School of Nursing Dissertations Collection

The Theory of Compromised Eating Behavior

Furman, Ellen Frances — Tue, 06 Mar 2012 10:02:32 PST

The purpose of this inquiry was to develop substantive theory that describes the social process that influences the eating behavior of hospitalized older adults. Undernutrition or the inadequate intake of dietary nutrients necessary to maintain health, contributes to negative health outcomes such as increased morbidity and mortality in hospitalized older adults. Inadequate dietary intake is a risk factor for undernutrition. Despite the availability of vast resources within the hospital environment, hospitalized older adults have inadequate dietary intake. Undernutrition has been studied from a dietary intake perspective; however, why dietary intake remains inadequate is unknown. Inquiry of eating behavior and the social process that influences eating behavior will provide insight into why dietary intake remains inadequate. The Quality Health Outcomes Model was the conceptual framework that guided this inquiry. A qualitative, grounded theory methodology was used to investigate this phenomenon. Participants included acutely ill, hospitalized older adults and their healthcare providers. Field work included observation, interview, and document review to better understand the actions, interactions and perceptions of participants as to the process that influenced hospitalized older adult eating behavior. Datum was compared, coded, and analyzed using the constant comparative method. The Theory of Compromised Eating Behavior was developed and describes the process of compromise older adults experience related to eating behavior while hospitalized. The Theory has four stages: self-indication, joint-action, negotiation, and action. Hospitalized older adults choose to compromise their health should they eat inadequately or alternatively compromise their acculturated foodways should they eat adequately. Additionally, healthcare providers compromise their beliefs when older adult patients do not eat adequately. Older adults are at risk for negative health outcomes due to inadequate dietary intake while hospitalized. The meaning of hospital food and mealtimes differs from traditional food and mealtimes for the older adult, resulting in compromise. Intervention which enhances the meaning of food and mealtimes for the older adult during hospitalization may improve dietary intake and nutritional outcomes.

Characteristics of patients on telehealth that influence their heart failure outcomes in the home-care setting

Radhakrishnan, Kavita — Wed, 18 Jan 2012 12:12:16 PST

Individuals with heart failure (HF) are often readmitted within 30 days of discharge from the hospital. Telehealth has been developed to help manage HF during this critical period. However, association of telehealth with improved HF outcomes is still unclear. There is a need to identify the patients who benefit most from telehealth and explore factors that work in conjunction with telehealth to improve HF outcomes. Therefore the purpose of this study was to explore the patient characteristic factors that impact health status and healthcare utilization outcomes of patients with HF who use telehealth in a homecare setting. ^ A descriptive, correlational study design using retrospective chart review was employed. The sample comprised Medicare patients admitted to a New England homecare agency, with HF as a diagnosis and had used telehealth from 2008 to 2010. OASIS and electronic documentation at the homecare agency served as data sources. Descriptive statistics, logistic and multiple regression analysis were used to analyze association of patient demographic, psychosocial status, and disease characteristics with HF outcomes of patients on telehealth. ^ The sample size was 403, of whom 70% were over 75 years of age, 55% were female, and 94% were Caucasian. Number of nursing contacts ranged 1 to 26 with a median value of 10. There were 118 (29.3%) all-cause readmissions, 76 cardiac-related hospitalizations (18.9%), 17 cases with mortality (4.2%) and 52 (12.7%) abrupt terminations of telehealth. For patients with HF on telehealth, patient characteristics such as: anxiety, high number of medications, acute cardiac events, musculoskeletal, psychiatric and anemia type of co-morbidity were associated with high nursing utilization patterns; dyspnea, high number of medications, obesity, ACEI/ARB and beta-blockers were associated with hospitalizations; and renal, psychiatric and cancer type of co-morbidities and female gender were associated with unplanned termination of telehealth. Abrupt termination of telehealth was also found to be correlated with hospitalizations. The findings of this study contribute to our understanding of healthcare utilization by patients with heart failure on telehealth.^

Nurse clinician self-disclosure: A qualitative study

Baldor, Kathryn Rising — Wed, 18 Jan 2012 12:11:10 PST

The nurse-client relationship is the context in which all nursing care is delivered. Despite changing trends in mental health nursing, authenticity has been identified as an enduring aspect of the therapeutic relationship. A behavioral aspect of therapeutic relationships that expresses authenticity on the part of the clinician is self-disclosure. The decision to self-disclose to clients remains a complex and unexplored area of clinical practice. As healthcare and economic trends push for briefer treatment in mental health, nurses are exploring new ways to build the therapeutic alliance more efficiently. Research from other disciplines indicates that therapist self-disclosure may have therapeutic value. This hermeneutic, phenomenologic study explored the experiences and the meaning that psychiatric nurse clinicians make of self-disclosure, and inevitably, nondisclosure in their therapeutic relationships with clients. ^ Participants included 13 European American nurse practitioners or clinical nurse specialists board-certified in mental health nursing with at least 4 years experience. Data were collected from demographic questionnaires, interviews, written correspondence, and researcher notes.^ Narrative analysis revealed five types of self-disclosure: (a) environmental; (b) intentional-direct; (c) intentional-indirect; (d) unintentional-direct; and (e) unintentional-indirect. The data also yielded antecedents contributing to decisions by participants for both disclosure and non-disclosure with clients. Goals, benefits, positive experiences, risks and negative outcomes were explored for clinician self-disclosure. The participants’ perceptions of the meaning of self-disclosure were described. Results showed the context that participants developed for actual use of self-disclosure was well developed with specific antecedents. Self-disclosures were usually seen as effective when carefully applied based on assessment of the client’s developmental stage, the length of the relationship, client need, and boundary strength. Self-disclosure, to be effective, seems to be associated with a level of context-dependent discernment and relational skill found in the experienced or expert nurse. Finally, changing patterns in the use of self-disclosure by nurse clinicians emerged from the interview data.^ Implications for practice include participants’ belief that self-disclosure by the clinician is unavoidable and that it can contribute to strengthening or weakening the therapeutic alliance. As such, self-disclosure by clinicians warrants training and discussion. Further research in the area of nurse clinician self-disclosure, especially client perceptions of the experience and its meaning, is indicated.^

Healing experiences of Chinese Americans with cancer illness in the United States

Wu, Jui-Wen — Wed, 18 Jan 2012 12:11:04 PST

Cancer is the leading cause of death among Asian or Pacific islanders (AAPIs) while it is only the second leading cause of death in other ethnic groups. Chinese Americans are the majority and the fastest growing sub-ethnic group of AAPIs. A cancer experience in some ways may make their lives more complicated than the lives of nonimmigrants. The challenges facing individuals with cancer often continue after leaving the acute care setting. Healing in relation to quality of life for cancer patients has been reported. Although the issue of healing has long been addressed in nursing literature, none of these studies have explored Chinese Americans with cancer illness.^ This phenomenological inquiry, grounded in Newman's theory of health as expanding consciousness and Heidegger's phenomenology aimed to explore the healing experience of Chinese Americans with cancer illness. Eight adult Chinese Americans with a cancer history completed interviews. The term (Quan Yu) were used as a translation for the word healing in interviews. Van Manen's methodical features and three approaches were utilized for gaining understanding of healing within cancer illness. Five criteria of appraisal trustworthiness as suggested by deWitt& Ploeg were utilized. ^ Four themes grounded in the recognition of cancer within oneself were: from common knowledge to personal ownership; seeing and naming cancer within oneself; one's theory of answering the "why me?"; and a changing pattern. The healing experience was introduced as an ongoing span, named healing in progress. The meaning of healing was central to the theme, healing (Quan Yu) as experiencing fullness of recovery from cancer illness. Three manifestations in healing included confidence, health and spirituality.^ This inquiry explored healing by adopting a healing outcome-based approach without assuming the causality between any specific healing practices and the healing outcome. Through appreciating healing within cancer illness we could become much more appreciative of our own being. Future studies may explore the issues of normalcy and stigma and how they are intertwined in one's healing experience.^

Puerto Rican Teens' Perceptions of Teen Pregnancy and Births in Holyoke, Massachusetts

Gilbert, Nancy J. — Fri, 19 Aug 2011 08:51:48 PDT

The high teen birth rate in Holyoke, Massachusetts is a complex problem. The teen birth rate is over five times the state‘s rate and nearly three times the national rate. Since a majority of these births are to Latinas of Puerto Rican descent it is important to include the perceptions of Puerto Rican teens in approaches to prevent teen pregnancy and reduce the birth rate. Although there is a plethora of research on the topic of teen pregnancy and births, there is scarcity in the area of perceptions held by teens of Puerto Rican descent about teen pregnancy and births, future consequences faced by teen parents, contributing and protective factors of teen pregnancy, and potential preventive interventions. This qualitative study used a series of eight focus groups to gather data and examine perceptions held by Puerto Rican teens living in Holyoke about teen pregnancy and birth. The Ecological Model of Health Behavior provided the theoretical framework. Findings indicate that Puerto Rican teens in Holyoke perceive that: teen pregnancy is largely unintentional and a problem with negative outcomes, a lack of information on sexual health and reproduction contributes to this problem, sexual and reproductive health education should be provided to all teens, social factors may either contribute to or prevent teen pregnancy teens, and they want their ideas heard. These findings suggest that teen pregnancy and birth is a complex public health problem in need of a comprehensive approach recognizing that interventions focused on individuals are not likely to have powerful or sustained effects. Rather a combination of interventions addressing individual, interpersonal, community and societal levels are needed for risk reduction and effective behavior change

Living With a Depressed Partner

Logan, Bridget — Thu, 07 Apr 2011 11:48:10 PDT

Individuals who live with depressed partners have increased rates of anxiety, depression, and difficult coping. They experience greater burdens of parenting and financial responsibilities, and often feel isolated and restricted. Much of this is similar to what has been termed caregiver burden in the context of other illnesses. This study used qualitative interviews to explore the day-to-day experience of what it is like to live with a depressed partner, as well as to test the fit of the term `caregiver burden' in the context of depression. Participants were seven individuals who were in long-term relationships with depressed partners. Analysis of the interviews identified four stages of a helping process that individuals go through as they care for their depressed partners and transition from partners to caregivers. These individuals are experts on their partners and have important perspective and essential support to offer when their depressed partners are seeking care. Findings underline the importance of advanced nursing and medical care that recognizes the significant burden that nondepressed partners experience and the important ways that they can help their depressed partners seek and stay with treatment.

What Women Want to Know: Assessing the Value, Relevance, And Efficacy of a Self-Management Intervention for Rural Women with Coronary Heart Disease

Madison, Holly Evans — Fri, 03 Dec 2010 10:26:14 PST

Background: Women have experienced increased mortality from coronary heart disease over the last two decades, while men‘s rate has declined. This suggests that current treatment and prevention strategies are less effective for women. Furthermore, since most women don‘t participate in cardiac rehabilitation, alternatives to these programs must be explored. Purpose: This study sought to refine an intervention for rural women with coronary heart disease designed to promote self-management and provide pilot data evaluating the efficacy of the intervention. Design and Methods: The study design was mixed methods. Focused qualitative interviews provided data regarding the self-management program. In-depth interviews determined the efficacy of the intervention including adoption of health promoting behaviors, self-awareness, and self-efficacy. The Self-efficacy for Managing Chronic Disease 6-Item Scale provided additional efficacy data and was administered over the course of the study. Ten women from rural New England, diagnosed with coronary heart disease within the last year, comprised the purposeful sample. Findings: The self-learning program met the women‘s needs; however they provided suggestions for improvement. While the women reported varying degrees of self-awareness, many believed the self-learning program influenced their adoption of health-promoting behaviors. In the interviews, the women expressed confidence in their ability to manage their disease; a finding that was congruent with the findings of the self-efficacy scale. Improvement was seen in five of six items on the self-efficacy scale from pre- to post intervention. The women‘s confidence in managing other symptoms or health problems and management of problems related to heart disease saw a statistically (p > .05) significant increase post intervention, and that increase persisted. One item, emotional distress, was flat over the series of administrations. Conclusions: Since women differ from men in the development, expression, and treatment outcomes for coronary heart disease, educational programs that address those differences and meet their needs must be developed. This study demonstrated that a paper-based, holistic, self-management program is a viable alternative or supplement to traditional cardiac rehabilitation programs. Using the self-and family management framework, this intervention enabled women to learn how to care for themselves.

Transition to Fatherhood: A Puerto Rican Perspective

Barenski, Suzanne — Wed, 01 Dec 2010 09:55:50 PST

The purpose of this study was to explore the events that have promoted or hindered a first-time Puerto Rican father's transition to fatherhood. Interviews were conducted with twelve fathers who reported one child one year of age or less. Within the United States the Hispanic population is the largest and the fasting growing minority population. Early father involvement for immigrant and ethnically diverse families has not been widely studied. Analysis of the interview data revealed two main themes; "Accepting of Fatherhood" and "Adjusting to Fatherhood." Specific to these themes, three categories became apparent; "Buying-In: Initial Step to Fatherhood," "The Journey: Going Through It," and "Moving Into Fatherhood: The Rest of the Story." Four sub-themes emerged and were relevant to the second stage: "emotions, connections, recognition, and responsibility." The journey and moving into fatherhood stages were conceptualized as a circular relationship allowing the father to interact with new experiences as the opportunity or challenge arises. Meleis' middle range theory of "Transitions" provided the theoretical framework for the study. Findings indicated most fathers in this study were highly present and involved throughout the childbearing period and the joy these fathers expressed for their child was clearly described. Fathers also identified feeling of exclusion and wanting to be viewed as an equal status parent with the mother. Fathers expressed appreciation for the opportunity to tell their story. These findings are supportive of the contemporary view of machismo. Policy and practice implications are described for educational programs and future research.

The Lived Experience of College Sudents Who have Been Medicated with Antidepressants

Aselton, Pamela Joan — Mon, 04 Oct 2010 13:53:24 PDT

Increasingly in the last two decades college students have been diagnosed with depression, with estimates of major depression higher than the general population (American Psychiatric Association {APA}, 2005). According to the literature, the stresses of college life along with increased rates of substance abuse, and binge drinking have contributed to the rise in depression in this population. In a large survey of American college students, over half reported some depression since entering college (National Center on Addiction and Substance Abuse {NCASA}, 2003). Correspondingly, the percentage of young people treated with antidepressants has grown over the past decade, and there is concern that for younger individuals the newer antidepressants may increase suicidal ideation (Simon, 2006). Suicide is the second leading cause of death among college students, and although people between the ages of 20 and 24 who are not in college are more likely to commit suicide, one study found that 10% of college students interviewed had considered suicide within the past year (NCASA, 2003). Although numerous studies have been completed (Wagner, Ambrosini, Rynn, Wohlberg, Yang, Greenberg et al., 2003; Keller, Ryna, Strober, Klein, Kutcher & Birmaher et al., 2001) to determine the appropriate use of antidepressants in depression, there have been few qualitative studies available that actually explore the experiences of young people being medicated with antidepressants (Fornos, Mika, Bayles, Serrano, Jimenez & Villarreal, 2005; Simon, 2006; Dundon, 2006). The purpose of this descriptive exploratory study was to explore how college students perceive the experience of having been medicated with antidepressants. A review of the literature related to depression and college students, the causes of stress in students‟ lives, non-medical treatment of depression, plus information on the SSRI antidepressants is presented. The study describes the lived experience of college students prescribed antidepressants utilizing phenomenology as its philosophical basis. The internet was used to obtain informed consent, and conduct qualitative interviews to gather information on students‟ lived experience. These interviews explored the students‟ experiences with being medicated for depression with antidepressants, and their experiences with stress, anxiety and depression in college. In presenting the findings, whenever possible the students own words were used to describe their experiences with antidepressants. The main findings of the this qualitative study included a feeling of numbness in students who were on antidepressants, a general dislike for the medication, even if they felt it was initially useful. It also presents a picture of the academic, familial and financial stresses college students are under as well as alternate ways they deal with depression and stress. Exercise, music and marijuana were seen as great stress relievers, and talking to good friends very helpful for overcoming depression. The students advised others to carefully do their research before they decide to start on an antidepressant medication. Implications for nursing and the role of Nurse practitioners in making decisions about medicating depressed college students are discussed.

Contentment in "Songs of the Gorilla Nation: My Journey through Autism": A humanbecoming hermeneutic study

Bonis, Susan A — Tue, 25 May 2010 11:00:59 PDT

Contentment is a universally lived experience that is inexplicably intertwined with health and quality of life. The aims of this humanbecoming hermeneutic study were to identify the essence of the experience of contentment, to contribute to knowledge about humanbecoming, and to contribute to the knowledge base of nursing. The source of data collection was the text of Songs of the Gorilla Nation: My Journey through Autism. Through a hermeneutic process of discoursing with penetrating engagement, interpreting with quiescent beholding, and understanding with inspiring envisaging the structure of the lived experience of contentment was illuminated in the text. The finding is that contentment is enduring serenity unfolding with inspiring unburdening as cherished convictions arise amid disharmony. This finding is comprised of three core concepts: enduring serenity, cherished convictions, and inspiring unburdening. This answers the research question: What is the structure of the lived experience of contentment as described in the text of Songs of the Gorilla Nation: Living with Autism. The findings are discussed in relation to how they enhance understanding of contentment and humanbecoming and how they can inform practice and future research.^