Nursing (M.S.)

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.