instruction (Bernier & Yasko, 1991). Gestational diabetes mellitus (GDM) patients require education about lifestyle modifications such as weight control, diet, exercise, and tight glycemic control in order to lessen risks of both maternal and fetal/neonatal complications (Ryan, 1998). These patients also need information about prognostic considerations.

A patient education pamphlet was created following the Evaluating Printed Education Materials (EPEM) model developed by Bernier and Yasko (1991). This pamphlet is intended to reinforce oral instructions given to GDM patients referred for counseling to a hospital-based diabetes education center in northwestern Pennsylvania. The content of the pamphlet includes: the etiology of GDM, risk factors for developing GDM, screening tests to detect GDM, implications GDM has for the mother and the baby, maternal and fetal complications associated with GDM, management of GDM, and prognostic considerations of GDM. The McLauglin (1969) SMOG formula was used to place the pamphlet at the sixth grade reading level.

Many different types of educational materials are used by health care providers to enhance the teaching process in our current health care arena. Persons require simplified information about risk factors and prevention of risks to decrease the incidence and severity of brain attack or stroke. The signs and symptoms of brain attack also need to be emphasized in order that persons will seek emergency help as soon as possible should these symptoms occur.

A patient education pamphlet was created for use in a northwestern Pennsylvania medical center. The pamphlet was designed to teach persons about risk factors for brain attack and that brain attack is a medical emergency. The pamphlet included what occurs in the brain during a brain attack, the risk factors for brain attack, a brain attack prevention plan, how to reduce the risk for brain attack, and the signs and symptoms of brain attack. The McLaughlin (1969) SMOG readability formula was used to write the pamphlet at the eighth grade reading level. The Evaluating Printed Education Materials Model (Bernier & Yasko, 1991) was used to develop the pamphlet. Dorothea Orem’s (1995) Self-care Deficit Theory served as the theoretical framework for this scholarly project.

As a result of the human and economic toll associated with musculoskeletal disorders in the workplace, the National Institute for Occupational Safety and Health (NIOSH) declared occupational musculoskeletal disorders to be one of the 10 priority work related conditions (Morbidity and Mortality Weekly Report, 1983).

The push for effectiveness and efficiency in health care has created a need to pursue models of care delivery that focus on outcomes, decrease utilization of clinical resources and promote patient satisfaction. Clinical pathways reflect accumulated knowledge from many disciplines, decrease variations in treatment, promote optimal outcomes and are cost effective.

This project is to develop a clinical pathway to guide the practitioner in the management of lateral epicondylitis in the work setting. The clinical pathway is utilized to address the assessment and treatment of the patient. It serves as a tool to communicate with other health care providers, case managers, employers, and insurance carriers. The pathway is outcome oriented. The goal is to return the employee to regular duty work status, pain free.

Since the U.S. Food and Drug Administration (FDA) relaxed its restrictions on broadcast TV advertising of pharmaceutical products in 1997, direct-to-consumer (DTC) advertising has boomed. DTC drug ads can encourage dialogue between patients and their health care providers (Morgan and Levy, 1998), which can strengthen the patient-provider bond if the patient gains a sense of participation in his health care (Woodward, 1996). However, these ads can also strain this relationship when the provider does not prescribe the requested drug (Gelles, 1997). With DTC drug ads having such an impact on the patient-provider relationship, it is important to understand the patient attitudes and behaviors that are a result of DTC drug ads. Nurse practitioners are in a position to educate patients who may have misconceptions resulting from DTC ads.

The purpose of this research is to survey health care consumers in order to determine their experiences with DTC drug advertisements, any actions they may have taken as a result of these ads, their attitudes and beliefs regarding DTC drug advertising, and the influence of DTC drug ads on the patient’s perception of the patient-provider relationship. Patients in a rural primary care facility in western New York state completed a self-administered questionnaire. The survey collected demographic information and investigated the respondents’ attitudes and behaviors associated with DTC advertisements. A total of 188 questionnaires were returned. Due to attrition, 137 questionnaires were included in the final analysis. Of the sample population (A=137), 90.51% had been exposed to DTC drug ads. Television was cited most frequently (97.58%) as the source of DTC drug ads. Only 5% of subjects indicated they would not talk with their health care provider about an ad because of trust issues.

In summary, exposure to DTC drug ads is high, with television and magazines being the leading sources of these ads. While the study results show no adverse effects on the patient-provider relationship, the continued rise and evolution of DTC advertising may have an effect on the patient-provider relationship. This provides nurse practitioners with an opportunity to educate patients about prescription drugs. Suggestions are offered for future research of DTC drug advertising.

Cardiac catheterizations are known to be anxiety provoking for patients. Originally an inpatient procedure, many are now outpatient procedures. The purpose of this study was to determine the effect that education, provided prior to the cardiac catheterization, had pre-cardiac catheterization anxiety in outpatients. This correlational study used a convenience sampling method. Fourteen males between the ages of 30 and 65 were given the State-Trait Anxiety Inventory prior to receiving, and at the conclusion of, their pre-cardiac catheterization education. The results were analyzed using the students' t-test. The State Anxiety scores decreased from pretest to post test. The Trait Anxiety scores increased from pretest to post test. These results were not statistically significant. Only the decrease in State Anxiety scores was supported by the literature, indicating education had an effect on anxiety. This study should be repeated with a larger sample size and with women.

The purpose of this project was to develop an informative article on enhanced external counterpulsation (ECCP) therapy. It focuses on providing primary care providers with knowledge about EECP and its potential benefits for their patients.

EECP is a noninvasive outpatient treatment for coronary artery disease that has been successful for some patients whose angina pectoris has not responded to medical and/or surgical therapy (Cohn, Hui, & Lawson, 2000). Patients undergo EECP treatment 1 hour per day for a total of 35 treatments (Cohn et al., 1995). Each treatment involves external cuffs applied to the patient’s calves, thighs, and buttocks (Burger, Guo, Hui, Lawson, & Soroff, 1997). Sequential inflation during diastole using EKG timing results in more effective coronary artery perfusion (Burger, Guo et al., 1997).

Research data suggest that EECP may provide adjunctive therapy for patients suffering from stable angina (Crawford, Feldman, Schneider, & Soran, 1999). Primary care providers, including nurse practitioners, play an important role in coordinating patient care and must know how to screen and refer patients appropriately (Cram & framework for this project. (Ettinger, 1998).

EECP has demonstrated usefulness in improving exercise tolerance, treating angina, and decreasing cardiac radionuclide perfusion defects (Cohn, Hui, & Lawson, 2000). Dorothea E. Orem’s (2001) Self-care Deficit Theory of Nursing provided the conceptual framework for this project.

The methods used to assess edema, an excessive amount of fluid in the body tissues, are varied. This descriptive, exploratory study used a researcher developed questionnaire to determine the assessment methods used by registered nurses providing bedside care in small to moderate sized Western Pennsylvania hospitals. The information obtained will be utilized to encourage the establishment of nursing protocols for edema assessment in medical care facilities in order to achieve consistency and accuracy in assessment of edema.

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.