▼ In spontaneous breathing modes, past laboratory work using a lung model indicated portable ventilators as compared to critical care ventilators may increase inspiratory work of breathing. The purpose of this study was to assess the imposed inspiratory work of breathing and breathing comfort of nonintubated healthy volunteers breathing spontaneously through three portable ventilators and a critical care ventilator in a controlled environment. A physiologic theoretical framework was used for the study. With all subjects having continuous positive airway pressure (CPAP) settings of 0 and 5 cm H2O and pressure support ventilation (PSV) settings of 0 and 10 cm H2O, the hypotheses were: 1) Imposed work (WOBI) and pressure-time product (PTPI) with the 7200ae (Mallinckrodt, critical care ventilator) will be less than those in the Achieva (Mallinckrodt) ventilator and LTV 1000 (Pulmonetic) ventilator, which will be less than those of the Univent 754 (Impact) ventilator (WOBI and PTPI with 7200ae < Achieva = LTV 1000 < Univent 754); 2) breathing comfort (BC) reported by subjects breathing with the 7200ae will be greater than that with the Achieva and LTV 1000, which will be greater than the Univent 754 (BC with 7200ae > Achieva = LTV 1000 > Univent 754). The study used a randomized, single blind repeated measures design using healthy nonobese subjects (n=16). Measured respiratory parameters were saved to a personal computer and subjects recorded BC on a visual analogue scale that had been previously assessed for validity. Control breathing periods were interposed after each fourth study period; maximum inspiratory pressure was the proxy measure for fatigue. Baseline airway pressure was determined in real-time and retrospectively with the differences compared for each ventilator and control period. Repeated measures ANOVA was used to analyze the data with α < 0.05. There were no significant differences in the measures during the control breathing periods or in baseline airway pressures. The ventilator was a source of significance for WOBI, PTPI, and BC (p < 0.0001). Tukey's method for comparison of means revealed the WOBI, PTPI were greater and BC of subjects was less with the Univent 754. Although the data did not fully support the research hypotheses, the WOBI, PTPI, and BC were significantly different in the Univent 754. The other portable ventilators offered no significant increase in WOBI, and PTPI nor decrease in BC compared to the critical care ventilator. The differences seen with the Univent 754 were likely due its triggering method, constant inspiratory flow, and intrinsic positive end-expiratory pressure. Further clinical studies are warranted. Advisors/Committee Members: Sommers, Marilyn Sawyer.

▼ The purpose of this study was to develop a substantive theory that explains how persons with schizophrenia (PWS) experience connecting with mental health professionals (MHPs). Nine PWS, clients from two community mental health centers, were asked to recount their interactions with MHPs. The interview transcripts were analyzed through the grounded theory method of Strauss and Corbin (1998). The interactional problem between PWS and MHPs stems from the stigma associated with schizophrenia. The central concept emerged from the data analysis as Connecting Through Humanness. Connecting Through Humanness is a three-part process where PWS identify whether MHPs stereotype them as schizophrenics or regard them as unique human beings. The first part, called Displaying, encompasses the circumstances under which PWS present themselves to MHPs for treatment. The second part, Sizing-Up, is the way in which PWS evaluate whether MHPs communicate understanding, compassion, and normalcy during the interactions. The result of Sizing-Up provides the basis for the final part of the process, called Classifying. PWS classify MHPs as helpful or not helpful. The MHPs who PWS classify as helpful, validate their self-perceptions as unique human beings. The resulting theory is that PWS experience connecting with MHPs as interactions that are based upon mutual humanness. Descriptions in the literature of PWS and MHP interactions support the findings of this study. In addition, the conceptualization of the theory’s central category, Connecting Through Humanness, is supported by nurse researchers in the extant literature. Nurse-patient relationships can be improved by applying the findings of this study to current practice and future research projects. Advisors/Committee Members: Miller, Elaine.

▼ The purpose of this study was to investigate possible predictive factors for juvenile criminality. This study was nested within a prospective cohort study that looked at two groups of inner city children at ages 4, 5, and 6 years old in 1991, 1992, and 1993, and ages 11, 12, and 13 in 1999. The subjects were randomly chosen from children referred to the Department of Health and Human Services (Child Protection Services) of Hamilton County Ohio for allegations of child abuse. The subjects were those subsequently substantiated as being high risk for continued abuse, and placed into either a foster home or a relative's home for protection (N = 77). Subjects (N = 20) were obtained from the Juvenile Justice database. The controls (N = 57) had no records with the Juvenile Justice System. The current study utilized an observational case control design. The information on potential factors was hand collected from the DHHS family based multi-record keeping system. Multivariate analysis yielded a model consisting of three factors suggestive as predictors for criminal behaviors in these groups. The three factors were (1) the age of the allegation (Odds Ratio 1.26) (2) the number of years from the initial allegation to initial placement (Odds Ratio 1.43), and (3) the subsequent placement into long term foster care after the initial placement (Odds Ratio 9.83). Descriptive data indicated that 88.3% of the children suffered more than 3 types of child abuse (Physical, Sexual, Neglect (including Psychological Maltreatment), and Witnessing Domestic Violence) and that 74 out of 77 of the mothers had a mental illness that had not been treated. This study has implications for early intervention in high-risk child abuse cases, and for investigation of identification and treatment of mental disorders in this population. Advisors/Committee Members: Betemps, Dr. Elizabeth.

▼ The purpose of this study was to identify the variables that influence the frequency of personal respiratory protection (PRP) use by workers in swine confinement buildings (SCBs). The study was designed to answer four research questions: 1). What is the validity and reliability of the Personal Respiratory Protection Survey (PRPS)? 2). How frequently do workers in SCBs wear PRP? 3). How do demographics, occupational histories, and self-reported respiratory health histories influence the use of PRP in SCBs? and 4). What are the relationships of the constructs (benefits, barriers, susceptibility, severity, norms) to the use of PRP by workers in SCBs? The investigator developed an instrument that included a questionnaire to elicit demographic information, occupational and respiratory histories, and frequency of PRP use among SCB workers. In addition, the instrument included the PRPS that contained five Likert scales developed to measure five constructs theorized to influence the frequency of PRP use by SCB workers. To establish the instrument’s content validity a two-phase process included a critique by a group of eight experts and a pilot test with six SCB workers. Data for the study were collected from 503 SCB workers attending the 2003 World Pork Expo in Des Moines, Iowa. Principle component analysis (PCA) and varimax rotation were used to establish construct validity and resulted in the identification of eight factors (i.e., benefits, norms, severity, susceptibility, personal barriers, knowledge barriers, external barriers, and habit barriers). Cronbach alpha values for the factors ranged from .58 to .91. Descriptive analysis found that 36.3% of the workers never used and 21.2% seldom used PRP at the worksite during the past year. Stepwise hierarchical regression was used to predict the frequency of PRP use with 38.9 % of the total variance explained by the study’s variables. Twelve percent of the variance was explained by a combination of the demographic, occupational history, and respiratory history variables. An additional 27% of the variance was explained by six of the theoretical constructs: knowledge deficit barriers, external barriers, norms, severity, benefits, and personal barriers. recommendations are shared for future research along with implications for theory and practice. Advisors/Committee Members: Gates, Dr. Donna G.

▼ The purpose of this quasi-experimental study was to examine the effect of a nonviolent crisis intervention program on the perceived self-efficacy of community mental health center staff. The research was guided by Social Cognitive Theory, using the construct of self-efficacy, which is belief in one’s capabilities (Bandura, 1986). Crisis intervention self-efficacy, along with seven other variables believed to influence crisis intervention self-efficacy were investigated: anxiety arousal, avoidant behavior, interpersonal self-efficacy, participant behavior, perceived risk, personal vulnerability, and risk discernment. The sample was non-randomized and consisted of 90 multidisciplinary mental health staff conveniently selected from two community mental health centers. The experimental group (n. = 56) received The Nonviolent Crisis Intervention® training program targeted toward managing potentially violent clients; the control group (n = 34) received no training. Data were collected using self-administered questionnaires immediately prior to the training, at the conclusion of the training, and six months later. The ANOVA showed there was a significant main effect for group (F [1,80] = 0.16, p < 0 .01, h =.15) and for time (F [1,80] = 10.17, p < .01. h=.11). Subjects who participated in the training demonstrated greater self-efficacy when compared to the subjects who did not have the training, and subjects who participated in the training increased their self-efficacy mean scores over time. Path analysis revealed a causal structure with interpersonal self-efficacy, risk discernment, and anxiety impacting personal vulnerability that mediated perceived risk, ultimately influencing crisis intervention self-efficacy. The results suggest community mental health staff that received the non-violent crisis training professed greater confidence in their ability to manage potentially violent clients. Perceived risk and interpersonal self-efficacy appear to directly influence crisis intervention self-efficacy. The staff’s increased confidence as a result of on-going training is significant given that prevalence of workplace violence has risen in the health care setting over the past ten years. This increased confidence and awareness of strategies for intervention should result in decreased injury/harm to both clients and staff. Additional research on crisis intervention self-efficacy and its impact on reduction of incidence of workplace violence is recommended to strengthen these findings. Advisors/Committee Members: Fitzwater, Dr. Evelyn.

▼ The purposes of this study were to investigate the effects of perceived daily life stress on selected health-risk behaviors and to examine the moderating function of approach coping in a sample of 722 Taiwanese adolescents. Life stress from personal, family, peer, school, and community was investigated. The selected health-risk behaviors were risky driving, cigarette smoking, beverage drinking, illicit drug use, and attempted suicide. This is a cross-sectional survey study. The sample was non-randomly selected from two senior high schools. Data were collected by using self-administrated questionnaires. The subjects were classified into three coping groups. Structural equation modeling was used to test a hypothesized model of life stresses on health-risk behaviors and to examine the moderating function of approach coping for three coping groups. The study had two main findings. First, different sources of life stresses are correlated with different health-risk behaviors. The relationships between life stresses and health-risk behaviors were demonstrated in the low coping group more than in the medium and the high coping groups, indicating the low coping group is most vulnerable. However, either positive or negative correlations appeared, indicating that the moderating function of approach coping may be effective within group in some situations. Secondly, the moderating effects of approach coping were not consistently demonstrated among the relationships between life stresses and health-risk behaviors. Three methodological reasons (the way of classifying coping groups, not enough items of the Approach Coping Scale, and global use versus situational use of the Approach Coping Scale) and two theoretical reasons (the effectiveness of approach coping strategies and gender-differences on approach coping) are considered for the mixed evidences in this study. The results of the study implicate that health promotion programs should be addressed to the needs of adolescents for the goal of promoting adolescents’ health behaviors. Moreover, more researches are needed for further understanding of the relationships between life stress and health-risk behaviors and the moderating effects of approach coping. Recommendations for development in practice, research, and theory are discussed. Advisors/Committee Members: Davis, Dr. L. Sue.

▼ Cumulative trauma disorders (CTDs) are soft tissue injuries of the muscles, nerves, and joints, such as carpal tunnel syndrome. CTDs are an accumulation of progressive pathological changes that ultimately culminate into an injury. The hallmark symptoms of clinical CTDs are discomfort, pain, and paresthesias. The severity of symptoms can vary between a transient aching, discomfort, and fatigue to significant pain and paresthesias that result in permanent disability. Upper extremity CTDs are common in industries that have jobs that include highly repetitive motion tasks. The prevalence of CTDs in these industries is significant, and has a considerable impact on both industry and the individual worker. This study was guided by theory from three separate disciplines, Biomechanics, Exercise Physiology, and Ergonomics. The purpose of this study was to test the effect of exercise on workers in an effort to reduce or delay discomfort, increase strength, and potentially reduce the progressive pathology of CTDs. Two exercise protocols at two intensities were performed by on workers doing occupational repetitive motion tasks. Flexion exercises were compared to extension exercises in a six-week exercise training program. Three industrial sites were used to conduct the study, all with a high incidence of upper extremity CTDs claims. A convenience sample of 85 subjects was initially entered into the study. Fifteen subjects dropped out of the study. The remaining 70 subjects were randomly assigned to one of four treatment exercise groups or a control group. The variables of interest were discomfort, as measured by a visual analog scale, and strength in six upper extremity muscle groups. A repeated measures ANOVA using a one-within, one-between design was used. The results of this study were as follows: iv Discomfort: Discomfort was significantly reduced in all subjects doing exercise training across the groups after six weeks [F=43.85, (2, 62) p=. 000]. Strength: An overall significant increase in strength was observed following six weeks of exercise training [F=12.32, p=. 000]. A significant difference in strength across all six muscles tested was also seen [F=67.38, p=. 000]. Finally, a significant interaction effect among the six muscle groups, the three time periods (baseline, three, and six weeks), and the five subject groups was observed [F=1.53, p=. 035]. However, the Mauchly's Test of Sphericity revealed that the sample had a high variance in strength across time. These data were interpreted cautiously due to the violation of this assumption. This study provides initial support for two exercise programs in workers doing repetitive motion tasks. Exercise training may be a factor in diminishing the individual workers' vulnerability to CTDs. Advisors/Committee Members: Baas, Linda S.

▼ Since the earliest times a major focus of nursing has been to provide health care information to those in their care. The purpose of this exploratory study was to investigate information retrieval of consumers using NetWellness Ò , a community health information network. Using Orem’s Self-Care Deficit Nursing Theory, six research questions were developed. These questions were designed to determine if there were any differences in information retrieval based on whether the participants were self-care agents or dependent-care agents, or whether differences were based on basic conditioning factors identified as age, gender, race, household income and educational levels. In addition questions were included to determine the consumers’ satisfaction with NetWellness Ò and to identify specific topics directed to experts. A convenience sample of 307 participants completed the on-line questionnaire; of these participants 215 were identified as either self-care or dependent care agents. There was a statistically significant finding at the .05 level (c2 Advisors/Committee Members: Weiner, Elizabeth.

▼ With increasing sophistication and portability of medical equipment and health care advances, infants and children who require technology to survive are cared for at home. Yet little is known about the population of technology dependent infants and their families. Therefore, the purpose of this study was to examine the experience of receiving and caring for a technology dependent in the home. van Manen's phenomenological method was selected for inquiry. Data were collected from interviews with eight mothers, as well as researcher personal experience, etymological sources, idiomatic phrases, and descriptions in literature. The seven common essential themes extracted from the data were receiving and caring for a technology dependent infant in the home is: (1) moving from learning care to making judgments regarding infant's health; (2) getting to know the infant's likes, dislikes, and health related behaviors; (3) recognizing changes in family dynamics and meeting family needs through adjustments in roles, responsibilities, and lifestyles; (4) learning to manage the increased work and time infant care requires; (5) navigating an ever changing array of emotions and concerns; (6) ascribing improvements in infant and family situation to being home; and (7) recognizing differences but seeing similarities when comparing infant to others. When the concepts of the Kenner Transition Model were linked with the essential themes, three overall themes that describe the essence of the phenomenon were extracted: (1) Moving from learning about infant to making judgments regarding infant's health; (2) Recognizing the need for adjustment in roles, responsibilities, and priorities; and (3) Navigating constantly changing emotions to achieve near normalcy. Practice implications include better preparation of the families for home life before discharge. An increase in responsibility for infant care and equipment negotiations before discharge can ease a family into these roles. Encouraging families to have multiple support people trained in infant care who can offer respite to parents. Examination of these families six months to one year after discharge is recommended to assess their personal and home adjustment. Advisors/Committee Members: Miller, Dr. Margaret.