Nursing (M.S.)

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).

The purpose of this study was to identify battered women in a health setting. The sample studied were 100 women in a local family planning clinic. 50 who reported themselves as having been battered within the last year and 50 who did not. Data was obtained by using a copywritten tool, the Abuse Risk Inventory (ARI). The tool included two parts: demographic data in which the client identified herself as having been battered and a survey entitled Interpersonal Relationships. The questionnaire was distributed to the sample population at a family planning clinic.
The researcher compared the means of the ARI of the two groups. The difference between the means analyzed was using a t TEST. Findings were significant at the p<.01 level. Several demographics were observed; among them Length of Relationship, Annual Income, and Physical Abuse for both the Respondent and Partner. Observations of the ARI means were made in each category.

Approximately 50 million adults in the United States either have elevated blood pressure or are taking antihypertensive medications. Unfortunately only 21% of hypertensive patients are being properly treated in the United States. After reviewing the literature the researcher found no studies that compare knowledge level of nonpharmacological treatments of hypertension and actual blood pressures in older adults.

The propose of the research was to assess the relationship between knowledge level about nonpharmacological treatments for hypertension and blood pressure control in older hypertensive adults. Knowledge of nonpharmacological treatments of hypertension was evaluated with the use of a survey. After the subjects completed the survey the researcher measured their blood pressures with a sphygmomanometer. Mean blood pressures were calculated for all the various knowledge levels. The Pearson r test was utilized to test for a correlation between knowledge level of nonpharmacological treatments of hypertension and blood pressure in the subjects.

The targeted convenience sample was approximately 34 middle aged adults ages 45 years and older that can read English. The setting was in the lobby of a northwest Pennsylvania pharmacy. The subjects were responding to a free blood pressure screening and were asked to participate in the study.

The research hypothesis was that persons with an increased knowledge level of nonpharmacological treatments of hypertension will have lower blood pressures. The study found a negative correlation between blood pressure and nonpharmacological treatments of hypertension, but they were not found to be statistically significant.

Throughout history, humankind has experienced the unpleasant sensation of pain. Pursuant to this, relief from the discomfort of pain has been sought through whatever means conceivable including the use of magnets. This study was done to help provide a basis for the decision as to weather or not health care providers should advocate the use of static magnets in pain management. The theoretical framework of this study was the Four Conservation Principals by Myra Levine (1969), specifically the conservation of patient energy regarding the inflammatory process.

This research studied the effects of commercially available medical magnets, of varying size, on a convenient sample of 10 patients from the northwestern Pennsylvania area having somatic pain for more than one month. The McGill Pain Questionnaire was used at baseline, 24 hours, and 7 days after beginning magnetic therapy. The Student t test revealed a statistically significant improvement after 24 hours, which continued at 1 week, as measured by the three parameters of the McGill Pain Questionnaire that were addressed. To be considered significant the t value had to be greater than 1.833. The three parameters were: The Number of Words Chosen which had a net improvement of t = 3.1058 (p - 0.0009), the Present Pain Index which had a net improvement of t = 6.5000 (p < 0.0001), and the Pain Rating Index which had a net improvement oft = 5.3930 (p < 0.0001). Magnetic therapy continues to be vigorously studied and shows promising results (Whitaker & Adderly, 1998).

Literature indicates that mammography is the single most effective method of screening for breast cancer. Several patient-related barriers to mammography for older women have been described (Costanza, 1994).

A survey of mature women was conducted in Chautauqua County, New York to determine if women who engaged in moderate physical activity, such as walking 15 to 30 minutes five to seven days per week also obtained yearly mammograms. The tool utilized was a researcher-developed survey that assessed the frequency of mammography screening as recommended by the American Cancer Society, and regular participation in moderate physical activity. The sample consisted of 66 mature women between the ages of 50 and 75. Most participants had a regular place for health care and most frequently went to a physician’s office for their health care. All the study participants were covered by some type of health insurance. Patient-related barriers to mammography screening reported by Weinberg et al. (1997) were not perceived as barriers by these research participants. The results of this study indicated that women who engaged in moderate physical activity were less likely to obtain yearly mammograms. The hypothesis that mature women who engage in the health promoting behavior of regular moderate exercise are more likely to obtain routine mammograms was rejected.

This non-experimental research study explored the motivational orientations/reasons and psychological motivational dimensions of life space and life chance of registered nurses participating in adult continuing nursing education. The psychological motivational dimensions were then related to participation/persistence and non-participation/drop out according to Roger Boshier's 1973 model of continuing education. This information is valuable to educators in identifying learning needs, planning, designing, implementing, and evaluating continuing education activities for registered nurses. The Education Participation Scale and a Demographic Survey were the tools utilized to collect data from 50 registered nurses attending three different "all day" (7-8 hours) non-college credit continuing nursing education classes offered by an education center in northwestern Pennsylvania. The characteristics of the total sample and statistical treatment/tests included determining the distribution of scores on the EPS for each of the seven motivational factors, the minimum/maximum score and range for each factor, the central tendency and variability for each factor, the Pearson product-moment correlations and the analysis of variance through the one way ANOVA: F-test. The level of significance utilized throughout was p=0.5. Significant motivational factors included professional advancement followed by cognitive interest and educational preparation. The first two factors identified are life space psychological motivational dimensions and the last factor listed is a life chance psychological dimension. According to Boshier’s model, registered nurses are more likely to participate and persist in continuing nursing education than to not participate or dropout. This prediction is dependent on congruency with self/others, and social, psychological, and subenvironmental variables.

Research indicates that the rate of immunizations of preschool children living in rural areas is lower than 90%. These too-low rates have been attributed to many factorsin the literature. The need was identified for research into what barriers, if any, parents encounter in getting their children the appropriate immunizations. The objective of this study was to discover if parents living in Wattsburg and Corry, in Erie County Pennsylvania, perceived any reasons for difficulty in getting their preschool children the immunizations they need. Interviewers were trained to use the interview questionnaire in order to maximize interviewer consistency, and to protect the subjects' anonymity. The target population was parents or primary caregivers of children under the age of 7 who resided in either Wattsburg or Corry in rural northwestern Erie County, Pennsylvania. The sample was a convenience sample. The 51 subjects were interviewed using a structured script and survey questionnaire, at three grocery stores located in the two areas of interest. Coupons and magnetic coupon holders were given as incentives to the parents to encourage completion of the interview. Subjects consisted of anyone who was the parent or primary caregiver of a preschool child under the age of seven and willing to complete the interview. The survey consisted of 34 questions designed to elicit both qualitative and quantitative data. The use of a small accidental sample was a limitation of this study. Results of this study confirm the hypothesis. Some parents of preschool children in these two areas do report barriers to immunizations and well child care.

Literature indicates that the majority of primary care providers are not meeting the health care needs of their adolescent patients. A survey of parents of adolescents with Down syndrome was conducted to determine the parents’ perception of the extent to which primary care providers are addressing the unique needs of their adolescent patients with Down syndrome. The tool utilized was a researcher developed survey that assessed the frequency of performance of multiple health care screenings and education as recommended by Guidelines for Adolescent Preventative Services, the American Academy of Pediatrics, and the Down Syndrome Medical Interest Group. The sample consisted of the parents of seven female and six male adolescents with a mean age of 15.77 years. The results from this study indicated that primary care providers were not addressing the unique health care needs of their adolescent patients with Down syndrome.

There has been a large increase over the last 10 years in the use of herbal remedies by the general population of the United States (Greenwald, 1998). The FDA does not regulate herbal remedies as drugs but as nutritional supplements (Glisson, Crawford, & Street, 1999). Up to 75% of patients are self-medicating with herbal remedies without consulting primary care physicians and practitioners (Glisson et al., 1999). There is a potential for drug-drug interactions, side effects from inappropriate dosing, and delay in the treatment of serious medical conditions with self-medication with herbal remedies (Barnes, Mills, Abbott, Willoughby, & Ernst, 1998) Understanding the reason for the nondisclosure of herbal remedy use is critical to the improvement of physician-patient communication and patient care and safety (Glisson et al.)).

A self-administered survey was conducted in a large rural primary care facility to further define demographics of herbal remedy users, to assess why they choose to utilize herbal remedies, and to assess the patient-provider communication barriers concerning herbal remedy use. The survey had an 86.5% return rate and showed that in this population sample of 865 subjects, 49% had used herbal remedies at some time. The herbal remedy users were more likely to be 36 to 45 years of age (%2=7.2, p=0.01), have about the same household income as nonusers, 2 be married, have some college or vocational education (% =13.4, p=0.001) or bachelor degree (X2=9.8, p=0.01), and, like nonusers, rate their overall health as "good" on the day of the survey.

In summary, the percent of herbal remedy users in primary care practices is much higher than the previous studies have shown. Fifty-seven percent of all subjects had not offered or asked information about herbal remedies from their providers and staff. Ninety-five percent of respondents had not been asked about them by the staff. Communication barriers may be causing a situation where herbal remedy users might have drug/herbal remedy interactions that would affect their medical care. Suggestions are offered for better provider/patient communication as well as future research.

Literature indicates that pediculosis capitis is a common contagious communicable disease among school age children. It is only exceeded in frequency by the common cold. Presently, there is no pesticide treatment that is 100% effective. Recent studies have shown that some lice are becoming resistant to the recommended pesticides. To ensure effective treatment, three steps are involved: use of the lice killing product in the safest most effective way, meticulous removal of all nits (lice eggs) and the treatment of personal articles and the environment.

This study, utilizing a self-administered researcher designed questionnaire, first gathered information regarding current occurrences, screening practices, policies, and protocols used by elementary school nurses in Mercer and Crawford Counties in northwestern Pennsylvania. The sample consisted of 17 practicing school nurses with a mean 14.7 years of experience in this field. The results from this study indicated that these school nurses were not currently implementing all of the interventions needed to make up an effective pediculosis prevention program. These survey results were then incorporated into the development of a protocol to be utilized by school nurses as a guideline for pediculosis preventive practices.

Little is known about personality traits of nurse practitioners (NPs). This information would be useful to the individual NP, the profession as a whole, and to foster educational offerings to mentor these traits in future NPs. The purpose of this study was to identify the personality traits of a sample of student nurse practitioners (SNPs) and NPs using the Guilford Zimmerman Temperament Survey (GZTS). The Model of Nursing Knowledge developed by Chinn & Jacobs-Kramer (1988) was used as the conceptual framework for this study. This Model defines the specifics of self and other as they relate in a conversation.

The GZTS was self administered by Internet access to the forty-four volunteer participants of 11 SNPs and 34 graduate NPs from a community in northwestern Pennsylvania. A comparison was made between these two groups and between the two groups and the Guilford data bank base population of 619 nursing student applicants (Guilford 1976). Trained staff from Career Assessment Concepts, Inc. of Erie, PA analyzed each individual's results. Grouped data was then forwarded to the researcher. No significant differences were found among the study participant group as compared to the normative base population of nursing student applicants. Of the ten personality traits according to Guilford, the study participants had mean scores higher in the areas of general activity, restraint, assertiveness, and masculinity (Guilford, Zimmerman, & Guilford, 1976).

Additional research within a larger nurse practitioner population is recommended. This will up date the data base population to include specific personality trait information for the nurse practitioner. This study was supported in part by a grant from Sigma Thetu Tau, International, Nu Theta Chapter.

The purpose of this study was to analyze the relationship between postmenopausal estrogen therapy and the presence of coronary artery disease (CAD), giving consideration to the other coexisting CAD risk factors of obesity, smoking, hypertension, diabetes mellitus, and CAD history. A retrospective descriptive research design was utilized. Data were collected using a researcher-designed survey that included subject interview and medical record review. The sample of 36 postmenopausal women was classified into 3 groups according to estrogen use: current users (n=9), past users (n=5), and those who had never used estrogen (n=22). The data were analyzed using descriptive and inferential statistics and nonparametric tests. A p=0.05 level of significance was used. A Fisher’s exact test showed no statistically significant differences among the estrogen groups in the presence of CAD or presence of obesity, smoking, hypertension, diabetes mellitus, and CAD history. A Cramer’s V was used for analysis of relationships in the study. A low positive correlation (PH).26) was found between estrogen use and the presence of CAD, however this was not statistically significant. A strong positive relationship (r=1.00) was found between history of CAD and presence of CAD in past users of estrogen (n=5), which was significant at p=0.03. The benefit of estrogen therapy as a means of CAD prevention in postmenopausal women cannot be inferred from the results of this study.

The purpose of this research study was to determine if rural health clinics were adequately prepared for pediatric medical emergencies. Preparedness was determined based on availability of minimal basic equipment, medications, and training as identified by the Committee of Pediatric Emergency Medicine guidelines (AAP, 1992). This study focused on rural health clinics in Crawford, Forest, and Venango counties. Eleven clinics participated. It was found that none of the clinics had every piece of equipment, two of 11 (18%) had all medications, and 18% had all the staff with Basic life support certification. The preparedness scores ranged from 35% to 89%, with no clinics reporting all the items recommended for minimal preparedness.

Recommendations included increasing education of primary care providers to better prepare the rural health clinic environment. Further research studies, more published literature, and legislation to establish criteria for minimal equipment, medications, and training were identified to improve preparedness.

National efforts have been directed toward the reduction of vaccine preventable diseases through improved immunization rates. The purpose of this study was to determine the
immunization status of a rural childhood population. Percent of children with up-to-date immunization series and individual antigens was calculated at the ages of 12 and 24 months, and school entry. Percent of children with age appropriate immunization series was calculated at the ages of 3, 5, 7, 16, and 19 months, and school entry. Data were compiled using
school-based Certification of Immunization Records of 122 kindergarten students in a rural school district in northwestern Pennsylvania.

This study examines the correlation between stress and academic performance using the life events model to measure stress. Full-time nursing students enrolled in an associate degree program at a rural community college were participants in this study. This study concludes that there is a weak negative correlation between stress and grade point average; r=.2553 with a significance of .024. Further study is recommended to examine the effect of coping strategies, age, socioeconomic status on stress and its relationship to academic performance among community college students.

With patient education achieving a position of prominence in today’s healthcare industry, tools to make the process easier and more effective are necessary. Printed educational materials are the most common form of instructional materials used, and the most economical. Obese patients participating in the Fen/Phen Weight Management Program, require detailed instruction in three major areas, proper usage of the anorexiant drugs dl fenfluramine and phentermine, a healthy eating plan, and an exercise program.

A patient education manual was constructed following the Evaluating Printed Education Materials (EPEM) Model developed by Bernier and Yasko (1991). The manual discusses medication administration and side effects, a healthy eating plan, and an exercise program. The SMOG formula, developed by McLaughlin (1969), was used to place the manual at the eighth grade readability level.

As health promotion and disease prevention becomes more of the focus for the primary care patient, education materials will be in greater demand. Printed education materials can provide an easily accessible source of information for patients to learn from and refer to at home (Bernier and Yasko, 1991). With women composing the largest segment of the elderly population there is increasing need for women to participate in weight bearing physical activities to promote optimal health throughout the lifespan (Evans & Nies, 1997).

A strength training pamphlet was constructed using the Evaluating Printed Education Materials (EPEM) Model developed by Bernier and Yasko (1991). Nola Pender’s (1996) revised Health Promotion Model (HPM) was used as the theoretical framework. The pamphlet teaches the techniques of using strength training to prevent bone density loss. The nurse practitioners role was to develop a pamphlet on strength training which promotes wellness. The SMOG formula was used to place the pamphlet on a 7th grade reading level (McLaughlin, 1969).

The purpose of this project was to develop an educational web-site for the parents of children with chronic constipation. As the climate of health care continues to change, patient education becomes a greater responsibility for health care providers, assessing and meeting informational needs of patients and their families are integral parts of health care practice (Canobbio, 1996). The nurse practitioner, at the forefront of healthcare, can use this tool to help patient and their families to combat the feeling of powerlessness that so frequently accompanies a health crisis (Davidhizer, 1992).

Chronic constipation in children is a frequent complaint in the primary care setting (Kirchner, 1999). Both a physical and emotional problem, it exacts a huge toll on the psychological well being of the family by eroding the self esteem of the child, and also the parents and their belief that they can effectively parent (Di Lorenzo, 2000). There is a deficit of educational material on this topic, particularly on the Internet. The Internet is the place to which more and more parents turn for medical information and emotional support (Chi-Lum,1999).

This thesis is a compilation of literature, and conclusions looking at the relationship between relationship between depression and quality of life in the community based elderly. The literature provided a great deal of information discussion the prevalence of depression in the elderly, and the corresponding need for quality of life.

The Geriatric Depression Scale was used to measure elderly depression, and the Life Satisfaction Index was used to measure quality of life. The two tools are less than 25 items in length promoting the participant's ease in completion. The scoring of the two tools are inverted. A low score on the Depression Scale would indicate a low level of depression, where a high score on the Satisfaction Index would indicate a positive view of quality of life.

The research data will establish the existence of the relationship between depression and quality of life. Even though a statistically significant relationship was established, a low level of predictability was obtained.

The purpose of this research was to assess the effectiveness of acupuncture for adults aged 20 to 50 with acute low back pain. Very little research has been conducted in this area, but case studies indicate that acupuncture has the potential to shorten disability, decrease medical costs, and hasten pain relief.

This retrospective study examined the difference in perception of pain experienced by subjects before and after a single acupuncture treatment. Acute low back pain was defined in this study as pain of less than 3 months duration in the absence of a serious underlying pathology. The subjects were between 20 an 50 years of age. This convenient sample of 12 patients completed a 0 to 10 pain scale prior to a single acupuncture treatment and again the day after the treatment. Treatments were administered by two certified acupuncturists. The results were analyzed using a one-tailed dependent t-test and revealed that there was a significant decrease in the perception of pain 24 hours after acupuncture treatment.

This study will enhance the knowledge of the health care community, as well as encourage additional research into acupuncture as a way of easing pain and decreasing medical costs. Recommendations for further research are made.