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Kristal L. Barbee
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Abstract: Nurses’ Beliefs and Teaching Practices of Postpartum Contraception Education
Among Postpartum Women
The rate of unintentional pregnancies is a concern in the United States. Although many
contraception options are available, unplanned pregnancies continue to be a cause for concern.
Targeting women in the postpartum period with education regarding contraception options may
be one way to reduce the rate of unintentional pregnancies. The purpose of this study was to
determine nurses’ beliefs and teaching practices regarding delivering contraception education to
postpartum women. A descriptive, exploratory study was used to survey 17 postpartum nurses at
The University of North Carolina Hospitals about their beliefs and teaching practices. This study
found that postpartum nurses do not believe contraception counseling is a priority among
postpartum women. The level of expertise involving different birth control methods varied
among nurses, and nurses reported needing more time to educate postpartum women adequately
about contraception. The researcher did not determine which healthcare professional should be
the one to provide contraception counseling to postpartum women. She did, however, rate oneon-one teaching as the most effective modality for educating new mothers about available
contraception methods, and she ranked adolescents as the number-one priority to receive
discharge teaching followed by all other mothers ranked equally. The dissemination of these
research findings will advance efforts to prevent unintentional pregnancies among postpartum
women.
Susan Barham
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Abstract: Evidence-Based Comfort Measures for Intrapartum Care
Research on the effectiveness of intrapartum comfort measures is lacking. Previous studies have
examined the better-known methods, such as epidurals, but little is known about alternative
interventions and the usefulness of one-to-one nursing support. This review of literature explores
several studies that have examined the various types of intrapartum care. The purpose of this
paper is to discover which comfort measures and interventions for women in labor are supported
by research. More specifically, the efficacy of complementary therapies such as aromatherapy
and acupuncture, the risk and benefits of epidurals, and the value of one-to-one nurse support
during labor were explored. After a review of the literature, the reviewer was able to make
several conclusions. Epidurals are highly effective in controlling pain during labor, but there are
serious risks that patients need to understand. Limited research describes the effectiveness of
alternative therapies, including aromatherapy, whirlpool baths, sterile water blocks, acupuncture,
and transcutaneous electrical nerve stimulation (TENS). Findings from the studies reviewed
suggested that alternative therapies did not have harmful effects for the mother or fetus and that
one-to-one nursing support was effective in decreasing cesarean sections and other medical
interventions. However, more research is needed in these areas before nurses can feel confident
that they are practicing evidence-based care.
Suzanne Brown
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Abstract: Homeless Children’s Access to Preventive Health Care in Durham,
North Carolina: A Resource Inventory
Despite a recent trend toward wealth and prosperity in our country, a rising rate of family
homelessness severely affects children. Homelessness and poverty have detrimental effects on
children that place them at risk for short-term and long-term physical and psychosocial problems.
Indeed, homeless children have more developmental, physical, emotional, and learning problems
than other children. Children in homeless shelters or welfare hotels live in chaotic environments
and lack privacy, autonomy, and a structured routine. This constellation of problems is referred
to as the “new morbidity.” Few studies have focused specifically on health promotion for
homeless children and the potential barriers that prevent them from accessing preventive health
care. Parents of these vulnerable children need the opportunity to voice the specific health care
needs their children have, what they perceive to be barriers to health care, and whether or not
health care is accessible. Hence, researchers need to examine resources currently available in
the community in order to identify existing services and any gaps in services for the target
population. The purpose of this project was to develop a resource inventory of preventive
pediatric health care services for homeless children in Durham, North Carolina (NC). This
inventory found that homeless families access three main sites for their health care: Lincoln
Community Health Center, Duke University Medical Center Emergency Department, and the
Durham County Health Department. Each facility provides homeless families with different
levels of care ranging from purely responding to an acute crisis to providing preventive health
care. However, the extent to which homeless families use these facilities and why they choose to
use or not use these agencies remain unclear. This inventory will serve as background
information for a future proposed study that will further examine access to health care for
homeless children in Durham, NC.
Megan Bumgarner
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Abstract: Diagnostic Uncertainty--One Family’s Encounter: A Case Study
Diagnostic uncertainty, or being uncertain about a medical illness/situation, can be stressful and
straining for the people involved. While limited research addresses the topic of uncertainty in
illness, it is a condition that many people will experience at some point in their lifetime. This
paper used a descriptive case study to illustrate one family’s encounter with diagnostic
uncertainty and to identify useful information that nurses could apply with patients and families
dealing with this issue. The findings revealed that the patient and her caregiver were not
satisfied with the care received from the nursing staff in the hospital and they made suggestions
for changes, including quicker response to patient requests, improved empathetic listening skills,
and appropriate inclusion and instruction of the family in patient care. Such advancements
would increase the patient’s and family’s satisfaction with the nursing care they receive in a time
of uncertainty.
Joyce Bussard
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Abstract: Factors Influencing Control of Type II Diabetes in Youth
Type II diabetes mellitus is a chronic condition that in the past traditionally affected older adults.
However, the rate of type II diabetes in youth has drastically increased over the last ten years.
Recent research has shown that the incidence of type II diabetes is on the rise among children
and adolescents. Current research has focused on evaluating the incidence of type II diabetes in
youth and identifying probable risk factors. Identification of risk factors for type II diabetes in
adolescents involves screening, which then leads to early detection, diagnosis and treatment. The
first step in treating the disease is to control the blood glucose levels. Adequate glucose control
involves four tasks: healthy nutrition, exercise, medication administration, and blood glucose
monitoring. Maintaining adequate blood glucose levels generally determines good control over
the disease process, which will improve overall health and decrease the incidence of secondary
complications. Because type II diabetes in youth is a relatively new diagnosis, few studies have
evaluated variables that may effect adolescent management of this complex disease. This
literature review examined research on the emerging crisis of type II diabetes in adolescents and
research on developing tools and models to assess compliance of young diabetics with regimens.
This review resulted in a data collection form that nurse clinicians and researchers can use to
assess glucose control in adolescents diagnosed with type II diabetes.
Joshua A. Carr
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Abstract: Effects of Organized Team Sports Participation on Health Behaviors and Leisure
Time Activities Among Children and Adolescents
Participation in organized team sports is one strategy that may be used to promote and increase
physical activity in children and adolescents. However, limited attention has been focused on the
effect that sports participation has on other aspects of childhood and adolescent life. A sample
made up of 1,220 sixth, seventh, and eighth graders, ages 11-14 years old, from three counties in
North Carolina, responded to survey questions as part of the Cardiovascular Health in Children
and Youth (CHIC II) study. The sample included forty-five percent males and fifty-five percent
females. The ethnic make-up of the sample was: White 64.2%, African American 24.0%,
Hispanic 5.8%, and the remaining 6.0% classified as “other.” The current study was a secondary
analysis using a subset of the original sample. This subset included 343 students who
participated in at least one of the following organized team sports: baseball, basketball, cheer
leading, football, soccer, and softball. The purpose of this secondary analysis was to examine
whether participation in organized team sport is related to health behaviors or leisure time
activities. The study found that there was a significant positive relationship between levels of
participation and number of hours spent engaged in leisure time activities. Furthermore, ANOVA
analysis indicated that there was a significant difference between type of sport that respondents
participated in and the number of hours that they spent watching television (F=5.16, p=0.0001)
and playing video games (F=12.33, p=0.0001). These finding are important because they
indicate that organized sport participation does not take time away from other leisure time
activities. Moreover, type of sport does not impact the amount of time that children and
adolescents spend doing homework
Tracy Jarrell Carroll
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Abstract: Health Education and Obesity in Children: Changes in Nutrition and
Exercise Choices of Middle School Students, One Year After Health Teaching
Obesity is a major health concern in the United States and is increasing most rapidly in the
childhood population.” Obesity in childhood is believed to perpetuate obesity, and the
complications associated with it, into adulthood. Health education sessions within the school
curriculum are a proposed intervention to inhibit or reduce the occurrence of obesity in
childhood. The purpose of this study was to determine whether health education in a group of
middle school students had an effect on their eating and exercise habits one year later. This was
a quantitative correlational study that focused on the relationship between health education and
lifestyle modifications of 9 eighth-grade students (ages 13-14) at a large school in the
southeastern United States. The students participated in 4 hour-long classes on exercise and
nutrition. One year later they were surveyed to determine whether the health education sessions
influenced their nutrition and physical activity. The results of the study showed that some
students had made positive changes in dietary and physical activity choices, which suggests that
the health education did influence the students to make healthier choices. Although an
undisputable link between health education and the behavioral choices of the participants was
not established, the findings strongly indicate that the health teaching did influence the
participants’ responses. Further research needs to be conducted in order to definitively show a
relationship between health education and interventions that could lower the occurrence of
obesity in youth.
Leslie Ann Collins
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Abstract: Nursing Support to Fathers of Preterm Infants With Severe
Bronchopulmonary Dysplasia (BPD)
The purpose of this study was to describe fathers' perceptions of supportive and nonsupportive
behaviors from the nursing staff during the hospitalization of their preterm infants with severe
bronchopulmonary dysplasia (BPD). BPD is one of the severe consequences of prematurity and
often requires the hospitalization of the infant for long periods following birth. This descriptive
qualitative study was part of a larger, longitudinal study of parental role attainment with
medically fragile infants (Miles, Holditch-Davis, & Burchinal, 1998). Researchers from the
larger study interviewed seven fathers of preterm infants with BPD during their children's
hospitalization. The conceptual framework that guided the original study was the Nurse Parent
Support Model (Miles, Carlson, & Brunssen, 1999). Narrative comments describing supportive
and nonsupportive nursing behaviors were categorized into the four dimensions of the model:
informational, emotional, parental role, and caregiving behaviors. The study found that the most
common supportive behaviors perceived by the fathers involved informational and caregiving
support. The lack of role support to the fathers from the nurses was the most often described
nonsupportive behavior. Emotional support was the least described behavior. Implementing
nursing interventions based on these findings can help nurses to support fathers during this
difficult and stressful time.
Meghan Costello
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Abstract: Secondary Traumatic Stress Reactions in Nurses: Examining Relationships
Between Compassion and Nurses’ Coping Strategies
Secondary Traumatic Stress (STS) is a significant threat to the emotional health, clinical
judgment and career satisfaction of nurses. STS refers to the negative emotional arousal that
helpers experience when confronted with victims’ accounts of and reactions to their experiences
with traumatic stress. Nurses in high intensity settings (e.g. emergency rooms and intensive care
units) are considered most vulnerable to STS. STS is a recently identified phenomenon, yet to be
included in the Diagnostic and Statistical Manual of Mental Disorders. The components and
correlates of STS remain under investigation. The standardized tool for measuring the degree of
STS in any helping population is the Compassion Satisfaction and Fatigue Test (CSFT). There is
little empirical evidence to support the reliability and validity of this tool in a nursing cohort.
Even less evidence exists to establish that this tool correlates with the theoretical risk factors of
STS, namely nurses’ personal stress histories and individual coping strategies. To measure these
risk factors the author developed a simple checklist and rating scale (STS Risk Inventory)
containing historical predisposing factors and coping strategies described as correlates in the
literature. The purpose of this study was to examine the usefulness of the CSFT in predicting
STS in a “high intensity” nursing population, and to gather some preliminary data about the
theoretical correlation between measures of STS and measures of its supposed risk factors. The
sample consisted of 20 full-time registered nurses working in a university hospital emergency
room. Because the hospital was undergoing accreditation review at the time when data
collection was to take place, the study could not be implemented; however, the need to fully
examine the presence of STS in high intensity nursing groups is essential in addressing one
potentially serious contributor to nursing ineffectiveness and attrition.
Julie Crutchfield
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Abstract: Assessment of Pediatric Primary Care Providers’ Knowledge of and Assessment
for Postpartum Depression
Postpartum depression is a disorder that can potentially affect every mother and her family and
can be a challenge for pediatric primary care providers to detect. Having information regarding
the primary care providers’ knowledge level and ability to assess for postpartum depression
could be potentially useful for the health care community. Without such knowledge and
assessment of new mothers, treatment for postpartum depression cannot be initiated, thereby
putting the mother and child at risk. In this study, a survey was distributed to pediatric primary
care providers who were attending the 8th Annual Conference for the North Carolina Chapter of
the National Association of Pediatric Nurse Practitioners. Study participants provided
demographic information and reported their knowledge of and assessment for postpartum
depression. The results revealed a negative relationship between participants’ knowledge of
postpartum depression and the degree to which they assessed for postpartum depression. By
becoming aware of the knowledge level of this specific group of pediatric caregivers, primary
care providers may gain insight into the importance of assessment skills in identifying mothers
with postpartum depression.
Sara D. Held
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Abstract: The Psychological Effects of War and Terrorism on School-aged Child and
Public Health Interventions: A Literature Review
Man-made violence in the form of war, terrorism, school violence, and domestic violence is a
pervasive, worldwide phenomenon. Children are frequent victims of these events resulting not
only in their loss of life, injury, famine, displacement, and loss of attachment figures but also
significant acute and chronic psychological problems. This integrative research review focused
on the psychological effects of war and terrorism on school-aged children and addressed public
health interventions for children exposed to traumatic events. Data sources included published
research literature and formal governmental surveys and reports. Key findings from studies
reviewed revealed significant levels of trauma symptoms and post-traumatic stress disorders
(PTSD) in children exposed to war and terrorism. Symptoms of traumatic stress were similar
across the studies and were independent of geographical location, culture, or the specific nature
of the traumatic event, suggesting similar reactions across cultural boundaries. The most
commonly reported symptoms included depression, anhedonia, anxiety, intrusive thoughts, and
avoidance of trauma-related stimuli. The studies also support a dose-response relationship of
trauma reactions. Sex differences in trauma reactions were not consistent, although the data
suggest that males may be more likely to suffer from more severe reactions. Major public health
interventions include critical incident stress debriefing, group therapy, and expressive therapy.
Nurses are a critical component of intervention because as first line responders they are
frequently in positions to recognize trauma symptoms in. Greater emphasis needs to be placed
on training all nurses in recognizing symptoms of trauma reactions in children and implementing
effective interventions.
Amy E. Kuchinski
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Abstract: Fetal Demise and Nursing Interventions to Facilitate Adaptive Coping:
Implications for Maternity-Nursing Practice
Supporting prospective parents at the time of intrauterine fetal death (IUFD) is an important
consideration for maternity nurses. The immediate care parents receive following a fetal death
poses important implications for their long-term grief response and ability to cope with future
pregnancies. The purpose of this critical review of literature is to explore and provide nurses
with information concerning the human experience associated with grief, perinatal loss, and
subsequent pregnancy, while examining the effectiveness of various nursing interventions to
facilitate coping and/or reducing maladaptive psychological sequelae for the mother and father.
Krista Latham
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Abstract: Knowledge Assessment of CHF Patients regarding Medication Regimen
and Disease Process
Congestive heart failure (CHF) is the leading cause for re-hospitalization in the Medicare
population in the United States. A common cycle with heart failure patients is lack of knowledge
that leads to non-adherence, poor diet regimen, inadequate symptom recognition and eventually
worsening symptoms. In an effort to decrease mortality, morbidity, and high health care
utilization, patient education to improve compliance and adherence has been a treatment goal by
health care providers. The purpose of this study is to assess chronic CHF patient knowledge of
their disease process, typical signs and symptoms of the disease, when to seek help from their
provider, and of their current medication regimen. A convenience sample of 10 established CHF
patients from a specialty clinic at a University Hospital outpatient setting was used. All
participants completed a brief interview. Eighty percent of the subjects were able to state an
understanding of their disease process, which was most often termed in relation to their specific
etiology of their CHF. Most referred to their CHF in terms of “decreased pumping ability” (60%)
and/or a “reduced ejection fraction”(30%). The most frequently cited symptoms of CHF were
fatigue (80%), dyspnea (60%), chest pain (50%), and orthopnea (40%). Key symptoms that
patient's identified that would prompt them to call their provider included: dyspnea (60%), chest
pain (50%), swelling (40%), fatigue (40%), cough (30%) and sudden weight gain (20%). Forty
percent of the patients were able to name all of their cardiac medications. Of these 4 subjects, 3
stated the purpose of their medications. None of the patients were able to identify common side
effects of their medications. CHF patients from one specialty clinic were knowledgeable of their
disease process, signs and symptoms of CHF, when to seek help and knew the names and
purposes of their major cardiac medications. However, none of the patients were able to state the
side effects of their cardiac medications which lends to areas for improvement in future patient
educational initiatives in this clinic setting. In addition, swelling and weight gain, major
indicators of deteriorating CHF, need to be reinforced throughout teaching since many subjects
failed to recognize these symptoms as symptoms of CHF.
Holly Ann Mantle RN
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Abstract: Legal Update for Nurses: For What Are Nurses Accountable?
The disciplines of law and professional nursing have been officially integrated since the first
mandatory nurse practice act was passed by New York in 1938. The profession of nursing has
continuously relied on statutory law for its right to exist on a licensure basis and on court
decisions for interpretation of statutes. The civil rights movement of the 1960s and the
malpractice crisis of the 1970s have led, seemingly quite naturally, to a heightened legal minded
ness of the 1990s and 2000s. No longer can nurses remain ignorant of the law and legal
doctrines. Today’s professionals must know, understand, and apply legal decisions and doctrines
to their everyday nursing practice. The purposes of this paper are to examine some of the issues
surrounding legalities in the nursing profession, to show that there is a knowledge deficit among
nurses, and to discuss the development of a program to facilitate the resolution of this deficit.
The paper reviews recent and past literature that analyzes, describes, and discusses general
medical legal issues in nursing. This paper not only examines the present knowledge deficit but
also illustrates how the introduction of an educational program among nursing staff in an acute
care setting can greatly improve the legal knowledge base of the nurse. A one-day educational
program was developed, implemented, and evaluated for effectiveness. This program provided
an update for nurses on current legal issues encountered by nurses in the health care organization
and was conducted in a NC hospital. The topics addressed in the sessions included nursing
malpractice, negligence, professional liability insurance and risk management issues.
Mindy Musumarra
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Abstract: Terrorism and Post-Traumatic Stress Disorder: Implications and Resulting
Sequelae
The terrorist attacks on the United States on September 11, 2001, with the resulting trauma to the
citizens of New York City, Washington, D.C., and the nation, bring the issue of the effects of
traumatic stress on the population front and center. This literature review examined studies
pertaining to acts of terrorism in Israel, France and the United States and the resulting
psychological effects on civilians. This work intended to identify variables that predict posttraumatic stress disorder (PTSD) development in individuals exposed to terrorist acts. Level of
exposure, signs and symptoms, and length of time to onset of signs and symptoms were variables
considered in determining the development of PTSD in individuals. Considering these variables,
the development of PTSD among victims was evident in all studies reviewed. In this literature
review, risk factors for poorer outcomes, such as previous mental illness, were examined, as
were protective factors for optimal outcomes, such as utilization of mental health services.
Finally, knowledge of the implications of these findings can benefit clinicians responsible for
providing mental health interventions to victims of terrorist attacks.
Scott Semones
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Abstract: Communication of Information about Elderly Patients from Nursing Aides:
A step in Assessing Acute Confusion
By the year 2030, the United States population over the age of 65 is projected to account for 20%
of the total U.S. population (Administration on Aging, 2000). Accounting for 36.1% of all
hospital days of care, with a length of hospital stay a full day longer and over $800 higher than
those ages 45 - 64, elders over 65 are significant users of hospital resources (Agency for
Healthcare Research and Quality, 2001). When hospitalized, these elders are at risk for
developing an alteration in cognitive function known as acute confusion (Miller, 1996). This
significant complication contributes to increased costs and poor prognosis (Ribby & Cox, 1996),
but may be reversible with early assessment and diagnosis (Murphy, 2000). Thus, it is necessary
to examine the communication between the nursing staff providing the care for this vulnerable
group. The purpose of this study was to identify behaviors exhibited by elderly patients, that
were interpreted by the nursing staff as indicators of a significant change in the patient’s
cognitive status, requiring the nurse’s attention, based upon the urgency of the nursing aide’s
reporting the behavior to the nurse. A study measure, the Nursing Staff Report: Priority of
Elderly Patient Behaviors (NSR:PEPB), was developed utilizing the NEECHAM Confusion
Scale and the Clinical Assessment of Confusion as guides. A patient scenario was created, and a
list of patient behaviors was provided to determine which were significant, requiring report from
nursing aides (NA) to nurses (RN & LPN). Following evaluation by experts in the field of
Gerontological nursing, pilot testing, and revision, the NSR:PEPB was administered to nursing
staff working on the study unit of a small community hospital. Twenty-eight nursing staff: RNs,
LPNs, and NAs representing 63.6% of the nursing staff volunteered to participate. The data was
analyzed using descriptive statistics. Behaviors were rated by the urgency of report from or
desired from the NA. Data was correlated to examine the relationship between the reactions of
nurses and NAs to patient behaviors. This relationship evaluated whether patient behaviors had
similar meanings for nurses and NAs, leading to reassessment of the patient.
Dama R. Yekeson-Koffa
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Abstract: “African American Women and Their Experiences in Seeking Healthcare
for Their HIV”
The Human Immunodeficiency Virus (HIV) has for the past two decades been a primary
contributing factor to the deaths of millions worldwide. Education about disease transmission,
safe sex practices, and medical treatment using rigorous HIV drugs has decreased these numbers
substantially in North Carolina. However, a pattern of new HIV cases has evolved, with AfricanAmerican females being the primary population affected. To provide effective healthcare and
establish a trusting rapport with this population, it is imperative that healthcare providers
understand the nature of HIV patients’ experiences in seeking healthcare for their HIV. The
purpose of this study was to examine the experiences of HIV+ African American women in their
quest for healthcare. Qualitative data collected from five women as part of a larger study was
used in this secondary analysis. Using the techniques of constant comparative analysis, six
categories and related subcategories that were indicative of HIV+ African American women’s
experiences in seeking healthcare were identified. The six categories were: (1) Diagnosis, (2)
Receiving Care, (3) HIV Therapy, (4) Advocacy Empowerment, (5) Outcome of Diagnosis, and
(6) Resources. Data analysis indicated that although all of the women had access to healthcare
and expressed satisfaction with caregivers, there were other issues to consider in improving their
overall experiences. Such information can be important to healthcare professionals in hospitals,
infectious disease clinics, local AIDS organizations, public health organizations and community
settings as they face the challenge of developing effective health care services for this
population.