Specific aims included (a) describing the estimated risk of CVD, the perceived risk of CVD, and the level of CVD risk factor knowledge; (b) describing the relationship between estimated and perceived risk, and (c) examining the influence of risk factor knowledge on perceived risk of CVD. The Health Belief Model was the theoretical framework that guided the study.

Methods: A prospective observational cohort; cross-sectional design. A convenience sample of 130 HIV-infected adults was recruited from two hospital-based HIV clinics. Each participant had one study visit in which all data were collected by direct interview.

Results: Results: Mean age of enrollees was 48 years (SD 8.4); 62% were male; 41.5% White, 32% Black, 23% Hispanic; 56% current smokers; mean years since HIV diagnosis were 14.7; mean BMI 27 (SD 5.5); 48.5% had prehypertension. Higher scores on the Heart Disease Fact Questionnaire indicate a higher degree of knowledge. In this sample, the Mean was 19, (S.D. 3.5; range 6–25), indicating a fair degree of knowledge. Estimated and perceived risk were significantly, though weakly, correlated r (126) = .24, p = .01. Controlling for age, risk factor knowledge was not predictive of perceived risk (F[1,117] = 0.13, p > .05).

Conclusions: HIV-infected adults are at increased risk for cardiovascular disease. Traditional CVD risk factors such as smoking, prehypertension, and being overweight are highly prevalent. Despite having a fair level of risk factor knowledge, knowledge did not influence perception of risk for CVD. Research to improve risk perception and to develop innovative interventions that reduce CVD risk is needed for this population.

Five focus groups with 29 SN were conducted and four themes emerged through analysis of data: Frequent flyers : student visits to SN offices, the observations that alert SN to potential MEB needs; Digging to get the whole picture : the process SN frequently used to collect information necessary to confirm MEB needs; Road to referral : the resources used and barriers encountered within the referral process; and, Safety zone : the important role SN play in the provision of services to students with early signs of MEB needs. Within the provision of services was a collective subtheme across all five focus groups: What we need to better help our kids. In this category SN identified their educational limitations and learning needs, as well as potential strategies to improve provision of services for students with MEB needs.

The findings of this study provide a lens into the complex and little explored are of early identification, referral and intervention processes used by SN to care for students with MEB needs. Understanding the role of the SN is a critical first step towards improving outcomes.

This Internet-based mixed-methods study used a dominant Qualitative Descriptive design with embedded quantitative QoL measurements. Participants completed the quantitative questionnaires online while open-ended questions were completed either online or by telephone. Interview data were analyzed through Qualitative Content Analysis; descriptive statistics were used to explore the quantitative measures. Participants were stratified by discontinuation status for comparison of variations in discontinuation experiences, QoL and influencing factors.

Thirty-four women (20 stopped, 9 resumed, 4 tapering) were enrolled. One overarching theme--'a solitary journey'--emerged: although all women embarked on this journey, each woman traveled her own path. Two subthemes--'burden and interference' and 'appraising risk'--encompassed the symptom factors (severity, interference and sensitivity) that influenced women's experiences and the manner in which women evaluated their options. Other influencing factors included: readiness viii and reasons for stopping HT, beliefs about menopause and roles. QoL was strongly connected to symptoms for many but not all women. Information from health care providers was inconsistent; women desired more support from providers and other women.

The rich description of women's experiences stopping HT highlights the need for providers to assess women's sensitivity to symptoms and readiness to discontinue to determine which women might benefit from more support. Greater health literacy would enhance women's understanding of HT risks. More research is needed on symptom clusters and interference and strategies for minimizing their impact.

Data were collected in individual audiotaped interviews with participants recruited from the Massachusetts Breastfeeding Coalition and UMass Memorial Medical Center. Interview data were compared to text and visual representation from 12 Internet sites on parenting and infant feeding. Data analysis was conducted simultaneously with data collection and was continued until saturation was achieved. The comparison findings demonstrated that the emerging themes from the participant interviews reflected the information represented on the Internet sites.

The main theme Media Matters Not suggested that mass media did not influence infant feeding decisions for this group of mothers. What did have an important impact on infant feeding decisions was the information and emotional support provided by partners, family, and HCPs (subtheme of Influences on Decisions). The participants offered suggestions of media messages they would like see in the future such as public service announcements of women breastfeeding their infants. In addition, the participants discussed media issues that had potential for influencing infant feeding decisions (Media Messages—Good and Bad), emphasized the need for public opinion to be altered so that breastfeeding in public would be viewed as more acceptable (Community/Public Opinions), and described suggestions for enhancing media messages about breastfeeding (Recommendations for Future Media Messages). The implications for nursing practice, public policy, and future research related to the topic were discussed.

Qualitative content analysis was used to describe the healthcare experiences of lesbian, gay, and bisexual college students in the local community. One overarching theme (not all the same), one main theme (comfort during the clinical encounter), three sub themes (personalizing the clinical encounter, deciding to disclose and social stigma, and seeking support of self-identified sexual orientation) and one preliminary sub theme (perceived confidentiality) emerged from the analysis. One major action emerged from the analysis and supported the development of the social network site (on Facebook) entitled: College Alliance Towards Community Health (CATCH). The mission of CATCH is to provide LGB college students in the local community with a comfortable forum to learn about various healthcare concerns of lesbian, gay, and bisexual college students. Additional implications for nursing practice and implications for further research in the LGB college community are addressed.

Patient turnover was measured by Unit Activity Index (UAI). Patient acuity was measured using case mix index (CMI). Nursing workload was measured as hours per patient day (HPPD). The adjustment to HPPD was made through the derivation of a weight factor based on UAI and CMI. The study consisted of fourteen medical, surgical, and mixed medical-surgical units within a large academic healthcare center. Data from 3 fiscal years were used.

This study found that there were significant, but generally weak correlations between UAI and CMI and HPPD. The method of deriving a weight factor for adjusting HPPD was not as important as the decision-making relative to when to adjust planned HPPD. In addition, the measure of unit activity index was simplified which will assist researchers to more easily calculate patient turnover. As a result of this study, nurse managers and will be better able to adjust and predict HPPD in cases where benchmarking has been problematic. Data-driven adjustments to HPPD based on UAI and CMI will assist the nurse manager to plan and budget resources more effectively.

The findings revealed significant differences between adolescent stages on Collaboration with Parents and the Diabetes Problem Solving subscale. The covariate analysis showed no significant effect modification for the covariates and stage on any of the subscales so the results did not differ from the ANOVA model. Covariate analysis showed significant associations between regimen and Collaboration with Parents, Diabetes Care Activities and Diabetes Problem Solving. DOI showed significant associations only with Diabetes Problem solving and gender had significant associations with Diabetes Care Activities and Diabetes Communication.

The mean scores on Collaboration with Parents show an incremental decline in collaboration with parents as adolescents move through stages. The higher mean Diabetes Problem Solving scores found in the late adolescent group compared correlated with a higher degree of problem solving in this group when compared to those in the early or middle adolescent stage group. Regimen had significant associations with three of the five subscales suggesting this is an important variable for future study. DOI did not have a significant impact on self-management whereas gender related differences in the areas of Diabetes Activities and Diabetes communication warrant further investigation.

The study sample included 510, 352 service members (49,998 females, 460,349 males) with a mean age of 29 years. The sample represented all components and branches of the military. Of the total sample, 51.9% (n=264,777) saw wounded, killed or dead individuals and 22.1% (n=112,620) discharged their weapon in combat. Environmental exposures were an important source of stress. Exposures to sand and dust were the largest complaint (89.8% of the sample). Multiple physical symptoms were identified and 40% of the sample reported four or more symptoms (e.g. diarrhea, back pain, headache, fatigue). PTSD symptoms were identified in 11.8% (n = 60,200) and depressive symptoms in 26.5%, (n=123,808) of participants. Results of the study indicated that age, gender, rank, race/ethnicity, military component and branch were important predictors of emotional and health-related concerns in this sample. Appraisal variables (danger of being killed and exposure concerns) mediated the relationship between immediate (physical and depressive symptoms) and long term outcomes (health perception, PTSD symptoms) for the majority of the analyses; supporting the study hypothesis. However, length of deployment did not have a significant impact on stress-related outcomes in this study. Implications for practice, policy and future research are discussed.

However, there is a dearth of research on the benefits, advantages and disadvantages of HPS as well as the learning experiences of students who used HPS in their nursing education. Therefore, the purpose of this qualitative study was to describe and analyze the learning experience of baccalaureate nursing students who used HPS during their education. Focus group interviews with HPS students were recorded and transcribed for content analysis in NVIVO, a qualitative analysis software program. The results of the analysis were categorized into four major themes: Structure, Environment, Instructor and Learning. The findings revealed that HPS students felt that structure was critical to optimize learning opportunities. Students wanted to be properly oriented to the environment of the HPS sessions, and they felt that the lack of realism of the simulators did not negatively affect their learning. Students wanted knowledgeable and competent instructors who had good interpersonal communication and interaction skills. Last, students expressed that there were benefits from acting as both the nurse and the observer during HPS. The opportunity to make mistakes without harming a patient and to experience different types of nurse-to-nurse reports were viewed as positive.

The findings of the study suggested that further research about student perceptions of HPS learning experiences could provide valuable information for educators and policymakers to improve the implementation of HPS in nursing and medical education.

Four focus groups were conducted with 27 nurses who represented different types of emergency departments (rural community facility to large urban Level 1 trauma center). Results of the study suggested that the majority of participants (96%) experienced some form of work-related violence and 75% had attended at least one violence education class. The major themes of frustration and powerlessness emerged from the data. Sub themes included professional conflict while caring for violent patients, personal detachment as an emotional survival mechanisms, and feelings of victimization. Additional factors contributing to workplace violence included: personal attributes of the nurse, the workplace, and the community where the emergency department was located. These study results have potential to guide intervention development aimed at reducing workplace violence in the emergency department setting.

Critical incidents were limited to events with children, patient deaths, and interactions with family; this differed from prior research in that no incidents were identified involving multiple casualties, violence, or mutilating injuries. Connections occurred when the patient was known to the nurse or reminded the nurse of self or family. Responses were the reactions of the participants to the critical incident and were physical, psychological, and spiritual in nature. The majority of study participants cried in response to a critical incident. Workplace culture, a subtheme not found in other studies, involved their perceptions of expected behavior in the emergency department and emphasized the influence of workplace culture on newer or inexperienced nurses.

The theme of aftermath described the time period following critical incident. Lasting effects occurred in the form of vivid memories that were triggered by different stimuli. The subtheme, strategies, revealed that nurses desired, but lacked formal strategies to manage their reactions following a critical incident. Thus, they described the use of informal strategies such as talking to co-workers and family members.

Implications of this study support the need for educational preparation and support of emergency nurses who deal with critical incidents in the workplace. Intervening during the critical incident experience and having follow-up strategies in place to prevent distress and enhance coping in the aftermath are important for well-being, practice, and patient care in the emergency setting.

Therefore, the purpose of this qualitative study was to describe how critical care mid-level practitioners (N = 17) make decisions within an interdisciplinary team, undergirded by the cognitive continuum theory. A qualitative research design using focus groups guided by naturalistic inquiry enabled data collection. An interview guide, developed from the literature review and undergirded by the cognitive continuum theory, was used to structure discussion in the focus groups. Additionally, a demographic questionnaire and vignette were used to aid in description of findings. Data was managed by note based analysis and summarized on a Microsoft Excel document. Qualitative description was used to illustrate the findings.

Prior to this study, there was a paucity of empirical literature describing the clinical decision making of critical care mid-level practitioners. The findings revealed a web of complexity in mid-level practitioner decision making on an interdisciplinary team. This included an overarching theme of quality of care, with central overlapping themes of judgment, resources, and negotiation interwoven with sub-themes of trust, communication, experience, and team structure. This study’s findings have direct implications for mid-level practitioner training courses, mid-level training, critical care orientation programs, theory development, and health policy.

This study used a cross sectional survey design and venue sampling. The survey included demographic questions, the Self Nurturance Survey, the Heart Disease Facts Questionnaire, the Physical Activity Questionnaire, Prime Screen, and questions about financial strain, cigarette smoking, and alcohol use. The sample included 136 women (survey response rate = 57%), the majority of whom were white (94.9%), married (80.1%), did not smoke (80.1%) and rarely drank alcohol (57.4%).

Results indicated that study participants were very knowledgeable about CVRFs. (Mean knowledge score = 19.53, possible range = 0 to 25 with higher scores indicating greater knowledge). Knowledge did not predict physical activity (p = .07), diet (p = .08) or smoking status (p = .11) in this sample. Self-nurturance was moderately correlated (r = .33) with consuming a heart-healthy diet. Hypotheses derived from the Nemcek Wellness Model were not supported in this study. More research is needed to identify factors that will help women translate knowledge into heart-healthy behaviors.

This dissertation was a secondary data analysis that examined whether CNAs’ perceptions of patient safety culture were correlated with clinical outcomes in a random sample of 74 nursing homes in five randomly selected states. This study matched CNA PSC survey data using the Hospital Survey of Patient Safety Culture (HSOPSC) with Minimum Data Set (MDS), Area Resource File (ARF) and Online Survey Certification and Reporting (OSCAR) data from those same homes during the first two quarters of 2005. In the original study, 1579 nurse aides out of 2872 completed the survey, for a 55% response rate.

In addition to clinical outcomes, this study examined the relationship between CNA PSC scores and staff turnover. The relationship between certain demographic variables, such as level of education, tenure as a CNA, and PSC scores was evaluated. The relationship between certain facility characteristics, such as profit status and bed occupancy was also assessed. An exploratory factor analysis of the original HSOPSC instrument was re-run for this nursing home CNA sample.

Data were analyzed using Poisson regression and multilevel techniques; descriptive statistics were compiled for demographic data. Major findings from the regression analyses and combined GEE models suggest that certain factors, such as CNA turnover and LPN staffing may predict CNA PSC scores. CNA PSC scores were associated with rates of falls and restraint use, but were not associated with differences in pressure ulcer rates in this sample. Few associations for CNA PSC with individual subscales were identified. The exploratory factor analysis revealed some potential differences in how items and subscales factored in this nursing home CNA population.

This dissertation represents an important step in the evaluation of CNA PSC in nursing homes and the relationship of PSC to safety outcomes. Future work on nursing home PSC and clinical and workforce outcomes is described.

Using the clinical microsystem as the conceptual framework, this qualitative descriptive investigation identified and described: 1) the components of systems knowledge needed by nurses, 2) how systems information is exchanged between nurses, and 3) systems information exchanged between staff nurses and travel nurses. Data were collected from a stratified maximum variation sample of 18 nurse leaders, staff nurses, and travel nurses working within a high-functioning neonatal intensive care nursery within a large academic medical center in New England. Data collection methods included participant observation, document review, individual interviews, and a focus group session. Data were analyzed through constant comparison for emerging themes and patterns. Findings were compared for commonalities and differences within and across groups.

Three components of systems knowledge emerged: structural, operational, and relational. Systems information exchange occurred through direct and indirect means. Direct means included formal and informal mechanisms. The formal mechanism of orientation was identified by each participant. Informal mechanisms such as peer teaching, problem solving, and modeling behaviors were identified by participants from each of the three nurse groups. Travel nurses’ descriptions of the common themes focused on individual efficacy. Staff nurses focused on fostering smooth unit functioning. Nurse leaders described common themes from a perspective of unit development. Four overarching domains of systems information were exchanged between staff nurses and travel nurses: practice patterns; staffing patterns and roles; tips, tricks, tidbits, and techniques; and environmental elements. Communication emerged as a common theme across nurse groups and domains of systems information exchanged. These findings have implications for nursing orientation and staff development, continuous improvement at the local level, and curriculum development.