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.

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.